THEORETICAL FOUNDATION IN NURSING

CHAPTER 1
introduction TO NURSING
THEORY
What is Nursing Theory? Concept
nursing theories are organized bodies of often called the building blocks of
knowledge to define what nursing is, what theories
nurses do, and why do they do it. primarily the vehicles of thought that
involve images.
Historical Eras of Nursing's Search for Models
Specialized Knowledge representations of the interaction
Curriculum Era: 1900 - 1940s among and between the concepts
Research Era: 1950 - 1970s showing patterns.
Graduate Education Era: 1950 - 1970s Conceptual Framework
Theory Era: 1980 - 1990s is a group of related ideas, statements,
Theory Utilization Era: 21st century or concepts.
Domain
Three (3) Different Levels of Nursing Theories is the perspective or territory of a
Grand Theory profession or discipline.
the broadest in scope Process
represents the most abstract level of series of organized steps, changes or
development functions intended to bring about the
addresses the broad phenomena of desired result.
concern within the discipline. Paradigm
Middle-Range Theory pattern of shared understanding and
addresses more concrete and more assumptions about reality and the
narrowly defined phenomena. world.
intended to answer questions about worldview or widely accepted value
nursing phenomena, yet they do not system.
cover the full range of phenomena of Metaparadigm
concern to discipline. most general statement of discipline
Micro-Range Theory and functions as a framework in which
concrete and narrow in scope the more restricted structures of
explains a specific phenomenon of conceptual models develop.
concern to the discipline.
Much of the theoretical work in nursing focused
Selected Terminologies, Definitions, and on articulating relationships among four major
Assumptions concepts.
Philosophy
beliefs and values that define a way of
thinking and are generally known and
understood by a group or discipline.
Theory
a belief, policy, or procedure proposed
or followed as the basis of action.
 CHAPTER 1
introduction
TO NURSING THEORY

Four (4) Major Concepts of Nursing Theory Concepts

Person interrelated concepts define a theory.
referred to as Client or Human Being used to help describe or label a
recipient of nursing care phenomenon.
person may include individuals patients, words or phrases that identify, define,
groups, families, and communities. and establish structure and boundaries
for ideas generated about a particular
Environment phenomenon.
defined as the internal and external concepts may be abstract or concrete.
surrounds that affect the client. Abstract Concepts - mentally
includes all positive or negative constructed independent of a
conditions that affect the patient, the specific time or place.
physical environment, such as families, Concrete Concepts - directly
friends, and significant others, and the experienced and related to a
setting for where they go for their particular time or place.
healthcare.
Definitions
Health used to convey the general meaning of
degree of wellness or well-being that the concepts of the theory.
the client experiences. Theoretical Definitions - define a
may have different meanings for each particular concept based on the
patient, the clinical setting, and the theorist’s perspective.
health care provider. Operational Definitions - states
how concepts are measured.
Nursing
attributes, characteristics, and actions Relational Statements
of the nurse providing care on behalf of relationships between two or more
or in conjunction with, the client. concepts.
there are numerous definitions of chains that link concepts to one
nursing, though nursing scholars may another.
have difficulty agreeing on its exact
definition. Assumptions
the ultimate goal of nursing theories is accepted as truths and are based on
to improve patient care. values and beliefs.
statements that explain the nature of
Five (5) Components of Nursing Theories concepts, definitions, purpose,
Phenomenon relationships, and structure of a theory.
term given to describe an idea or
responses about an event, a situation, a
process, a group of events, or a group
of situations.
phenomena may be temporary or
permanent.
nursing theories focus on the
phenomena of nursing.
 CHAPTER 1
introduction
TO NURSING THEORY

History of Nursing Martha Rogers, 1970

the first nursing theories appeared in the viewed nursing as both a science and
late 1800s an art as it provides a way to view the
there was a strong emphasis placed on unitary human being, who is integral
nursing education. with the universe.

Florence Nightingale, 1860 Dorothea Orem, 1971

defined nursing in her "Environmental states in her theory of nursing care, the
Theory" as “the act of utilizing the Self-Care Deficit Theory.
environment of the patient to assist him nursing care is required if the client is
in his recovery.” unable to fulfill biological,
psychological, developmental, or social
Hildegard Peplau, 1952 needs.
introduced her Theory of Interpersonal
Relations that puts emphasis on the Imogene King, 1971
nurse-client relationship as the Theory of Goal Attainment was
foundation of nursing practice. introduced.
states that the nurse is considered part
Virginia Henderson, 1955 of the patient’s environment and the
conceptualized the nurse’s role as nurse-patient relationship is for meeting
assisting sick or healthy individuals to goals towards good health.
gain independence in meeting 14
fundamental needs, thus her Nursing Betty Neuman, 1972
Need Theory was developed. states in her theory that many needs
exist, and each may disrupt client
Faye Abdellah, 1960 balance and stability.
published her work "Typology of 21 stress reduction is the goal of the
Nursing Problems" that shifted the focus system model of nursing practice.
of nursing from a disease-centered
approach to a patient-centered Sr. Callista Roy, 1979
approach. viewed the individual as a set of
interrelated systems who strives to
Ida Jean Orlando, 1962 maintain the balance between these
emphasized the reciprocal relationship various stimuli.
between patient and nurse and viewed
the professional function of nursing as Jean Watson, 1979
finding out and meeting the patient’s developed the philosophy of caring
immediate need for help. highlighted humanistic aspects of
nursing as they intertwine with scientific
Dorothy Jonson, 1968 knowledge and nursing practice.
pioneered the Behavioral System Model
and upheld the fostering of efficient
and effective behavioral functioning in
the patient to prevent illness.
CHAPTER 2
nursing
in clinical practice
theory
Nursing Process in this phase, the nurse use critical
functions as a systematic guide to client- thinking skills to interpret assessment
centered care with 5 sequential steps. data and identify client’s strengths and
these are assessment, diagnosis, problems.
planning, implementation, and different from diagnosis, because
evaluation. diagnosis is a statement or conclusion
regarding the nature of a phenomenon,
Five (5) Steps in the Nursing Process while diagnosing refers to the
Assessment reasoning process.
systematic and continuous collection,
organization, validation, and Outcome Identification
documentation of data. outcome is a “measurable behavior
first phase of the nursing process. demonstrated by the patient responsive to
a continuous process carried out during nursing interventions.”
all phases of the nursing process. should be identified before nursing
must include the client’s perceived interventions are planned.
needs, health problems, related after nursing interventions are implemented,
experience, health practices, values, the nurse will evaluate if the outcomes were
and lifestyles. met in the time frame indicated for that
patient.
Types of Data includes setting short- and long-term goals
Subjective Data and then creating specific expected
referred to as “symptoms” or covert outcome statements for each nursing
data; apparent only to the person diagnosis.
affected and can be described or
verified only by the person. Planning
Objective Data third phase of the nursing process.
referred to as “signs” or overt data; the nurse refers to the client’s
detectable by an observer and can be assessment data and diagnostic
measured or tested against an statements for direction in formulating
acceptable standard. client goals and designing the nursing
interventions required to prevent,
Sources of Data reduce, or eliminate the client’s health
Client problems.
Support people
Client records Types of Planning
Health care professionals Initial planning
planning done as soon as possible after
Nursing Diagnosis the initial assessment.
second phase of the nursing process.
 CHAPTER 2 nursing theory
IN CLINICAL PRACTICE

Ongoing planning Evaluation

done by all nurses who work with the the final step of the nursing process, is
client; also occurs at the beginning of a crucial to determine whether, after
shift as the nurse plans the care to be application of the nursing process, the
given that day. client's condition or well-being
Discharge planning improves.
process of anticipating or planning for nurse conducts evaluation measures to
needs after discharge. determine if expected outcomes are
met, not the nursing interventions.
The Planning Process
Setting priorities 5 Components of the Evaluation Process
Establishing client goals and desired Collecting data related to the desired
outcomes. outcomes
Selecting nursing interventions Comparing data with the outcomes
Writing nursing orders. Relating nursing activities to outcomes
Drawing conclusions about problem status
Nursing Interventions Continuing, modifying, or terminating the
are actions a nurse takes to nursing care plan
implement their patient care plan.
include any treatments, procedures, or
teaching moments intended to improve
the patient's comfort and health.

Types of Nursing Interventions

Independent interventions
activities that nurses are licensed to
initiate on the basis of their knowledge
and skills.
Dependent interventions
are activities carried out under the
physician’s orders or supervision,
according to specified routines.
Collaborative/Interdependent
interventions
actions the nurse carries out in
collaboration with other health team
members.

