NURSING THEORIES AND ITS THEORISTS

FLORENCE NIGHTINGALE – Environmental Theory

Florence Nightingale (May 12, 1820 – August 13, 1910) Defined nursing as an “act of
utilizing the environment of the patient to assist in their recovery.”
BIOGRAPHY

 Born on May 12, 1820 in Florence, Italy.

 Entered Deaconesses School at Kaisserwerth Institute at the age of thirty-one
(31) and received three (3) months “training” in nursing, before studying in Paris
with the Sisters of Charity.
 1854 – Crimean War: Invited by Sir Sydney Herbert to take a group of 38 female
nurses to work in hospitals.
 Dubbed as the Lady with a Lamp; tended to the soldiers at night with a lamp to
see them.
 Utilized the environment, her statistical and managerial skills to lower soldiers
and war victims’ mortality rates.
 Returned to England after the war, where she was awarded £4.5k, which she
used to develop the Nightingale Training School for Nurses (1860).
 Developed a self-appointed goal: “to change the profile of nursing.”
 Highly advocated for those with diseases caused by lack of proper hygienic
practices, she was then recognized as nursing’s first scientist-theorist for her
work: Notes on Nursing: What it is and What it is Not.
 Disapproved of the restrictions on admission of patients and considered this act
to be un-Christian and incompatible with healthcare.
AWARDS
o The first woman to be granted the Order of Merit (OM) and Royal Red
Cross (RCC) by the Queen Victoria of Great Britain.
o Her birthday (May 12) marks the International Nurses Day celebration.

ENVIRONMENTAL THEORY: Five Environmental Factors

Florence Nightingale linked health with the following five factors:
1. Pure fresh air.
2. Pure water
3. Efficient drainage.
4. Cleanliness
5. Direct sunlight.
Florence Nightingale defined the following terms:
1. PERSON
a. The patient; defined in relation to their environment and its impact
on said patient.
2. HEALTH
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a. The best state of an individual’s wellbeing; envisioned the

maintenance of health through disease prevention by means of
environmental control.
3. ENVIRONMENT
a. Believed that individuals who are poor or struck with diseases
will benefit from environmental improvements that adhere to
their physical and mental aspects.
b. Uplifting the environmental and social status of the poor will help
in the improvement of their living conditions.
4. NURSING
a. The responsibility for other’s health.
NIGHTINGALE’S CANONS*
*Canon is referred to as a rule or law imposed. These cannons were found in
Notes on Nursing (1860/1946).

NIGHTINGALE’S CANONS NURSING PROCESS AND THOUGHT

Ventilation and Warmth  Check room temperature,

Light  Check room for adequate light as
exposure to sunlight is beneficial
for the patient.
 Create and implement
Cleanliness  Check room for any signs of dust,
dampness and dirt.
 Keep room free from the things
mentioned above,
Health of Houses  Check surroundings for pure
water, drainage, cleanliness, and
adequate light.
 Remove garbage, stagnant water,
and ensure fresh, clean water and
fresh air.
Noise  Check for noise level inside the
patient’s room and surroundings.
 Attempt to keep level of noise at a
minimum.
Bed and Bedding  Check the bed and beddings for
any signs of wrinkles, dampness
and soiling.
 Keep the bed at lowest height and
ensure comfort by keeping it dry
and wrinkle-free.
Personal Cleanliness  Attempt to keep the patient dry
and clean at all times
 Frequent assessment of patient’s
skin is important to maintain good
skin integrity
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Variety  Attempt to accomplish variety in

the room and with the
patient/client.
 This includes the following: cards,
flowers, décor, books, pictures,
etc.
 Encourage friends and relatives.
Chattering Hope and Advice  Respect the patient as a person
(privacy) and avoid personal talk.
 Avoid giving false advice
Taking Food  Check and ensure that the diet of
the patient is adequate and that
the patient is eating right.
 Take note of the amount of food
and fluids ingested by the patient
at every meal
Petty Management  Ensure continuity of nursing care.
 Document the care plan and
evaluate outcome to secure and
ensure continuity
Observation of the Sick  Observe and record anything
about the patient
 Continue observation in the
patient’s environment and make
changes in the care plan if need
be.
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VIRGINIA HENDERSON – 14 Basic Human Needs

Virginia Henderson (March 30, 1897 – March 19, 1996) has been dubbed as the First
Lady of Nursing and the First Truly International Nurse. She defined nursing as assisting the
individual (sick or well) in performing activities that contribute to the health or its recover, or a
peaceful death that the individual could do given that they have the knowledge and strength to
do so.
BIOGRAPHY

 Born in Kansas City, Missouri (March 30, 1897).

