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“I think one’s feelings waste
themselves in words; they ought all to
be distilled into actions which bring
Florence Nightingale (1860)
F lo rence Nigh t inga le de f ined Nurs ing “theas
act of
utilizing the environment of the patient to assist him in
his recovery” (1860 /1969) , tha t i t i nvo lves the nurse ' s
initiative to configure environmental settings
for the gradual restoration of the patient's health, and
that external factors associated with the patient's
surroundings affect life or biologic and physiologic
processes , and h i s deve lopment .
Environmental Factors Affecting Health
Defined in her environmental theory are the following
factors present in the patient’s environment:
• pure or f resh a i r
• pure wate r
• su f f i c i en t f ood supp l i es
• e f f i c i en t dra inage
• c lean l iness
• l i gh t ( espec ia l l y d i rec t sun l igh t )
Adequate ventilation has also been regarded as a
factor contributing to changes of the patient’s process of
illness recovery. Any deficiency in one or more of these
factors could lead to impaired functioning of life
processes or diminished health status.
She also emphasized in her environmental theory is the
provision of a quiet or noise-free and warm environment,
attending to patient’s dietary needs by assessment,
documentation of time of food intake, and evaluating it’s
effects on the patient.
Nightingale believed that the environment was the
major component creating illness in a patient; she regarded
disease as “the reactions of kindly nature against the
conditions in which we have placed ourselves.” Her theory
Contains three major relationships:
• environment to patient
• nurse to environment
• nurse to patient