Process of Implementing
Reassessing the client
Determining the nurse’s need for assistance
Implementing the nursing interventions
Supervising the delegated care
Documenting nursing activities
CHAPTER 3
nursing theorists
of historical significance

Hildegard Peplau According to Peplau, nursing is therapeutic

Credentials & Background because it is a healing art, assisting an
A remarkable nurse, educator, and individual who is sick or in need of health
administrator and a pioneer in nursing care
Born in Reading, Pennsylvania The theory explains the purpose of nursing is
Received B.A.degree in Interpersonal to help others identify their felt difficulties.
Psychology Nurses should apply principles of human
Had M.A. degree in Psychiatric Nursing and relations to the problems that arise at all
Ed.D in Curriculum Development levels of experience.
Peplau’s nursing experience included Peplau's theory explains the phases of
private and general duty hospital nursing, interpersonal process, roles in nursing
the U.S. Army Nurse Corps, nursing research, situations and methods for studying nursing
and a private practice in Psychiatric as an interpersonal process.
Nursing.
Teach for 20 years and held the title of Different Concepts of Nursing
Professor Emeritus Therapeutic in that it is a healing art,
Peplau influenced the development of many assisting an individual who is sick or in need
nursing programs, including the creation of of health care.
the first post baccalaureate nursing An interpersonal process because it involves
program in Belgium interaction between two or more individuals
Peplau published the book, Interpersonal with a common goal.
Relations in Nursing in 1952 The attainment of goal is achieved through
Dr. Peplau long held national and the use of a series of steps following a
international recognition as a nurse and series of pattern.
leader in health care. The nurse and patient work together so both
She is a remarkable person participated in become mature and knowledgeable in the
the development of the National Mental process.
Health Act of 1946
Served with many organizations, including Nursing Roles
WHO, National Institute of Mental Health, Teacher
and the Nurse Corps one who imparts knowledge concerning
§Inducted into a Hall of Fame by the ANA a need or interest.
being an Executive Director and past Resource Person
President. one who provides specific, needed
Peplau died March 17, 1999 information that aids in understanding a
problem or new situation.
Theory of Interpersonal Relations Counselor
Published Interpersonal Relations in Nursing, one who, through the use of certain
referring to her book as a “partial theory for skills and attitudes, aids another in
the practice of nursing”. recognizing, facing, accepting, and
She discussed the phases of the resolving problems.
interpersonal process.
 CHAPTER 3 nursing theorists
OF HISTORICAL SIGNIFICANCE

Leader Orientation Phase

one who carries out the process of Defines the purpose, roles, and rules of
initiation and maintenance of group the process, and provides a framework
goals through interaction. for assessing client’s needs. The nurse
Technical expert begins to build a sense of trust by
one who provides physical care by providing the client with basic
displaying clinical skills and operating information (introduction).
equipment in this care. A client’s dignity, autonomy (decision of
Surrogate one’s own self) and privacy are kept
one who takes the place of another. safe within the nurse-client relationship.
For example, “Hello, may name is Nurse
Theory of Interpersonal Relations Christina, I am a Registered Nurse, and I
According to Peplau (1952/1988), nursing is will be taking care of you until 3:00
therapeutic because it is a healing art, p.m.”
assisting an individual who is sick or in need This information would be presented in
of health care. a respectful manner
In nursing, this common goal provides the
incentive for the therapeutic process in Working Phase
which the nurse and patient respect each The problem-solving phase of the
other as individuals, both of them learning therapeutic nurse-client relationship.
and growing as a result of the interaction. Engaging clients as an active partners
for mutual planning of decisions about
Therapeutic Nurse-Client their care.
Therapeutic nurse-client relationship Relevant treatment goals are
relationship between client and nurse established to guide nursing
that focuses on the client’s needs, interventions and client actions.
feelings, problems, and ideas. Focuses on self-direction and self-
management
Four (4) phases of therapeutic nurse-patient
relationship Termination Phase
Pre-interaction Phase The nurse and client evaluate the
The only phase of the therapeutic nurse- client’s response to treatment and
client relationship in which the client explore the meaning of the relationship
does not directly participate. and what goals have been achieved.
During this phase, the nurse prepares to Discussing the achievements, how the
meet the client by gathering relevant client and nurse feel about concluding
client information and anticipating the relationship, and plans for the future
client concerns prior to the first are an important part of the termination
interaction. phase.
Being aware of potential client Termination of a meaningful nurse-client
concerns before meeting with the client relationship should be final in any
is helpful. setting.
 CHAPTER 3 nursing theorists
OF HISTORICAL SIGNIFICANCE

Summary She was the incarnation of those Greek

Peplau conceptualized clear sets of nurse’s verities--the good, the true, and the
roles that can be used by each and every beautiful.
nurse with their practice. Virginia Henderson was arguably the most
It implies that a nurse’s duty is not just to famous nurse of the 20th century. With her
care but the profession encompasses every silky drawl, bright blue eyes, wispy curls, and
activity that may affect the care of the beautiful clothes, Miss Henderson was the
patient. embodiment of an impish Southern
gentlewoman.
Virginia Henderson (1897-1996) Died on March 19, 1996 at the age of 98
"First Lady of Nursing”
"First Truly International Nurse”
accomplished author, avid researcher and a
visionary.
She identified fourteen basic needs.
“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 Nursing Need Theory
the mother, the mouthpiece for those too was developed to define the unique focus
weak or withdrawn to speak and so on.” of nursing practice.
Credentials & Background the theory focuses on the importance of
Born in Kansas City, Missouri on Nov. 30, increasing the patient’s independence to
1897, the 5th of eight children of Daniel B., hasten their progress in the hospital.
an attorney and Lucy Minor (Abbot) Henderson’s theory emphasizes on the basic
Henderson, a native from state of Virginia. human needs and how nurses can assist in
World War I developed her interest in meeting those needs.
nursing in 1918.
She was educated at the U.S. Army School Assumptions of the Need Theory
of Nursing (1921) then worked as a staff Nurses care for patients until they can care
nurse of the Henry Street Visiting Nurse for themselves once again. Although not
Service in New York City. precisely explained.
1922, began teaching in Norfolk Protestant Patients desire to return to health.
Hospital, Virginia. Nurses are willing to serve and that “nurses
She recognized early on the importance of will devote themselves to the patient day
an outcomes orientation, health promotion, and night.”
continuity of care, patient advocacy, Henderson also believes that the “mind and
multidisciplinary scholarship, integration of body are inseparable and are interrelated.”
the arts and sciences, and boundary
spanning.
Her elegant definition of nursing, with its
emphasis on complementing the patient's
capabilities, provides a clear direction for
what nursing should be.
 CHAPTER 3 nursing theorists
OF HISTORICAL SIGNIFICANCE

Henderson's Definition of Nursing went on to earn three degrees from

defined nursing as “the unique function of Columbia University:
the nurse is to assist the individual, sick or Bachelor of Science degree in Nursing in
well, in the performance of those activities 1945
contributing to health or its recovery that he Master of Arts degree in Physiology in 1947
would perform unaided if he had the Doctor of Education degree in 1955.
necessary strength, will or knowledge. And With her advanced education, Abdellah
to do this in such a way as to help him gain could have chosen to become a doctor.
independence as rapidly as possible.” However, as she explained in one of her
The nurse’s goal is to make the patient interviews that she wanted to be an M.D.
complete, whole, or independent. In turn, because she could do all she wanted to do
the nurse collaborates with the physician’s in nursing which is a caring profession.
therapeutic plan.
Career as Educator and Researcher
Faye Glenn Abdellah She served as Chief Nurse Officer from 1970
Credentials & Background to 1987
Faye Abdella is a celebrated nurse theorist, Was the first nurse to achieve the rank of a
military nurse, and a leader in nursing two-star Flag Officer and was named by
research. U.S. Surgeon General C. Everett Koop as
pioneer in nursing research who developed the first woman and nurse Deputy Surgeon
the “Twenty-One Nursing Problems.” General from 1982 to 1989
First nurse officer to earn the ranking of a After retirement, Abdellah founded and
two-star rear admiral and the first nurse and served as the first dean in the Graduate
the first woman to serve as a Deputy School of Nursing, GSN, Uniformed Services
Surgeon General. University of the Health Sciences.
Born on March 13, 1919 in New York to a
father of Algerian heritage and Scottish Abdellah's Awards and Honors
mother. Recognized as a leader in the development
Her family subsequently moved to New of nursing research and nursing as a
Jersey where she attended high school. profession within the Public Health Service
Years later, on May 6, 1937, the German (PHS).
hydrogen-fueled airship Hindenburg An international expert on health problems
exploded over Lakehurst. Abdellah and her and was named a “living legend” by the
brother witnessed the explosion, destruction American Academy of Nursing in 1994.
and the fire subsequent to the ignited National Women’s Hall of Fame in 2000 for
hydrogen that killed many people. a lifetime spent establishing and leading
That incident became the turning point in essential health care programs for the
Abdellah’s life. It was at that moment she United States.
vowed that she would learn nursing and Inducted into the American Nurses
become a professional nurse. Association Hall of Fame for a lifetime of
Faye Abdellah earned a nursing diploma contributions to nursing in 2012.
from Fitkin Memorial Hospital’s School of
Nursing, now known as Ann May School of
Nursing.
 CHAPTER 3 nursing theorists
OF HISTORICAL SIGNIFICANCE

