CONCEPTUAL AND THEORETICAL MODELS OF NURSING PRACTICE

A. NIGHTANGLE’S THEORY ( mid-1800)

➢ Focuses on the patient and his environment.
➢ Developed the described the first theory of nursing. Notes on Nursing: What It Is, What It Is
Not. She focused on changing and manipulating the environment in order to put the
patient in the best possible conditions for nature to act.
➢ She believed that in the nurturing environment, the body could repair itself. Client’s
environment is manipulated to include appropriate noise, nutrition, hygiene, socialization
and hope.
B. PEPLAU, HILDEGARD (1951)
Defined nursing as a therapeutic, interpersonal process which strives to develop a nurse- patient
relationship in which the nurse serves as a resource person, counselor and surrogate.
Introduced the Interpersonal Model. She defined nursing as an interpersonal
process of therapeutic between an individual who is sick or in need of health services and a
nurse especially educated to recognize and respond to the need for help. She identified four
phases of the nurse client relationship namely:
1. Orientation: the nurse and the client initially do not know each other’s goals and testing the
role each will assume. The client attempts to identify difficulties and the amount of nursing
help that is needed;
2. Identification: the client responds to help professionals or the significant others who can
meet the identified needs. Both the client and the nurse plan together an appropriate
program to foster health;
3. Exploitation: the clients utilize all available resources to move toward a goal of maximum
health functionality;
4. Resolution: refers to the termination phase of the nurse-client relationship. it occurs when the
client’s needs are met and he/she can move toward a new goal. Peplau further assumed
that nurse-client relationship fosters growth in both the client and the nurse.

C. ABDELLAH, FAYE G. (1960)

➢ Defined nursing as having a problem-solving approach, with key nursing problems
related to health needs of people; developed list of 21 nursing-problem areas.
➢ Introduced Patient – Centered Approaches to Nursing Model She defined nursing as
service to individual and families; therefore the society. Furthermore, she
conceptualized nursing as an art and a science that molds the attitudes, intellectual
competencies and technical skills of the individual nurse into the desire and ability to
help people, sick or well, and cope with their health needs.

D. LEVINE, MYRA (1973)

➢ Believes nursing intervention is a conservation activity, with conservation of energy as

a primary concern, four conservation principles of nursing: conservation of client
energy, conservation of structured integrity, conservation of personal integrity,
conservation of social integrity.

➢ Described the Four Conversation Principles. She advocated that nursing is a human
interaction and proposed four conservation principles of nursing which are
concerned with the unity and integrity of the individual. The four conservation
principles are as follows:
1. Conservation of energy. The human body functions by utilizing energy. The human body
needs energy producing input (food, oxygen, fluids) to allow energy utilization output.
2. Conservation of Structural Integrity. The human body has physical boundaries (skin and
mucous membrane) that must be maintained to facilitate health and prevent harmful
agents from entering the body.
3. Conservation of Personal Integrity. The nursing interventions are based on the conservation of
the individual client’s personality. Every individual has sense of identity, self worth and self
esteem, which must be preserved and enhanced by nurses.
4. Conservation of Social integrity. The social integrity of the client reflects the family and the
community in which the client functions. Health care institutions may separate individuals
from their family. It is important for nurses to consider the individual in the context of the
family.

E. JOHNSON, DOROTHY (1960, 1980)

➢ Focuses on how the client adapts to illness; the goal of nursing is to reduce stress so
that the client can move more easily through recovery.
➢ Viewed the patient’s behavior as a system, which is a whole with interacting parts.
➢ The nursing process is viewed as a major tool.
Conceptualized the Behavioral System Model. According to Johnson, each person as a
behavioral system is composed of seven subsystems namely:
1. Ingestive. Taking in nourishment in socially and culturally acceptable ways.
2. Eliminative. Riddling the body of waste in socially and culturally acceptable ways.
3. Affiliative. Security seeking behavior.
4. Aggressive. Self – protective behavior.
5. Dependence. Nurturance – seeking behavior.
6. Achievement. Master of oneself and one’s environment according to internalized standards
of excellence.
7. Sexual role identity behavior

F. ROGERS, MARTHA
➢ Considers man as a unitary human being co-existing with in the universe, views nursing
primarily as a science and is committed to nursing research.

