OUTLINE OF TOPICS

Definitions of Theory and Nursing Theory

Introduction
Historical Perspective and Key concepts
Terms used in Theory Development
Types of Nursing Theories
Framework of Analysis
Significance of Nursing Theories
Nursing Theorists and their Works
Florence Nightingale Environmental Theory
Virginia Henderson Needs Theory
Faye Abdellah 21 Nursing Problems
Dorothea Orem Self-care deficit Theory
NURSING
THEORIES
NRSG 202-1

Prepared by: Mae Michelle F. Aguilar RN & Kaysie

Bustamante RN
 LEARNING OBJECTIVES
By the end of the lecture, nurses will be able to:

Define terms used in Theory Development.

Explain the significance of Nursing Theories

(Nightingale, Henderson, Abdellah and Orem) in the
Nursing Practice.

Examine the nursing theories and how it applies in

the clinical practice setting.
 THEORY
ORIGIN: THOERIA speculate

GREEK WORD
 THEORIES are a set of interrelated concepts
that give a systematic view of a phenomenon
(an observable fact or event) that is
explanatory & predictive in nature.

Theory is a creative and rigorous structuring

of ideas that projects a tentative, purposeful,
and systematic view of phenomena. (Chinn
and Kramer 1999)
 Theories are composed of concepts, definitions,
models, propositions & are based on assumptions.

They are derived through two principal methods;

deductive reasoning and inductive reasoning.

A theory makes it possible to organize the

relationship among the concepts to describe,
explain, predict, and control practice
(Torres,1986,p.21).Torres(1990,pp.69)
NURSING THEORY
Defined as a belief, policy, or procedure proposed
or followed as the basis of action. It is an
organized framework of concepts and purposes
designed to guide the practice of nursing.
CHARACTERISTICS OF THEORIES

1. Theories can interrelate concepts in such a way

as to create a different way of looking at a
particularphenomenon.

2. Theories must be logical in nature.

3. Theoriesshouldbe relatively simpleyet

generalizable.

4. Theories canbe the bases forhypothesesthat

can betested.
5. Theories contribute to and assist in increasing the
general body of knowledge within the discipline
through the research implemented to validate them.

6. Theories can beused by the practitioners to guide

and improve their practice.

7. Theories must be consistent with other validated

theories, laws, and principles but will leave open
unanswered questions that need to be investigated.
INTRODUCTION TO
NURSING THEORY
Historical Perspectives and Terminology
MID 1800S AND 1960S

Mid 1800s Nursing Knowledge is distinct from

medical knowledge (Nightingale)

Nursing practices was based on principles and

traditions passed on through apprenticeship education
and common sense wisdom.

Nursing as a Vocational heritage more than professional

vision.

1960s debates and discussion regarding the proper

direction and appropriate disciple for nursing
knowledge development.
 RESEARCH
ERA
Research is the path to new knowledge.
Part of the curricula of developing graduate programs.
CURRICULU
Moving nursing education from hospital-based diploma M ERA
programs into college and universities.
HISTORICAL ERAS
 THEORY
Outgrowth of research era. ERA
Research without theory produced isolated information;
however research and theory produced nursing science.
GRAD.
Masters program in nursing emerged to meet the need for EDU. ERA
nurses with specialized education in nursing.
Nursing Theory and Nursing Conceptual models were included
as courses in the study of nursing.
MID 1970S

Evaluation of 25 years of nursing research revealed

that nursing lacked conceptual connections and
theoretical frameworks.

MILESTONES: 1. Standardization of curricula for

nursing masters education. 2. Doctoral education
for nurses should be in nursing.

Transition from vocation to profession.

Nursing practice is based on Nursing Science

1980S

Preparadigm period to Paradigm period

Introduced an organizational structure for

nursing knowledge development to the nursing
literature.

Utilization phase of the Theory Era emphasis

shifts from the development to the use and
application of what is known.
KEY CONCEPTS
To facilitate the bodys
Nightingale reparative processes by
manipulating clients
1860: environment

Nursing is; therapeutic

Peplau 1952: interpersonal process.

Henderson The needs often called

Hendersons 14 basic needs
1955:
 delivering nursing care for the
whole person to meet the
Abdellah 1960: physical, emotional, intellectual,
social, and spiritual needs of the
client and family.

the client is an individual; with a

need; that, when met,
Orlando 1962: diminishes distress, increases
adequacy, or enhances well-
being.

focuses on how the client

adapts to illness and how actual
Johnsons or potential stress can affect the
ability to adapt. The goal of
Theory 1968: nursing to reduce stress so that;
the client can move more easily
through recovery.
 maintain and promote
health, prevent illness, and
care for and rehabilitate ill
Rogers 1970: and disabled client through
humanistic science of
nursing
self-care deficit theory.
Nursing care becomes
necessary when client is
Orem1971: unable to fulfill biological,
psychological,
developmental, or social
needs.
use communication to help
King 1971: client reestablish positive
adaptation to environment.
 Stress reduction is goal of
Neuman 1972: system model of nursing
practice

This adaptation model is

based on the physiological,
psychological, sociological
Roy 1979: and dependence-
independence adaptive
modes.
defines the outcome of
Watsons nursing activity in regard to
Theory 1979: the; humanistic aspects of
life.
TERMINOLOGY
CONCEPTS

vehicles of thought that involve images. Are

words that describe objects, properties, or
events & are basic components of theory.