Abdellah's 21 Nursing Problems Theory To facilitate the maintenance of

made a name in the nursing profession with regulatory mechanisms and functions
the formulation of her “21 Nursing Problems To facilitate the maintenance of sensory
Theory.” function
Her theory changed the focus of nursing To identify and accept positive and
from disease-centered to patient-centered negative expressions, feelings, and
and began to include the care of families reactions
and the elderly in nursing care. To identify and accept interrelatedness
The Patient Assessment of Care Evaluation of emotions and organic illness
developed by Abdellah is now the standard To facilitate the maintenance of
used in the United States. effective verbal and nonverbal
According to Faye Glenn Abdellah’s theory, communication
“Nursing is based on an art and science that To promote the development of
moulds the attitudes, intellectual productive interpersonal relationships
competencies, and technical skills of the To facilitate progress toward
individual nurse into the desire and ability to achievement and personal spiritual
help people, sick or well, cope with their goals
health needs.” To create or maintain a therapeutic
The patient-centered approach to environment
nursing was developed from Abdellah’s To facilitate awareness of self as an
practice, and the theory is considered a individual with varying physical,
human needs theory. emotional, and developmental needs
To maintain good hygiene and physical To accept the optimum possible goals in
comfort the light of limitations, physical and
To promote optimal activity: exercise, emotional
rest, sleep To use community resources as an aid in
To promote safety through prevention of resolving problems that arise from illness
accident, injury, or other trauma and To understand the role of social
through prevention of the spread of problems as influencing factors in the
infection cause of illness
To maintain good body mechanics and •To promote the development of
prevent and correct deformity productive interpersonal relationships
To facilitate the maintenance of a To facilitate progress toward
supply of oxygen to all body cells achievement and personal spiritual
To facilitate the maintenance of goals
nutrition for all body cells To create or maintain a therapeutic
To facilitate the maintenance of environment
elimination To facilitate awareness of self as an
To facilitate the maintenance of fluid individual with varying physical,
and electrolyte balance emotional, and developmental needs
To recognize the physiologic responses To accept the optimum possible goals in
of the body to disease conditions the light of limitations, physical and
pathologic, physiologic, and emotional
compensatory To use community resources as an aid in
resolving problems that arise from illness
 CHAPTER 3 nursing theorists
OF HISTORICAL SIGNIFICANCE

To understand the role of social In her attempt to bring nursing practice

problems as influencing factors in the to its proper relationship with restorative
cause of illness and preventive measures for meeting
To promote the development of total client needs, she seems to swing
productive interpersonal relationships the pendulum to the opposite pole, from
To facilitate progress toward the disease orientation to nursing
achievement and personal spiritual orientation, while leaving the client
goals somewhere in the middle.
To create or maintain a therapeutic
environment Ernestine Wiedenbach
To facilitate awareness of self as an Credentials & Background
individual with varying physical, Theory: THE HELPING ART OF CLINICAL
emotional, and developmental needs NURSING
To accept the optimum possible goals in Known for her work in theory development
the light of limitations, physical and and maternal infant nursing developed
emotional while teaching maternity nursing at the
To use community resources as an aid in School of Nursing, Yale University.
resolving problems that arise from illness She directed the major curriculum in
To understand the role of social maternal and newborn health nursing when
problems as influencing factors in the the Yale School of Nursing established a
cause of illness master’s degree program and authored
books used widely in nursing education.
§Her definition of nursing: “People may
differ in their concept of nursing, but few
would disagree that nursing is nurturing or
caring for someone in a motherly fashion”
(Wiedenbach, 1964, p.1)
Wiedenbach’s orientation is a philosophy of
nursing that guides the nurse’s action in the
art of nursing.
She specified four (4) elements of clinical
nursing: philosophy, purpose, practice
Forces of Care Pendulum and art.
Focus of Care Pendulum of Faye Abdellah’s §She postulated that clinical nursing is
Theory directed toward meeting the patient’s
The nursing-centered orientation to perceived need for help in a vision of
client care seems contrary to the client- nursing that reflects considerable emphasis
centered approach that Abdellah on the art of nursing.
professes to uphold. The apparent In her book (1964), Clinical Nursing: A
contradiction can be explained by her helping Art, Wiedenbach outlines nursing
desire to move away from a disease- steps in sequence.
centered orientation.
 CHAPTER 3 nursing theorists
OF HISTORICAL SIGNIFICANCE

Theory: The Helping Art of Clinical Nursing Lydia Eloise Hall

Wiedenbach proposes that nurses identify Credentials & Background
patient needs for help in the following ways: a nursing theorist who developed the Care,
Observing behaviors consistent or Cure, Core model of nursing.
inconsistent with their comfort. Her theory defined Nursing as “a
Exploring the meaning of their behavior. participation in care, core and cure aspects
Determining the cause of their of patient care, where CARE is the sole
discomfort or incapability. function of nurses, whereas the CORE and
Determining whether they can resolve CURE are shared with other members of the
their problems or have a need for help. health team.”
Wiedenbach’s theory identifies the She was an innovator, motivator, and
patient as “any individual who is mentor to nurses in all phases of their
receiving help of some kind, be it care, careers and an advocate for chronically ill.
instruction or advice from a member of born on September 21, 1906 in New York
the health profession or from a worker in City as Lydia Eloise Williams. She was the
the field of health.” A patient is any eldest child of Louis V. Williams and Anna
person who has entered the healthcare Ketterman Williams and was named after
system and is receiving help, which her maternal grandmother. Her brother,
means he or she does not need to be ill. Henry, was several years younger. At a
The theory identifies four main elements young age, her family decided to move to
in clinical nursing: a philosophy, a York, Pennsylvania, where her father was a
purpose, a practice, and the art. physician in general practice.
The nurse’s philosophy is his or her In 1945, she married Reginald A. Hall who
attitude and belief about life, and how was a native of England.
that affects reality for him or her. graduated from York Hospital School of
The three essential components Nursing in 1927 with a diploma in nursing
Wiedenbach associated with a nursing and entered Teacher’s College at Columbia
philosophy are reverence for life; University in New York
respect for the dignity, worth, autonomy, Bachelor of Science degree in public health
and individuality of each human being; nursing in 1932.
and the resolution to act on personally Master’s degree in the teaching of natural
and professionally held beliefs. life sciences from Columbia University in
The art of nursing includes 1942.
understanding the patient’s needs, Doctorate and completed all of the
developing goals and actions intended requirements except for the dissertation.
to enhance the patient’s ability, and Spent her early years as a registered nurse
directing the activities related to the working for the Life Extension Institute of the
medical plan to improve the patient’s Metropolitan Life Insurance Company in
condition. The nurse’s focus is also on Pennsylvania and New York.
the prevention of complications related Work for the New York Heart Association
to reoccurrence or the development of from 1935 to 1940.
new concerns. In 1941, she became a staff nurse with the
The theory explains that knowledge Visiting Nurses Association of New York and
encompasses all that has been stayed there until 1947.
perceived and grasped by the human
mind.
 CHAPTER 3 nursing theorists
OF HISTORICAL SIGNIFICANCE

