Nursing Theories

1) FLORENCE NIGHTINGALE:
ENVIRONMENTAL NURSING
THEORY
• Often considered the first nurse
theorist

• Defined nursing as “the act of

utilizing the environment of the
patient to assist him in his
recovery”.

• Nightingale’s theory remains an

integral part of nursing and
healthcare today.
1) FLORENCE NIGHTINGALE:
ENVIRONMENTAL NURSING
THEORY
• 5 Factors for a Healtthy
Environment:

– Pure or fresh air

– Pure water
– Efficient drainage
– Cleanliness
– Light, especially direct
sunlight
1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING THEORY

Nightingale’s general
concepts of Environmental
Sanitation includes:

 Proper Ventilation
Adequate Lighting
Cleanliness
Adequate Warmth
Quiet
Diet
1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING THEORY

Application:
A. Nursing Practice
The principles of Nursing Practice by FN are
continuously used to this very day. With the advent of
technology and with it globalization, comes threats
from the environment.
> Global Warming
> Industrial Noise
> Air Pollution
> Fad Diets
> Vanity
Nurses of today still needs to:
 Maintain Adequate Ventilation
 Promote Adequate & Appropriate Nutrition
 Maintain Normal Homeostatic Body
Temperature
 Observe Basic Hygiene
 Comfort Measures including Environmental
Sanitation
1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING THEORY

B. Nursing Education
St. Thomas & King’s College Hospital in London
- able to provide framework for the
establishment of Nursing Training Schools through
a Universal template that contains principles of
nursing training. It included instruction in Scientific
Principles & Practical Experience for the mastery of
skills
- FN advocated the separation of nursing
training from hospital to more appropriate learning
environment in the School or University setting. This
was advocated for FN believed the SN’s role is to
learn the Art & Science of Nursing before being
employed in the Nursing Service.
- FN is also a strong proponent of practice
nursing in education. She believed that Good
Nursing only come from Good Education
2) VIRGINIA HENDERSON:
FOURTEEN FUNDAMENTAL
NEEDS

Assisting sick or
healthy individuals to
gain independence in
meeting 14
fundamental needs

• Patient-centered
 2) VIRGINIA HENDERSON:
FOURTEEN FUNDAMENTAL NEEDS
• Virginia Henderson’s 14 Fundamental Needs of a
Person

1) Breathing normally
2) Eating and drinking adequately
3) Eliminating body waste
4) Moving and maintaining a desirable position
5) Sleeping and resting
6) Selecting suitable clothes
7) Maintaining body temperature within normal
range by adjusting clothing and modifying the
environment
 2) VIRGINIA HENDERSON:
FOURTEEN FUNDAMENTAL NEEDS
8) Keeping the body clean and well groomed
to protect the integument
9) Avoiding dangers in the environment and
avoiding injuring others
10) Communicating with others in expressing
emotions, needs, fears, or opinions
11) Worshipping according to one’s faith
12) Working in a such way that one feels a
sense of accomplishment
13) Playing or participating in various forms of
recreation
14) Learning, discovering, or satisfying the
curiosity that leads to normal development
and health, and using available health
facilities
 2) VIRGINIA HENDERSON:
FOURTEEN FUNDAMENTAL NEEDS

Application:

Bedside Nursing
- pt.’s
ability to perform the 14 basic
needs should be assessed before
considering the kind of nursing care function
you will administer. Essential to determine if
the N will be performing as a HELPER,
DOER or a PARTNER
Nsg interventions are implemented
according to the 14 basic human needs of
the patient. The degree of performance,
involvement of the pt. and the level of
nursing activity will be dependent on the
specific role the nurse will be playing
 3) FAYE ABDELLA:
PROBLEM SOLVING APPROACH
TO
21 NURSING PROBLEMS
• Focus is on PROPER
IDENTIFICATION of
the problem

• Particularly about the

proper NURSING
DIAGNOSIS

• Nurse-centered
 3) FAYE ABDELLA:
PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS

21 Nursing Problems
1.To maintain good hygiene.
2.To promote optimal activity:
exercise, rest, and sleep.
3.To promote safety.
4.To maintain good body
mechanics.
5.To facilitate the maintenance of
supply of oxygen.
6.To facilitate maintenance of
nutrition.
7.To facilitate maintenance of
elimination.
 3) FAYE ABDELLA:
PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS

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.
.
 3) FAYE ABDELLA:
PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS

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.
 3) FAYE ABDELLA:
PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS

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.
 3) FAYE ABDELLA:
PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS

Application:
• Bedside Nursing
The N’s ability to address &
effectively manage the 21 Nursing
problems will spell the patient’s
state of health – whether he fully
recovers well & fast, or deteriorate
further with devastating
consequences
Ns therefore, have very
important role to play. By adhering
to these nursing problems, the
work of a N becomes More Definite
4) MADELEINE LEININGER:
TRANSCULTURAL NURSING
THEORY
• Nursing is a HUMANISTIC and
SCIENTIFIC mode of helping
through CULTURE-SPECIFIC
PROCESS
• Emphasizes human caring
varies among cultures
• Culture Care Preservation and
Maintenance
• Culture Care Accommodation
and Negotiation
• Culture Care Restructuring and
Repatterning
 4) MADELEINE LEININGER:
TRANSCULTURAL NURSING THEORY

Application:
Important esp because of the rapid
expansion of knowledge & increasing
globalization with the advent of advances in
ICT.

Working Overseas
Impt to learn the cultures of other
people because each culture has its own sets
of patterns, expressions & values of caring.
Getting acquainted with the culture of
a country you are seeking employment as a
professional nurse will be a good stepping
stone towards a more fulfilling career in
nursing.
 5) MARTHA ROGERS
SCIENCE of UNITARY HUMAN BEING
Views the person as a irreducible
whole, the whole being greater
than the sum of its parts
– Man is composed of energy fields,
which are in constant interaction
with the environment
– Seek to promote harmonic
interactions between the two
energy fields (Human and
Environmental)
 5) MARTHA ROGERS
SCIENCE of UNITARY HUMAN BEING

Application
Her theory is relevant in
today’s nurses focusing
on the Totality of the
Person. Nurses should
strive to promote
symphonic interaction
between the 2 energy
fields in order to
strengthen the coherence
& integrity of the person.
 6) IMOGENE KING
GOAL ATTAINMENT THEORY
Patient has THREE (3) interacting
systems

– Individuals / Personal systems

How the nurse views and integrates self based
from personal goals and beliefs.
– Group systems / Interpersonal
systems
How the N interrelates w/ a co-workers or pt.
particularly in N-Pt. relationship
– Social systems
how the N interacts w/ co-workers, superiors,
subordinates & the ct. environment in general
 6) IMOGENE KING
GOAL ATTAINMENT THEORY
Action
A means of behavior or activities that are
towards the accomplishment of certain act. It is both
PHYSICAL & MENTAL.
Mental (POA)

Action (Goal Setting w/ Ct.)

Perform Achieve Goal

Reaction
A form of reacting or response to a certain
Stimuli.

Interaction
Any situation wherein the N relates & deals
With a ct. or pt.

Transaction
 6) IMOGENE KING
GOAL ATTAINMENT THEORY

Application:
Provides enough direction to how
nurses should be able to behave or
act in the presence of pts. Since
majority of nursing activities involves
direct interaction w/ pts., Ns should
understand the basic implications of
the Action-Reaction-Interaction-
Transaction model of the N-Pt.
Relationship.
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL

Peplau is a psychiatric
nurse

– Focus: Therapeutic
process

– Attained through: Healthy

Nurse-Patient
Relationship
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL
• Four (4) Phases of Nurse-
Patient Interaction

1. Orientation
• Nurse and patient test the
role each one assumes
• Prepares patient for
termination
• Patient identifies areas of
difficulty
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL

2. Identification Phase
• Patient identifies with
the personnel who can
satisfy his needs

3. Exploitation Phase
• Nurse maximizes all the
resources to benefit the
patient
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL

4. Resolution Phase or
Termination Phase
• Occurs when patient’s
needs have been met
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL
Application
Significant in terms of the
different phases of the N-Pt.
interaction & the different ROLES the
N can play in giving nursing care to
pts. It thus becomes important for
nurses to understand the principles
behind each of these concepts so
that clinical nsg will be more
meaningful for the nurse. Eventually,
this will translate to pt. outcomes like:
Improved health
Prevention of Disease pr
Enhancement of care faculties
 8) JEAN WATSON:
HUMAN CARING MODEL
• Nursing involves the
application of ART and
HUMAN SCIENCE
through
TRANSPERSONAL
TRANSACTIONS in
order to help the person
achieve mind, body and
soul harmony
 8) JEAN WATSON:
HUMAN CARING MODEL
7 Assumptions on the Science of
Caring
1. Caring can be effectively demonstrated
& practiced only interpersonally
2. Effective caring promotes health and
individual or family growth
3. Caring responses accept a person not
only as he or she is now but as what he
or she may become
4. A caring envi. Is one that offers the
dev’t of potential while allowing the
person to choose the best action for
himself at a given point in time.
 8) JEAN WATSON:
HUMAN CARING MODEL
5. Caring is more “healthogenic”
than is curing. The practice of
caring integrates biophysical
knowledge w/ knowledge of
human behavior to generate or
promote hx & to provide care to
those who are ill. A science of
caring is therefore
complementary to the science of
curing
6. The practice of caring is central to
nursing
 8) JEAN WATSON:
HUMAN CARING MODEL
10 CARATIVE FACTORS
1. Formation of a Humanistic-Altruistic system
of values
2. Instillation of faith-Hope
3. Cultivation of sensitivity to one’s self & to
others
4. Development of a helping-trusting, human
caring relationship
5. Promotion and acceptance of the
expression of positive & negative feelings;
6. Systematic use of a creative problem-
solving caring process
 8) JEAN WATSON:
HUMAN CARING MODEL
10 CARATIVE FACTORS

7. Promotion of transpersonal teaching-learning

8. Provision for a supportive, protective and
corrective mental, physical, societal &
spiritual environment
9. Assistance with gratification of human needs
10. Allowance for existential-phenomenological-
spiritual forces
 8) JEAN WATSON:
HUMAN CARING MODEL
Application:
Her model of nursing reflects & embodies the
TRUE ESSENCE or nursing profession to this very
day. It viewed the pt. as the Mind-Body-Spirit entity
that needs holistic nursing care. It thus becomes a
must for all nurses to view each pt. in the light of
the caring theory of Watson.

One major implication of the theory is in the realm

of Bedside Nursing, where Ns of today have
particularly begun to neglect. The essence of
nursing is in the caring aspect & caring is taking the
wholeness, the totality of the pt. into consideration.
It is every Ns duty & obligation to care for his pt. not
by merely looking into and caring for his physical
dse.but try to care for the pt. for who he is.
 9) IDA JEAN ORLANDO:
NURSING PROCESS THEORY

The Nursing Process is an interaction of Three Basic Elements:

1. Patient’s Behavior
2. Nurse’s reaction
3. Nursing Actions – designed for the patient’s benefit

The Role of the Nurse is to find out & meet the Pt’s stat need for help. Ns should use his perception, thoughts about the perception or the feeling engendered from
their thoughts to explore with patients the meaning of their behavior
 9) IDA JEAN ORLANDO:
NURSING PROCESS THEORY

The use of the theory keeps the N’s focus on the patient

Application:
The Theory increases the Therapeutic Effectiveness of nurses by
the expression of Empathy, Warmth & Genuineness esp in the light of
addressing the Stat Need of the Patient for help. This framework will be
important for Ns who are assigned in special clinical areas that requires
quick decision making & critical thinking skills.
If the patient’s condition improved, then the intervention is effective
and the patient moves on to new problems
 10) JOYCE TRAVELBEE
INTERPERSONAL ASPECTS OF NURSING THEORY
Human to Human Relationship
 Greatly emphasized on the
Therapeutic Human Relationship
between the Nurse & the Patient.