Types:
Empirical concepts
Inferential concepts
Abstract concepts
METAPARADIGM
Specifies the main concepts that encompass the
subject matter and the scope of discipline.

There is a general agreement that nursings

metaparadigm consists of the central concepts
of person, environment, health and nursing.
(Powers and Knapp)
METAPARADIGM CONCEPTS

THE PERSON

THE ENVIRONMENT

HEALTH

NURSING (GOALS, ROLES &

FUNCTIONS)
PHILOSOPHY

Specifies the definitions of the metaparadigm

concepts in each of the conceptual models of
nursing.

There are other theoretical works that may be

considered philosophies, works that specify
philosophical approaches to nursing.
 MODELS

representations of the interaction among and

between the concepts showing patterns.

In nursing, models are often designed by theory

authors to depict the beliefs in their theory
(Lancaster and Lancaster 1981).
 VERBAL MODELS
worded statements, a
form of closely related
knowledge development.

SCHEMATIC MODELS
diagrams, drawings,
graphs and pictures that
facilitate understanding.
PROPOSITION
statements that explain the relationship between
the concepts.

PROCESS
a series of actions, changes or functions
intended to bring about a desired result.
CONCEPTUAL FRAMEWORK
The delivery of nursing care within the nursing
process is directed by the way specific
conceptual frameworks & theories define the
person (patient), the environment, health &
nursing.

outlines possible courses of action or to present

a preferred approach to an idea or thought.
 THE DEVELOPMENT OF
NURSING THEORIES

GENERAL SYSTEMS THEORY

describes how to break whole things into parts &

then to learn how the parts work together in
systems.

These concepts may be applied to different kinds of

systems, e.g. Molecules in chemistry, cultures in
sociology, and organs in Anatomy & Health in
Nursing.
 ADAPTATION THEORY
defines adaptation as the adjustment of living
matter to other living things & to environmental
conditions.

Adaptation is a continuously occurring process

that effects change & involves interaction &
response.
Human adaptation occurs on three levels :
1.The internal (self)
2.The social (others) &
3.the physical (biochemical reactions)
 DEVELOPMENTAL THEORY

It outlines the process of growth & development of

humans as orderly & predictable, beginning with
conception & ending with death.

The progress & behaviors of an individual within each

stage are unique.

The growth & development of an individual are

influenced by heredity, temperament, emotional, &
physical environment, life experiences & health
status.
TYPES OF NURSING
THEORIES
According to Scope, Functions and
Philosophy
 SPECULATIVE yet to be tested through research
and found to be consistently true, valid and reliable
in answering questions, solving problems and
exploring phenomenon.

ESTABLISHED Accumulation of facts, principles

and laws that have been repeatedly tested through
research over time and found to be consistently valid
and reliable.
TYPES ACCORDING TO SCOPE

GRAND THEORY - It is the broadest in scope, represents

the most abstract level of development, and addresses the
broad phenomena of concern within the discipline.

MIDDLE-RANGE THEORY - theory that addresses more

concrete and more narrowly defined phenomena. It is
intended to answer questions about nursing phenomena,
yet they do not cover the full range of phenomena of
concern to the discipline

MICRO-RANGE THEORY - concrete and narrow in scope. It

explains a specific phenomenon of concern to the discipline

 TYPES According to
KNOWLEDGE BASE and
CHARACTERISTICS
1. NURSING PHILOSOPHY

Meaning of nursing phenomenon through

analysis, reasoning and logical argument.

Includes works which predate or introduce the

nursing theory era and have contributed to the
knowledge development in nursing.
2. NURSING CONCEPTUAL MODELS

Works of grand theorists or pioneers in Nursing.

Provides a distinct frame of reference for its

adherents that tells them how to observe and
interpret the phenomena of interest to the
discipline.
3. NURSING THEORIES AND MIDDLE-RANGE
THEORIES

Addresses the specifics of nursing situations

within the perspective of the model or theory
from which they are derived.
 PHILOSOPHIES CONCEPTUAL MODELS THEORIES AND MIDDLE-
AND GRAND THEORIES RANGE THEORIES

NIGHTINGALE OREM BARNARD

LEININGER
WIEDENBACH LEVINE
PARSE
HENDERSON ROGERS MISHEL
ABDELLAH JOHNSON NEWMAN
HALL ROY ADAM
WATSON NEUMAN PENDER
BENNER KING PEPLAU
ORLANDO
ROPER, LOGAN, TRAVELBEE
TIERNEY KOLCABA
ERICKSON, TOMLIN,
SWAIN
MERCER
TYPES ACCORDING TO FUNCTION (Polit
et. al 2001)

Descriptive-to identify the properties and

workings of a discipline

Explanatory-to examine how properties relate

and thus affect the discipline

Predictive-to calculate relationships between

properties and how they occur

Prescriptive-to identify under which conditions

relationships occur
Based on the philosophical
underpinnings of the theories:
1. Needs theories
Are based around helping individuals to fulfill
their physical and mental needs.
 2.Interaction
theories
As described by
Peplau (1988), these
theories revolve
around the
relationships nurses
form with patients.
3. Outcome theories"
Outcome theories portray the nurse as
the changing force, who enables
individuals to adapt to or cope with ill
health.
4. Humanistic Theories

Humanistic theories
developed in response to
the psychoanalytic thought
that a persons destiny was
determined early in life.

