FLORENCE NIGHTINGALE — Notes on Nursing - provide essential principles
for rendering and implementing an efficient and
ENVIRONMENTAL THEORY
➤ The lady with the lamp
➤ Matriarch of Modern Nursing.
➤ Born in Florence, Italy on May 12, 1820.
Sir Thomas Cook - Nightingale’s biographer.
FIRST NURSE EDUCATOR
Germany - the place of the first nursing school.
Theodor Fleidner
- a protestant pastor in Kaiserswerth, Germany
- he opened a hospital in a “vacant textile factory
with one patient, one nurse, and a cook”
➤ July 6, 1851, Nightingale entered the nursing
program as the 134th nursing student to attend
the Fleidner School of Nursing.
➤ October 7, 1851, she left Kaiserswerth and was
considered to be educated as a nurse.
➤ She developed skills in both nursing care and
management which she took back to England.
THE LADY WITH THE LAMP (CRIMEAN WAR)
➤ Nightingale transverse the night during the
Crimean War — the battle of English versus
Turkish — to look for the wounded soldiers and to
heal them with her consoling hands.
➤ November 5, 1854, she arrived in Scutari
accompanied by 38 nurses.
➤ Nightingale became a heroine in Great Britain as
a result of her work in the Crimean War
NURSE STATISTICIAN
➤ She was an expert statistician who used statistics
to present her case for hospital reform.
➤ Pioneer in the graphic display of statistics & was
selected a fellow of the Royal Statistical Society
in 1858.
➤ In 1874 an honorary membership in the American
Statistical Association was bestowed on her.
Given her dependence on observable data to
support her position.
➤ First nurse researcher.
➤ Notes on Nursing — most frequently cited work;
was written not as a nursing text but to give hints
for thoughts of women who have personal charge
of the health of others.
❈ METAPARADIGM IN NURSING
➣ Person
— she viewed the essence of a person as a
patient.
— she believed that nurses should perform tasks
to and for the patient as well as control the
patient’s environment to facilitate easy recovery.
➣ Health
— “being well and using every power that the
person has to the fullest extent.”
— she defined disease as “a reparative process
that nature instituted from a want of attention”
— she believed that prevention of disease through
environmental control will greatly uplift the
maintenance of health.
➣ Environment
— she believed that the sick, poor people would
benefit from environmental improvement that
addressed their physical and mental aspects.
➣ Nursing
— very essential for everybody’s well being.
effective nursing care.
— she stressed that nurses could have a special
role in uplifting the social status of the poor by
improving their living situations.
— “everything from the patient’s food and flowers
to the patient’s verbal and non-verbal interactions
with the patient.”
VIRGINIA HENDERSON
14 BASIC HUMAN NEEDS
➤ The “First Lady of Nursing” and the “First Truly
International Nurse”
➤ She began her career in public health nurse in
the Henry Street Settlement & in the visiting
nurse service in Washington, D.C.
➤ First full-time instructor in nursing in Virginia
when she was at Norfolk Protestant Hospital.
➤ She was an early advocate for the introduction of
psychiatric nursing in the curriculum and as the
committee to develop such a course at Eastern
State Hospital in Williamsburg, Virginia in 1929.
❈ METAPARADIGM IN NURSING
➣ Person
— Henderson referred to a person as a patient.
— she stated that a person is an individual who
requires assistance to achieve health and
independence or in some cases, a peaceful
death.
— she introduced the concept of the mind and the
body of a person as inseparable.
— for a person to function to the utmost, he must
be able to maintain physiological and emotional
balance.
➣ Health
— Henderson viewed health as a quality of life
and is very basic for a person to function fully.
— health requires independence and interdepen-
dence.
— influenced by both internal and external factors
which play independent and interdependent roles
in achieving health.
— she also gives emphasis in prioritizing health
promotion as more important than care of the sick.
➣ Environment
— it is important for a healthy individual to control
the environment, but as illness occurs, this ability
is diminished or affected.
