THEORETICAL FOUNDATION OF NURSING

NURSING THEORIES AND HISTORY

THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

VIRGINIA HENDERSON
HEALTH
14 BASIC HUMAN NEEDS THEORY  a quality of life and is very basic to function
fully( requires health independence and
The nurse is temporarily the interdependence ).
consciousness of the unconscious,
the love of life for the suicidal, the leg ENVIRONMENT
of the amputee, the eyes of the newly  It is important to control, but as illness occurs,
blind, a means of locomotion for the this ability is diminished or affected in caring for
infant, knowledge and confidence for the sick. It is the responsibility of the nurse to
the mother, the mouthpiece for those help the patient manage his surroundings to
too weak or withdrawn to speak and protect him from any harm or any mechanical
so – on. “ injury.

BIOGRAPHY NURSING
 The nurse must be knowledgeable in both
 “First Lady of Nursing” biological and social sciences and must have
 “First Truly International Nurse” the ability to assess basic human needs as the
 She began her career in Public Health Nursing signature of the profession that coincides with
( Henry St. Settlement and in the visiting Nurse Henderson’s definition of nursing. Nurses
Service in Washington D.C. should function independently from the
 She was the first full time instructor in nursing physician but they must promote the treatment
( Virginia ) plan prescribed by the physician.
 She designed a plan to create district organizations
within the state. 14 BASIC NEEDS
14 BASIC HUMAN NEEDS
 An early advocate for the introduction of Psychiatric
Nursing in the curriculum and served on a  Breathe normally. Eat and drink adequately.
committee to develop such a course at Eastern  Eliminate body wastes.
State Hospital in Williamsburg Virginia in 1929  Move and maintain desirable postures.
 An outstanding teacher at Teachers College  Sleep and rest.
Columbia university.  Select suitable clothes-dress and undress.
 At the age of 75, she directed her career to  Maintain body temperature within normal
international teaching and speaking. range by adjusting clothing and modifying
 Honorary degree from thirteen universities. environment
 American Nurses Association (ANA) Hall of fame  Keep the body clean and well groomed and
and had a Sigma Theta Tau International Library protect the integument
named in her honor.
 Avoid dangers in the environment and avoid
 Haloran,a nurse theorist wrote: “Henderson was to
injuring others.
the Twentieth Century as Florence Nightingale was
 Communicate with others in expressing
to the Nineteenth.”
emotions, needs, fears, or opinions.
 Died: March 19, 1996.
 Worship according to one’s faith.
 In 1939, she revised: Harmer’s classic textbook of
nursing for its 4th edition, and later wrote the 5th;  Work in such a way that there is a sense of
edition, incorporating her personal definition of accomplishment.
nursing (Henderson,1991)  Play or participate in various forms of
recreation.
 Learn, discover, or satisfy the
METAPARADIGM curiosity that leads to normal
PERSON development and health and use
 Referred to as a person as a patient the available health facilities.
who requires an assistance to achieve
health and independence or in some
cases a peaceful death.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

The first 9 components are physiological. The tenth and

fourteenth are psychological aspects of communicating
and learning. The eleventh component is spiritual and
moral The twelfth and thirteenth components are
sociologically oriented to occupation and recreation

NURSES SPECIFIC ROLES AND RESPONSIBILIITIES

THE NURSE-PATIENT RELATIONSHIP

Nursing Process Henderson’s 14 components and definition of nursing

Nursing Assessment Henderson’s 14 components
Nursing Diagnosis Analysis: Compare data to knowledge base of health and disease.
Nursing plan Identify individual’s ability to meet own needs with or without assistance, taking into
consideration strength, will or knowledge.
Nursing Document how the nurse can assist the individual, sick or well.
implementation
Nursing Assist the sick or well individual in to performance of activities in meeting human needs to maintain
implementation health, recover from illness, or to aid in peaceful death.
Nursing process Implementation based on the physiological principles, age, cultural background, emotional balance, and
physical and intellectual capacities.
Carry out treatment prescribed by the physician.
Nursing evaluation Henderson’s 14 components and definition of nursing
Use the acceptable definition of nursing and appropriate laws related to the practice of nursing.
The quality of care is drastically affected by the preparation and native ability of the nursing
personnel rather that the number of hours of care.
Successful outcomes of nursing care are based on the speed with which or degree to which the patient
performs independently the activities of daily living
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

Maslow's
Breathe normally
Physiological needs Eat and drink adequately Eliminate by all avenues of elimination Move and maintain desirable posture
Sleep and rest Select suitable clothing Maintain body temperature Keep body clean and well-groomed
and protect the integument
Safety Needs Avoid environmental dangers and avoid injuring other
Belongingness and Communicate with others worship
love needs according to one's faith
Work at something providing a sense of accomplishment
Esteem needs Play or participate in various forms of recreation
Learn, discover, or satisfy curiosity

