T HEORETICAL FOUNDATIONS

OF NURSING

Maria Cherry G. Tanodra, RN,MAN

FLORENCE NIGHTINGALE
MOTHER OF MODERN NURSING
MAY 12, 1820- AUGUST 13,1910
 FLORENCE NIGHTINGALE
ENVIRONMENTAL MODEL
Ventilation Noise

Nutrition Air

Chattering Hopes Health of Houses

Variety
Cleanliness
Bedding Light

 What Nursing has to do.. is to put the patient

in the best condition for nature to act upon
him.(1859)
FLORENCE NIGHTINGALE
ENVIRONMENTAL MODEL
 Nursing is about
environmental
manipulation, nutrition,
and conservation of the
patient’s energy.
 Nursing is not limited
to or defined by medical
acts.
Central Theme:
Environmental conservation

Person: The one whose well-

being the nurse cares for.

Health: Believed in
systematic approach to health
care with focus on prevention.

Environment: Stressed the

importance of clean air ,water,
housing
 Virginia Henderson
November 30, 1897 - March 19, 1996
 Central
theme:
Nature of
nursing

Henderson’s Definition
& Components of Nursing
Environment:
Person:
Basic nursing care
The person has
involves providing
physiological,
conditions under
spiritual, sociological,
which persons can
and psychological
perform their
components.
activities unaided.
VIRGINIA HENDERSON
• Health: An individual's
ability to function
independently.
• Nursing: The unique function of
the nurse is to assist the individual,
sick or well, in the performance of
those activities contributing to
health or its recovery(or to peaceful
death) that he would perform
unaided if he had the necessary
strength, will or knowledge. And to
do this in such a way as to help him
gain independence as rapidly as
possible..
FAYE GLENN ABDELLAH
MARCH 13, 1919-PRESENT

Central theme
 Person Health
Nursing:
Recipient of Environment Health is
Nursing
nursing care Not clearly the state
care is the
having defined when the
use of the
physical, Discussions individual
problem
emotional,& indicate has no
solving
sociologic persons unmet needs
approach
needs that interact with and no
using 21
may be their envt in anticipated
nsg problem
overt or which the or actual
areas.
covert. nurse is part. impairment.
 FAYE GLENN ABDELLAH: ON NURSING
 Nursing is broadly grouped into 21 nursing
problems which center around needs for:
• Hygiene • Hydration
• Comfort • Physical and
• Activity emotional health
• Rest promotion
• Safety • Interpersonal
• Oxygen relationships
• Nutrition • Development of self-
awareness
• Elimination
 TYPOLOGY OF 21 NURSING PROBLEMS
•To maintain good hygiene & physical comfort
•To promote optimal activity: exercise, rest, sleep
•To promote safety through prevention of accident, injury or
other trauma and through the prevention of the spread of the
infection
• To maintain good body mechanics & prevent and correct
deformity
•To facilitate the maintenance of a supply of oxygen to all body
cells
• To facilitate the maintenance of nutrition of all body cells
• To facilitate the maintenance of elimination
• To facilitate the maintenance of fluid and electrolyte balance
 TYPOLOGY OF 21 NURSING PROBLEMS
• To recognize the physiological responses of the body to
disease conditions- pathological, physiological and
compensatory
• To facilitate the maintenance of the regulatory mechanism &
functions
• To facilitate the maintenance of sensory function
• To identify & accept positive & negative expressions, feelings
& reactions
• To identify & accept interrelatedness of emotions & organic
illness
• To facilitate the maintenance of effective verbal & non verbal
communications
• To promote the development of productive interpersonal
relationships
 TYPOLOGY OF 21 NURSING PROBLEMS
• 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 & developmental needs

• To accept the optimum possible goals in the light of

limitations, physical & emotional

• To use community resources as an aid in resolving problems

arising from illness

• To understand the role of social problems as influencing

factors in the cause of illness
Dorothea Elizabeth Orem
1914 – June 22, 2007

 Central theme:
Nursing and self-care
activities
 Person: Humans with
physical, psychological,
interpersonal, and social
components, meeting
self-care needs through
learned behaviour.
MAN AS AN INTEGRATED WHOLE
 A unit functioning  Man’s capacity to
biologically, reflect on his or her
symbolically and own experience and
socially. the environment and
 She described man as his or her use of
self–reliant and symbols, ideas, words
responsible for self– distinguish him or her
care and well–being of from other species.
his or her dependents.
 Self–care is a
requisite for all.
MAN AS AN INTEGRATED WHOLE

