FLORENCE NIGHTINGALE

Introduction Health

Born - 12 May 1820 is “not only to be well, but to be able to use well every power we
Founder of mordern nursing. have”.
The first nursing theorist. Disease is considered as dys-ease or the absence of comfort.
Also known as "The Lady with the Lamp"
She explained her environmental theory in her famous book Notes Environment
on Nursing: What it is, What it is not .
She was the first to propose nursing required specific education and "Poor or difficult environments led to poor health and disease".
training. "Environment could be altered to improve conditions so that the
Her contribution during Crimean war is well-known. natural laws would allow healing to occur."
She was a statistician, using bar and pie charts, highlighting key
points. Nightingale's Theory and Nursing Practice
International Nurses Day, May 12 is observed in respect to her
contribution to Nursing. Application of Nightingale's theory in practice:
Died - 13 August 1910
"Patients are to be put in the best condition for nature to act on them,
Assumpations of Nightingale's Theory it is the responsibility of nurses to reduce noise, to relieve patients’
anxieties, and to help them sleep."
Natural laws As per most of the nursing theories, environmental adaptation
Mankind can achieve perfection remains the basis of holistic nursing care.
Nursing is a calling
Nursing is an art and a science Criticisms
Nursing is achieved through environmental alteration
Nursing requires a specific educational base She emphasized subservience to doctors.
Nursing is distinct and separate from medicine She focused more on physical factors than on psychological needs of
patient.
Nightingale’s Canons: Major Concepts
Applications of Nightingale's Theory
Ventilation and warming
Light, Noise Nightingale theory and intentional comfort touch in management of
Cleanliness of rooms/walls tinea pedis in vulnerable populations
Health of houses Incorporating Florence Nightingale's theory of nursing into teaching a
Bed and bedding group of preadolescent children about negative peer pressure.
Personal cleanliness
Variety Conclusion
Chattering hopes and advices
Taking food. What food? Florence Nightingale provided a professional model for nursing
Petty management/observation organization.
She was the first to use a theoretical founation to nursing.
Nursing Paradigms Her thoghts have influenced nursing significantly.

Nightingale's documents contain her philosophical assumptions and

beliefs regarding all elements found in the metaparadigm of nursing.
These can be formed into a conceptual model that has great utility in
the practice setting and offers a framework for research
conceptualization. (Selanders LC, 2010)
Nursing
Nursing is different from medicine and the goal of nursing is to place
the patient in the best possible condition for nature to act.
Nursing is the "activities that promote health (as outlined in canons)
which occur in any caregiving situation. They can be done by
anyone."
Person
People are multidimensional, composed of biological, psychological,
social and spiritual components.
Health
Florence nightingale’s environment theory
1. Florence Nightingale’s Environment theory Shrooti Shah Lecturer
National Medical College Nursing Campus, Birganj
2. Introduction • Florence Nightingale was born on May 12, 1820,
while her parents were on an extended European tour. • Much
attention has been to the “Calling” that Nightingale recorded in her
diary in 1837, when she wrote that “ God spoke to me and called me
to his service”. • Florence Nightingale began her nursing training in
1851 in Germany.
3. Introduction • She pioneered the concept of formal education for
nurses. • She served the injured soldiers during the Crimean war
which strongly influenced her philosophy of nursing. • In 1859, she
published her views on nursing care in notes on nursing. • She is
considered the first nursing theorist.
4. Introduction • She stated in her nursing notes that nursing “is an
act of utilizing the environment of the patient to assist him in his
recovery.” • Her contribution during Crimean war is well-known. • She
was a statistician, using bar and pie charts, highlighting key points. •
International Nurses Day, May 12 is observed in respect to her
contribution to Nursing. • Died- 13 August 1910
5. Introduction • The foundation of Nightingale’s theory is the
environment- all the external conditions and forces that influence the
life and development of an organism. • According to her, external
influences and conditions can prevent, suppress, or contribute to
disease or death. • Her goal was to help the patient retain his own
vitality by meeting his basic needs through control of the
environment.
6. Types of Environment There are three types of environments.
Physical, Psychological and Social Physical Environment: • Physical
Environment consists of physical elements where the patient is being
treated. • It affects all other aspects of the environment. Cleanliness
of environment relates directly to disease prevention and patient
mortality. • Aspects of the physical environment influence the social
and psychological environments of the person
7. Types of Environment Psychological Environment: • Psychological
environment can be affected by a negative physical environment
which then causes STRESS. • It requires various activities to keep
the mind active. • It involves communication with the person, about
the person, and about other people.
8. Types of Environment Social environment • It includes
components of the physical environment - clean air, clean water,
proper drainage. • It consists of a person’s home or hospital room, as
well as the total community
9. Health of houses • The importance of the health of houses as
being closely related to the presence of pure air, pure water, efficient
drainage, cleanliness and light. • Cleanliness outside the house
effected the inside.
10. Ventilation and warming • Nurses was “ to keep the air he
breathes as pure as the external air, without chilling”. • Nightingale
was very concerned about “noxious air” or “effluvia” or foul odours
that came from excrement. • Nightingale stressed the importance of
room temperature. The patient should not be too warm or too cold.
11. Light • She viewed that direct sunlight was what patients wanted.
• Although acknowledging a lack of scientific rationale for it, she
noted that light has “ quite real and tangible effects upon the human
body”.
12. Noise • She stated that patient should never be waked
intentionally or accidentally during the first part of sleep. • She
asserted that whispered or long conversations about patients are
thoughtless and cruel. • Nurses responsibility is to assess and stop
different king of noise.
13. Variety • She believed that variety in the environment was a
critical aspect of affecting the patients recovery. • She discussed the
need for changes in colour and form, including bringing the patient
brightly coloured flowers or plants.
14. Bed and bedding • She stated that dirty carpets and walls
containing large quantities of organic matter and provided ready
source of infection, just as dirty sheets and beds did.
15. Personal cleanliness • The need for cleanliness is extended to
the patient, the nurse and the environment. • Nightingale viewed the
functions of the skin is important, believing that many disease
“disorders” or caused breaks in the skin.
16. Nutrition and taking food • Nightingale addressed the variety of
food presented to the patients and discussed the importance of
variety in the food presented.
17. Chattering hopes and advices • False hope was depressing to
patients, she felt and caused them to worry and become fatigued. •
She believed that sick persons should hear good news that would
assist them in becoming healthier.
18. Social considerations • Nightingale supported the importance of
looking beyond the persons to the social environments in which he or
she lived. • She observed that generations of families lived and died
in poverty.
19. Four major concepts of Nightingale’s theory
20. Nursing • Nursing is different from medicine and the goal of
nursing is to place the patient in the best possible condition for nature
to act. • Nursing is the "activities that promote health which occur in
any care giving situation. They can be done by anyone."
21. Person • Nightingale referred person as a patient. Person is
affected by environment. • Person is multidimensional, composed of
biological, psychological, social and spiritual components. • He has a
vital reparative power to deal with disease, recovery is within the
person’s power as long as a safe environment for recuperation
exists.
22. Health/Disease • Health is “not only to be well, but maintaining
well- being by using a person’s power to the fullest extent”. • Health
is maintained by controlling the environmental factors to prevent
disease. • Disease is considered as dys-ease or the absence of
comfort. • Health and disease are the focus of nurse, who helps a
person through the healing process.
23. Environment • "Poor or difficult environments led to poor health
and disease". • "Environment could be altered to improve conditions
so that the natural laws would allow healing to occur."
24. Relevance of theory in nursing practice, education and research
Nursing Practice 1. Disease control 2. Sanitation and water treatment
3. Utilized by modern architecture in the prevention of "sick building
syndrome" applying the principles of ventilation and good lighting. 4.
Waste disposal 5. Control of room temperature 6. Noise
management.
25. Relevance of theory in nursing practice, education and research
Education 1. Principles of nursing training. Better practice result from
better education. 2. Skills measurement through licensing by the use
of testing methods, the case studies. Research 1. Use of graphical
representations like the bar, pie diagrams. 2. Notes on nursing.
26. Application of nightingale's theory in nursing process Assessment
The following information should be adequate. • Adequacy of
ventilation • Cleanliness of environment • Presence of draft • Sudden
noises • Amount of sunlight and artificial light
27. Application of nightingale's theory in nursing process • Variety of
dietary offerings • Odors present in throughout ward • Methods of
disposal of human waste and sputum • Opportunity to communicate
with others • Insufficient warmth • company from family and other
patient • Insufficient knowledge regarding disease
28. Nursing Diagnosis • Non-stimulating environment
29. Implementation • Provide adequate ventilation by opening doors
and windows. • Keep the surrounding environment clean (linen, bed,
utensils) • Keep the patient in warm and comfortable room, avoid
unnecessary noise. • Increase stimulus through a greater exposure
to sunlight and fresh air. • Provide nutritious diet and encourage for
liquid diet frequently. • Proper disposal of sputum, human excreta
and other waste to remove odors.
30. Implementation • Proper dress-up, maintain room temperature
and wear warm clothes. • Isolate the patient from the children from
the other patients but keep in touch and interaction with limited
visitors. • Keep in stimulating environment such as listening to radio,
reading magazines and newspapers. • Provide sufficient advice,
information about disease, it’s prognosis, course of treatment to the
patient and family members.
31. Evaluation • It is based on observation on the effect of a changing
environment on the health of a person specially focus on the vital
signs and adequate knowledge about disease condition.
32. Application of Nightingale’s work in the nursing process •
Assessment: Nancy Smith, a 10 yrs old was injured in an accident
related to farm machinery. She had head injury then she was
admitted to PICU. Because of PICU envt., she had interrupted sleep
and she became increasingly confused. Her leg has become
infected. • Analysis of data: includes data gap • Nursing Diagnosis:
Impaired sleep pattern related to environmental light and noise and
separation from family.
33. Application of Nightingale’s work in the nursing process •
Planning and implementation: nursing actions focus on changing the
environment to support more normal sleep patterns, that is, being
awake during the day and sleeping at night. • Evaluation: After two
nights of uninterrupted sleep, normal sounds, and parental
encouragement, Nancy will demonstrate increased orientation to
place being able to identify that she is in the hospital.
34. Nightingale and the Characteristics of theory
35. Nightingale model and the characteristics of theory • Theories
can interrelate concepts in such a way to create different way of
looking at phenomena: – Using her envt. Model, new insights into the
phenomena of interest to nursing can be identified. – Examining
envt.al aspects such as light, noise or warmth can provide new
insights into human responses to health and illness, which means
that health and illness not only influenced by the pathophysiology
and also psychosocial envt.
36. Theories must be logical in nature • Her model is illogical. • She
built her conclusion from observations, she made her case, drew her
conclusions and then acted. She used logic to correct her conclusion.
37. Theories must be relatively simple yet generalizable • Her
writings are simple. • The beauty of her model is its generalizability,
including its continued applicability today.
38. Theories can be bases for hypothesis that can be tested or for
theory to the explained • Nightingale has stimulated the development
of nursing science with her work. • She has had a profound effect on
many of the other nursing theorists. • The research related to the
impact of the envt. on client health has been influenced by
Nightingale.
39. Theories contribute to and assist in increasing the general body
of knowledge • This theory seems to have more relevance to
practitioners today than ever before. • More and more data are
becoming available to indicate the critical nature of the impact of the
environment on the health and well-being of the individual.
40. Theories can be used by practitioner to guide and improve them •
Her work raises a consciousness on the nurse about how the
environment influences client outcomes. • For example: controlling
sound in the wards, mounting ventilation and light, put off light during
nights all and all help in recovery from illness.
41. Theories must be consistent with validated theories, laws and
principles but will have open unanswered questions that need to be
investigated • Works well with ecological, systems, adaptation and
interpersonal theories. • she did not believe in germ theory; however
the practices she recommended were not inconsistent with scientific
knowledge we have today. • Many of her suggestions which she
based on observation of client response to their envt., have been
documented on scientifically sound when tested with rigorous
application of modern research methods.
42. Critiques of the nightingale’s environment theory • Although four
major concepts are not explicit in Nightingale’s theory, they do offer
nursing a specific way of looking at particular phenomenon. • The
relationship between each concept is logical and consistent with
similar assumptions. • Nightingale’s theory, although limited, has a lot
of generalizability. • These ideas are basically simple to apply and
easy to measure in terms of outcomes.
43. Critiques of the nightingale’s environment theory • Prevention of
disease would be achieved through environmental controls. • The
environmental aspects of her theory remain integral components of
current nursing care. • Yet it is not clear that Nightingale intended to
develop a theory of nursing, she did intend to define the science and
art of nursing and provide general rules with explanations.
44. Critiques of the nightingale’s environment theory • The relation
concepts-nurse, patient and environment are applicable in all nursing
today. • Nightingale rejected the germ theory and her inability to
recognize a unified body of nursing knowledge that is testable. • She
was only relying on personal observation and experience.
45. Nightingale and the characteristics of theory 1. What is the
historical context of theory? i. Florence Nightingale is the founder of
modern nursing. ii. Her work in the mid 1800s provided the basis for
much of modern nursing. iii. Nightingale’s environment model fits
neither the totality nor the simultaneity paradigms.
46. What are the basic concepts and relationships presented by the
theory? • Nightingale presented her ideas not as a theory but as
strategies to help women care for the ill in the home and in hostels. •
Relationship of concepts are not clearly articulated. However she
presents her ideas in a clear manner. • Using the basic concepts she
presents, new insights into phenomena of interest to nursing can be
identified.
47. What major phenomena of concern to nursing are presented? •
The manipulation of the environment by the nurse to put the patients
in the best place. • Nightingale does not address interpersonal
relations specifically but does talk about the need for the nurse to
consider what she says when talking around the patient. •
Cleanliness is also of major importance.
48. To whom does this theory apply? In what situations? In what
way? • Nightingale’s writing are simple. • Nightingale’s theory applies
in all situations in which nursing care is provided. • Concepts related
to pure air, light, noise and cleanliness can be applied across specific
environments. • Reading her work raises a consciousness in the
nurse about how the environment influences client outcomes. It has
directed interventions toward modulating the environment.
49. To whom does this theory apply? In what situations? In what
way? • Works well with ecological, systems, adaptation and
interpersonal theories. • Her focus on the environment has relevance
to practitioners in today’s global health care climate.
50. By what method or methods can this theory be tested? • While
direct testing of Nightingale’s theory has not been done, she has
stimulated the development of nursing science with her work. • For
example: she did not believe in germ theory; however the practices
she recommended were not inconsistent with scientific knowledge
we have today. • Both quantitative and qualitative methods of
research could be used to test relationships in the environmental
model.
51. Does this theory direct nursing actions that lead to favourable
outcome? • Her work has not been tested in a manner that nursing
actions are prescribed. • However, her writings have helped nurses
develop interventions that result in restructuring the environment.
52. How contagious is this theory? • Examples of how nightingale
continues to influence both modern nursing and health care can be
seen in a number of articles.
 VIRGNIA HENDERSON
introduction
 “The Nightingale of Modern Nursing”
 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."
 Born in Kansas City, Missouri, in 1897.
 Diploma in Nursing from the Army School of Nursing at
Walter Reed Hospital, Washington, D.C. in 1921.
 Worked at the Henry Street Visiting Nurse Service for 2
years after graduation.
 In 1923, started teaching nursing at the Norfolk Protestant
Hospital in Virginia
 In 1929, entered Teachers College at Columbia University
for Bachelor’s Degree in 1932, Master’s Degree in 1934.
 Joined Columbia as a member of the faculty, remained
until 1948.
 Since 1953, a research associate at Yale University School
of Nursing.
 Recipient of numerous recognitions.
 Honorary doctoral degrees from the Catholic University of
America, Pace University, University of Rochester,
University of Western Ontario, Yale University
 In 1985, honored at the Annual Meeting of the Nursing and
Allied Health Section of the Medical Library Association.
 Died: March 19, 1996.
 In 1939, she revised: Harmer’s classic textbook of nursing
for its 4th edition, and later wrote the 5th; edition,
incorporating her personal definition of nursing
(Henderson,1991)
Theory Background
 She called her definition of nursing her “concept”
(Henderson1991)
 She emphasized the importance of increasing the patient’s
independence so that progress after hospitalization would
not be delayed (Henderson,1991)
 "assisting individuals to gain independence in relation to
the performance of activities contributing to health or its
recovery" (Henderson, 1966).
 She categorized nursing activities into 14 components,
based on human needs.
 She described the nurse's role as substitutive (doing for the
person), supplementary (helping the person),
complementary (working with the person), with the goal of
helping the person become as independent as possible.
 Her definition of nursing was:
"The unique function of the nurse is to assist the individual, sick or
well, in the performance of those activities contributing to health or its
recovery (or to peaceful death) that he would perform unaided if he
had the necessary strength, will or knowledge. And to do this in such
a way as to help him gain independence as rapidly as possible"
(Henderson, 1966).
The 14 components
 Breathe normally. Eat and drink adequately.
 Eliminate body wastes.
 Move and maintain desirable postures.
 Sleep and rest.
 Select suitable clothes-dress and undress.
 Maintain body temperature within normal range by
adjusting clothing and modifying environment
 Keep the body clean and well groomed and protect the
integument
 Avoid dangers in the environment and avoid injuring
others.
 Communicate with others in expressing emotions, needs,
fears, or opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of
accomplishment.
 Play or participate in various forms of recreation.
 Learn, discover, or satisfy the curiosity that leads to normal
development and health and use the available health
facilities.
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
Assumption
The major assumptions of the theory are:
 "Nurses care for patients until patient can care for
themselves once again. Patients desire to return to health,
but this assumption is not explicitly stated.
 Nurses are willing to serve and that “nurses will devote
themselves to the patient day and night” A final assumption
is that nurses should be educated at the university level in
both arts and sciences.
Henderson’s theory and the four major concepts
1. Individual
 Have basic needs that are component of health.
 Requiring assistance to achieve health and independence
or a peaceful death.
 Mind and body are inseparable and interrelated.
 Considers the biological, psychological, sociological, and
spiritual components.
 The theory presents the patient as a sum of parts with
biopsychosocial needs.
2. Environment
 Settings in which an individual learns unique pattern for
living.
 All external conditions and influences that affect life and
development.
 Individuals in relation to families
 Minimally discusses the impact of the community on the
individual and family.
 Basic nursing care involves providing conditions under
which the patient can perform the 14 activities unaided
3. Health
 Definition based on individual’s ability to function
independently as outlined in the 14 components.
 Nurses need to stress promotion of health and prevention
and cure of disease.
 Good health is a challenge -affected by age, cultural
background, physical, and intellectual capacities, and
emotional balance Is the individual’s ability to meet these
needs independently.
4. Nursing
 Temporarily assisting an individual who lacks the
necessary strength, will and knowledge to satisfy 1 or more
of 14 basic needs.
 Assists and supports the individual in life activities and the
attainment of independence.
  Nurse serves to make patient “complete” “whole", or
"independent."
 The nurse is expected to carry out physician’s therapeutic
plan Individualized care is the result of the nurse’s
creativity in planning for care.
 “Nurse should have knowledge to practice individualized
and human care and should be a scientific problem solver.”
 In the Nature of Nursing Nurse role is,” to get inside the
patient’s skin and supplement his strength will or
knowledge according to his needs.”
Henderson’s and Nursing Process
”Summarization of the stages of the nursing process as applied
to Henderson’s definition of nursing and to the 14 components
of basic nursing care.
Nursing Process Henderson’s 14 components and definition of
nursing
Nursing Henderson’s 14 components
Assessment
Nursing Analysis: Compare data to knowledge base of
Diagnosis 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
implementation individual, sick or well.
Nursing Assist the sick or well individual in to
implementation performance of activities in meeting human
needs to maintain 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 Henderson’s 14 components and definition of
evaluation 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 amount 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
Comparison with Maslow's Hierarchy of Need
Maslow's Henderson
Breathe normally
Eat and drink adequately Eliminate by all
avenues of elimination Move and maintain
Physiological
desirable posture Sleep and rest Select
needs
suitable clothing Maintain body temperature
Keep body clean and well groomed and
protect the integument
Avoid environmental dangers and avoid
Safety Needs
injuring other
Belongingness Communicate with others
and love needs worship 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
Characteristic of Henderson’s theory
 There is interrelation of concepts.
 Concepts of fundamental human needs, biophysiology,
culture, and interaction, communication are borrowed from
other discipline.Eg.. Maslow’s theory.
 Her definition and components are logical and the 14
components are a guide for the individual and nurse in
reaching the chosen goal.
 Relatively simple yet generalizable.
 Applicable to the health of individuals of all ages.
 can be the bases for hypotheses that can be tested.
 assist in increasing the general body of knowledge within
the discipline.
 Her ideas of nursing practice are well accepted.
 can be utilized by practitioners to guide and improve their
practice.
Limitations
 Lack of conceptual linkage between physiological and
other human characteristics.
 No concept of the holistic nature of human being.
 If the assumption is made that the 14 components
prioritized, the relationship among the components is
unclear.
 Lacks inter-relate of factors and the influence of nursing
care.
 Assisting the individual in the dying process she contends
that the nurse helps, but there is little explanation of what
the nurse does.
 “Peaceful death” is curious and significant nursing role.
Conclusion
 Henderson provides the essence of what she believes is a
definition of nursing.
 Her emphasis on basic human needs as the central focus
of nursing practice has led to further theory development
regarding the needs of the person and how nursing can
assist in meeting those needs.
 Her definition of nursing and the 14 components of basic
nursing care are uncomplicated and self-explanatory.