ACCEPTANCE / CONTRIBUTIONS

PRACTICE
- Nurses as direct caregiver help patients to become
independent.
EDUCATION
- Nurse’s education demands universal
understanding of diverse human being.
- Designed three phases of curriculum development
RESEARCH
- Recommended library research.
- Advocated research as a way to improve practice.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

H Promotion in Nursing Practice

E has served as a member of a number of
A organizations.
L She is also a co-founder of the Midwest
T Nursing Research Society, and currently
H serves as a trustee. She is currently a
professor emerita in the Division of Health
P
Promotion and Risk Reduction at the
R
University of Michigan School of Nursing, and
O
M serves as a Distinguished Professor at Loyola
O University Chicago’s School of Nursing.
T She is currently retired, and spends her
I time consulting on health promotion
O research nationally and internationally.
N
METAPARADIGM
M
O
PERSON
D
E
L is a biophysical organism shaped by the
b environment, but also seeks to create an
y environment in which human potential can be
fully expressed.
N Because of this, the
O relationship between person
L and environment is reciprocal.
A Individual characteristics and
life experiences shape
P behaviors
E
N ENVIRONMENT
D
E is described as the social, cultural, and
R physical context in which life unfolds. It can
be manipulated by the individual to create a
August 16, 1941 (age 81 years), Lansing, positive context of cues and facilitators for
Michigan, United States health-enhancing behaviors.
attended Michigan State University to earn her
bachelor and master’s degrees in 1964 and 1965,
NURSING
respectively.
She earned her Ph.D. from Northwestern
University in 1969. is a collaboration among patients, families,
She received a Lifetime Achievement and communities to create the best
Award from the Midwest Nursing conditions for the expression of optimal
Research Society in 2005. She was health and high-level well-being.
awarded an honorary doctorate of
science degree in 1992 from Widener HEALTH
University.
She was given a Distinguished Alumni is defined as the actualization of human
Award from the Michigan State University potential through goal-directed behavior, self-
School of Nursing in 1972. care, and relationships with others with
She has many publications in a variety of texts necessary adjustments made to maintain
and journals, including sixth edition Health relevant environments. Illnesses are discrete
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

events in the life that can hinder or facilitate

the patient’s continuing quest for health.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

The model focuses on following three areas; s

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o  The health promotion model notes that
r each person has unique personal
-
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

characteristics and experiences that affect

subsequent actions.
 The set of variables for behavioral specific
knowledge and affect have important motivational
significance.
 These variables can be modified through nursing
actions.
 Health promoting behavior is the desired
behavioral outcome and is the end point in the
HPM.
 Health promoting behaviors should result in
improved health, enhanced functional ability
and better quality of life at all stages of
development.
 The final behavioral demand is also
influenced by the immediate competing
demand and preferences, which can derail
an intended health promoting actions.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

Individual characteristics and experiences

The first category explores the concept that

each individual has his or her own set of
characteristics and experiences, which in turn
help shape their actions. Pender emphasized
that one’s past actions have a direct link to
whether they would partake in future health-
promoting behaviours. Personal attributes and
habits can also be a barrier to health-
promoting behaviours.

Behavior-specific cognitions and affect

The second category involves the behaviour-

specific cognitions and affect which have a
direct impact on the individual’s motivation for
change. Nursing interventions can be tailored
to these variables to assist in forming positive
changes. Variables include; the observed
benefits and barriers to the action, self-worth,
and the activity- related result.

Behavioral outcomes
The third category is the behavioural
outcome. The start of the outcome begins
with the person committing to taking the
steps necessary to make a change. During
this phase the individual must be supported
with barriers addressed in order to produce a
positive health-promoting behaviour. The
goal of the health promotion model is to
stimulate a behavioural change that results in
a positive health outcome.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

