Nurse-Driven Health System Strategies

Introduction and Overview of the Nursing Theories

The role of nurses in institutions of healthcare is changing as they find themselves in positions where they have to make critical decisions that can save the lives of the patients under their care. According to Butts and Rich (2016), nurses were traditionally considered assistants to the doctors and were always expected to have regular consultation before making a decision. It is true that doctors still have to consult medical specialists to understand how to handle a specific patient. However, some decisions can be made by the nurses based on the established standards of practice within a specific institution. Nurses must be ready to take the new role where they are expected to be more responsible in their places of work. Alligood (2014) says that the education system needs to be aligned with the emerging needs of the nurses. Grand nursing theories and middle-range theories have emerged to help explain how nurses can undertake their new roles. In this study, the researcher focused on The Family Stress Adaptation Theory, which is middle-range theory, and Travelbee’s Human to Human Relationship Model, which is a grand nursing theory. The researcher looked at how these theories can help in improving the performance of nurses in different care institutions.

Background of the Theories

Human to Human Relationship Model

According to Smith and Parker (2015), The Human to Human Relationship Theory was developed by Joyce Travelbee as she tried to explain how a nurse should handle patients with psychological problems. This theory holds that people are constantly faced with situations where they have to make choices and that the choices they make have implications on their lives and other people related to them. Similarly, patients often have decisions to make when they are hospitalized or after being discharged. The decisions they make may have a positive or negative impact on their ability to achieve full recovery. The theory holds that decisions that patients make can be influenced positively by the nurses. However, nurses can only sway patients’ decisions if they succeed in developing a successful relationship. Hodder (2012) says that the relationship can be developed in five main stages. The initial encounter is the first stage where the nurse should develop a positive image with the patient. The second stage is the emergence of identities, while the third stage is empathy (Yoost & Crawford, 2015). The fourth stage is sympathy where the nurse appreciates the pain the patient is going through and promises to do all that is possible to bring relief. The final stage is the establishment of rapport where the nurse can influence the decision of a patient.

Family Stress Adaptation Theory

The Family Stress Adaptation Theory was developed by different psychologists who sought to explain sources of family-related stress and how the issue can be managed. Hill’s ABCX model was one of the initial models that explain family stress and the need for the nurses to understand the concept (Kramer, 2016). In families, various factors may lead to stressful situations that may have serious negative medical complications. Stress is known to cause many problems such as high blood pressure, which may lead to stroke. Internal problems such as alcohol and drug abuse and physical illnesses may cause stress. Job loss, abusive marriages, irresponsible parents/spouses or children, and excess financial burden on one member of the family may cause stress. Smith and Parker (2015) say that if the stress is not managed, then the patient may be on the path towards acquiring serious illnesses, some of which may be life-shortening such as ischemic stroke. Nurses need to understand how to identify such stresses that their patients could be going through. They should know how to help their patients avoid or manage the stressors so that they can lead a normal life.

Philosophical Underpinnings of the Theories

The two theories are underpinned by different philosophies, which are worth discussing critically. The Human to Human Relationship Model is underpinned by the philosophy that patients can only trust a nurse that they develop a close personal relationship with during the time of receiving care. They tend to believe in and follow their instructions as much as possible. As such, nurses should understand that it is their responsibility to develop such a relationship. They need to make their patients believe in them so that they can influence their decisions. This theory primarily seeks to enable nurses to promote self-care among patients. Nurses can simply make follow-ups through phone calls to ensure that the patients are adhering to the medical instructions given to them while at home. The Family Stress Adaption Theory is underpinned by the philosophy that understanding the source and nature of stress is the most important stage in managing depression. Patients going through depression need to understand the source and nature of their problem. They can then determine if it is possible to eliminate/avoid the problem or find ways of dealing with it. For nurses, their role is to help their patients to understand the sources and nature of the problem and to help them in making decisions about how to deal with it.

Major Assumptions, Concepts, and Relationships

It is important to note that each of these theories makes various assumptions, has concepts that need to be understood, and emphasizes the need to have a close relationship between a nurse and a patient. The Human to Human Relationship Model assumes that after a personal relationship is developed between a nurse and a patient, the patient is likely to follow instructions received from the nurse. Butts and Rich (2016) say that chances are higher for the patient to follow the set instructions if the rapport is developed than when there is no close relationship. However, one should not assume that the patient will observe all the instructions. That is why it is important to ensure that the patient is advised to make regular visits to be certain that they are on the path to recovery even with the belief that they will embrace self-care practices.

The concept is to make sure that the relationship created seeking to promote self-care is backed up by regular physical examination to achieve the desired health outcome. The Family Stress Adaption Theory assumes that once a person knows the source and nature of the medical problem (which in this case is stress), then it is easy to deal with it effectively. Although this assumption is largely true, Yoost and Crawford (2015) observe that there are cases when people are unable to deal with their problems even after gaining such knowledge. The main concept in this theory is to empower patients so that they can easily deal with their situations. The relationship between nurses and patients under this model is very clear. Nurses should help their patients to understand their problem, and then provide them with alternatives that can be used to overcome the identified issues.

Clinical Applications to Extending Nursing Science Testability

These two theories need to be tested to determine their applicability in a nursing environment. As Hodder (2012) notes, nurses need theories that can help them understand how to handle their patients in ways that can enhance the rate of recovery. That is why clinical applications of these theories need to be tested. To test the applicability of The Human to Human Relationship Model, one needs to look at the context under which the concept can be applied by a nurse when handling a patient. The theory emphasizes the need for nurses to develop a close and personal relationship with a patient as a way of promoting self-care among patients. Alligood (2014) says that self-care can only be promoted if patients are empowered.