“The kind of person that the nurse
becomes makes a substantial difference in
what each patient will learn as he or she
receives nursing care.”
Hildegard Peplau (1952)
She de f ined Nurs ing as an “interpersonal process of
therapeutic interactions between an individual who is sick
or in need of health services and a nurse especially
educated to recognize, respond to the need for help.”
Dr. Peplau emphasized the nurse-client relationship as
the foundation of nursing practice. At the time, her
research and emphasis on the give-and-take of nurse-client
relationships was seen by many as revolutionary. She
described the nurse-patient relationship as a four-phase
phenomenon. Each phase is unique and has distinguished
contributions on the outcome of the nurse-patient
Phases Of Nurse-Patient Relationship
1. Orientation
Individual/family has a “felt need”
and seeks professional assistance from a
nurse (who is a stranger). This is the
problem identification phase.
2. Identification
Where the patient begins to have
feelings of belongingness and a capacity
for dealing with the problem, creating an
optimistic attitude from which inner
strength ensues. Here happens the
selection of appropriate professional
3. Exploitation
The nurse uses communication tools
to offer services to the patient, who is
expected to take advantage of all
4. Resolution
Where patient’s needs have already
been met by the collaborative efforts
between the patient and the nurse.
Therapeutic relationship is terminated
and the links are dissolved, as patient
drifts away from identifying with the
nurse as the helping person.
Nursing Roles
In the course of the nurse-patient relationship, the
nurse assumes several roles which empower and equip her in
meeting the needs of the patient.
1 . Stranger Role: Rece ives the c l i en t the same way one
meets a stranger in other life situations; provides
an accepting climate that builds trust.
2 . Resource Role: Answers ques t ions . I n te rp re ts
clinical treatment data, gives information.
3 . Teaching Role: Gives i n s t ruc t i ons and prov ides
training; involves analysis and synthesis of the
learner’s experience.
4 . Counseling Role: He lps c l i en t unders tand and
integrate the meaning of current life circumstances;
provides quidance and encouragement to make changes.
5 . Surrogate Role: He lps c l i en ts c la r i f y doma ins o f
dependence, interdependence, and independence and
acts on clients behalf as advocate.
6 . Leadership Role: He lps c l i en t assume max imum
responsibility for meeting treatment goals in a
mutually satisfying way.
Additional Roles i nc lude :
1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10.Recorder observer
Definition of the Unique Function of Nursing
“The nurse is temporarily the
consciousness of the unconscious, the
love of life for the suicidal, the leg of
the amputee, the eyes of the newly blind,
a means of locomotion for the infant,
knowledge and confidence for the mother,
the mouthpiece for those too weak or
withdrawn to speak and so on.”
Virginia Henderson (1955)
Henderson de f ined Nurs ing as assisting
“ the
individual, sick or well, in the performance of those
activities contributing to health or it’s recovery (or to
peaceful death) that an individual would perform
unaided if
he had the necessary strength, will or knowledge”.
She conceptualized the 14 Fundamental Needs o f
humans .
These needs are:
• Brea th ing norma l l y
• Eat ing and dr ink ing adequate ly
• E l im ina t ing body wastes
• Mov ing and main ta in ing des i rab le pos i t i on
• S leep ing and res t ing
• Se lec t ing su i tab le c lo thes
• Main ta in ing body tempera tu re wi th in norma l range
• Keep ing the body c lean and we l l - groomed
• Avo id ing dangers i n the env i ronment
• Commun ica t ing wi th othe rs
• Worsh ipp ing acco rd ing to one ’ s f a i th
• Work ing i n such a way tha t one f ee l s a sense o f
• P lay ing /pa r t i c ipa t ing i n var ious f o rms o f rec rea t ion
• Lea rn ing , d i scover ing or sa t i s fy ing the cu r ios i t y tha t
leads to normal development and health and using
available health facilities.
The Nurse-Patient Relationship
Henderson stated that there are three levels
comprising the nurse-patient relationship:
1 . The nurse as a substitute for the patient. I n t imes
of illness, when the patient cannot function fully,
the nurse serves as the substitute as to what the
patient lacks such, as knowledge, will, and strength
in order to make him complete, whole and independent
once again.
2 . The nurse as a helper to the patient. I n s i tua t i ons
where the patient cannot meet his basic needs, the
nurse serves as a helper to accomplish them.
3 . The nurse as a partner with the patient. As par tne rs ,
the nurse and the patient formulate the care plan
together. Both as an advocate and as a resource
person, the nurse can empower the patient to make
effective decisions regarding his care plans.
Dynamic Nurse-Patient Relationship
“The role of the nurse is to find
out and meet the patient's immediate
need for help. The patient's presenting
behavior may be a plea for help,
however, the help needed may not be what
it appears to be.”
Ida Jean Orlando (1961)
Or l ando ' s theo ry was deve loped i n the l a te 1950s f rom
observations she recorded between a nurse and patient.
Despite her efforts, she was only able to categorize the
records as "good" or "bad" nursing. It then dawned on her
that both the formulations for "good" and "bad" nursing
were contained in the records. From these observations she
formulated the deliberative nursing process.
Therefore, nurses need to use their perception,
thoughts about the perception, or the feeling engendered
from their thoughts to explore with patients the meaning of
their behavior. This process helps the nurse find out the
nature of the distress and what help the patient needs.
Orlando's theory remains one the of the most effective
practice theories available. The use of her theory keeps
the nurse's focus on the patient. The strength of the
theory is that it is clear, concise, and easy to use. While
providing the overall framework for nursing, the use of her
theory does not exclude nurses from using other theories
while caring for the patient.
Key Concepts of Three Interlocking Circles Theory
• Acco rd ing to Ha l l , Nurs ing i s
par t i c ipa t i on care,
i n core and cure
aspects, where CARE is the sole
function of nurses, whereas the CORE
and CURE are shared with other
members of the health team
• The major purpose of care is to
achieve an interpersonal
relationship with the individual
that will facilitate the development
of the core
Lydia Hall (1961)