T -She merited her Bachelor of Science degree from

R Benedictine College Atchison,Kansas in 1953.
A -Obtained her masters of
N Science (Doctor of
S Philosophy) in Anthropology
C from the University of
U Washington,Seattle.
-One of the first nursing theorist and transcultural global
L
nursing consultants.
T
-Developed the concept of transcultural nursing and the
U
ethno nursing research model.
R
-Her theory has now developed as a discipline in
A
nursing.
L -Evolution of her theory can be understood from her
books:
T A. Culture Care Diversity and Universality (1991)
H B. Transcultur
E al nursing
O theory is also
R known as
Y Culture Care
b theory.
y C.Theoretical
framework is
M depicted in
A her model
D called the
E Sunrise
L Model (1997)
E
I METAPARADIGM
N
E PERSON–Humans are thus believed to be
caring and capable of being concerned
L about the desires, welfare and continued
E existence of others.Human care is
I collective.(culture dependent)
N
I ENVIRONMENT – The totality of an
N event, situation or experience. Her
G description of culture centers on a
E particular group (society) and the
R patterning of actions, thoughts and
decisions that occurs as the result of
‘”Care is the heart of nursing. Care is power. Care is learned, shared and transmitted values,
essential to healing. Care is curing and Care is the norms, beliefs and lifeways.
central and dominant focus of nursing and transcultural
HEALTH –Health is universal. Discussed
nursing decisions and actions.”
components: Health systems, health care
practices, changing health patterns,
BIOGRAPHY:
health promotions and health
maintenance.
-She is considered as the founder of the theory of
transcultural nursing.
NURSING – Showed her concern to
-She obtained her basic nursing
nurses who do not have sufficient
education at St. Anthony School
preparation for a transcultural
of Nursing, Denver, Colorado
perspective. For that reason they will not
and graduated in 1948.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

value nor practice such viewpoint to the

fullest extent possible.

-Transcultural nursing is a comparative

study of cultures to understand
similarities (culture universal) and
difference (culture-specific) across
human groups (Leininger, 1991).
Culture
-Set of values, beliefs and traditions,
that are held by a specific group of
people and handed down from
generation to generation.
-Culture is also beliefs, habits, likes, dislikes, customs
and rituals learn from one’s family.
-Culture is the learned, shared
and transmitted values, beliefs,
norms and life way practices of
a particular group that guide
thinking, decisions, and actions
in patterned ways.
-Culture is learned by each generation through both
formal and informal life experiences.
-Language is primary through means of transmitting
culture.
-The practices of particular culture often arise because
of the group's social and physical environment.
-Culture practice and beliefs are
adapted over time but they mainly
remain constant as long as they satisfy
needs.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

* A key component of Leininger’s theory unfamiliarity, and incompatibility to

is that of refers to cultural diversity this the stranger's perceptions and
the differences or variations that can be expectations at is differentiated
found both between end among different from others by symbolic markers
cultures. By recognizing the variations, (cultures, biology, territory,
the nurse can avoid the problem of religion).
stereotyping -Ethnic groups share a common social and cultural
(using general standards) and assuming heritage that is passed on to successive generations.,
that all people will reach to the same -Ethnic identity refers to a subjective
nursing care. A similar concept is that of perspective of the person's heritage and to
culture universality , the opposite of a sense of belonging to a group that is
diversity, which refers to the distinguishable from other groups.
commonalities that exist in different -Race the classification of people
culture. These ideas have led to an according to shared biologic
important achievement of the theory – characteristics, genetic markers, or
that is” to discover similarities and features. Not all people of the same race
differences about care and it’s impact on have the same culture.
the health and well being of groups. -Cultural awareness It is an in-depth
self-examination of one's own
-Religion Is a set of belief in a divine or background, recognizing biases and
super human power (or powers) to be prejudices and assumptions about
obeyed and worshipped as the creator other people.
and ruler of the universe. -Culturally congruent care Care that
-Ethnic refers to a group of people who fits the people's valued life patterns
share a common and distinctive culture and set of meanings -which is
and who are members of a specific generated from the people
group. themselves, rather than based on
-Ethnicity a consciousness of belonging to a group. predetermined criteria.
-Cultural -Identify the sense of being part of an ethnic Culturally competent care is the
group or culture ability of the practitioner to bridge
-Culture-universals commonalities cultural gaps in caring, work with
of values, norms of behaviour, cultural differences and enable
and life patterns that are similar clients and families to achieve
among different cultures. meaningful and supportive caring.
-Culture-specifies values, beliefs, and patterns of
behaviour that tend to be unique to a designate culture. Nursing Decisions
-Material culture refers to objects (dress, art, religious Leininger (1991) identified three nursing decision and
arti1acts) action modes to achieve culturally congruent care.
-Non-material culture refers to beliefs customs,
languages, social institutions. C
-Subculture composed of people who have a distinct u
identity but are related to a larger cultural group. l
-Bicultural a person who crosses two cultures, lifestyles, t
and sets of values. u
-Diversity refers to the fact or state of r
being different. Diversity can occur a
between cultures and within a cultural l
group.
-Acculturation People of a minority p
group tend to assume the attitudes, r
values, beliefs, find practices of the e
dominant society resulting in a blended s
cultural pattern. e
-Cultural shock the state of being r
disoriented or unable to respond to v
a different cultural environment a
because of its sudden strangeness, t
i
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

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THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