1950, she became a professor at Teacher’s Credentials & Background

College at Columbia and also a research Ida Jean Orlando was a first generation Irish
analyst. American born in 1926.
Hall’s interest and research in the field of nursing diploma from New York Medical
rehabilitation of chronically ill patients College.
brought her to develop her now-famous A Bachelor of Science in Public Health from
Care, Cure, Core Theory. St. John’s University in Brooklyn, and her
First director of the Loeb Center for Nursing. Master of Arts Degree in Mental Health
Through her leadership, the center became Nursing from Teachers College, Columbia
a prime example of nursing-led care, and University.
many centers in the United States and Married to Robert Pelletier and lives in the
Canada followed its principles. Boston area.
During her time there, Hall authored 21 Orlando was an associate professor at Yale
publications and a bulk of articles and School of Nursing
addresses regarding her theory. In 1961- served as the Director of the
Graduate Program in Mental Health
Awards and Honors Psychiatric Nursing that led to Orlando’s
In 1967, Lydia Hall received the Teacher’s development of the Deliberative Nursing
College Nursing Education Alumni Process published in The Dynamic Nurse-
Association (TCNEAA) achievement in Patient Relationship: Function, Process, and
Nursing Practice Award Principles (NLN Classics in Nursing Theory).
Also in 1967, a Nursing Hall of Fame She also worked as the director of a
inductee. research project at McLean Hospital in
In 1984, American Nurses Association (ANA) Belmont, Massachusetts.
Hall of Fame.
Hall died on February 27, 1969, at Queens Nursing Theory: Deliberative Nursing
Hospital in New York. Process
The goal of this model is for a nurse to act
Ida Jean Orlando deliberately rather than automatically. This
Theory Of Deliberative Nursing Process way, a nurse will have a meaning behind the
Regardless of how well thought out a action which means the patient gets care
nursing care plan is for a patient, obstacles geared specifically toward his or her needs
to the patient’s recovery may come up at at that time.
any time. This may cause problems for the This nursing process is also one that can
original nursing care plan, and it’s the easily be adapted to different patients with
nurse’s job to know how to deal with those different problems, and can be stopped at
obstacles so the patient can continue to anytime, depending on the patient’s
recover and stay on the path to health. progress or health. This makes Orlando’s
Ida Jean Orlando’s Deliberative Nursing theory universal for the nursing field.
Process is a nursing theory that allows
nurses to create an effective nursing care
plan that can be easily adapted to prevent
complications.
CHAPTER 4
nursing philosophies
Florence Nightingale Nightingale’s main focus was the control of
Credentials and Background the physical environment of individuals and
Was born in Florence, Italy on May 12, 1820. families, both healthy and ill, as major
According to her biographer, Sir Thomas component of nursing care.
Cook, Nightingale was a linguist and had a Her most frequent cited work, Notes on
broad knowledge in science, mathematics, Nursing, was written not as nursing text but
literature and arts to “give hints for thought to women who
She was well read in philosophy, history, have personal charge of the health of
politics, and economics and was others”.
knowledgeable about the workings of Nightingale was the first nurse
government. researcher.
Had strong belief in God, and for time
believed she had religious calling. Nightingale's Environmental Model
Became a heroine in Great Britain as a Health of Houses
result of her work in the Crimean War. Nightingale stress the importance of the
She describe the very poor sanitary health of houses as being closely
conditions in the hospital wards at Scutari. related to the presence of pure air, pure
She demonstrated great concern for the water, efficient drainage, cleanliness,
well-being of the English soldier-well, and light.
injured, or sick.
She spent the years after the Crimea Ventilation and Warming
establishing schools of nursing and Essential to “keep the air he breathes as
influencing public policy. pure as the external air, without chilling
Nightingale was romanticized by Henry him”.
Wadsworth Longfellow in his poem, “The She urged the caregiver to consider the
Lady with the Lamp”. source of the air in the patient’s room,
She died on August 13, the importance of room temperature.
1910, she was honored
each year in a Light
commemorative service at The sick needed light, direct sunlight
St. Margaret’s Church, was what patients wanted. She noted
East Wellow, Great Britain, that light has “quite real and tangible
where she is buried. effects upon the human body”.
Nightingale is viewed as the mother of
modern nursing because she synthesized Noises
information gathered in many of her life Noises could jar the patient, according
experiences to assist her in the development to Nightingale. She viewed unnecessary
of modern nursing. noise as cruel and irritating to the
The seeds of modern nursing were being patient.
planted in Germany (the site of the first
organized nursing school).
CHAPTER 4 nursing
PHILOSOPHIES

Variety Observation of the Sick

Nightingale believed that variety in the She stated “the most important
environment affects patient’s practical lesson that can be given to
recovery, the need for changes in color nurses is to teach them what to observe
and form, including bringing the patient and how to observe for the
brightly colored flowers and plants. improvement of patients condition.
She advocated reading, needlework,
writing, and cleaning as activities to Social Considerations
relieve the sick of boredom. Nightingale supported the importance
of looking beyond the individual to
Bed and bedding the social environment in which he or
The organic matter (microorganisms) she lived.
enters the sheet and stays there unless She observed that generations of
the bedding is changed and aired families lived and died in poverty
frequently.
Four(4) major concepts are used to
Cleanliness of rooms and walls organize nursing theory, according to
Nightingale indicated that “the greater nightingale. These are:
part of nursing consists in preserving Nursing
cleanliness”. Person
Environment ,
Personal Cleanliness Health
Nightingale viewed the function of the
skin as important, believing that many Conclusion
diseases “disordered "or caused breaks The Environmental Theory of Nursing is a
in the skin. patient-care theory. It focuses in the
She thought that excretion that comes alteration of the patient’s environment in
from the skin must be washed away. order to affect change in his or her
health.
Nutrition and Taking Food Caring for the patient is of more
Nightingale addressed the variety of important rather than the nursing process,
food presented to the patient and the relationship between patient and nurse,
discussed the importance of variety in or the individual nurse. In this way, the
the food presented. model must be adapted to fit the needs of
She urged that the right food be individual patients.
brought at the right time and “be taken
away, eaten or uneaten, at the right Jean Watson
time”. Credentials and Background
Dr. Jean Watson is a
Chattering hopes and Advices nurse theorist who
She considered it stressful for a patient developed “Philosophy
to hear opinions after only brief and Theory of
observations had been made. Transpersonal Caring”
False hope was depressing to patients or “Caring Science”
and caused them to worry. and founder of Watson
Caring Science Institute.
 CHAPTER 4 nursing
PHILOSOPHIES

June 10, 1940 – present A distinguished professor of nursing.

an American nurse theorist and nursing Received six (6) honorary doctoral
professor. degrees from universities in the United
Watson’s study on caring has been States and three Honorary Doctorates in
integrated into education and patient care international universities.
to various nursing schools and healthcare National League for Nursing (NLN)
facilities all over the world. Martha E. Rogers Award
1961
Jean Watson married her husband, Philosophy & Theory of Transpersonal Caring
Douglas, and moved west to his native Watson’s Philosophy and Science of Caring
state of Colorado with their two grown is concerned on how nurses express care
daughters, Jennifer and Julie, and five to their patients.
grandchildren. Her theory stresses humanistic aspects of
Watson states that through her sufferings, nursing and that caring is essential to
there was the privilege of experiencing and nursing.
receiving my own theory through the care The nursing model states that “nursing is
from her husband and loving nurse friends concerned with promoting health,
and colleagues. These two personal life- preventing illness, caring for the sick, and
altering events contributed to writing her restoring health.”
third book, Postmodern Nursing and It focuses on health promotion, as well
Beyond. as the treatment of diseases.
1964
Bachelor’s degree in Nursing Watson's Metaparadigm Concepts in Nursing
1966 Human being
Master of Science in Nursing in as a valued person in and of him or
psychiatric and mental health nursing. herself to be cared for, respected,
1973 nurtured, understood and assisted.
Ph.D. in educational psychology and Health
counseling, all from the University of defined as a high level of overall
Colorado at Boulder. physical, mental, and social functioning.
1981 - 1982 Nursing
pursued international sabbatical studies science of persons and health-illness
in New Zealand, Australia, India, experience that are mediated by
Thailand, and Taiwan. professional, personal, scientific, and
1980s ethical care interactions.
Watson and colleagues established the Carative Factors
Center for Human Caring at the She does not define the fourth
University of Colorado. metaparadigm concept of environment
but instead devised 10 caring needs
Awards & Honors specific carative factors.
Watson has authored 11 books, shared in
authorship of six books, and has written Watson's 10 Carative Factors
countless articles in nursing journals. The forming humanistic-altruistic value systems
following publications reflect the evolution instilling faith-hope
of her theory of caring from her ideas about cultivating a sensitivity to self and others
the philosophy and science of caring. developing a helping-trust relationship
 CHAPTER 4 nursing
PHILOSOPHIES

promoting an expression of feelings 1970s

using problem-solving for decision-making Research at UCSF and UC Berkeley.
promoting teaching-learning Has taught and done research at UCSF
promoting a supportive environment, since 1979
assisting with gratification of human needs 1982
allowing for existential-phenomenological Published 9 books and numerous
forces. articles; Published ‘Novice to Expert
Theory’
Conclusion 1984,1990,1996, 2000
The Philosophy and Science of Caring Received Book of the Year from AJN
addresses how nurses express care to
their patients. Benner's Theory of Novice to Expert
Caring is central to nursing practice, and
promotes health better than a simple
medical cure.
Watson believes that a holistic approach to
health care is central to the practice of
caring in nursing.

