THEORIES OF NURSING

Florence Nightingale (1960/1969)

Often considered the first nurse

theorist
Defined nursing as the act of
utilizing the environment of the
patient to assist him in his
recovery.
Nightingales theory remains an
integral parts of nursing and
healthcare today.

5 Environmental Factors:

Pure or fresh air

Pure water
Efficient drainage
Cleanliness
Light, especially direct sunlight

Nightingales general concepts are:

1.Ventilation 4.Warmth
2.Cleanliness 5.Diet
3.Quiet

Dorothy E. Johnson (1980)

The Behavioral System Model for
Nursing
Focuses on how the client adapt to
illness; the goal of nursing is to reduce
stress so that the client can move
easily through recovery.
Viewed the patients behavior as a
system that is a whole with interacting
parts. The nursing process is viewed as
a major tool.
Purpose: To reduce stress so the client
can recover as quickly as possible.

View of components
Person: A system of interdependent parts with
patterned, repetitive, and purposeful ways of
behaving.
Environment: All forces that affect the person
and that influence the behavioral system.
Health: Focus on person, not illness. Health is a
dynamic state influenced by biologic,
psychological, and social factors.
Nursing: Promotion of behavioral system,
balance, and stability. An art and science
providing external assistance before and
during system balance disturbances.

Myra Estrin Levin(1973)

Conservation Model
Described the Four Conservation
Principles. She advocated that
nursing is a human interaction and
proposed four conservation
principles of nursing which are
concerned with the unity and
integrity of the individual. The four
principles are as follows:

1. Conservation of Energy The

human
body functions by utilizing energy.
The human body needs energy
producing input (food, oxygen,
fluids) to allow energy utilization as
output.
2. Conservation of Structural Integritythe human body has physical
boundaries (skin, and mucous
membranes) that must be
maintained to facilitate health and
prevent harmful agents from

3.Conservation of Personal Integrity- the nursing

interventions are based on the conservation
of the individuals personality. Every individual
has a sense of identity, self-worth and selfesteem, which must be preserved and
enhanced by the nurses.
4.Conservation of Social Integrity- the social
integrity of the clients reflects the family and
the community in which the clients functions.
Health care institutions may separate
individuals form their family. It is important
for nurses to consider the individual in the
context of a family.

Imogene King (1971)

Goal Attainment Theory
Highlights the importance of the
participation of all the individuals in
decision making & deals with the
choices, alternatives, & outcomes of
nursing care
This theory offers insights into
nurses interactions with individuals
& groups within the environment

Defines Health as a dynamic state in

the life cycle; illness is an interference
in the life cycle. Health implies a
continuous adaptation to stress
Described nursing as a helping
profession that assists individuals and
groups in society to attain, maintain and
restore health. If this is not possible,
nurses help individuals to die with
dignity.

Viewed nursing as an interaction

between the client and the nurse
whereby perceiving, setting goals
and acting on them, transaction
occurs and goals are achieved.

Social Systems (Society)

Interpersonal System
(Groups)
Personal
Systems
(Individuals)

Imogene King
A conceptual framework
for nursing:Dynamic
interacting systems.
Nursing process is
defined as dynamic
interpersonal process
between nurse, client
and health care
system.

Faye Glenn Abdellah (1960)

Patient-Centered Approaches to Nursing
Purpose: To deliver nursing care for the whole
individual.
Abdellah described nursing as a service to
people, families and society. The nurse helps
people, sick or well, to cope with their health
needs. In Abdellahs model, nursing care
means providing information to the client or
doing something to the client with the goal of
meeting needs or alleviating an impairment.

View of components
Person: The recipient of nursing care
having physical, emotional, and
sociologic
needs that may be overt or covert.
Environment: Not clearly defined. Some
discussion indicates that client interact
with their environment, of which the
nurse is a part.
Health: Implicitly defined as a state
when the individual has no unmet
needs and

1.
2.
3.
4.
5.
6.
7.

no anticipated or actual impairments.

Nursing: Broadly grouped in 21 nursing
problems.
To maintain good hygiene.
To promote optimal activity: exercise, rest, and
sleep.
To promote safety.
To maintain good body mechanics.
To facilitate the maintenance of supply of
oxygen.
To facilitate maintenance of nutrition.
To facilitate maintenance of elimination.

8. To facilitate the maintenance of fluid and

electrolytes balance.
9. To recognize the physiologic response of the
body to disease conditions.
10. To facilitate the maintenance of regulatory
mechanisms and functions.
11. To facilitate the maintenance of sensory
function.
12. To identify and accept positive and negative
expressions, feelings and reactions.
13. To identify and accept the interrelatedness of
emotions and illness.
14. To facilitate the maintenance of effective
verbal and non-verbal communication.

15. To promote the development of productive

interpersonal relationship.
16. To facilitate progress toward achievement of
personal spiritual goals.
17. To create and maintain a therapeutic
environment.
18. To facilitate awareness of self as an individual
with varying needs.
19. To accept the optimum possible goals.
20. To use community resources as an aid in
resolving problems arising from illness.
21. To understand the role of social problems as
influencing factors.