MAJOR CONCEPTS AND DEFINITIONS features of interrelated structural and

organizational factors of a particular
Care refers to abstract and concrete
culture (subculture or society) which
phenomena related to assisting,
includes religious, kinship (social),
supporting or enabling experiences or
political (and legal), economic,
behaviours toward or for others with
educational, technologic and cultural
evident or anticipated to ameliorate or
values and ethnohistorical factors, and
improve a human condition or lifeway.
how these factors may be interrelated
Caring refers to actions and activities and function to influence human behavior
directed toward assisting, supporting, or in different environmental contexts
enabling another individual or group with
evident or anticipated needs to Environmental context refers to the
ameliorate or improve a human condition totality of an event, situation or
or lifeway, or to face death particular experiences that give
meaning to human expressions,
Culture refers to the learned, shared interpretations, and social
and transmitted values, beliefs, interactions in particular physical,
norms and lifeways of a particular ecological, socio-political and/ or
group that guides their thinking, cultural settings.
decisions and actions in patterned
ways Ethnohistory refers to those past facts,
events, instances and experiences of
Cultural care refers to the subjectively individual, groups, cultures and
and objectively learned and transmitted institutions that are primarily people-
values, beliefs and patterned lifeways that centered (ethno) and that describe,
assist, support, facilitate, or enable explain, and interpret human lifeways
another individual or group to maintain within particular cultural contexts and
their well- being, health, to improve their over short or long periods of time
human condition and lifeway, or to deal
with illness, handicaps, or death Generic (folk or lay) care system refer
to culturally learned and transmitted,
Cultural care diversity refers to the indigenous (or traditional ), folk (home
variabilities and/ or differences in based) knowledge and skills used to
meanings, patterns, values, lifeways, or provide assistive, supportive, enabling
symbols of care within or between or facilitative acts toward or for another
collectivities that are related to assistive, individual, group or institution with
supportive or enabling human care evident or anticipated needs to
expressions ameliorate or improve a human lifeway
or health condition (or well-being) or to
Nursing refers to a learned humanistic deal with handicaps and death
and scientific profession and discipline situations
which is focused on human care
phenomena and activities in order to Professional care system(s) refers to
assist, support, facilitate, or enable formally taught, learned and
individuals or groups to maintain or transmitted professional care, health,
regain their well-being (or health) in illness, wellness and related knowledge
culturally meaningful and beneficial and practice skills that prevail in
ways, or to help people face handicaps professional institutions usually with
or death multidisciplinary personnel to serve
consumers
Worldview refers to the way people
tend to look out on the world or their
universe to form a picture or a value
stance about their life or world
around them

Cultural and social structure dimensions

refers to the dynamic patterns and
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

Health refers to a state of well-being background knowledge to

that is culturally defined, valued and understand nursing
practiced, and that reflects the ability of phenomena.
individuals (or groups) to perform their
daily role activities in culturally EDUCATION – Helps produced a
expressed, beneficial, and patterned well-qualified faculty prepared in
lifeways Transcultural Nursing to teach and
guide students.
Cultural care preservation or -Educator in transcultural Nursing leads
maintenance refers to those assistive, to culturally competent nursing care.
supporting, facilitative or enabling
professional actions and decisions that RESEARCH-Focused on culture care
help people of a particular culture to -With research method of (ethnonursing) to examine
retain and/or preserve relevant care theories.
values so that they can maintain their
well-being, recover from illness, or face
handicaps and/or death

Cultural care accommodation or

negotiation refers to those assistive,
supporting, facilitative or enabling
creative professional actions and
decisions that help people of a
designated culture to adapt to, or to
negotiate with, others for a beneficial or
satisfying health outcome with
professional care providers

Cultural care repatterning or restructuring

refers to those assistive, supportive,
facilitative or enabling professional
actions and decisions that help clients
reorder, change or greatly modify their
life ways for new, different and beneficial
health acre pattern while respecting the
client’s cultural values and beliefs and
still providing a beneficial, healthier
lifeway than before the changes were co-
established with the client

Cultural congruent (nursing) care refers

to those cognitively based assistive,
supportive, facilitative, or enabling acts
or decisions that are tailor made to fit
the individual, group or institutional
cultural values, beliefs and life ways in
order to provide or support meaningful
beneficial and satisfying health care or
well- being services.

APPLICATIONS / CONTRIBUTIONS

PRACTICE – Prepares nurses to

prevent culture shock and conflicts
as they practice in different places
with different cultures.
- Provides human care and
health behaviours as
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

lifeway than before the changes were co-

established with the client

Cultural congruent (nursing) care refers

to those cognitively based assistive,
supportive, facilitative, or enabling acts
or decisions that are tailor made to fit
the individual, group or institutional
cultural values, beliefs and life ways in
order to provide or support meaningful
beneficial and satisfying health care or
well- being services.

