Theoretical Frameworks Explored in Advanced Nursing Degrees

Nursing theories are based on frameworks created by nursing pioneers of the past. Learning about these theories is very important as they will greatly impact what kind of a nurse a student will be in future and the nursing approach they will follow. All the frameworks are based on evidence-based strategies that nursing professionals of their time tried and tested, then used the results to formulate their theories.

This article will go over some of the most important and fundamental nursing theories that nursing students will study in an advanced nursing degree. Learning about them beforehand will give students an edge over others and help them better understand what is being taught in class.

The importance of learning nursing theories

Nursing theories lay the groundwork for contemporary nursing practice and are widely used to guide the development of knowledge as well as the direction of research, practice, and teaching. Both nursing as an area of study and the modern profession were not historically acceptable. Before nursing theories were developed, it was believed that the nursing profession was task oriented. But by clearly explaining different concepts in nursing, we now know that nursing theories contribute to the understanding of what should form the basis of practice.

A nursing theory provides a definition of nursing and helps nurses understand the position and function they play in the healthcare system. These theories also generate new knowledge and forecast the direction of nursing in the future. Furthermore, these theories offer evidence-based support for nursing interventions and give nurses the knowledge base they need to respond and act appropriately in nursing care settings.

The Environmental Theory by Florence Nightingale

Florence Nightingale’s name is often mentioned wherever nursing theories are discussed. She was named the mother of nursing and her theories laid the foundations of modern-day nursing practices. So, most of what nurses do today was taught by Nightingale many years ago.

The Environmental Theory was one of her most famous theories. When Florence Nightingale first described the role of a nurse, she highlighted that they must provide a clean environment for the patient, fulfill their dietary needs, provide round-the-clock care, collect evidence, and numerous other essential tasks.

This teaching is very relevant today and will continue to remain relevant in the field of nursing for the foreseeable future. Infection control has been significantly changed by Nightingale’s Environmental Theory. Recommendations by Florence Nightingale are a crucial part of nursing practice to the extent that they are continually being revised.

The Nursing Need Theory by Virginia Henderson

The Nursing Need Theory was created by Virginia Henderson, a nursing theorist, to describe the unique focus of nursing practice. According to Henderson’s Need Theory, raising a patient’s level of independence is crucial for preventing post-hospitalization delays in their rehabilitation.

She believed that a nurse’s responsibility included ensuring that patients can care for themselves after leaving the hospital in addition to providing for their medical needs. In her theory, Henderson described the human being, environment, healthcare, and nursing as follows.

Human being

The patient is a person who needs assistance returning to health and being independent or dying peacefully. The patient and their immediate family are one entity, as both body and mind are interdependent.


In every facet of human existence, balance and equilibrium are a sign of health. It is equivalent to a sense of autonomy or capacity for carrying out tasks that are fundamental human requirements without assistance. She believed that a person is healthy as long as they can breathe easily and normally, have a sound night’s sleep, dress and undress themselves without any help, eat and drink, maintain personal hygiene, move freely, get rid of their body wastes, have a normal body temperature, and can learn and communicate.


She described a patient’s environment as all the elements that have an impact on the growth and quality of life.


Henderson defined nursing as the role of someone who helps the person, whether they are sick or healthy, undertake tasks that will improve their health, recovery, or ability to die peacefully if they had the requisite strength, will, or knowledge on their own.

Novice-to-Expert Theory by Dr. Patricia C. Benner

By building on a solid educational basis and a multitude of experiences, Dr. Patricia C. Benner argued that professional nurses develop their knowledge and skills in patient care through time. She states that the two primary elements of knowledge growth in applied sciences, like medicine and nursing, are the extension of practical understanding via study and the characterization and grasp of clinical practice. She views gaining skill in nursing as a process that takes time and practice.

In her theory, there are five levels of nursing.

A novice nurse

A novice nurse is a beginner nurse who has no experience and requires learning. These nurses need to take instructions and be taught the general rules and principles of nursing.

An advanced nurse

This is the second level of nursing. Nurses at this level perform well as they have prior experience gained through instructions. They have been exposed to different real-life situations as well, which have further enhanced their learning. To direct activities, principles founded on experiences start to be developed too.