 She further describe

man as a logical
organism with
rational powers. As a
biological organism,
man exists and
responds both as
organism and object
in an environment
with physical and
biological
components.
Self-Care Deficit Theory of Nursing

 Theory of Self-Care
 Theory of Self-Care
Deficit
 Theory of Nursing
Systems
 Theory of Self-care
Performance Human’s Universal self-
Self-Care

Self-Care Requisites
Self-Care Agency
or practice of Acquired care
activities that ability or Developmental
individuals power to self-care
initiate and engage in Health
perform on self-care. deviation self-
their own care
behalf to
maintain life,
health and
well-being
 Theory of Self-Care Deficit
 Nursing is required when adults are
incapable of or limited in their ability to
provide continuous effective self-care.
Dorothea Elizabeth Orem…
• Environment: Environment is the modern
society’s values and expectations.

Values

Person

Expectations
 Orem’s concept of environment
encompasses elements external to man.
She considered man and environment
as an integrated system.
1. Opportunities to be helped by being with other
persons or groups where care is offered.
2. Available opportunities for solitude and
companionship.
3. Provision of help for personal and group
concerns without limiting individual decisions
and personal pursuits.
4. Shared respect, belief, and trust.
5. Recognition and fostering of developmental
potential.
HEALTH
 Orem defined Health as a
 Wellness is the state of wholeness or
integrity of the integrity of the individual
individual, illness human being, his parts, and
results in the his modes of functioning.
person’s inability to  Orem also viewed health
maintain self-care. as the responsibility of a
total society and all its
members.
Nursing:
A service, an
art, and a
technology
 The giving of direct
assistance to persons who
are unable to meet their
own self-care needs,
developed through nursing
education and experiences.
 as a community
service
Nursing is a service of
deliberately selected and
performed actions to assist
individuals or groups to
maintain self–care, including
structural integrity,
functioning, and development
 as an interpersonal
process since it requires
the social interaction of a
nurse with a patient and
involves transaction
between them.
 Nursing:
A service, an art, and a
technology
 Orem also described Nursing as a
technology. She stated: Nursing
 Orem defined the art of has formalized methods or
nursing as the ability to techniques of practice, clearly
assist others in the
design, provision, and describe ways of performing
management of specific actions so that some
systems of self–care to particular result will be achieved.
improve or to maintain  Techniques of nursing must be
human functioning at learned, and skill and expertness
some level of in their use must be developed
effectiveness. by persons who pursue nursing as
a career.
 Theory of nursing systems
O Nursing systems
Are the approaches nurses use to assist patient with
deficits in self–care due to a conditions of health.

O Wholly compensatory system

The patient has no active role in the performance of his
care. The nurse acts for the patient.

O Partly Compensatory system

Both nurse and patient perform care measures
requiring manipulative tasks or ambulation.

O Supportive – educative system

The patient is able to perform, or can learn to perform,
required measures of therapeutic self–care but cannot
do so without assistance.
 Jean Watson
June 10, 1940-Present
Transpersonal
Caring Theory
• Central theme:
Human science
and care
Transpersonal Caring Relationship
• A nurse enters into the life space or
phenomenal field of another person and is
able to detect the other person’s condition of
being(spirit or soul level), feels this condition
within self and responds in such a way that
the person being cared for has a release of
feelings, thought and tension(Watson, 1996)
 Ten Carative Factors
1. The formation of a humanistic-altruistic system of values.
2. The instillation of faith-hope.
3. The cultivation of sensitivity to one’s self and to others.
4. The development of a helping-trusting relationship.
5. The promotion and acceptance of the expression of
positive and negative feelings.
6. The systematic use of the scientific problem-solving
method for decision making.
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective, and (or)
corrective mental, physical, sociocultural, and spiritual
environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces
 Caring Occasion/Caring Moment
• Occurs in a holographic context manifested
within a field of caring(healing consciousness)
• It opens up a higher, deeper energy field of
consciousness” that has metaphysical and
spiritual potentialities for healing and goes
beyond the separate ego self and separate
body(physical self.”
 Jean Watson…