Human-to-Human Relationship Model

“A nurse does not only seek to alleviate physical pain
or render physical care- she ministers to the whole person.
The existence of suffering, whether physical, mental or
spiritual is the proper concern of the nurse.”
Joyce Travelbee (1966)
Travelbee's experience in initial psych nursing
practice at a Catholic charity hospital led her to believe
that the care given in these type of institutions lacked
compass ion . She f e l t nurs ing needed humanistic
a "
revolution" and a renewed f ocus on ca r ing as cen t ra l to
nursing--she warned that if this didn't happen, consumers
might seeka "new and different kind of health care
worker". Trave lbee ' s i deas have grea t l y i n f l uenced the
hospice movement.
In her human-to-human relationship model, the nurse
and the patient undergoes the following series of
interactional phases:
1 . Original Encounter- th i s i s desc r ibed as the f i r s t
impression by the nurse of the sick person and viceversa
The nurse and patient see each other in
stereotyped or traditional roles.
2 . Emerging Identities- th i s phase i s desc r ibed by the
nurse and patient perceiving each other as unique
individual. At this time, the link of relationship
begins to form.
3 . Empathy- th i s phase i s desc r ibed as the ab i l i t y to
share in the person’s experience.
4 . Sympathy- I t happens when the nurse wants to l e ssen
the cause of the patient’s suffering. It goes beyond
empathy. The nurse at this time should use a
disciplined intellectual approach together with
therapeutic use of self to make helpful nursing
5 . Rapport- th i s i s desc r ibed as nurs ing i n te rven t i ons
that lessens the patient’s suffering. The nurse and
the sick person are relating as human being to human
being. The sick person shows trust and confidence in
the nurse.

System Model in Nursing Practice

“Health is a condition in which
all parts and subparts are in harmony
with the whole of the client”
Betty Neuman (1972)
Her theory incorporated the concept of a whole person
and an open system approach. The concept is aimed towards
the development of a person in a state of wellness having
the capacity to function optimally. The main role of the
nurse in her theory is to help a person to adapt with
environmental stimuli causing illnesses back to a state of
Terms Related to Neuman’s System Theory
Client Variables
The clients’ variables can be one or combination of
the following: physiological, sociocultural, developmental
and spiritual. These variables function to achieve
stability in relation to the environmental stressors
experienced by the client.
Lines of Resistance
Lines of Resistance act when the Normal Line of
Defense is invaded by too much stressor, producing
alterations in the client’s health.
Normal Line of Defense
To achieve the stability of the system, the Normal
Line of Defense must act in coordination with the normal
wellness state. It must reflect the actual range of
responses that is normally acted by clients in response to
any stressors. It is the baseline in determining the level
of client within the continuum of health.
Flexible Line of Disease
It serves as a boundary for the Normal Line of Defense
to adjust to situations that threaten the imbalance within
the client’s stability.
These are forces that produce tensions, alterations or
potential problems causing instability within the client’s
These are the outcomes or produced results of certain
stressors and actions of the lines resistance of a client.
It can be positive or negative depending on the degree of
reaction the client produces to adjust and adapt with the
s i tua t i on . Neuman spec i f i ed these reac t inegentropy
ons as
or entropy. Negentropy is set towards stability or wellness
while Egentropy is set towards disorganization of the
system producing illness.
Behavioral System Model
“Each individual has a predisposition
to act, with reference to the goal, in
certain ways rather than in other ways”
Dorothy Johnson (1971)
Johnson believes that each individual has a focusing
and repeating ways of acting which covers a behavioral
system distinct to that individual. These behaviors are
logical, fixed, predictable and adequately secure and
persistent to be satisfying to depiction and clarification.
Seven Behavioral Subsystems
1 . The Attachment or Affiliative Subsystem i s
we l l known
as the earliest response system to expand in
the individual. The most favorable functioning of
this subsystem allows social inclusion, closeness,
and the pattern and continuance of a strong public
2 . The Dependency Subsystem a re ac t i ons tha t t r i gge r
nurturing behaviors from other individuals in the
environment. The product of dependency behavior is
consent, interest or appreciation, and physical
3 . The Ingestive Subsystem re la tes to the behav io r s
surrounding the ingestion of food. Behaviors related
to the ingestion of food may relate more to what is
socially satisfactory in a specified culture, than
to the biological necessities of the human being.
4 . The Eliminative Subsystem re la tes to behav io r s
surrounding the secretion of waste products from the
body. Human cultures have defined different socially
acceptable behaviors for excretion of waste, but the
continuation of such an outline remains from culture
to culture.
5 . The Sexual Subsystem im i ta tes behav io r s rea l ted to
procreation or reproduction.
6 . The Aggressive Subsystem re la tes to behav io r s
concerned with the defense and self-preservation.
7 . The Achievement Subsystem con ta ins behav io r s tha t
attept to control the environment. Intellectual,
physical, imaginative, mechanical, and communl
skills are some of the areas that Johnson

