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Major Concepts Subconcepts

Nursing Nightingale’s (1859/1992) statements:

“What nursing has to do… is to put the Health of Houses

patient in the best condition for nature to act
upon him” (Nightingale, 1859/1992) “Badly constructed houses do for the healthy
what badly constructed hospitals do for the
Nightingale stated that nursing “ought to sick. Once insure that the air is stagnant and
signify the proper use of fresh air, light, sickness is certain to follow.”
warmth, cleanliness, quiet, and the proper
selection and administration of diet – all at Ventilation and Warming
the least expense of vital power to the
patient.” “Keep the air he breathes as pure as the
external air, without chilling him.”
She reflected the art of nursing in her
statement that, “the art of nursing, as now Nightingale believed that the person who
practised , seems to be expressly constituted repeatedly breathed his or her own air would
to unmake what God had made disease to be, become sick or remain sick.
viz., a reparative process.”
Nightingale was very concerned about
Human Beings “noxious air” or “effluvia” or foul odors that
came from excrement
Human beings are not defined by Nightingale
specifically. They are defined in relationship She also criticized “fumigations,” for she
to their environment and the impact of the believed that the offensive source, not the
environment upon them. smell, must be removed.

Environment The importance of room temperature was

stressed by Nightingale. The patient should
The physical environment is stressed by not be too warm or too cold. The temperature
Nightingale in her writing. Nightingale’s could be controlled by appropriate balance
writings reflect a community health model in between burning fires and ventilation from
which all that surrounds human beings is windows.
considered in relation to their state of health.
Nightingale believed that second to fresh air
Nightingale (1859/1992) did not define the sick needed light. She noted that direct
health specifically. She stated, “We know sunlight was what patients wanted.
nothing of health, the positive of which
pathology is the negative, except from the Noise
observation and experience. Given her
definition that of the art of nursing is to She stated that patients should never be
“unmake what God had made disease,” then waked intentionally or accidentally during
the goal of all nursing activities should be the first part of sleep. She asserted that
client health. whispered or long conversations about
patients are thoughtless and cruel. She
She believed that nursing should provide care viewed unnecessary noise, including noise
to the healthy as well as the ill and discussed from female dress, as cruel and irritating to
health promotion as an activity in which the patient.
nurses should engage.

She discussed the need for changes in color

and form, including bringing the patient
brightly colored flowers or plants. She also
advocated rotating 10 or 12 paintings and
engravings each day, week, or month to
provide variety for the patient. Nightingale
also advocated reading, needlework, writing,
and cleaning as activities to relieve the sick
of boredom.

Bed and Bedding

She noted that an adult in health exhales

about three pints of moisture through the
lungs and skin in a 24-hour period. This
organic matter enters the sheets and stays
there unless the bedding is changed and aired

She believed that the bed should be placed in

the lightest part of the room and placed so the
patient could see out of a window. She
reminded the caregiver never to lean against,
sit upon, or unnecessarily shake the bed of
the patient.

Personal Cleanliness

“Just as it is necessary to renew the air round

a sick person frequently to carry off morbid
effluvia from the lungs and skin, by
maintaining free ventilation, so it is necessary
to keep pores of the skin free from all
obstructing excretions.”

“Every nurse ought to wash her hands very

frequently during the day.”

Nutrition and Taking Food

She noted that individuals desire different
foods at different times of the day and that
frequent small servings may be more
beneficial to the patient than a large breakfast
or dinner.

She urged that no business be done with

patients while they are eating because this
was distraction.

Chattering Hopes and Advices

She wrote that to falsely cheer the sick by

making light of their illness and its danger is
not helpful.

Nightingale encouraged the nurse to heed

what is being said by visitors, believing that
sick persons should hear good news that
would assist them in becoming healthier.

Social Considerations

Nightingale supported the importance of

looking beyond the individual to the social
environment in which he or she lived.
Nightingale (1860/1957/1969) believed that five points were essential in achieving a healthful
house: “pure air, pure water, efficient drainage, cleanliness and light.”

A healthy environment is essential for healing. She stated that “nature alone cures.”

Nurses must make accurate observations of their patients and be able to report the state of the
patient to the physician in an orderly manner.

Nursing is an art, whereas medicine is a science. Nurses are to be loyal to the medical plan, but
not servile.

The language she used to write her books was cultured and flowing, logical in format, and
elegant in style.

Nightingale’s theory has broad applicability to the practitioner. Her model can be applied in most
complex hospital intensive care environment, the home, a work site, or the community at large.
Reading her work raises a consciousness in the nurse about how the environment influences
client outcomes.