— it is the responsibility of the nurse to help the
patient manage his surroundings to protect him
from harm.
— the nurse must be educated about safety and
must be aware of different social customs and
religious practices to asses dangers.
— nurses must provide physicians data about the
safety needs of the patient, nurses observations
and judgement regarding these needs as the
latter uses this as basis in prescribing protective
devices.
— it is also the responsibility of the nurse to
recommend changes regarding construction of
buildings, purchase of equipment and mainte-
 nance in order for him/her to minimize chances of
injury.
➣ Nursing
— Henderson asserted that nurses function
independently from the physician, but they must
promote the treatment plan prescribed by the
physician.
— The nurse must act independently but in
coordination with the therapeutic plan developed
by the team.
— to help both the sick and well individual.
— The care given by the nurse must empower the
patient to gain independence as rapidly as
possible.
— The nurse must be knowledgeable in both
biological and social sciences and must have the
ability to assess basic human needs
— Henderson’s definition of nursing was
considered as the signature of the profession.
❈ 14 BASIC NEEDS
— she conceptualized the 14 Fundamental Need
of Humans. These are:
1. Breathing Normally
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining a desirable position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining normal body temperature by
adjusting clothing and modifying the
environment
8. Keeping the body clean and well groomed to
promote integument (skin)
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 such ways 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
— Henderson also emphasized the need to view
the patient and his family as a single unit.
— for the patient to achieve health, he must be
able to meet his need for support system
(emotional needs) which in many cases provided
by the family.
— Henderson postulated that nurse functions in
relation with the patient, physician and other
members of the health team and each type
relationships gives nurses specific responsibilities
and roles.
FAYE GLENN ABDELLAH
TWENTY-ONE NURSING PROBLEMS
➤ In March 21, 1919, Faye Glenn Abdellah was
born in New York City.
➤ Magna Cum Laude in 1942 from Fitkin Memorial
Hospital School of Nursing, in Neptune, New
Jersey.
➤ She obtained her Bachelor of Science in 1945
➤ Her Master of Arts in 1947
➤ Her Doctor of Education in 1955 from the
Teachers College at Columbia University
➤ First nurse and first women to serve as Deputy
Surgeon General of the United States.
➤ She was inducted into the US National Women’s
Hall of Fame in 2000.
➤ According to her, Nursing is grounded as an art
and science that molds the attitudes, intellectual
capabilities, and technical know-how of the
individual nurse into the desire and capacity to
assist people, sick or well, and to deal with their
health needs.
❈ METAPARADIGM IN NURSING
➣ Person
— Abdellah classifies the beneficiary of care as
individuals.
— The twenty-one nursing problems relate with
biological, psychological and social aspects of
individuals and can be said to correspond to
concepts of importance.
➣ Health
— The concept of health is defined as the center
and purpose of nursing services.
— She speaks to a “total health needs” and a
“healthy state of mind and body”
➣ Environment
— included in “planning for optimum health on
local, state, national, and international levels”.
— Abdellah elaborates her ideas, the apex (core)
of nursing service is the individual.
➣ Nursing
— Abdellah considers nursing to be an all-
inclusive service that is based on the disciplines of
art and science that serves individual, sick or well,
cope with their health needs.
❈ TWENTY-ONE NURSING PROBLEMS
THREE CHIEF CONCEPTS:
1. Health
2. Nursing problems
3. Problem solving
— Abdellah’s theory proposes that nursing is the
utilization of the problem-solving techniques with
chief nursing problems related to the health
requirements of clients.
NURSING PROBLEMS
Health Needs are seen as problems:
• Overt — obvious or can-be-seen condition.
• Covert — an unseen or masked one.
— Abdellah’s usage of the term Nursing Problem is
more in tune with “nursing goals” and “nursing
functions” than client-centered problems.
— the focus of the theory is more nursing-centered
than client-centered.