Goal Attainment Theory

“If the students can’t do the fundamentals, how can
they use advanced knowledge.”
Imogene King (1971)
King stated that Nursing is a process
o f action, reaction, and interaction
whereby nurse and client share information
about their perception in the nursing situation.
Action is a means of behavior or activities that are
towards the accomplishment of certain act. It is both
physical and mental.
In King’s theory, reaction is not specified but
somehow relates reaction as part of action. According to
her, reaction is a response to a stimuli.
Interaction, as defined by King, is any situation
wherein the nurse relates and deals with a clientele or
Open System
It is the absence of boundary existence, where a
dynamic interaction between the internal and external
environment can exchange information without barriers or
King proposed that the nurse interacts in the system
simultaneously at three different levels. These levels are
independent and at the same time co-exist to influence
over-all nursing practice.
• Personal- how the nurse views and integrates self
based from personal goals and beliefs
• Interpersonal- how the nurse interrelates with a coworker
or patient, particularly in a nurse-patient
• Social- how the nurse interacts with co-workers,
superiors, subordinates and the client environment in
Self-Care Theory
“Individuals, families, groups
and communities need to be taught
Dorothea Orem (1971)
Orem de f ined Nurs ing as “The act of assisting
in the provision and management of self-care to
maintain/improve human functioning at home level
The theory focuses on activities that adult
individuals perform on their own behalf to maintain
health and well-being. It has a strong health
promotion and
maintenance focus.
She identified 3 related concepts:
1 . Self-care - ac t i v i t i e s an I nd iv idua l per fo rms
independently throughout life to promote and
maintain personal well-being.
2 . Self-care deficit - resu l t s when se l f - ca re agency
(Individual’s ability) is not adequate to meet
the known self-care needs.
3 . Nursing System - nurs ing i n te rven t ions needed
when Individual is unable to perform the
necessary self-care activities:
1 . Wholly compensatory - nurse prov ides ent i re
self-care for the client.
Example : ca re o f a new born , ca re o f
client recovering from surgery in a
post-anesthesia care unit
2 . Partial compensatory - nurse and c l i en t
perform care, client can perform selected
self-care activities, but also accepts care
done by the nurse for needs the client
cannot meet independently.
Example : Nurse can ass i s t pos t
operative client to ambulate, Nurse can
bring a meal tray for client who can
feed himself
3 . Supportive-educative - nurse ’ s ac t ions a re
to help the client develop/learn their own
self-care abilities through knowledge,
support and encouragement.
Example : Nurse gu ides a mother how to
breastfeed her baby, Counseling a
psychiatric client on more adaptive
coping strategies.

Twenty-One Nursing Problems

“I never wanted to be a medical
doctor because I could do all I wanted to
do in nursing, which is a caring
Faye Glen Abdellah (1960)
The concept of Nursing in this theory is generally
grouped into twenty-one problem areas for nurses to work
out their judgment and appropriate care. Abdellah considers
nursing to be an all-inclusive service that is based on the
disciplines of art and science that serves individuals,
sick or well with their health needs.
Typology of Twenty-one Nursing Problems
1 . To main ta in good hyg iene .
2. To promote optimal activity; exercise, rest and sleep.
3 . To promote sa fe t y.
4 . To main ta in good body mechan ics .
5 . To f ac i l i t a te the main tenance o f a supp ly o f oxygen
6 . To f ac i l i t a te main tenance o f nut r i t i on
7 . To f ac i l i t a te main tenance o f e l im ina t ion
8 . To f ac i l i t a te the main tenance o f f l u id and e lec t ro l y te
9 . To recogn i ze the phys io log i c response o f the body to
disease conditions
10 .To f ac i l i t a te the main tenance o f regu la to ry mechan i sms
and f unc t i ons .
11 .To f ac i l i t a te the main tenance o f senso ry f unc t i ons
12 .To i den t i f y and accept pos i t i ve and negat i ve
expressions, feelings and reactions
13 .To i den t i f y and accept the i n te r re la tedness o f
emotions and illness.
14 .To f ac i l i t a te the main tenance o f e f fec t i ve verba l and
non-verbal communication
15 .To promote the deve lopment o f produc t i ve i n te rpe rsona l
16 .To f ac i l i t a te prog ress toward ach ievement o f persona l
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 opt imum poss ib le goa l s
20 .To use commun i ty resou rces as an a id i n reso lv ing
problems arising from illness.
21 .To unders tand the ro le o f soc ia l prob lems as
influencing factors

