VALDRIZ, BRIX ALVIN L.

BSN I – B

THEORETICAL FOUNDATION OF NURSING

NURSING THEORISTS:

FLORENCE NIGHTINGALE
Florence Nightingale was born in Florence, Italy, on May 12, 1820. Part of a wealthy
family, Nightingale defied the expectations of the time and pursued what she saw as her God-
given calling of nursing. During the Crimean War, she and a team of nurses improved the
unsanitary conditions at a British base hospital, greatly reducing the death count. Her writings
sparked worldwide health care reform, and in 1860 she established St. Thomas' Hospital and the
Nightingale Training School for Nurses. A revered hero of her time, she died on August 13, 1910,
in London. (Biography.com)

Figure 1.1 Florence Nightingale, “Lady with a Lamp”

At a young age she was a philanthropist, ministering to the ill and poor people in the
village neighboring her family’s estate. Nightingale eventually came to the conclusion that
nursing was her calling; she believed the vocation to be her divine purpose.
In 1850, she enrolled as a nursing student at the Institution of Protestant Deaconesses in
Kaiserswerth, Germany. Before the Crimean War broke, she returned to London and she took a
job as a nurse in Harley Street hospital for ailing governesses. By October 1854, during the
Crimean War, approximately 18, 000 soldiers had been admitted into hospitals, in late 1854,
Nightingale received a letter from Secretary of War Sidney Herbert, asking her to organize a
corps of nurses to tend to the sick and fallen soldiers in the Crimea. Given full control of the
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operation, she quickly assembled a team of almost three dozen nurses from a variety of religious
orders and sailed with them to the Crimea just a few days later.
She procured hundreds of scrub brushes and asked the least infirm patients to scrub the
inside of the hospital from floor to ceiling. Nightingale herself spent every waking minute caring
for the soldiers. In the evenings she moved through the dark hallways carrying a lamp while
making her rounds, ministering to patient after patient. In addition to vastly improving the
sanitary conditions of the hospital, Nightingale instituted an "invalid's kitchen" where appealing
food for patients with special dietary requirements was prepared. She also established a laundry
so that patients would have clean linens. as well as a classroom and library for intellectual
stimulation and entertainment. The soldiers, who were both moved and comforted by her
endless supply of compassion, took to calling her "the Lady with the Lamp." (Biography.com)

NIGHTINGALE’S THEORY

ENVIRONMENTAL THEORY
This theory states that the role of the nurse is to use the patient's environment to help him
or her recover and get back to the usual environment. The environment is important is because it
can affect patient’s health in a positive or negative way.
Some environmental factors affecting health according to Nightingale's theory are fresh
air, pure water, sufficient food and appropriate nutrition, efficient drainage, cleanliness, and light
or direct sunlight. The focus of nursing in this model is to alter the patient's environment in order
to affect change in his or her health. If any of these factors is lacking, it can delay the patient's
recovery. Nightingale also emphasized providing a quiet, warm environment for patients to
recover in. The theory also calls for nurses to assess a patient's dietary needs, document food
intake times, and evaluate how the patient's diet affects his or her health and recovery. (Nursing-
theory.org)
Determining a patient's environment for recovery based on his or her condition or disease
is still practiced today, such as in patients suffering from tetanus, who need minimal noise to
keep them calm and prevent seizures.

THE FOUR METAPARADIGM OF NIGHTINGALE

ENVIRONMENT
The environment plays a vital role in promoting health and recovery of the patient’s
illness. There are five environmental component’s needed for the promotion of health to the
patients known collectively as the “health of houses”, and outline factors of the physical
environment which must receive attention (Nightingale, 1860). The underlying principle of
maintaining health of houses is to put the patient in a condition which is best for nature to act
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upon him or her. An environment that promotes health allows the patient to retain their energy,
or “vital powers” for use towards self healing (Nightingale, 1860).

PERSON
Based on the theory of nightingale, the person, is the individual that will receive care.
Nightingale’s perception of the Person is that the person is a multidimensional being, that
includes biological, psychological, social and spiritual components (Selanders, 2010). The
biological component is addressed by the use of medicine and nursing to address various
diseases (Selanders, 2010).
The psychological and social components consists of self-concept, feelings, thought-
processes and social interactions (Selanders, 2010). The component of spirituality is intertwined
with Nightingale’s own spiritual beliefs; that the person is valued (Selanders, 2010). Lastly,
Nightingale theory of the Person is based on holism. Holism is the concern of integrating the
biological, social, psychological and spiritual with its environment (Selanders, 2010).

HEALTH
Health is viewed as the combined result of environmental, psychological and physical
factors, not just the absence of disease (Parker, M. E., 2005). Nightingale states that “health is
not only to be well, but to be able to use well every power we have.” (Selanders, 2010).
Nightingale said that she knew nothing on the principle of health which is positive and
pathology is negative except from observation and experience. Disease is portrayed as t he
absence of comfort. Disease was seen as a reparative process of the body to correct a problem.
Symptoms would alert one to the presence of a disease and allow appropriate interventions to be
applied (Selanders, 2010). Nightingale isolated 5 factors essential in securing an individual’s
health; these include pure air, pure water, efficient drainage, cleanliness and light (Parker, M. E.,
2005).
NURSING
According to Nightingale (1860), the goal of nursing is strictly different from that of
medicine as the goal of the former is to “place the patient in the best possible condition for
nursing to act” or to facilitate a healing process by placing the patient in the best possible
environment for nature to influence health. Nightingale believed that the sufferings patients is
not directly related to illnesses but rather to the poor conditions of the environment. Nightingale
believed that many of the symptoms and sufferings of patients were not directly related to their
disease or ailment, but rather consequences of poor environmental conditions. The duties of
nursing include providing essentials such as fresh air, warmth, light, cleanliness, quiet and a
proper diet. By helping to control environmental influences, nurses can aid in the maintenance
of health of their patients. (Wordpress.com)
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MARTHA ROGERS
Rogers is an American nurse researcher, theorist, and author widely known for
developing the Science of Unitary Human Beings and for her landmark book, An Introduction to
the Theoretical Basis of Nursing.
She was born on May 12, 1914 which had the same birth date of Florence Nightingale.
She had a thirst for knowledge at an early age. She found Kindergarten to be “terribly exciting”
and had a love and passion for books that was fostered by her parents. In fact, Rogers already
knew the Greek alphabet by age 10. By the sixth grade, she already finished reading all 20
volumes of The Child’s Book of Knowledge and was into the Encyclopedia Britannica.
She also loved to read various topics like anthropology, archaeology, cosmology, ethnography,
astronomy, ethics, psychology, eastern philosophy, and aesthetics. By her senior year she had
completed all the high school math courses and was taking a college level algebra course where
she was the only female in the class.