— According to Abdellah, the practice of competent
nursing care in the future is for the nursing student
to realize that identifying and answering Overt and
Covert nursing problems is the core of nursing.
PROBLEM-SOLVING APPROACH
The problem-solving process includes:
1. Identifying the problem
2. Selecting relevant data
3. Devising hypotheses
4. Testing hypotheses through the assortment of
data
5. Revising hypotheses when necessary on the
basis of conclusions obtained from the data.
— this steps resemble the pace of the Nursing
Process of Assessment, Diagnosis, Planning,
Implementation, and Evaluation.
TYPOLOGY OF TWENTY-ONE NURSING PROBLEM
1. To maintain good hygiene and physical
comfort.
2. To promote optimal activity: exercise, rest,
sleep.
3. To promote safety through prevention of
accident, injury or other trauma and through
prevention of the spread of infection.
4. To maintain good body mechanics and prevent
and correct deformity
5. To facilitate the maintenance of a supply of
oxygen to all body cells
6. To facilitate the maintenance of nutrition of all
body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and
electrolyte balance.
9. To recognize the physiological responses of
the body to disease conditions-pathological,
physiological and compensatory.
10. To facilitate the maintenance of the regulatory
mechanism and functions.
11. To facilitate the maintenance of sensory
function
12. To identify and accept positive and negative
expressions, feelings and reactions.
13. To identify and accept interrelatedness of
emotions and organic illness.
14. To facilitate the maintenance of effective verbal
and non verbal communications.
15. To promote the development of productive
interpersonal relationships.
16. To facilitate progress toward achievement and
personal spiritual goals.
17. To create or maintain therapeutic environment.
18. To facilitate awareness of self as an individual
with varying physical, emotional, and
developmental needs.
19. To accept the optimum possible goals in the
light of limitations, physical and emotional.
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 in the cause of illness.
— The twenty-one Problem’s focal point is on
the holistic (biopsychospiritual) requirements of the
client and the challenge to provide a more
meaningful starting point for association than the
category system of the body.
— Abdellah’s Twenty-One Typology of Nursing
Problems is one of the forerunners of the Nursing
Diagnoses as compiled by the North American
Nursing Diagnosis Association (NANDA).
MARGARET JEAN WATSON
PHILOSOPHY AND SCIENCE OF CARING
➤ Born in Southern West Virginia
➤ She attended high school in West Virginia & then
attended the Lewis Gale School of Nursing in
Roanoke, Virginia.
➤ She earned a B.S. in Nursing in 1964 at the
Boulder campus;
➤ An M.S. in Psychiatric-Mental Health Nursing in
1966 at the health sciences campus;
➤ A Ph.D. in educational psychology and
counseling in 1973 at the Graduate School,
Boulder campus.
➤ She is a distinguished Professor and Director of
Center of Human Caring, School of Nursing,
University of Colorado Health Science Center,
Denver.
➤ Watson noted that the ideas associated with her
philosophy and theory of human caring are
concerned with spirit than matter, flux rather than
form, inner knowledge and power rather than
circumstance
➤ “it is both theoretical and beyond theory”
❈ METAPARADIGM IN NURSING
➣ Person
— Human being is a valued person in and of him
to be cared for, respected, nurtured, understood
and assisted.
— fully functional integrated self.
— she viewed human as a greater than, and
different from, the sum of his parts.
➣ Health
— refers to unity and harmony within the mind,
body, and soul.
— Watson, in addition to WHO’s definition,
includes this three elements:
• A high level of over-all physical, mental, and
social functioning;
• A general adaptive-maintenance level of daily
functioning; and
 • The absence of illness (or the presence of
efforts that lead to its absence).
➣ Environment
— provides the values that determine how one
should behave.
— Watson states, “Caring (and nursing) has
existed in every society. Every society has had
some people who have cared for others. A caring
attitude is not transmitted form generation to
generation by genes. It is transmitted by the
culture of the profession as a unique way of
coping with its environment.”