Humanistic theories
emphasize a persons
capacity for self-
actualization.
 Carl Rogers developed a person centered model
of psychotherapy that emphasizes the
uniqueness of the individual.
FRAMEWORK OF
ANALYSIS
Criteria for Evaluating Theoretical Works
 Major Concepts and sub-
concepts and their
definitions are identified.
CLARITY The danger of lost
meaning when terms
are borrowed from
other disciplines and
used in a different
HOW CLEAR IS YOUR context. (Ellis)
THEORY?

Diagrams and examples

may facilitate clarity and
should be consistent.
 Nurse in practice need simple
theory, such as middle-range
SIMPLICITY theory to guide practice.
(Chinn and Kramer)

The most useful theory

provides the greatest sense of
understanding. (Reynolds)
How simple is this theory?
Elegant in its simplicity, even
though it may be broad in
content. (Walker and Avant)

GENERALITY
How general is this theory?
Scopes of concepts and
goals within the theory
are examined.
The situations the
theory applies to should
not be limited.
The broader the
scope, the greater
the significance of
the theory. (Chinn
and Kramer)
EMPIRICAL PRECISION
How well the evidence
supports the theory is
indicative of empirical
How accessible is this adequacy. (Hardy)
theory?

Other scientists should

be able to evaluate and
verify results by
themselves.
DERIVABLE
CONSEQUENCE

It is essential for a
How important is this theory to develop and
theory? guide
practice...Theories
should reveal what
knowledge nurses must
and should, spend time
pursuing.
SIGNIFICANCE OF
THEORY FOR
NURSING
As a Discipline and Profession
 DISCIPLINE
Specific to the
academia and
refers to a branch
of education, a
department of
PROFESSION
learning or a A specialized field
domain of of practice, which
knowledge. is founded upon
the theoretical
structure of the
science or
knowledge of the
discipline and the
accompanying
practice abilities.
NURSING AS A DISCIPLINE
Theories provided frameworks to structure
curriculum content or to guide the teaching of
nursing practice in nursing programs.

Discipline is dependent upon theory.

 Focus on knowledge about how nurses function
which concentrated on the nursing process to a
focus on what nurses know and how they use
knowledge to guide their thinking and decision
making while concentrating on the patient.

New nursing science is developed through

theory based research studies.
NURSING AS A PROFESSION
Criteria of a profession by Bixler and Bixler
published in the American Journal of Nursing 1959

1. Utilizes in its practice a well defined and well-

organized body of specialized knowledge that
is on the intellectual level of higher learning.
2. Constantly enlarges the body of knowledge it
uses and improves its techniques of education
and service by the use of the scientific method.
3. Entrusts the education of its practioners to
institutions of higher education.

4. Applies its body of knowledge in practical

services that are vital to human and social
welfare.

5. Functions autonomously in the formulation of

professional policy and in the control of
professional activity thereby.
6. Attracts individuals of intellectual and personal
qualities who exalt service above personal gain
and who recognize their chosen occupation as a
life work.

7. Strives to compensate its practitioners by

providing freedom of action, opportunity for
continuous professional growth, and economic
security.
 Presented specific goals and achievements of
the profession.

Nurses are recognized for the contribution they

make in healthcare and the society.
 Nursing theory is a useful tool for reasoning, critical
thinking, and decision making in the nursing practice.

NURSING THEORY AND THE PRACTICE OF

NURSING
Theory assists the practicing nurse to:
Organize patient data
Understand patient data
Analyze patient data
Make decisions about nursing interventions
Plan patient care
Predict outcomes of care
Evaluate patient outcomes
 Professional practice requires a systematic
approach that is focused on the patient. Nursing
theoretical works provide a perspective of the
patient.
 IMPORTANCE OF NURSING
THEORIES

aims to describe, predict and explain the

phenomenon of nursing (Chinn and Jacobs1978).

provides the foundations of nursing practice,

help to generate further knowledge and indicate
in which direction nursing should develop in the
future (Brown 1964).

helps us to decide what we know and what we

need to know (Parsons1949).

helps to distinguish what should form the basis

of practice by explicitly describing nursing.
 The benefits of having a defined body of theory
in nursing include better patient care, enhanced
professional status for nurses, improved
communication between nurses, and guidance
for research and education (Nolan 1996).

The main exponent of nursing caring cannot

be measured, it is vital to have the theory to
analyze and explain what nurses do.
NURSING THEORISTS
AND THEIR WORKS
 FLORENCE
NIGHTINGALE
MODERN NURSING
and
ENVIRONMENTAL
THEORY

Nursing is an act of utilizing

the environment of the
patient to assist him in his
recovery.
Biography First Nursing Theorists
and the Mother of
Modern Nursing.
Born in May 12, 1820 in
Italy to a wealthy British
family.
In 1853, she accepted
the position of
superintendent at the
Institute for the Care of
Sick Gentlewomen in
She tended to wounded soldiers
during the Crimean War. She became
known as the "Lady with the
Lamp" because of her night rounds.
Immortalized in the poem Santa
Filomena by Henry Wadsworth
Longfellow

After the Crimean War, she

established a nursing school at St.
Thomas' Hospital and Kings College
in London in 1860.
 Nightingale wroteNotes on Nursing(1859), which
was the foundation of the curriculum for her
nursing school and other nursing schools.