Figure 1.2 Martha Rogers

Throughout her education, Rogers wanted to do something that would, hopefully
contribute to social welfare like law and medicine. However, she only studied medicine for a
couple of years because women in medicine were not particularly desirable during her time.
Instead, Rogers along with her friend entered a local hospital that had a school of nursing. But
just like Nightingale, her parents weren’t really any happier over that decision than they had
between over medicine. She later on went to Knoxville General Hospital and studied the arts of
nursing and received her diploma from the Knoxville General Hospital School of Nursing in
1936, then earned her Public Health Nursing degree from George Peabody College in Tennessee
in 1937.
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After completing her degree in 1945, she sent out a number of job inquiry letters,
considered staying in Hartford, but settled on a position as the Executive Director at the Visiting
Nurse Service in Phoenix, Arizona. She believed she may have been the first nurse in Arizona
with a masters degree and for 1945 to 1951, she built up the Visiting Nursing Service in Phoenix.
She believes that a patient can never be separated from his or her environment when
addressing health and treatment. Her knowledge about the coexistence of the human and his or
her environment contributed a lot in the process of change toward better health.

ROGER’S THEORY
THEORY OF UNITARY HUMAN BEINGS
According to this theory, the belief of the coexistence of the human and the environment
has greatly influenced the process of change toward better health. In short, a patient can’t be
separated from his or her environment when addressing health and treatment or the patient
cannot be divided into parts, but have to be looked at as a whole. (Nurselabs.com)
Rogers defined nursing as an art and science which is considered humanitarian and
humanistic. It is directed toward the unitary human and is concerned with the nature and
direction of human development. The goal of nurses is to participate in the process of change.
According to Rogers, the Science of Unitary Human Beings contains two dimensions: the
science of nursing, which is the knowledge specific to the field of nursing that comes from
scientific research; and the art of nursing, which involves using the science of nursing creatively
to help better the life of the patient.

THE FOUR METAPARADIGMS OF ROGERS

ENVIRONMENT
The environment is a wave pattern – an abstraction – open system focus on real world
and it’s environment. It is also the an "irreducible, pan dimensional energy field identified by
pattern and integral with the human field. Roger’s theory relating to the environment is the
unique human energy field pattern is integrated with the unique environment field pattern. As
one changes, so does the other. (Marthaerogers.weebly.com)

HEALTH
Rogers defined health as an expression of the life processes. It is the characteristics and
behavior coming from the mutual, simultaneous interaction of the human and environmental
fields, and health and illness are part of the same continuum. The events vary in their expressions
from greatest health to those conditions that are incompatible with the maintaining life process
(Nurselabs.com)
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HUMAN
According to Rogers, she defined a person as a unified whole, having its own distinct
characteristics that can’t be viewed by looking at, describing, or summarizing the parts. Also,
that can’t be predicted from knowledge of the parts (Nurselabs.com)

NURSING
Nursing is the study of unitary, indivisible human and environmental fields (Rogers as
cited in McEwen & Wills, 2007). Nursing exists to serve people and promote health
Nursing aims to assist people in achieving their maximum health potential. Maintenance
and promotion of health, prevention of disease, nursing diagnosis, intervention, and
rehabilitation encompass the scope of nursing’s goals. It provides a positive approach to the
patients in order to reach the greatest ideal level of well-being. Nursing is concerned with
people-all people-well and sick, rich and poor, young and old. The arenas of nursing’s services
extend into all areas where there are people: at home, at school, at work, at play; in hospital,
nursing home, and clinic. (Marthaerogers.weebly.com)

VIRGINIA HENDERSON

Virgina Henderson was born on November 30, 1897, she was a nurse, theorist, and author
known for her Need Theory and defining nursing as: “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.”
She was named after the State her mother longed for. At age four, she returned to
Virginia and began her schooling at Bellevue, a preparatory school owned by her grandfather
William Richardson Abbot. Her father was a former teacher at Bellevue and was an attorney
representing the Native American Indians in disputes with the U.S. Government, winning a
major case for the Klamath tribe in 1937.
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Figure 1.3 Virginia Henderson, “The Nightingale of Modern Nursing”

Henderson received her early education at home in Virginia with her aunts, and uncle
Charles Abbot, at his school for boys in the community Army School of Nursing at Walter Reed
Hospital in Washington D.C. In 1921, she received her Diploma in Nursing from the Army
School of Nursing at Walter Reed Hospital, Washington D.C.
In 1923, she started teaching nursing at the Norfolk Protestant Hospital in Virginia. In
1921 after receiving her Diploma, Henderson worked at the Henry Street Visiting Nurse Service
for two years after graduation. Throughout the years, she helped remedy the view of nurses in
part through exhaustive research that helped establish the scholarly underpinnings of her
professions. In 1929, she entered Teachers College at Columbia University for her Bachelor’s
Degree in 1932, and took her Master’s Degree in 1934. (Wayne, RN 2018)