Helping Art of Clinical Nursing

"My thesis is that nursing art is
not comprised of rational nor
reactionary actions but rather of
deliberative action."
Ernestine Wiedenbach (1964)
Wiedenbach conceptualizes nursing as the practice
identification of a patient’s need for help through
observation of presenting behaviors and symptoms,
exploration of the meaning o f those symptoms wi th
patient, determining the cause(s) of discomfort, and
determining the patient’s ability to resolve the
or if the patient has a need for help from the nurse
other healthcare professionals.
Nursing primarily consists of identifying a patient’s
need for help. If the need for help requires intervention,
the nurse facilitates the medical plan of care and also
creates and implements a nursing plan of care based on
needs and desires of the patient. In providing care, a nurse
exercises sound judgment through deliberative, practiced,
and educated recognition of symptoms. The patient’s
perception of the situation is an important consideration
to the nurse when providing competent care.
According to Wiedenbach there are four elements to
c l i n i ca l nurs ing
(1): philosophy, (2) purpose, (3)
practice, and (4) art.
• The nurses ’ ph i l osophy was the i r a t t i tude and
belief about life and how that effected reality
for them. Philosophy is what motivates the nurse
to act in a certain way.
Wiedenbach also believed that there were 3
essential components associated with a nursing
○ Reverence for life
○ Respect for the dignity, worth, autonomy and
individuality of each human being
○ Reso lu t i on to ac t on persona l l y and
professionally held beliefs
• Nurses ’ purpose i s tha t wh ich the nurse wants to
accomplish through what she does. It is all of
the activities directed towards the overall good
of the patient.
• Prac t i ces a re those obse rvab le nurs ing ac t ions
that are affected by beliefs and feelings about
meeting the patient’s need for help.
• The Ar t o f nurs ing i nc ludes unders tand ing
patient’s needs and concerns, developing goals
and actions intended to enhance patient’s ability
and directing the activities related to the
medical plan to improve the patient’s condition.
The nurses also focuses on prevention of
complications related to reoccurrence or
development of new concerns.
The Conservation Model
"Ethical behaviour is not the display of one's moral
rectitude in times of crisis. It is the day-to-day
expression of one's commitment to other persons and the
ways in which human beings relate to one another in their
daily interactions.”
Myra Levine (1977)
She defined nursing as supportive & therapeutic
interventions based on scientific or therapeutic knowledge.
Nursing actions based on four principles:
• conse rva t ion o f energy
• s t ruc tu ra l i n teg r i t y
• persona l i n teg r i t y
• soc ia l i n teg r i t y

Adaptation Model
“The model provides a way of thinking
about people and their environment that is
useful in any setting. It helps one
prioritize care and challenges the nurse
to move the patient from survival to
Sister Callista Roy (1979)
She viewed humans as biopsychosocial beings
interacting with a changing environment and who cope
their environment through Biopsychosocial adaptation
mechanisms. There are two categories of coping
according to Roy namely the regulator and the cognator
• Regulator Subsystem t ransp i res th rough neut ra l ,
chemical and endocrine processes like the increase in
vital signs-sympathetic response to stress.
• Cognator Subsystem, on the othe r hand , occurs th rough
cognitive-emotive processes. For instance, are the
effects of prolonged hospitalization for a four-year
old child.
The degree of internal or external environmental
change and the person’s ability to cope with that change is
likely to determine the person’s health status. Nursing
interventions are aimed at promoting physiologic,
psychologic, and social functioning or adaptation.
Transcultural Theory
“Care is the heart of nursing; Care
is power; Care is essential to healing;
Care is curing; and Care is the central
and dominant focus of nursing and
transcultural nursing decisions and
Madeleine Leininger (1985)
She stated that Nursing is a learned humanistic and
scientific profession and discipline which is focused on
human care phenomena and activities in order to
support, facilitate, or enable individuals or groups to
maintain or regain their well being (or health) in
culturally meaningful and beneficial ways, or to help
people face handicaps or death.
Transcultural nursing as a l ea rned sub f i e ld or
of nursing which focuses upon the comparative study
analysis of cultures with respect to nursing and
caring practices, beliefs and values with the goal
to provide meaningful and efficacious nursing care services
to people according to their cultural values and healthillness
context. It focuses on the fact that different
cultures have different caring behaviors and different
health and illness values, beliefs, and patterns of
behaviors. Awareness of the differences allows the nurse to
design culture-specific nursing interventions.