Notes on Matters Affecting the Health, Efficiency

and Hospital Administration of the British Army
Notes on Hospitals
Report on Measures Adopted for Sanitary
Improvements in India from June 1869 to June
1870
 She helped to pioneer the revolutionary notion
that social phenomena could be objectively
measured and subjected to mathematical
analysis. (Cohen)

Nightingales research skills: Recording,

Communicating, ordering, coding,
conceptualizing, inferring, analyzing and
synthesizing (Palmer)

Nightingale emphasized the concurrent use of

observation and the performance of tasks in the
education of nurses.
 In 1883 - Royal Red Cross by Queen Victoria.
In 1907 - the Order of Merit.
In 1908 - Honorary Freedom of the City of London.

She was able to work into her eighties and died in her
sleep on August 13, 1910 at age 90

International Nurses Day is celebrated on her birthday.

INFLUENCES
Education provided by her Father
Familys aristocratic social status.
Exposure to political process of the Victorian
England
The Industrial Age
Charles Dickens social commentaries and
novels
Dialogues with many political leaders
Unitarian religious affiliation.
ENVIRONMENTAL
THEORY
 Nightingales Major Concepts
1. Person

Patient who is acted on by

nurse
Emphasized that the Nurse
has in control of the
patients environment.
Affected by environment
Passive yet has reparative
powers
2. Environment

Foundation of theory.

Included everything, physical,

psychological, and social

Nurses are instruments to

change the social status of
the poor by improving their
living conditions
3. Health

We know nothing of health, the positive of which

pathology is the negative, except from the
observation and experience.

Given her definition that of the art of nursing is to

unmake what God had made disease, then the
goal of all nursing activities should be client
health.
 Nursing should provide care to the healthy as
well as the ill and discussed health promotion as
an activity in which nurses should engage.

Envisioned maintenance of health through

prevention of disease via environmental control.
4. Nursing

What nursing has to do is to put the patient in

the best condition for nature to act upon him
(Nightingale, 1859/1992)

nursing ought to signify the proper use of fresh

air, light, warmth, cleanliness, quiet, and the
proper selection and administration of diet all at
the least expense of vital power to the patient.
 Nursing is having the responsibility for someone
elses health.

She wrote her Notes on Nursing to provide

women
how to Think like a Nurse.
 Ventilation and warming
Light and noise
Health of houses
Bed and bedding
Personal cleanliness
Variety
Chattering hope and advices
Food
VENTILATION
AND
WARMING
Keep the air he breathes
as pure as the external air,
without chilling him.

Recognized this
environmental component
as a source of disease and
recovery.
 Provided description
for measuring the
patients body
temperature through
palpation of
extremities.

Nurses were
instructed to
manipulate the
environment to
maintain both
ventilation and
patient warm by good
fire, opening windows
and properly
positioning the
patient in the room.
LIGHT
Light has quite as real
and tangible effects
upon the human body
who has not observed
the purifying effect of
light, and especially of
direct sunlight, upon
the air of the room?
NOISE

Noises created by
physical activities in
the environment
(room) was to be
avoided by the nurse.
CLEANLINESS

Bathing of patients on a
frequent, even daily, basis.

Nurses should wash their

hands regularly.
BED AND
BEDDINGS
Noted that a dirty
environment (floors, carpets,
walls and bed linens) was a
source of infection through
the organic matter it
contained.

The appropriate handling and

disposal of bodily excretions
and sewage was required to
prevent contamination of the
environment.
HEALTH OF
HOUSES

Badly
constructedhouses
dofor
thehealthywhat
badly
constructedhospital
s dofor thesick.
 To any but an old
VARIETY
nurse, or an old
patient, the degree
would be quite
inconceivable to
which the nerves of
the sick suffer from
seeing the same
walls, the same
ceiling, the same
surroundings during a
long confinement to
one or two rooms
FOOD

Instructed nurses to
assess dietary intake ,
meal schedules and
its effect on the
patient.
Chattering of
Hope and
Advices

Protects patient from

receiving upsetting new,
seeing visitors who can
affect the patients
recovery negatively and
from suddenly receiving
disruptions from sleep.
ASSUMPTIONS

Nightingale (1860/1957/1969) believed that five

points were essential in achieving a healthful
house: pure air, pure water, efficient drainage,
cleanliness and light.

A healthy environment is essential for healing. She

stated that nature alone cures.
 Nurses must make accurate observations of their
patients and be able to report the state of the
patient to the physician in an orderly manner.

Nursing is an art, whereas medicine is a science.

Nurses are to be loyal to the medical plan, but
not servile.
 Disease is a reparative process. Disease is natures
effort to remedy a process of poisoning or decay, or a
reaction against the conditions in which a person was
placed.

Nature is synonymous with God .

Committed to nursing education (training.) Women

were to be specifically trained to provide care for the
sick and that nurses requiring preventive healthcare
requires more training.
 Nurses should use common sense, observation,
perseverance and ingenuity.

Persons desired good health and that they would

cooperate with the nurse.

Did not embrace germ theory but clearly

understood the concept of contagion and
contamination through organic materials from
patients and the environment.
 Believed that nurses should be MORAL AGENTS.

Addressed Professional relationship with patients.

Instructed nurses on principle of confidentiality

and advocated care for the poor.