HENDERSON’S THEORY
THEORY OF NEEDS
This theory emphasizes the importance of patient independence so that the patient or the
client will continue to progress after being discharged from the hospital.
Henderson described the role of the nurse as one of the following: substitutive, which is
doing something for the patient; supplementary, which is helping the patient do something; or
complementary, which is working with the patient to do something. All of these roles are to help
the patient become as independent as possible. (Nursing-theory.org)

14 BASIC NEEDS OF MAN BY HENDERSON

Physiological Components
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1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and undress
7. Maintain body temperature within normal range by adjusting clothing and modifying
environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others

Psychological Aspects of Communicating and Learning

10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Learn, discover, or satisfy the curiosity that leads to normal development and health and use
the available health facilities.
Spiritual and Moral
12. Worship according to one’s faith
Sociologically Oriented to Occupation and Recreation
13. Work in such a way that there is sense of accomplishment
14. Play or participate in various forms of recreation
(Nurselabs.com)

THE FOUR METAPARADIGM OF HENDERSON

ENVIRONMENT
Henderson stated that maintaining a supportive and sanitized environment conducive for
health is one of the elements of her 14 activities for client assistance.
The theory supports the tasks of the private and the public health sector or agencies in
keeping the people healthy. She believes that society wants and expects the nurse’s service of
acting for individuals who are unable to function independently.
HUMAN
Henderson states that individuals have basic needs that are component of health and
require assistance to achieve health and independence or a peaceful death. According to her, an
individual achieves wholeness by maintaining physiological and emotional balance.
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She defined the patient as someone who needs nursing care, but did not limit nursing to
illness care. Her theory presented the patient as a sum of parts with biopsychosocial needs and
the mind and body are inseparable and interrelated.
HEALTH
Based on Henderson’s theory, nurses are the vital aspects in promoting health, prevention
of sicknesses, and being able to cure. According to Henderson, a good health is a challenge
because it is affected by numerous factors such as age, cultural background, emotional balance,
and others.
Health was taken to mean balance in all realms of human life. It is equated with the
independence or ability to perform activities without any aid in the 14 components or basic
human needs. (Vera, 2014)
NURSING
She defined nursing as “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 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.” The nurse’s goal is to make the
patient complete, whole, or independent. In turn, the nurse collaborates with the physician’s
therapeutic plan. (Vera, 2014)

FAYE GLENN ABDELLAH

Faye Glenn Abdellah was born in March 13, 1919 in New York City. During an airship
explotion in May 6, 1937, Abdellah and her brother ran to the scene to help. In an interview with
a writer for Advance for Nurses, Abdellah recalled: "I could see people jumping from the
zeppelin and I didn't know how to take care of them, so it was then that I vowed that I would
learn nursing." (Encyclopedia.com)
Abdellah earned a nursing diploma from Fitkin Memorial Hospital's School of Nursing.
In the 1940s, this was sufficient for practicing nursing, but Abdellah believed that nursing care
should not primarily focused on care but should be focused on extensive research.
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Figure 1.4 Faye Glenn Abdellah

She went on to earn three degrees from Columbia University: a bachelor of science
degree in nursing in 1945, a master of arts degree in physiology in 1947 and a doctor of
education degree in 1955.
In another innovation within her field, Abdellah developed the Patient Assessment of
Care Evaluation (PACE), a system of standards used to measure the relative quality of individual
health-care facilities that was still used in the health care industry into the 21st century. She was
also one of the first people in the health care industry to develop a classification system for
patient care and patient-oriented records.

ABDELLAH’S THEORY
TWENTY ONE NURSING PROBLEMS’ THEORY
Faye Glenn Abdellah’s focus on this theory is that nursing should not focus on the
implications of disease but rather focus on the patients. She began to include the care of families
and the elderly in nursing care. The Patient Assessment of Care Evaluation developed by
Abdellah is now the standard used in the United States.
According to Abdellah’s theory, “Nursing is based on an art and science that moulds the
attitudes, intellectual competencies, and technical skills of the individual nurse into the desire
and ability to help people, sick or well, cope with their health needs.”
The patient-centered approach to nursing was developed from Abdellah’s practice, and
the theory is considered a human needs theory. It was formulated to be an instrument for nursing
education, so it most suitable and useful in that field. (Wayne RN, 2014)
10 STEPS IN IDENTIFYING PATIENT’S PROBLEMS
1. Learn to know the patient.
2. Sort out relevant and significant data.
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3. Make generalizations about available data in relation to similar nursing problems
presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient's conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting his or her behavior.
8. Explore the patient and his or her family's reactions to the therapeutic plan and involve
them in the plan.
9. Identify how the nurses feel about the patient's nursing problems.
10. Discuss and develop a comprehensive nursing care plan.