There is scant information on the psychosocial environment when compared to the physical

The application of her concepts in the twentieth century is in question.

In the era that we are in today, we are faced with environmental conditions beyond what was
ought to be natural and nurturing. Some of the global environmental issues that we have now are
the global warming, nuclear radiation threats, man-made environmental calamities and pollution.
From these occurrences, Nightingale’s model seemed to be very ideal. Her concept of providing
fresh air to patients is in question with today’s industrialization effects.

In addition to the analysis of the concept of ventilation, it is not always beneficial for all clients
to have fresh air. Natural air has its impurities which in turn may infect open wounds and
drainages such as in burns.

With the idea of providing light, the light emitted by the sun today is proven to be harmful
already because of the destruction of the ozone layer of the Earth. Exposing the patient
constantly to direct sunlight may then be more destructive to patient’s betterment than being

It is true that a health environment heals as what Nightingale stated but the question now is how
our environment would remain health amidst the negative effects of the progress of technology
and industrialization.

Since the applicability of some of the concepts to specific situations today are non-feasible,
development of this theory is utterly needed to accommodate the changes of the environment that
we currently have. Still, above all this, it is very much clear the Nightingale’s theory is superb as
a starting point of the progression of our profession and served as a catalyst for nursing’s
Theoretical Foundations of Nursing

 Home
 Virginia Henderson
 Dorothea E. Orem
 Nola Pender
 Myra Estrin Levine
 Sister Callista Roy
 Lydia E. Hall
 Hildegard E. Peplau
 Ida Jean Orlando
 Imogene M. King
 Jean Watson
 Madeleine M. Leininger
 Betty Neuman
 Florence Nightingale
 Faye G. Abdellah
 Martha Rogers
 Dorothy Johnson
 References
 TFNWeebly Blogspot
 Course Application

Dorothea E. Orem
The Self-Care Deficit Nursing Theory.

Orem developed the Self-Care Deficit Theory of Nursing, which is composed of three interrelated
theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing

“The condition that validates the existence of a requirement for nursing in an adult is the absence of the
ability to maintain continuously that amount and quality of self-care which is therapeutic in sustaining
life and health, in recovering from disease or injury, or in coping with their effects. With children, the
condition is the inability of the parent (or guardian) to maintain continuously for the child the amount
and quality of care that is therapeutic.” (Orem, 1991)

Major Concepts Subconcepts

Nursing is as art through which the practitioner Self-care Requisites or requirements can be
of nursing gives specialized assistance to persons defined as actions directed toward the provision
with disabilities which makes more than ordinary of self-care. It is presented in three categories:
assistance necessary to meet needs for self-care.
The nurse also intelligently participates in the A. Universal self-care requisites are associated
medical care the individual receives from the with life processes and the maintenance of the
physician. integrity of human structure and functioning.

Humans are defined as “men, women, and 1. The maintenance of a sufficient intake of air
children cared for either singly or as social units,”
and are the “material object” of nurses and 2. The maintenance of a sufficient intake of
others who provide direct care. water

Environment has physical, chemical and 3. The maintenance of a sufficient intake of food
biological features. It includes the family, culture
and community. 4. The provision of care associated with
elimination process and excrements
Health is “being structurally and functionally
whole or sound.” Also, health is a state that 5. The maintenance of a balance between
encompasses both the health of individuals and activity and rest
of groups, and human health is the ability to
reflect on one’s self, to symbolize experience, 6. The maintenance of a balance between
and to communicate with others. solitude and social interaction

Self-care is the performance or practice of 7. The prevention of hazards to human life,