Virginia henderson's theory of nursing
1. 1. CLASS PRESENTATION ON VIRGINIA
HENDERSON’S NURSING THEORY PRESENTER:
Mandeep Kaur M.Sc.1st Year Roll No. 1 1
2. 2. 2
3. 3. EVOLUTION OF THEORY Virginia Henderson was the
nurse-theorist who devoted her career to defining nursing
practice. She believed that an occupation that affects
human life must outline its functions particularly if it is to be
regarded as profession. Her ideas about definition of
nursing were influenced by her nursing education and
practice by her students and colleagues at Columbia
University School of Nursing, and by distinguished nursing
leaders of her time. Two events are the basis for her
development of definition of nursing and these are: • First,
she participated in the revision of a nursing text book.
During revision of the “Textbooks of the principles and
practice of nursing” written with Bertha Harmer (1922)
Henderson realized the need to be clear about the
functions of the nurse. • Second, she was concerned that
the many states had no provision for nursing licensure to
ensure safe and competent care for the consumers. 3
4. 4. She examined the earlier statements of the nursing
functions by American Nurses Association and viewed
these statements as non specific and unsatisfactory
definition of nursing practice. In 1966, Henderson’s first
definition of nursing was published in Bertha harmer’s
revised nursing text book. It reads as “the unique function
of the nurse is to assist the individual (sick or well) in the
performance of those activities contributing to health or its
recovery (or peaceful death) that he would perform unaided
if he had the necessary strength, will or knowledge. And to
do this in such a way as to help him gain independence as
rapidly as possible.” 4
5. 5. CONCEPTS USED BY HENDERSON Henderson called
her definition of nursing as concept. Henderson viewed
human being, health, environment and nursing as follow:
Human being: The patient as an individual who requires
assistance to achieve health and independence or peaceful
death. The mind and the body are inseparable. The patient
and his family are viewed as a unit. Health: She views
health in terms of patient’s ability to perform unaided the 14
components of nursing care. She says it is “the quality of
the health rather than life itself, that margins of mental
physical vigor that allows a person to work most effectively
to reach his highest potential of satisfaction in life.”
Contd…… 5
6. 6. Environment: She used Webster dictionary, which
defines environment as “the aggregate of all the external
conditions and influences affecting the life and
development of an organism.” Nursing: In1966, Henderson
ultimate statements in the definition of nursing were
published of her ideas it reads as follows: “The unique
function of the nurse is to assist the individual (sick or well)
in the performance of those activities contributing to health
or its recovery (or peaceful death) that he would perform
unaided if he had the necessary strength, will or
knowledge. And to do this, in such a way as to help him
gain independence as rapidly as possible.” 6
7. 7. CHARACTERISTICS OF HENDERSON’S THEORY •
There is interrelation of concepts. • Concepts of
fundamental human needs are borrowed from other
discipline e.g. Maslow’s theory. • Her definition and
components are logical and the 14 components are a guide
for the individual and nurse in reaching the chosen goal. •
Relatively simple yet generalizable. • Applicable to the
health of individuals of all ages. 7
8. 8. Contd….. • Can be the bases for hypotheses that can be
tested. • Assist in increasing the general body of
knowledge within the discipline. • Her ideas of nursing
practice are well accepted. • Can be utilized by
practitioners to guide and improve their practice. 8
9. 9. FUNDAMENTAL NEEDS OF HUMAN ACCORDING TO
VIRGINIA HENDERSON 9
10. 10. FUNDAMENTAL NEEDS OF HUMAN 10
11. 11. 11
12. 12. 12 Play or participate in various forms of recreation.
Learn, discover, or satisfy the curiosity that leads to normal
development and health and use the available health
facilities.
13. 13. MATAPARADIGM OF HENDERSON’S THEORY
INDIVIDUAL:  Have basic needs that are component of
health.  Requiring assistance to achieve health and
independence or a peaceful death.  Mind and body are
inseparable and interrelated.  Considers the biological,
psychological, sociological, and spiritual components. 
The theory presents the patient as a sum of parts with
biopsychosocial needs. 13
14. 14. Environment:  Settings in which an individual learns
unique pattern for living.  All external conditions and
influences that affect life and development.  Individuals in
relation to families.  Minimally discusses the impact of the
community on the individual and family.  Basic nursing
care involves providing conditions under which the patient
can perform the 14 activities unaided. 14
15. 15. Health:  Definition based on individual’s ability to
function independently as outlined in the 14 components.
 Nurses need to stress promotion of health and
prevention and cure of disease.  Good health is a
challenge -affected by age, cultural background, physical,
and intellectual capacities, and emotional balance Is the
individual’s ability to meet these needs independently. 15
16. 16. Nursing:  Temporarily assisting an individual who
lacks the necessary strength, will and knowledge to satisfy
1 or more of 14 basic needs.  Assists and supports the
individual in life activities and the attainment of
independence.  Nurse serves to make patient “complete”
“whole", or "independent."  The nurse is expected to
carry out physician’s therapeutic plan. Individualized care is
the result of the nurse’s creativity in planning for care. 
“Nurse should have knowledge to practice individualized
and human care and should be a scientific problem solver.”
 In the Nature of Nursing Nurse role is,” to get inside the
patient’s skin and supplement his strength will or
knowledge according to his needs.” 16
17. 17. HENDERSON’S THEORY AND NURSING PROCESS
 Nursing assessment: Assess needs of human being
based in the 14 components of basic nursing care. 
Nursing Diagnosis: Identify individual’s ability to meet own
needs with or without assistance, taking into consideration
 strength, will or knowledge.  Nursing Plan: Document how 25. 25. Research • Research questions arise from each of the
the nurse can assist the individual, sick or well. 17 14 components of basic nursing care. • Henderson
18. 18.  Nursing Implementation Assist the sick or well concluded no profession, occupation or industry in this age
individual in to performance of activities in meeting human can evaluate adequately or improve it practice without
needs to maintain health, recover from illness, or to aid in research. • Offer a framework for generating knowledge
peaceful death. Implementation based on the physiological and new ideas. • She emphasized the importance of
principles, age, cultural background, emotional balance, research in evaluating and improving the nurses’ practice.
and physical and intellectual capacities.Carry out treatment 25
prescribed by the physician. 18 26. 26. VIRGINIA HENDERSON’S THEORY 26
19. 19. Nursing Evaluation Use the acceptable definition of 27. 27. STRENGTHS  The concept of nursing formulated by
nursing and appropriate laws related to the practice of Henderson in her definition of nursing and the 14
nursing. The quality of care is drastically affected by the components of basic nursing is uncomplicated and self-
preparation and native ability of the nursing personnel explanatory. Therefore, it can be used without difficulty as
rather that the amount of hours of care.Successful a guide for nursing practice by most nurses.  Henderson’s
outcomes of nursing care are based on the speed with work is relatively simple yet generalizable with some
which or degree to which the patient performs limitations.  Her work can be applied to the health of
independently the activities of daily living. 19 individuals of all ages.  Each of the 14 activities can be
20. 20. THEORETICAL ASSERTIONS The Nurse-Patient the basis for research. 27
Relationship: Henderson stated that there are three levels 28. 28. WEAKNESS A major shortcoming in her work is the
compromising the nurse-patient relationship: The nurse lack of a conceptual linkage between physiological and
as a substitute for the patient. The nurse as a helper to other human characteristics. No concept of the holistic
the patient. The nurse as a partner with the patient. 20 nature of human being. Lacks inter-relate of factors and
21. 21. The Nurse-Physician Relationship Henderson asserted the influence of nursing care. 28
that nurses function independently from physicians. 29. 29. BIBLIOGRAPHY • Basavanthappa BT. Nursing
Though the nurse and the patient, as partners, formulate theories. 1st ed. New Delhi: Jaypee Brothers Medical
the plan of care, it must be implemented in such a way that Publisher; 2007.p. 61-65. • Basavanthappa BT.
will promote the physician’s prescribed therapeutic plan. Fundamentals of nursing. 2nd ed. New Delhi: Jaypee
She also insisted that nurses do not follow doctor’s orders; Brothers Medical Publisher; 2007.p. 52. • Kozier and erb’s.
rather they follow in a philosophy which allows physicians Fundamental of nursing. 8th ed. New Delhi: Pearson; 2009.
to give orders to patients or other healthcare team p. 43-44. • Sr. Nancy. Principles and practice of nursing.
members. 21 6th ed. Indore: N.R. Brothers; 2007.p. 602-603. •
22. 22. The Nurse as a Member of the Healthcare Team: For a http://currentnursing.com/nursing_theory/Henderson.html •
team to work together in harmony, every member must http://vhenderson2011.blogspot.in/p/major-concepts.html •
work interdependently. The nurse, as a member of the http://currentnursing.com/nursing_theory/Henderson.html •
healthcare team, works and contributes in carrying out the http://nursing-theory.org/theories-and-models/henderson-
total program of care. However, working interdependently, need-theory.php 29
as Henderson indicated, does not include taking other 30. 30. 30
member’s roles and responsibilities. 22
23. 23. APPLICATIONS Practice: • The nurse can help the
patient move to an independent state by  Assessment-
assess the patients for 14 fundamental needs and
determine what are lacking.  Planning- plan to meet the
needs fit to the doctors prescribed plan.  Implementation-
uses the 14 basic needs in answering the factors contribute
to the illness. Assist the sick or well individual to maintain
health or recover from illness.  Evaluation phase- decides
whether goals are met or not. • Provide a rationale for
collecting reliable and valid data about the health status of
clients. • Help build a common nursing terminology to use
in communicating with other health professionals. 23
24. 24. Education Development of 3 phases of curriculum
development that students should progress in their
learning. The focus in all three phases remains the same
these are: • Assisting the patient when he needs strength,
will or knowledge in performing his daily activities or in
carrying out prescribed therapy with the ultimate goal of
independence. • Develop a habit of inquiry; take courses in
biological, physical, and social sciences and in the
humanities; study with students in other fields, observe
effective care, and give effective care in a variety of
settings. • Involve students in the complete study of the
patient and all his needs. 24
Faye Glenn Abdellah's Theory patients, and refers to the object of nursing as ‘patient’
Twenty-One Nursing Problems rather than client or consumer.
This page was last updated on October 31, 2011 She referred to Nursing diagnosis during a time when
nurses were taught that diagnosis was not a nurses’
INTRODUCTION.
prerogative.
"Nursing is based on an art and science that mould the
Assumptions were related to
attitudes, intellectual competencies, and technical skills of
change and anticipated changes that affect nursing;
the individual nurse into the desire and ability to help
the need to appreciate the interconnectedness of social
people , sick or well, cope with their health needs." -
enterprises and social problems;
Abdellah
the impact of problems such as poverty, racism, pollution,
Abdellah explained nursing as a comprehensive service,
education, and so forth on health care delivery;
which includes:
changing nursing education
Recognizing the nursing problems of the patient
continuing education for professional nurses
Deciding the appropriate course of action to take in terms
development of nursing leaders from under reserved
of relevant nursing principles
groups
Providing continuous care of the individuals total needs
Abdellah and colleagues developed a list of 21 nursing
Providing continuous care to relieve pain and discomfort
problems.They also identified 10 steps to identify the
and provide immediate security for the individual
client’s problems. 11 nursing skills to be used in
Adjusting the total nursing care plan to meet the patient’s
developing a treatment typology
individual needs
10 steps to identify the client’s problems
Helping the individual to become more self directing in
Learn to know the patient
attaining or maintaining a healthy state of mind & body
Sort out relevant and significant data
Instructing nursing personnel and family to help the
Make generalizations about available data in relation to
individual do for himself that which he can within his
similar nursing problems presented by other patients
limitations
Identify the therapeutic plan
Helping the individual to adjust to his limitations and
Test generalizations with the patient and make additional
emotional problems
generalizations
Working with allied health professions in planning for
Validate the patient’s conclusions about his nursing
optimum health on local, state, national and international
problems
levels
Continue to observe and evaluate the patient over a
Carrying out continuous evaluation and research to
period of time to identify any attitudes and clues affecting
improve nursing techniques and to develop new
his behavior
techniques to meet the health needs of people
Explore the patient’s and family’s reaction to the
(In 1973, the item 3, - “providing continuous care of the
therapeutic plan and involve them in the plan
individual’s total health needs” was eliminated.)
Identify how the nurses feels about the patient’s nursing
ABOUT THE THEORIST AND THEORETICAL SOURCES
problems
Birth:1919
Discuss and develop a comprehensive nursing care plan
Abdellah’s patient - centred approach to nursing was
11 nursing skills
developed inductively from her practice and is considered
Observation of health status
a human needs theory.
Skills of communication
The theory was created to assist with nursing education
Application of knowledge
and is most applicable to the education of nurses.
Teaching of patients and families
Although it was intended to guide care of those in the
Planning and organization of work
hospital, it also has relevance for nursing care in
Use of resource materials
community settings.
Use of personnel resources
MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS
Problem-solving
She uses the term ‘she’ for nurses, ‘he’ for doctors and
Direction of work of others
Therapeutic use of the self
Nursing procedure
21 NURSING PROBLEMS
Three major categories
Physical, sociological, and emotional needs of clients
Types of interpersonal relationships between the nurse
and patient
Common elements of client care
BASIC TO ALL PATIENTS
To maintain good hygiene and physical comfort
To promote optimal activity: exercise, rest and sleep
To promote safety through the prevention of accidents,
injury, or other trauma and through the prevention of the
spread of infection
To maintain good body mechanics and prevent and
correct deformity
SUSTENAL CARE NEEDS
To facilitate the maintenance of a supply of oxygen to all
body cells
To facilitate the maintenance of nutrition of all body cells
To facilitate the maintenance of elimination
To facilitate the maintenance of fluid and electrolyte
balance
To recognize the physiological responses of the body to
disease conditions
To facilitate the maintenance of regulatory mechanisms
and functions
To facilitate the maintenance of sensory function.
REMEDIAL CARE NEEDS
To identify and accept positive and negative expressions,
feelings, and reactions
To identify and accept the interrelatedness of emotions
and organic illness
To facilitate the maintenance of effective verbal and non
verbal communication
To promote the development of productive interpersonal
relationships
To facilitate progress toward achievement of personal
spiritual goals
To create and / or maintain a therapeutic environment
To facilitate awareness of self as an individual with varying
physical , emotional, and developmental needs
RESTORATIVE CARE NEEDS
To accept the optimum possible goals in the light of
limitations, physical and emotional
To use community resources as an aid in resolving
problems arising from illness
To understand the role of social problems as influencing
factors in the case of illness
ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS
NURSING
Nursing is a helping profession.
Nursing care is doing something to or for the person or
providing information to the person with the goals of
meeting needs, increasing or restoring self-help ability, or
alleviating impairment.
Nursing is broadly grouped into the 21 problem areas to
guide care and promote use of nursing judgment.
Nursing to be comprehensive service.
PERSON
Abdellah describes people as having physical, emotional,
and sociological needs.
Patient is described as the only justification for the
existence of nursing.
Individuals (and families) are the recipients of nursing
Health, or achieving of it, is the purpose of nursing
services.
HEALTH
In Patient–Centered Approaches to Nursing, Abdellah
describes health as a state mutually exclusive of illness.
Although Abdellah does not give a definition of health, she
speaks to “total health needs” and “a healthy state of
mind and body” in her description of nursing as a
comprehensive service.
SOCIETY AND ENVIRONMENT
Society is included in “planning for optimum health on
local, state, national, and international levels”. However,
as she further delineated her ideas, the focus of nursing
service is clearly the individual.
The environment is the home or community from which
patient comes.
CHARACTERISTICS OF THE THEORY
Abdellah’s theory has interrelated the concepts of health,
nursing problems, and problem solving.
Problem solving is an activity that is inherently logical in
nature.
Framework focus on nursing practice and individuals.
The results of testing such hypothesis would contribute to
the general body of nursing knowledge
Easy to apply in practice.
USE OF 21 PROBLEMS IN THE NURSING PROCESS
ASSESSMENT PHASE
Nursing problems provide guidelines for the collection of
data.
A principle underlying the problem solving approach is
that for each identified problem, pertinent data are
collected.
The overt or covert nature of the problems necessitates a
direct or indirect approach, respectively.
NURSING DIAGNOSIS
The results of data collection would determine the client’s
specific overt or covert problems.
These specific problems would be grouped under one or
more of the broader nursing problems.
This step is consistent with that involved in nursing
diagnosis
PLANNING PHASE
The statements of nursing problems most closely
resemble goal statements. Once the problem has been
diagnosed, the nursing goals have been established.
IMPLEMENTATION
Using the goals as the framework, a plan is developed and
appropriate nursing interventions are determined.
EVALUATION
The most appropriate evaluation would be the nurse
progress or lack of progress toward the achievement of
the stated goals..
Progressive Patient Care :: Models of Nursing Care
Delivery
CONCLUSION
Using Abdellah’s concepts of health, nursing problems,
and problem solving, the theoretical statement of nursing
that can be derived is the use of the problem solving
approach with key nursing problems related to health
needs of people. From this framework, 21 nursing
problems were developed.
Abdellah’s theory provides a basis for determining and
organizing nursing care. The problems also provide a basis
for organizing appropriate nursing strategies.
Abdellah’s theory
1. 1. PRESENTED BYMr. NAVJYOT SINGH ChoudharyM.SC
NURSING 1st YEARDept. of Pediatric Nursing
2. 2. Faye Glenn Abdellah was one of the most influential
nursing theorist and public health scientists . It is extremely
rare to find someone who has dedicated all her life to the
advancement of the nursing profession and accomplish this
feat with so much distinction and merit.
3. 3. Faye Glenn Abdellah was born on March 13, 1919, in
New York City.EDUCATIONAL ACHIEVEMENTSIn
1942, Abdellah earned a nursing diploma from Fitkin
Memorial Hospitals School of Nursing New Jersey (now
Ann May School of Nursing). She received her Bachelor of
Science Degree in 1945, a Master of Arts degree in 1947
and Doctor of Education in Teacher’s College, Columbia
University. In 1947 she also took Master of Arts Degree in
Physiology.
4. 4. Abdellah went on to become a nursing instructor and
researcher and helped transform the focus of the
profession from disease centered to patient centered. She
expanded the role of nurses to include care of families and
the elderly.She worked in many settings. She had been a
staff nurse, a head nurse, a faculty member at Yale
University and at Columbia University, a public health
nurse, a researcher and an author of more than 147
articles and books.She was selected as Deputy Surgeon
General in 1982. She retired in 1989.
5. 5. 1937 – She wanted to be a nurse on the day she saw
Hindenburg explode.1949 – She spent 40 years in Public
Health Service where she first became involved in
research, being assigned to perform studies to improve
nursing practices.1960 – She was influenced by the
desire to promote client- centered comprehensive nursing
care.
6. 6. BASIC TO ALL PATIENTS1. To maintain good hygiene
and physical comfort –After colonoscopy, patients are
usually soiled from theprocedure. It is therefore important
to clean themproperly. Physical comfort through proper
positioningin bed.2. To promote optimal activity: exercise,
rest, andsleep – Patients who were sedated during
theprocedure stay in the unit until the effect of thesedation
has decreased to a safe level. As anurse, make sure the
patients are able to rest andsleep well by providing a
conducive environment forrest, such as decreasing
environmental noise anddimming the light if necessary.
7. 7. 3. To promote safety through prevention ofaccident,
injury, or other trauma and through theprevention of the
spread of infection – Making surethe side rails are always
up when leaving the patient .one way we prevent the
spread of infection is throughproper disinfection of the
equipments .4. To maintain good body mechanics and
prevent andcorrect deformity – Positioning the
patientproperly, allowing for the normal anatomical
positionof body parts.
8. 8. 5. facilitate the maintenance of a supply of oxygen to all
body cells –when patients manifest breathing problems,
oxygen is attached tothem, usually via nasal cannula.
Sedated patients are attached tocardiac monitor and pulse
oxi meter while having the oxygendelivered. When the
oxygen saturation falls below the normallevels, the rate of
oxygen is increased accordingly, as per physiciansorder.6.
To facilitate the maintenance of nutrition of all body cells –
patients undergoing endoscopic procedures are on NPO.
For thisreason it is important to monitor the blood glucose
level. When thepatients blood glucose falls from the normal
value, we inject D50Wto the patient or we change the
patients IVF to a dextrose containingfluid.
9. 9. 7. To facilitate the maintenance of elimination –
Providingbedpans or urinals to patients and at times,
insertion of Foleycatheter when the patient is not able to
void.8. To facilitate the maintenance of fluid and
electrolytebalance – Proper regulation of the intravenous
 solutions as wellas proper incorporations it may have. An
example is whenpatients have low serum potassium; KCl is
incorporated in thesolution.
10. 10. 9. To recognize the physiological responses of the
body todisease conditions—pathological, physiological,
andcompensatory – it is important to check the patients for
signs ofinternal gastrointestinal bleeding by monitoring the
bloodpressure and cardiac rate.10.To facilitate the
maintenance of regulatory mechanisms andfunctions –
When a patient has a difficulty in breathing and isshowing
an increase respiratory rate, elevating the head part ofthe
bed is done to facilitate the respiratory function.
11. 11. 11. To facilitate the maintenance of sensory function –
Sometimes there are semi-conscious patients, in these
cases, itis still necessary to talk to them while performing
nursinginterventions to maintain their auditory sense.
12. 12. 12. To identify and accept positive and
negativeexpressions, feelings, and reactions – most
patients feel anxiousbefore undergoing the procedures. It is
necessary to listen to thepatients expressions and allow
them to ask questions. To decreasetheir anxiety, proper
instructions are given, what they are toexpect, how long the
procedure will take, what they should doduring and after
the procedure as well as other concerns.13. To identify and
accept interrelatedness of emotions and organicillness –
Encourage patients to verbalize their feelings and
allowthem to cry when they have the need to do so will
help thememotionally. Some patients are diagnosed with
malignancy afterthe procedure and during this time the
emotional needs of thepatient is a priority.
13. 13. 14. To facilitate the maintenance of effective verbal
andnonverbal communication – when patients are not able
toexpress themselves verbally, it is important to assess
fornonverbal cues. For instance when patients are in pain,
assessingfor facial grimacing.15. To promote the
development of productive interpersonalrelationships –
allow the patients significant others to stay withthe patient
before and after the procedure. This allows forbonding and
promotes interpersonal relationship.
14. 14. 16. To facilitate progress toward achievement of
personalspiritual goals – nurse usually visits the patients in
the unit.Patients may benefit from this, allowing them time
to practicetheir faith.17. To create and/or maintain a
therapeutic environment -providing proper lighting, proper
room temperature, a quietenvironment are done to patients
staying in the unit.
15. 15. 18. To facilitate awareness of self as an individual with
varyingphysical, emotional, and developmental needs –
care topatients vary according to their developmental
needs. Allowingthe parents to stay during the procedure
help the pediatricpatients in their emotional and
developmental needs.
16. 16. 19. To accept the optimum possible goals in the light
oflimitations, physical, and emotional – The goals for each
patientvary depending on the capability of the patient. The
nutritionalgoal for a patient with a PEG tube for instance
will bedifferent, knowing that the patient has limited feeding
options.20. To use community resources as an aid in
resolving problemsarising from illness – Some patients live
far from the city andthus referral to health centers is
sometimes done.
17. 17. 21. To understand the role of social problems as
influencingfactors in the cause of illness – Some patients
who arediagnosed with amoebic colitis for instance are
advised to avoidbuying street foods to which the
preparation they are not sureof, and also avoid drinking
water that are not safe.
18. 18. Abdellah describes people as having physical,
emotional, and sociological needs. These needs may overt,
consisting of largely physical needs, or covert, such as
emotional, sociological and interpersonal needs- which are
often missed and perceived incorrectly The individuals
(and families) are the recipients of nursing, and health, or
achieving of it, is the purpose of nursing services.
19. 19.  Emphasis should be placed upon prevention and
rehabilitation. Holistic approach must be taken by the nurse
to help the client achieve state of health. However the
nurse must accurately identify the lacks or deficits
regarding health that the client is experiencing. These lacks
or deficits are the client’s health needs.
20. 20. The environment is implicitly defined by Abdellah as
the home or community from which patient comes. Society
is included in “planning for optimum health.” However, as
Abdellah further delineated her ideas, the focus of nursing
service is clearly the individual.
21. 21. These would mean a comprehensive nursing service,
this would include:1. Recognizing the nursing problems of
thepatient.2. Deciding the appropriate actions to takein
terms of relevant nursing principles.3. Providing continuous
care of theindividual’s total health needs.4. Providing
continuous care to relieve painand discomfort.5. Adjusting
total nursing care plan to meetthe patient’s individual
needs.
22. 22. 6. Helping the individual to become more self directing
inattaining or maintaining a healthy state of mind and
body.7. Instructing nursing personnel and family to help
theindividual8. Helping the individual to adjust to his
limitations andemotional problems.9. Working with allied
health professional in planning foroptimum health10.
Carrying out continuous evaluation and research to
improvenursing techniques and to develop new techniques
to meet allthe health needs of the people.
23. 23. 1. Observation of health status2. Skills of
communication3. Application of knowledge4. Teaching of
patients and families5. Planning and organization of work6.
Use of resource materials7. Use of personnel resources8.
Problem-solving9. Direction of work of others10.
Therapeutic use of the self11. Nursing procedures
24. 24. Physical, Sociological, emotional NeedsCommon
Elements Of Patient Interpersonal Relationship Area
25. 25. Nursing PracticeAbdeallah’s main goal is the
improvement of the nursing education.The most
important impact of Abdellah’s theory to the nursing
practice is that it helped transform the focus of the
profession from being “disease- centered” to “patient-
centered.”The steps of the nursing process are
assessment, diagnosis, planning, implem entation and
evaluation
26. 26. Professors and educators realized the importance of
client centered care rather than focusing on medical
interventions. Nursing education then slowly deviated its
concentration from the complex, medical concepts, into
exercising better attention to the client as the primary
 concern. It’s very strong nurse-centered orientation—is, on attempts to create a different way of viewing nursing
the other hand, it’s major contribution to nursing education. phenomenon.
27. 27. Her theories continue to guide researchers to focus 39. 39. The major limitation of Abdellah theory and the
on the body of nursing knowledge itself, the identification of twenty one nursing problems is their very strong nursing
patient problems, the organization of nursing interventions, centered orientation. With the orientation appropriate use
the improvement of nursing education, and the structure of might be the organization of teaching content for nursing
the curriculum. The extensive research done regarding students, the evaluation of a students, performance in the
the patient’s needs and problems has served as a clinical area or both. But in terms of client care there is little
foundation for the development of what is now known as emphasis on what the client is to achieve.
nursing diagnoses. 40. 40. Using Abdellah’s concepts of health, nursing
28. 28. Nursing problems provide guidelines for the collection problems, and problem solving, the theoretical statement of
of data.A principle underlying the problem solving nursing that can be derived is the use of the problem
approach is that for each identified problem, pertinent data solving approach with key nursing problems related to
are collected.The overt or covert nature of the problems health needs of people. From this framework, 21 nursing
necessitates a direct or indirect approach, respectively. problems were developed.Abdellah’s theory provides a
29. 29. NURSING DIAGNOSISThe results of data basis for determining and organizing nursing care. The
collection would determine the client’s specific overt or problems also provide a basis for organizing appropriate
covert problems.These specific problems would be nursing strategies.
grouped under one or more of the broader nursing
problems.This step is consistent with that involved in
nursing diagnosis
30. 30. PLANNING PHASEThe statements of nursing
problems most closely resemble goal statements. Once the
problem has been diagnosed, the nursing goals have been
established.
31. 31. IMPLEMENTATIONUsing the goals as the
framework, a plan is developed and appropriate nursing
interventions are determined.
32. 32. EVALUATIONThe most appropriate evaluation
would be the nurse progress or lack of progress toward the
achievement of the stated goals..
33. 33. The case of SimarHe experienced severe chest
pain. In addition he experienced shortness of breadth,
tachycardia and profuse diaphoresis.
34. 34. Assessmentreveals: cardiac Past History : He damage
had gone through similar episodes since past 2 years.
35. 35. PAIN IMPAIRED CARDIAC FUNCTIONING` WORK
RELATED STRESS FAILURE TO SEEK MEDICAL
ATTENTION
36. 36. STAGES OF Abdellah nsg Nsg intervensions
NsgILLNESS problem intervensionsBasic to care 1. To
maintain good 1. Administer oxygen Amount of pain
hygiene and 2. Elevate headrest physical comfort 3.
Reposition of client 4. Administer analgesics as
advisedSusternal care 5 to facilitate the 1 promote rest
Vital signs.needs maintenance of 2 Place in sitting supply
of oxygen to position body cells 3 Promote deep breathing
and coughing exercises 4 Implement exercises as
toleratedRemedial care 13 To identify and 1 to find the
nature of his knowledge ofneeds accept the job.
relationship interrelatedness of 2 explore his work related
between stress emotional and goal and his illness organic
illness 3 stress associated with jobs.
37. 37. Stages of illness Abdellah nsg Nsg intervensions
Criterion measure problemsRestorative care 20 to use 1.
Teach early Knowledge aboutneeds community signs and
the use of resources as an symptoms of community aid in
resolving cardiac resources. problems arising distress.
from illness 2. Teach course of action .
38. 38. Abdellah’s theory has interrelated the concepts of
health, nursing problems and problem solving as she