➣ Nursing
— having to move educationally in the two areas
of stress and developmental conflicts to provide
holistic health care, which she believes is central
to the practice of caring in Nursing.
— “…a human science of people and human
health-illness experiences that are mediated by
professional, personal, scientific, aesthetic, and
ethical human care transactions.”
❈ PHILOSOPHY AND SCIENCE OF CARING
— she stressed that the focus of nursing is on
carative factors that are derived from a humanistic
perspective combined with scientific knowledge
base.
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 and to others
4. Development of a helping-trusting, human caring
relationship
5. Promotion and acceptance of the expression of
positive and negative feelings;
6. Systematic use of a creative problem-solving caring
process
7. Promotion of transpersonal teaching-learning
8. Provision for a supportive, protective and corrective
mental, physical, societal and spiritual environment
9. Assistance with gratification of human needs
10. Allowance for existential-phenomenological-spiritual
forces
DOROTHEA OREM
SELF-CARE DEFICIT THEORY OF NURSING
➤ One of America’s foremost nursing theorists
➤ Born in Baltimore, Maryland in 1914.
➤ Orem began her nursing career at Providence
Hospital School of Nursing in Washington, D.C.
where she received a diploma of nursing in the
early 1930’s.
➤ Orem later received a BS in Nursing Education
from the Catholic University of America in 1939,
➤ In 1946, she received an MS in Nursing
Education from the same university.
➤ Early nursing experiences: operating room
nursing, private duty nursing, hospital staff
nursing.
❈ METAPARADIGM IN NURSING
➣ Person
— Human beings are much different from other
living things in terms of their capacity.
— Human functioning is an integrated system
comprised of physical, psychological, interperso-
nal and social aspects.
— Orem believes that individuals have the
potential to be developed and learned.
➣ Health
— Orem support the WHO’s definition of health as
the “state of physical, mental, and social well-
being and not merely the absence of disease or
infirmity.
— Orem believes that health should be perceived
this way since she believes that these integrated
aspects of health are inseparable.
➣ Environment
— Orem’s view of health as a phenomenon
affected by inseparable entities shows her view of
the surrounding environment as an external
source of influence in the internal interaction of a
person’s different aspects.
➣ Nursing
— According to Orem, Nursing is helping client to
establish or identify ways to perform self-care
activities.
— Orem defines nursing as a human service.
— She added that nursing is based on values.
❈ SELF-CARE DEFICIT THEORY OF NURSING
— Orem’s theory addresses client’s self-care needs.
— It is defined as goal-oriented activities that are set
towards generating interest in the part of the client to
maintain life and health development.
— The theory is aimed towards making the clients
perform self-care activities in order to live indepen-
dently.
Self-care
— activity that promotes a person’s well-being.
Self-Care Requisites
— insights of actions or requirements that a
person must be able to meet and perform in order
to achieve well-being.
— two elements of self-care requisites are:
• The factor to be controlled or managed to keep
as aspects of human functioning and
development within the norms compatible with
life, health and personal well-being and;
• The nature of required action.
Universal Self-care Requisites
— These are universally set goals that must be
undertaken in order for an individual to function in
scope of a healthy living.
Maintenance of a sufficient intake of air
Maintenance of a sufficient intake of food
Maintenance of a sufficient intake of water
Provision of care associated with elimination
Maintenance of balance between activity and rest
Maintenance of balance between solitude and social
interaction
Prevention of hazards to human life, human functioning
and human well-being; and
Promotion of human functioning and development
Developmental Self-Care Requisites
The following are actions to be undertaken
that will provide developmental growth:
• Provision of conditions that promote development;
• Engagement in self-development and;
• Prevention of the effects of human conditions that
threatens life.
Health Deviation Requisites
— requisites required for a person to be consid-
ered as sick or ill.
Therapeutic Self-Care Demand
— the summation of all activities needed to
alleviate the existing disease or illness.