Cultural care preservation or

maintenance refers to those assistive,
supporting, facilitative or enabling
professional actions and decisions that
help people of a particular culture to
retain and/or preserve relevant care
values so that they can maintain their
well-being, recover from illness, or
face handicaps and/or death

Cultural care accommodation or

negotiation refers to those assistive,
supporting, facilitative or enabling
creative professional actions and
decisions that help people of a
designated culture to adapt to, or to
negotiate with, others for a beneficial or
satisfying health outcome with
professional care providers

Cultural care repatterning or restructuring

refers to those assistive, supportive,
facilitative or enabling professional
actions and decisions that help clients
reorder, change or greatly modify their
life ways for new, different and beneficial
health care pattern while respecting the
client’s cultural values and beliefs and
still providing a beneficial, healthier
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

MAJOR CONCEPTS [Leininger (1991)]

Illness and wellness are shaped by a

various factors including perception
and coping skills, as well as the social
level of the patient.
Cultural competence is an important component of
nursing.
Culture influences all spheres of human
life. It defines health, illness, and the
search for relief from disease or distress.
Religious and Cultural knowledge is an important
ingredient in health care.
The health concepts held by many
cultural groups may result in people
choosing not to seek modern medical
treatment procedures.
Health care provider need to be flexible in
the design of programs, policies, and
services to meet the needs and concerns of
the culturally diverse population, groups
that are likely to be encountered.
Most cases of lay illness have multiple
causalities and may require several
different approaches to diagnosis,
treatment, and cure including folk and
Western medical interventions..
The use of traditional or alternate models
of health care delivery is widely varied
and may come into conflict with Western
models of health care practice.
Culture guides behavior into
acceptable ways for the people in a
specific group as such culture
originates and develops within the
social structure through inter personal
interactions.
For a nurse to successfully provide care for a client
of a different cultural or ethnic to background,
effective intercultural communication must take
place.

APPLICATION TO NURSING

To develop understanding, respect

and appreciation for the individuality
and diversity of patients beliefs,
values, spirituality and culture
regarding illness, its meaning, cause,
treatment, and outcome.
To encourage in developing and
maintaining a program of
physical, emotional and spiritual
self-care introduce therapies
such as ayurveda and pancha
karma.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

HealthAsExpandingConsciousness
MargaretNewman

“Health is the expansion of consciousness.” - Newman, 1983

INTRODUCTION

 The theory of health as expanding consciousness stems from Rogers' theory of unitary human beings.
 The theory of health as expanding consciousness was stimulated by concern for those
as the absence of disease or disability is not possible, (Newman,
 The theory has progressed to include the health of all persons regardless of the presence
disease, (Newman, 2010).
 The theory asserts that every person in every situation, no matter how disordered and hopeless it may
seem, is part of the universal process of expanding consciousness – a process of becoming more of
oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other
people and the world, (Newman, 2010).

BACKGROUND OF THE THEORIST

 Born on October 10, 1933.

 Bachelor’s degree - University of Tennessee in 1962
 Master’s degree - University of California in 1964
 Doctorate - New York University in 1971
 She has worked in - University of Tennessee, New York University, Pennsylvania
University of Minnesota, University of Minnesota

THEORY DEVELOPMENT

She was influenced by following theorists:

 Martha Rogers
o Martha Roger’s theory of Unitary Human Beings was the main basis of
development of her theory, Health as Expanding Consciousness
 Itzhak Bentov – The concept of evolution of consciousness
 Arthur Young – The Theory of Process
 David Bohm – The Theory of Implicate

ASSUMPTIONS

1. Health encompasses conditions heretofore described as illness, or, in medical

2. These pathological conditions can be considered a manifestation of the total pattern of the individual
3. The pattern of the individual that eventually manifests itself as pathology is primary
structural or functional changes
4. Removal of the pathology in itself will not change the pattern of the
5. If becoming ill is the only way an individual's pattern can manifest itself, then that is
6. Health is an expansion of consciousness.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