Biography of Jean Watson
Jean Watson (June 10, 1940 – present) is an American nurse
theorist and nursing professor who is well known for her “Philosophy
and Theory of Transpersonal Caring.” She has also written numerous
texts, including Nursing: The Philosophy and Science of Caring.
Watson’s study on caring has been integrated into education and
patient care to various nursing schools and healthcare facilities all
over the world.
Early Life
Jean Watson was born Margaret Jean Harmon and grew up in the
small town of Welch, West Virginia, in the Appalachian Mountains.
She was the youngest of eight children and was surrounded by an
extended family–community environment. Watson attended high
school in West Virginia and then the Lewis Gale School of Nursing in
Roanoke, Virginia, where she graduated in 1961.
ADVERTISEMENT
Personal Life
Jean Watson, RN, PhD, FAAN, AHN-BC
After her graduation in 1961, Jean Watson married her husband,
Douglas, and moved west to his native state of Colorado. In 1997,
she experienced an accidental injury that resulted in the loss of her
left eye and soon after, in 1998, her husband, whom she considers
as her physical and spiritual partner, and her best friend passed
away and left Watson and their two grown daughters, Jennifer and
Julie, and five grandchildren.
Watson states that she is “attempting to integrate these wounds into
my life and work. One of the gifts through the suffering was the
privilege of experiencing and receiving my own theory through the
care from my husband and loving nurse friends and colleagues.”
These two personal life-altering events contributed to writing her third
book, Postmodern Nursing and Beyond.
Education
Jean Watson ardently and quickly progressed through her nursing
education earning her bachelor’s degree in nursing in 1964, a master
of science in nursing in psychiatric and mental health nursing in
1966, and a Ph.D. in educational psychology and counseling in 1973,
all from the University of Colorado at Boulder.
Career and Appointments
Lecture series celebration, Taken at St Peter’s College, New Jersey
After Jean Watson concluded her doctoral degree, she has served in
both faculty and administrative positions in the School of Nursing
faculty, University of Colorado Health Sciences Center in Denver. In
1981 and 1982, she pursued international sabbatical studies in New
Zealand, Australia, India, Thailand, and Taiwan.
In the 1980s, Watson and colleagues established the Center for
Human Caring at the University of Colorado, the nation’s first
interdisciplinary center committed to using human caring knowledge
for clinical practice, scholarship, and administration and leadership.
At the center, Watson and others sponsor clinical, educational, and
community scholarship activities and projects in human caring.
These activities involve national and international scholars in
residence, as well as international connections with colleagues
around the world, such as Australia, Brazil, Canada, Korea, Japan,
New Zealand, the United Kingdom, Scandinavia, Thailand, and
Venezuela, among others. Activities such as these continue at the
University of Colorado’s International Certificate Program in Caring
Healing, where Watson offers her theory courses for doctoral
students.
Henry Ford Hospital research conference
Watson served as chairperson and assistant dean of the
undergraduate program at the University of Colorado School of
Nursing. She was involved in planning and implementation of the
nursing PhD program and served as coordinator and director of the
PhD program between 1978 and 1981. From 1983 to 1990, she was
Dean of University of Colorado School of Nursing and Associate
Director of Nursing Practice at University Hospital. During her
deanship, she was instrumental in the development of a post-
baccalaureate nursing curriculum in human caring, health, and
healing that led to a Nursing Doctorate (ND), a professional clinical
doctoral degree that in 2005 became the Doctor of Nursing Practice
(DNP) degree.
Between 1993 and 1996, Watson served as a member of the
Executive Committee and the Governing Board, and as an officer for
the NLN, and she was elected president from 1995 to 1996.
In 2005, she took a sabbatical for a walking pilgrimage in the Spanish
El Camino. And in 2008, Watson created a non-profit foundation:
Watson Caring Science Institute, to further the work of Caring
Science in the world.
Philosophy and Theory of Transpersonal Caring
Watson’s Philosophy and Science of Caring is concerned on how
nurses express care to their patients. Her theory stresses humanistic
aspects of nursing as they intertwine with scientific knowledge and
nursing practice.
International Hiroshima Conference on Caring and Peace
The nursing model states that “nursing is concerned with promoting
health, preventing illness, caring for the sick, and restoring health.” It
focuses on health promotion, as well as the treatment of diseases.
According to Watson, caring is central to nursing practice, and
promotes health better than a simple medical cure. She believes that
a holistic approach to health care is central to the practice of caring in
nursing.
According to her theory, caring can be demonstrated and practiced
by nurses. Caring for patients promotes growth; a caring environment
accepts a person as he or she is, and looks to what he or she may
become.
Watson also defined three of the four metaparadigm concepts in
nursing including person or human being, health, and nursing. She
referred human being as a valued person in and of him or herself to
be cared for, respected, nurtured, understood and assisted; in
general a philosophical view of a person as a fully functional
integrated self. Human is viewed as greater than and different from
the sum of his or her parts. Health, meanwhile, is defined as a high
level of overall physical, mental, and social functioning; a general
adaptive-maintenance level of daily functioning; and the absence of
illness, or the presence of efforts leading to the absence of illness.
And nursing as a science of persons and health-illness experience
that are mediated by professional, personal, scientific, and ethical
care interactions.
She does not define the fourth metaparadigm concept
of environment but instead devised 10 caring needs
specific carative factors critical to the caring human experience that
need to be addressed by nurses with their patients when in a caring
role.
10 Carative Factors
Watson’s 10 carative factors are: (1) forming humanistic-altruistic
value systems, (2) instilling faith-hope, (3) cultivating a sensitivity to
self and others, (4) developing a helping-trust relationship, (5)
promoting an expression of feelings, (6) using problem-solving for
decision-making, (7) promoting teaching-learning, (8) promoting a
supportive environment, (9) assisting with gratification of human
needs, and (10) allowing for existential-phenomenological forces.
The first three factors form the “philosophical foundation” for the
science of caring, and the remaining seven come from that
foundation.
Charles Drew University Medicine Dymally School of Nursing, Los
Angeles
Within assisting with the gratification of human needs, Watson’s
hierarchy of needs begins with lower-order biophysical
needs or survival needs, which include the need for food and fluid,
elimination, and ventilation. Next are the lower-order
psychophysical needs or functional needs, which include the
need for activity, inactivity, and sexuality. The higher order
psychosocial needs or integrative needs include the need for
achievement, and affiliation. And finally the higher order
intrapersonal-interpersonal need or growth-seeking need which
is self-actualization.
The nursing process outlined in Watson’s model contains the same
steps as the scientific research process: assessment, plan,
intervention, and evaluation. The assessment includes observation,
identification, and review of the problem, as well as the formation of a
hypothesis. Creating a care plan helps the nurse determine how
variables would be examined or measured, and what data would be
collected. Intervention is the implementation of the care plan and
data collection. Finally, the evaluation analyzes the data, interprets
the results, and may lead to an additional hypothesis.
Works
Watson has authored 11 books, shared in authorship of six books,
and has written countless articles in nursing journals. The following
publications reflect the evolution of her theory of caring from her
ideas about the philosophy and science of caring.
Nursing: The Philosophy and Science of Caring (1979)
Watson’s first book was developed from her notes for an
undergraduate course taught at the University of Colorado. Her early
work embraced the 10 carative factors but evolved to include
“caritas,” making explicit connections between caring and love. This
book was reprinted in 1985 and translated into Korean and French.
Human Science and Human Care – A Theory of Nursing (1985)
This book, published in 1985 and reprinted in 1988 and 1999,
addressed her conceptual and philosophical problems in nursing. Her
second book has been translated into Chinese, German, Japanese,
Korean, Swedish, Norwegian, Danish, and probably other languages
by now.
Postmodern Nursing and Beyond (1999)
Watson’s third book was presented as a model to bring nursing
practice into the twenty-first century.
Watson describes two personal life-altering events that contributed to
her writing. In 1997, she experienced an accidental injury that
resulted in the loss of her left eye and soon after, in 1998, her
husband died. Watson states that she is “attempting to integrate
these wounds into my life and work. One of the gifts through the
suffering was the privilege of experiencing and receiving my own
theory through the care from my husband and loving nurse friends
and colleagues.” This book has been translated into Portuguese and
Japanese.
Instruments for Assessing and Measuring Caring in Nursing and
Health Sciences (2002)
This is a collection of 21 instruments to assess and measure caring,
received the American Journal of Nursing Book of the Year Award.
This book provides all the essential research tools for assessing and
measuring caring for those in the caring professions. Watson’s text is
the only comprehensive and accessible collection of instruments for
care measurement in clinical and educational nursing research. The
measurements address quality of care, patient, client, and nurse
perceptions of caring, and caring behaviors, abilities, and
efficacy.This is Watson’s fourth book.
Caring Science as Sacred Science (2005)
Watson’s fifth book describes her personal journey to enhance
understanding about caring science, spiritual practice, the concept
and practice of care, and caring-healing work. In this book, she leads
the reader through thought-provoking experiences and the
sacredness of nursing by emphasizing deep inner reflection and
personal growth, communication skills, use of self-transpersonal
growth, and attention to both caring science and healing through
forgiveness, gratitude, and surrender. It received the American
Journal of Nursing 2005 Book of the Year Award.
Recent books include Measuring Caring:
International Research on Caritas as Healing (Nelson & Watson,
2011), Creating a Caring Science Curriculum (Hills & Watson, 2011),
and Human Caring Science: A Theory of Nursing (Watson, 2012).
Awards and Honors
Molloy College Division of Nursing’s third annual doctoral forum
research lecture and poster sessions
Jean Watson has been active and hardworking in many community
programs during her career. She has been a founder and a member
of the Board of Boulder County Hospice, and numerous other
collaborations with area health care facilities. She has received
several research and advanced education federal grants and awards
and numerous university and private grants and extramural funding
for her faculty and administrative projects and scholarships in human
caring.
In 1992, the University of Colorado School of Nursing honored
Watson as a distinguished professor of nursing. She received
six honorary doctoral degrees from universities in the United States
and three Honorary Doctorates in international universities, including
Göteborg University in Sweden, Luton University in London, and the
University of Montreal in Quebec, Canada. She received the National
League for Nursing (NLN) Martha E. Rogers Award, which
recognizes nurse scholars’ significant contributions to advancing
nursing knowledge and knowledge in other health sciences in 1993.
In 1997, the NLN awarded her an honorary lifetime certificate as a
holistic nurse. Finally, in 1999, Watson assumed the nation’s first
Murchison-Scoville Endowed Chair of Caring Science and currently
is a distinguished professor of nursing.
Qatar Conference Unified Caring Model for Gulf Countries UAE
Watson was recognized as a Distinguished Nurse Scholar by New
York University in 1998. And in 1999, she received the Fetzer
Institute’s National Norman Cousins Award in recognition of her
commitment to developing, maintaining, and exemplifying
relationship-centered care practices.
She is a Distinguished and/or Endowed Lecturer at national
universities, including Boston College, Catholic University, Adelphi
University, Columbia University-Teachers College, State University of
New York, and at universities and scholarly meetings in numerous
foreign countries.
Her international activities also include an International Kellogg
Fellowship in Australia in 1982, a Fulbright Research and Lecture
Award to Sweden and other parts of Scandinavia in 1991, and a
lecture tour in the United Kingdom in 1993. Watson has been
involved in international projects and has received invitations to New
Zealand, India, Thailand, Taiwan, Israel, Japan, Venezuela, Korea,
and other places. She is featured in at least 20 nationally distributed
audiotapes, videotapes, and/or CDs on nursing theory.
In 2010, Watson received an Honorary Doctor of Sciences in
Nursing from the University of Victoria in British Columbia, Canada.
Theory of Human Caring of Jean Watson
Nowadays, a lot of people choose nursing as a profession. There are
many reasons to consider in becoming a professional nurse, but
compassion is often a trait required of nurses. This is for the reason
that taking care of the patients’ needs is its primary purpose. Jean
Watson’s “Philosophy and Theory of Transpersonal
Caring” mainly concerns on how nurses care for their patients, and
how that caring progresses into better plans to promote health and
wellness, prevent illness and restore health.
In today’s world, nursing seems to be responding to the various
demands of the machinery with less consideration of the needs of the
person attached to the machine. In Watson’s view, the disease might
be cured, but illness would remain because, without caring, health is
not attained. Caring is the essence of nursing and connotes
responsiveness between the nurse and the person; the nurse co-
participates with the person. Watson contends that caring can assist
the person to gain control, become knowledgeable, and promote
health changes
ADVERTISEMENTS
What is Watson’s Theory of Transpersonal Caring?
According to Watson’s theory, “Nursing is concerned with promoting
health, preventing illness, caring for the sick, and restoring health.” It
focuses on health promotion, as well as the treatment of diseases.
According to Watson, caring is central to nursing practice, and
promotes health better than a simple medical cure.
The nursing model also states that caring can be demonstrated and
practiced by nurses. Caring for patients promotes growth; a caring
environment accepts a person as he or she is, and looks to what he
or she may become.
Assumptions
Watson’s model makes seven assumptions: (1) Caring can be
effectively demonstrated and practiced only interpersonally. (2)
Caring consists of carative factors that result in the satisfaction of
certain human needs. (3) Effective caring promotes health and
individual or family growth. (4) Caring responses accept the patient
as he or she is now, as well as what he or she may become. (5) A
caring environment is one that offers the development of potential
while allowing the patient to choose the best action for him or herself
at a given point in time. (6) A science of caring is complementary to
the science of curing. (7) The practice of caring is central to nursing.
Major Concepts
The Philosophy and Science of Caring has four major concepts:
human being, health, environment or society, and nursing.
Society
Society provides the values that determine how one should behave
and what goals one should strive toward. Watson states:
“Caring (and nursing) has existed in every society. Every society has
had some people who have cared for others. A caring attitude is not
transmitted from generation to generation by genes. It is transmitted
by the culture of the profession as a unique way of coping with its
environment.”
Human being
Human being is a valued person to be cared for, respected, nurtured,
understood, and assisted; in general a philosophical view of a person
as a fully functional integrated self. Human is viewed as greater than
and different from the sum of his or her parts.
Health
Health is the unity and harmony within the mind, body, and soul;
health is associated with the degree of congruence between the self
as perceived and the self as experienced. It is defined as a high level
of overall physical, mental, and social functioning; a general
adaptive-maintenance level of daily functioning; and the absence of
illness, or the presence of efforts leading to the absence of illness.
Nursing
Nursing is a human science of persons and human health-illness
experiences that are mediated by professional, personal, scientific,
esthetic, and ethical human care transactions.
Actual Caring Occasion
Actual caring occasion involves actions and choices by the nurse and
the individual. The moment of coming together in a caring occasion
presents the two persons with the opportunity to decide how to be in
the relationship – what to do with the moment.
Transpersonal
The transpersonal concept is an intersubjective human-to-human
relationship in which the nurse affects and is affected by the person
of the other. Both are fully present in the moment and feel a union
with the other; they share a phenomenal field that becomes part of
the life story of both.
Subconcepts
Phenomenal field
The totality of human experience of one’s being in the world. This
refers to the individual’s frame of reference that can only be known to
that person.
Self
The organized conceptual gestalt composed of perceptions of the
characteristics of the “I” or “ME” and the perceptions of the
relationship of the “I” and “ME” to others and to various aspects of
life.
Time
The present is more subjectively real and the past is more objectively
real. The past is prior to, or in a different mode of being than the
present, but it is not clearly distinguishable. Past, present, and future
incidents merge and fuse.
10 Carative Factors
Watson devised 10 caring needs specific carative factors critical to
the caring human experience that need to be addressed by nurses
with their patients when in a caring role. As carative factors evolved
within an expanding perspective, and as her ideas and values
evolved, Watson offered a translation of the original carative factors
into clinical caritas processes that suggested open ways in which
they could be considered.
The first three carative factors are the “philosophical foundation” for
the science of caring, while the remaining seven derive from that
foundation. The ten primary carative factors with their corresponding
translation into clinical caritas processes are listed in the table below.
Carative Factors and Caritas Processes
Watson’s Hierarchy of Needs
Within assisting with the gratification of human needs, Watson’s
hierarchy of needs begins with lower-order biophysical needs or
survival needs, the lower-order psychophysical needs or functional
needs, the higher order psychosocial needs or integrative needs, and
finally the higher order intrapersonal-interpersonal need or growth-
seeking need.Watson’s Hierarchy of Needs
Lower Order Biophysical Needs or Survival Needs
Watson’s hierarchy of needs begins with lower-order biophysical
needs or survival needs. These include the need for food and fluid,
elimination, and ventilation.
Lower Order Psychophysical Needs or Functional Needs
Next in line are the lower-order psychophysical needs or functional
needs. These include the need for activity, inactivity, and sexuality.
Higher Order Psychosocial Needs or Integrative Needs
The higher order psychosocial needs or integrative needs include the
need for achievement, and affiliation.
Higher Order Intrapersonal-Interpersonal Need or Growth-
seeking Need
The higher order intrapersonal-interpersonal need or growth-seeking
need is the need for self-actualization.
Watson’s Theory and The Nursing Process
The nursing process in Watson’s theory includes the same steps as
the scientific research process: assessment, plan, intervention, and
evaluation. The assessment includes observation, identification, and
review of the problem, as well as the formation of a hypothesis.
Creating a care plan helps the nurse determine how variables would
be examined or measured, and what data would be collected.
Intervention is the implementation of the care plan and data
collection. Finally, the evaluation analyzes the data, interprets the
results, and may lead to an additional hypothesis.
Analysis
It is undeniable that technology has already been part of nursing’s
whole paradigm with the evolving era of development. Watson’s
suggestion of purely “caring” without giving much attention to
technological machinery cannot be solely applied but then her
statement is praiseworthy because she dealt with the importance of
the nurse-patient interaction rather than a practice confined with
technology.
Watson stated the term “soul-satisfying” when giving out care for the
clients. Her concepts guide the nurse to an ideal quality nursing care
provided for the patient. This would further increase the involvement
of both the patient and the nurse when the experience is satisfying.
ADVERTISEMENTS
In providing the enumerated clinical Caritas processes, the nurse
becomes an active co-participant with the patient. Thus, the quality of
care offered by the nurse is enhanced.
Strengths
Although some consider Watson’s theory complex, many find it easy
to understand. The model can be used to guide and improve practice
as it can equip healthcare providers with the most satisfying aspects
of practice and can provide the client with holistic care.
Watson considered using nontechnical, sophisticated, fluid, and
evolutionary language to artfully describe her concepts, such as
caring-love, carative factors, and Caritas. Paradoxically, abstract and
simple concepts such as caring-love are difficult to practice, yet
practicing and experiencing these concepts leads to greater
understanding.
Also, the theory is logical in that the carative factors are based on
broad assumptions that provide a supportive framework. The carative
factors are logically derived from the assumptions and related to the
hierarchy of needs.
Watson’s theory is best understood as a moral and philosophical
basis for nursing. The scope of the framework encompasses broad
aspects of health-illness phenomena. In addition, the theory
addresses aspects of health promotion, preventing illness and
experiencing peaceful death, thereby increasing its generality. The
carative factors provide guidelines for nurse-patient interactions, an
important aspect of patient care.
Weakness
The theory does not furnish explicit direction about what to do to
achieve authentic caring-healing relationships. Nurses who want
concrete guidelines may not feel secure when trying to use this
theory alone. Some have suggested that it takes too much time to
incorporate the Caritas into practice, and some note that Watson’s
personal growth emphasis is a quality “that while appealing to some
may not appeal to others.”
Conclusion
Watson began developing her theory while she was assistant dean of
the undergraduate program at the University of Colorado, and it
evolved into planning and implementation of its nursing Ph.D.
program.
The Philosophy and Science of Caring addresses how nurses
express care to their patients. 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.
This led to the formulation of the 10 carative factors: (1) forming
humanistic-altruistic value systems, (2) instilling faith-hope, (3)
cultivating a sensitivity to self and others, (4) developing a helping-
trust relationship, (5) promoting an expression of feelings, (6) using
problem-solving for decision-making, (7) promoting teaching-
learning, (8) promoting a supportive environment, (9) assisting with
gratification of human needs, and (10) allowing for existential-
phenomenological forces. The first three factors form the
“philosophical foundation” for the science of caring, and the
remaining seven come from that foundation.
Describing her theory as descriptive, Watson acknowledges the
evolving nature of the theory and welcomes input from others.
Although the theory does not lend itself easily to research conducted
through traditional scientific methods, recent qualitative nursing
approaches are appropriate.
Watson’s theory continues to provide a useful and important
metaphysical orientation for the delivery of nursing care. Watson’s
theoretical concepts, such as use of self, patient-identified needs, the
caring process, and the spiritual sense of being human, may help
nurses and their patients to find meaning and harmony during a
period of increasing complexity. Watson’s rich and varied knowledge
of philosophy, the arts, the human sciences, and traditional science
and traditions, joined with her prolific ability to communicate, has
enabled professionals in many disciplines to share and recognize her
work.
Watson theory
1. 1. Presented by- Ms. Nidhi Shukla M .Sc. Nursing 1st year
2. 2. “Too often we underestimate the power of a touch, a smile,
a kind word, a listening ear, an honest compliment, or the
smallest act of caring, all of which have the potential to turn a
life around.”
3. 3. Jean Watson • Born in West Virginia, currently living in
Colorado. • She earned a B.Sc. in 1964, MS in Psychiatric
Nursing in 1966 and PhD in Educational Psychology and
Counseling in 1973. • Founder of the Center for Human
Caring in Colorado.
4. 4. JEAN WATSON’S THEORY OF HUMANCARING
5. 5.  Watson's philosophy of caring attempts to define
outcome of nursing activity in regard to the humanistic
aspects of life. Her theory and philosophy of caring is based
on the values of kindness, concern, love of self and others
and respect for the spiritual dimensions of the person.  The
foundation of Jean Watsons’s theory of nursing was
published in 1979 in nursing- The philosophy and science of
caring.
6. 6.  Watson’s defined nursing as a human science of
persons and human health- illness experiences that are
mediated by professional, personal, scientific, esthetic and
ethical human care transactions.
7. 7. Watson’s defined human caring in nursing as “an act and a
science in which caring is a human to human process
demonstrated through a therapeutic interpersonal
interactions.
8. 8. MAJOR ELEMENTS OF WATSON’S THEORY OF
HUMAN CARING ELEMENTS CARATIVE FACTORS
TRANSPERSONAL CARING RELATIONSHIP CARING
OCCASION/ CARING MOVEMENTS
9. 9. CARATIVE FACTORS- The structure for the science of
caring is built upon the ten carative factors, these are- 1.
Formation of a humanistic- altruistic system of values. 2. The
installation of faith-hope. 3. The cultivation of sensitivity to
one’s self and to others. 4. The development of helping- trust
relationship. 5. The promotion and acceptance of the
expression of positive and negative feelings.
10. 10. Conti….. 6.The systematic use of the scientific problem-
solution method for decision making. 7.The promotion of
interpersonal teaching- learning. 8. The provision for a
supportive, protective and/or corrective mental, physical,
socio-cultural and spiritual environment. 9. Assistance with
the gratification of human need. 10. The allowance for
existential- phenomenological forces.
11. 11. 1.The formation of a humanistic-altruistic system of
values-  Begins developmentally at an early age with values
shared with the parents.  Mediated through ones own life
experiences, the learning one gains and exposure to the
humanities.  Is perceived as necessary to the nurses own
maturation which then promotes altruistic behavior towards
others.
12. 12. 2.Faith hope-  Is essential to both the carative and the
curative processes.  When modern science has nothing
further to offer the person, the nurse can continue to use
faith- hope to provide a sense of well- being through beliefs
which are meaningful to the individual.
13. 13. 3.Cultivation of sensitivity to one’s self and to others- 
Development of one’s own feeling is needed to interact
genuinely and sensitivity with others.  Striving to become
sensitive, makes the nurse more authentic, which encourages
self-growth and self actualization, in both the nurse and those
with whom the nurse interacts.  The nurse promote health
and higher level functioning only when they form person to
person relationship.
14. 14. 4.Establishing a helping- trust relationship-  Strongest
tool is the mode of communication, which establishes rapport
and caring.  She has defined the characteristics needed to
develop the helping- trust relationship. They are congruence,
empathy and warmth.  Communication includes verbal,
nonverbal and listening in a manner which express empathy,
understanding.
15. 15. 5.The expression of feelings, both positive and negative-
 According to Watson, “feelings alter thoughts and behavior,
and they need to be considered and allowed for in a caring
relationship.”  According to her such expression improves
one’s level of awareness.  Awareness of the feelings helps
to understand the behavior its engenders.
16. 16. 6.The systematic use of the scientific problem- solving
method for decision making-  According to Watson, the
scientific problem solving method is the only method that
allows for control and prediction, and that permits self
correction.  She also values the relative nature of nursing
and supports the need to examine and develop the other
methods of knowing to provide a holistic perspective.  The
science of caring should not be always neutral and objective.
17. 17. 7.Promotion of interpersonal teaching- learning-  The
caring nurse must focus on the learning process as much as
the teaching process.  Understanding the person’s
perception of the situation assist the nurse to prepare a
cognitive plan.
18. 18. 8. Provision for a supportive, protective and /or corrective
mental, physical, socio-cultural and spiritual environment- 
Watson divides these into external and internal variables,
which the nurse manipulates in order to provide support and
protection for the persons mental and physical well being. 
The external and internal environments are interdependent. 
Watson suggests that the nurse also must provide comfort,
privacy and safety as a part of this carative factors.
19. 19. 9.Assistance with the gratification of human needs-  It is
grounded in a hierarchy of need similar to that of the
Maslow’s.  She has created a hierarchy which she believes
is relevant to the science of caring in nursing.  According to
her, each need is equally important for optimal health. All the
needs deserve to be attended to and valued.
20. 20. Watson’s ordering of needs- Lower order needs
(biophysical needs, psychological need)-  The need for food
and fluid.  The need for elimination  The need for
ventilation  The need for sexuality Watson’s ordering of
needs- Higher order needs ( psychosocial needs).  The
need for achievement.  The need for affiliation.  The need
for self- actualization.
21. 21. 10. Allowance for existential- phenomenological forces- 
Phenomenology is a way of understanding people from the
way things appear to them, from their frame of reference. 
Existential psychology is the study of human existence using
phenomenological analysis.  This factor helps the nurse to
reconcile and mediate the incongruity of viewing the person
holistically while at the same time attending to the hierarchical
ordering of needs.  Thus the nurse assists the person to find
the strength of courage to confront life or death.
22. 22. TRANSPERSONAL CARING RELATIONSHIP 
Transpersonal describes an intersubjective, human to human
relationship that encompasses two individuals, both the nurse
and the patient in a given moment.  Describes how the
nurse goes beyond the objective assessment to show
concern toward the person’s subjective/deeper meaning of
their healthcare situation.  Involves mutuality between the
two individuals involved
23. 23. Is protects, enhances and preserve human dignity,
humanity, wholeness and inner harmony Goal of
transpersonal caring relationship
24. 24. Transpersonal caring relationship is a special kind of
human relationship that depends on-  Nurse’s commitment
on protecting and enhancing human dignity .  The nurses
caring and connection have potential to heal since
experience, intension and perception are taking place. 
Nursing goals beyond an objective assessment and shows
concern for the patients own health care.
25. 25. CARING OCCASION / MOMENT  A caring occasion is
the moment when the nurse and another person come
together in such a way that an occasion for human caring is
created.  Both persons come together in a human-human
transaction.  The one caring for and the one being cared for
 are influenced by the choices and actions decided within the
relationship.
26. 26. WATSON’S THEORY AND THE FOUR MAJOR
CONCEPTS CONCEPTS HUMAN BEING HEALTH
ENVIRONM ENTAL/ SOCIETY NURSING
27. 27. Human being- She adopts a view of the human being as a
valued person in and of him or herself to be cared for
respected, nurtured, understood and assisted. In general a
philosophical view of a person as a fully functional integrated
self.
28. 28. Health- Watson believes that there are other factors that
are needed to be included in the WHO definition of health.
She adds the following three elements-  A high level of
overall physical, mental and social functioning.  A general
adaptative - maintenance level of daily functioning.  The
absence of illness (or the presence of efforts that leads its
absence).
29. 29.  Environment / society- according to Watson caring (and
nursing) has existed in every society. A caring attitudes is not
transmitted from generation to generation. It is transmitted by
the culture of the profession as a unique way of coping with
its environment.
30. 30. Nursing –  according to Watson “nursing is concerned
with promoting health, preventing illness, caring for the sick
and restoring health.”  It focuses on health promotion and
treatment of disease. She believes that holistic health care is
central to the practice of caring in nursing.  She defines
nursing as- a human science of persons and human health-
illness experiences that are mediated by professional,
personal, scientific, esthetic and ethical human transaction.
31. 31. WATSON’S THEORY AND NURSING PROCESS
Watson’s points out that nursing process contains the same
steps as the scientific research process. They both try to
solve a problem, both provide a framework for decision
making. Assessment-  Involves observation, identification
and review of the problem, use of applicable knowledge in
literature.  Also includes conceptual knowledge for the
formulation and conceptualization of framework.  Includes
the formulation of hypothesis, defining variables that will be
examined in solving the problem.
32. 32.  Plan- It helps to determine how variables would be
examined or measured, includes a conceptual approach or
design for problem solving. It determines what data would be
collected and how on whom.
33. 33.  Intervention- it is the direct action and implementation
of the plan. It involves the collection of data.
34. 34. Evaluation-  Analysis of the data as well as the
examination of the effects of interventions based on the data.
 Includes the interpretation of the results, the degree to
which positive outcome has occurred and whether the result
can be generalized.  It may also generate additional
hypothesis or may ever lead to the generation of a nursing
theory.
35. 35. WATSON’S WORK AND THE CHARACTERISTICS OF A
THEORY  According to Watson’s “a theory is an imaginative
grouping of knowledge, ideas and experiences that are
represented symbolically and seek to illuminate a given
phenomenon.  The basic assumptions for the science of
caring in nursing and the ten carative factors that form the
structure for that concepts in unique in Watson’s theory.
36. 36. Conti..  Watson’s also indicates that needs are
interrelated.  The science of caring suggests that the nurse
recognize and assist with each of the interrelated needs in
order to reach the highest order need of self- actualization.
37. 37. Theories must be logical in nature-  Watson’s work is
logical in that the factors are based on broad assumptions
which provide a supportive framework.  With these carative
factors she delineates nursing from other professions. 
These carative factors are logically derived from the
assumptions and related to the hierarchy of needs.
38. 38. Theories should be relatively simple yet generalizable- 
The theory is relatively simple as it does not use theories from
other disciplines that are familiar to nursing.  She discusses
on the “trim” and the “core” of nursing.  She defines trim as
the clinical focus, the procedure and the techniques.  The
core of the nursing is that which is intrinsic to the nurse-client
interaction that produces a therapeutic result. Core
mechanism are the carative factors.
39. 39. Theories can be the basis for hypothesis that can be
tested-  Watsons theory is based on phenomenological
studies that generally ask questions rather than state
hypothesis. Its purpose is to describe the phenomena to
analyse and to gain an understanding.  According to
Watson the best method to test this theory is through field
study.
40. 40. Theories can be utilized by practitioners to guide and
improve their practice-  Watson’s work can be used to guide
and improve practice.  It can provide the nurse with the
most satisfying aspects of practice and can provide the client
with the holistic care so necessary for human growth and
development.  Theories must be consistent with other
validated theories, laws and principles but will leave upon
unanswered questions that need to be investigated.
41. 41. STRENGTHS  Besides assisting in providing the quality
of care that client ought to receive, it also provides the soul
satisfying care for which many nurses enter the profession. 
As the science of caring ranges from the biophysical through
the intrapersonal, each nurse becomes an active co-
participant in the clients struggle towards self- actualization. 
The client is placed in the context of the family, the
community and the culture.  It places the client as the focus
of practice rather than the technology.
42. 42. LIMITATIONS  Given the acuity of illness that leads to
hospitalization, the short length stay, such quality of care may
be deemed impossible to give in the hospital.  While Watson
acknowledge the need for biophysical basis to nursing, the
area receives little attention in her writings.  The ten carative
factors primarily delineate the psychosocial needs of the
person.  While the carative factors have a sound foundation
based on other disciplines, they need further research in
nursing to demonstrate their application to practice.
43. 43. HOW TO INTEGRATE JEAN WATSON’S THEORY OF
CARING INTO NURSING PRACTICE  Establishing a caring
relationship with patients.  Treat patients as holistic beings.
 Display unconditional acceptance.  Treat patients with
positive regard.  Promote health through knowledge and
intervention.  Spend uninterrupted time with patient.
Carative Factors Caritas Process