Self-Care Agency
— complex set of activities required to purposively
regulate the actions needed for planning a care
plan for a client.
Agent
— the individual who is engage in meeting the
needs of a person
— they are like bridges that facilitate what has
been done and what needs to be done.
Dependent Care Agent
— individual who takes full responsibility of taking
care of a person who are incapable of providing
care for themselves or those who are living
dependently with others aid.
Nursing Agency
— set of established capabilities of a nurse who
can legitimately perform activities of care for a
client.
Nursing Design
— professional functions that must be performed
by the nurse in order to meet clients need.
DOROTHY JOHNSON
BEHAVIORAL SYSTEM MODEL
➤ Born in Savannah, Georgia in 1919
➤ She obtained her Bachelor of Science in Nursing
Degree from Vanderbilt University, Nashville,
Tennessee
➤ Her Masters in Public Health from Harvard
University in Boston, Massachusetts
➤ Most of her education career was in Pediatric
Nursing at the University of California, Los
Angeles
➤ She withdraw from the academe as a Professor
Emeritus at January 1, 1978
➤ Johnson projected that the science of nursing
necessary for effective nursing care included a
mixture of key concepts drawn from basic and
applied sciences
➤ Johnson proposed that nursing care facilitated
the client’s maintenance of a state of equilibrium
➤ Johnson projected that clients were “stressed” by
a stimulus of either an internal or external nature.
❈ METAPARADIGM
➣ Person
— Johnson views a person as having two major
systems:
• Biological System - the role of medicine
• Behavioral System - nursing’s focus
➣ Health
— an elusive state that is affected by social,
psychological, biological and physiological factors.
— The individual’s goal is to sustain the entire
behavioral system efficiently and effectively but
with adequate amount of flexibility to return to an
acceptable balance if a malfunction disrupt the
original balance.
➣ Environment
— An individual’s behavior is influenced by all the
events in the environment.
— Cultural influences on the individual’s behavior
are viewed as profound.
— there are many factors that influence specific
behavior in a group of people.
— These factors are believed to vary from culture
to culture although the outcomes for all the groups
or individuals are the same.
➣ Nursing
— The primary goal of nursing is to cultivate
equilibrium within the individual, which allows for
the practice of nursing with individuals at any point
in the health-illness continuum.
— In earlier works, Johnson focused nursing on
impaired individuals
— By 1980, she stated that nursing is concerned
with the organized and integrated whole or holistic
growth of the individual.
— The chief focus is on maintaining a balance in
the behavioral system when illness occurs in the
individual.
❈ BEHAVIORAL SYSTEM MODEL
— Johnson believes that each individual has a
focusing and repeating ways of acting which covers
a behavioral system distinct to that individual.
SEVEN BEHAVIORAL SUBSYSTEM
• The Attachment or Affiliative Subsystem
— the earliest response system to expand in the
individual.
— allows social inclusion, closeness, and the
pattern and continuance of a strong public bond.
• The Dependency Subsystem
— actions that trigger nurturing behavior from other
individuals in the environment.
— the product of dependency behavior is consent,
interest or appreciation, and physical support.
• The Ingestive Subsystem
— relates to the behavior surrounding the ingestion
of food.
• The Eliminative Subsystem
— relate to behaviors surrounding the secretion of
waste products from the body.
• The Sexual Subsystem
— imitates behavior related to procreation or
reproduction.
• The Aggressive Subsystem
— relates to behaviors concerned with defense and — a nurse must be able to adjust to meet the
self-preservation. individual and unique needs of every client.
— one that creates defensive responses from the
individual when life or territory is threatened. ❈ SYSTEM MODEL IN NURSING PRACTICE
• The Achievement Subsystem Client Variable
— behaviors that attempt to control the environment. — can be one or combination of the following:
— Intellectual, physical, imaginative, mechanical, physiological, sociocultural, developmental and
and communal skills are some of the areas that spiritual.