 Graduated from Army School of Nursing in Washington, D.C. (1921).
 Graduated from Teachers’ College, Columbia University with a Masters’ Degree
in Nursing Education.
BACKGROUND

 Given the first Christianne Reimann Prize in June 19, 1985 (age 87).
 An honorary member/fellow of the Royal College of Nursing in UK.
 American Nurse Association Hall of Fame.
 Virginia Historical Nurse Leadership Award was given to her in 1988.
FOUR METAPARADIGM IN NURSING

 PERSON
o The patient that requires assistance; the mind and body of patient are
inseparable, and thus have to maintain balance (physiological and
emotional) to function efficiently.
 HEALTH
o The quality of life; requires independence and interdependence. Can be
achieved and/or maintained if they have the adequate strength, will,
and/or knowledge.
 ENVIRONMENT
o Can be controlled if individual if healthy; nurses must be aware of
different customs, beliefs, etc. to access dangers and protect patients
from external forces from injury.
 NURSING
o Nurses function independently from physicians, but promotes plans
prescribed by them; must provide care to from “all walks of life” and
empower patient to obtain independence.
o Must be knowledgeable in both biological and social sciences and have
the ability to assess basic human needs.
NURSE-PATIENT RELATIONSHIP – Three Levels

 Nurse as a Substitute for the Patient

o Nurse acts as a substitute to identify what the patient lacks in terms of
knowledge, will, and strength to bring the patient as complete, whole and
independent as they are.
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 Nurse as a Helper to the Patient

o Nurse aids clients to accomplish basic needs that the patient can’t do to
regain independence as soon as possible.
 Nurse as a Partner with the Patient
o The nurse acts as an advocate and resource person for the patient to
empower them to create and formulate effective decisions and create an
efficient and effective plan together.
RELATIONSHIP TO NURSING PROCESS

 ASSESSMENT PHASE
o The nurse would gather data by observing, smelling, feeling, etc. and will
use critical thinking to analyze every data collected to fully understand the
patient’s condition; assess the 14 fundamental needs of the patient to see
which ones are achieved and which ones are lacking.
 PLANNING PHASE
o Giving the plan of care to meet the patient’s needs and personality;
serves as a record and must also fit the prescribed plan made by the
physician.
 IMPLEMENTATION PHASE
o Performs the activities directed in helping the patient gain their
independence; interventions are focused on maintenance, recovery, or
aid in a peaceful death.
 EVALUATION PHASE
o The nurse and patient review the relationship to see if the goals are met;
nurse should also assess if patient’s independence has been attained
and if health is achieved or not.

THE 14 BASIC HUMAN NEEDS

Breathe normally. Keep the body clean and well groomed

and protects the integument.
Eat and drink adequately. Avoid dangers in the environment and
avoid injuring others.
Eliminate body waste. Communicate with others in expressing
emotions, needs, fears, or opinions.
Move and maintain desirable postures. Worship according to one’s faith.
Sleep and rest. Work in such a way that one feels a
sense of accomplishment.
Select suitable clothes Play or participate in various forms of
recreation.
Maintain body temperature within normal Learn, discover, or satisfy the curiosity
range by adjusting clothing and modifying that leads to normal development and
the environment. health and use of the available health
facilities.
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FAYE GLEN ABDELLAH – 21 Nursing Problems

Faye Glenn Abdellah (March 13, 1919 – February 24, 2017) helped transform nursing
theory, nursing care, and nursing education.
BIOGRAPHY

 Born in New York City, New York, United States (March 13, 1919).
 Worked as a Deputy Surgeon General.
 A former Chief Nurse Officer for the US Public Health Service, Dept. of Health, and
human services in Washington, D.C.
ABDELLAH’S THEORY