G. OREM, DOROTHEA (1970, 1985)

➢ Emphasizes the client’s self-care needs, nursing care becomes necessary when client is
unable to fulfill biological, psychological, developmental or social needs.
➢ Developed the Self-Care Deficit Theory. She defined self-care as “the practice of
activities that individuals initiate to perform on their own behalf in maintaining life, health
well-being.” She conceptualized three systems as follows:
1. Wholly Compensatory: when the nurse is expected to accomplish all the patient’s
therapeutic self-care or to compensate for the patient’s inability to engage in self
care or when the patient needs continuous guidance in self care;

2. Partially Compensatory: when both nurse patient engage in meeting self care
needs;
3. Supportive-Educative: the system that requires assistance decision making,
behavior control and acquisition knowledge and skills.

H. IMOGENE KING (1971, 1981)

➢ Nursing process is defined as dynamic interpersonal process between nurse,
client and health care system.
 ➢ Postulated the Goal Attainment Theory. She described nursing as a helping
profession that assists individuals and groups in society to attain, maintain, and
restore health. If is this not possible, nurses help individuals die with dignity.
➢ In addition, King viewed nursing as an interaction process between client and
nurse whereby during perceiving, setting goals, and acting on them transactions
occurred and goals are achieved.

I. BETTY NEUMAN
➢ Stress reduction is a goal of system model of nursing practice. Nursing actions are
in primary, secondary or tertiary level of prevention.
J. SIS CALLISTA ROY (Adaptation Theory) (1979, 1984)
➢ Views the client as an adaptive system. The goal of nursing is to help the person
adapt to changes in physiological needs, self-concept, role function and
interdependent relations during health and illness.
➢ Presented the Adaptation Model. She viewed each person as a unified
biopsychosocial system in constant interaction with a changing environment.
She contented that the person as an adaptive system, functions as a whole
through interdependence of its part. The system consists of input, control
processes, output feedback.

K. LYDIA HALL (1962)

➢ The client is composed of the ff. overlapping parts: person (core), pathologic
state and treatment (cure) and body (care).
➢ Introduced the model of Nursing: What Is It?, focusing on the notion that centers
around three components of CARE, CORE and CURE. Care represents nurturance
and is exclusive to nursing. Core involves the therapeutic use of self and
emphasizes the use of reflection. Cure focuses on nursing related to the
physician’s orders. Core and cure are shared with the other health care
providers.

L. Virginia Henderson (1955)

➢ Introduced The Nature of Nursing Model. She identified fourteen basic needs.
➢ She postulated that the unique function of the nurse is to assist the clients, sick or well, in
the performance of those activities contributing to health or its recovery, the clients
would perform unaided if they had the necessary strength, will or knowledge.
➢ She further believed that nursing involves assisting the client in gaining independence as
rapidly as possible, or assisting him achieves peaceful death if recovery is no longer
possible.

M. Madaleine Leininger (1978, 1984)

➢ Developed the Transcultural Nursing Model. She advocated that nursing is a humanistic
and scientific mode of helping a client through specific cultural caring processes
(cultural values, beliefs and practices) to improve or maintain a health condition.

N. Ida Jean Orlando (1961)

➢ Conceptualized The Dynamic Nurse – Patient Relationship Model.
➢ She believed that the nurse helps patients meet a perceived need that the patient
cannot meet for themselves. Orlando observed that the nurse provides direct assistance
to meet an immediate need for help in order to avoid or to alleviate distress or
helplessness.
➢ She emphasized the importance of validating the need and evaluating care based on
observable outcomes.
O. Ernestine Weidanbach (1964)
➢ Developed the Clinical Nursing – A Helping Art Model.
➢ She advocated that the nurse’s individual philosophy or central purpose lends credence
to nursing care.
➢ She believed that nurses meet the individual’s need for help through the identification of
the needs, administration of help, and validation that actions were helpful. Components
of clinical practice: Philosophy, purpose, practice and an art.