Johnson distinguishes. — this variable function to achieve stability in
— personal accomplishment or success Amy also relation to the environmental stressors experien-
be integrated in this subsystem. ced by the client.
Lines of Resistance
BETTY NEUMAN — when the Normal Line of Defense is invaded by
too much stressors, producing alterations in the
SYSTEM MODEL IN NURSING PRACTICE client’s health.
— acts to facilitate coping to overcome the
➤ Born in 1924 on a farm near Lowell, Ohio
stressors that are present within the individual.
➤ Completed double honors at People’s Hospital of
Normal Line of Defense
Nursing, Akron, Ohio in 1947
— must act in coordination with the normal
➤ She attended the University of California at Los
wellness state.
Angeles with a double major in Public Health and
— must reflect the actual range of responses that
Psychology.
is normally acted by clients in response to any
➤ She completed her Baccalaureate Degree with
stressors.
honors in Nursing in 1957.
— baseline in determining the level of wellness of
➤ In 1966, she received her Master’s Degree in
client within the continuum of health.
Mental Health.
Flexible Line of Defense
➤ She received a Doctoral Degree in Clinical
— serves as a boundary for the Normal Line of
Psychology from Pacific Western University in
Defense to adjust to situations that threaten the
1985.
imbalance within the client’s stability.
— it expanded the range of normal defense from
❈ METAPARADIGM IN NURSING
becoming invaded by the stressors thus
➣ Person
increasing its protection.
— Neuman regarded the concept of a person as
Stressors
an individual, family, community or the society.
— forces that produces tension, alterations or
— She sees a person as an open system that
potential problems causing instability within the
works together with other parts of its body as it
client’s system.
interact with the environment.
Reaction
— An open system is characterized presence of
— the outcomes or produced results of certain
an exchange of information and reaction with
stressors and actions of the lines resistance of a
other factors surrounding a person.
client.
➣ Health
— it can be positive or negative depending on the
— dynamic in nature
degree of reaction the client produces to adjust
— depends upon which state of the health
and adapt with the situation.
continuum they are in line with, the person maybe
— Neuman specified these reactions as:
in line with the state of wellness or illness.
➣ Environment • Negentropy - set towards stability or
wellness
— can be internal, external, and created forces
that interacts with a person’s state of health. • Egentropy - set towards disorganization of
the system producing illness.
— it can alter or improve the systems in which a
Prevention
person exists.
—used to attain balance within the continuum of
— Stressors are tensions that produce alterations
health.
in the normal flow of the environment. These
—These are actions that generate good result or
stressors can be:
are aimed towards hindering negative outcomes.
• Intrapersonal - occurs within the self and
Three Levels of Prevention:
comprises of man as a psychospiritual
1. Primary prevention
being.
— focuses on foreseeing the result of an act or
• Interpersonal - occurs between one or
situation and preventing its unnecessary effects as
more individual and consist of man as a
possible.
social being.
— it also aims to strengthen the capacity of a person
➣ Nursing
to maintain an optimum level of functioning while
— requires a holistic approach
being interactive with the environment, like health
— an approach that considers all factors affecting
promotion and disease prevention.
a client’s health.
2. Secondary prevention
— This concept provides the nurse to consider
— focuses on helping alleviate the actual existing
that a client’s physical, physiological, psycholo-
effects of an action that altered that balance of
gical, mental, social, cultural, developmental and
health of a person.
spiritual well-being is dynamic.
— it aims to reduce environmental influences that
lead to the decline of the level of functioning of a
person and strengthening or restoring a person’s
resistance after the illness exposure
3. Tertiary prevention
— focuses on actual treatment or adjustment to
facilitate the strengthening of person after being
exposed to a certain disease or illness.
— it aims to prevent the regression or reoccurrence
of the illness in the manner of rehabilitation, as in
the case of disability avoidance and physical
therapy.
Reconstitution
— the adjustment state from the degree of
reaction.
— state of going back to the actual state of health
before the illness occurred.