THE FOUR METAPARADIGMS OF ABDELLAH

HUMAN
She described nursing and patients as individuals in which nurses interact with the
individual in order to give medical attention and support.
HEALTH
Achieving proper health is the goal of nursing services. Abdellah speaks to “total health
needs” and “a healthy state of mind and body.”
Health may be defined as the dynamic pattern of functioning whereby there is a
continued interaction with internal and external forces that results in the optimal use of necessary
resources to minimize vulnerabilities. (Nurse-labs.com)
ENVIRONMENT
Society and environment is included in achieving optimum health on local, state, and
international levels. However, as Abdellah further delineates her ideas, the focus of nursing
service is clearly the individual.
NURSING
(PROBLEMS)
The client’s health needs can be viewed as problems, which may be overt as an apparent
condition, or covert as a hidden or concealed one.
These problems can be viewed emotionally, sociologically, and interpersonal in nature,
they are often missed or perceived incorrectly. A good quality, professional nursing care trains
the nurses be able to identify and solve overt and covert nursing problems by problem-solving
process
Problem-solving includes identifying the problem, selecting pertinent data, formulating
hypotheses, testing hypotheses through the collection of data, and revising hypotheses when
necessary on the basis of conclusions obtained from the data. (Nurse-labs.com)
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DOROTHEA OREM
Dorothea Orem was born in Baltimore, Maryland on July 15, 1914. After earning degrees
from the Providence Hospital School of Nursing and Catholic University of America, where she
earned a BS in Nursing Education and an MS in Nursing Education, she practiced nursing at
Providence Hospital and St. John’s Hospital. (Papermasters.com)
She was known for her contribution for the development of Self-Care Deficit Nursing
Theory and General Theory of Nursing.
Her contributions in the nursing foundation made her a hero, and she was asked to give
lectures at numerous universities and hospitals. She was awarded from diffrent organizations as
the Sigma Theta Tau Nursing Honor Society and the National League for Nursing.

Figure 1.5 Black and white portrait of Dorothea Orem

OREM’S THEORY
SELF-CARE DEFICIT THEORY
Orem’s theory is primarily on individual’s ability to perform self-care, also explained as
the practice of activities that individuals initiate and perform on their own behalf in maintaining
life, health, and well-being.
The theory of self-care includes self-care, which is the practice of activities that an
individual initiates and performs on his or her own behalf to maintain life, health, and well-being;
self-care agency, which is a human ability that is "the ability for engaging in self-care,"
conditioned by age, developmental state, life experience, socio-cultural orientation, health, and
available resources; therapeutic self-care demand, which is the total self-care actions to be
performed over a specific duration to meet self-care requisites by using valid methods and
related sets of operations and actions; and self-care requisites, which include the categories of
universal, developmental, and health deviation self-care requisites. (Nursing-theory.org)
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According to Orem, “The condition that validates the existence of a requirement for
nursing in an adult is the absence of the ability to maintain continuously that amount and quality
of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury,
or in coping with their effects. With children, the condition is the inability of the parent (or
guardian) to maintain continuously for the child the amount and quality of care that is
therapeutic.” (Wayne RN, 2014)

UNIVERSAL SELF-CARE REQUISITES

1. the maintenance of sufficient intake of air, food, and water
2. provision of care associated with the elimination process
3. a balance between activities and rest, as well as between solitude and social interaction
4. the prevention of hazards to human life and well-being
5. the promotion of human functioning

THE FOUR METAPARADIGMS OF OREM

HUMAN
She defined a person as an individual with physical and emotional requirements for self-
development and maintenance of their well being
ENVIRONMENT
It was believed that the patient’s environment can affect their ability to perform their self-
care activities
HEALTH
Orem (1911) stressed health as a structural and functional soundness and wholeness of
individuals
NURSING
According to Orem, a nurse is specially trained and able individual to help a person or
multiple people deal with their actual or potential self-care deficits.

JOYCE TRAVELBEE
Joyce Travelbee was born in 1926 and is known for her work as a nursing theorist. In
1956, Travelbee earned her Bachelor of Science in Nursing degree from Louisiana State
University. She was given a Master of Science in Nursing degree in 1959 from Yale University.
Her career dealt predominantly with psychiatric nursing and education. She worked as a
psychiatric nursing instructor at the DePaul Hospital Affiliate School in New Orleans, Louisiana,
and worked later in the Charity Hospital School of Nursing in Louisiana State University, New
York University, and the University of Mississippi. (Nursing-theory.org)
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Figure 1.6 Joyce Travelbee

TRAVELBEE’S THEORY
HUMAN TO HUMAN RELATIONSHIP MODEL
The Human to Human Relationship Model of Nursing deals with the interpersonal
aspects of nursing, focusing especially on mental health.
Travelbee's theory defines health in two categories: subjective and objective. Subjective
health is an individually defined state of well being in accord with self-appraisal of the physical-
emotional-spiritual status. Objective health is an absence of discernible disease, disability of
defect as measured by physical examination, laboratory tests and assessment by spiritual director
or psychological counselor.
SEVEN BASIC CONCEPTS:
1. Suffering, which is "an experience that varies in intensity, duration and depth...a feeling
of unease, ranging from mild, transient mental, physical or mental discomfort to extreme
pain...."
2. Meaning, which is the reason attributed to a person
3. Nursing, which helps a person find meaning in the experience of illness and suffering;
has a responsibility to help people and their families find meaning; and the nurse's
spiritual and ethical choices, and perceptions of illness and suffering, which are crucial to
help patients find meaning.
4. Hope, which is a faith that can and will be a change that would bring something better
with it. Six important characteristics of hope are: dependence on other people, future
orientation, escape routes, the desire to complete a task or have an experience, confidence
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that others will be there when needed, and the acknowledgment of fears and moving
forward towards its goal.
5. Communication, which is "a strict necessity for good nursing care."
6. Self-therapy, which is the ability to use one's own personality consciously and in full
awareness in an attempt to establish relatedness and to structure nursing interventions.
This refers to the nurse's presence physically and psychologically.
7. Targeted intellectual approach by the nurse toward the patient's situation.

