4 Major Concepts of Nursing Theories:

I. Introduction to Nursing Theories

a. Person
Nursing is as varied as the people who
practice it, and is dynamic and diverse as a b. Health
kaleidoscope of ethnic, cultural and religious
manifestations of the people who receive nursing c. Environment
care. All nursing acts are geared towards
realizing and restoring the patient’s d. Nursing
biopsychospiritual well-being and assisting the
client to live a dignified and normal life. It is PERSON
important that nursing is grounded on accepted  Unique
scientific truths and principles in order to give  Open system with subsystems
safe and quality nursing care. Simply put, a  Motivated by needs
Nursing Theory strives to explain the Science  Capable of Adaption
and Art of Nursing.  Seeks Homeostasis
 Interacts with Environment
There is no single exact classification of
Nursing Theory in a given time, place, and HEALTH
setting. Nursing theorists regardless of  Dynamic
orientation, have tried to shed light to it in their  A continuum
own unique way. We Filipinos, as a unique  Holistic (Physical, emotional, spiritual,
nation and race, have our own interpretation of social and psychological)
Nursing, both as an art and a science. It can be  Affected by health beliefs and health
said then, that Filipino nurses do practice a behaviors
unique form of Nursing that is attune with the
Filipino spirit and culture. ENVIRONMENT
 Promotes of interferes with well-
Nursing Science, therefore, is a melting – being
pot of the different knowledge, creeds and  Physical environment
backgrounds of care and healing that has been  Non-Physical environment
collected and preserved since the dawn of time.
It is important for the nursing students to achieve NURSING
a simple and working knowledge of the concepts  Integrates concepts from person,
that make up a nursing theory, since ii is highly environment, and health to form a
dynamic and undergoes change, or evolution, as meaningful whole
new discoveries are made and information are  It is the diagnosis and treatment of
renewed from time to time ( Octaviano and human responses to actual or
Balita, 2008). potential health problems

Nursing is a dynamic discipline. It is

II. DEFINITION OF TERMS and an art and a science of caring for
STRUCTURES OF NURSING individuals, families, groups, and
KNOWLEDGE: communities geared toward promotion
and restoration of health, prevention of
□ CONCEPT: an idea, thought or notion illness, alleviation of suffering and
conceived in the mind; a general assisting clients to face death with
impression; building blocks of theories dignity and peace. It is focused on
which can either be an empirical or assisting the client as he or she
abstract data. responds to health- illness situations,
utilizing the nursing process and guided
Types of Concepts: by ethico -legal moral principles(
ADPCN- Association of Deans of the
 Abstract concepts are indirectly Philippine Colleges of Nursing)
observed or intangible. It is
independent of time and place.  PROPOSITION: explains the
Example: relationship of different concepts
Love, Care, Freedom, Hope
 DEFINITION: is composed of various
 Concrete Concepts are directly descriptions which convey a general
observed of tangible. meaning and reduces the vagueness
Example: in understanding a set of concepts
Nurse, Mother
  ASSUMPTIONS: are beliefs about
phenomena one must accept as true A collective term used to denote four
concepts for Nursing ( Person, Environment,
 THEORY: is an organized system of Health, Nursing). These four major concepts
accepted knowledge that is establish a better direction and
composed of concepts, propositions, understanding of nursing profession.
definitions and assumptions intended
to explain a set of fact, event or  PRINCIPLE: fundamental truth, law,
phenomena. doctrine, or motivating force upon which
others are based; a basic generalization
Components of a theory that is accepted as true and that can be
 Concept used as a basis for reasoning or
 Definition conduct
 Assumptions or
proposiitons III. HISTORY AND DEVELOPMENT OF
 Phenomenon NURSING THEORY AND PHILOSOPHY
OF SCIENCE
 PHENOMENA: are the designation
of an aspect of reality that can be The history of professional nursing began with
consciously sensed or experienced Florence Nightingale. It was Nightingale who
envisioned nurses as a body of educated women
Examples of Phenomena in at a time when women were neither educated nor
Nursing: employed in public service.
 Caring
 Nursing Care Nursing began with a strong emphasis on
practice, but throughout the century, nurses
worked toward the development of nursing as a
 NURSING THEORY: is a group of profession through successive periods
interrelated concepts or a compilation of data recognized as historical eras.
that defines, describes, and logically relates
information that will explain past nursing The curriculum era addressed the question of
phenomena and predict future trends. what prospective nurses should study to learn
Theories provide a foundation for developing how to be a nurse. In this era, the emphasis was
models or frameworks for nursing practice. on what courses nursing students should take,
with the goal of arriving at a standardized
curriculum. By the mid-1930s, a standardized
 THEORETICAL MODELS OR curriculum had been published. However, it was
FRAMEWORKS: highly established set of also in this era that the idea of moving nursing
concepts that are testable; it is a structure of education from hospital-based diploma programs
concepts which has existed and tested in the into colleges and universities emerged.
literature
As nurses increasingly sought degrees in higher
education, a research emphasis era, as it is
 CONCEPTUAL FRAMEWORK OR deemed, began to emerge. This era came about
CONCEPTUAL MODEL : representation of a as more and more nurses embraced higher
body of knowledge based on the own education and arrived at a common
understanding or perception of a person or understanding of the scientific age, that is, that
researcher on a certain topic, phenomena, or research is the path to new nursing knowledge.
theory
 Also referred to as PARADIGMS The research era and the graduate education era
developed in tandem. Master’s degree programs
□ PARADIGM – a pattern or in nursing emerged to meet the public need for
a model; another term for nurses with specialized clinical nursing
conceptual model education.
□ METAPARADIGM- core content of a
The theory era was a natural outgrowth of the
discipline, stated in the most global or research and graduate education eras. As our
abstract terms understanding of research and knowledge
 Meta – “with” development increased, it soon became obvious
that research without theory produced isolated
 Paradigms – “Patterns” information, and that it was research and theory
together that produced nursing science. In the
early years of the theory era, doctoral education
in nursing flourished with an emphasis on theory In the 1970s, nursing continued to make the
development. transition from vocation to profession as more
and more nurses asked, “Will nursing be other-
In the theory utilization era, emphasis was placed discipline based or be nursing based?”
on middle range theory for theory- based nursing
practice, as well as on theory development. The history records the answer, “Nursing practice
needs to be based on nursing science”. “theory is
Each era addressed nursing knowledge in a not a luxury in the discipline of nursing ... but an
unique way that contributed to and is observable integral part of the nursing lexicon in education,
in the history of nursing. Within each era, the administration, and practice”
pervading question “What is the nature of the
knowledge that is needed for the practice of “Practice without theory, like map without route,
nursing?” is blind; theory without practice, like route without
map, is empty. “
Nightingale’s (1859/1969) vision of nursing has
been practiced for more than a century, and Highlight:
theory development in nursing has evolved
rapidly over the past 5 decades, leading to the Nursing education has changed drastically since
recognition of nursing as an academic discipline the mid-1800s. Early apprenticeship programs
with a substantive body of knowledge. established in the 1800s were designed to meet
the service needs of the hospital, not educational
In the mid-1800s, Nightingale wrote that nursing needs of the student.
knowledge is distinct from medical knowledge.
She described a nurse’s proper function as Nursing Theories:
putting the patient in the best condition for nature
(God) to act upon him or her. She proposed that Florence Nigtingale
care of the sick is based on knowledge of (1860/1969)
persons and their surroundings—a different
knowledge base than that used by physicians in “Environmental Theory”
their practice.
- defined nursing as “the act
Until the emergence of nursing as a science in of utilizing the environment
the 1950s, nursing practice was based on of the patient to assist him
principles and traditions that had been passed on in his recovery”
through an apprenticeship model of education
and hospital-kept procedure manuals Linked health with five environmental factors:
1. Pure or fresh air
Although some nursing leaders aspired for 2. Pure water
nursing to be recognized as a profession and 3. Efficient drainage
become an academic discipline, nursing practice 4. Cleanliness
continued to reflect its vocational heritage more 5. Light, especially direct sunlight
than a professional vision. The transition from
vocation to profession included successive eras
of history as nurses searched for a body of
substantive knowledge on which to base nursing
practice.