Dr. Patricia Benner

Allow yourself to be a beginner. No one Starts off being
excellent -----------------

Credentials & Background

Dr. Patricia Benner Levels of Nursing Experience
introduced the concept that Novice
expert nurses develop Beginner with no experience
skills and understanding Taught general rules to help perform
of patient care over time tasks
through a sound Rules are:
educational base as well as context-free
multitude of experiences. independent of specific cases
applied universally
She proposed that one could gain
Rule-governed behavior is limited and
knowledge and skills ("knowing how")
inflexible
without ever learning the theory ("knowing
Ex. “Tell me what I need to do and I’ll do
that")
it.”
She conceptualizes in her writing about
nursing skills as experience is a prerequisite
Advanced Beginner
for becoming an expert.
Demonstrates acceptable performance
Patricia E. Benner, R.N., Ph.D., FAAN is a
Has gained prior experience in actual
Professor Emerita at the University of
situations to recognize recurring
California, San Francisco.
meaningful components
BA in Nursing - Pasadena College/Point
Principles, based on experiences
Loma College
Begin to be formulated to guide action
MS in Med/Surg nursing from UCSF
1982
PhD from UC Berkeley
 CHAPTER 4 nursing
PHILOSOPHIES

Competent Kari Martinsen

Typically a nurse with 2-3 years Nursing is founded on caring for life, on neighbourly love.
At the same time it is necessary that the nurse is
experience on the job in the same professionally educated -------------
area or in similar day-to-day situations
Credentials & Background
More aware of long-term goals
A nurse and philosopher,
Gains perspective from planning own
was born in Oslo, the
actions based on conscious,
capital of Norway
abstract, and analytical thinking
After the war, moral and
Helps to achieve greater efficiency and
sociopolitical discussions
organization.
dominated home life.
Proficient Both parents were economists who were
Perceives and understands situations as educated at the University of Oslo. Her
whole parts. mother worked all of her adult life outside
More holistic understanding improves the home.
decision-making 1964
Learns from experiences what to Graduated at Ullevål College of Nursing
expect in certain situations and how in Oslo.
to modify plans. She worked in clinical practice at
Ullevål hospital for 1 year.
Expert 1966
No longer relies on principles, rules, She specialized as a psychiatric nurse
or guidelines to connect situations and worked for 2 years at Dikemark
determine actions Psychiatric Hospital near Oslo.
Much more background of experience 1968
Has intuitive grasp of clinical A Bachelor’s degree in psychology at
situations the University of Oslo with the goal of
Performance is now fluid, flexible, and obtaining a Master’s degree in
highly-proficient Psychology.
As a prerequisite, she needed an
Significance of the Theory intermediate examination in physiology and
Each step builds on the previous one as another free credit at the intermediate
abstract principles are refined and level; here she chose philosophy.
expanded by experience and the learner In her work for the graduate degree in
gains clinical expertise. philosophy (Magister artium), Martinsen’s
This theory changed the profession's dissertation ”Philosophy and Nursing: A
understanding of what it means to be an Marxist and Phenomenological
expert, placing this designation not on the Contribution” (Martinsen, 1975), created an
nurse with the most highly paid or most instant debate and received much critical
prestigious position, but on the nurse who attention.
provided "the most exquisite nursing care." She was affiliated with the Department of
Hygiene and Social Medicine at the
University of Bergen, where she lectured her
students in the nursing teachers’ training
program and medical students in social
medicine.
 CHAPTER 4 nursing
PHILOSOPHIES

Philosophy of Caring
“Moral practice is based upon caring." Patient-Oriented Professionalism
Caring does not merely form the value “to demand professional knowledge
foundation of nursing; it is a which affords the view of the patient as
fundamental precondition of our life. a suffering person, and which protects
Discernment demands emotional his integrity."
involvement and the capacity for It challenges professional
situational analysis in order to assess competence and humanity in a
alternatives for action benevolent reciprocation, gathered in
To learn moral practice in nursing is a communal basic experience of the
to learn how the moral is founded in protection and care for life.
concrete situations. It is accounted for
through experiential objectivity or Sovereign Life Utterances
through discretion, in action or in are phenomena that accompany the
speech. In both cases learning good Creation itself.
nursing is of the essence They are present as potentials. They
(Martinsen, 1990, pp. 60, 64-65) are beyond human control and
influence, and are therefore sovereign.
Major Concepts & Definitions Sovereign life utterances are openness,
Care mercy, trust, hope, and love
forms not only the value base of nursing, (Alvsvåg, 2003)
but is a fundamental precondition for
our lives. The Untouchable Zone
Care is the positive development of the In caring, the untouchable zone is
person through the Good. united with its opposite, which is
(Martinsen, 1990, p. 60) openness, in which closeness,
vulnerability, and motive have their
Professional Judgement and correct place. Openness and the
Discernment untouchable zone constitute a unifying
These qualities are linked to the contradiction in caring
concrete. It is through the exercise of (Martinsen, 1990, 2006)
professional judgment in practical, living
contexts that we learn clinical Katie Eriksson
Caritative caring means that we take “caritas” into use
observation. when caring for the human being in health and suffering.
Caritative caring is a manifestation of the love that ‘just
exist". Caring communion, true caring, occurs when the
Moral Practice is Founded on Care one caring in a spirit of caritas alleviates the suffering of
“Moral practice is when empathy and the patient--------------
reflection work together in such a way
Credentials & Background
that caring can be expressed in nursing”
One of the pioneers of caring science in
(Martinsen, 1990, p. 60)
the Nordic countries.
Morality is present in concrete
She work and progress in Finland and
situations and must be accounted
noticed her ability from the beginning to
for. Our actions need to be accounted
design caring science as a discipline, while
for; they are learned and justified
bringing to life the abstract substance of
through the objectivity of empathy,
caring.
which consists of empathy and
reflection.
CHAPTER 4 nursing
PHILOSOPHIES

Eriksson was born on November 18, 1943, in 1970s

Jakobstad, Finland. She belongs to the Eriksson model for caring formed the
Finland-Swedish minority in Finland, and her basis for the caritative caring theory.
native language is Swedish. Eriksson, one of the few caring science
researchers in the Nordic countries,
1965 developed a caring theory and is a
graduate of the forerunner of basic research in caring
Helsinki Swedish science.
School of Nursing 1975
receive the 3M-ICN (International
Council of Nurses) Nursing
Fellowship Award in Finland

1967 Awards & Honors

completed her public health nursing 1987
specialty education at the same Sophie Mannerheim Medal of the
institution. Swedish Nursing Association in Finland
1970 1998
graduaed from the nursing teacher Caring Science Gold Mark for
education program at Helsinki Finnish academic nursing care at Helsinki
School of Nursing. University Central Hospital and Honorary
1974 Doctorate in Public Health from the
She continued her academic studies at Nordic School of Public Health in
University of Helsinki, where she Gothenburg, Sweden.
received her MA degree in philosophy 2001
1976 Åland Islands Medal for caring science
licentiate degree in 1976. 2003
1982 Topelius Medal
She defended her doctoral dissertation she was honored nationally as a Knight,
in pedagogy (The Patient Care Process First Class, of the Order of the White
—An Approach to Curriculum Rose of Finland.
Construction within Nursing Education:
The Development of a Model for the Major Concepts & Definitions
Patient Care Process and an Approach Caritas
for Curriculum Development Based on means love and charity
the Process of Patient Care) In caritas, erosand agapé are united,
1993 and 1999- and caritas is by nature unconditional
Professor in caring science at University love.
of Helsinki It is the fundamental motive of caring
Faculty of Medicine science, also constitutes the motive for
Served as Director of Nursing at Helsinki all caring.
University Central Hospital.
Late 1960s and early 1970s
Eriksson’s main area of work has been in
teaching and research.
CHAPTER 4 nursing
PHILOSOPHIES