“Practice of loving-kindness and equanimity within the context of caring

1. “The formation of a humanistic-altruistic system of values”
consciousness”

“Being authentically present and enabling and sustaining the deep belief
2. “The instillation of faith-hope”
system and subjective life-world of self and one being cared for”

“Cultivation of one’s own spiritual practices and transpersonal self going

3. “The cultivation of sensitivity to one’s self and to others”
beyond the ego self”

4. “Development of a helping-trust relationship” became “development of a

“Developing and sustaining a helping trusting authentic caring relationship”
helping-trusting, human caring relation” (in 2004 Watson website)

“Being present to, and supportive of, the expression of positive and
5. “The promotion and acceptance of the expression of positive and
negative feelings as a connection with deeper spirit and self and the one-
negative feelings”
being-cared for”
6. “The systematic use of the scientific problem solving method for
“Creative use of self and all ways of knowing as part of the caring process;
decision making” became “systematic use of a creative problem solving
to engage in the artistry of caring-healing practices”
caring process” (in 2004 Watson website)

“Engaging in genuine teaching-learning experience that attends to unity of

7. “The promotion of transpersonal teaching-learning”
being and meaning, attempting to stay within others’ frame of reference”

“Creating healing environment at all levels (physical as well as

8. “The provision of supportive, protective, and (or) corrective mental,
nonphysical, subtle environment of energy and consciousness, whereby
physical, societal, and spiritual environment”
wholeness, beauty, comfort, dignity, and peace are potentiated)”

“Assisting with basic needs, with an intentional caring consciousness,

9. “The assistance with gratification of human needs” administering ‘human care essentials,’ which potentiate alignment of mind
body spirit, wholeness, and unity of being in all aspects of care”