 NURSING PROBLEMS
o A condition faced either by the patient or the family, which the nurse can
assist to meet the performance of functioning.
o OVERT (Objective)
a. Apparent or obvious; a condition that can be seen.
o COVERT (Subjective)
a. Concealed or hidden; a condition that can’t be seen instantly.
 TYPOLOGY OF 21 NURSING PROBLEMS
o Identification and classification of the problem.
o Areas of the Nursing Problem
a. Physical, sociological and emotional needs of patient.
b. Types of interpersonal relationship between patient and nurse.
c. Common elements of patient care.
 NURSING PROBLEMS
o PROBLEM SOLVING PROCESS
a. Assessment – Identifying the overt and covert problem
 Interviews, physical assessments, lab results.
b. Diagnosis – Selecting relevant data
 Interpret and analyze problem.
c. Planning – Devising a plausible hypothesis
 Formulation of care plan based on identified problem/s.
d. Implementation – Testing hypothesis through data assortment
 Nursing actions provided to client that leads to solving the
issue/s.
e. Evaluation – Revising hypothesis
 Evaluate client’s response to interventions and compare to
the goal and desired outcome.
 If client’s response is positive, problem is solved.
Otherwise, revise care plan.
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10 STEPS IN IDENTIFYING CLIENT’S PROBLEM/S

1. Learn to know the patient. 6. Validate the patient’s conclusions about

his nursing problems.
2. Sort out relevant and significant data. 7. Continue to observe and evaluate the
patient over a period of time to identify any
attitudes and clues affecting his behavior.
3. Make generalizations about available 8. Explore the patient’s and family’s
data in relation to similar nursing problems reaction to the therapeutic plan and involve
presented by other patients. them in the plan.
4. Identify the therapeutic plan. 9. Identify how the nurses feels about the
patient’s nursing problems.
5. Test generalizations with the patient and 10. Discuss and develop a comprehensive
make additional generalizations. nursing care plan.

TYPOLOGY OF 21 NURSING PROBLEMS

1. To maintain good hygiene and physical 11. To facilitate the maintenance of sensory
comfort. function.
2. To promote optimal activity: exercise, 12. To identify and accept positive and
rest and sleep. negative expressions, feelings, and
reactions.
3. To promote safety through the 13. To identify and accept the
prevention of accidents, injury, or other interrelatedness of emotions and organic
trauma and through the prevention of the illness.
spread of infection.
4. To maintain good body mechanics and 14. To facilitate the maintenance of
prevent and correct deformity. effective verbal and non-verbal
communication.
5. To facilitate the maintenance of a supply 15. To promote the development of
of oxygen to all body cells. productive interpersonal relationships.
6. To facilitate the maintenance of nutrition 16. To facilitate progress toward
of all body cells. achievement of personal spiritual goals.
7. To facilitate the maintenance of 17. To create and / or maintain a
elimination. therapeutic environment.
8. To facilitate the maintenance of fluid and 18. To facilitate awareness of self as an
electrolyte balance. individual with varying physical, emotional,
and developmental needs.
9. To recognize the physiological 19. To accept the optimum possible goals
responses of the body to disease in the light of limitations, physical and
conditions. Emotional.
10. To facilitate the maintenance of 20. To use community resources as an aid
regulatory mechanisms and functions. in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors in the case of illness.
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DOROTHEA OREM – Self Care Theory

Dorothea Orem (July 15, 1914 – June 24, 2007), who introduced the Self Care Theory,
recognized the need to continue in developing a conceptualization of nursing.
BIOGRAPHY

 Born in Baltimore, Maryland, USA (July 15, 1914).

 Earned her Bachelor of Science in Nursing in 1939 and Masters of Science in
Nursing in 1945.
 Worked as a staff nurse, private duty nurse, nurse educator and administrator,
and nurse consultant.
 Published her first formal articulation of her ideas in Nursing: Concepts of
Practice in 1971, 1980, and in 1995.
THEORY OF SELF-CARE

 SELF-CARE
o The practice of activities that an individual does to maintain life, health,
and state of well-being.
 SELF-CARE AGENCY
o The ability to engage in self-care; conditioned by age, developmental
stage, life experience, socio-cultural status, health, etc.
 SELF-CARE REQUISITES
o Actions directed to supply self-care.
 CATEGORIES of SELF-CARE REQUISITES
o Universal Self-Care Requisite – Universally set goals that’s provided to
function in scope of healthy living.