activities that individuals initiate and perform on human functioning, and human well-being
their own behalf to maintain life, health and
well-being. 8. The promotion of human functioning and
development within social groups in accord with
Self-care agency is the human’s ability or power human potential, known human limitations, and
to engage in self-care and is affected by basic the human desire to be normal
conditioning factors.
Normalcy is used in the sense of that which is
Basic conditioning factors are age, gender, essentially human and that which is in accord
developmental state, health state, sociocultural with the genetic and constitutional
orientation, health care system factors, family characteristics and the talents of individuals.
system factors, patterns of living, environmental
factors, and resource adequacy and availability. B. Developmental self-care requisites are
“either specialized expressions of universal self-
Therapeutic Self-care Demand is the totality of care requisites that have been particularized for
“self-care actions to be performed for some developmental processes or they are new
duration in order to meet known self-care requisites derived from a condition or associated
requisites by using valid methods and related with an event.”
sets of actions and operations.”
C. Health deviation self-care requisites are
Self-care Deficit delineates when nursing is required in conditions of illness, injury, or
needed. Nursing is required when an adult (or in disease or may result from medical measures
the case of a dependent, the parent or guardian) required to diagnose and correct the condition.
is incapable of or limited in the provision of
continuous effective self-care. 1. Seeking and securing appropriate medical
Nursing Agency is a complex property or
attribute of people educated and trained as 2. Being aware of and attending to the effects
nurses that enables them to act, to know, and to and results of pathologic conditions and states
help others meet their therapeutic self-care
demands by exercising or developing their own 3. Effectively carrying out medically prescribed
self-care agency. diagnostic, therapeutic, and rehabilitative
Nursing System is the product of a series of
relations between the persons: legitimate nurse 4. Being aware of and attending to or regulating
and legitimate client. This system is activated the discomforting or deleterious effects of
when the client’s therapeutic self-care demand prescribed medical measures
exceeds available self-care agency, leading to the
need for nursing. 5. Modifying the self-concept (and self-image) in
accepting oneself as being in a particular state of
health and in need of specific forms of health

6. Learning to live with the effects of pathologic

conditions and states and the effects of medical
diagnostic and treatment measures in a life-style
that promotes continued personal development

The Three Basic Nursing Systems:

(1) The wholly compensatory nursing system is

represented by a situation in which the
individual is unable “to engage in those self-care
actions requiring self-directed and controlled
ambulation and manipulative movement or the
medical prescription to refrain from such
activity… Persons with these limitations are
socially dependent on others for their continued
existence and well-being.”

(2) The partly compensatory nursing system is

represented by a situation in which “both nurse
and perform care measures or other actions
involving manipulative tasks or ambulation…
[Either] the patient or the nurse may have the
major role in the performance of care

(3) In the supportive-educative system also

known as supportive-developmental system, the
person “is able to perform or can and should
learn to perform required measures of externally
or internally oriented therapeutic self-care but
cannot do so without assistance.”

Relationship of the major components of Orem’s self-care deficit theory

R indicates a relationship between components; < indicates a current or potential deficit where nursing
would be required


Humans engage in continuous communication and interchange among themselves and their
environments to remain alive and to function.

In humans, the power to act deliberately is exercised to identify needs and to make needed judgments.
Mature human beings experience privations in the form of action in care of self and others involving
making life-sustaining and function-regulating actions.

Human agency is exercised in discovering, developing, and transmitting to others ways and means to
identify needs for, and make inputs into, self and others.

Finally, groups of human beings with structured relationships cluster tasks and allocate responsibilities
for providing care to group members who experience privations for making required deliberate
decisions about self and others (Orem, 1995).



A major strength of Orem’s theory is that it is applicable for nursing by the beginning practitioner as well
as the advanced clinicians.

The terms self-care, nursing systems, and self-care deficit are easily understood by the beginning student
nurse and can be explored in greater depth as the nurse gains more knowledge and experience.

She specifically defines when nursing is needed: Nursing is needed when the individual cannot maintain
continuously that amount and quality of self-care necessary to sustain life and health, recover from
disease or injury, or cope with their effects.

Three identifiable nursing systems were clearly delineated and are easily understood.


Orem’s theory is simple yet complex. The use of self-care in multitude of terms, such as self-care agency,
self-care demand, self-care deficit, self-care requisites, and universal self-care, can be very confusing to
the reader.

Orem’s definition of health was confined in three static conditions which she refers to a “concrete
nursing system,” which connotes rigidity.

Throughout her work, there is limited acknowledgement of the individual’s emotional needs.


There is a superb focus of Orem’s work which is self-care. Even though there is a wide range of scope
seen in the encompassing theory of nursing systems, Orem’s goal of letting the readers view nursing
care as a way to provide assistance to people was apparent in every concept presented.
From the definition of health which is sought to be rigid, it can now be refined by making it suitable to
the general view of health as a dynamic and ever changing state.

The role of the environment to the nurse-patient relationship, although defined by Orem was not

The role of nurses in maintaining health for the patient was set by Orem with great coherence in
accordance with the life-sustaining needs of every individual.

Although Orem viewed the importance of the parents or guardian in providing for their dependents, the
definition of self-care cannot be directly applied to those who needs complete care or assistance with
self-care activities such as the infants and the aged.

(c) 2011 Gonzalo, A. All rights reserved

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