DESCRIPTION OF THE THEORY  Newman also redefines

nursing according to her
 “The theory of health as nursing is the process of
expanding consciousness (HEC) recognizing the individual in
was stimulated by concern for relation to environment and it is
those for whom health as the the process of understanding
absence of disease or disability of consciousness.
is not possible. Nurses often  The nurse helps to understand
relate to such people: people people to use the power within
facing the uncertainty, to develop the higher level of
debilitation, loss and eventual consciousness.
death associated with chronic  Thus it helps to realize the disease process, its
illness. The theory has recovery and prevention.
progressed to include the health  Newman also explains the interrelatedness of
of all persons regardless of the time, space and movement.
presence or absence of disease.  Time and space are
The theory asserts that every the temporal pattern of
person in every situation, no the individual, both
matter how disordered and have complementary
hopeless it may seem, is part of relationship.
the universal process of  Humans are constantly
expanding consciousness – a changing through time and
process of becoming more of space and it shows unique
oneself, of finding greater pattern of reality.
meaning in life, and of reaching
new dimensions of NURSING PARADIGMS
connectedness with other
people and the world” (Newman, Health
2010).
 Humans are open to the  “Health and illness are
whole energy system of the synthesized as health - the
universe and constantly fusion on one state of being
interacting with the energy. (disease) with its opposite
With this process of (non-disease) results in
interaction humans are what can be regarded as
evolving their individual health”.
pattern of whole.
 According to Nursing
Newman
understanding  Nursing is “caring in the human health
the pattern is experience”.
essential. The  Nursing is seen as a
expanding partnership between the nurse
consciousness and client, with both grow in the
is the pattern “sense of higher levels of
recognition. consciousness”
 The manifestation of disease
depends on the pattern of
individual so the pathology of
the diseases exists before
the symptoms appear so
removal of disease
symptoms does not change
the individual structure.
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

Human

 “The human is unitary, that is cannot be divided

into parts, and is inseparable from the
larger unitary field”
 “Persons as individuals, and
human beings as a species
are identified by their patterns
of consciousness”…
 “The person does not possess consciousness-
the person is consciousness”.
 Persons are “centers of consciousness” within
an overall pattern of expanding
consciousness”

Environment

 Environment is described as a “universe of

open systems”

STRENGTHS AND WEAKNESSES

Strengths

 Can be applied in any setting

 “Generates caring interventions”

Weaknesses

 Abstract
 Multi-dimensional
 Qualitative
 Little discussion on environment
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

NursingProcessTheoryby
IDA ORLANDO

INTRODUCTION

About the Theorist

 Ida Jean Orlando - born in 1926.

 wrote about the nursing process.
 Nursing diploma - New York Medical College
 BS in public health nursing - St. John's University, NY,
 MA in mental health nursing - Columbia University, New York.
 Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental
Nursing.
 Project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a
Basic Nursing Curriculum.
 published in her 1961 book, The Dynamic Nurse-Patient Relationship and revised 1972 book: The Discipline and
Teaching of Nursing Processes
 A board member of Harvard Community Health Plan.

MajorDimensions

 The role of the nurse is to find out and meet the patient's immediate need for
 The patient's presenting behavior may be a plea for help, however, the help needed may not be what it appears to
 Therefore, nurses need to use their perception, thoughts about the perception, or the feeling
thoughts to explore with patients the meaning of their behavior.
 This process helps nurse find out the nature of the distress and what help the patient

METAPARADIGMP

ERSON
Human being – developmental beings with needs, individuals have their own subjective perceptions and
feelings that may not be observable directly

ENVIRONMENT
not defined directly but implicitly in the immediate context for a patient.

NURSING
is responsive to individuals who suffer or anticipate a sense of helplessness.
Goal:
increased sense of well being, increase in ability, adequacy in better care of self and improvement in patients behavior
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

HEALTH
S
e o
n
s f
e

o
f c

a o
d
e m
q
u f
a
c o
y
r
o
r t

w
e
l T
l
E
b
e R
i
n M
g
S
F
u :
l
f Distress is
i the
l experience
l of a patient
e whose need
d has not
been met.
n Nursing role
e is to
e discover
d and meet
s the patient’s
. immediate
S need for
help.
e Patient’s
behavior
n may not
represent
s the true
need.
e The nurse
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

validates his/her i
understanding z
of the need with i
the patient. n
Nursing actions g
directly or
indirectly p
provide for the r
patient’s i
immediate n
need. c
An outcome is a change in the behavior of the i
patient indicating either a relief from distress or p
an unmet need. l
Observable verbally and nonverbally. e

CONCEPTS P
r
F e
u s
n e
c n
t t
i i
o n
n g

o b
f e
h
p a
r v
o i
f o
e r
s
s -
i
o p
n r
a o
l b
l
n e
u m
r a
s t
i i
n c
g
s
- i
t
o u
r a
g t
a i
n o
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

n s
I c
m i
m p
e l
d i
i n
a e
t
e –

r i
e n
a v
c e
t s
i t
o i
n g
a
- t
i
i o
n n
t
e I
r m
n p
a r
l o
v
r e
e m
s e
p n
o t
n
s –
e
r
N e
u s
r o
s l
i u
n t
g i
o
p n
r
o FUNCTION OF PROFESSIONALNURSING-ORGANIZING
c PRINCIPLE
e
s Finding out and meeting the patients immediate
s needs for help
"Nursing….is responsive to individuals who
d suffer or anticipate a sense of helplessness, it is
i focused on the process of care in an immediate
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

experience, it is concerned with providing direct a

assistance to individuals in whatever setting they u
are found for the purpose of avoiding, relieving, t
diminishing or curing the individuals sense of o
helplessness." – Orlando m
a
PRESENTING BEHAVIOR-PROBLEMATIC SITUATION t
i
To find out the immediate need for help the nurse c
must first recognize the situation as problematic
The presenting behavior of the patient, f
regardless of the form in which it appears, e
may represent a plea for help e
The presenting behavior of the patient, the l
stimulus, causes an automatic internal i
response in the nurse, and the nurses behavior n
causes a response in the patient g