Patient decision making indecision or changing

the mind is more harmful to the patient than the
patient having to make a decision.
LOGICAL FORM

Used Inductive Reasoning to

extract laws of health, disease
and nursing from her
observations and experiences.
ACCEPTANCE BY
THE NURSING
COMMUNITY
Practice, Education and Research
PRACTICE
Environmental aspects remain integral
components of current nursing care.

Multiple authors reviewed her work Petty

management concepts and actions , again
identifying some of the timelessness and
universality of her management style.
EDUCATION
Principles of Nursing Training provided a
universal template for early nurse training
schools.

Experimental schools established in the USA

1873 : 1. Bellevue Hospital in New York 2. New
Haven Hospital 3. Massachusetts Hospital in
Boston
 Advocated Nursing schools independence from
a hospital to ensure that students would not be
involved in the hospitals labor pool as part of
their training.

Measurement of the art of nursing could not be

accomplished through licensing examinations
but she used testing methods, including case
studies (notes).
RESEARCH
Graphically represented data was first identified
in the polar diagrams.

Empirical approach in solving problems of

healthcare delivery.

Concepts Nightingale identified have served as

basis for current research.
CRITIQUE
 Simple? General
?

Clear?
Accessible
?

Important?
Weaknesses
There is scant information on the
psychosocial environment when compared
to the physical environment.

The application of her concepts in the

twentieth century is in question.
Strengths
Has broad applicability to the practitioner. Her
model can be applied in most complex
hospital intensive care environment, the
home, a work site, or the community at large.

Reading her work raises a consciousness in

the nurse about how the environment
influences client outcomes.
I think ones feelings waste
themselves in words; they
ought all to be distilled into
actions which bring results.
-Florence Nightingale

VIRGINIA
HENDERSON
THE PRINCIPLES AND
PRACTICE OF
NURSING
I believe that the function the nurse
performs is primarily an independent
one that of acting for the patient
when he lacks knowledge , physical
strength, or the will to act for himself
as he would ordinarily act in health,
or in carrying out prescribed therapy.
This function is seen as complex and
creative, as offering unlimited
opportunity for the application of the
physical, biological, and social
sciences and the development of
skills based on them. (Henderson,
1960)
Biography The Nightingale of
Modern Nursing.
Others named her as
the First Lady of
Nursing and Modern-
Day Mother of Nursing

Born on November 30,

1897 in Kansas City,
Missouri and lived in
Virginia.
 In 1918, she entered the Army School of Nursing
in Washington, DC.

1921, she was a staff nurse Henry Street Visiting

Nurse Service in New York

She began her career as a nurse educator in

1924 at the Norfolk Protestant Hospital in
Virginia where she was the first and only teacher
in the school of nursing
 Five years later she entered Teachers College at
Columbia University where she earned her B.S. and
M.A. degrees in Nursing Education.

1939 rewrote the 4th edition of Bertha Hammers

Textbook of the Principles and Practice of Nursing.

Henderson's career in research began when she joined

the Yale School of Nursing as Research Associate in
1953 to work on a critical review of nursing research.
 In 1955 she published the 5th edition with her own
definition of nursing.

1960 Coauthored Basic of Principles in Nursing

care for the International Council of Nurses which
was translated into more than 20 languages.

1966-The Nature of Nursing. A definition and its

implication for practice, Research and Education
 In 1985, Henderson was presented with the first Christianne
Reimann Prize from the International Council of Nurses.

She was also an honorary fellow of the United Kingdom's

Royal College of Nursing. The same year, she was also
honored at the Annual Meeting of the Nursing and Allied
Health Section of the Medical Library Association.

Awarded in 1988 by the American Nurses Association for her

lifelong contributions to nursing research, education and
professionalism.

Henderson died on March of 1996 at the age of 98

 INFLUNCES
ANNIE W. GOODRICH
Dean of the Army School of Nursing.
Lifted her sights above techniques and routines
Nursing is not merely ancillary to medicine.

CAROLINE STACKPOLE
Philosophy Professor at Teachers College
Importance of physiological balance.
 JEAN BROADHURST
Microbiology Professor at Teachers College
Importance of hygiene and asepsis

DR. EDWARD THORNDIKE

Illness is more than a state of disease that
most fundamental needs are not met in
hospitals.
 Dr. GEORGE DEAVER
Physicist at Bellevue Hospital
The Goal of rehabilitative efforts at the institute
was rebuilding the patients independence.

BERTHA HARMER
Canadian Nurse
Nursing is rooted in the needs of humanity.
 IDA JEAN ORLANDO (PELLETIER)
Influence on her Nurse-patient
relationship
Ida Orlando made me realize how
easily a nurse can act on
misconceptions of the patients needs if
she does not check her interpretation of
them with him.
NURSING NEED
THEORY
 NURSING NEED THEORY
Hendersons Major Concepts
1. Person/ Individual

considers the biological,

psychological,
sociological, and spiritual
components.

She defined
thepatientas someone
who needs nursing care,
but did not limit nursing
to illness care.
2. Society or
Environment

The aggregate of all

external conditions
and influences
affecting the life and
development of an
organism.
Websters Dictionary
maintaining a
supportive
environment is one of
 She sees individuals in relation to their families
but minimally discusses the impact of the
community on the individual and family.

She supports the tasks of private and public

health agencies keeping people healthy.