FOUR METAPARADIGMS OF TRAVELBEE

HUMAN
Travelbee described the patient and the nurse as human individuals. The nurse’s role is to
assess the patient through human interaction
ENVIRONMENT
Travelbee did not clearly defined the environment but she defined human conditions and
life experiences encountered by all men as sufferings, hope, pain and illness.
HEALTH
Travelbee classified health into two which is subjective and objective. Subjective health
is an individually defined state of well being in accord with self-appraisal of physical-emotional-
spiritual status. Objective health is an absence of discernible disease, disability of defect as
measured by physical examination, laboratory tests and assessment by spiritual director or
psychological counselor.
NURSING
According to Travelbee, nursing is an interpersonal process whereby the professional
nurse practitioner helps the individual to prevent or cope with experience or illness and suffering,
and if necessary to find meaning in these experiences. (Currentnursing.com)

HILDEGARD PEPLEU
She was born in 1909 in Pennsylvania. When she was a child, she saw on alerting effects
of the flu epidemic in 1918, which influenced her to understand the impact of illnesses and death
to the patients.She graduated from the Pottstown, Pennsylvania School of Nursing in 1931 and
worked as a staff nurse in Pennsylvania and New York City.
After a summer position led to Peplau being recommended to work as a school nurse at
Bennington College in Vermont, she earned her Bachelor's Degree in Interpersonal Psychology
in 1943. She earned her Master's and Doctoral degrees from Teacher's College, Columbia
University, and was certified in psychoanalysis at the William Alanson White Institution of New
York City.
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Figure 1.7 Portrait of Hildegard Pepleu

After earning her Bachelor's Degree, Peplau studied psychological issues at Chestnut
Lodge, a private psychiatric facility, with Erich Fromm, Frieda Fromm-Reichmann, and Harry
Stack Sullivan. This led to Peplau's life long work, which extended Sullivan's interpersonal
theory to be used in the nursing field. From 1943 to 1945 Peplau served as an Army Corps Nurse.
Being stationed at the 312th Field Station Hospital in England allowed her the opportunity to
work with leading figures in American and British psychiatry. (Nurse-labs.com)

PEPLEU’S THEORY
INTERPESONAL RELATIONS THEORY
The need for a partnership between nurse and client is very substantial in nursing practice.
This definitely helps nurses and healthcare providers develop more therapeutic interventions in
the clinical setting.
According to Pepleu, nursing is an interpersonal process of therapeutic interactions
between an individual who is sick or in need of health services and a nurse especially educated to
recognize, respond to the need for help. It is also a “maturing force and an educative instrument”
involving an interaction between two or more individuals with a common goal. In nursing, this
common goal provides the incentive for the therapeutic process in which the nurse and patient
respect each other as individuals, both of them learning and growing as a result of the interaction.
An individual learns when she or he selects stimuli in the environment and then reacts to these
stimuli. (Wayne RN, 2014)

THE FOUR METAPARADIGMS OF PEPLEU

HUMAN
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Peplau defines man as an organism that “strives in its own way to reduce tension
generated by needs.” The client is an individual with a felt need.
ENVIRONMENT
Peplau does not defined exactly the factor of environment but she does encourage the
nurse to consider the patient’s culture and mores when the patient adjusts to hospital routine.
HEALTH
Health is defined as “a word symbol that implies forward movement of personality and
other ongoing human processes in the direction of creative, constructive, productive, personal,
and community living.”
NURSING
Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal
process.” She defines it as a “human relationship between an individual who is sick, or in need of
health services, and a nurse specially educated to recognize and to respond to the need for help.”

BETTY NEUMAN
Betty Neuman was born in 1924 in Lowel, Ohio. She went to University of California,
Los Angeles to complete both of her Bachelor of Science in Nursing in 1957 and Master of
Science in Mental Health in 1966. Neuman was given an Honorary Doctorate of Letters at the
Neumann College in Aston, Pennsylvania. Finally, in 1998, the Grand Valley State University in
Michigan gave her an Honorary Doctorate of Science.

Figure 1.8 Betty Neuman

After earning her Masters degree, Neuman began working as a nurse. Specifically, she
was a pioneer in nursing involvement in community mental health. While she was developing
her systems model, she was working as a lecturer at the University of California-Los Angeles in
VALDRIZ, BRIX ALVIN L.
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community health nursing. Due to her work in nursing, Neuman was named as an Honorary
Member of the Fellowship of the American Academy of Nursing. (Nursing-theory.org)

NEUMAN’S THEORY
SYSTEM THEORY
The theory focuses on the response of the patient system to actual or potential
environmental stressors and the use of primary, secondary, and tertiary nursing prevention
intervention for retention, attainment, and maintenance of patient system wellness.
In the System theory, it focuses the client as an open system that responds to
stressors in the environment. The client variables are physiological, psychological, sociocultural,
developmental, and spiritual. The client system consists of a basic or core structure that is
protected by lines of resistance. The usual level of health is identified as the normal line of
defense that is protected by a flexible line of defense. Stressors are intra-, inter-, and
extrapersonal in nature and arise from the internal, external, and created environments. When
stressors break through the flexible line of defense, the system is invaded and the lines of
resistance are activated and the system is described as moving into illness on a wellness-illness
continuum. (Nusringtheories.weebly.com)

THE FOUR PARADIGMS OF NEUMAN

HUMAN
In this theory, Neuman viewed the person as an open system that interacts with both
internal and external environment forces or stressors. The human is in constant change, moving
toward a dynamic state of system stability or toward illness of varying degrees.
HEALTH
Health is defined as the condition or degree of system stability and is viewed as a
continuum from wellness to illness. When system needs are met, optimal wellness exists. When
needs are not satisfied, illness exists. When the energy needed to support life is not available,
death occurs. (Nursingtheories.weebly.com).
Nursing should define the appropriate action needed to address the possible reaction of
the client’s system.
Nursing interventions are aimed at helping the system adapt or adjust and to retain,
restore, or maintain some degree of stability between and among the client system variables and
environmental stressors with a focus on conserving energy.
ENVIRONMENT
It is a vital area that is focused to the system and its function. The environment may be
viewed as all factors that affect and are affected by the system.
NURSING
VALDRIZ, BRIX ALVIN L.
BSN I – B
Neuman views nursing as a unique profession concerned with the variables that influence
the response the patient might have to a stressor. Nursing also addresses the whole person, giving
the theory a holistic perspective.
The theory defines nursing as "actions which assists individuals, families and groups to
maintain a maximum level of wellness, and the primary aim is stability of the patient-client
system, through nursing interventions to reduce stressors." (Nursing-theory.org)
SISTER CALLISTA ROY
Sister Callista Roy is a nursing theorist and an author. She was born in October 14, 1939
in Los Angeles.