10. “The allowance for existential-phenomenological forces” became

“Opening and attending to spiritual-mysterious and existential dimensions
“allowance for existential-phenomenological spiritual forces” (in 2004
of one’s own life-death; soul care for self and the one-being-cared for”
Watson website)
2.Caring consists of carative factors that result in the satisfaction of certa
human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept person not only as he or she is now but as
what he or she may become.
5. A caring environment is one that offers the development of potential
Jean Watson's Philosophy of Nursing while allowing the person to choose the best action for himself or hers
This page was last updated on January 26, 2012 at a given point in time.
6. Caring is more “ healthogenic” than is curing. A science of caring is
Introduction complementary to the science of curing.
 Theorist - Jean Watson was born in West Virginia, US 7. The practice of caring is central to nursing.
 Educated: BSN, University of Colorado, 1964, MS, University of The ten primary carative factors
Colorado, 1966, PhD, University of Colorado, 1973 1. The formation of a humanistic- altruistic system of values.
 Distinguished Professor of Nursing and Chair in Caring Science at the 2. The installation of faith-hope.
University of Colorado Health Sciences Center. 3. The cultivation of sensitivity to one’s self and to others.
 Fellow of the American Academy of Nursing. 4. The development of a helping-trust relationship
 Dean of Nursing at the University Health Sciences Center and President 5. The promotion and acceptance of the expression of positive and
of the National League for Nursing negative feelings.
 Undergraduate and graduate degrees in nursing and psychiatric-mental 6. The systematic use of the scientific problem-solving method for decisi
health nursing and PhD in educational psychology and counseling. making
 Six (6) Honorary Doctoral Degrees. 7. The promotion of interpersonal teaching-learning.
 Research has been in the area of human caring and loss. 8. The provision for a supportive, protective and /or corrective mental,
 In 1988, her theory was published in “nursing: human science and physical, socio-cultural and spiritual environment.
human care”. 9. Assistance with the gratification of human needs.
The seven assumptions 10. The allowance for existential-phenomenological forces.
1. Caring can be effectively demonstrated and practiced only
interpersonally. The first three carative factors form the “philosophical foundation” for the science
of caring. The remaining seven carative factors spring from the foundation laid b
these first three.  Lower order needs (biophysical needs)
1. The formation of a humanistic- altruistic system of values o The need for food and fluid
 Begins developmentally at an early age with values shared with the o The need for elimination
parents. o The need for ventilation
 Mediated through ones own life experiences, the learning one gains and  Lower order needs (psychophysical needs)
exposure to the humanities. o The need for activity-inactivity
 Is perceived as necessary to the nurse’s own maturation which then o The need for sexuality
promotes altruistic behavior towards others.  Higher order needs (psychosocial needs)
2. Faith-hope o The need for achievement
 Is essential to both the carative and the curative processes. o The need for affiliation
 When modern science has nothing further to offer the person, the nurse o Higher order need (intrapersonal-interpersonal need)
can continue to use faith-hope to provide a sense of well-being through o The need for self-actualization
beliefs which are meaningful to the individual. 10. Allowance for existential-phenomenological forces
3. Cultivation of sensitivity to one’s self and to others  Phenomenology is a way of understanding people from the way things
 Explores the need of the nurse to begin to feel an emotion as it presents appear to them, from their frame of reference.
itself.  Existential psychology is the study of human existence using
 Development of one’s own feeling is needed to interact genuinely and phenomenological analysis.
sensitively with others.  This factor helps the nurse to reconcile and mediate the incongruity of
 Striving to become sensitive, makes the nurse more authentic, which viewing the person holistically while at the same time attending to the
encourages self-growth and self-actualization, in both the nurse and hierarchical ordering of needs.
those with whom the nurse interacts.  Thus the nurse assists the person to find the strength or courage to
 The nurses promote health and higher level functioning only when they confront life or death.
form person to person relationship. Watson’s theory and the four major concepts
4. Establishing a helping-trust relationship 1. Human being
 Strongest tool is the mode of communication, which establishes rapport  Human being refers to “….. a valued person in and of him or herself to
and caring. be cared for, respected, nurtured, understood and assisted; in general
 Characteristics needed to in the helping-trust relationship are: philosophical view of a person as a fully functional integrated self. He,
o Congruence human is viewed as greater than and different from, the sum of his or
o Empathy her parts”.
o Warmth 2. Health
 Communication includes verbal, nonverbal and listening in a manner  Watson adds the following three elements to WHO definition of health
which connotes empathetic understanding. o A high level of overall physical, mental and social functioning
5. The expression of feelings, both positive and negative o A general adaptive-maintenance level of daily functioning
 “Feelings alter thoughts and behavior, and they need to be considered o The absence of illness (or the presence of efforts that leads
and allowed for in a caring relationship”. absence)
 Awareness of the feelings helps to understand the behavior it 3. Environment/society
engenders.  According to Watson, caring (and nursing) has existed in every society
6. The systematic use of the scientific problem-solving method for decision  A caring attitude is not transmitted from generation to generation.
making  It is transmitted by the culture of the profession as a unique way of
 The scientific problem- solving method is the only method that allows for coping with its environment.
control and prediction, and that permits self-correction. 4. Nursing
 The science of caring should not be always neutral and objective.  “Nursing is concerned with promoting health, preventing illness, caring
7. Promotion of interpersonal teaching-learning for the sick and restoring health”.
 The caring nurse must focus on the learning process as much as the  It focuses on health promotion and treatment of disease. She believes
teaching process. that holistic health care is central to the practice of caring in nursing.
 Understanding the person’s perception of the situation assist the nurse  She defines nursing as…..
to prepare a cognitive plan. “a human science of persons and human health-illness experiences th
8. Provision for a supportive, protective and /or corrective mental, physical, are mediated by professional, personal, scientific, esthetic and ethical
socio-cultural and spiritual environment human transactions”.
 Watson divides these into eternal and internal variables, which the nurse Watson’s theory and nursing process
manipulates in order to provide support and protection for the person’s  Nursing process contains the same steps as the scientific research
mental and physical well-being. process. They both try to solve a problem. Both provide a framework f
 The external and internal environments are interdependent. decision making.
 Nurse must provide comfort, privacy and safety as a part of this carative 1. Assessment
factor.  Involves observation, identification and review of the problem; use of
9. Assistance with the gratification of human needs applicable knowledge in literature.
 It is based on a hierarchy of need similar to that of the Maslow’s.  Also includes conceptual knowledge for the formulation and
 Each need is equally important for quality nursing care and the conceptualization of framework.
promotion of optimal health.  Includes the formulation of hypothesis; defining variables that will be
 All the needs deserve to be attended to and valued. examined in solving the problem.
Watson’s ordering of needs 2. Plan
  It helps to determine how variables would be examined or measured;
includes a conceptual approach or design for problem solving. It
determines what data would be collected and how on whom.
3. Intervention
 It is the direct action and implementation of the plan.
 It includes the collection of the data.
4. Evaluation
 Analysis of the data as well as the examination of the effects of
interventions based on the data.
 Includes the interpretation of the results, the degree to which positive
outcome has occurred and whether the result can be generalized.
 It may also generate additional hypothesis or may even lead to the
generation of a nursing theory.
Watson’s theory and the characteristic of a theory
1. Logical in nature.
2. Relatively simple
3. Generelizable
4. Based on phenomenological studies that generally ask questions rather
than state hypotheses.
5. Can be used to guide and improve practice.
6. Supported by the theoretical work of numerous humanists, philosophers,
developmentalists and psychologists.
Strengths
 This theory places client in the context of the family, the community and
the culture.
 It places the client as the focus of practice rather than the technology.
Limitations
 Biophysical needs of the individual are given less important.
 The ten caratiive factors primarily delineate the psychosocial needs of
the person.
 Needs further research to apply in practice.
Research related to Watson’s theory
The effectiveness of Watson's Caring Model on the quality of life and blood
pressure of patients with hypertension. J Adv Nurs. 2003 Jan;41(2):130-9.
 This study demonstrated a relationship between care given according to
Watson's Caring model and increased quality of life of the patients with
hypertension. Further, in those patients for whom the caring model was
practised, there was a relationship between the Caring model and a
decrease in patient's blood pressure. The Watson Caring Model is
recommended as a guide to nursing patients with hypertension, as one
means of decreasing blood pressure and increase in quality of life.
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406 .
Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual caring
occasions to treat depressed women . Journal of Holistic Nursing, 18(2), 129-142
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406
Conclusion
 Watson provides many useful concepts for the practice of nursing.
 She ties together many theories commonly used in nursing education.
 The detailed descriptions of the carative factors can give guidance to
those who wish to employ them in practice or research.
Biography of Dorothea E. Orem
Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one
of America’s foremost nursing theorists who developed the Self-
Care Deficit Nursing Theory, also known as the Orem Model of
Nursing.
Her theory defined Nursing as “The act of assisting others in the
provision and management of self-care to maintain or improve
human functioning at home level of effectiveness.” It focuses on each
individual’s ability to perform self-care, defined as “the practice of
activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.”
ADVERTISEMENT
Early Life
Dorothea Orem was born in July 15, 1914 in Baltimore, Maryland.
Her father was a construction worker and her mother is a
homemaker. She was the youngest among two daughters.
In the early 1930s, she earned her nursing diploma from the
Providence Hospital School of Nursing in Washington, D.C. She went
on to complete her Bachelor of Science in Nursing in 1939 and her
Master’s of Science in Nursing in 1945, both from the Catholic
University of America in Washington, D.C.
Education
Dorothea Elizabeth Orem
Dorothea Orem attended Seton High School in Baltimore, and
graduated in 1931. She received a diploma from the Providence
Hospital School of Nursing in Washington, D.C. in 1934 and went on
to the Catholic University of America to earn a B.S. in Nursing
Education in 1939, and an M.S. in Nursing Education in 1945.
She had a distinguished career in nursing. She earned several
Honorary Doctorate degrees. She was given Honorary Doctorates of
Science from both Georgetown University in 1976 and Incarnate
Word College in 1980. She was given an Honorary Doctorate of
Humane Letters from Illinois Wesleyan University in 1988, and a
Doctorate Honoris Causae from the University of Missouri in
Columbia in 1998.
Self-Care Theory
Dorothea Orem’s Self-Care Deficit Theory focuses on
each “individual’s ability to perform self-care, defined as ‘the practice
of activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.'” The Self-Care or Self-Care
Deficit Theory of Nursing is composed of three interrelated theories:
(1) the theory of self-care, (2) the self-care deficit theory, and
(3) the theory of nursing systems, which is further classified into
wholly compensatory, partial compensatory and supportive-
educative. It is discussed further below.
Appointments of Dorothea Orem
Photo of Dorothea Orem
by Lynne Nickle, 1988
Dorothea Orem occupied important nursing positions, like the
directorship of both the nursing school and the department of nursing
at Providence Hospital, Detroit from 1940 to 1949, where she also
taught biological sciences and nursing from 1939 to 1941. At the
Catholic University of America, Orem served as Assistant Professor
from 1959 to 1964, Associate Professor from 1964 to 1970, and
Dean of the School of Nursing from 1965 to 1966.
She also served as curriculum consultant to The Office of Education,
United States Department of Health, Education and Welfare,
Practical Nurse Section in 1958, 1959, and 1960, to the Division of
Hospital and Institutional Services, The Indiana State Board of Health
from 1949 to 1957, and to the Center for Experimentation and
Development in Nursing, The Johns Hopkins Hospital, 1969-1971,
and to the Director of Nursing, Wilmer Clinic, The Johns Hopkins
Hospital, 1975-1976.
She was a member of the group of nurse theorists who presented
Patterns of Unitary Man (Humans), the initial framework for nursing
diagnosis, to the North American Nursing Diagnosis Association in
1982.
Works of Dorothea Orem
Dorothea Orem helped publish the “Guidelines for Developing
Curricula for the Education of Practical Nurses” in 1959.
The 6th edition of Nursing: Concepts of Practice, published by Mosby
in January 2001.
In 1971 Orem published Nursing: Concepts of Practice, the work in
which she outlines her theory of nursing, the Self-care Deficit Theory
of Nursing. The success of this work and the theory it presents
established Orem as a leading theorist of nursing practice and
education.
She also served as chairperson of the Nursing Development
Conference Group, and in 1973 edited that group’s work in the book
Concept Formalization in Nursing.
She authored many other papers and during the 1970s and 1980s
spoke at numerous conferences and workshops around the world.
The International Orem Society was founded to foster research and
the continued development of Orem’s theories of nursing.
The second edition of Nursing: Concept of Practice was published in
1980. Orem retired in 1984 but she continued to work on the third
edition which was published in 1985; fourth edition of her book was
completed in 1991. She continued to work on the conceptual
development of Self-Care Deficit Nursing Theory.
Orem continued to be active in theory development. She completed
the 6th edition of Nursing: Concepts of Practice, published by Mosby
in January 2001.
Awards and Honors of Dorothea Orem
Orem’s grave
Dorothea Orem was also given many awards during her career: the
Catholic University of America Alumni Achievement Award for
Nursing Theory in 1980, the Linda Richards Award from the National
League for Nursing in 1991, and was named an Honorary Fellow of
the American Academy of Nursing in 1992.
She also received accolades for her contributions to the field of
nursing, including honorary degrees from Georgetown University,
Incarnate Word College, Illinois Wesleyan University, and the
University of Missouri-Columbia.
She was inducted into the American Academy of Nursing, and
received awards from the National League for Nursing and the Sigma
Theta Tau Nursing Honor Society.
Death
Dorothea Orem died on June 22, 2007 in Savannah, Georgia, where
she had spent the last 25 years of her life as a consultant and author.
She was 92.
Dorothea Orem’s Self-Care Deficit Theory
There are instances wherein patients are encouraged to bring out the
best in them despite being ill for a period of time. This is very
particular in rehabilitation settings, in which patients are entitled to be
more independent after being cared for by physicians and nurses.
Through these, the Self-Care Nursing Theory or the Orem Model
of Nursing was developed by Dorothea Orem between 1959 and
2001. It is considered a grand nursing theory, which means the
theory covers a broad scope with general concepts that can be
applied to all instances of nursing.
Description
Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The
act of assisting others in the provision and management of self-care
to maintain or improve human functioning at home level of
effectiveness.” It focuses on each individual’s ability to perform self-
care, defined as “the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well-
being.”
“The condition that validates the existence of a requirement for
nursing in an adult is the absence of the ability to maintain
continuously that amount and quality of self-care which is therapeutic
in sustaining life and health, in recovering from disease or injury, or in
coping with their effects. With children, the condition is the inability of
the parent (or guardian) to maintain continuously for the child the
amount and quality of care that is therapeutic.” (Orem, 1991)
Assumptions of the Self-Care Deficit Theory
The assumptions of Dorothea Orem’s Self-Care Theory are: (1) In
order to stay alive and remain functional, humans engage in constant
communication and connect among themselves and their
environment. (2) The power to act deliberately is exercised to identify
needs and to make needed judgments. (3) Mature human beings
experience privations in the form of action in care of self and others
involving making life-sustaining and function-regulating actions. (4)
Human agency is exercised in discovering, developing, and
transmitting to others ways and means to identify needs for, and
make inputs into, self and others. (5) Groups of human beings with
structured relationships cluster tasks and allocate responsibilities for
providing care to group members.
Major Concepts of the Self-Care Deficit Theory
In this section are the definitions of the major concepts of Dorothea
Orem’s Self-Care Deficit Theory:
Nursing
Nursing is an art through which the practitioner of nursing gives
specialized assistance to persons with disabilities which makes more
than ordinary assistance necessary to meet needs for self-care. The
nurse also intelligently participates in the medical care the individual
receives from the physician.
Humans
Humans are defined as “men, women, and children cared for either
singly or as social units,” and are the “material object” of nurses and
others who provide direct care.
Environment
The environment has physical, chemical and biological features. It
includes the family, culture, and community.
Health
Health is “being structurally and functionally whole or sound.” Also,
health is a state that encompasses both the health of individuals and
of groups, and human health is the ability to reflect on one’s self, to
symbolize experience, and to communicate with others.
Self-Care
Self-care is the performance or practice of activities that individuals
initiate and perform on their own behalf to maintain life, health, and
well-being.
Self-Care Agency
Orem’s Self-Care Theory: Interrelationship among concepts. Click to
enlarge.
Self-care agency is the human’s ability or power to engage in self-
care and is affected by basic conditioning factors.
Basic Conditioning Factors
Basic conditioning factors are age, gender, developmental state,
health state, socio-cultural orientation, health care system factors,
family system factors, patterns of living, environmental factors, and
resource adequacy and availability.
Therapeutic Self-Care Demand
Orem’s Self-Care Theory – Conceptual Framework. Click to enlarge.
Therapeutic Self-care Demand is the totality of “self-care actions to
be performed for some duration in order to meet known self-care
requisites by using valid methods and related sets of actions and
operations.”
Self-Care Deficit
Self-care Deficit delineates when nursing is needed. Nursing is
required when an adult (or in the case of a dependent, the parent or
guardian) is incapable of or limited in the provision of continuous
effective self-care.
ADVERTISEMENTS
Nursing Agency
Nursing Agency is a complex property or attribute of people educated
and trained as nurses that enables them to act, to know, and to help
others meet their therapeutic self-care demands by exercising or
developing their own self-care agency.
Nursing System
Nursing System is the product of a series of relations between the
persons: legitimate nurse and legitimate client. This system is
activated when the client’s therapeutic self-care demand exceeds
available self-care agency, leading to the need for nursing.
Theories
The Self-Care or Self-Care Deficit Theory of Nursing is composed of
three interrelated theories: (1) the theory of self-care, (2) the self-
care deficit theory, and (3) the theory of nursing systems, which
is further classified into wholly compensatory, partial
compensatory and supportive-educative.
Theory of Self-Care
This theory focuses on the performance or practice of activities that