In the mid-1970s, an evaluation of the first 25

years of the journal Nursing Research revealed
that nursing studies lacked conceptual
connections and theoretical frameworks.

An awareness of the need for concept and theory

development coincided with two other significant
milestones in the evolution of nursing theory.

The nursing theory era, coupled with an

awareness of nursing as a profession and as an
academic discipline in its own right, emerged
from debates and discussions in the 1960s
regarding the proper direction and appropriate
discipline for nursing knowledge development.
Conceptual Framework of Nightingale’s Environmental problems. Abdellah’s 21 Nursing
Theory. Note that the client, the nurse, and the major
Problems are the following:
environment concepts are in balance; that is; the nurse
can manipulate the environment to compensate for the  To maintain good hygiene and physical
client’s response to it. The goal of the nurse is to assist comfort
the patient in staying in balance. If the environment of a  To promote optimal activity: exercise, rest,
client is out of balance, the client expends unnecessary
energy. sleep
 To promote safety through prevention of
accident, injury, or other trauma and
Deficiencies in these five factors produced lack through prevention of the spread of
or health or illness. infection
She also stated the importance of keeping
the client warm, maintaining a noise-free
environment, and attending to the client’s diet in
terms of assessing intake, timeless of the food,
and effect on the person.

Nightingale set the stage for further work

in the development of nursing theories. Her
general concepts were ventilation, cleanliness,
quiet, warmth, and diet remain integral parts of
nursing and health care today.

In this way, the model must be adapted to

fit the needs of individual patients. The
environmental factors affect different patients
unique to their situations and illnesses, and the
nurse must address these factors on a case-by-
case basis in order to make sure the factors are
altered in a way that best cares for an individual
patient and his or her needs.

Faye Abdellah

“21 Nursing Problems

Theory”

- Abdellah’s typology of 21
nursing problems is a
 To maintain good body mechanics and
conceptual model mainly
prevent and correct deformity
concerned with patient’s needs and the
 To facilitate the maintenance of a supply
role of nurses in problem identification
of oxygen to all body cells
using a problem analysis approach.
 To facilitate the maintenance of nutrition
for all body cells
According to Faye Glenn Abdellah’s
 To facilitate the maintenance of
theory, “Nursing is based on an art and
elimination
science that moulds the attitudes,
 To facilitate the maintenance of fluid and
intellectual competencies, and technical
electrolyte balance
skills of the individual nurse into the desire
 To recognize the physiologic responses of
and ability to help people, sick or well,
the body to disease conditions—
cope with their health needs.”
pathologic, physiologic, and
compensatory
The 21 nursing problems fall into three
 To facilitate the maintenance of regulatory
categories: physical, sociological, and
mechanisms and functions
emotional needs of patients; types of
 To facilitate the maintenance of sensory
interpersonal relationships between the
function
patient and nurse; and common elements
 To identify and accept positive and
of patient care. She used Henderson’s 14
negative expressions, feelings, and
basic human needs and nursing research
reactions
to establish the classification of nursing
  To identify and accept interrelatedness of
emotions and organic illness
 To facilitate the maintenance of effective
verbal and nonverbal communication
 To promote the development of
productive interpersonal relationships
 To facilitate progress toward achievement
and personal spiritual goals
 To create or maintain a therapeutic
environment
 To facilitate awareness of self as an
individual with varying physical,
emotional, and developmental needs Focus of Care Pendulum of Faye Abdellah’s
Theory. The nursing-centered orientation to client
 To accept the optimum possible goals in
care seems contrary to the client-centered
the light of limitations, physical and approach that Abdellah professes to uphold. The
emotional apparent contradiction can be explained by her
 To use community resources as an aid in desire to move away from a disease-centered
resolving problems that arise from illness orientation. In her attempt to bring nursing
 To understand the role of social problems practice to its proper relationship with restorative
as influencing factors in the cause of and preventive measures for meeting total client
needs, she seems to swing the pendulum to the
illness
opposite pole, from the disease orientation to
nursing orientation, while leaving the client
Moreover, the needs of patients are further somewhere in the middle.
divided into four categories: basic to all patients,
sustenal care needs, remedial care needs, and Weakness of the Theory:
restorative care needs. Framework seems to focus quite heavily
on nursing practice and individuals. This
Restorative Care Needs: somewhat limits the ability to generalize although
Abdellah’s work, which is based on the the problem-solving approach is readily
problem-solving method, serves as a vehicle for generalizable to clients with specific health needs
delineating nursing (patient) problems as the and specific nursing.
patient moves toward a healthy outcome. The
theory identifies ten steps to identify the patient’s As a whole, the theory is intended to guide care
problem and 11 nursing skills used to develop a not just in the hospital setting, but can also be
treatment typology. applied to community nursing, as well. The model
has interrelated concepts of health and nursing
problems, as well as problem-solving, which is an
The 11 nursing skills are: activity inherently logical in nature.