P. Rosemarie Rizzo Parse (1979-1992)

➢ Introduced the theory of Human Becoming. She emphasized free choice of personal
meaning in relating value priorities, co – creating the rhythmical patterns, in exchange
with the environment, and co transcending in many dimensions as possibilities unfold.

Q. Joyce Travelbee (1966,1971)

➢ She postulated the Interpersonal Aspects of Nursing Model. She advocated that the goal
of nursing individual or family in preventing or coping with illness, regaining health finding
meaning in illness, or maintaining maximal degree of health.
➢ She further viewed that interpersonal process is a human-to-human relationship formed
during illness and “experience of suffering”
➢ She believed that a person is a unique, irreplaceable individual who is in a continuous
process of becoming, evolving and changing.
R. Josephine Peterson and Loretta Zderad (1976)
➢ Provided the Humanistic Nursing Practice Theory. This is based on their belief that nursing
is an existential experience.
➢ Nursing is viewed as a lived dialogue that involves the coming together of the nurse and
the person to be nursed.
➢ The essential characteristic of nursing is nurturance. Humanistic care cannot take place
without the authentic commitment of the nurse to being with and the doing with the
client. Humanistic nursing also presupposes responsible choices.

S. Helen Erickson, Evelyn Tomlin, and Mary Ann Swain (1983)

➢ Developed Modeling and Role Modeling Theory. The focus of this theory is on the person.
The nurse models (assesses), role models (plans), and intervenes in this interpersonal and
interactive theory.
➢ They asserted that each individual unique, has some self-care knowledge, needs
simultaneously to be attached to the separate from others, and has adaptive potential.
Nurses in this theory, facilitate, nurture and accept the person unconditionally.
T. Margaret Newman
➢ Focused on health as expanding consciousness. She believed that human are unitary in
whom disease is a manifestation of the pattern of health.
➢ She defined consciousness as the information capability of the system which is
influenced by time, space movement and is ever – expanding.
U. Patricia Benner and Judith Wrudel (1989)
➢ Proposed the Primacy and Caring Model. They believed that caring central to the
essence of nursing. Caring creates the possibilities for coping and creates the possibilities
for connecting with and concern for others.

V. Anne Boykin and Savina Schoenhofer

➢ Presented the grand theory of Nursing as Caring. They believed that all person are
caring, and nursing is a response to a unique social call. The focus of nursing is on
 nurturing person living and growing in caring in a manner that is specific to each nurse-
nursed relationship or nursing situation. Each nursing situation is original.
➢ They support that caring is a moral imperative. Nursing as Caring is not based on need or
deficit but is egalitarian model helping.
Moral Theories
1. Freud (1961)
➢ Believed that the mechanism for right and wrong within the individual is the
superego, or conscience. He hypnotized that a child internalizes and adopts the
moral standards and character or character traits of the model parent through
the process of identification.
➢ The strength of the superego depends on the intensity of the child’s feeling of
aggression or attachment toward the model parent rather than on the actual
standards of the parent.
2. Erikson (1964)
➢ Erikson’s theory on the development of virtues or unifying strengths of the “good
man” suggest that moral development continuous throughout life. He believed
that if the conflicts of each psychosocial developmental stages favorably
resolved, then an ‘ego-strength” or virtue emerges.
3. Kohlberg
➢ Suggested three levels of moral development. He focused on the reason for the
making of a decision, not on the morality of the decision itself.
1. At first level called the premolar or the preconventional level, children are responsive to
cultural rules and labels of good and bad, right and wrong. However children interpret
these in terms of the physical consequences of the actions, i.e., punishment or reward.
2. At the second level, the conventional level, the individual is concerned about
maintaining the expectations of the family, groups or nation and sees this as right.
3. At the third level, people make postconventional, autonomous, or principal level. At this
level, people make an effort to define valid values and principles without regard to
outside authority or to the expectations of others. These involve respect for other human
and belief that relationships are based on mutual trust.
4. Peter (1981)
➢ Proposed a concept of rational morality based on principles. Moral development
is usually considered to involve three separate components: moral emotion (what
one feels), moral judgment (how one reasons), and moral behavior (how one
acts).
➢ In addition, Peters believed that the development of character traits or virtues is
an essential aspect or moral development. And that virtues or character traits
can be learned from others and encouraged by the example of others.
➢ Also, Peters believed that some can be described as habits because they are in
some sense automatic and therefore are performed habitually, such as
politeness, chastity, tidiness, thrift and honesty.
5. Gilligan (1982)
➢ Included the concepts of caring and responsibility. She described three stages in the
process of developing an “Ethic of Care” which are as follows.
1. Caring for oneself.
2. Caring for others.
3. Caring for self and others.
➢ She believed the human see morality in the integrity of relationships and caring. For
women, what is right is taking responsibility for others as self-chosen decision. On the
other hand, men consider what is right to be what is just.