SISTER CALLISTA ROY
ADAPTATION MODEL
➤ Born on October 14, 1939 in Los Angeles,
California
➤ She is a nurse theorist and a professor at the
William F. Connell School of Nursing at Boston
College, Massachusetts where she educates
doctoral, master’s and undergraduate students.
➤ Roy was a Post-Doctoral Fellow and Robert
Wood Johnson Clinical Nurse Scholar at the
University of California, San Francisco.
➤ She earned her Bachelor of Science in Nursing in
1963 from Mount Saint Mary College, Los
Angeles.
➤ Her Master’s Degree in Pediatric Nursing was
finished in 1966.
➤ Doctorate in Sociology was conferred on her in
1977 from the University of California, Los
Angeles.
➤ Dr. Roy is best known for her work on the Roy
Adaptation Model of Nursing
❈ METAPARADIGM IN NURSING
➣ Person
— as a biopsychosocial being in constant
interaction with a changing environment.
— the person is an open, adaptive system who
uses coping skills to deal with stressors.
— An adaptive system has cognator and regulator
subsystems which act to maintain adaption in the
four adaptive modes: physiological, self-concept
group identity, role function, and interdependence.
➣ Health
— the process of being and becoming an
integrated and whole person.
— Adaptation is defined as the process and
outcome whereby thinking and feeling as
individual and in groups, use conscious aware-
ness and choice to create human and environ-
mental integration.
➣ Environment
— conditions, circumstances and influences that
surround and affect the development and behavior
of the person.
— she described stressors as stimuli and uses the
term ‘residual stimuli’ to describe those stressors
whose influence on the person are not clear.
— Three kinds of stimuli:
• Focal
• Contextual
• Residual
➣ Nursing
— the science and practice that expands adaptive
abilities and enhances person and environment
transformation.
— Roy’s goal of nursing is the promotion of
adaptation in each of the four modes.
❈ ROY ADAPTATION MODEL
The Roy Adaptation Model contains the
following key concepts:
• The person is adapting in a stable interaction with
the environment, either internal or external.
• The environment serves as the source of a range
of stimuli that will either threaten or promote the
person’s unique wholeness.
• The person’s major task is to maintain integrity in
face of these environmental stimuli.
Integrity — the degree of wholeness achieved by
adapting to changes in needs. (Roy and Andrews,
1999)
Types of Stimuli
Those most immediately
FOCAL confronting the person, it attracts
the most attention.
All other stimuli that strengthens
CONTEXTUAL
the effect of the focal stimulus.
Those stimuli that can affect the
RESIDUAL focal stimulus but the effects are
unclear.
The three types of stimuli act together and
influence the adaptation level which is defined as
the ability to respond positively in a situation.
Two Categories of Coping Mechanisms:
1. Regulator subsystem - transpires through
neutral, chemical and endocrine processes
like the increase in vital signs—sympathetic
response to stress.
2. Cognator subsystem - occurs through
cognitive-emotive processes.
Two Control Processes:
1. Stabilizer subsystem
2. Innovator subsystem - allows the person to
change to higher levels of potential through
cognitive and emotional strategies.
Roy suggest that although direct observation
of the processes of the regulator and cognator
subsystem is not possible, the behavioral responses
of these two subsystem can be observed in any of
the four adaptive modes, namely:
• Physiological
• Self-concept
• Role function
• Interdependence adaptive modes
Roy’s theory of the Person as an Adaptive
System claims that the four adaptive modes are
interrelated through perception. An adaptive or
ineffective response in one mode can influence
adaption in the other modes.
ADAPTIVE I Coping mechanism from close
INDIVIDUAL GROUP
MODES N relationship which results to giving and
T receiving of love, respect and value.
The way a person responds as a physical E Occurs between the person and the most
P being to stimuli from the environment
R significant other or between the persons
H Goal: Physiological Integrity D and support system.