1. observation of health status Hildegard Peplau

2. skills of communication
“Interpersonal Relations
3. application of knowledge Theory”
4. teaching of patients and families -Central to Peplau’s theory is
5. planning and organization of work he use of a therapeutic
relationship between the
6. use of resource materials nurse and client. Continued
7. use of personnel resources to be use when working with
individuals who have psychological problems.
8. problem-solving
9. direction of work of others Nurses enter into a personal relationship with an
individual when a need is present.
10. therapeutic uses of the self
The nurse-client relationship evolves in four
11. nursing procedure phases:
1. Orientation – during this phase, the client
seeks help, and the nurse assists the
client to understand the problem and the
extent of the need for help.
 2. Identification – the client assumes a behavior coming from the mutual,
posture of independence, simultaneous interaction of the human and
interdependence, or interdependence in environmental fields, and health and illness
relation to the nurse. The nurse’s focus is are part of the same continuum. The
to assure a person that the nurse
multiple events occurring during the life
understands the interpersonal meaning of
a client’s situation. process show the extent to which a person
3. Exploitation – The client derives full is achieving his or her maximum health
value from what the nurse offers through potential.
the relationship. The client uses available
services based on self-interest and needs.  Nursing
Power shifts from the nurse to the client. It is the study of unitary, irreducible,
4. Resolution – In this final phase, old indivisible human and environmental fields:
needs and goals are put aside and new people and their world. Rogers claims that
ones adopted. Once older needs are nursing exists to serve people, and the safe
resolved, newer and more mature ones practice of nursing depends on the nature
emerge.
and amount of scientific nursing knowledge
the nurse brings to his or her practice.
To help the clients fulfill their needs, nurses
assume many roles: stranger, teacher,
resource person, surrogate, leader and  Scope of Nursing
counselor. Nursing aims to assist people in achieving
their maximum health potential.
Maintenance and promotion of health,
Martha Rogers prevention of disease, nursing diagnosis,
intervention, and rehabilitation encompass
“Science of Unitary the scope of nursing’s goals.
Human Beings”
 Environmental Field
Rogers’ theory defined “An irreducible, indivisible, pandimensional
Nursing as “an art and energy field identified by pattern and
science that is humanistic
integral with the human field.”
and humanitarian. It is
directed toward the
 Energy Field
unitary human and is
concerned with the nature The energy field is the fundamental unit of
and direction of human development. The goal of both the living and the non-living. It
nurses is to participate in the process of change.” provides a way to view people and the
environment as irreducible wholes. The
According to Rogers, the Science of energy fields continuously vary in intensity,
Unitary Human Beings contains two dimensions: density, and extent.
the science of nursing, which is the knowledge
specific to the field of nursing that comes from
scientific research; and the art of nursing, which Subconcepts:
involves using the science of nursing creatively to  Openness
help better the life of the patient.  Pandimensional
 Pattern
Major Concepts:
 Principles of Homeodynamics
 Human-unitary human beings  Principle of Reciprocy
A person is defined as an indivisible, pan-  Principle of synchrony
dimensional energy field identified by a  Principle of Integrality
pattern, and manifesting characteristics  Principle of Resonancy
specific to the whole, and that can’t be  Principle of Helicy
predicted from knowledge of the parts. A
person is also a unified whole, having its The nursing process has three steps in Rogers’
own distinct characteristics that can’t be Theory of Unitary Human
viewed by looking at, describing, or Beings: assessment, voluntary mutual
summarizing the parts.
patterning, and evaluation.

 Health The areas of assessment are: the total pattern of

Rogers defines health as an expression of events at any given point in space-time,
the life process. It is the characteristics and simultaneous states of the patient and his or her
environment, rhythms of the life process,
supplementary data, categorical disease entities, wholeness by maintaining physiological
subsystem pathology, and pattern appraisal. The and emotional balance. She defined the
assessment should be a comprehensive patient as someone who needs nursing
assessment of the human and environmental care but did not limit nursing to illness
fields. care. Her theory presented the patient as
a sum of parts with biopsychosocial needs
and the mind and body are inseparable
Mutual patterning of the human and
environmental fields includes: and interrelated.
 Environment - Although the Need Theory
did not explicitly define the environment,
 sharing knowledge Henderson stated that maintaining a
supportive environment conducive for
 offering choices
health is one of the elements of her 14
 empowering the patient activities for client assistance.
Henderson’s theory supports the tasks of
 fostering patterning the private and the public health sector or
 evaluation agencies in keeping the people healthy.
She believes that society wants and
 repeat pattern appraisal, which expects the nurse’s service of acting for
includes nutrition, work/leisure individuals who are unable to function
activities, wake/sleep cycles, independently.
relationships, pain, and fear/hopes  Health - Although not explicitly defined in
 identify dissonance and harmony Henderson’s theory, health was taken to
mean balance in all realms of human life.
 validate appraisal with the patient It is equated with the independence or
ability to perform activities without any aid
 self-reflection for the patient
in the 14 components or basic human
needs. Nurses, on the other hand, are key
The Science of Unitary Human Beings is highly
persons in promoting health, prevention of
generalizable as the concepts and ideas are not
illness and being able to cure. According
confined with a specific nursing approach unlike
to Henderson, good health is a challenge
the usual way of other nurse theorists in defining
because it is affected by numerous factors
the major concepts of a theory.
such as age, cultural background,
emotional balance, and others.
Her statements, in general, made us believe that  Nursing - Virginia Henderson wrote her
a person and his or her environment are integral definition of nursing before the
to each other. That is, a patient can’t be development of theoretical nursing. She
separated from his or her environment when defined nursing as “the unique function of
addressing health and treatment. Her conceptual the nurse is to assist the individual, sick or
framework has greatly influenced all aspects of well, in the performance of those activities
nursing by offering an alternative to traditional contributing to health or its recovery that
approaches of nursing. he would perform unaided if he had the
necessary strength, will or knowledge.
And to do this in such a way as to help
Virginia Henderson him gain independence as rapidly as
possible.” The nurse’s goal is to make the
“Need Theory” patient complete, whole, or independent.
In turn, the nurse collaborates with the
- The theory focuses on physician’s therapeutic plan. Nurses
the importance of
increasing the patient’s
independence to hasten
their progress in the
hospital. Henderson’s theory emphasizes on the
basic human needs and how nurses can assist in
meeting those needs.