A competent nurse

This is the third level of nursing, where a competent nurse has had at least two to three years of practical experience, has undergone intensive training, and has worked in a clinical environment to address the day-to-day issues of patients. At this level, nurses are aware of their long-term goals, plan their actions consciously, employ analytical thinking, and use a problem-solving approach to address issues and improve the position of their organization.

A proficient nurse

At this level, the nurse has so much knowledge that they can perceive various problems as a whole, rather than small parts. Through experience, proficient nurses develop a holistic mindset through which they can make better decisions and solve problems efficiently.

An expert nurse

An expert nurse is the most experienced. They do not need to follow rules, instructions, or any guidance. Instead, they can make decisions and implement them confidently based on their experience and learned skills. At this point, a nurse has a lot of clinical knowledge, and can provide better care to patients based on evidence. An expert nurse is more flexible and fluid in nature, making them very good at quick decision-making.

Nursing Theory of Goal Achievement and Attainment by Imogene King

The Nursing Theory of Goal Achievement and Attainment developed by Imogene King in the 1960s offers a framework for directing and mentoring newly graduated nurses who enter the workforce. According to this theory, people pursue their goals within the context of three interconnected systems, including their own individual, interpersonal, and societal systems. Perception, self-development and improvement, physical appearance, space, and time are the ideas for the personal system. Meanwhile, communication, interaction, role, and distress are interpersonal concepts. Finally, organizational authority, power, position, and decision-making are notions for the social system.

King’s theory has endured time and holistic change because it is built on the fundamental principle of interaction and communication. According to the theory, nurses collaborate with patients to attain a health objective that has been set up front. The patient is the primary emphasis according to the theory, with the nurse assisting patients in sustaining and caring for themselves. Although the theory contains numerous principles, King selected the transaction as its fundamental idea as it involves the patient as a proactive participant in establishing targets and health attainment.

How are these frameworks put into practice?

As per the understanding of Florence Nightingale, if nurses alter the patient’s environment in accordance with personal environmental standards, they can assist the patient in regaining normal health or recovering. Although environmental standards can vary, nurses are taught specifically how a patient’s environment should be and how it will promote healing throughout their studies. In this regard, all nurses are on the same page and even after so many years, Florence Nightingale’s words and concepts remain relevant. The environment of the patient does play a crucial role in how quickly they recover.

The environment not only includes untouchable factors such as light and air, but also touchable and transferable factors such as f germs. If the air that a patient is breathing is not clean, or if the nurses do not follow proper hand hygiene, it is very likely that the patient’s health will deteriorate. This is especially true for patients who are extremely vulnerable when hospitalized. In fact, all such environmental factors can further increase their hospitalization duration. This can put a psychological stress on the patient who is already unwell. As a result, they might become sicker. So, everything is interconnected and this teaching by Florence Nightingale, through her framework, has a major impact on how nurses plan their actions today.

Henderson’s Nursing Need Theory is also a crucial part of modern-day nursing because it focuses on how nurses can analyze small information from their patients to discover what they need and how these needs can be met to satisfy the patient completely. This is important because both patient satisfaction and provision of high-quality care are key components of excellent nursing.

Dr. Benner’s ‘novice to expert’ paradigm has significantly changed how healthcare professionals practice their craft. As a nurse moves through each level, the model allows for the development of skills and knowledge. This framework enables nurses to invest in continuous development and enroll in advanced courses to increase their knowledge.

In line with this framework and the belief that nurses must pursue advanced education, the University of Indianapolis has created a BSN DNP course that is taught completely online to make it easier for on-duty nurses to continue the process of continuous education. By the end of the course, graduates will have transitioned from Bachelor of Science in Nursing (BSN) to Doctor of Nursing Practice (DNP), advancing their skills for career growth.

Finally, King’s theory is also a crucial part of modern nursing practice. Today, nurses are taught that they must have the appropriate communication skills to perform well. Communication and interpersonal skills are extremely important as the job of a nurse requires potentially communicating with hundreds of patients in a day. In addition, they must also communicate with their peers, other members of nursing staff, and their department. Therefore, it is extremely important to maintain not only great nurse-patient interaction, but also clear and transparent nurse-nurse communication.

Advanced nursing degrees and theoretical frameworks

The theoretical frameworks that dictate the field of nursing may have been established over the decades and even centuries gone by, but they are still incredibly relevant today. Reputable and accredited nursing degrees continue to educate nursing students about these frameworks so they can be used in practice in hospitals and clinics across the US.