She believes that society wants and expects the

nurses service of acting for individuals who are
unable to function independently.
3. Health

Equated health
with independence.

The quality of health rather than life itself, that

margin of mental/physical vigor that allows a
person to work most effectively and to reach his
highest potential level of satisfaction in life.
4. Nursing
14 Activities for Client
Assistance

Physiological
Psychological Aspects
of Communicating
and Learning
Spiritual and Moral
Sociologically
Oriented to
Occupation and
Recreation
ASSUMPTIONS
"nurses care for a patient until a patient can care for
him or herself."

nurses are willing to serve and that "nurses will

devote themselves to the patient day and night."

nurses should be educated at the college level in

both sciences and arts and should be knowledgeable
in both biological and social sciences.
THE NURSE-PATIENT RELATIONSHIP
Three Levels of Relationship:

Nurse as a substitute for the patient

Nurse as a helper to the patient
Nurse as a partner with the patient

The nurse is a substitute for what the patient

lacks to make him complete, whole, or
independent, by the lack of physical strength,
will or knowledge
 The nurse is temporarily the consciousness
of the unconscious, the love of life for the
suicidal, the leg of the amputee, the eyes of
the newly blind, a means of locomotion for
the infant, knowledge and confidence for the
young mother, the mouthpiece for those too
weak or withdrawn to speak and so on.
 Nurse must able to assess not only the patients
needs but the condition and pathological states
that alters them.

Nurses can alter the environment whenever

necessary.

One goal of the nurse is to keep the patients

days as normal as possible

Another goal is promotion of health. There is

more to be gained by helping every man learn
how to be healthy than be preparing the most
skilled therapists for service to those in crises.
NURSE-PHYSICIAN RELATIONSHIP
Unique distinction from the Physicians function
the CARE PLAN

Nursing Care Plan promotes the physicians

therapeutic plan.
NURSE AS A MEMBER OF THE
HEALTH CARE TEAM
Works in interdependence with other healthcare
professionals.

No one of the team should make such heavy

demands on another members that any one of
them is unable to perform his or her unique
functions.
LOGICAL FORM

Used the deductive form of logical reasoning.

Deduced her definition of

nursing and the 14 needs
from physiological and
psychological principles.
ACCEPTANCE BY
THE NURSING
COMMUNITY
Practice, Education and Research
PRACTICE
Nursing Process is the problem solving
process and is not peculiar to nursing.

ASSESSMENT PHASE assess pt. in 14

components of nursing care. Use observation,
smell, feeling and hearing. Analyze collected
data and differentiate normal from abnormal.
 PLANNING PHASE Must fit individuals needs,
updating the plan as necessary on the basis of the
changes and depending on physicians prescribed
plan.

IMPLEMENTATION PHASE Individualized

interventions depending on factors.

EVALUATION PHASE evaluate according to the

degree in which he or she performs independently.
EDUCATION
In order for a nurse to practice as an expert in
her own right and to use a scientific approach to
the improvement of practice, the nurse needs
the kind of education available only in colleges
and universities.

3 Phases of Curriculum Development

1. Fundamental needs of the patient, the
planning of nursing care and the unique
function of the nurse to assist in pt.s
activities of daily living.
2. Helping patients meet their needs during
body disturbances or pathological states that
demand modifications in the nurses plan of
care.

3. Patient and family centered. Complete study

of patient and patients needs
RESEARCH
Believed that research was needed to evaluate
and improve practice.

Recommended library research.

1964 Survey and Assessment of Nursing

Research identified several reasons for the lack
of research in clinical nursing.
Major energies of the profession have gone
toward improving the preparation for nursing.
 Learning how to recruit and hold sufficient
numbers of nurses to meet the growing demand
has taken considerable energy.

The need for administrators and educators has

almost exhausted the supply of degree of nurses.

A lack of support from the administrators, nursing

service administrators and physicians has
discouraged researchers.
CRITIQUE
 Simple? General
?

Clear?
Accessible
?

Important?
Weaknesses
Limited in a way that it can generally be
applied to fully functional individuals.

A major shortcoming in her work is the lack of

a conceptual linkage between physiological
and other human characteristics.
Strengths
Her work can be applied to the health of
individuals of all ages.
Each of the 14 activities can be the basis for
research. Although the statements are not
written in testable terms, they may be
reformulated into researchable questions.
The concept of nursing formulated by
Henderson in her definition of nursing and the
14 components of basic nursing is
uncomplicated and self-explanatory.
Therefore, it can be used without difficulty as
a guide for nursing practice by most nurses.
Nursing must not exist in a vacuum.
Nursing must grow and learn to meet
the new health needs of the public as
we encounter them.
Virginia Henderson
 KEEP
CALM
And
More Slides to
GO!!!
FAY
ABDELLAH
PATIENT-CENTERED
APPROACHES TO
NURSING
"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."
Biography Born
on March 13,
1919 New York City.

the first nurse officer to

earn the ranking of a
two-star rear admiral.
She was the first nurse
and the first woman to
serve as a Deputy
Surgeon General.
 Herwork changed the focus of nursing from
disease-centered to patient-centered, and 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.
 Her publications includeBetter Nursing Care
Through Nursing ResearchandPatient-Centered
Approaches to Nursing.