 Her model emphasizes:

Empathy
Sympathy
Rapport & the
Emotional aspects of Nursing

4 Interlocking Phases that precedes

RAPPORT
And the establishment of N-Pt.
Relationship:
 Original Encounter
 Emerging Identities
 Empathy
 10) JOYCE TRAVELBEE
INTERPERSONAL ASPECTS OF NURSING THEORY
Human to Human Relationship

Application:
The theory describes the
various stages of interpersonal elations
that occur bet a Patient and a N. It thus
becomes important for Ns to fully
understand the phases and its effects
to the patient’s welfare. Due
consideration should be given to the
pt’s inherent personal characteristics
to interact w/ other people, most
especially Ns & other members of the
healthcare professions.
The key concept of Empthy,
Sympathy, Rapport & Emotional
Understanding are very important for
the Ns of today because it makes the
 11) NOLA PENDER:
HEALTH PROMOTION MODEL

• Focuses on 10 Categories of
determinants of health-
Promoting Behaviors.

• Views a person’s health-

promoting behavior in the
light of his individual
characteristics & experiences
 11) NOLA PENDER:
HEALTH PROMOTION MODEL
• The 10 Determinants are:
– Prior related behavior
– Perceived benefits of action
– Perceived barriers of action
– Perceived self-efficacy
– Activity related effect
– Interpersonal Influences (family, friends,
providers) norms, support & models
– Situational Influences ( options, demand
characteristics, aesthetics)
– Immediate competing demands (low
control) and preferences (high demand)
– Commitment to a plan of action
– Personal Factors ( Biological,
Psychological, Sociocultural)
 11) NOLA PENDER:
HEALTH PROMOTION MODEL
Application:

Health Promotion Activities are the

major Focus of Hx Care Organizations.
In order for Patients to take on the
Behaviour we, Hx care professionals,
advise them to take, we should carefully
looked into a host of factors that can
influence his decision to really adopt the
behaviour.
It is important for Ns to be ROLE MODELS
for the pts.
 12) BETTY NEUMAN:
HEALTH CARE SYSTEMS
MODEL
• The model is based on
the Person’s
Relationship to Stress,
his Reaction to it and
Reconstitution factors
that are dynamic in
nature

• The concern of nursing is to

PREVENT STRESS INVASION
 12) BETTY NEUMAN:
HEALTH CARE SYSTEMS
MODEL
• Person is viewed as an Open
System composed of Basic
Structure of Energy Resources
which includes:
• Physiologic
• Psychologic
• Sociocultural
• Developmental
• Spiritual
 12) BETTY NEUMAN:
HEALTH CARE SYSTEMS
MODEL
Basic Structure/Central Core
- surrounded by 2 concentric
boundaries or Rings called
Lines Of Resistance which
represents the internal factors
that AID the person Defend
against a Stressor.

Lines of Resistance – further

surrounded by 2 lines of
Defense
1. Normal Line of Defense
2. Flexible Line of Defense
 12) BETTY NEUMAN:
HEALTH CARE SYSTEMS
MODEL
1. Normal Line of Defense
- person’s state of equilibrium
or the state of adaptation developed
& maintained over time and which is
considered normal for the person

2. Flexible Line of Defense

- dynamic and can be readily and
rapidly changed over a short period
of time.
- adjusts to situations that threatens the imbalance
w/in the client’s stability

Stressors:
Intrapersonal
Interpersonal
Extrapersonal
 12) BETTY NEUMAN:
HEALTH CARE SYSTEMS
FOCUS MODEL
of Nursing Interventions :
- keeping or maintaining the stability of the open
system which can be carried out on three levels of
prevention
APPLICATION
Very comprehensive model of nsg that outlines the
way how Ns provide HOLISTIC NURSING CARE to
pts. Emphasis is on the management of Stress thru
adequate understanding of the complex client system.
Strong Advocate of Prevention Interventions which is
congruent to the aims of modern-day nsg & Hxcare
services. It is a MUST that Ns perform thorough &
comprehensive assessment that includes ALL
aspects of the Ct.
13) SISTER CALISTA ROY:
ADAPTATION MODEL