Patient empowerment requires that the nurse (responsible for the process of empowering) be trusted by the patient (the recipient of the process). It is, therefore, true that this theory can be applied in clinical practice. The theory also believes in empowering patients to overcome stress-related health problems. In this case, it emphasizes the need for the nurses to ensure that they enable their patients to understand the causes of their problems and the magnitude of the impact. Kramer (2016) says that it is almost impossible to manage depression among patients who cannot explain the source of their stress. Understanding the source and magnitude of the problem is the first step towards dealing with the problem. It means that this theory can be applied in the field of nursing.

Comparison of the Use of the Theories in Nursing Practice

When comparing the use of the theories in nursing practice, it is important to look at both the similarities and differences. One of the most conspicuous similarities between The Human to Human Relationship Model and The Family Stress Adaptation Theory is that they both emphasize the need to empower patients as a means of promoting self-care. Patients can only care for themselves outside of hospitals if they know what they need to do at specific times. The Human to Human Relationship Model seeks to ensure that nurses build rapport with patients so that they can create mutual trust. In such settings, patients will believe in what these nurses tell them to do while at home. The Family Stress Adaption Theory looks at how nurses can empower patients to understand the cause and nature of the problem.

With such information, these patients can easily take care of their health even away from hospitals. The knowledge of their stressors, the impact of these stressors, and how to deal with them will enable these patients to be efficient in managing their condition. They will know how to address each issue. Despite the similarities, it is important to appreciate the difference that exists between these theories. The most significant difference between these theories is that The Human to Human Relationship Model is nurse-centered, while The Family Stress Adaption Theory is patient-centered. The former places the responsibility of developing the relationship on the patient, while the latter places emphasis on the patient understanding of the source and magnitude of the impact of the stressors.

Specific Examples of How the Theories Could Be Applied in Specific Clinical Setting

The theories can only be relevant if they can be applied in a practical clinical setting. Nurses should be capable of applying these theories as they try to manage the conditions of their patients. In this section, the researcher looked at the applicability of each of these theories in specific clinical settings.

The Human to Human Relationship Model

The Human to Human Relationship Model can be applied in various clinical settings. The following are some of the examples of the settings where the nurses can use this theory:

  • When the medical condition requires that the patient is open to specific issues that may be shameful to the patient. Sometimes doctors may need to understand a specific historical nature of a problem before prescribing a drug. If it is established that the patient is not comfortable in providing such historical facts, it may be necessary for the nurse to develop that relationship to mine the needed information.
  • When it is necessary to prescribe drugs and practices that a patient should embrace while at home (self-care), it is important to ensure that there is trust between the patient and the nurse. This model should be applied in such cases.

The Family Stress Adaptation Theory

The Family Stress Adaption Theory is critical when handling patients with stress disorders. The following are examples of how this theory can be put into practice in a clinical setting:

  • When handling war veterans who are suffering from post-traumatic stress disorder (PTSD). Such patients need to appreciate that past events should not be allowed to influence their current life negatively.
  • When handling patients with high blood pressure. Such patients need to understand possible sources of stress in their families and how to deal with the problem.


It is important to appreciate that the cost of medical care is consistently on the rise. Diamond (2017) says that quality care in the current society is a preserve of the rich. The two theories can help cut down expenses related to medical services. As explained above, they both focus on empowering patients so that they can manage their conditions without spending a significant amount of resources. The Human to Human Relationship Model enables patients to develop a close relationship with nurses so that they can understand how to deal with their conditions outside of hospitals. They can easily make a call to these nurses in case they need clarification, hence avoid unnecessary expenses. The Family Stress Adaption Theory enables patients to self-examine themselves, identify the stressors, and eliminate them without having to spend money on medication.


Nurses are finding themselves in positions where they have to make critical decisions to help their patients overcome their medical problems. Different theories have been developed to help nurses to understand how they can undertake their new roles in effective ways. The Human to Human Relationship Model is one of the grand nursing theories that have gained popularity. It explains how and why nurses should develop a close relationship with their patients to promote self-care. The Family Stress Adaption Theory, on the other hand, is a mid-range nursing theory that focuses on how nurses can help their patients to understand the source and impact of various stressors. It also seeks to promote self-care among patients.


Alligood, M. (2014). Nursing theorists and their work. St. Louis, MO: Elsevier.

Butts, J., & Rich, L. (2016). Nursing ethics: Across the curriculum and into practice. Burlington, MA: Jones & Bartlett Learning.

Diamond, J. (2017). Guns, germs, and steel: The fates of human societies (20th ed.). New York, NY: W.W. Norton & Company.

Hodder, I. (2012). Entangled: An archaeology of the relationships between humans and things. Malden, MA: Wiley-Blackwell.

Kramer, B. (2015). Shareology: How sharing is powering the human economy. New York, NY: Morgan James Publishing.

Smith, C., & Parker, M. (2015). Nursing theories & nursing practice (4th ed.). Philadelphia, PA: F.A. Davis Company.

Yoost, B., & Crawford, L. (2015). Fundamentals of nursing: Active learning for collaborative practice. New York, NY: Mosby Publishing.

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