She was inducted into the National Women's Hall

of Fame in 2000.
 21 Nursing Problems

Abdellahs Major Concepts

1. Nursing

A helping profession
A comprehensive service to meet patients
needs
Increases or restores self-help ability
Uses 21 problems to guide nursing care
Nursing Problems
The clients health needs can be viewed as
problems, which may beovertas an apparent
condition, orcovertas a hidden or concealed
one.
Problem Solving
Problem-solving process involves 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. (Abdellah & Levine, 1986)
2. Health

No unmet needs and no actual or anticipated

impairments
The purpose of nursing services.
she speaks of total health needs and a healthy
state of mind and body. (Abdellah et al., 1960)

3. Person

One who has physical, emotional, or social needs

The recipient of nursing care.
4. Environment

Did not discuss much

Includes room, home, and community
Societyis included in planning for optimum
health on local, state, and international levels.
The focus of care pendulum

In her attempt to bring nursing practice to its

proper relationship with restorative and
preventive measures for meeting total client
needs, she seems to swing the pendulum to the
opposite pole, from the disease orientation to
nursing orientation, while leaving the client
 10 Steps to Identify Patients Problems

1. Learn to know the patient

2. Sort out relevant and significant data
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 behavior
8. Explore the patient's and family's reaction 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
 11 Nursing Skills

1. Observation of health status

2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel materials
8. problem-solving
9. direction of work of others
10. therapeutic use of the self
11. nursing procedure
4 Categories of Needs

BASIC NEEDS
SUSTENAL CARE NEEDS
REMEDIAL CARE NEEDS
RESTORATIVE CARE NEEDS
 21 Nursing Problems
1. To maintain good hygiene and physical
comfort.

2. To promote optimal activity: exercise, rest, and

sleep.

3. To promote safety through the prevention of

accidents, injury, or other trauma and through
the prevention of the spread of infection.
4. To maintain good body mechanics and
prevent and correct deformities.

5. To facilitate the maintenance of a supply of

oxygen to all body cells.

6. To facilitate the maintenance of nutrition of all

body cells.

7. To facilitate the maintenance of elimination.

8. To facilitate the maintenance of fluid and electrolyte
balance.

9. To recognize the physiological responses of the body to

disease conditions pathological, physiological, and
compensatory.

10. To facilitate the maintenance of regulatory mechanisms

and functions.

11. To facilitate the maintenance of sensory functions.

12. To identify and accept positive and negative
expressions, feelings, and reactions.

13. To identify and accept the interrelatedness of

emotions and organic illness.

14. To facilitate the maintenance of effective verbal

and nonverbal communication.

15. To promote the development of productive

interpersonal relationships.
16. To facilitate progress toward achievement of
personal spiritual goals.

17. To create and/or maintain a therapeutic

environment.

18. To facilitate awareness of self as an

individual with varying physical, emotional, and
developmental needs.
19. To accept the optimum possible goals in the
light of limitations, physical and emotional.

20. To use community resources as an aid in

resolving problems arising from illness.

21. To understand the role of social problems as

influencing factors in the case of illness.
Weaknesses
Little emphasis on what the client is to achieve was
given in terms of client care.

Failure of the framework to provide a perspective

on humans and society in general limits the
generalizability of the theory.

Abdellahs framework is inconsistent with the

concept of holism.
Strengths
As a logical and simple statement, Abdellahs
problem-solving approach can easily be used
by practitioners to guide various activities
within their nursing practice.

The theoretical statement places heavy

emphasis on problem solving, an activity that
is inherently logical in nature.

The problem-solving approach is readily

generalizable to client with specific health
needs and specific nursing problems.
DOROTHEA
OREM

OREMS MODEL OF
NURSING
 Born in 1914 in
Baltimore, Maryland

In the early 1930s, she

earned her nursing
diploma from the
Providence Hospital
School of Nursing in
Washington, D.C.
 She went on to complete her Bachelor of Science in
Nursing in 1939 and her Master's of Science in Nursing in
1945, both from the Catholic University of America in
Washington, D.C.

Dorothea Orem had a distinguished career in nursing. She

earned several Honorary Doctorate degrees.

the Catholic University of America Alumni Achievement

Award for Nursing Theory in 1980, the Linda Richards
Award from the National League for Nursing in 1991, and
was named an honorary Fellow of the American Academy
of Nursing in 1992.
 Self-Care Deficit Theory

Orems Major Concepts

1.Nursing
an art through which the practitioner of
nursing gives specialized assistance to persons
with disabilities which makes more than
ordinary assistance necessary to meet needs
for self-care.
The nurse also intelligently participates in the
medical care the individual receives from the
physician.
2. Human/Person
are defined as men, women, and children
cared for either singly or as social units, and are
the material object of nurses and others who
provide direct care.

3. Environment
has physical, chemical and biological
features. It includes the family, culture and
community.
4. Health
Being structurally and functionally whole or
sound. Also, health is a state that encompasses
both the health of individuals and of groups, and
human health is the ability to reflect on ones
self, to symbolize experience, and to
communicate with others.
 Orem developed the Self-Care Deficit Theory of
Nursing, which is composed of three interrelated
theories: (1) the theory of self-care, (2) the
self-care deficit theory, and (3) the theory
of nursing systems.
THEORY OF SELF-CARE

Self-careis the performance or practice of

activities that individuals initiate and perform on
their own behalf to maintain life, health and well-
being.