Philosophy and Science of Caring

“Caring in nursing conveys physical
Acts but embraces the mind-body-spirit
as it reclaims the embodied spirit as
its focus attention.”
Margaret Jean Watson (1979)
Watson proposes seven assumptions about the
sc ience o f
caring and ten primary carative factors to f o rm the
framework of her theory. The basic assumptions are:
• Car ing can be e f fec t i ve ly demons t ra ted and
prac t i ced
only interpersonally;
• E f fec t i ve ca r ing promotes hea l th and i nd iv idua l or
family growth;
• Car ing responses accept a person not on ly as he or
is now but as what he or she may become;
• A ca r ing env i ronment i s one tha t o f fe r s the
development of potential while allowing the person to
choose the best action for himself or herself at a
given point in time
• Car ing i s more “hea l thogen ic” than i s cu r ing . The
practice of caring integrates biophysical
knowledge of human behavior to generate or promote
health and to provide care to those who are ill. A
science of caring is therefore complementary to the
science of curing.
• The prac t i ce o f ca r ing i s cen t ra l to nurs ing
Ten Carative Factors
1 . The promot ion o f a human is t i c - a l t ru i s t i c sys tem o f
2 . I n s t i l l a t i on o f f a i th - hope
3 . The cu l t i va t i on o f sens i t i v i t y to one ’ s se l f and othe rs
4. The development of a helping-trusting, human caring
5 . Promot ion and acceptance o f the express ion o f pos i t i ve
and negative feelings.
6 . The sys temic use o f the sc ien t i f i c prob lem-so lv ing
method for decision making
7 . The promot ion o f i n te rpe rsona l teach ing - l ea rn ing
8 . The prov i s i on f o r suppor t i ve , pro tec t i ve and
corrective mental, physical, socio-cultural and
spiritual environment
9 . Ass i s tance wi th the gra t i f i ca t i on o f human needs
10 .The a l l owance f o r ex i s ten t ia l phenomeno log i ca l f o rces

The Science of Unitary Human Beings, and Principles of

“Nursing is 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.”
Martha Rogers (1970)
Nursing interventions seek to promote
harmonious interaction between persons and their
environment, strengthen the wholeness of the
individual and
redirect human and environmental patterns or
to achieve maximum health. There are 5 Basic
1 . The human be ing i s a un i f i ed who le , possess ing
individual integrity and manifesting characteristics
that are more than and different from the sum of
2 . The i nd iv idua l and the env i ronment a re
continuously exchanging matter and energy with each
3 . The l i f e processes o f human be ings evo lve i r reve rs ib l y
and unidirectionally along a space-time continuum
4 . Pa t te rns i den t i f y human be ing and re f l ec t the i r
innovative wholeness
5 . The i nd iv idua l i s charac te r i zed by the capac i ty f o r
abstraction and imagery, language and thought,
sensation and emotion

Theory of Human Becoming

“Nursing is a scientific
discipline, the practice of which is a
performing art.”
Rosemarie Rizzo Parse (1981)
Three assumptions about Human Becoming
• Human becoming i s f ree ly choos ing persona l
mean ing
in situation in the inter-subjective process of
relating value priorities
• Human becoming i s co - c rea t ing rhy thmic pat te rns or
relating in mutual process in the universe
• Human becoming i s co - t ranscend ing
mul t id imens iona l l y
with emerging possibilities.
Octaviano, Eufemia F., RN, RM, MN, EdD, Balita, Carl E.,
RN, RM, MAN, DrHum.“Theoretical Foundations of Nursing:
The Philippine Perspective”, 2008 .