Major Concepts of the Nursing Need Theory

 Individual - Henderson states that

individuals have basic needs that are
component of health and require
assistance to achieve health and
independence or a peaceful death.
According to her, an individual achieves
 temporarily assist an individual who lacks prevention occurs before the stressor invades
the necessary strength, will, and the system; secondary prevention occurs after
knowledge to satisfy one or more of the the system has reacted to an invading
14 basic needs. stressor; tertiary prevention occurs after
secondary prevention as reconstitution is being
Application of the Need Theory established.
Henderson’s Needs Theory can be
applied to nursing practice as a way for
 Primary prevention occurs before the
nurses to set goals based on Henderson’s 14
system reacts to a stressor; it
components. Meeting the goal of achieving
includes health promotion and
the 14 needs of the client can be a great
maintenance of wellness. Primary
basis to further improve one’s performance
prevention focuses on strengthening
towards nursing care. In nursing research,
the flexible line of defense through
each of her 14 fundamental concepts can
preventing stress and reducing risk
serve as a basis for research although the
factors. This intervention occurs when
statements were not written in testable terms.
the risk or hazard is identified but
before a reaction occurs. Strategies
that might be used include
Betty Neuman
immunization, health education,
exercise, and lifestyle changes.
“Neuman Systems Model”
 Secondary prevention occurs after
It focuses on the response the system reacts to a stressor and is
of the patient system to provided in terms of existing
actual or potential symptoms. Secondary prevention
environmental stressors and focuses on strengthening the internal
the maintenance of the lines of resistance and, thus, protects
client system’s stability the basic structure through appropriate
through primary, secondary, and tertiary nursing treatment of symptoms. The intent is to
prevention intervention to reduce stressors. regain optimal system stability and to
conserve energy in doing so. If
Betty Neuman describes the Neuman Systems secondary prevention is unsuccessful
Model as “a unique, open-system-based and reconstitution does not occur, the
perspective that provides a unifying focus for basic structure will be unable to
approaching a wide range of concerns. A system support the system and its
acts as a boundary for a single client, a group, or interventions, and death will occur.
even a number of groups; it can also be defined
 Tertiary prevention occurs after the
as a social issue. A client system in interaction
with the environment delineates the domain of system has been treated through
nursing concerns.” secondary prevention strategies. Its
purpose is to maintain wellness or
The Neuman Systems Model views the client as protect the client system reconstitution
an open system that responds to stressors in the through supporting existing strengths
environment. The client variables are and continuing to preserve energy.
physiological, psychological, sociocultural, Tertiary prevention may begin at any
developmental, and spiritual. The client system point after system stability has begun
consists of a basic or core structure that is to be reestablished (reconstitution has
protected by lines of resistance. The usual level begun). Tertiary prevention tends to
of health is identified as the normal line of lead back to primary prevention.
defense that is protected by a flexible line of
defense. Stressors are intra-, inter-, and The delineation of Neuman’s three defense lines
extrapersonal in nature and arise from the were not clearly explained. In reality, the
internal, external, and created environments. individual resists stressors with internal and
When stressors break through the flexible line of external reflexes which were made complicated
defense, the system is invaded and the lines of with the formulation of different levels of
resistance are activated and the system is resistance in the open systems model of
described as moving into illness on a wellness- Neuman.
illness continuum. If adequate energy is Neuman made mention of energy sources in her
available, the system will be reconstituted with model as part of the basic structure. It can be
the normal line of defense restored at, below, or more of help when Neuman has enumerated all
above its previous level. sources of energy that she is pertaining to. With
such, new nursing interventions as to the
provision of needed energy of the client can be
Nursing interventions occur through three conceptualized.
prevention modalities. Primary
The holistic and comprehensive view of the client current health status. Perception is the base for
system is associated with an open system. the collection and interpretation of data.
Health and illness are presented on a continuum Communication is required to verify the accuracy
with movement toward health described as of the perception, as well as for interaction and
negentropic and toward illness as entropic. Her translation.
use of the concept of entropy is inconsistent with
the characteristics of entropy which is closed,
The next phase is the nursing diagnosis. This
rather than an open system.
phase is developed using the data collected in
the assessment. In the process of attaining
goals, the nurse identifies problems, concerns,
and disturbances about which the patient is
seeking help.
Imogene King

The planning phase arises after the diagnosis.

“Theory of Goal Attainment”
The nurse and other health care team members
create a care plan of interventions to solve the
focuses on this process to problems identified. This phase is represented by
guide and direct nurses in setting goals and making decisions about the
the nurse-patient means to achieve those goals. This part of
relationship, going hand-in- transaction and the patient’s participation is
hand with their patients to meet the goals encouraged in making decisions on the means to
towards good health. achieve the goals.

King’s Theory of Goal Attainment was first The actual activities done to achieve the goals
introduced in the 1960s. From the title itself, the make up the implementation phase of the
model focuses on the attainment of certain life nursing process. Whereas in this model of
goals. It explains that the nurse and patient go nursing, it is the continuation of transaction.
hand-in-hand in communicating information, set
goals together, and then take actions to achieve
Finally, in the evaluation phase, the nurse
those goals.
evaluates the patient to determine whether or not
the goals were achieved. Evaluation involves
The Theory of Goal Attainment states determining whether or not goals were achieved.
that “Nursing is a process of action, reaction and The explanation of evaluation in King’s theory
interaction by which nurse and client share addresses meeting goals and the effectiveness
information about their perception in a nursing of nursing care.
situation” and “a process of human interactions
between nurse and client whereby each
In the healthcare field, the final goal in the nurse-
perceives the other and the situation, and
patient relationship is to help the patient achieve
through communication, they set goals, explore
his or her goals for getting healthy. By using the
means, and agree on means to achieve goals.”
nursing process described in King’s Theory of
Goal Attainment, a nurse can be more effective
In this definition, the action is a sequence of in working with a patient to achieve those goals,
behaviors involving mental and physical action, and can truly help patients.
and the reaction is included in the sequence of
behaviors described in action. King states that
the goal of a nurse is to help individuals to Interacting Systems of Theory of Goal
maintain their health so they can function in their
roles. The domain of the nurse “includes Attainment
promoting, maintaining, and restoring health, and
caring for the sick, injured and dying.” The According to King, there are three interacting
function of a professional nurse is “to interpret systems in the Theory of Goal Attainment. These
information in the nursing process to plan, are the personal system, the interpersonal
implement, and evaluate nursing care.” system, and the social system. Each system is
given different concepts. The concepts for the
personal system are: perception, self, growth and
The theory explains that assessment takes
development, body image, space, and time. The
place during interaction. The nurse uses his or
concepts for the interpersonal system are:
her special knowledge and skills while the patient
interaction, communication, transaction, role, and
delivers knowledge of him or her self, as well as
stress. The concepts for the social system are:
the perception of problems of concern to the
organization, authority, power, status, and
interaction. During this phase, the nurse gathers
decision making.
data about the patient including his or her growth
and development, the perception of self, and
 Interactions are defined as the observable
1. Personal Systems behaviors of two or more individuals in mutual
presence.
Each individual is a personal system. King
designated an example of a personal system as
a patient or a nurse. King specified the concepts King (1990) defines communication as “a
of body image, growth, and process whereby information is given from one
development, perception, self, space, and time in person to another either directly in a face-to-face
order to comprehend human beings as persons. meeting or indirectly through telephone,
television, or the written word.”
“The self is a composite of thoughts and feelings
which constitute a person’s awareness of his King defines transactions as “a process of
individual existence, his conception of who and interactions in which human beings communicate
what he is. A person’s self is the sum total of all with the environment to achieve goals that are
he can call his. The self includes, among other valued… goal-directed human behaviors.
things, a system of ideas, attitudes, values, and
commitments. The self is a person’s total
The characteristics of the role include reciprocity
subjective environment. It is a distinctive center
in that a person may be a giver at one time and a
of experience and significance. The self
taker at another time, with a relationship between
constitutes a person’s inner world as
two or more individuals who are functioning in
distinguished from the outer world consisting of
two or more roles that learned, social, complex,
all other people and things. The self is the
and situational.
individual as known to the individual. It is that to
which we refer when we say “I.”
Stress is “a dynamic state whereby a human
being interacts with the environment to maintain
Growth and development can be defined as the
balance for growth, development, and
processes in people’s lives through which they
performance, which involves an exchange of
move from a potential for the achievement to the
energy and information between the person and
actualization of self.
the environment for regulation and control of
stressors.”
King defines body image as the way one
perceives both one’s body and others’ reactions
to one’s appearance. 3. Social Systems