Betty Neuman (1972)

Health Care Systems Model
Views client as an open system
consisting of a basic structure or
central core of energy resources
(physiologic, psychologic,
sociocultural, developmental, &
spiritual) surrounded by lines of
resistance that defends client
against stressors

She asserted that nursing is a

unique profession in that it is concerned
with all the variables affecting an
individuals response to stresses which
are intra (within), inter (between one or
more people) and extra-personal
( outside the individual) in nature.
The concern of nursing is to
prevent stress invasion, to protect the
clients

basic structure and obtain or

maintain maximum level of
wellness.
The nurse helps the client,
through primary, secondary, and
tertiary prevention modes, to adjust
to environmental stressors and
maintain client system stability.

Sister Callista Roy (1979)

Adaptation Model
Focuses on the individual as a
biopsychosocial adaptive system.
Both the individual & the
environment are sources of stimuli
that require modification to promote
adaptation, an on-going purposive
response
The individual receives inputs or
stimuli from both the self & the
environment

She contended that the person is an

adaptive system, function as a
whole through interdependence of
its parts.
The system consist of input, control
process, output and feedback.
In addition, she advocated that all
people have certain needs which
they endeavor to meet in order to
maintain integrity

These needs are divided into four

different modes, the physiological,
self concept, role function, and
interdependence.
Accordingly Roy believed that
adaptive human behavior is directed
toward an attempt to maintain
homeostasis or integrity of the
individual by conserving energy and
promoting the survival, growth,
reproduction and mastery of the
human system.

Ida Jean Orlando (1961)

The Dynamic Nurse-Patient
Relationship
Three elements Client behavior,
nurse reaction and nurse actions
compose the nursing situation.
Purpose: To interact with clients to
meet immediate needs by
identifying client
behaviors, nurses reactions, and
nursing actions to take.

Views of Components
Person: Unique individual behaving
verbally and nonverbally.
Assumption is that
individuals are at times able to meet
their own needs and at other times
unable to do so.
Health: Not defined. Assumption is
that being without emotional or
physical
discomfort and having a sense of
well-being contribute to a healthy
state.

Nursing: Professional nursing is

conceptualized as finding out and
meeting the clients immediate need
for help. Medicine and nursing are
viewed as distinctly different.
The concept of need is central to
Orlandos theory, which focuses on
clients and their unmet needs.
Orlando believed that the purpose of
nursing is to provide the assistance
that a client requires to meet his or
her needs.

Virginia Henderson (1955)

Definition of Nursing

Nursing as a discipline separate from medicine.

Described nursing in relation to the client and the
clients environment
Concerned with both healthy and ill individuals
even when recovery may not be feasible
Teaching and advocacy roles of the nurse
The unique function of the nurse is to assist the
individual sick or well to perform his/her activities
contributing to health, its recovery, or to a peaceful
death, the client would perform, if he had the
necessary strength, will and knowledge.

The 14 Fundamental Needs

Breathing normally
Eating and drinking adequately
Eliminating body waste
Moving and maintaining a desirable
position
Sleeping and resting
Selecting suitable clothes
Maintaining body temperature
within normal range by adjusting
clothing and modifying the
environment

Keeping the body clean and well groomed to

protect the integument.
Avoiding dangers in the environment and
avoiding injuring others.
Communicating with others in expressing
emotions, needs, fears, or opinions
Worshipping according to ones faith
Working in a such way that one feels a sense
of accomplishment
Playing or participating in various forms of
recreation
Learning, discovering, or satisfying the
curiosity that leads to normal development
and health, and using available health facilities

Hildegard Peplau (1952)

Interpersonal Relations Model
The use of a therapeutic relationship between the
nurse and the client.
Nursing as a therapeutic, interpersonal process which
strives to develop a nurse-patient relationship in which
the nurse serves as a resource person, counselor and
surrogate.
The nurse-client relationship evolves four phases:
Orientation
The client seeks help
The nurse assist the client to understand the problem
and the extent of the need for help.

Identification

The client assumes a posture of dependence,

interdependence, or independence in relation to the
nurse.

The nurses focus is to assure the person that the

nurse understands the interpersonal meaning of the
clients situation.
Exploitation

The client derives full value from what the nurse

offers through the relationship.

The client uses available services based on selfinterest and needs.

Power shifts from the nurse to the client.

Resolution

Old needs and goals are put aside and new ones
adopted. Once older needs are resolved, newer and
more mature ones emerge.

Nurses Roles:
Stranger
Teacher
Resource Person
Surrogate
Leader
Counselor

Martha Rogers (1970)

Science of Unitary Human Beings
Views person as an irreducible whole, the
whole being greater than the sum of its parts.
Whole is differentiated from holistic.
States that the humans are dynamic energy
fields in continuous exchange with
environmental fields, both of which are infinite.

Both human and environmental fields are

characterized by pattern, a universe of open
systems, and four dimensionality.