Caring Communion It implies in some sense dying away from

a form of intimate connection that something, and through reconciliation,
characterizes by intensity and vitality, the wholeness of body, soul, and spirit is
warmth, closeness, rest, respect, re-created.
honesty, and tolerance as the source of Suffering is a unique, isolated total
strength and meaning in caring. experience and is not synonymous with
pain
The Act of Caring (Eriksson, 1984, 1993)
contains the caring elements
faith Suffering Related to Illness, to Care, and
hope to Life:
love There are three (3) different forms of suffering
tending Suffering related to illness
playing When the patient is exposed to suffering
learning caused by care or absence of caring,
The act of caring is the art of making which is always a violation of the
something very special out of patient’s dignity
something less special. In the situation of being a patient, the
entire life of a human being may be
Caritative Caring Ethics experienced as suffering related to life.
the ethics of caring, the core of which is
determined by the caritas motive, and The Suffering Human Being
nursing ethics, which deals with ethical Is the concept that Eriksson uses to
principles and rules that guide nurse's describe the patient. The patient refers
work or decisions. to the concept of patients (Latin), which
means “suffering.”
Dignity The patient is a suffering human being,
constitutes one of the basic concepts of or a human being who suffers and
caritative caring ethics, having dignity patiently endures.
that involves the right to be confirmed (Eriksson, 1994a; Eriksson & Herberts,
as a unique human being. 1992)

Invitation Reconciliation
refers to the act that occurs when the refers to the drama of suffering.
carer welcomes the patient to the It implies a change through which a new
caring communion. The concept of wholeness is
invitation finds room for a place where formed of the life the human being has
the human being is allowed to rest, a lost in suffering.
place that breathes genuine hospitality,
and where the patient’s appeal for Caring Culture
charity meets with a response. the concept that Eriksson (1987a) uses
instead of environment. It characterizes
Suffering the total caring reality and is based on
an ontological concept described as a cultural elements such as traditions,
human being’s struggle between good rituals, and basic values.
and evil in a state of becoming.
CHAPTER 4 nursing
PHILOSOPHIES

Summary
The human being is fundamentally an entity
of body, soul, and spirit.
The human being is fundamentally a
religious being.
Human dignity means accepting the human
obligation of serving with love, of existing
for the sake of others.
Caring is something human by nature, a call
to serve in love.
Suffering is an inseparable part of life.
CHAPTER 5
nursing conceptual
models

Myra Estrin Levine Nurse accomplishes the goal of model

Conservation Model through the conservation of energy,
Credentials & Background structure and personal and social integrity.
1944
Diploma in nursing:-Cook County SON, Adaptation
Chicago Every individual has a unique range of
1949 adaptive; An ongoing process of
BSN:-University of Chicago change in which patient maintains his
1962 integrity within the realities of
MSN:-Wayne State University, Detroit environment.
1969, 1973 & 1989
Publication: An Introduction to Clinical Wholeness
Nursing Exist when the interaction or constant
1992 adaptations to the environment permits
Received honorary doctorate from the assurance of integrity.
Loyola University
Clinical experience in OT technique and Conservation
oncology nursing The product of adaptation; "Keeping
Civilian Nurse at the together "of the life systems or the
Gardiner General wholeness of the individual.
Hospital.
Director of Nursing at Nursing's Paradigm
Drexel Home in Person
Chicago. A holistic being who constantly strives to
Clinical Instructor at Bryan Memorial preserve wholeness and integrity; A
Hospital in Lincoln, Nebraska unique individual in unity and integrity,
Administrative supervisor at University of feeling, believing, thinking and whole
Chicago system of system.
Chairperson of clinical nursing at Cook
Country SON Environment
Visiting professor at Tel Aviv University in Competes the wholeness of person.
Israel Internal
Died in 1996 Homeostasis (maintaining balance)
Homeorrhesis (stabilized
Major Concepts of Conservation Model adaptation)
Goal of the model is to promote External
adaptation and maintain wholeness Preconceptual (Operational;
using the principles of conservation. Conceptual (elements that affects
Model guides the nurse to focus on the the individual)
influences and responses at the
organismic level.
 CHAPTER 5
nursing conceptual
MODELS

Adaptation Characteristics Characteristics of Theory

Historicity The concept of illness adaptation, using
Adaptations are grounded in history and interventions, and the evaluation of
await the challenges to which they nursing interventions are interrelated.
respond Concepts can be used to explain the
consequences of nursing action.
Specificity Levine’s theory is easy to use and elements
Individual responses and their adaptive are easily comprehensible.
pattern varies on the base of specific The principle of conservation are specific
genetic structure enough to be testable
Levine’s idea have not yet been widely
Redundancy researched; has been applied in surgical
Safe and fail options available to the settings.
individual to ensure continued Levine’s ideas are consistent with other
adaptation theories, laws and principles particularly
those from the humanities and sciences.
Organismic response
A change in behavior of an individual Conservational Principles
during an attempt to adapt to the Conservation of energy-Refers to balancing
environment energy; includes adequate rest, nutrition
Help individual to protect and maintain and exercise.
their integrity. Conservation of structural integrity-Refers
to maintaining or restoring the structure of
Four (4) Types of Organismic Response body preventing physical breakdown and
Flight or fight promoting healing
An instantaneous response to real or Conservation of personal integrity-
imagined threat, most primitive Recognizes the individual as one who strives
response for recognition, respect, self awareness,
selfhood and self determination.
Inflammatory Conservation of social integrity-An
response intended to provide for individual is recognized as some one who
structural integrity and the promotion of resides with in a family, a community ,a
healing religious group, an ethnic group, a political
system and a nation.
Stress
Response developed over time and Martha Rogers
influenced by each stressful experience Unitary Human Beings
encountered by person Credentials & Background
Martha Elizabeth Rogers
Perceptual May 12, 1914 – March 13, 1994
Involves gathering information from the An American nurse, researcher, theorist, and
environment and converting it in to a author widely known for developing the
meaning experience Science of Unitary Human Beings and for
her landmark book, An Introduction to the
Theoretical Basis of Nursing.
 CHAPTER 5
nursing conceptual
MODELS

She believes that a patient can never be Educational Revolution in Nursing (1961)
separated from his or her environment when Reveille in Nursing (1964)
addressing health and treatment. An Introduction to the Theoretical Basis
Martha Rogers died on March of Nursing (1970)
13, 1994 and was buried in
Knoxville, Tennessee. Her publications include:
1937 Theoretical Basis of Nursing (1970),
she worked for the Nursing Science and Art: A Prospective
Children’s Fund of (1988)
Michigan. Nursing: Science of Unitary, Irreducible,
Human Beings Update (1990)
Rogers was then appointed Professor and Vision of Space Based Nursing (1990)
Head of the Division of Nursing at New York
University. Awards of the Theorist
Rogers was also actively involved in Martha Rogers was honored with numerous
professional nursing organizations and awards and citations for her sustained
associations concerned with education and contributions to nursing and science.
scholarship. 1996
1979 she was posthumously inducted into the
she became Professor Emerita and American Nurses Association’s Hall of
continued to have an active role in the Fame.
development of nursing and the Science
of Unitary Human Beings. Roger's Theory of Science of Unitary Human
1936 Beings
Rogers received her nursing diploma The theory views nursing as both a science
from the Knoxville General Hospital and an art.
School of Nursing The unitary human being and his or her
1937 environment are one.
Public Health Nursing degree from Her model addresses the importance of the
George Peabody College in Tennessee. environment as an integral part of the
1945 patient, and uses that knowledge to help
Master’s degree was from Teachers nurses blend the science and art of nursing
College at Columbia University to the best health possible.
1954 Rogers’ theory defined Nursing as “an art
Doctorate in Nursing was given to her and science that is humanistic and
from Johns Hopkins University in humanitarian. The goal of nurses is to
Baltimore. participate in the process of change.”
The title of her dissertation was “The According to Rogers, the Science of Unitary
association of maternal and fetal Human Beings contains two dimensions: the
factors with the development of science of nursing, which is the knowledge
behavior problems among elementary specific to the field of nursing that comes
school children.” from scientific research; and the art of
nursing, which involves using the science of
Works of the Theorist nursing creatively to help better the life of
Martha Rogers wrote three books that the patient.
influenced the direction of nursing research
for countless students:
 CHAPTER 5
nursing conceptual
MODELS