A more comprehensive interacting system

Space includes that space exists in all directions,
consists of groups that make up society, referred
is the same everywhere, and is defined by the
to as the social system. Religious, educational,
physical area known as “territory” and by the
and health care systems are examples of social
behaviors of those occupying it.
systems. The influential behavior of an extended
family on an individual’s growth and development
Time is defined as “a duration between one is another social system example. Within a social
event and another as uniquely experienced by system, the concepts of authority, decision
each human being; it is the relation of one event making, organization, power, and status guide
to another event.” system understanding.

King (1986) added learning as a subconcept in Power is the capacity to use resources in
the personal system but did not further define it. organizations to achieve goals… is the process
whereby one or more persons influence other
persons in a situation… is the capacity or ability
2. Interpersonal Systems of a person or a group to achieve goals… occurs
in all aspects of life and each person has
These are formed by human beings interacting. potential power determined by individual
Two interacting individuals form a dyad; three resources and the environmental forces
form a triad, and four or more form small or large encountered. Power is a social force that
groups. As the number of interacting individuals organizes and maintains society. Power is the
increases, so does the complexity of the ability to use and to mobilize resources to
interactions. Understanding the interpersonal achieve goals.
system requires the concepts
of communication, interaction, role, stress,
and transaction. Status is “the position of an individual in a group
or a group in relation to other groups in an
organization” and is identified that status is
accompanied by “privileges, duties, and
obligation.”
Decision making is “a dynamic and systematic
process by which goal-directed choice of Process of Interaction
perceived alternatives is made and acted upon
by individuals or groups to answer a question
and attain a goal” (King, 1990).

King (1986) added control as a subconcept in

the social system but did not further define the
concept.

Dynamic Conceptual Systems

The figure above represents a process of human

interactions that lead to transactions: A model of
transaction. According to King, “The human
process of interactions formed the basis for
designing a model of transactions that depicted
theoretical knowledge used by nurses to help
individuals and groups attain goals.”

Interaction
Interaction is a process of perception and
communication between person and environment
and between person and person represented by
verbal and nonverbal behaviors that are goal-
directed.

Transaction
Transaction is a process of interactions in which
human beings communicate with the
environment to achieve goals that are valued;
The figure below demonstrates the conceptual transactions are goal-directed human behaviors.
system that provided “one approach to studying Perception is “each person’s representation of
systems as a whole rather than as isolated parts reality.”
of a system” and was “designed to explain the
organized wholes within which nurses are
expected to function.” Communication
Communication is defined as “a process whereby
information is given from one person to another
King has interrelated the concepts of interaction, either directly in face-to-face meetings or
perception, communication, transaction, self, indirectly through telephone, television, or the
role, stress, growth and development, time, and written word.”
space into a theory of goal attainment. Her theory
deals with a nurse-client dyad, a relationship to
which each person brings personal perceptions Role
of self, role, and personal levels of growth and Role is defined as “a set of behaviors expected of
development. The nurse and client communicate, persons occupying a position in a social system;
first in interaction and then in transaction, to rules that define rights and obligations in a
attain mutually set goals. The relationship takes position; a relationship with one or more
place in space identified by their behaviors and individuals interacting in specific situations for a
occurs in forward-moving time. purpose.”

She believed that her “framework differs from

other conceptual schema in that it is concerned Stress
not with fragmenting human beings and the Stress is “a dynamic state whereby a human
environment but with human transactions in being interacts with the environment to maintain
different kinds of environments.” balance for growth, development, and
performance… an energy response of an
individual to persons, objects, and events called
stressors.”
 The original hierarchy of needs five-stage
Growth and Development model includes:
Growth and development can be defined as the Maslow (1943, 1954) stated that people are
“continuous changes in individuals at the cellular, motivated to achieve certain needs and that
molecular, and behavioral levels of activities… some needs take precedence over others.
the processes that take place in the life of
individuals that help them move from potential Our most basic need is for physical survival, and
capacity for achievement to self-actualization.” this will be the first thing that motivates our
behavior. Once that level is fulfilled the next level
up is what motivates us, and so on.
Time
Time is “a sequence of events moving onward to
the future… a continuous flow of events in 1. Physiological needs - these are biological
successive order that implies a change, a past requirements for human survival, e.g. air, food,
and a future… a duration between one event and drink, shelter, clothing, warmth, sex, sleep.
another as uniquely experienced by each human
being… the relation of one event to another.” If these needs are not satisfied the human body
cannot function optimally. Maslow considered
physiological needs the most important as all the
Space other needs become secondary until these needs
Space exists in every direction and is the same in are met.
all directions. Space includes that physical area
called territory. Space is defined by the behaviors
2. Safety needs - Once an individual’s
of those individuals who occupy it
physiological needs are satisfied, the needs for
All in all, King contributed to the advancement of
security and safety become salient. People want
nursing knowledge through the development of
to experience order, predictability and control in
her conceptual system and middle-range Theory
their lives. These needs can be fulfilled by the
of Goal Attainment. By focusing on the
family and society (e.g. police, schools, business
attainment of goals, or outcomes, by nurse-
and medical care).
patient partnerships, King provided a conceptual
system and middle-range theory that has For example, emotional security, financial
demonstrated its usefulness to nurses. Nurses security (e.g. employment, social welfare), law
working in a variety of settings with patients from and order, freedom from fear, social stability,
around the world continue to use King’s work to property, health and wellbeing (e.g. safety
improve the quality of patient care. against accidents and injury).