Figure 1.9 Portrait of Sister Callista Roy

She earned a Bachelor of Arts Degree in Nursing from Mount St. Mary's College in Los
Angeles. In 1966, she earned a Master's Degree in Pediatric Nursing from the University of
California-Los Angeles. She also earned a Master's Degree in Sociology in 1973, and went on to
complete a Doctoratal degree in Sociology in 1977. She is a sister of St. Joseph of Carondelet.

CALLISTA’S THEORY
ADAPTATION MODEL
Roy conceptualized the person in a holistic perspective. Individual aspects of parts act
together to form a unified being. Additionally, as living systems, persons are in constant
interaction with their environments. Between the system and the environment occurs an
exchange of information, matter, and energy. Characteristics of a system include inputs, outputs,
controls, and feedback.

ADAPTIVE MODES (Currentnursing.com)

VALDRIZ, BRIX ALVIN L.
BSN I – B
A. PERSONS
1. Physiologic
2. Self Concept
3. Role Function
4. Interdependence
B. GROUPS
1. Physical
2. Group Identity
3. Role Function
4. Interdependence

THE FOUR METAPARADIGMS OF ROY

HUMAN
Based on Roy, humans are holistic beings that are in constant interaction with their
environment. Humans use a system of adaptation, both innate and acquired, to respond to the
environmental stimuli they experience. Human systems can be individuals or groups, such as
families, organizations, and the whole global community.
HEALTH
According to Roy, health is defined as the state where humans can continually adapt to
stimuli. Because illness is a part of life, health is the result of a process where health and illness
can coexist. If human can continue to adapt holistically, they will be able to maintain health to
reach completeness and unity within themselves. If they cannot adapt accordingly, the integrity
of the person can be affected negatively.
ENVIRONMENT
The environment is defined as conditions, circumstances, and influences that affect the
development and behavior of humans as adaptive system. The environment is a stimulus or input
that requires a person to adapt. This stimuli can be positive or negative.
Roy categorized this stimuli as focal, contextual, and residual. Focal stimuli are that
which confronts the human system, and requires the most attention. Contextual stimuli are
characterized as the rest of the stimuli that present with the focal stimuli, and contribute to its
effect. Residual stimuli are the additional environmental factors present within the situation, but
whose effect is unclear. This can include previous experience with certain stimuli.
(Nurselabs.com)
NURSING
Nurse’s roles are facilitators of adaptation. They assess the patient’s behaviors for
adaptation, promote positive adaptation by enhancing environment interactions and helping
patients react positively to stimuli. Nurses eliminate ineffective coping mechanisms and
eventually lead to better outcomes.
VALDRIZ, BRIX ALVIN L.
BSN I – B
JEAN WATSON
Dr. Jean Watson was born as Margaret Jean Harman on June 10, 1940, in a small town in
West Virginia close to the Appalachian Mountains. She was the youngest of eight children and
was raised in a family oriented environment. After graduating with a diploma from Lewis Gale
School of Nursing in Roanoke, Virginia, in 1961, she married her husband, Douglas Watson.
They moved to Boulder in his home state of Colorado where she continued her education. She
credits her husband with his unwavering support and encouragement for her career.
After moving to Colorado, Watson enrolled at the University of Colorado in Boulder,
Colorado, and earned a Bachelor of Science in Nursing in 1964. In 1966, she received a master's
degree in psychiatric mental health nursing with a minor in psychology from the University of
Colorado Medical Center in Denver. (Whyiwanttobeanurse.org)

WATSON’S THEORY
HUMAN CARING THEORY
Based on this theory, Watson’s main concern is on how the nurses care for their patients,
and how that caring progresses in order to practice health and wellness and to prevent illnesses.
This theory focuses on health promotion, as well as the treatment of diseases. According
to Watson, caring is central to nursing practice, and promotes health better than a simple medical
cure.
Human Caring theory also states that caring can be demonstrated and practiced by nurses.
Caring for patients promotes growth; a caring environment accepts a person as he or she is, and
looks to what he or she may become. (Wayne RN, 2014)

THE FOUR METAPARADIGMS OF WATSON

HUMAN
Humans are the individuals being cared for, respected, nurtured and even understood.
Human is viewed as greater than and different from the sum of his or her parts.
ENVIRONMENT
According to the this theory, the environment provides the order that determines how the
person behave and the goals that one should achieve. According to Watson, care is transmitted
by the culture and practice of the profession (nursing) as a unique way in coping up with the
environment
HEALTH
Health is the unity and harmony within the mind, body, and soul; health is associated
with the degree of congruence between the self as perceived and the self as experienced. It is
defined as a high level of overall physical, mental, and social functioning; a general adaptive-
maintenance level of daily functioning; and the absence of illness, or the presence of efforts
leading to the absence of illness.
VALDRIZ, BRIX ALVIN L.
BSN I – B
NURSING
Nursing is a human science of persons and human health – illness experiences that are
mediated by professional, personal, scientific, esthetic, and ethical human care transactions.