• Man is a BIOPSYCHOSOCIAL
BEING

• Four (4) modes of Adaptation

– Physiologic Mode
– Self Concept
– Role Function
– Interdependence
13) SISTER CALISTA ROY:
ADAPTATION MODEL

Her Model is best exemplified in

the Nursing Process which
includes the following steps:
1. Assessment of Behavior
2. Assessment of Stimuli
3. Nursing Diagnosis
4. Goal Setting
5. Intervention
6. Evaluation
13) SISTER CALISTA ROY:
ADAPTATION MODEL
APPLICATION
Best applied in the performance of the Nursing
Process which is cyclical in nature.
The Assessment component is the Stimuli or Input
The Planning & Implementation are the Throughput
process.
The Evaluation which provides necessary feedback to the
Goal of care is the Output.
The N decides what necessary actions should be
taken next in the light of the patient’s response to the Nursing
Interventions. This action by the N is Adaptation in its simplest
terms
Patients adopt too. The Nursing interventions we perform
ultimately elicits a response from them. Depending on the
nature & extent of the nursing interventions, pts may or may
not actually adopt according to our expectations
 14) DOROTHEA OREM:
SELF CARE AND
SELF CARE DEFICIT THEORY
Three (3) Nursing Systems based on
Art of Care of Patient Needs

• 1. Wholly Compensatory or
Total Compensatory
– For paralyzed patients, for ICU
patients
• 2. Partial Compensatory
– Patient performs some of
nursing care needs
• 3. Supportive-Educative
– For up and about patient
 14) DOROTHEA OREM:
SELF CARE AND
SELF CARE DEFICIT THEORY
APPLICATION
The elements of the theory clearly emphasize
the need to understand the importance of
self- care in the Promotion and maintenance of
Health & Wellbeing.
Focus on the pt’s capacity/ability to perform
self-care activities in order to determine which
self-care activities to perform for the client.
The model emphasizes on Education
& Supportive Measures
Health Education – very important
aspect of clinical nursing today
 15) PATRICIA BENNER
NURSING EXPERTISE MODEL
Her concern is:
“How do Nurses learn to
do Nursing”
Experience-based skill
acquisition – is safer &
quicker when it is founded on
a sound educational base

Skill – refers to Nursing

interventions and Clinical
judgment skills in actual
clinical
As situations.
the N gains experience, Clinical knowledge
becomes a GOOD MIX of PRACTICAL &
THEORETICAL KNOWLEDGE
 15) PATRICIA BENNER
NURSING EXPERTISE MODEL

LEVELS OF SKILL ACQUISITION:

1. Novice
2. Advanced Beginner
3. Competent
4. Proficient
5. Expert
 15) PATRICIA BENNER
NURSING EXPERTISE MODEL

APPLICATION

Instrumental in
differentiating knowledge
development & career
progression in Nursing.
It is important for Nursing
students and professional nurses
alike to learn through Experience
or by Experiential Learning.
Learning by experience will allow
you to gain Mastery of a given
skill.
 16) LYDIA HALL
CORE, CARE, CURE MODEL
Individuals could be conceptualized in
3 Separate Domains:
1. CARE – hands on bodily care
2. CORE – using the self in relationship to the
client
3. CURE – applying medical knowledge

Nurses function in all 3 Domains but in

different Degrees.
1. CURE – limited to helping patients/families
deals w/ the measures instituted by the
physician
2. CARE – exclusive for nursing
3. CORE – shared w/ Social workers,
Psychologists, Clergy & other Professionals
 16) LYDIA HALL
CORE, CARE, CURE MODEL
APPLICATION
Foundation for classifying the
Professional N’s functions today. Ns are able to
carry out Nursing Interventions
INDEPENDENTLY
DEPENDENTLY
INTERDEPENDENTLY