Non-Nursing Theories 3. Love and belongingness needs - after

physiological and safety needs have been
Maslow’s Hierarchy of Human Needs fulfilled, the third level of human needs is social
and involves feelings of belongingness. The need
Maslow's hierarchy of needs is a for interpersonal relationships motivates behavior
motivational theory in psychology comprising a Examples include friendship, intimacy, trust, and
five-tier model of human needs, often depicted as acceptance, receiving and giving affection and
hierarchical levels within a pyramid. Needs lower love. Affiliating, being part of a group (family,
down in the hierarchy must be satisfied before friends, work).
individuals can attend to needs higher up. From
the bottom of the hierarchy upwards, the needs
are: physiological, safety, love and belonging,
4. Esteem needs are the fourth level in Maslow’s
esteem, and self-actualization.
hierarchy - which Maslow classified into two
categories: (i) esteem for oneself (dignity,
achievement, mastery, independence) and (ii)
the desire for reputation or respect from others
(e.g., status, prestige).
Maslow indicated that the need for respect or
reputation is most important for children and
adolescents and precedes real self-esteem or
dignity.

5. Self-actualization needs are the highest level

in Maslow's hierarchy, and refer to the realization
of a person's potential, self-fulfillment, seeking
personal growth and peak experiences. Maslow sexual experiences, service to others, the pursuit
(1943) describes this level as the desire to of science, religious faith, etc.).
accomplish everything that one can, to become
the most that one can be. Sullivian’s Transactional Analysis
Transactional analysis is a brief
Individuals may perceive or focus on this need therapeutic approach based on Freud's as well
very specifically. For example, one individual as Adler's and Sullivan's ideas. It was formulated
may have a strong desire to become an ideal by Eric Berne (1910-1970) and had great
parent. In another, the desire may be expressed success, especially in America. Its strength is in
economically, academically or athletically. For its simplicity, not least its everyday,
others, it may be expressed creatively, in understandable terminology. TA therapists and
paintings, pictures, or inventions. their patients talk about Parent, Adult, Child,
concepts which correspond to the Freudian
Hierarchy of needs summary Superego, ego and id.
(a) human beings are motivated by a hierarchy of
needs. The therapy's main aim being that of
(b) needs are organized in a hierarchy of putting the patient's conscious, mature, realistic,
prepotency in which more basic needs must be ethical Adult in charge of his reckless, impulsive,
more or less met (rather than all or none) prior to selfish Child and the harsh, controlling Parent.
higher needs. The therapy is conducted in a group setting,
(c) the order of needs is not rigid but instead may where the members' "scripts", "games", self-
be flexible based on external circumstances or defeating and self-perpetuating transactions are
individual differences. analysed. TA claims to demystify human
(d) most behavior is multi-motivated, that is, psychology, but it ends up by becoming
simultaneously determined by more than one oversimplistic and mechanistic.
basic need.

Changes to the original five-stage model are Ludwig von Bertalanffy’s General Systems
highlighted and include a seven-stage model and Theory
an eight-stage model; both developed during the General system theory, therefore, is a
1960s and 1970s. general science of wholeness... The meaning of
the somewhat mystical expression, “The whole is
1. Biological and physiological needs - air, food, more that the sum of its parts” is simply that
drink, shelter, warmth, sex, sleep, etc. constitutive characteristics are not explainable
from the characteristics of the isolated parts. The
2. Safety needs - protection from elements, characteristics of the complex, therefore, appear
security, order, law, stability, freedom from fear. as new or emergent... - Ludwig von Bertalanffy

3. Love and belongingness needs - friendship, Systems theory was proposed in the
intimacy, trust, and acceptance, receiving and 1940's by the biologist Ludwig von Bertalanffy
giving affection and love. Affiliating, being part of and furthered by Ross Ashby (1964). Von
a group (family, friends, work). Bertalanffy was reacting against both
reductionism and attempting to revive the
4. Esteem needs - which Maslow classified into unity of science. He is considered to be the
two categories: (i) esteem for oneself (dignity, founder and principal author of general
achievement, mastery, independence) and (ii) systems theory.
the desire for reputation or respect from others
(e.g., status, prestige).
If one were to analyze current notions
and fashionable catchwords, he would find
5. Cognitive needs - knowledge and
“systems” high on the list - Ludwig von
understanding, curiosity, exploration, need for
Bertalanffy.
meaning and predictability.
6. Aesthetic needs - appreciation and search for
beauty, balance, form, etc. Ludwig von Bertalanffy (1968) wrote that
a system is a complex of interacting elements
7. Self-actualization needs - realizing personal and that they are open to, and interact with their
potential, self-fulfillment, seeking personal growth environments. In addition, they can acquire
and peak experiences. A desire “to become qualitatively new properties through emergence,
everything one is capable of becoming”(Maslow, thus they are in a continual evolution. When
1987, p. 64). referring to systems, it also generally means that
they are self-regulating (they self-correct through
8. Transcendence needs - A person is motivated feedback).
by values which transcend beyond the personal
self (e.g., mystical experiences and certain
experiences with nature, aesthetic experiences,
 System thinking is both part-to-whole between the driving and restraining
and whole-to-part thinking about making forces.
connections between the various elements so STAGES
that they fit together as a whole. Consists of three distinct and vital stages:

Lewin’s Change Theory 1. “Unfreezing”

 Unfreezing is the process which
 Kurt Lewin (1890-1947) is considered as involves finding a method of
the father of social psychology making it possible for people to let
 He was born in Germany, later emigrated go of an old pattern that was
to the US. counterproductive in some way.
 He is well known for his writings on group  Unfreezing is necessary to
dynamics, group therapy and social overcome the strains of individual
psychology. resistance and group conformity.
 Kurt Lewin introduced his field theory  Unfreezing can be achieved by the
concepts, emphasizing that the group use of three methods.
differs from the simple sum of its parts. o First, increase the driving
 Lewin coined the term group dynamics in forces that direct behavior
1939. away from the existing
 His field theory states that "one’s behavior situation or status quo.
is related both to one’s personal o Second, decrease the
characteristics and to the social situation restraining forces that
in which one finds oneself." negatively affect the
movement from the existing
LEWIN’S CHANGE THEORY equilibrium.
His most influencial theory was his model o Third, find a combination of
of the change process in human systems. the two methods listed
Kurt Lewin theorized a three-stage model above.
of change that is known as the unfreezing-
change-refreeze model that requires prior 2. “Moving to a new level or Changing” or
learning to be rejected and replaced. Movement
Lewin's theory states behavior as "a  This stage involves a process of
dynamic balance of forces working in change in thoughts, feeling,
opposing directions." behavior, or all three, that is in
some way more liberating or more
CONCEPTS productive.
Driving forces
 Driving forces are forces that push 3. “Refreezing”
in a direction that causes change  Refreezing is establishing the
to occur. change as a new habit, so that it
 Driving forces facilitate change now becomes the “standard
because they push the person in operating procedure.” Without this
the desired direction. stage of refreezing, it is easy to go
 They cause a shift in the back to the old ways.
equilibrium towards change.
APPLICATION
Restraining forces  It is pertinant that the driving and
 Restraining forces are forces that restraining forces must be analyzed
counter driving forces. before implimenting a planned change.
 Restraining forces hinder change
because they push the person in
the opposite direction. Erikson’s Psychosocial Development Theory
 Restraining forces cause a shift in
the equilibrium which opposes
change.