DOROTHY JOHNSON
Dorothy Johnson was born on August 21, 1919 in Savannah, Georgia. Her father was the
superintendent of a shrimp and oyster factory and her mother was very involved and enjoyed
reading. In 1938, she finished her associates degree in Armstrong Junior College in Savannah,
Georgia. Due to the Great Depression, she took a year off from school to be a governess, or
teacher, for two children in Miami, Florida. This is when she began to realized her love for
children, nursing and education.

Figure 1.11 Portrait of Dorothy Johnson

Johnson’s professional nursing career began in 1942 when she graduated from Vanderbilt
University School of Nursing in in Nashville, Tennessee. She was the top student in her class and
received the prestigious Vanderbilt Founder’s Medal. In 1948, she received her Masters in public
health from Harvard University in Boston, Massachusetts. (Wayne RN, 2014)

JOHNSON’S THEORY
BEHAVIORAL SYSTEM THEORY
Johnson’s theory defined nursing as an regulatory force which acts to preserve the
organization and integration of the patients behaviors at an optimum level under those conditions
in which the behavior constitutes a threat to the physical or social health, or in which illness is
found.
VALDRIZ, BRIX ALVIN L.
BSN I – B

She also stated that each individual has a purposeful, repetitive ways of acting that
comprises a behavioral system specific to that individual. (Wayne RN, 2014)

THE FOUR PARADIGMS OF JOHNSON

HUMAN
Johnson views human beings as having two major systems: the biological system and the
behavioral system. It is the role of medicine to focus on the biological system, whereas nursing’s
focus is the behavioral system.
The concept of human being was defined as a behavioral system that strives to make
continual adjustments to achieve, maintain, or regain balance to the steady-state that is
adaptation.
HEALTH
Health is seen as the opposite of illness, and Johnson defines it as “some degree of
regularity and constancy in behavior, the behavioral system reflects adjustments and adaptations
that are successful in some way and to some degree. Adaptation is functionally efficient and
effective. (Wayne RN, 2014)
ENVIRONMENT
Johnson did not directly stressed environment, but it is implied to include all elements of
the surroundings of the human system and includes interior stressors.
NURSING
Nursing is seen as “an external regulatory force” which acts to preserve the organization
and integration of the patient’s behavior at an optimal level under those conditions in which the
behavior constitutes a threat to physical or social health, or in which illness is found. (Wayne RN,
2014)

IMOGENE KING
Imogene King was born on January 30,1923 in West Point, Iowa. During her early high
school years, she decided to pursue a career in teaching. However, her uncle, the town surgeon,
offered to pay her tuition to nursing school. She eventually accepted the offer, seeing nursing
school as a way to escape life in a small town. Thus began her remarkable career in nursing.
King excelled in her nursing studies despite the fact that it was not her first choice to
consider. In 1945, she received a diploma in Nursing from St. John’s Hospital School of Nursing
in St. Louis, Missouri. While working in a variety of staff nurse roles, King started coursework
toward a Bachelor of Science in Nursing Education, which she received from St. Louis
University in 1948. In 1957, she received a Master of Science in Nursing from St. Louis
University.
VALDRIZ, BRIX ALVIN L.
BSN I – B

She went on to study with Mildred Montag as her dissertation chair at Teacher’s College,
Columbia University, New York, and received her EdD in 1961. (Nurselabs.com)

Figure 1.12 Imogene King

KING’S THEORY
GOAL ATTAINMENT THEORY
King’s Theory focuses on this process to guide and direct nurses in the nurse-patient
relationship, going hand-in-hand with their patients to meet the goals towards good health.
It explains that the nurse and patient go hand-in-hand in communicating information, set
goals together, and then take actions to achieve those goals.
Also, King stated that “Nursing is a process of action, reaction and interaction by which
nurse and client share information about their perception in a nursing situation” and “a process of
human interactions between nurse and client whereby each perceives the other and the situation,
and through communication, they set goals, explore means, and agree on means to achieve goals.”
In this definition, action is a sequence of behaviors involving mental and physical action,
and reaction is included in the sequence of behaviors described in action. King states that the
goal of a nurse is to help individuals to maintain their health so they can function in their roles.
The domain of the nurse “includes promoting, maintaining, and restoring health, and caring for
the sick, injured and dying.” The function of a professional nurse is “to interpret information in
the nursing process to plan, implement, and evaluate nursing care.” (Nurselabs.com)

THE FOUR PARADIGMS OF KING

HEALTH
VALDRIZ, BRIX ALVIN L.
BSN I – B
Health is a dynamic life experience of a human being, which implies continuous
adjustment to stressors in the internal and external environment through optimum use of one’s
resources to achieve maximum potential for daily living.
ENVIRONMENT
Environment represents the background of human interactions.
HUMAN
Persons exhibit common characteristics such as the ability to perceive, to think, to feel, to
choose between alternative courses of action, to set goals, to select the means to achieve goals,
and to make decisions.
NURSING
Nursing is a process of action, reaction, and interaction whereby nurse and client share
information about their perceptions in the nursing situation. According to King, the nurse and
client share specific goals, problems, and concerns and explore means to achieve a goal.