CORE – maintains that it is the N responsibility

to make sure that the client receives the highest
level of care possible from all concerned Hx
Professionals. Ns ROLES: COLLABORATOR,
COORDINATOR and in COOPERATION with
other members of the HX team that pertains to
PATIENT’S WELFARE.
 16) LYDIA HALL
CORE, CARE, CURE MODEL

CURE – clearly delineates nursing

functions that are DEPENDENT on the
members of the Medical Profession.
Interventions carried out needs a written
order from the doctor/s

CARE – refers to the independent roles

& functions of the Nurse insofar as her
knowledge & skills about the patient’s
condition will allow her to carry on with
her Nursing Responsibilities
 17) MYRA LEVINE:
FOUR CONSERVATION
PRINCIPLES OF NURSING
• 1. Conservation of Energy
– Example: complete bed
rest without bathroom
privileges

• 2. Conservation of Structural
Integrity
– Example: turn patient
from side to side every
two hours to avoid bed
sores
 17) MYRA LEVINE:
FOUR CONSERVATION
PRINCIPLES OF NURSING
• 3. Conservation of
Personal Integrity
– Example: maintain
patient’s privacy

• 4. Conservation of Social
Integrity
– Example: maintenance
of patient’s
relationships
 17) MYRA LEVINE:
FOUR CONSERVATION
PRINCIPLES OF NURSING
APPLICATION
Ns should be able to identify the
many Nurse-Patient activities which
are implied in the 4 Conservation
Models. It can be applied to geriatric
nursing where majority of the elderly
pts will have some problems in at least 2
of the conservation models.
Structural integrity focuses on the
body’s ability to ward of infections &
other bodily harm. It means that it is
important to keep these barriers – skin &
mucous membranes - intact
18) MARJORIE GORDON:
HUMAN FUNCTIONAL HEALTH
PATTERNS
– Focus is on Eleven
(11) Health Patterns

– Advantage to the
nurse:
• It enables the nurse
to determine the
client’s response as
functional or
dysfunctional
18) MARJORIE GORDON:
HUMAN FUNCTIONAL HEALTH
PATTERNS
• Eleven Functional Health
Patterns

– Health perception
– Nutritional / Metabolic
– Elimination
– Activity and Exercise
Pattern
– Cognitive Perceptual
Pattern
18) MARJORIE GORDON:
HUMAN FUNCTIONAL HEALTH
PATTERNS
• Eleven Functional Health
Patterns
– Sleep and Rest
– Self perception / Self
concept
– Role Relationship
Pattern
– Sexuality /
Reproductive
– Coping-Stress-
Tolerance
– Value Belief Patterns
18) MARJORIE GORDON:
HUMAN FUNCTIONAL HEALTH
PATTERNS
 SISTER LETTY G. KUAN
Dissertation: “Retirement & Role Discontinuities”

“I have grown and sown and

now I can reap the reward &
blessing of a life lived in joy
& love,
CONCEPTUAL MODEL for I too have made
others grow”
Determinants of Fruitful Aging
 Prepared retirement
 Health Status
 Income
 Family Constellation
 Self-preparation

Outcome
Retirement
Fruitful Retirement
Role Discontinuities Change of Life And Aging
(Aging Process)
 CARMENCITA ABAQUIN
Dissertation: “PREPARE ME” Interventions & the
Quality of Life of Advance Progressive Cancer
Patients
“To Nursing… may be able to
provide the care that our clients
need in maintaining their quality
of life and being instrumental in
“Birthing” them to External life”
CONCEPTUAL FRAMEWORK

Holistic Nursing Intervention Terminally ILL Patients

(CANCER)
“PREPARE ME” Physical
 Presence
Psychological QUALITY
Reminisce Therapy
Social
Prayer OF LIFE
Religious
Relaxation Activities
Level of Independence
Meditation
Environment
Value Clarification
Spiritual