individuals initiate and perform on their own behalf to maintain life,
health and well-being.
Self-Care Requisites
Self-care Requisites or requirements can be defined as actions
directed toward the provision of self-care. It is presented in three
categories:
Universal Self-Care Requisites
Universal self-care requisites are associated with life processes and
the maintenance of the integrity of human structure and functioning.
 The maintenance of a sufficient intake of air
 The maintenance of a sufficient intake of water
 The maintenance of a sufficient intake of food
 The provision of care associated with elimination process
and excrements
 The maintenance of a balance between activity and rest
 The maintenance of a balance between solitude and social
interaction
 The prevention of hazards to human life, human
functioning, and human well-being
 The promotion of human functioning and development
within social groups in accord with human potential, known
human limitations, and the human desire to be normal
Normalcy is used in the sense of that which is essentially human
and that which is in accord with the genetic and constitutional
characteristics and the talents of individuals.
Developmental self-care requisites
Developmental self-care requisites are “either specialized
expressions of universal self-care requisites that have been
particularized for developmental processes or they are new
requisites derived from a condition or associated with an event.”
Health deviation self-care requisites
Health deviation self-care requisites are required in conditions of
illness, injury, or disease or may result from medical measures
required to diagnose and correct the condition.
  Seeking and securing appropriate medical assistance
 Being aware of and attending to the effects and results of
pathologic conditions and states
 Effectively carrying out medically prescribed diagnostic,
therapeutic, and rehabilitative measures
 Being aware of and attending to or regulating the
discomforting or deleterious effects of prescribed medical
measures
 Modifying the self-concept (and self-image) in accepting
oneself as being in a particular state of health and in need
of specific forms of health care
 Learning to live with the effects of pathologic conditions
and states and the effects of medical diagnostic and
treatment measures in a lifestyle that promotes continued
personal development
Theory of Self-Care Deficit
This theory delineates when nursing is needed. Nursing is required
when an adult (or in the case of a dependent, the parent or guardian)
is incapable of or limited in the provision of continuous effective self-
care. Orem identified 5 methods of helping:
 Acting for and doing for others
 Guiding others
 Supporting another
 Providing an environment promoting personal development
in relation to meet future demands
 Teaching another
Theory of Nursing System
This theory is the product of a series of relations between the
persons: legitimate nurse and legitimate client. This system is
activated when the client’s therapeutic self-care demand exceeds
available self-care agency, leading to the need for nursing.
Wholly Compensatory Nursing System
This is represented by a situation in which the individual is unable “to
engage in those self-care actions requiring self-directed and
controlled ambulation and manipulative movement or the medical
prescription to refrain from such activity… Persons with these
limitations are socially dependent on others for their continued
existence and well-being.”
Example: care of a newborn, care of client recovering from surgery in
a post-anesthesia care unit
Partial Compensatory Nursing System
This is represented by a situation in which “both nurse and perform
care measures or other actions involving manipulative tasks or
ambulation… [Either] the patient or the nurse may have a major role
in the performance of care measures.”
Example: Nurse can assist postoperative client to ambulate, Nurse
can bring a meal tray for client who can feed himself
Supportive-Educative System
This is also known as supportive-developmental system, the person
“is able to perform or can and should learn to perform required
measures of externally or internally oriented therapeutic self-care but
cannot do so without assistance.”
Example: Nurse guides a mother how to breastfeed her baby,
Counseling a psychiatric client on more adaptive coping strategies.
Dorothea Orem’s Theory and The Nursing Process
The Nursing Process presents a method in determining self-care
deficits and to define the roles of persons or nurse to meet the self-
care demands.
Assessment
 Diagnosis and prescription; determine why nursing is
needed. Analyze and interpret by making a judgment
regarding care.
 Design of a nursing system and plan for delivery of care.
 Production and management of nursing systems.
Step 1 – Collect Data in Six Areas
1. The person’s health status
2. The physician’s perspective of the person’s health status
3. The person’s perspective of his or health health
4. The health goals within the context of life history, lifestyle,
and health status.
5. The person’s requirements for self-care
6. The person’s capacity to perform self-care
Nursing Diagnosis & Care Plans
Step 2
 The nurse designs a system that is wholly or partly
compensatory or supportive-educative.
 The two actions are: (1) Bringing out a good organization of
the components of patients’ therapeutic self-care demands.
(2) Selection of combination of ways of helping that will be
effective and efficient in compensating for/overcoming
patient’s self-care deficits.
Implementation & Evaluation
Step 3
 Nurse assists the patient or family in self-care matters to
achieve identified and described health and health-related
results. Collecting evidence in evaluating results achieved
against results specified in the nursing system design.
 Actions are directed by etiology component of nursing
diagnosis.
Analysis of the Self-Care Deficit Theory
There is a superb focus of Orem’s work which is self-care. Even
though there is a wide range of scope seen in the encompassing
theory of nursing systems, Orem’s goal of letting the readers view
nursing care as a way to provide assistance to people was apparent
in every concept presented.
ADVERTISEMENTS
From the definition of health which is sought to be rigid, it can now be
refined by making it suitable to the general view of health as a
dynamic and ever-changing state.
The role of the environment to the nurse-patient relationship,
although defined by Orem was not discussed.
The role of nurses in maintaining health for the patient was set by
Orem with great coherence in accordance with the life-sustaining
needs of every individual.
Although Orem viewed the importance of the parents or guardian in
providing for their dependents, the definition of self-care cannot be
directly applied to those who need complete care or assistance with
self-care activities such as the infants and the aged.
Strengths
 A major strength of Dorothea Orem’s theory is that it is
applicable for nursing by the beginning practitioner as well
as the advanced clinicians.
 Orem’s theory provides a comprehensive basis for nursing
practice. It has utility for professional nursing in the areas
of nursing practice, nursing education and administration.
 The terms self-care, nursing systems, and self-care
deficit are easily understood by the beginning student
nurse and can be explored in greater depth as the nurse
gains more knowledge and experience.
 She specifically defines when nursing is needed: Nursing is
needed when the individual cannot maintain continuously
that amount and quality of self-care necessary to sustain
life and health, recover from disease or injury, or cope with
their effects.
  Her self-care approach is contemporary with the concepts
of health promotion and health maintenance.
 Three identifiable nursing systems were clearly delineated
and are easily understood.
Limitations
 Orem’s theory, in general, is viewed as a single whole thing
while Orem defines a system as a single whole thing.
 Orem’s theory is simple yet complex. The use of self-care
in multitudes of terms, such as self-care agency, self-care
demand, self-care deficit, self-care requisites, and
universal self-care, can be very confusing to the reader.
 Orem’s definition of health was confined in three static
conditions which she refers to a “concrete nursing system,”
which connotes rigidity.
 Throughout her work, there is limited acknowledgement of
the individual’s emotional needs.
 Health is often viewed as dynamic and ever-changing.
Conclusion
Orem’s theory is relatively simple, but generalizable to apply to a
wide variety of patients. It explains the terms self-care, nursing
systems, and self-care deficit which are very essential to students
who plan to start their career in nursing.
Moreover, this theory signifies that all patients want to care for
themselves, and they are able to recover more quickly and
holistically by performing their own self-care as much as they’re able.
This theory is particularly used in rehabilitation and primary care or
other settings in which patients are encouraged to be independent.
Though this theory greatly influences every patient’s independence,
the definition of self-care cannot be directly applied to those who
need complete care or assistance with self-care activities such as the
infants and the aged.
Orem's theory
1. 1. Self-Care Deficit Nursing Theory Dorothea Elizabeth
Orem Shrooti shah Lecturer National Medical College
Nursing Campus
2. 2. Introduction to the theorist • Theorist : Dorothea Orem
(1914-2007) • Born 1914 in Baltimore, US • Received her
diploma at Providence Hospital – Washington, DC in 1934
• 1939 – BSN Ed. And Master of science in nursing
education (1945) from Catholic University of America,
Washington D.C.
3. 3. Introduction cont… • Her clinical practice included staff
nurse in the operating room, paediatrics and adult medical
surgical units. • She also did private-duty nursing in private
homes and the hospital and was an emergency room
supervisor. • She taught biological sciences and later
served as director of nursing service and director of the
school of nursing at Providence Hospital, Michigan. •
Received several honorary degrees.
4. 4. Introduction… • Orem’s concept of nursing as the
provision of self- care was first published in 1959. • Orem
continued to develop her nursing concepts and her self-
care deficit theory of nursing. In 1971 she published
Nursing: Concepts of practice. • The second, third, fourth,
fifth and sixth editions of this book were published in 1980,
1985, 1991, 1995 and 2001 respectively.
5. 5. Introduction • 1st edition: focus on individual • 2nd
edition: include multiperson units (families, groups and
communities) • 3rd edition: Orem’s general theory of
nursing, comprised of three related theoretical constructs:
self-care, self-care deficit and nursing system • 4th edition:
fully developed the ideas presented • 5th edition: Provided
an increased emphasis on multiperson situation • 6th
edition: continued development of orem’s ideas
6. 6. Orem’s general theory of nursing Orem’s general theory
of nursing in three related parts:- • Theory of self care •
Theory of self care deficit • Theory of nursing system
7. 7. Relationship of Orem’s concept to the three theories
Theory of self - care Theory of self- care deficit Theory of
nursing system Self-care When therapeutic self-care
demand exceeds self-care agency, a self-care deficit exists
and nursing is needed. Nursing agency Self-care agency
Nursing systems Wholly compensatory Partly
compensatory Supportive education Self care requisites
Universal Developmental Health Deviation Therapeutic
self- care demand
8. 8. Theory of self-care • Self –care is the performance or
practice of activities that individuals initiate and perform on
their own behalf to maintain life, health and well- being. •
When self-care is effectively performed, it helps to maintain
structural integrity and human functioning and contributes
to human development.
9. 9. Self care agency • Self-care agency is the human’s
acquired powers and capabilities to engage in self care. •
The ability to engage in self-care is affected by basic
conditioning factors. • The basic conditioning factors are
age, gender, developmental stat, health state, socio-
cultural orientations, health care system factors, pattern of
living etc.
10. 10. Therapeutic self-care demand • Total of care activities
needed, either at an identified moment or over a period of
time, to meet a person’s known requirements for self-care.
11. 11. Self-care requisites • Actions directed towards provision
of self- care. • Three categories of self-care requisites are:
– Universal self care requisites – Developmental self care
requisites – Health deviation self care requisites
12. 12. Universal self care requisites • Associated with life
processes and the maintenance of the integrity of human
structure and functioning. • A common term for these
requisites is activities of daily living.
13. 13. Universal self care requisites Orem identifies self-care
requisites as follows: • The maintenance of a sufficient
intake of air. • The maintenance of a sufficient intake of
water. • The maintenance of a sufficient intake of food. •
The provision of care associated with elimination
processes and excrements • The maintenance of a balance
between activity and rest.
14. 14. Universal self care requisites • The maintenance of a
balance between solitude and social interaction. • The
prevention of hazards to human life, human functioning,
and human well-being • The promotion of human
functioning and development within social groups in accord
with human potential. Known human life, human
functioning and human well-being.
15. 15. Developmental self-care requisites • More specific to
the processes of growth and development and are
influenced by what is happening during the life cycle
stages; such influence may be positive or negative. • Ex:
Adjusting to new job or adjusting to body changes.
16. 16. Health deviation self-care requisites • Changes in
human structure and function, out of the range of normal,
 and may be associated with genetic variations or other
defects. • May deal with the effects of defects or deviations
and the effects of efforts to diagnose and treat them.
17. 17. Health deviation self-care requisites The health
deviation self-care requisites are as follows: • Seeking and
securing appropriate medical assistance • Being aware of
and attending to the effects and results of pathologic
condition and states • Effectively carrying out medically
prescribed diagnostic, therapeutic and rehabilitative
measures
18. 18. • Modifying the self-concept in accepting oneself as
being in a particular state of health and in need of specific
forms of health care. • Learning to live with the effects of
pathologic conditions and states and the effect of medical
diagnostic and treatment measures in a life-style that
promotes continued personal development.
19. 19. Theory of self care deficit • It is the central focus of
Orem’s general theory of nursing. • It describes how people
can be helped through nursing. • Orem identifies 5
methods of helping: – Acting for and doing for others –
Guiding and directing – Providing physical or psychological
support – Providing an environment promoting personal
development – Teaching
20. 20. Theory of self-care deficit • Orem has identified work
operations of nurses in clinical nursing practice: – Entering
into and maintaining nurse-patient relationships with
individuals, families, or groups – Designing, planning for,
instituting, and managing systems of nursing care –
Responding to patients’ requests, desires and needs for
nurse contact and assistance.
21. 21. Theory of self-care deficit • Coordinating nursing care •
Establishing the kind and amount of immediate and
continuing care needed • Coordinating the care with other
services, such as other health care, social, or educational
services, needed or being received. • Discharging patients
from nursing care when they have regained their abilities to
perform their own self-care needs
22. 22. C. Theory of Nursing Systems • This theory describes
how the patient’s self care needs will be met by the nurse,
the patient, or both. • If there is a self-care deficit- that is, if
there is a difference between what the individual can do
(self-care agency) and what needs to be done to maintain
optimum functioning (therapeutic self- care demand)-
nursing is required.
23. 23. Classification of nursing system It identifies 3
classifications of nursing system to meet the self care
requisites of the patient:- • Wholly compensatory system •
Partly compensatory system • Supportive – educative
system
24. 24. Wholly compensatory system • Represented by a
situation in which the individual is unable to carry out
needed self-care actions, either through inability to be self-
directed or due to medical prescription. • Those who have
such limitations are dependent upon others for their well-
being and even their very existence.
25. 25. Wholly compensatory system • Subtypes of this system
are: o unable to engage in self care(person in coma). o
aware but could not engage in self-care(person with C3-C4
vertebral fracture) o Include persons who are severely
mentally impaired (senile persons, some forms of mental
retardation).
26. 26. Partly compensatory system • It is used when a patient
can meet some self-care requisites but needs a nurse to
help meet other needs; the nurse and the patient play
major role in performing self- care. • For example: a patient
undergone abdominal surgery.
27. 27. Supportive – educative system • It is used when a
patient can meet self- care requisites but needs assistance
with decision making, behavior control, or knowledge
acquisition skills. • For e.g, patient with controlled HTN who
seeks additional diet information from the nurse: in this
system, the nurse attempts to promote the self-care
agency.
28. 28. Orem states that one or more of these three types of
nursing systems may be used with a single patient over a
period of time
29. 29. Major Assumptions • All patients wish to care for
themselves. • Humans are capable and willing to engage in
self-care and care for dependent members of the family. •
Self-care and dependent care are learned behaviors
through human communication and interaction with each
other. • Nursing is a deliberate helping actions performed
by nurses for the benefits of others over a certain period of
time.
30. 30. Major Assumptions • Humans are supposed to be self-
reliant and responsible for their self-care needs and care
needs for dependent members of the family. • Humans are
unique individuals that are separated from each other and
from their environment.
31. 31. Four Major Concepts of Orem’s Theory • Person •
Health • Environment • Nursing
32. 32. Person • Person is defined by Orem as the patient (a
recipient of nursing care)- a being who functions
biologically, symbolically, and socially and who has the
potential for learning and development. • Person is an
individual, who is with the capacity for self knowledge, who
can engage in deliberate action, interpret experiences, and
perform beneficial actions
33. 33. Health • A state characterized by soundness or
wholeness of bodily structure and function; illness is its
opposite. • It consists of physical, psychological,
interpersonal and social aspects; these aspects are
inseparable. • Health includes promotion and maintenance
of health, treatment of illness, and prevention of
complications.
34. 34. Environment • Environment consists of environmental
factors, environment elements, environmental conditions
(external physical and psychological surrounding), and
developmental environment. • Environment can positively
or negatively affects the person’s ability to provide self
care.
35. 35. Nursing • Orem defines the art of nursing as an
intellectual quality of the individual nurse; this quality is
related to creativity as well as analysis and synthesis of
information, all of which contribute to development of
nursing systems to assist individuals or multiperson units.
36. 36. Nursing • Orem further defines nursing as a human
service. • Nursing is distinguished from other human
services by its focus on persons with inabilities to maintain
the continuous provision of health care.
37. 37. Nursing cont… Goal of nursing is: • to render the
patient or members of his family capable of meeting the
patient’s self care needs • to maintain a state of health • to
 regain normal or near normal state of health in the event of
disease or injury • to stabilize ,control ,or minimize the
effects of chronic poor health or disability
38. 38. Comparison of Orem’s Nursing Process and Nursing
process Nursing Process Orem’s Nursing Process 1.
Assessment 2. Nursing Diagnosis 3. Plans with scientific
Rationale 4. Implementation 5. Evaluation Step I:
Diagnosis and prescription, determine why nursing is
needed. Analyze and interpret- make judgment regarding
care. Step II: Design of a nursing system and plan for
delivery of care. Step III: Production and management of
nursing systems.
39. 39. Orem’s Theory and the Nursing Process The steps of
Orem’s nursing process may be as followed. • Step I:
nursing diagnosis and prescription: the initial and
continuing determination of why a person should be under
nursing care. • Step II: the designing of the nursing system
and planning for the delivery of nursing care • Step III: The
production and management of nursing systems, also
labelled planning and controlling.
40. 40. Orem’s Theory and the Nursing Process Step 1-collect
data in six areas:- • The person’s health status • The
physician’s perspective of the person’s health status • The
person’s perspective of his or her health • The health goals
within the context of life history ,life style, and health status
• The person’s requirements for self care • The person’s
capacity to perform self care
41. 41. Orem’s Theory and the Nursing Process • Nurse
designs a system that is wholly or partly compensatory or
supportive-educative. The two actions are:- 1. Bringing out
a good organization of the components of patients’