Person:
One who is in need of the caring Environment:
process to attain or maintain
health or die a peaceful death. Social environment, caring,
The person has personal, and the culture of caring
internal, mental, and spiritual which affects health.
mechanisms to allow the self to
be healed.
Jean Watson…
• Health: It refers to
the unity and
harmony within the
mind, body, and soul.
It is the degree of
congruence between
the self as perceived
and the self as
experienced.
 Jean Watson…
• Nursing: Nursing is an art and science of human
to human care process with a spiritual dimension.
It comprises knowledge, thought, values,
philosophy, commitment, and
action.
 Madeleine Leininger
Founder of Transcultural Nursing
July 13, 1925 - present
 Madeleine Leininger…

Transcultural care
 Madeleine Leininger…
• Person: Caring beings capable of being
concerned about, holding interest in, or
having personal regard for other people’s
needs, well-being, and survival.
 Madeleine Leininger…
• Environment: It is the culture of each
individual, group or society.
• Health: It is the state of well-being that is
mainly known and expressed in cultural
meanings and ways.
 Madeleine Leininger: On Nursing
• A learned humanistic art
and science that focuses on
personalized care
behaviors and processes
that are directed toward
promoting and maintaining
health behaviors or
recovery from illness.
• These behaviors and
processes have physical,
psycho-cultural, and social
significance or meaning.
 3 Models of Actions and Decisions

Refers to those assistive, supportive, facilitative,

or enabling professional actions and decisions
that help individuals preserve or maintain
favorable health and caring life ways.
Example: Promotion of breastfeeding practices
and also maintaining the involvement of
families/ relatives in caring for the client.
3 Models of Actions and Decisions

Refers to those culturally based assistive,

supporting, or enabling professional actions and
decisions that help people of a particular culture
adapt to, or negotiate with others, a beneficial or
satisfying health outcome.
3 Models of Actions and Decisions

Refers to those assistive, supportive, facilitative,

or enabling professional actions and decisions that
help people change or modify their life ways to
accommodate new or different health care patterns
that are culturally meaningful and satisfying to
them.
Example: A client who is a chronic smoker can
work together with a nurse so that the former will
stop smoking for his own health and well being.
Lydia Eloise Hall
1926-Feb. 27,1969
Central theme: 3 components of nursing
– core, care, and cure

Core
Caring is the nurse’s
primary function. Care
(hands-on bodily care)
represents nurturance and
is exclusive to nursing.
Core involves the
therapeutic use of self
and emphasizes the use
of reflection.
Person: The patient is composed of body,
pathology, and person. People set their own
goals and are capable of learning and
growing.

Person
Environment:
It should
facilitate the
achievement of
the client’s
personal goal.
Health: The
development of a
mature self-
identity that
assists in the
conscious
selection of
actions that
facilitate growth.
Nursing as
A Model for Transforming Practice

Anne Boykin Savina Schoenhoffer

( 1944 – present) (1940-present)
Boykin and Schoenhoffer….

• Central Theme:
• Nurturing persons living caring
and growing in caring
: Know persons
as caring
person
 Two Perspectives:
• Perception of Person as caring – all persons are caring
• Conception of Nursing as a Discipline and Profession
Discipline :
Nursing is a unity of science, art and illness
Nursing is a response which involves knowing, living,
and valuing all at once.
Develops knowledge
Profession:
Based on everyday human experiences and responses
to one another.
Uses knowledge to respond to specific human needs.
 Boykin and Schoenhoffer….
– Nursing is both a discipline and a profession
– Person are viewed complete and continuously
growing in completeness, fully caring moment to
moment
• Fundamental assumptions:
– Person-as-person
– Person-as-whole
– Person-as-caring
 Boykin and Schoenhoffer….