8 SELF-CARE REQUISITES COMMON IN MEN, WOMEN AND

CHILDREN
Maintain sufficient air intake. Maintain balance between activity
and rest.
Maintain sufficient food intake. Maintain balance between solitude
and social interaction.
Maintain sufficient water intake. Prevention of hazard/s to human
life, functioning, and well-being.
Provision of care associated with Promotion of human functioning
elimination. and development.

o Developmental Self-Care Requisite – Provision of conditions that promote

health; prevents the effects of human conditions that may threaten life.
 HEALTH DEVIATION REQUISITES
o Required in conditions of illness, injury and disease. These include:
 Seeking and securing appropriate medical assistance.
 Awareness of and attendance to the effects and results of
pathologic conditions
 Effectively carrying out medical prescribed measures.
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 Learning to live with effects of said conditions.

 THERAPEUTIC SELF-CARE DEMAND
o The summation of all activities needed to aid in the recovery of the patient
from an existing disease/illness.
THEORY of SELF-CARE DEFICIT
Nursing is required when an individual is incapable/limited in the provision of
continuous and effective self-care.

 5 METHODS OF HELPING
o Acting for and doing for others.
o Guiding others.
o Supporting others.
o Provide an environment that encourages personal development to meet
future demands.
o Teaching another.

THEORY OF NURSING SYSTEM

Describes how patient’s self-care need will be met by either the nurse or patient,
or both.

 3 CLASSIFICATIONS OF NURSING SYSTEM

o WHOLLY COMPENSATORY SYSTEM
 Individual is unable to accomplish or engage in self-care
plans/actions that require self-direction.
 They are socially dependent on others for their health and well-
being.
o PARTLY COMPENSATORY SYSTEM
 Both nurse and patient are actively participating in self-care
plans/actions, with either the patient or the nurse taking the major
role in performing said self-care actions.
o SUPPORTIVE– EDUCATIVE SYSTEM (Supportive-developmental)
 Individual can and is able to perform self-care, but has to have
assistance.
 ASSUMPTIONS
o Individuals as well as their family, should be self-reliant and responsible
to their care.
o People are distinct individuals.
o Nursing is a form of action; an interaction between two or more people.
o Successfully meeting universal and developmental self-care plans and
requisites is an integral part of primary care, prevention, and ill health.
o An individual’s knowledge of potential health problems is needed to
encourage and promote self-care behavior/s.
o Self-care and dependent care are behaviors learned within a socio-
cultural context.
 WEAKNESS
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o The use of self-care is in multiple terms.

o Rigid, as the definition of health was confined in three static conditions.
o Limited acknowledgement of the emotional needs of the individual.
 STRENGTHS
o Applicable for nursing, both for beginning practitioners and advanced
clinicians.
o Specifies when nursing is needed: when the individual can’t maintain
amount and quality of self-care continuously to sustain, recover, and/cope
with the current condition of their health.
o Nursing systems are clearly stated and understood.
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JEAN WATSON – The Philosophy and Science of Caring

Jean Watson (June 10, 1940) believes that nursing is on “carative” factors as opposed
curative factors; developing humanistic philosophies and value system.
BIOGRAPHY

 Born in Williamson, West Virginia, USA (June 10, 1940).

 Educated: acquiring a BSN (1964), MS (1966), and PhD (1973) all in the
University of Colorado.
 A distinguished professor of Nursing; founder and holder of Chair in Caring
Science in University of Colorado Health Sciences Center.
 A fellow of the American Academy of nursing.
 Previously served as Dean of Nursing in University Health Sciences Center,
former President of the National League of Nursing.
THE PHILOSOPHY AND SCIENCE OF CARING: Carative Factor
This philosophy provides a solid basis for the science of caring; assertion that
caring stances that nurses always held is threatened by curative factor’s tasks and
technology demands.

SEVEN ASSUMPTIONS
Caring can be effectively demonstrated Caring responses accept a person not
and practiced only interpersonally, only as he/she is now but as what he/she
may become.
Caring consists of carative factors that A caring environment offers the
result in the satisfaction of certain human development of potential while allowing
needs. the person to choose the best action for
himself at a given time.
Effective caring promotes health and Caring is more “healthogenic” than is
individual or family growth. curing. A science of caring is therefore
complementary to the science of curing.
The practice of caring is central to nursing.