Self-care agencyis the humans ability or

power to engage in self-care and is affected by
basic conditioning factors.
 Basic conditioning factors:

age
Gender
Developmental state
Health state,
Socio-cultural orientation
Health care system factors
Family system factors
Patterns of living
Environmental factors
Resource adequacy and availability.
 Therapeutic Self-care Demandis the totality of
self-care actions to be performed for some
duration in order to meet known self-care requisites
by using valid methods and related sets of actions
and operations.

Self-care Deficitdelineates when nursing is

needed. Nursing is required when an adult (or in the
case of a dependent, the parent or guardian) is
incapable of or limited in the provision of
continuous effective self-care.
 Nursing Agencyis a complex property or
attribute of people educated and trained as
nurses that enables them to act, to know, and to
help others meet their therapeutic self-care
demands by exercising or developing their own
self-care agency.

Nursing Systemis the product of a series of

relations between the persons: legitimate nurse
and legitimate client. This system is activated
when the clients therapeutic self-care demand
exceeds available self-care agency, leading to
the need for nursing.
 SELF-CARE REQUISITESor requirements can
be defined as actions directed toward the
provision of self-care.
Universal self-care requisites
Developmental self-care requisites
Health deviation self-care requisites
 Universal self-care requisitesare associated
with life processes and the maintenance of the
integrity of human structure and functioning.
1. The maintenance of a sufficient intake of air

2. The maintenance of a sufficient intake of

water

3. The maintenance of a sufficient intake of

food

4. The provision of care associated with

elimination process and excrements
5. The maintenance of a balance between activity and rest

6. The maintenance of a balance between solitude and

social interaction

7. The prevention of hazards to human life, human

functioning, and human well-being

8. The promotion of human functioning and development

within social groups in accord with human potential, known
human limitations, and the human desire to be normal
Developmental self-care requisitesare
either specialized expressions of universal self-
care requisites that have been particularized for
developmental processes or they are new
requisites derived from a condition or associated
with an event.
 Health deviation self-care requisitesare
required in conditions of illness, injury, or
disease or may result from medical measures
required to diagnose and correct the condition.

1. Seeking and securing appropriate medical

assistance

2. Being aware of and attending to the effects

and results of pathologic conditions and
states

3. Effectively carrying out medically

prescribed diagnostic, therapeutic, and
rehabilitative measures
 4. Being aware of and attending to or regulating
the discomforting or deleterious effects of
prescribed medical measures

5. Modifying the self-concept (and self-image) in

accepting oneself as being in a particular state of
health and in need of specific forms of health
care

6. Learning to live with the effects of pathologic

conditions and states and the effects of medical
diagnostic and treatment measures in a life-style
that promotes continued personal development
THEORY OF SELF-CARE DEFICIT

According to Orem, nursing is required when an

adult is incapable or limited in the provision of
continuous, effective self-care.

5 METHODS OF HELPING:
Acting for and doing for others
Guiding others
Supporting another
Providing an environment promoting personal
development in relation to meet future demands
Teaching another.
THEORY OF NURSING SYSTEMS
Describes how the patient's self-care needs will
be met by the nurse, the patient, or by both.

Orem identifies three classifications of

nursing system to meet the self-care requisites
of the patient:
wholly compensatory system
partly compensatory system
supportive-educative system.
 Wholly compensatory nursing
system

represented by a situation in which

the individual is unable to engage in
those self-care actions requiring self-
directed and controlled ambulation
and manipulative movement or the
medical prescription to refrain from
such activity Persons with these
limitations are socially dependent on
others for their continued existence
and well-being.
 Partly compensatory nursing system
represented by a situation in which both
nurse and patient perform care measures or
other actions involving manipulative tasks or
ambulation [Either] the patient or the nurse
may have the major role in the performance
of care measures.
 Supportive-educative system
also known as supportive-developmental
system, the person is able to perform or can
and should learn to perform required
measures of externally or internally oriented
therapeutic self-care but cannot do so without
assistance.
ASSUMPTIONS
People should be self-reliant, and responsible for
their care, as well as others in their family who
need care.
People are distinct individuals.
Nursing is a form of action. It is an interaction
between two or more people.
 Successfully meeting universal and development
self-care requisites is an important component of
primary care prevention and ill health.

A person's knowledge of potential health

problems is needed for promoting self-care
behaviors.

Self-care and dependent care are behaviors

learned within a socio-cultural context.
Weaknesses
Simple yet complex. The use of self-care in multitude
of terms.

Orems definition of health was confined in three static

conditions which she refers to a concrete nursing
system, which connotes rigidity.

Throughout her work, there is limited

acknowledgement of the individuals emotional needs.
Strengths
applicable for nursing by the beginning
practitioner as well as the advanced
clinicians.

specifically defines when nursing is needed:

Nursing is needed when the individual cannot
maintain continuously that amount and
quality of self-care necessary to sustain life
and health, recover from disease or injury, or
cope with their effects.

Three identifiable nursing systems were

REFERENCES
George B. Julia , Nursing Theories- The base for professional
Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
Betty M. Johnson and Pamela B. Webber, Theory and
Reasoning in Nursing., 2nd ed. New York, Williams & Wilkins
Mariner 5th edition
http://nursingtheories.weebly.com/index.html
http://nursing-theory.org/articles/nursing-theory-
definition.php
http://currentnursing.com/nursing_theory/development_of_n
ursing_theories.html
 KEEP
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