Spiritual Theories
1. Fowler (1979)
➢ Described the development of faith. He believed that faith, or the spiritual dimension is a
force that gives meaning to a person’s life.
➢ He used the term “faith” as a form of knowing a way of being in relation “to an ultimate
environment.” To Fowler, faith is a relational phenomenon: it is “an active made-of-
being-in-relation to others in which we invest commitment, belief, love, risk and hope.”

2. Westerhoff
Proposed that faith is a way of behaving. He developed a four-stage theory of faith
development based largely on his life experiences and the interpretation of those
experienced.

ROLES AND FUNCTIONS OF THE NURSE

➢ Care giver
➢ Decision-maker
➢ Protector
➢ Client Advocate
➢ Manager
➢ Rehabilitator
➢ Comforter
➢ Communicator
➢ Teacher
➢ Counselor
➢ Coordinator
➢ Leader
➢ Role Model
➢ Administrator

Selected Expanded Career Roles of Nurses

1. Nurse Practitioner
➢ A nurse who has an advanced education and is a graduate of a nurse
practitioner program.
➢ These nurses are in areas as adult nurse practitioner, family nurse practitioner,
school nurse practitioner, pediatric nurse practitioner, or gerontology nurse
practitioner.
➢ They are employed in health care agencies or community based settings. They
usually deal with non-emergency acute or chronic illness and provide primary
ambulatory care.
2. Clinical Nurse Specialist
➢ A nurse who has an advanced degree or expertise and is considered to be an expert in
a specialized area of practice (e.g., gerontology, oncology).
➢ The nurse provides direct client care, educates others, consults, conducts research, and
manages care.
➢ The American Nurses Credentialing Center provides national certification of clinical
specialists.

3. Nurse Anesthetist
➢ A nurse who has completed advanced education in an accredited program in
anesthesiology.
➢ The nurse anesthetist carries out pre-operative visits and assessments, and Administers
general anesthetics for surgery under the supervision of a physician prepared in
anesthesiology.
➢ The nurse anesthetist also assesses the postoperative of clients

4. Nurse Midwife
➢ An RN who has completed a program in midwifery.
➢ The nurse gives pre-natal and post-natal care and manages deliveries in normal
pregnancies.
➢ The midwife practices the association with a health care agency and can obtain
medical services if complication occurs.
➢ The nurse midwife may also conduct routine Papanicolaou smears, family planning, and
routine breast examination.
5. Nurse Educator
➢ Nurse educator is employed in nursing programs, at educational institutions, and in
hospital staff education.
➢ The nurse educator usually ha a baccalaureate degree or more advanced preparation
and frequently has expertise in a particular area of practice. The nurse educator is
responsible for classroom and clinical teaching.
6. Nurse Entrepreneur
➢ A nurse who usually has an advanced degree and manages a health-related business.
➢ The nurse may be involved in education, consultation, or research, for example.