Conclusion Theoretical Sources of Orem's Self-Care Deficit

Rogers gave much emphasis on how a nurse Theory
should view the patient. She developed The primary source for
principles which emphasize that a nurse Orem’s ideas about
should view the client as a whole. nursing was her
Her statements, in general, made us believe experiences in nursing.
that a person and his or her environment are From works of other
integral to each other. That is, a patient nurses such as:
can’t be separated from his or her Abdellah
environment when addressing health and Henderson
treatment Johnson
King and others.
Dorothea Orem She also cited authors from a number of
Self-Care Deficit Theory of Nursing disciplines influenced by scholars such as:
Credentials & Background Alport (1955),
Was born in Baltimore, Maryland on 1914. Barnard (1962)
She began her nursing career at Providence others that can be seen in Orem’s ideas
Hospital School of Nursing in Washington, and positions.
DC
1939 Major Concepts & Definitions
BSN Education The self-care deficit nursing theory is a
1946 general theory composed of the
MSN Education from Catholic University following four related theories:
of America
Her papers and presentations provide Theory of self-care
insight into her views on nursing practice, Comprises the practice of activities
nursing science, and nursing education. that maturing and mature persons
Her clinical practice includes operating initiate and perform, within time
room nurse and hospital staff nurse on frames of their own behalf in the
pediatric and adult medical surgical units interest of maintaining life, healthful
and an evening supervisor in the emergency functioning, continuing personal
room. development and well being by
1959 meeting known requisites for
Guides for Developing Curricula for the functional and developmental
Education Of Practical Nurses was regulations.
developed by Orem
Orem continued to develop her nursing Theory of dependent-care
concepts and her self-care deficit theory of the care that is provided to a
nursing. person who, because of age or
1971 related factors, is unable to perform
she published a book of Nursing: the self-care needed to maintain
Concepts of Practice. life and well being.
She died on June 22, 2007 at the age of 92
after being bedridden. Theory of self-care deficit
The central focus of Orem’s
general theory of nursing.
 CHAPTER 5
nursing conceptual
MODELS

The relationship between an Imogene King

individual’s therapeutic self-care Goal Attainment Theory
demand and his or her powers of “Theory is an abstraction that implies prediction based in
self-care agency in which the research. Theory without research and research without
some theoretical basis will not build scientific knowledge
constituent-developed self-care
for a discipline” Imogene King (1923-2007) --------
capabilities within self-care agency
are inoperable or inadequate for
Credentials & Background
knowing and meeting some or all
was born on January 30, 1923, in West
components of the existent or
Point, Iowa.
projected therapeutic self-care
She died December 24, 2007, in St.
demand.
Petersburg, Florida, and is buried in Fort
Orem’s identifies 5 helping
Madison, Iowa.
methods:
1945
1. Acting for or doing for another
Received a diploma in Nursing from St.
2. Guiding and directing
John’s Hospital School of Nursing,
3. Providing physical or
St.Louie University, Missouri
psychological support
1948
4. Providing and maintaining an
While working in a variety of staff nurse
environment that supports
roles, King began course work toward a
personal development
Bachelor of Science in Nursing
5. Teaching
Education
1957
Theory of Nursing System
Received a Master of Science in
It describes how the patient’s self
Nursing, at St. Louis University
care needs will be met by the nurse,
1947-1958
the patient, or both.
King worked as an instructor in medical-
It identifies 3 classification of
surgical nursing
nursing system:
1961-1966
1. Wholly Compensatory System
Master’s degree program in nursing
2. Partly Compensatory System
1968
3. Supportive-Educative System
King served under Jessie Scott as
Assistant Chief of Research Grants
Branch, Division of Nursing. Her article
Conclusion
“A Conceptual Frame of Reference for
The Theory of Self-Care Deficit describes
Nursing” was published in Nursing
the limitations involved in meeting
Research.
requirements for ongoing care and the
1971
effects they have on the health and well-
Director of the School of Nursing at
being of the person.
Ohio State University
The Self-Care Deficit Theory developed as a
1978-1980
result of Dorothea E. Orem working toward
Served as Coordinator of Research in
her goal of improving the quality of nursing
Clinical Nursing at Loyola Medical
in general hospitals in her state.
Center, Department of Nursing
 CHAPTER 5
nursing conceptual
MODELS

1980 Personal System, Interpersonal System, Social

King was awarded an honorary PhD System
from Southern Illinois University and was nurse or patient:
appointed professor in South Florida body image, growth
College of Nursing and development,
She authored multiple book chapters and perception, self,
articles. space, time
King retired and was named professor nurse or patient:
emeritus at the University of South Florida. communication,
interaction, role,
Honors & Awards stress, transaction
Old medallion from Governor Chiles for religious, educational, and health care
advancing the nursing profession in the systems:
State of Florida. authority, decision making, organization,
2004 power, status
FNA Hall of Fame and the ANA Hall of
Fame King's Middle-Range Theory of Goal Attainment
Inducted into the American Academy of
Nursing (AAN) and as a Living Legend; Jessie
M. Scott Award
Teachers College, Columbia University of
Hall of Fame; STTI Elizabeth Russell Belford
Founders Awards for Excellence in
Education Hypotheses From the Theory of Goal Attainment
Perceptual accuracy in nurse-patient
Theoretical Sources interactions increases mutual goal setting.
“Proposing a conceptual frame of reference Communication increases mutual goal
for nursing, intended to be utilized setting between nurses and patients and
specifically by students and teachers, and leads to satisfaction.
also by researchers and practitioners, to Satisfactions in nurses and patients
identify and analyze events in specific increase goal attainments.
nursing situations. The conceptual system Goal attainment decreases stress and
suggests that the essential characteristics anxiety in nursing situations.
of nursing are those properties that have Goal attainment increases patient learning
persisted in spite of environmental changes” and coping ability in nursing situations.
Role conflict experienced by patients,
Dynamic Conceptual Systems nurses, or both decreases transactions in
nurse-patient interactions.
Congruence in role expectations and role
performance increases transactions in
nurse-patient interactions.
 CHAPTER 5
nursing conceptual
MODELS

Summary Adaptation inspired her to make it as a

Imogene king contributed to the conceptual frame work for nursing.
advancement of nursing knowledge through 1964-1988
the development of her conceptual system she developed the basic concepts of
and middle-range theory of goal the model
attainment. 1968
King provided a conceptual system and began operationalizing her model
middle-range theory that has demonstrated 1970
its usefulness to nurses. Nurses working It was first presented in Nursing Outlook
around the world, within the hospital titled “Adaptation: A Conceptual
settings, continue to use King’s work to Framework for Nursing”.
improve the quality of patient care. Roy has published many books, chapters,
and periodical articles and has presented
Sister Callista Roy numerous lectures and workshops focusing
Adaptation Model on her nursing adaptation theory.
"I have always believe that if you want to achieve
anything special in your life, you have to work, work and 1981
then work some more" ------------- she received a
National Founder’s
Credentials & Background Award for Excellence
born on October 14, 1939 in Los Angeles, in Fostering
California Professional Nursing
a member of the Sisters of Saint Joseph of Standards.
Carondelet.
1963 1984
She received a bachelor’s degree in Honorary Doctorate of Humane Letters
nursing from Mount Saint Mary’s College from Alverno College
in Los Angeles. 1985
1966 Honorary Doctorates from Eastern
She received master’s degree in nursing Michigan University
from University of California, Los 1999
Angeles. St. Joseph’s College in Maine (1999) and
1973 and 1977 an American Journal of Nursing Book of
Roy began her education in sociology the year award for “Essentials of the
,receiving both master’s and doctorate Roy Adaptation Model.”
degree in sociology from the University Roy received the Outstanding Alumna
of California. Award and the prestigious Carondelet
Roy was challenged in a seminar with Medal from her alma mater, Mount Saint
Dorothy E. Johnson to develop a conceptual Mary’s.
model in nursing. 2007
She was had noticed while working as a The American Academy of Nursing
pediatric staff nurse the great resiliency of honored Roy for her extraordinary life
children and their ability to adapt in achievements by recognizing her as a
response to major physical and Living Legend.
psychological changes.
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Roy's Adaptation Model Ineffective Response

those who don’t contribute to integrity
in terms of the goals of the human
system.