IMMEDIATE REACTION-INTERNAL RES T

PONSE h
Person e
perceives n
with any one
of his five t
sense organs h
an object or e
objects The
perceptions p
stimulate e
automatic r
thought s
E o
a n
c
h a
c
t t
h s
o The first three items taken together are defined as
u the person’s immediate reaction
g
h
t

s
t
i
m
u
l
a
t
e
s

a
n
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

NURSING PROCESS DISCIPLINE-INVESTIGATION s

Any observation shared and explored with the –

patient is immediately useful in ascertaining
and meeting his need or finding out that he is t
not in need at that time h
The nurse does not assume that any aspect of e
her reaction to the patient is correct, helpful or
appropriate until she checks the validity of it in i
exploration with the patient n
The nurse initiates a process of exploration to t
ascertain how the patient is affected by what e
she says or does . r
When the nurse does not explore with the a
patient her reaction it seems reasonably c
certain that clear communication between t
them stops i
o
n
IMPROVEMENT- RESOLUTION
It is not the nurses activity that is evaluated
o
but rather its result : whether the activity
f
serves to help the patient communicate her or
his need for help and how it is met.
1
)
In each contact the nurse t
h
repeats a process of learning how to e

help the individual patient DOMAIN b

e
CONCEPTS h
Process of care in an immediate experience….. for a
avoiding, relieving, diminishing or curing the v
individuals sense of helplessness. Finding out i
meeting the patients immediate need for help. o
Nursing client – patients who are under medical r
care and who cannot deal with their needs or
who cannot carry out medical treatment alone o
Nursing problem – distress due to unmet f
needs due to physical limitations, adverse
reactions to the setting or experiences t
which prevent the patient from h
communicating his needs e
N
u p
r a
s t
i i
n e
g n
t
p ,
r 2) the reaction of the nurse and
o 3)the nursing actions which are assigned for the
c patients benefit
e Nurse – patient relations – central in theory
s and not differentiated from nursing
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

therapeutics or nursing process t

Nursing therapeutics – Direct function : i
initiates a process of helping the patient v
express the specific meaning of his e
behavior in order to ascertain his distress
and helps the patient explore the distress in –
order to ascertain the help he requires so
that his distress may be relieved. o
Indirect function – calling for help of others , u
whatever help the patient may require for his t
need to be met Nursing therapeutics - s
Disciplined and professional activities – i
automatic activities plus matching of verbal and d
nonverbal responses, validation of perceptions, e
matching of thoughts and feelings with action ,
Automatic activities – perception by five senses,
automatic thoughts, automatic feeling, action e
v
NURSING PROCESS - EXAMPLE i
A d
s e
s n
e c
s e
s s
m ,
e
n o
t b
s
S e
u r
b v
j a
e b
c l
t e
i
v N
e u
r
c s
u i
e n
s g
-
d
i i
n a
s g
i n
d o
e s
O i
b s
j -
e e.g. Fever,( alterations in body temperature)
c Actual -39- after up & down –potential –high risk-
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

wellness- 37 - syndrome
Planning – goal; After 2 hours of nrsg intervention the
client’s body temperature would be normalized
from 39 - 37
Implementation- nursing interventions-tepid sponge
bath
Evaluation- After 2 hours of nrsg intervention the
client’s body temperature was able to normalize from
39
– 37-
goal met 11am- T = 36.9(body temperature
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

TECHNOLOGICA
L COMPETENCY To illustrate the
AS CARING harmonious co-
b existence between
y technology and caring
in nursing. To place
R nursing in the context of
O modern healthcare
Z Technology brings the patient closer
Z to the nurse. Conversely, technology
A can also increase the gap & between
N the NURSE & and the NURSED.
O
The Process of Nursing
L
O
C A. KNOWING
S B. DESIGNING
I C. PARTICIPATION IN APPRECIATION
N D. VERIFYING KNOWLEDGE

Knowing persons is a process of

nursing that allows for
continuous appreciation of
persons moment to moment
(Locsin,2005).

Technology is use to now wholeness of

persons moment to moment (Locsin,2004).
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

I4NOWING PERSONS: Frameworlc for Nursing

Calls and responses between the niimi•

nursed
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

METAPARADIGM

PERSON
Patients seen as “participants in their care
rather than object of nurse care” (Locsin,20-
7).