therapeutic self care demands 2. Selection of combination
of ways of helping that will be effective and efficient in
compensating for/ overcoming patient’s self care deficits
42. 42. Orem’s Theory and the Nursing Process • Nurse
assists the patient or family in self care matters to achieve
identified and described health and health related results . •
Collecting evidence in evaluating results achieved against
results specified in the nursing system design
43. 43. Patient Profile Areas Patient details Name Age Sex
Education Occupation Marital status Religion Diagnosis
Theory applied Mrs. Yaita Maya Limbu 56 years Female
No formal education House hold Married Buddhist
Rheumatoid arthritis Orem’s theory of self care deficit.
44. 44. History • She came to the hospital with complaints of
pain over all the joints, stiffness which is more in the
morning and reduces by the activities. • She has these
complaints since 5 years and has taken treatment from
local hospital. • The symptoms were not reducing and
came to NMCTH for further management. • Patient was
able to do the ADL by herself but the way she performed
and the posture she used was making her prone to develop
the complications of the disease. • She also was
malnourished and was not having awareness about the
deficiencies and effects.
45. 45. Basic conditioning factors Age 56 years Gender
Female Health state Disability due to health condition
Development state Ego integrity vs despair Socio-cultural
orientation No formal education, Nepali, Buddhist Health
care system Treatment from local hospital and Medical
College Family system Married, husband Labourer
Patterns of living At homewith partner Environment Rural
area, items for ADL not in easy reach, no special
precautions to prevent injuries Resources Husband,
daughter, son
46. 46. UNIVERSAL SELF-CARE REQUISITES Air Breaths
without difficulty, no pallor cyanosis Water Fluid intake is
sufficient. Edema present over ankles. Turgor normal for
the age Food Food intake is not adequate. Elimination
Voids and eliminates bowel without difficulty. Activity/ rest
Frequent rest is required due to pain. Pain not completely
relieved, Activity level has come down. Social interaction
Communicates well with neighbors and calls the daughter
by phone, need for medical care is communicated to the
daughter. Prevention of hazards Need instruction on care
of joints and prevention of falls. Need instruction on
improvement of nutritional status. Prefer to walk bare foot.
Promotion of normalcy Has good relation with daughter
47. 47. Developmental self-care requisites Maintenance of
developmental environment Able to feed self , Difficult to
perform the dressing, toileting etc Prevention/ management
of the conditions threatening the normal development Feels
that the problems are due to her own behaviours and
discusses the problems with husband and daughter.
48. 48. Health deviation self care requisites Adherence to
medical regimen Reports the problems to the physician
when in the hospital. Cooperates with the medication, Not
much aware about the use and side effects of medicines
Awareness of potential problem associated with the
regimen Not aware about the actual disease process. Not
compliant with the diet and prevention of hazards. Not
aware about the side effects of the medications
Modification of self image to incorporates changes in health
status Has adapted to limitation in mobility. The adoption of
new ways for activities leads to deformities and
progression of the disease. Adjustment of lifestyle to
accommodate changes in the health status and medical
regimen. Adjusted with the deformities. Pain tolerance not
achieved
49. 49. Priority of nursing problems according to orem’s theory
of self care deficit • Air • Water • Food • Elimination •
Activity/ Rest • Solitude/ Interaction • Prevention of hazards
• Promotion of normalcy • Maintain a developmental
environment.
50. 50. Priority of nursing problem according to Orem’s theory
of self care deficit • Prevent or manage the developmental
threats • Maintenance of health status • Awareness and
management of the disease process. • Adherence to the
medical regimen • Awareness of potential problem. •
Modify self image • Adjust life style to accommodate health
status changes
51. 51. Nursing Diagnosis • Altered nutrition less than body
requirement related to inadequate intake and knowledge
deficit • Self-care deficit: dressing, toileting related to
restricted joint movement, secondary to the inflammatory
process in the joints. • Pain related to lack of utilization of
pain relief measures • Risk for fall and injury related to joint
pain. • Risk for impaired skin integrity related to edema •
Knowledge deficit regarding disease condition and
treatment related to lack of information.
52. 52. Application of Orem’s self-care deficit theory in nursing
practice, education and research Practice • Many articles
document the use of the self-care theory as a basis for
clinical practice. • Orem’s self-care deficit theory has been
 used in the context of the nursing process to teach patients
to increase their self-care agency to evaluate nursing
practice and to differentiate nursing from medical practice.
53. 53. Application of Orem’s self-care deficit theory in nursing
process Education • Orem’s self-care deficit theory has
been the focus of the curriculum in nursing education at
many schools of nursing. Research • The self-care theory
provided conceptual framework for many researches.
54. 54. Orem’s work and characteristics of theory
55. 55. Theories can interrelate concepts in such a way as to
create a difference • Orem’s theoretical constructs of self-
care, self- care deficits and nursing systems are
interrelated in her general comprehensive theory of nursing
which is unique phenomena.
56. 56. Theories must be logical in nature • Orem’s theory
follows a logical thought process. She states her general
theory, that presents the central idea of each of the three
interrelated theories. • Statements that describe a concept
or explain and predict relationship between two concept.
57. 57. Theories should be relatively simple yet generalizable •
The theory is used by several colleges of nursing as a
theoretical foundation for students’ basic preparation for
practice. • The theory can be applied to all individual
patients and with further adaptation, to multiperson units.
58. 58. Theories can be the bases for the hypothesis that can
be tested or for theory to be explained • Several
researchers tested Orem’s theory in the area of self-care
agency including studies focused on the development of
tools to measure aspects of self-care.
59. 59. Theories can be used by practitioner to guide and
improve their practice • Theory focuses on nursing a
helping art that assists an individual to meet self-care
needs and that is the foundation for nursing practice. •
Adds nursing’s body of knowledge.
60. 60. Theories must be consistent with other validated
theories, laws, principles but leave unanswered questions
that need to be investigated. • Consistent with role theory,
need theory, field theory and health promotional concepts.
61. 61. Critiques of Orem’s Theory
62. 62. Strengths • Provides a comprehensive base to nursing
practice • It has utility for professional nursing in the areas
of nursing practice, curricula, education, administration,
and research • Specifies when nursing is needed • Her self-
care approach is contemporary with the concepts of health
promotion and health maintenance • Expanded her focus of
individual self-care to include multiperson units
63. 63. Limitations • In general system theory, a system is
viewed as a single whole thing while Orem defines a
system as a single whole, thing. • Appears that the theory
is illness oriented rather with no indication of its use in
wellness settings.
Biography of Martha E. Rogers
Martha Elizabeth Rogers (May 12, 1914 – March 13, 1994) was an
American nurse, researcher, theorist, and author widely known for
developing the Science of Unitary Human Beings and for her
landmark book, An Introduction to the Theoretical Basis of Nursing.
She believes that a patient can never be separated from his or her
environment when addressing health and treatment. Her knowledge
about the coexistence of the human and his or her environment
contributed a lot in the process of change toward better health.
ADVERTISEMENT
Early Life
Martha Rogers was born on May 12, 1914; sharing a birthday
with Florence Nightingale. She was the eldest of four children of
Bruce Taylor Rogers and Lucy Mulholland Keener Rogers.
Portrait of Martha E. Rogers
She had a thirst for knowledge at an early age. She found
Kindergarten to be “terribly exciting” and had a love and passion for
books that was fostered by her parents. Her father introduced her to
the public library at the age of 3 where she loved story time. She
liked to go off by herself with a book. And by the fourth grade, she
had read every book in her school library. She used to go to the
public library before I was 6 even before she could read. She was
well acquainted with the public library and started reading eight
books at a time. Her father used to be bothered if she was just
skimming but he later on discovered that the young Rogers was
learning fast.
In fact, Rogers already knew the Greek alphabet by age 10. By the
sixth grade, she already finished reading all 20 volumes of The
Child’s Book of Knowledge and was into the Encyclopedia Britannica.
Four Generations, Left to right: Lucy K Rogers, mother; Martha E.
Rogers; Laura B. Keener, grandmother; Lucy M. Brownlee, great-
grandmother. via V. M. Malinski & E.A.M. Barrett, 1994
She also loved to read various topics like anthropology, archaeology,
cosmology, ethnography, astronomy, ethics, psychology, eastern
philosophy, and aesthetics. By her senior year she had completed all
the high school math courses and was taking a college level algebra
course where she was the only female in the class.
Education
Initially, Martha Rogers wanted to do something that would, hopefully
contribute to social welfare like law and medicine. However, she only
studied medicine for a couple of years because women in medicine
were not particularly desirable during her time. Instead, Rogers along
with her friend entered a local hospital that had a school of nursing.
But just like Nightingale, her parents weren’t really any happier over
that decision than they had between over medicine.
Bruce T. Rogers (Father), Martha, Keener (Brother), Laura (Sister),
Lucy K. Rogers (Mother), via E.A.M. Barrett & V.M. Malinski, 1994
She then transferred to Knoxville General Hospital’s nursing program
and was one of 25 students in her class. She described her training
as at times as being miserable because the training was like the
“Army, pre-Nightingale.” She even spent a week at home, thinking of
not returning to school but eventually enjoyed working with people
and patients.
Rogers received her nursing diploma from the Knoxville General
Hospital School of Nursing in 1936, then earned her Public
Health Nursing degree from George Peabody College in Tennessee
in 1937. She sold her car to pay for tuition and entered a Masters
degree program full-time.
Rogers Family, circa 1945. Jane L. Coleman, Martha E. Rogers,
Lucy K. Rogers, (Mother) Keener (Brother) , Laura B. Whihte (sister)
via E.A.M. Barrett & V.M. Malinski, 1994
Her Master’s degree was from Teachers College at Columbia
University in 1945, and her Doctorate in Nursing was given to her
from Johns Hopkins University in Baltimore in 1954. She completed
her studies in 1954 and the title of her dissertation was “The
association of maternal and fetal factors with the development of
behavior problems among elementary school children.”
Career and Appointments
After Martha Rogers graduated from George Peabody College in
Tennessee in 1937, she worked for the Children’s Fund of Michigan
for two years as public health nurse.
Rogers in her Teens via E.A.M. Barrett &
V.M. Malinski, 1994
In 1940, she accepted a position in Hartford, CT at the Visiting Nurse
Association. She worked at the Association for five years, first as an
Assistant Supervisor, then as the Assistant Education Director, and
lastly as the acting Director of Education. At the same time she was
completing her coursework at Teacher’s College and completed her
degree requirements (Master of Arts) in 1945.
After completing her degree in 1945, she sent out a number of job
inquiry letters, considered staying in Hartford, but settled on a
position as the Executive Director at the Visiting Nurse Service in
Phoenix, Arizona. She believed she may have been the first nurse in
Arizona with a masters degree and for 1945 to 1951, she built up the
Visiting Nursing Service in Phoenix.
While a doctoral student, she did spend a year as a visiting lecturer
at a Catholic University in Washington, DC.
Rogers and her predecessor Vera Fry at NYU circa 1954
Rogers was then appointed Professor and Head of the Division of
Nursing at New York University right after graduating from Hopkins.
She was encouraged to accept the position by Ruth Freeman. When
Rogers arrived at NYU, Vera Fry was the previous Division Head and
Joan Hoexter stated that all of the nursing faculty left except her. She
was also a Fellow for the American Academy of Nursing.
Rogers officially retired as Professor and Head of the Division of
Nursing in 1975 after 21 years of service. Following her retirement,
she continued to teach at NYU, was a frequent presenter at scientific
conferences throughout the world, and consistently worked to refine
her conceptual system.
Rogers with John Phillips
Rogers was also actively involved in professional nursing
organizations and associations concerned with education and
scholarship. In 1979, she became Professor Emerita and continued
to have an active role in the development of nursing and the Science
of Unitary Human Beings.
Theory
The Science of Unitary Human Beings
Rogers with Sr. Callista Roy (right)
Martha Rogers’ theory is known as the Science of Unitary Human
Beings (SUHB). The theory views nursing as both a science and an
art as it provides a way to view the unitary human being, who is
integral with the universe. The unitary human being and his or her
environment are one. Nursing focuses on people and the
manifestations that emerge from the mutual human-environmental
field process.
SUHB contains two dimensions: the science of nursing, which is the
knowledge specific to the field of nursing that comes from scientific
research; and the art of nursing, which involves using the science of
nursing creatively to help better the life of the patient.
Rogers wearing “Just visiting this planet!” cap, Photo by M Bramlett,
1991
Her model addresses the importance of the environment as an
integral part of the patient, and uses that knowledge to help nurses
blend the science and art of nursing to ensure patients have a
smooth recovery and can get back to the best health possible.
There are eight concepts in Rogers’ nursing theory: energy field,
openness, pattern, pan-dimensionality, homeodynamic principles,
resonance, helicy, and integrality.
Rogers’ development of the said theory has become an influential
nursing theory in the United States. When first introduced, it was
considered profound, and was too ambitious, but now is simply
thought to be ahead of its time. Her conceptual framework has
greatly influenced all aspects of nursing by offering an alternative to
traditional approaches of nursing.
Her theory is discussed further below.
Works
Front cover of Reveille in Nursing (1964)
Martha Rogers wrote three books that enriched the learning
experience and influenced the direction of nursing research for
countless students: Educational Revolution in Nursing
(1961), Reveille in Nursing (1964).
In about 1963 Rogers edited a journal called Nursing Science. It was
during that time that Rogers was beginning to formulate ideas about
the publication of her third book, An Introduction to the Theoretical
Basis of Nursing (1970), the last of which introduced the four
Rogerian Principles of Homeodynamics.
Her publications include: Theoretical Basis of Nursing (1970),
Nursing Science and Art: A Prospective (1988), Nursing: Science of
Unitary, Irreducible, Human Beings Update (1990), and Vision of
Space Based Nursing (1990).
Roger’s third book “An Introduction to the Theoretical Basis of
Nursing” (1970)
Awards and Honors
Martha Rogers was honored with numerous awards and citations for
her sustained contributions to nursing and science. In 1996, she was
posthumously inducted into the American Nurses Association’s Hall
of Fame.
Death
Martha Rogers died on March 13, 1994 and was buried in Knoxville,
Tennessee. She has a memorial placed in the sidewalk near her
childhood home in Knoxville.
Memorial placed in the sidewalk near her childhood home in
Knoxville by Gamma Chi, Sigma Theta Tau, International. Photo by
Martha Alligood
Rogers’ Theory of Unitary Human Beings
The belief of the coexistence of the human and the environment has
greatly influenced the process of change toward better health. In
short, a patient can’t be separated from his or her environment when
addressing health and treatment. This view lead and opened Martha
E. Rogers’ theory, known as the “Science of Unitary Human
Beings,” which allowed nursing to be considered one of the scientific
disciplines.
Rogers’ theory defined Nursing as “an art and science that is
humanistic and humanitarian. It is directed toward the unitary human
and is concerned with the nature and direction of human
development. The goal of nurses is to participate in the process of
change.”
According to Rogers, the Science of Unitary Human Beings contains
two dimensions: the science of nursing, which is the knowledge
specific to the field of nursing that comes from scientific research;
and the art of nursing, which involves using the science of nursing
creatively to help better the life of the patient.
Assumptions
The assumptions of Rogers’ Theory of Unitary Human Beings are as
follows: (1) Man is a unified whole possessing his own integrity and
manifesting characteristics that are more than and different from the
sum of his parts. (2) Man and environment are continuously
exchanging matter and energy with one another. (3) The life process
evolves irreversibly and unidirectionally along the space-time
continuum. (4) Pattern and organization identify the man and reflect
his innovative wholeness. And lastly, (5) Man is characterized by the
capacity for abstraction and imagery, language and thought
sensation and emotion.
Major Concepts
The following are the major concepts and metaparadigm of Martha
Rogers’ nursing theory:
Human-unitary human beings
A person is defined as an indivisible, pan-dimensional energy field
identified by a pattern, and manifesting characteristics specific to the
whole, and that can’t be predicted from knowledge of the parts. A
person is also a unified whole, having its own distinct characteristics
that can’t be viewed by looking at, describing, or summarizing the
parts.
Health
Rogers defines health as an expression of the life process. It is the
characteristics and behavior coming from the mutual, simultaneous
interaction of the human and environmental fields, and health and
illness are part of the same continuum. The multiple events occurring
during the life process show the extent to which a person is achieving
his or her maximum health potential. The events vary in their
expressions from greatest health to those conditions that are
incompatible with the maintaining life process.
ADVERTISEMENTS
Nursing
It is the study of unitary, irreducible, indivisible human and
environmental fields: people and their world. Rogers claims that
nursing exists to serve people, and the safe practice of nursing
depends on the nature and amount of scientific nursing knowledge
the nurse brings to his or her practice
Scope of Nursing
Nursing aims to assist people in achieving their maximum health
potential. Maintenance and promotion of health, prevention of
disease, nursing diagnosis, intervention, and rehabilitation
encompass the scope of nursing’s goals.
Nursing is concerned with people-all people-well and sick, rich and
poor, young and old. The arenas of nursing’s services extend into all
areas where there are people: at home, at school, at work, at play; in
hospital, nursing home, and clinic; on this planet and now moving
into outer space.
Environmental Field
“An irreducible, indivisible, pandimensional energy field identified by
pattern and integral with the human field.”
Energy Field
The energy field is the fundamental unit of both the living and the
non-living. It provides a way to view people and the environment as
irreducible wholes. The energy fields continuously vary in intensity,
density, and extent.
Subconcepts
Openness
There are no boundaries that stop energy flow between the human
and environmental fields, which is the openness in Rogers’ theory. It
refers to qualities exhibited by open systems; human beings and their
environment are open systems.
Pandimensional
Pan-dimensionality is defined as “non-linear domain without spatial
or temporal attributes.” The parameters that humans use in language
to describe events are arbitrary, and the present is relative; there is  offering choices
no temporal ordering of lives.  empowering the patient
Synergy is defined as the unique behavior of whole systems,  fostering patterning
unpredicted by any behaviors of their component functions taken  evaluation
separately.  repeat pattern appraisal, which includes nutrition,
Human behavior is synergistic. work/leisure activities, wake/sleep cycles,
Pattern relationships, pain, and fear/hopes
Rogers defined the pattern as the distinguishing characteristic of an  identify dissonance and harmony
energy field seen as a single wave. It is an abstraction and gives  validate appraisal with the patient
identity to the field.
 self-reflection for the patient
Principles of Homeodynamics
Strengths
Homeodynamics should be understood as a dynamic version
Martha Rogers’ concepts provide a worldview from which nurses
of homeostasis (a relatively steady state of internal operation in the
