by: Marie John C. Jardiolin RN.

³Environmental Theory´

‡ Crimean War ‡ "The Lady with the Lamp" ‡ µministering angel¶ ‡ Nightingale School

Crimean War

Nightingale's lasting contribution has been her role in founding the modern nursing profession. She set an example of compassion, commitment to patient care, and diligent and thoughtful hospital administration.

Three Components of Environmental Theory of Nightingale
‡ Consists of physical elements where the patient is being treated ‡ 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

‡ Can be affected by a negative physical environment which then causes STRESS ‡ Requires various activities to keep the mind active (i.e, manual work, appealing food, a pleasing environment) ‡ Involves communication with the person, about the person, and about other people ‡ Communication should be therapeutic, soothing, & unhurried!

3. SOCIAL ENVIRONMENT ‡ Involves collecting data about illness and disease
prevention ‡ Includes components of the physical environment clean air, clean water, proper drainage ‡ Consists of a person¶s home or hospital room, as well as the total community that affects the patient¶s specific environment

The Advantage of the Theory to HEALTH
1. Maintained by using a person¶s healing powers to their fullest extent 2. Maintained by controlling the environmental factors so as to prevent disease 3. Disease is viewed as a reparative process instituted by nature 4. Health & disease are the focus of the nurse 5. Nurses help patients through their healing process

Nightingale¶s Theory and Nursing¶s Metaparadigm - NURSING
1. Provides fresh air, light, warmth, cleanliness, quiet, and a proper diet 2. Facilitates a patient¶s reparative process by ensuring the best possible environment 3. Influences the environment to affect health 4. Supports the nursing process (even though it was not even developed yet!) 5. Nursing education belongs in the hands of nurses! 6. Nursing is a discipline distinct from medicine focusing on the patient¶s reparative process rather than on their disease!!

Jean Watson
³Theory of Caring´

The Seven Assumptions
Watson proposes seven assumptions about the science of caring. The basic assumptions are:
1. Caring can be effectively demonstrated and practiced only interpersonally. Caring consists of carative factors that result in the satisfaction of certain human needs. Effective caring promotes health and individual or family growth. Caring responses accept person not only as he or she is now but as what he or she may become. 6. 5. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time. Caring is more ³healthogenic´ than is curing. A science of caring is complementary to the science of curing. The practice of caring is central to nursing.





The Ten Primary Carative Factors
The structure for the science of caring is built upon ten carative factors. These are: 1. The formation of a humanisticaltruistic system of values. The installation of faith-hope. The cultivation of sensitivity to one¶s self and to others. The development of a helpingtrust relationship The promotion and acceptance of the expression of positive and negative feelings. The systematic use of the scientific problem-solving method for decision making 9. 7. The promotion of interpersonal teaching-learning. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment. Assistance with the gratification of human needs. The allowance for existentialphenomenological forces.

2. 3.






Watson¶s Theory & The Four Major Concepts
1. Human being She adopts a view of the human being as: ³«.. 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. He, human is viewed as greater than and different from, the sum of his or her parts´. 2. 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 adaptive-maintenance level of daily functioning ‡ The absence of illness (or the presence of efforts that leads its absence)

Watson¶s Theory & The Four Major Concepts
3. Environment/society According to Watson caring (and nursing) has existed in every society. A caring attitude 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. 4. Nursing According to Watson, ³nursing 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 ³A human science of persons and human healthillness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions´.

Virginia Henderson
³Need theory´

³Nursing theories mirror different realities, throughout their development; they reflected the interests of nurses of that time.´ Henderson¶s concept of nursing was derived from her practice and education therefore, her work is inductive. She called her definition of nursing her ³concept´. Although her major clinical experiences were in medicalsurgical hospitals, she worked as a visiting nurse in New York City. This experience enlarges Henderson¶s view to recognize the importance of increasing the patient¶s independence so that progress after hospitalization would not be delayed .

‡ Defined nursing as "assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery´. ‡ One of the first nurses to point out that nursing does not consist of merely following physician's orders. ‡ Categorized nursing activities into 14 components, based on human needs. ‡ 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 famous definition of nursing was one of the first statements clearly delineating nursing from medicine.

³The 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´.

The Development of Henderson¶s Definition of Nursing
Two events are the basis for Henderson¶s development of a definition of nursing. 1. First, she participated in the revision of a nursing textbook. 2. Second, she was concerned that many states had no provision for nursing licensure to ensure safe and competent care for the consumer. In the revision she recognized the need to be clear about the functions of the nurse and she believed that the textbook serves as a main learning source for nursing practice should present a sound and definitive description of nursing.

‡ Furthermore, the principles and practice or nursing must be built upon and derived from the definition of the profession. ‡ Although official statements on the nursing function were published by the ANA in 1932 and 1937, Henderson viewed these statements as nonspecific and unsatisfactory definitions of nursing practice. ‡ Then in 1955, the earlier ANA definition was modified. ‡ Henderson's focus on individual care is evident in that she stressed assisting individuals with essential activities to maintain health, to recover, or to achieve peaceful death. ‡ She proposed 14 components of basic nursing care to augment her definition. ‡ In 1955, Henderson¶s first definition of nursing was published in Bertha Harmer¶s revised nursing textbook.

Henderson¶s Theory and the Four Major Concepts
Individual Environment Health Nursing

‡ 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, and the patient is neither client nor consumer.

‡ 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. ‡ Supports tasks of private and public agencies ‡ Society wants and expects nurses to act for individuals who are unable to function independently. ‡ In return she expects society to contribute to nursing education. ‡ Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided

‡ Definition based on individual¶s ability to function independently as outlined in the 14 components. ‡ Nurses need to stress promotion of health & 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?

‡ 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 ³complete´ ³whole", 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. ‡ Use nursing research ‡ Categorized  Nursing : nursing care  Non nursing: ordering supplies, cleanliness and serving food.

‡ In the Nature of Nursing ³that the nurse is and should be legally, an independent practitioner and able to make independent judgments as long as s/he is not diagnosing, prescribing treatment for disease, or making a prognosis, for these are the physicians function.´ ‡ ³Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver.´ ‡ Nurse role is, ³to get inside the patient¶s skin and supplement his strength will or knowledge according to his needs.´ ‡ And nurse has responsibility to assess the needs of the individual patient, help individual meet their health need, and or provide an environment in which the individual can perform activity unaided.

Henderson's Classic Definition of Nursing:
"I say that the nurse does for others what they would do for themselves if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible."

Henderson & Nursing Process
‡ Henderson views the nursing process as ³really the application of the logical approach to the solution of a problem. The steps are those of the scientific method.´ ‡ ³Nursing process stresses the science of nursing rather than the mixture of science and art on which it seems effective health care service of any kind is based.´

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