1. Persons are caring by virtue of their humanness

2. Person are caring, moment to moment
3. Persons are whole or complete in the moment
4. Personhood is a process of living grounded in caring
5. Personhood is enhanced through participating in
nurturing relationship with caring others
6. Nursing is both a discipline and a profession.
7. Persons are viewed complete and continuously
growing in completeness
 HEALTH AND
PERSON NURSING
ENVIRONMENT
Not Defined Human Beings are Nurse knows self as
caring from moment a caring person and
to moment and are coming to know the
whole and complete other as caring.
in the moment
Creation of caring
= Enhanced through responses to
participation in nurture personhood
nurturing relationships
with caring others = Actualizing personal
and professional
All persons are commitment to the
caring belief that all persons
=but not all actions are are caring.
caring
The Dance of Caring Persons
 Boykin and Schoenhoffer….
• The Dance of Caring Persons
 Represents lived caring between the nurse and the nursed.
 The contributions of each dancer including the nursed are
honored.
 Dancers enter the nursing situation, visualized as a circle of a
caring that provides purpose and integrated function
 Move freely, touch or don’t touch = all dance in relation to
each other and to the circle
 Each dancer brings special gift
 With different notes and rhythms =all harmonize in the unity
of the dance and the oneness of the circle
 Personal knowing of self and other leads to respect
Sister Callista Roy
October 14, 1939 - Present
 Sr. Callista Roy…
• Central theme: As living systems, persons are in
constant interaction with the changing environment

Person

Environment
 Sister Callista Roy…
• Health: Health is a state or process of being or
becoming an integrated and whole person.
 Sister Callista Roy…
• Environment: All conditions, circumstances
and influences that surround and affect the
development and behavior of humans as
adaptive systems, with particular
consideration of person and earth resources.
 Sister Callista Roy…
• Nursing: A theoretical system of knowledge that
prescribes a process of analysis and action related
to the care of the ill or potentially ill persons.
 Roy Adaptation Model

Humans as adaptive systems ,both as individuals and groups.

 Roy Adaptation Model

Stimuli: Coping mechanisms

Focal
Contextual
Residual
Adaptation Level
Integrated Adaptive
Compensatory Stabilizer Ineffective
Compromised Innovator behavior

Regulator
(chemical, neural, endocrine)

Cognator
(Perception, Information, learning, judgment, emotions)
 Roy Adaptation Model

Basic needs

Psychic and spiritual integrity

Relational integrity

Social Integrity/Role clarity

Humans as adaptive systems ,both as individuals and groups.
 Myra Estrin Levine
1920-1996
“The Conservation Principle:
A model for Health”
 Concepts and Assumptions

• Central Theme:
Adaptation,
conservation and
Integrity.
 ADAPTATION CONSERVATION
 Process by which, over  Product of adaptation.
time, people maintain
 Defends the wholeness of
their wholeness or living systems by
integrity as they respond ensuring their ability to
to environmental changes. confront change
 Varies and specific. appropriately and retain
 Explanatory rather than their unique identity.
predictive.  Essence is the successful
 A historical process. use of responses that cost
Responses are base on the least.
past experiences, personal
and genetic.
Four principles of Conservation
(Core of Levine’s Theory)

Conservation of energy of the individual

Conservation of the structural integrity of the
individual
Conservation of the personal integrity of the
individual
Conservation of the social integrity of the
individual
INTEGRITY
• Being in control of one’s life, having the freedom to
choose, to move without constraint and to exercise
decisions on all matters.
• It is the essence of wholeness

Structural integrity- focuses on healing process

Personal integrity – focuses on sense of self

Social integrity – involve s a definition of self that goes

beyond the individual and includes the holiness of each
person.
 PERSON
• Focus should be on person’s wholeness
• Continually adapts interactions with
environment which results in
conservation.
• In need of nursing when suffering arise.
Independence are set aside and accepts
services of another
 HEALTH
• Goal of conservation
• Health and diseases are patterns
of adaptive change
• Successful adaptation is the one
that achieve the best fit in the
most conserving manner.
ENVIRONMENT
• Social context is an
important consideration
of the wholeness of an
individual.
• Difficult to measure but it
is vital because
adaptation and
conservation are based
on human being’s
interaction with the
environment.
3 Aspects of Environment
»Operational – consists of
undetected natural forces
that impinge on the
individual

»Perceptual – consist of
information that is recorded
by the sensory organs

»Conceptual – influenced by
language, culture, ideas and
cognition.
NURSING
• To take care of others when
they need to be taken care of
although this need is only
temporary.
• Nursing takes place whenever
there is an individual who needs
care to some degree.
Moving towards…

QUALITY
SAFE
NURSING
CARE