NURSING THEORIES

Environmental Theory by Florence Nightingale

The theory of nightingale emphasized greatly the role of the environment in the care of the
patient. Environment is defined as the external condition and influences affecting the life and
development of an organism and capable of preventing, suppressing, or contributing to disease, accidents,
or deaths. She defined and described her key concepts of Ventilation, Light, Diet, Cleanliness and Noise.
(Bautista, 2008)
Her concept of healthy environment was based on her experience in the Crimean War where more
than 80% of soldier deaths were not due to wounds from the war but because of the dismal setup of the
hospitals in the battlegrounds. Healthy environment is characterized by pure air, water, efficient drainage,
cleanliness and light. (Bautista, 2008)
For Nightingale, nurses are responsible to keep the air that the patient breathes pure as the
external air without chilling him. She recognized the possibility that inadequate ventilation may be the
source of disease. (Bautista, 2008)
Nightingale mentioned that direct sunlight has quite as real and tangible effects on the human
body where in it has a purifying effect of light, and especially of direct sunlight. She means that due to the
natural rays of sunlight, it could help heal the problems of the person both physically and spiritually
because it has this uplifting feeling from its glow. (Bautista, 2008)
Nightingale also recognized the presence of organic matter in a dirty environment, which can
contribute to the development of disease. For this, she promoted the essence and principle of cleanliness
through giving the soldiers a bath daily and keeping their uniforms and hands of the clean. (Bautista,
2008)
Another role of the nurses as mentioned by Nightingale is to manipulate the environment so that
there is a healthy balance of ventilation and normal body warmth. Positioning the patient, opening the
windows, and regulating the room temperature are ways of maintaining this balance. She also mentioned
that unnecessary noise could be harmful to the ill patient. (Bautista, 2008)
Nightingale maintained that one of the nurses roles is to assess both the meal schedule and its
effects on the patient, in addition to assessing the patients dietary intake. Obviously, we nurses have to
ensure that the patient gets to eat on the right time and the meal was prepared properly, neatly and
efficiently. (Bautista, 2008)
This theory can be applied to our client in the community for his disease or illness is under
Communicable Diseases, which can be obtained from the environment. Key preventive measures of
Tuberculosis are to keep the environment and surroundings clean as possible and house should be well
ventilated. Since Mycobacterium is transmitted airborne and through droplets, it is necessary to be
considerate of others by covering your mouth and nose while coughing or sneezing, which would keep
the ventilation clean. The concepts of this theory are not just applicable for the patient but also to his
house and surroundings. Since he lives within the community that is congested and rural-type of area, it is

necessary to still try keeping the surrounding clean and orderly to become comfortable and prevent
certain accidents, infections and transmission.
Self-Care Deficit Theory of Nursing by Dorothea E. Orem
The focus of this theory is to enhance the persons ability for self-care and this also extends to the
care of dependents. A persons self-care deficits are the result of environmental situations. There are three
systems that exist within this nursing practice, namely:
1. Wholly Compensatory System nurse provides total care
2. Partially Compensatory System nurse and patient share responsibility for care
3. Educative-Development System client has primary responsibility for personal health, with
nurse as a consultant.
(Bautista, 2008)
The basic premise of the model is that individuals can take responsibility for their health and the
health of others. In a general sense, individuals have the capacity to care for themselves or their
dependents. It is based upon the philosophy that all patients wish to care for themselves. (Bautista,
2008)
Self-Care requisites are groups of needs or requirements that Orem identified and classified as the
following:
1. Universal those needs that all people have
2. Developmental those needs that relate to the development of the individual
3. Health Deviation those needs that arise as a result of a patients condition
When an individual is unable to meet his own self-care requisites, a self-care deficit occurs. It is the duty
and obligation of the nurse to recognize and identify such in order to define a support intervention. SelfCare is composed of the practice of activities that maturing and mature individuals initiate and perform on
their behalf. Self-Care Requisites are expressed insights about actions to be performed, which are known
to be relevant and vital to human functioning. (Bautista, 2008)
Base from the Initial Data Base, it is stated that the family of the patient of this case left him due
to his illness, so he is alone in the house and no one would take responsibility for his health except
himself. With that, this theory can be applied to the patient for he has to develop a sense of independence
and must strive to reach wellness. He should mature enough that he should take action in order to recover
from his current illness and protect his health. Unfortunately, he lives within the community and not
enough PHN nurses would cater his needs but he can be taught on how to be responsible for his health
and gain knowledge of his illness for him to develop an Educative-Development approach to his self-care
deficit.
Fourteen Basic Human Needs by Virginia Henderson

Henderson viewed the patient as an individual requiring help toward achieving independence and
has envisioned the practice of the nursing as wholly independent from the practice of medicine. She
identified three levels of nurse-patient relationships in which the nurse acts as the following:
1. Substitute doing for the patients
2. Helper/Supplement helping the patient
3. Partner/Complement working with the patient
(Bautista, 2008)
Henderson believed nursing as primarily complementing the patient by supplying what he needs
in knowledge, will or strength to perform his daily activities and to carry out the treatment prescribed for
him by the physician. She strongly believed in getting inside the skin of the patients in order to know
what he needs. The nurse should be the substitute, helper or partner to the patient. (Bautista, 2008)
Her fourteen basic needs are the following: (Bautista, 2008)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Breathe normally
Eat and Drink adequately
Eliminate body wastes
Move and Maintain desirable postures
Sleep and Rest
Select suitable clothes
Maintain body temperature within a normal range
Keep the body clean and well groomed and protect the skin
Avoid danger in the environment and avoid injuring others
Communicate with others
Worship according to ones 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

As said in the Initial Database, the patients family left him, leaving him to take care of himself,
his Tuberculosis developed an MDR condition and he has no work to earn income. This theory can be
applied to the patient for he still needs to develop the sense of independence and must sustain his basic
needs for him to still compensate with his illness. As for his case, he still needs to maintain his needs of
water, diet, cleanliness and other physiologic needs in order to prevent the complications of his illness. As
part of the nurse, the nurse can take the role as a partner or helper to the patient, considering the resources
and availability of the professional and services. The important thing here in a patient-centered
understanding is that the patient needs to overcome the problems by still sustaining his needs and would
make effort in taking care of himself.