ENVIRONMENT
Technological world in which we live

NURSING
“Nurses value technological competency as
an expression of caring in nursing” (Locsin,
2013)
HEALTH
Humanity is preserved by technology.
“An experience that is often expressed in
terms of wellness and illness, and may
occur in the
presence or absence of disease” (Nursing
Scope and Standards of Practice, 2010, p.
65)
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

H b
U e
M ,
A
N h
e
N
E
E m
D u
S s
t
T
H b
E e
O ”
R (
Y 1
b
9
y
0
A
B 8
R -
A 1
H 9
A 7
M 0
)
H
A
Born April 1, 1908 in Brooklyn, New York
R
O He first studied law at the City College of
L New York (CCNY) and after three semesters,
D he transferred to Cornell, and then back to
CCNY
M He received his BA in 1930, his MA in 1931,
A and his PhD in 1934, all in psychology, all from
S the University of Wisconsin
L He began teaching full time at Brooklyn College.
O Maslow served as the chair of the psychology
W department at Brandeis from 1951 to 1969.
“ He met Kurt Goldstein, who had
W originated the idea of self-
h actualization in his famous book, The
Organism (1934).
a
He spend his final years in semi-retirement in
t
California, until, on June 8 1970, he died of a
heart attack after years of ill health.
a

m
ASSUMPTIONS
a
n People’s behaviour is based on their needs
A satisfied need does not motivate
c A
a
n s
a
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

t s
i
s s
f a
i t
e i
d s
f
n i
e e
e d
d ,

c a
a n
n o
t
n h
o e
r
l
o r
n e
g p
e l
r a
c
m e
o s
t
i i
v t
a
t
e

p
e
r
s
o
n

A
s

o
n
e

n
e
e
d

i
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

o
r
d
e
r
,

a
n
d

p
h
y
s
i
c
a
l

Physiological needs - these are biological s

requirements for human survival, oxygen, food, a
water, shelter, clothing, sleep. f
S e
a t
f y
e .
t
y L
o
n v
e e
e
d a
s n
– d

s b
e e
c l
u o
r n
i g
t i
y n
, g
–
s
t a
a f
b f
i e
l c
i t
t i
y o
, n
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

, i
n
i t
d o
e
n t
t w
i o
f
i c
c a
a t
t e
i g
o o
n r
, i
e
c s
o :
m (i) esteem for oneself (dignity, achievement, mastery,
p independence) and
a (ii) the desire for reputation or respect from others (e.g.,
n status, prestige).
i Self-actualization needs are the highest level in Maslow's
o
n hierarchy, and refer to the realization of a person's
s
h Behaviors leading to self-actualization: potential, self-
i
p fulfillment, seeking personal growth and peak
.
experiences.
E
s 1. They perceive reality efficiently and can tolerate
t
uncertainty;
e
e
2. Accept themselves and others for what they are;
m 3. Spontaneous in thought and action;
4. Problem-centered (not self-centred);
n 5. Unusual sense of humour ;
e 6. Able to look at life objectively;
e 7. Highly creative;
d 8. Resistant to enculturation, but not purposely
s unconventional;
- 9. Concerned for the welfare of humanity;
10. Capable of deep appreciation of basic life-experience;
c 11. Establish deep satisfying interpersonal relationships with a
l
few people;
a
s 12. Peak experiences;
s 13. Need for privacy;
i 14. Democratic attitudes;
f 15. Strong moral/ethical standards
i
e
d
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

DEFICIENCY NEEDS VS. GROWTH NEEDS

This five-stage model can be divided into deficiency

needs and growth needs. The first four levels are
often referred to as deficiency needs (D-needs), and
the top level is known as growth or being needs (B-
needs). Deficiency needs arise due to deprivation
and are said to motivate people when they are
unmet. Also, the motivation to fulfil such needs will
become stronger the longer the duration they are
denied. For example, the longer a person goes
without food, the hungrier they will become.

Maslow termed the highest level of the pyramid as growth

needs.
Growth needs do not stem from a lack of something, but
rather from a desire to grow as a person. Once these
growth needs have been reasonably satisfied, one may
be able to reach the highest level called self-actualization
THEORETICAL FOUNDATION OF NURSING
NURSING THEORIES AND HISTORY

SUMMARY

Human beings are motivated by a hierarchy of needs.

(b) needs are organized in a hierarchy of prepotency in which more basic needs must be more or less met
prior to higher needs.

(c) the order of needs is not rigid but instead may be flexible based

(d) most behavior is multi-motivated, that is, simultaneously determined by more than one basic

END OF PRE-FINALS