MADELINE LEININGER
Leininger was born on July 13, 1925 in Sutton, Nebraska. She lived in a farm with her
four brothers and sisters, and graduated from Sutton High School. After graduation from Sutton
High she was in the U.S. Army Nursing Corps while pursuing a basic nursing program. It was
due to her aunt who suffered from congenital heart disease that led her to pursue a career in
nursing. (Wayne RN, 2014)
In 1945, Leininger, together with her sister, entered the Cadet Nurse Corps which is a
federally-funded program to increase the numbers of nurses being trained to meet anticipated
needs during World War II. She earned a nursing diploma from St. Anthony’s Hospital School of
Nursing, followed by undergraduate degrees at Mount St. Scholastica College and Creighton
University.
Leininger opened a psychiatric nursing service and educational program at Creighton
University in Omaha, Nebraska. She earned the equivalent of a BSN through her studies in
biological sciences, nursing administration, teaching and curriculum during 1951-1954.
(Nursinglabs.com)
VALDRIZ, BRIX ALVIN L.
BSN I – B

Figure 1.13 Portrait of Madeline Leininger

LEININGER’S THEORY
TRANSCULTURAL NURSING THEORY
Leininger's Culture Care Theory attempts to provide culturally congruent nursing care
through "cognitively based assistive, supportive, facilitative, or enabling acts or decisions that
are mostly tailor-made to fit with individual, group's, or institution's cultural values, beliefs, and
lifeways." The intent of the care is to fit with or have beneficial meaning and health outcomes for
people of different or similar culture backgrounds.
Culturally congruent care is possible when the following occurs in the nurse-patient
relationship: "Together the nurse and the client creatively design a new or different care lifestyle
for the health or well-being of the client. This mode requires the use of both generic and
professional knowledge and ways to fit such diverse ideas into nursing care actions and goals.
Care knowledge and skill are often repatterned for the best interest of the clients. Thus all care
modalities require coparticipation of the nurse and clients (consumers) working together to
identify, plan, implement, and evaluate each caring mode for culturally congruent nursing care.
(Nursing-theory.org)
The theory's culturalogical assessment provides a holistic, comprehensive overview of
the client's background. The assessment addresses the following:
1. communication and language
2. gender considerations
3. sexual orientation
4. ability and disability
5. occupation
6. age
7. socioeconomic status
8. interpersonal relationships
9. appearance
VALDRIZ, BRIX ALVIN L.
BSN I – B
10. dress
11. use of space
12. foods and meal preparation and related lifeways

THE FOUR PARADIGMS OF LEININGER

HUMAN
Such are believed to be caring and to be capable of being concerned about the needs,
well-being, and survival of others. Leininger also indicates that nursing as a caring science
should focus beyond traditional nurse-patient interactions and dyads to include families, groups,
communities, total cultures, and institutions.

HEALTH
Health is a state of well-being that is culturally defined, valued, and practiced, and which
reflects the ability of individuals (or groups) to perform their daily role activities in culturally
expressed, beneficial, and patterned lifeways.

ENVIRONMENT
Totality of an event, situation, or particular experience that gives meaning to human
expressions, interpretations, and social interactions in particular physical, ecological,
sociopolitical and/or cultural settings; she also speaks instead of worldview, social structure, and
environmental context.
NURSING
Nursing is defined as a learned humanistic and scientific profession and discipline which
is focused on human care phenomena and activities in order to assist, support, facilitate, or
enable individuals or groups to maintain or regain their well-being (or health) in culturally
meaningful and beneficial ways, or to help people face handicaps or death.

PATRICIA BENNER
Dr. Benner was born in Hampton, Virginia, and received her bachelor's degree in Nursing
from Pasadena College in 1964, and later a master's degree in Medical-Surgical Nursing from the
University of California, Berkeley. After completing her doctorate in 1982, she became an
Associate Professor in the Department of Physiological Nursing at the University of California,
San Francisco. Dr. Benner is an internationally known lecturer and researcher on health, and her
work has influenced areas of clinical practice as well as clinical ethics.
VALDRIZ, BRIX ALVIN L.
BSN I – B

Figure 1.14 Portrait of Patricia Benner

Benner earned her Bachelor of Arts degree in nursing from Pasadena College in 1964.
She was given a Master of Science in Medical-Surgical Nursing from the University of
California at San Francisco in 1970, and a Ph.D. from the University of California at Berkeley in
1982. (Nursing—theory.org)

BENNER’S THEORY
FROM NOVICE TO EXPERT THEORY
Patricia Benner believed that the best nurses develop their skills over time. Education and
experience help to contribute to this development, allowing a nurse to fully understand what it
means to provide high quality patient care. This process of development would become the
foundation for the Novice to Expert Nursing Theory.
Benner believed that nurses gained knowledge and skills, lending to their personal
expertise, even if they didn’t realize that this process was happening. This idea would become
the “Knowing How, Knowing That” component of this theory.
She also believed that this process of development could occur in any applied discipline
with the medical field. Every person, Benner theorized, would follow through specific steps of
development, allowing them to progress from novice to expert if they were given enough time to
do so. (healthresearchfunding.org)

LEVELS OF NURSING EXPERIENCE

VALDRIZ, BRIX ALVIN L.
BSN I – B

She described 5 levels of nursing experience as;

1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert

THE FOUR METAPARADIGMS OF BENNER

HUMAN
The person is viewed as a participant in common meanings.” (Tomey, 2002 p173)
HEALTH
Health is described as not just the absence of disease and illness. Also, a person may
have a disease and not experience illness because illness is the human experience of loss or
dysfunction, whereas disease is what can be assessed at the physical level.
ENVIRONMENT
Instead of using the term “environment,” Benner used the term “situation,: because it
suggests a social environmentwith social definition and meaning. She used the
phenomenological terms of being situated and situated meaning, which are defined by the
person‟s engaged interaction, interpretation an understanding of the situation.
NURSING
Patricia Benner described nursing as an “enabling condition of connection and concern”
(Marriner-Tomey, 1989, p192) which shows a high level of emotional involvement in the nurse-
client relationship. She viewed nursing practice as the care and study of the lived experience of
health, illness, and disease and the relationships among these three elements