1. Formation of Humanistic-Altruistic System of Value

a. Learned early in life, but can be influenced by nurse-educators;
satisfaction through giving and extension of the sense of self.
2. Instillation of Faith-Hope
a. Facilitates promotion of holistic care and positive health within patient’s
population, promotes wellness by helping patient adopt health-seeking
behavior.
3. Cultivation of Sensitivity to Self and Others
a. Recognition of feelings that lead to stabilization through self-acceptance
for both patient and nurse.
4. Development of a Helping-Trust Relationship
a. Promotes and accepts negative and positive emotions and feelings.
i. Congruence – Honest, genuine and authentic.
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ii. Empathy – Ability to understand other’s perceptions and

communicate said understandings.
iii. Non-possessive Warmth – sensitivity, friendliness, and
consideration; demonstrated by moderate speaking volume,
relaxed and open posture, etc.
iv. Effective Communication – Cognitive, affective and behavior
response components.
5. Promotion and Acceptance of Positive and Negative Feelings
a. Sharing of feelings – risk-taking experience for both patient and nurse.
6. Systematic use of Scientific Problem-Solving Method for Decision Making
a. Use of the nursing process brings scientific problem-solving approach to
nursing care.
7. Promotion of Interpersonal Teaching-Learning
a. Separates care for cure; allows patient to be informed and shifts
responsibility for wellness and health to patient.
8. Provision for Supportive, Protective, and Corrective Mental, Physical
a. Recognize influence that internal and external environment have on
health and illness.
9. Assistance with Gratification of Human Needs
a. Recognizes biophysical, psychophysical and intrapersonal needs of self
and patient; attempt to attain low-order needs before high-order needs.
10. Allowance for Existential Phenomenological Forces
a. A way of understanding people from the way they perceive things to be
(their frame of reference).
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JOYCE TRAVELBEE – Human to Human Relationship

Joyce Travelbee (1926 – 1973) believed that nursing needed a humanistic revolution;
focusing back on the caring aspect towards the ill.
BIOGRAPHY

 Born in New Orleans, Louisiana, USA (1926).

 Attained BSN in 1954 at Louisiana State University and MSN in 1959 at Yale
University.
 1952: Started as an instructor focusing on psychiatric nursing.
 1966: Published her first book (Interpersonal Aspects of Nursing).
 1969: Published her second book (Intervention in Psychiatric Nursing: Process
in the One-to-One Relationship).
4 METAPARADIGM IN NURSING

PERSON ENVIRONMENT
 Defined as human being.  Associates illness, pain or
 Unique, irreplaceable individual in suffering to environment (unclear
continuous process of becoming, definition).
evolving and changing.
HEALTH NURSING
 Measured by subjective and  Interpersonal process; nurse
objective health. assists an individual, family or
 Subjective Health: individually- community to prevent/cope with
defined state of well-being experience of illness, find meaning
 Objective Health – absence of in said experiences if necessary.
disease, disability or defect
measured by physical
examination, lab test, etc.

INTERACTIONAL PHASES
1. ORIGINAL ENCOUNTER
a. Initial interaction between nurse and patient.
2. EMERGING IDENTITIES
a. Characterized by nurse and patient perceiving each other as unique
individuals.
3. EMPATHY
a. Ability to co-experience and relate to individual’s thoughts, emotions, or
experiences without direct communication.
4. SYMPATHY
a. Ability to understand and extend support patient’s emotional situation or
experience with compassion and sensitivity.
5. RAPPORT
a. Relationship formed by mutual trust or emotional affinity.
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KEY THEORETICAL CONCEPTS

Illness Interaction
Suffering Empathy
Pain Sympathy
Hope Raport
Communication Therapeutic Use-of-Self

THERAPEUTIC USE-OF-SELF
The ability to use one’s personality consciously (in full awareness) to establish
relatedness and to nurture nursing intervention
REQUIREMENTS

 Self-insight.
 Self-understanding.
 An understanding dynamics of human behavior.
 Ability to interpret one’s own behavior and others.
 Ability to intervene effectively in nursing situations.
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