Coping Process
innate or acquired ways of interacting with
the changing environment.
Innate Coping Mechanisms
genetically determined or common to
the species and are generally viewed as
automatic processes; humans do not
have to think about them.
Acquired Coping Mechanisms
are developed through strategies such
Stimuli
as learning. The experiences
is any factor that provokes a stimuli.
encountered throughout life contribute
to customary responses
Focal Stimuli
immediately confront the individual.
Regulator Subsystem
Contextual Stimuli
a major coping process involving the
all other stimuli present that contribute
neural, chemical, and endocrine
to the effect of the focal stimulus.
systems.
Cognator subsystem
Residual Stimuli
a major coping process involving four
are environmental factors of which the
cognitive-emotive channels; perceptual
effects are unclear in a given situation.
and information processing, learning,
judgement, and emotion.
Adaptive Modes
Physiological – Physical Mode
associated with the physical and
chemical processes involved in the
function and activities of a living
organisms.
Oxygenation
Nutrition
Elimination
Major Assumptions
Activity and rest
Scientific Assumptions
Protection
Systems of matter and energy progress
The basic need of the physical mode is
to higher levels of complex self-
integrity.
organization.
Awareness of self and environment is
Response
rooted in thinking and feeling.
Adaptive Response
Humans by their decisions are
those that promote integrity in terms of
accountable for the integration of
goals of human systems.
creative processes.
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Philosophical Assumptions Neuman Systems Model that has been

Persons have mutual relationships with accepted, adopted, and applied as a core
the world and God for nursing curriculum in many areas around
Persons use human creative abilities of the world.
awareness, enlightenment, and faith. She grew up on a farm which later
Persons are accountable for the encouraged her to help people who are in
processes of deriving, sustaining and need.
transforming the universe Her love for nursing started when she took
the responsibility of taking care of her
Acceptance by Nursing Community father which later created her compassion
Education in her chosen career path.
The Adaptation Model of Nursing 1947
a prominent nursing theory aiming to she received her RN Diploma from
explain or define the provision of Peoples Hospital School of Nursing,
nursing science. Akron, Ohio.
In her theory, Sister Callista Roy’s model A hospital nurse and head nurse at Los
sees the individual as a set of interrelated Angeles County General Hospital
systems who strives to maintain a School nurse, industrial nurse, and clinical
balance between various stimuli. instructor at the University of Southern
California Medical Center, Los Angeles
Importance of the Adaptation Model 1957
Roy adaptation model has defined nursing Baccalaureate degree in public health
process and is useful in guiding clinical and psychology with honors.
practice. 1966
The utility of the model has been Master’s degree in mental health, public
demonstrated globally by nurses. Roy's health consultation from the University
model provides direction for quality nursing of California, Los Angeles (UCLA).
care that address the holistic needs of the 1985
patients. Betty Neuman concluded a doctoral
The model is also capable of generating degree in clinical psychology at Pacific
new information through the testing of Western University.
hypotheses that have been derived from it. Private practice as a marriage and family
therapist, specializing in Christian
Betty Neuman counseling.
Neuman's System Model She is a Fellow of the American Association
“Health is a condition in which all parts and subparts are of Marriage and Family Therapy and of the
in harmony with the whole of the client.” American Academy of Nursing and was the
director of the Neuman Systems Model
Credentials & Background Trustees Group, Inc
born in 1924 at Lowell, Ohio 1972
a nursing theorist who Neuman published a draft of her model
developed the Neuman .She developed and improved the concepts
Systems Model. and published her book, The Neuman
She gave many years System Model: Application to Nursing
perfecting a systems model Education and Practice
that views at patients
holistically.
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Neuman has also been involved in numerous Betty Neuman describes the Neuman
publications, paper presentations, Systems Model as “a unique, open-system-
consultations, lectures, and conferences on based perspective that provides a unifying
application and use of the model. focus for approaching a wide range of
concerns. A system acts as a boundary for a
Awards & Honors single client, a group, or even a number of
1992 groups; it can also be defined as a social
Honorary Doctorate of Letters, Neumann issue. A client system in interaction with the
College, Aston, PA environment delineates the domain of
1993 nursing concerns.”
Honorary Member of the Fellowship of
the American Academy of Nursing Major Concepts of Neuman System Models
1998 The Neuman Systems Model views the
Honorary Doctorate of Science, Grand client as an open system that responds to
Valley State University, Michigan stressors in the environment.
She was honored by President Richard The client variables are physiological,
Jusseaume and Provost Dr. Laurence Bove psychological, sociocultural, developmental,
with the Walsh University Distinguished and spiritual.
Service Medal The client system consists of a basic or core
In an annual Nursing Research Day structure that is protected by lines of
sponsored by Walsh’s Phi Eta Chapter of resistance.
Sigma Theta Tau, Byers School of Nursing The usual level of health is identified as the
Dean Dr. Linda Linc granted Neuman with normal line of defense that is protected by
the first annual Neuman Award, named in a flexible line of defense.
her honor, for outstanding service in the Stressors are intra-, inter-, and
nursing profession. extrapersonal in nature and arise from
Throughout the years, she earned many the internal, external, and created
awards and honors including several environments.
honorary doctorates and was an honorary When stressors break through the flexible
member of the American Academy of line of defense, the system is invaded and
Nursing. the lines of resistance are activated and the
system is described as moving into illness on
Neuman System Model a wellness-illness continuum.
based on the person’s relationship to If adequate energy is available, the system
stress, the response to it, and will be reconstituted with the normal line of
reconstitution factors that are defense restored at, below, or above its
progressive in nature. previous level.
A broad, holistic and system-based method Nursing interventions occur through three
to nursing that maintains a factor of prevention modalities:
flexibility. Primary prevention
It focuses on the response of the patient occurs before the stressor invades
system to actual or potential environmental the system.
stressors and the maintenance of the client Secondary prevention
system’s stability through nursing prevention occurs after the system has reacted
intervention to reduce stressors. to an invading stressor
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Tertiary prevention Dorothy Johnson

occurs after secondary prevention Behavioral Systems Model
as reconstitution is being “All of us, scientists and practicing professionals, must
established. turn our attention to practice and ask questions of that
practice. We must be inquisitive and inquiring, seeking the
fullest and truest possible understanding of the
Client Variables theoretical and practical problems we encounter”
Physiological variable (Johnson 1976) --------------------
refers to the structure and functions
of the body. Credentials & Background
Psychological variable born on August 21, 1919, in Savannah,
refers to mental processes and Georgia.
relationships. 1938
Sociocultural variable She received her Associate’s degree
refers to system functions that from Armstrong Junior College in
relate to social and cultural Savannah, Georgia
expectations and activities. 1942
Developmental variable Bachelor of Science in Nursing from
refers to those processes related to Vanderbilt University in Nashville,
development over the lifespan. Tennessee
Spiritual variable 1948
refers to the influence of spiritual Master’s of Public Health Degree from
beliefs Harvard University in Boston
Johnson’s professional experiences involved
mostly teaching.
1943-1944
she was a staff nurse at the Chatham-
Savannah Health Council.
1949-1978
An instructor and an assistant professor
in pediatric nursing at Vanderbilt
University School of Nursing
Johnson’s publications include four books;
more than 30 articles in periodicals; and
many papers, reports, proceedings and
Analysis monographs.
The holistic and comprehensive view of 1975
the client system is associated with an Faculty Award
open system. 1977
Health and illness are presented on a Lulu Hassenplug Distinguished
continuum with movement toward health Achievement Award from The California
described as negentropic and toward illness Nurses Association
as entropic. 1981
Her use of the concept of entropy is Vanderbilt University School of Nursing
inconsistent with the characteristics of She died in February 1999 at 80 years of
entropy which is closed, rather than an open age.
system.
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Theory of Dorothy Johnson Behavioral system

Behavioral Systems Model It encompasses the patterned,
She was pleased that her behavioral system repetitive, and purposeful ways of
model had been found useful in furthering behaving.
the development of a theoretical basis for
nursing and was being used as a model for Subsystems
nursing practice on an institution-wide basis is a “ mini system with its own
but she reported that her greatest source of particular goal and function that can
satisfaction came from following the be maintained as long as its relationship
productive careers of her students. to the other subsystems or the
environment is not disturbed”
Theoretical Sources
Johnson’s behavioral system model was Equilibrium
heavily influenced by Florence it implies that biological and
Nightingale’s book , Notes on Nursing. psychological forces are in balance
She accepted Nightingale’s belief that the with each other and with impinging
first concern of nursing is with the social forces”
“relationship between the person who is ill
and their environment, not with the illness. Theoretical Assertions
Johnson’s behavioral theory addresses the
Johnson's Behavioral System Model metaparadigm concepts of person,
environment, and nursing.
Each subsystem is described and analyzed
in terms of structural and functional
requirements.

Acceptance by the Nursing Community

Practice
Johnson’s behavioral system theory have
been used in a variety of clinical
settings, age groups and client
populations.
The nursing process becomes applicable in
the behavioral system model when
Major Concepts and Definitions behavioral malfunction occurs.
Behavior Individual experiencing stress of health-
that is the output of intraorganismic illness nature which disturbs the equilibrium
and processes as they are coordinated needs assistance.
and articulated by and responsive to
changes in sensory stimulation. Further Development
Johnson acknowledged that the knowledge
System base for her model was incomplete and she
A system is a whole that functions as challenged researchers to complete her
a whole by the virtue of the work.
interdependence of its parts” The gaps in knowledge offered challenged
for educators and practitioners.
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Johnson noted that a group of individuals

could be considered group of behavioral
systems .
Preventive nursing is not the same as
preventive medicine.
Further development is indicated to identify
nursing actions that facilitate appropriate
functioning of the systems toward disease
prevention and health maintenance.