may derive theories and hypotheses and propose relationships
living system).
specific to different situations.
Homeodynamic principles postulate a way of viewing unitary human
Rogers’ theory is not directly testable due to lack of concrete
beings. The three principles of homeodynamics are resonance,
hypotheses, but it is testable in principle.
helicy, and integrality.
ADVERTISEMENTS
Principle of Reciprocy
Weaknesses
Postulates the inseparability of man and environment and predicts
Rogers’ model does not define particular hypotheses or theories for it
that sequential changes in life process are continuous, probabilistic
is an abstract, unified and highly derived framework.
revisions occurring out of the interactions between man and
Testing the concepts’ validity is questionable because its concepts
environment.
are not directly measurable.
Principle of Synchrony
The theory was believed to be profound and was too ambitious
This principle predicts that change in human behavior will be
because the concepts are extremely abstract.
determined by the simultaneous interaction of the actual state of the
Rogers claimed that nursing exists to serve people, however, nurses’
human field and the actual state of the environmental field at any
roles were not clearly defined.
given point in space-time.
The purpose of nurses is to promote health and well-being for all
Principle of Integrality (Synchrony + Reciprocy)
persons wherever they are. However, Rogers’ model has no
Because of the inseparability of human beings and their environment,
concrete definition of health state.
sequential changes in the life processes are continuous revisions
Conclusion
occurring from the interactions between human beings and their
The Science of Unitary Human Beings is highly generalizable as the
environment.
concepts and ideas are not confined with a specific nursing approach
Between the two entities, there is a constant mutual interaction and
unlike the usual way of other nurse theorists in defining the major
mutual change whereby simultaneous molding is taking place in both
concepts of a theory.
at the same time.
Rogers gave much emphasis on how a nurse should view the
Principle of Resonancy
patient. She developed principles which emphasize that a nurse
It speaks to the nature of the change occurring between human and
should view the client as a whole.
environmental fields. The life process in human beings is a
Her statements, in general, made us believe that a person and his or
symphony of rhythmical vibrations oscillating at various frequencies.
her environment are integral to each other. That is, a patient can’t be
It is the identification of the human field and the environmental field
separated from his or her environment when addressing health and
by wave patterns manifesting continuous change from longer waves
treatment. Her conceptual framework has greatly influenced all
of lower frequency to shorter waves of higher frequency.
aspects of nursing by offering an alternative to traditional approaches
Principle of Helicy
of nursing.
The human-environment field is a dynamic, open system in which
change is continuous due to the constant interchange between the
human and environment.
This change is also innovative. Because of constant interchange, an
open system is never exactly the same at any two moments; rather,
Science of Unitary Human Beings
the system is continually new or different.
This page was last updated on January 26, 2012
Science of Unitary Human Beings and Nursing Process
The nursing process has three steps in Rogers’ Theory of Unitary
Human Beings: assessment, voluntary mutual patterning, Introduction
and evaluation.  Theorist - Martha E Rogers
The areas of assessment are: the total pattern of events at any given  Born :May 12, 1914, Dallas, Texas, USA
point in space-time, simultaneous states of the patient and his or her
 Diploma : Knoxville General Hospital School of Nursing(1936)
environment, rhythms of the life process, supplementary data,
 Graduation in Public Health Nursing : George Peabody Colleg
categorical disease entities, subsystem pathology, and pattern
1937
appraisal. The assessment should be a comprehensive assessment
 MA :Teachers college, Columbia university, New York, 1945
of the human and environmental fields.
Mutual patterning of the human and environmental fields  MPH :Johns Hopkins University, Baltimore, MD, 1952
includes:  Doctorate in nursing :Johns Hopkins University, Baltimore, 195
 sharing knowledge  Fellowship: American academy of nursing
  Position: Professor Emerita, Division of Nursing, New York University,Helicy
Consultant, Speaker
 Died : March 13 , 1994
Publications of Martha Rogers
 Theoretical basis of nursing (Rogers 1970)
 Nursing science and art :a prospective (Rogers 1988)
 Nursing :science of unitary, irreducible, human beings update (Rogers
1990)
 Vision of space based nursing (Rogers 1990)
Overview of Rogerian model
 Rogers conceptual system provides a body of knowledge in nursing.
 Rogers model provides the way of viewing the unitary human being.
 Humans are viewed as integral with the universe.
 The unitary human being and the environment are one, not
dichotomous
 Nursing focus on people and the manifestations that emerge from the
mutual human /environmental field process
 Change of pattern and organization of the human field and the
environmental field is propagated by waves
 The manifestations of the field patterning that emerge are observable
events
 The identification of the pattern provide knowledge and understanding
of human experience
 Basic characteristics which describes the life process of human:
energy field, openness, pattern, and pan dimensionality
 Basic concepts include unitary human being, environment, and
homeodynamic principles
Concepts of Rogers model
Energy field
 The energy field is the fundamental unit of both the living and nonliving
 This energy field "provide a way to perceive people and environment
as irreducible wholes"
 The energy fields continuously varies in intensity, density, and extent.
Openness
 The human field and the environmental field are constantly exchanging  Two dimensions Independent science of nursing
their energy
 There are no boundaries or barrier that inhibit energy flow between
fields
Pattern
 Pattern is defined as the distinguishing characteristic of an energy field
perceived as a single waves
 "pattern is an abstraction and it gives identity to the field"
Pan dimensionality
 Pan dimensionality is defined as "non linear domain without spatial or
temporal attributes"
 The parameters that human use in language to describe events are
arbitrary.
 The present is relative, there is no temporal ordering of lives.
Homeodynamic principles
 The principles of homeodynamic postulates the way of perceiving
unitary human beings
 The fundamental unit of the living system is an energy field
 Three principle of homeodynamics
o Resonancy
o Helicy
o integrality
Resonance
 Resonance is an ordered arrangement of rhythm characterizing both
human field and environmental field that undergoes continuous
dynamic metamorphosis in the human environmental process
 Helicy describes the unpredictable, but continuous, nonlinear
of energy fields as evidenced by non repeating rhythmicties
 The principle of Helicy postulates an ordering of the humans
evolutionary emergence
Integrality
 The mutual, continuous relationship of the human energy field
environmental field .
 Changes occur by by the continuous repatterning of the huma
environmental fields by resonance waves
 The fields are one and integrated but unique to each other
Nursing Paradigms
Unitary Human Being (person)
 A unitary human being is an "irreducible, indivisible, pan dimen
(four-dimensional) energy field identified by pattern and manife
characteristics that are specific to the whole and which cannot
predicted from knowledge of the parts" and "a unified whole ha
own distinctive characteristics which cannot be perceived by lo
at, describing, or summarizing the parts"
Environment
 The environment is an "irreducible, pan dimensional energy fie
identified by pattern and integral with the human field"
 The field coexist and are integral.
 Manifestation emerge from this field and are perceived.
Health
 "an expression of the life process; they are the "characteristics
behavior emerging out of the mutual, simultaneous interaction
human and environmental fields"
 Health and illness are the part of the sane continuum.
 The multiple events taking place along life's axis denote the ex
which man is achieving his maximum health potential and very
expressions from greatest health to those conditions which are
incompatible with the maintaining life process
Nursing
1. An organized body of knowledge which is specific to
is arrived at by scientific research and logical analys
2. Art of nursing practice:
 The creative use of science for the betterm
the human
 The creative use of its knowledge is the ar
practice
 Nursing exists to serve people.
 It is the direct and overriding responsibility to the society
 The safe practice of nursing depends on the nature and amou
scientific nursing knowledge the individual brings to practice…
imaginative, intellectual judgment with which such knowledge
in service to the man kind.
Rogerian theories-Grand theories
 The theory of paranormal phenomena
 The theory of rhythmicities
 The theory of accelerating evolution
Theory of paranormal phenomena
 This theory explains precognition, déjàvu, clairvoyance, telepa
therapeutic touch
 Clairvoyance is rational in a four dimensional human field in
continuous mutual, simultaneous interaction with a four dimen
world; there is no linear time nor any separation of human and
environmental fields
The theory of accelerating evolution
 Theory postulates that evolutionary change is speeding up an
 range of diversity of life process is widening. process. • The energy flows freely between the individual
 Higher wave frequencies are associated with accelerating human and environment. • Human being possesses the ability to
development think, imagine, sense, feel, and can use language for
Theory of Rhythmicity expression. • Human beings have the ability to adapt
 Focus on the human field rhythms (these rhythms are different from according to the new changes in the environment.
the biological, psychological rhythm) 7. 7. Major Concepts:
 Theory deals with the manifestations of the whole unitary man as 8. 8. Concepts: • All the human beings are viewed as an
changes in human sleep wake patterns, indices of human field motion, integral part of universe. • Human beings and the
perception of time passing, and other rhythmic development environment have energy field, nursing action is directed
Theories derived from the science of unitary human beings towards patterning and maintaining these energy fields.
 The perspective rhythm model (Patrick 1983) Energy fields Pandime nsioal Openness Patter n
 Theory of health as expanding consciousness (Neuman, 1986) 9. 9. Energy fields: • it is the inevitable part of life. Human and
 Theory of creativity, actualization and empathy (Alligood 1991) environment both have energy field which is open i.e.
 Theory of self transcendence (Reed1997) energy can freely flow between human and environment.
10. 10. Openness: • there is no boundary or barrier that can
 Power as knowing participation in change (Barrett 1998)
inhibit the flow of energy between human and environment
which leads to the continuous movement or matter of
energy.
NURSING THEORY Martha Rogers - The Science of Unitary Human
11. 11. Pattern: • is the distinguishing character of the energy
Beings
field.
1. 1. NURSING THEORY MARTHA ROGERS - THE
12. 12. Pandimensioal: • Undeviating field which is not
SCIENCE OF UNITARY HUMAN BEINGS AJESH KUMAR
constricted by space or time, it is an infinite domain without
ASSISTANT PROFESSOR M.M COLLEGE OF NURSING
boundary.
M.M UNIVERSITY, MULLANA PICTURE COURTESY
13. 13. Principle of Homeodynamics
http://images.google.com
14. 14. Principle of Homeodynamics: • Homeodynamics refers
2. 2. Introduction: • Martha Roger’s theory Science of Unitary
to the balance between the dynamic life process and
Human Beings is mainly focusing on the four concepts and
environment. • These principles help to view human as
three principles of homeodynamic that are energy fields,
unitary human being. The three separate principles are
openness, pattern, pandimensioal, integrality, resonancy,
integrality, resonancy, and heliecy.
and helicy respectively.
15. 15. Principles of integrality: • Energy fields are dynamic and
3. 3. Biography: • She was born in Dallas, Texas May 12,
constantly interact with the human and environment, which
1914; sharing her birthday with Florence Nightingale. • Her
affects our environment and vice versa. • This is the
family moved to Knoxville, Tennessee before she turned
principle on which meditation and humor works to produce
one. • As a young child she was very inquisitive to gain
a positive environment.
more and more knowledge, she had passion of reading
16. 16. Principles of resonancy: • is an ordered arrangement of
books • In 1936 She attended nursing diploma programme
rhythm characterizing both human field and environmental
at Knoxville General Hospital • She continued her
field • Constant change in the way or pattern of the energy
schooling at George Peabody College and completed
field from a lower to higher frequency. • This movement of
Bachelors of Science in Public Health Nursing in 1937. •
energy can be made by human touch, guided imagery
She worked as a Public Health Nurse for two years after
activities, drawing, storytelling and other active use of
obtaining degree in Public Health Nursing.
imagination.
4. 4. Biography: • After completeing her Masters in Public
17. 17. Principles of heliecy: • Any minute change in the
Health Nursing from Teachers College Columbia University
environment which leads to ripple effect i.e. results in a
in 1946, she started working as a public health nurse. • She
larger changes in other field. • This change is constant,
worked as director of Visiting Nurses Association in
unpredictable and there are many factors which mutually
Phoenix, Arizona. • In 1951 she joined Johns Hopkins
interact and cause the change.
University, Baltimore and completed Doctor of Science in
18. 18. Metaparadigm in Nursing Person Environment Health
1954 while she was working at Catholic University. • After
Nursing
completing her Doctor of Science she served as the Head
19. 19. Person: • a unitary human being is open systems which
of the Division of nursing at New York University • In 1963
continuously interact with environment. A person cannot be
she edited the second journal in Nursing i.e. Nursing
viewed as parts, it should be considered as a whole.
Science
20. 20. Environment: • it includes the entire energy field other
5. 5. Biography: • An Introduction to the Theoretical Basis of
than a person. • These energy fields are irreducible, not
Nursing was the most famous work of Rogers which was
limited by space and time, identified by its pattern and
published in 1970. • In 1975 she retired as Head of the
organization
Division of nursing from New York University • She joined
21. 21. Health: • Not clearly defined by Roger. It is determined
Emeritus University in 1979 as a Professor and continued
by the interaction between energy fields i.e. human and
to work on The Science of Unitary Human Beings till the
environment. • Bad interaction or misplacing of the energy
time of her demise in March 13, 1994.
leads to illness.
6. 6. Assumptions: • Human being is considered as whole
22. 22. Nursing: • Is both science and art. • It constantly
which cannot be viewed as subparts. • The life process of
maintains the energy field which is conducive for patient. •
human is irreparable and one way i.e. from birth to death. •
Health and illness are the continuous expression of the life
 Nursing action directs the interaction of person and
environment to maximize health potential.
23. 23. Application of SUBH: PRACTICE EDUCATION
RESEARCH Monday, April 20, 2015 23
24. 24. Clinical Practice: • Nursing action is always focused on
unitary human being and change the energy field between
human and environment. • Nursing interventions include all
the noninvasive actions such as guided imaginary, humor,
therapeutic touch, music etc. which are used to increase
the potential of human being.
25. 25. Clinical practice cont… • The more importance should
be on the management of pain, supportive psychotherapy
and rehabilitation of the human being.
26. 26. Clinical practice cont… Nursing Assessment &
Diagnosis Interventions and Rehabilitation Prevention of
Illness Maintennace of Health Promotion of Health
27. 27. Nursing Education: • Emphasis should be given on the
understanding of the patient and self, energy field and
environment. • Training should lay more focus on teaching
non- invasive modalities such as therapeutic touch,
meditation, humor, regular in-service education programme
etc.
28. 28. Nursing Research: • Rogerian theory has been used in
many research works and has always been found testable
and applicable in research.
29. 29. Nursing process according to SUBH: Monday, April 20,
2015 29 Pattern appraisal Mutual patterning Evaluation
30. 30. Pattern appraisal: • It is an inclusive assessment of
human and environment energy fields, its organization of
energy field, and identification of areas of dissonance. •
Nurses validate the entire appraisal along with the client.
31. 31. Mutual patterning: • It is the proper patterning of the
energy fields between the human and environment. • It is
the mutual interaction between the client and nurse •
Patterning can be done by suggesting the various
alternatives, educating, empowering, encouraging etc.
depending on the client’s condition and needs.
32. 32. Mutual patterning cont.. • Pattern appraisal include
appraisal of nutrition, rest and sleep, exercises, discomfort,
and relation with others. • The pattering activities can be
therapeutic touch, meditation, humor, imaginery etc.
33. 33. Evaluation: • Evaluation is done by repeating the
pattern appraisal after the mutual patterning to determine
the extents of dissonance and harmony. •
34. 34. Clinical scenario: • Mr. X is a 54 years old male
admitted in the Male Psychiatric ward with the diagnosis of
major depression secondary to the diagnosis of Myocardial
Infraction (MI). • He was very tense and sobbing during the
history collection. • He was accompanied by his wife and
son. Even though his wife was anxious but still she was
supportive and helpful. • Mr. X was diagnosed with MI four
months back and underwent the angioplasty three months
ago. • Currently he is on Statins and Antihypertensives.
35. 35. Clinical scenario: • He started to show the sings and
symptoms of depression from the past one month. • He
used to sit alone, diminished the activities of daily living,
regular crying spells, decreased chat, self muttering,
insomnia, anorexia, body aches, least bothered about
personal hygiene, two days before he attempted suicide by
hanging on ceiling fan. • His present findings based on the
assessment shows that he is very tearful, socially
withdrawn, nutritional status is impaired, crying spells, sad
mood, and risk for committing suicide.
36. 36. Assessment(PatternAppraisal) • Mr. X is experiencing
the pattern of dissonance. i.e. depression with suicidal
ideation, MI, pain, fear , sleep pattern disturbances,
impaired nutritional status, tendencies to commit suicide
and appraisal is essential for all of these symptoms.
MutualPatterning: • It is the mutual interaction between Mr.
X and nurse for changing the pattern and making his all
emerging pattern as unitary pattern. • Therapeutic touches,
meditation, guided imagery, are the pattering activities
planned for Mr. X. • Therapeutic touch is implemented
which will cure the pain, promote the speedy recovery and
building trust on nurse. • Social withdrawn can be managed
by using humor, participating in small group activities and
this will help him to develop self confidence. • Advices are
given for changing the dietary pattern and improving the
personal hygiene. • Involvement of family for the
environment pattering. Evaluation • Repeating the pattern
appraisal after the mutual patterning to determine the
extents of dissonance and harmony. • Current symptoms
experiencing by Mr. X is shared with him and if changes is
needed in the mutual patterning that can be incorporated or
implement the same.
37. 37. Critique of the SUBH:
38. 38. Simplicity: • although the concepts seems to quite
difficult to understand. • It’s a parsimonious theory. •
Parsimony refers to theory based on simple assumption
but proves to be very valuable.
39. 39. Clarity: • overall Rogerian SUBH is considered as
complex but still efforts are going on to clarify the complex
concepts.
40. 40. Generality: • The uses on non- invasive modalities are
very useful and important to nursing even today. • SUBH is
the foundation of many theories and it can be apply in a
variety of setting and all spheres of life.
41. 41. Empirical precision: • Rogerian theory has been used in
many research works and has been found testable and
applicable in research. • But, many limitations have also
been identified by the researchers such as difficult to
understand the concepts, lack of operational definitions
and instruments for the proper evaluation of the
instruments.
42. 42. Conclusion: • SUBH leads to a new way of seeing the
person as a unitary human being and new style of nursing
practice. • This model is applicable in all the setting and
every spheres of life. • Rogers emphasized the need for
noninvasive nursing modalities in achieving the health
potential, it is very evident in today’s situation that there is
more focus on the alternative system of medicine and
noninvasive nursing actions are in getting much
importance.
43. 43. References • Margaret Ruddy; Model & Theories of
Nursing; Cardinal Stritch University Library; 2007; p. 34-35.
• Tomey, A.M. & Alligood,M.R.; Nursing Theorist & their
work; 5th edition; 2006; p. 226-249. • George B. Julia,
Nursing Theories, The base for Professional Nursing
Practice, 5th Edition 2002
44. 44. Thank you….