Selected Nursing Theories and Theorists in Practice

Key Points

• Major nursing theorists provide complementary lenses for clinical decision-making.
• Nightingale emphasizes environmental determinants of healing and safety.
• Peplau, Orem, Henderson, Roy, Leininger, and Watson offer distinct guidance for relationships, self-care, needs, adaptation, culture, and caring.
• Theory selection should match patient context, goals, and care-setting priorities.

Pathophysiology

Nursing theories are explanatory and practice-guidance models rather than physiologic mechanisms. They shape how nurses assess patient situations, prioritize needs, and design interventions that align with person and context.

Using multiple theories improves fit across diverse clinical scenarios by expanding interpretation beyond a single framework.

Classification

• Environment-oriented: Nightingale environmental theory.
• Relationship-oriented: Peplau interpersonal relations theory; Watson theory of human caring.
• Needs and self-care: Henderson nursing need theory; Orem self-care deficit theory.
• Adaptation and systems: Roy adaptation model; general systems perspective.
• Culture-oriented: Leininger culture care theory.

Nursing Assessment

NCLEX Focus

Select the framework that best explains the current patient problem, then choose actions consistent with that theory.

• Assess environmental contributors to illness burden and recovery barriers.
• Assess relationship quality, trust, and communication readiness.
• Assess self-care capacity and support requirements.
• Assess adaptation responses to stressors and changing health states.
• Assess cultural beliefs that influence treatment acceptance and adherence.

Nursing Interventions

• Match intervention design to dominant patient need and theoretical lens.
• Use therapeutic communication strategies for relationship-centered care.
• Build self-care support plans when independence is limited.
• Modify environment to reduce risk and promote recovery.
• Deliver culturally congruent care by integrating patient values and practices.

Theory-Context Mismatch

Applying a framework without considering patient context can produce rigid care plans and weak outcomes.

Pharmacology

Pharmacologic planning improves when theory informs education, adherence strategy, and culturally responsive counseling around medication purpose and monitoring.

Clinical Judgment Application

Clinical Scenario

A hospitalized older adult with infection becomes disoriented overnight in a noisy, brightly lit unit and refuses treatment.

Recognize Cues: Environmental stress, altered cognition, and treatment refusal. Analyze Cues: Nightingale and Peplau perspectives indicate environment and relationship factors are central. Prioritize Hypotheses: Delirium risk and communication breakdown are immediate priorities. Generate Solutions: Reduce environmental stimuli and reestablish therapeutic communication. Take Action: Implement calming environment changes and person-centered dialogue. Evaluate Outcomes: Orientation, cooperation, and treatment adherence improve.

Related Concepts

• nursing-theory-metaparadigm-and-philosophy-domains - Theoretical foundation for comparing models.
• nurse-client-relationship - Practical extension of interpersonal theory.
• transcultural-nursing-and-culture-care-theory-in-maternal-care - Applied culture-care perspective.

Self-Check

1. Which theorist is most helpful when environmental modification is the main intervention?
2. How does self-care deficit theory change discharge planning priorities?
3. Why is using more than one theory often useful in complex care?