Equilibrium
 Equilibrium is a state of being
where driving forces equal
restraining forces and no change
occurs
 Equilibrium can be raised or
lowered by changes that occur
 balance between the two opposing sides. When
Each stage in Erikson's theory builds on this happens, children acquire hope, which
the preceding stages and paves the way for Erikson described as an openness to experience
following periods of development. In each stage, tempered by some wariness that danger may be
Erikson believed people experience a conflict present.
that serves as a turning point in development.
If people successfully deal with the Stage 2: Autonomy vs. Shame and Doubt
conflict, they emerge from the stage with The second stage of Erikson's theory of
psychological strengths that will serve them well psychosocial development takes place during
for the rest of their lives. early childhood and is focused on children
If they fail to deal effectively with these developing a greater sense of personal control.
conflicts, they may not develop the essential
skills needed for a strong sense of self. The Role of Independence

At this point in development, children are

just starting to gain a little independence.
They are starting to perform basic
actions on their own and making simple
decisions about what they prefer. By
allowing kids to make choices and gain
control, parents and caregivers can help
children develop a sense of autonomy.

Potty Training
The essential theme of this stage is that
children need to develop a sense of personal
control over physical skills and a sense of
independence. Potty training plays an
important role in helping children develop this
sense of autonomy.
Like Freud, Erikson believed that toilet training
was a vital part of this process. However,
Erikson's reasoning was quite different than
Stage 1: Trust vs. Mistrust that of Freud's. Erikson believed that learning
The first stage of Erikson's theory of to control one's bodily functions leads to a
psychosocial development occurs between birth feeling of control and a sense of
and 1 year of age and is the most fundamental independence. Other important events include
stage in life. Because an infant is utterly gaining more control over food choices, toy
dependent, developing trust is based on the preferences, and clothing selection.
dependability and quality of the child's
caregivers. Outcomes
At this point in development, the child is Children who struggle and who are shamed for
utterly dependent upon adult caregivers for their accidents may be left without a sense of
everything they need to survive including food, personal control. Success during this stage of
love, warmth, safety, and nurturing. If a caregiver psychosocial development leads to feelings of
fails to provide adequate care and love, the child autonomy; failure results in feelings of shame
will come to feel that they cannot trust or depend and doubt.
upon the adults in their life.
Stage 3: Initiative vs. Guilt
Outcomes The third stage of psychosocial development
If a child successfully develops trust, the takes place during the preschool years. At this
child will feel safe and secure in the world. point in psychosocial development, children
Caregivers who are inconsistent, emotionally begin to assert their power and control over the
unavailable, or rejecting contribute to feelings of world through directing play and other social
mistrust in the children under their care. Failure interactions. Children who are successful at this
to develop trust will result in fear and a belief that stage feel capable and able to lead others.
the world is inconsistent and unpredictable. Those who fail to acquire these skills are left
During the first stage of psychosocial with a sense of guilt, self-doubt, and lack of
development, children develop a sense of trust initiative.
when caregivers provide reliability, care, and
affection. A lack of this will lead to mistrust. Outcomes
No child is going to develop a sense of 100% The major theme of the third stage of
trust or 100% doubt. Erikson believed that psychosocial development is that children need
successful development was all about striking a to begin asserting control and power over the
environment. Success in this stage leads to a central focus during the identity versus
sense of purpose. Children who try to exert too confusion stage of psychosocial
much power experience disapproval, resulting in development.
a sense of guilt.
According to Erikson, our ego identity
Stage 4: Industry vs. Guilt constantly changes due to new experiences
The fourth psychosocial stage takes place and information we acquire in our daily
during the early school years from approximately interactions with others. As we have new
ages 5 to 11. Through social interactions, experiences, we also take on challenges
children begin to develop a sense of pride in that can help or hinder the development of
their accomplishments and abilities. identity.
Children need to cope with new social and
academic demands. Success leads to a sense
of competence, while failure results in feelings of Stage 6: Intimacy vs. Isolation
inferiority. Young adults need to form intimate, loving
relationships with other people. Success
Outcomes leads to strong relationships, while failure
Children who are encouraged and results in loneliness and isolation. This
commended by parents and teachers stage covers the period of early adulthood
develop a feeling of competence and belief when people are exploring personal
in their skills. Those who receive little or no relationships.
encouragement from parents, teachers, or
peers will doubt their abilities to be Erikson believed it was vital that people
successful. develop close, committed relationships with
other people. Those who are successful at
Stage 5: Identity vs. Confusion this step will form relationships that are
The fifth psychosocial stage takes place enduring and secure.
during the often turbulent teenage years.
This stage plays an essential role in Stage 7: Generativity vs. Stagnation
developing a sense of personal identity Adults need to create or nurture things that
which will continue to influence behavior will outlast them, often by having children or
and development for the rest of a person's creating a positive change that benefits
life. Teens need to develop a sense of self other people. Success leads to feelings of
and personal identity. Success leads to an usefulness and accomplishment, while
ability to stay true to yourself, while failure failure results in shallow involvement in the
leads to role confusion and a weak sense world. During adulthood, we continue to
of self. build our lives, focusing on our career and
family.
During adolescence, children explore their
independence and develop a sense of self. Those who are successful during this
Those who receive proper encouragement phase will feel that they are contributing to
and reinforcement through personal the world by being active in their home and
exploration will emerge from this stage with community. Those who fail to attain this
a strong sense of self and feelings of skill will feel unproductive and uninvolved in
independence and control. Those who the world.
remain unsure of their beliefs and desires
will feel insecure and confused about Stage 8: Integrity vs. Despair
themselves and the future. The final psychosocial stage occurs during
old age and is focused on reflecting back
What Is Identity? on life. At this point in development, people
look back on the events of their lives and
When psychologists talk about identity, they determine if they are happy with the life that
are referring to all of the beliefs, ideals, and they lived or if they regret the things they
values that help shape and guide a did or didn't do.
person's behavior. Completing this stage
successfully leads to fidelity, which Erikson Erikson's theory differed from many others
described as an ability to live by society's because it addressed development
standards and expectations. throughout the entire lifespan, including old
age. Older adults need to look back on life
While Erikson believed that each stage of and feel a sense of fulfillment. Success at
psychosocial development was important, this stage leads to feelings of wisdom, while
he placed a particular emphasis on the failure results in regret, bitterness, and
development of ego identity. Ego identity is despair.
the conscious sense of self that we develop
through social interaction and becomes a
At this stage, people reflect back on the Kohlberg’s Moral Development Theory
events of their lives and take stock. Those
who look back on a life they feel was well- Lawrence Kohlberg was, for many years, a
lived will feel satisfied and ready to face the professor at Harvard University. He became
end of their lives with a sense of peace. famous for his work there beginning in the
Those who look back and only feel regret early 1970s. He started as a developmental
will instead feel fearful that their lives will psychologist and then moved to the field of
end without accomplishing the things they moral education. He was particularly well-
feel they should have. known for his theory of moral development
which he popularized through research
Outcomes studies conducted at Harvard's Center for
Those who are unsuccessful during this Moral Education.
stage will feel that their life has been
wasted and may experience many regrets. His theory of moral development was
The person will be left with feelings of dependent on the thinking of the Swiss
bitterness and despair. Those who feel psychologist Jean Piaget and the American
proud of their accomplishments will feel a philosopher John Dewey. He was also
sense of integrity. Successfully completing inspired by James Mark Baldwin. These
this phase means looking back with few men had emphasized that human beings
regrets and a general feeling of satisfaction. develop philosophically and
These individuals will attain wisdom, even psychologically in a progressive fashion.
when confronting death.
Kohlberg believed...and was able to
Strengths and Weaknesses of Erikson's demonstrate through studies...that people
Theory progressed in their moral reasoning (i.e., in
their bases for ethical behavior) through a
Erikson's theory also has its limitations and series of stages. He believed that there were
attracts valid criticisms. What kinds of six identifiable stages which could be more
experiences are necessary to successfully generally classified into three levels.
complete each stage? How does a person
move from one stage to the next? Level 1 - Pre-conventional morality