Considers man as a unitary human being coexisting within the universe, views nursing
primarily as a science and is committed to
nursing research.

What is an unitary man? Unitary

man :

Is an irreducible, four-dimensional energy

field identified by pattern
Manifests characteristics different from
the sum of parts
Interacts continuously and creatively with
the environment
Behaves as a totality
As a sentient being, participates
creatively in change.

Nurses applying Rogers theory in

practice:
focus on the persons wholeness
seek to promote symphonic
interaction between the two energy
fields to strengthen the coherence
and integrity of the person
coordinate the human field with the
rhythmicities of the environment
field
direct and redirect patterns of
interaction between the two energy
fields to promote maximum health
potential.

Non-therapeutic touch:
based on human energy fields
affected by pain and illness
can assess and feel the energy field
and manipulate it to enhance the
healing process of people who are ill
or injured.

Dorothea Orem (1971)

General Theory of Nursing
Emphasizes the clients self-care
needs, nursing care becomes
necessary when client is unable to
fulfill biological, psychological,
developmental or social needs.
Three related concepts
Self-care
Self-care deficit
Nursing systems

Self-care theory is based on four

concepts:

Self-care activities an individual

performs independently to promote
and maintain personal well-being.

Self-care agency individuals

ability to perform self-care
activities. Consists of two agents

A self care agent an individual who

performs self-care independently
A dependent care agent a person
other than the individual who provides
the care

Self care requisites (self-care needs)

actions or measures taken to provide care.
There are three categories:

Universal requisites includes: Intake and

elimination of air, water and food; balancing
rest, solitude, and social interaction;
preventing hazards to life and well-being; and
promoting normal human functioning.
Developmental requisites results from
maturation or are associated with conditions
and events.
Health deviation requisites result from
illness, injury or disease or its treatment. (eg.
Seeking health care assistance, carrying out
prescribed therapies, and learning to live with
the effects of illness or treatment)

Therapeutic self- care demand all self-care

activities required to meet existing self-care
requisites. ( Actions to maintain health and
well-being Self-care deficit results when selfcare agency is not adequate to meet the
known self-care demand.)
5 Methods in helping:
a. Acting or doing for
b. Guiding
c. Teaching
d. Supporting
e. Providing an environment that promotes
abilities to meet current demands

3 Types of Nursing Systems:

Wholly compensatory systems are required for
individuals who are unable to control and
monitor their environment and process
information.
Partly compensatory systems are designed for
individuals who are unable to perform some,
but not all, self-care activities
Supportive-educative (developmental) systems
are designed for persons who need to learn to
perform self-care measures and need
assistance to do so.

Basic Conditioning Factors for Self-care

Agency and Therapeutic Self Care
Demand:
Age
Gender
Developmental state
Sociocultural orientation
Health State
Family system factors
Health care system factors
Patterns of living
Environmental factors
Resource availability and adequacy

Basic Conditioning Factors for

Nursing Agency
Age
Gender, race
Physical and constitutional
characteristics
Health state
Family/Community roles
Nursing educational preparation
Nursing experience
Maturity/Status as a person

R
Contributin
g
Self-care
Factors agency

Self-care

R
<

Self-care
demands

Deficit
R
Contributin
g
Factors

Nursing
Agency

Contributin
g
Factors

Jean Watson (1979)

Human Caring Theory

Believes the practice of caring is central

to nursing: it is the unifying focus for
practice
Carative factors nursing intervention
related to human care.
Redefining nursing as a caring-healing
health model

10 Factors
Forming a humanistic-altruistic system of values
Instilling faith and hope
Cultivating sensitivity to ones self and others
Developing a helping-trust (human care) relationship
Promoting and accepting the expression of positive
and negative feelings
Systematically using the scientific problem-solving
method for decision making.
Promoting interpersonal teaching-learning
Providing a supportive, protective, or corrective
mental, physical, socio-cultural, and spiritual
environment
Assisting with the gratification of human needs
Allowing for existential-phenomenologic forces

Watsons Assumptions of Caring

Human caring is not just an emotion, concern,

attitude or benevolent desire. Caring connotes a
personal response.
Caring is an intersubjective human process and is
the moral ideal of nursing.
Caring can be effectively demonstrated only
interpersonally.
Effective caring promotes health and individual or
family growth.
Caring promotes health more than does curing.
Caring responses accept a person not only as they
are now, but also for what the person may become.
A caring environment offers the development of
potential while allowing the person to choose the
best action for the self at a given point in time.

Caring occasions involve action and choice by nurse

and client. If the caring occasion is transpersonal,
the limits of openness expand, as do human
capacities.
The most abstract characteristic of a caring person
is that the person is somehow responsive to
another person as a unique individual, perceives
the others feelings, and sets one person apart from
another.
Human caring involves values, a will and a
commitment to care, knowledge, caring actions,
and consequences.
The ideal and value of caring is a starting point, a
stance, and an attitude that has to become a will,
an intention, a commitment, and a conscious
judgment that manifests itself in concrete acts.