Criticism At the pre-conventional level (most nine-year-

One major weakness of psychosocial olds and younger, some over nine), we don’t
theory is that the exact mechanisms for have a personal code of morality. Instead, our
resolving conflicts and moving from one moral code is shaped by the standards of adults
stage to the next are not well described or and the consequences of following or breaking
developed. The theory fails to detail exactly their rules.
what type of experiences are necessary at Authority is outside the individual and reasoning
each stage in order to successfully resolve is based on the physical consequences of
the conflicts and move to the next stage. actions.
Support • Stage 1. Obedience and Punishment
One of the strengths of psychosocial theory Orientation. The child/individual is good in order
is that it provides a broad framework from to avoid being punished. If a person is punished,
which to view development throughout the they must have done wrong.
entire lifespan. It also allows us to
• Stage 2. Individualism and Exchange. At this
emphasize the social nature of human
stage, children recognize that there is not just
beings and the important influence that
one right view that is handed down by the
social relationships have on development.
authorities. Different individuals have different
viewpoints.
Researchers have found evidence
supporting Erikson's ideas about identity
and have further identified different sub- Level 2 - Conventional morality
stages of identity formation. Some research
At the conventional level (most adolescents and
also suggests that people who form strong
adults), we begin to internalize the moral
personal identities during adolescence are
standards of valued adult role models.
better capable of forming intimate
relationships during early adulthood. Other Authority is internalized but not questioned, and
research suggests, however, that identity reasoning is based on the norms of the group to
formation and development continues well which the person belongs.
into adulthood.
• Stage 3. Good Interpersonal Relationships. which seeks to do what will gain the
The child/individual is good in order to be seen approval of others. The second stage is
as being a good person by others. Therefore, one oriented to abiding by the law and
answers relate to the approval of others. responding to the obligations of duty.
• Stage 4. Maintaining the Social Order. The
child/individual becomes aware of the wider rules The third level of moral thinking is one that
of society, so judgments concern obeying the Kohlberg felt is not reached by the majority of
rules in order to uphold the law and to avoid guilt. adults. Its first stage (stage 5) is an
understanding of social mutuality and a
genuine interest in the welfare of others. The
Level 3 - Post-conventional morality last stage (stage 6) is based on respect for
universal principle and the demands of
Individual judgment is based on self-chosen
individual conscience. While Kohlberg always
principles, and moral reasoning is based on
believed in the existence of Stage 6 and had
individual rights and justice. According to
some nominees for it, he could never get
Kohlberg this level of moral reasoning is as far as
enough subjects to define it, much less
most people get.
observe their longitudinal movement to it.
Only 10-15% are capable of the kind of abstract
thinking necessary for stage 5 or 6 (post- Kohlberg believed that individuals could only
conventional morality). That is to say, most progress through these stages one stage at a
people take their moral views from those around time. That is, they could not "jump" stages.
them and only a minority think through ethical They could not, for example, move from an
principles for themselves. orientation of selfishness to the law and order
stage without passing through the good boy/girl
• Stage 5. Social Contract and Individual
stage. They could only come to a
Rights. The child/individual becomes aware that
comprehension of a moral rationale one stage
while rules/laws might exist for the good of the
above their own. Thus, according to Kohlberg,
greatest number, there are times when they will
it was important to present them with moral
work against the interest of particular individuals.
dilemmas for discussion which would help them
The issues are not always clear-cut. For to see the reasonableness of a "higher stage"
example, in Heinz’s dilemma, the protection of morality and encourage their development in
life is more important than breaking the law that direction. The last comment refers to
against stealing. Kohlberg's moral discussion approach. He saw
this as one of the ways in which moral
• Stage 6. Universal Principles. People at this development can be promoted through formal
stage have developed their own set of moral education. Note that Kohlberg believed, as did
guidelines which may or may not fit the law. The Piaget, that most moral development occurs
principles apply to everyone. through social interaction. The discussion
E.g., human rights, justice, and equality. The approach is based on the insight that
person will be prepared to act to defend these individuals develop as a result of cognitive
principles even if it means going against the rest conflicts at their current stage.
of society in the process and having to pay the
consequences of disapproval and or
imprisonment. Kohlberg doubted few people Pre-Convetional
reached this stage.  Stage 1 Obedience and Punishment Driven
 Stage 2 Self Interest Driven

Conventional
The first level of moral thinking is that  Stage 3 Interpersonal Accord & Conformity
generally found at the elementary school level. Driven
In the first stage of this level, people behave  Stage 4 Authority & Social-order Obedience
according to socially acceptable norms Driven
because they are told to do so by some
authority figure (e.g., parent or teacher). This Post-Conventional
obedience is compelled by the threat or  Stage 5 Social Contract Driven
application of punishment. The second stage  Stage 6 Universal Ethical Principles Driven
of this level is characterized by a view that
right behavior means acting in one's own best
interests.

The second level of moral thinking is that

generally found in society, hence the name
"conventional." The first stage of this level
(stage 3) is characterized by an attitude