Y E
S Five Physiological Operating P Goal: Affectional Integrity
I Needs - oxygenation, Resources: E Need is to
O nutrition, elimination, participants, N Need is achieve achieve relational
L activity and rest, and capacities, D relational integrity integrity using
O protection
physical facilities E using process of process of
G Four Complex and fiscal N affectional adequacy. developmental
I Processes - senses; resources C and resource
C fluids, electrolyte, and E adequacy
A acid-base balance;
L neurologic function,
endocrine function NURSING PROCESS
— is a goal-oriented, problem-solving
Psychological and spiritual characteristics approach to guide the provision of comprehensive,
of the person consist of all beliefs and competent nursing care to a person or group of
feelings that one has formed about persons.
oneself.

They incorporate two components:

physical self (body sensation & image) Six steps in the Nursing Process:
S and personal self (self consistency, self NURSING PROCESS
E ideal and moral ethical spiritual self)

L Definition: A problem-solving approach for gathering

F Goal: Psychological Integrity data, identifying the capacities and needs of the
human adaptive system, selecting and implementing
C Need is a psychic and Need is group approaches for nursing care and evaluation the
O spiritual integrity so identity integrity outcome of care provided.
N that one can be or through shared
C exist with a sense of relations, goals, STEP 1: Assessment of Behavior
E unity, meaning, and values, and
Data gathering about the behavior of the person as
P purposefulness in the responsibility for
T universe. goal an adaptive system in each of the adaptive modes.
achievement; Observable behavior: Vital Signs (temperature,
implies honest pulse rate, respiratory rate, blood pressure)
soundness, and Non-observable behavior: Feelings experienced
completeness of by the person (anxiety)
identifications
with the group STEP 2: Assessment of Stimuli
A stimulus is defined as any change in the internal
Primary, secondary and tertiary roles that and external environment that induces a response in
a person performs in the society.
the adaptive system.
According to Roy and Andrew (1991), a
role is a set of expectations bout how a — in this level of assessment the nurse analyzes the
person occupying one’s position behaves subjective and objective behaviors and look more
towards a person occupying another deeply for possible causes of a particular set of
position.
behaviors.
R
Goal: Social Integrity
O STEP 3: Nursing Diagnosis
L
Need is social Needs is role Formulation of statement that interpret data about
E
integrity; knowing one clarity, the adaption status of the person, including the
who is in relation to understanding behavior and most relevant stimuli.
F
others so one can act; and committing
U
role set is complex of to fulfill expected STEP 4: Goal Setting
N
positions individual task so group
C Establishment of clear statement of the behavioral
holds; involves role can achieve
T outcomes for nursing care which is realistic and
development, common goals;
I attainable. This is done together with the client.
instrumental and process on
O
expressive behaviors, integrating roles
N STEP 5: Intervention
and role taking in managing
process. different roles Determination of how best to assist the person in
and their attaining the established goals.
expectations,
complementary STEP 6: Evaluation
roles are Judging the effectiveness of the nursing intervention
regulated. in relation to the behavior after it was performed in
comparison with the goal established.
 IMOGENE KING action, and has the ability to record their history
through their own language and symbols
GOAL ATTAINMENT THEORY ➣ Health
— the ability of a person to adjust to the stressors
➤ Earned a diploma in nursing from St. John’s
that the internal and external environment
Hospital of Nursing in St. Louis, Missouri, in 1945
exposes to the client.
➤ She began a course work toward a Bachelor of
— it is the maximal use of the potentials that a
Science in Nursing education, which she
person can perform to achieve balance in one’s
received from St. Louis University in 1948.
health.
➤ From 1947 - 1958, King worked as an instructor
— adjusting to the environment bring the client
in Medical-Surgical Nursing and an assistant
back to their usual roles before the reaction
director at St. John’s Hospital of Nursing.
occurred.
➤ She earned an MSN (1957) from St. Louis
➣ Environment
University
— the process of balance involving internal and
➤ A Doctor of Education (1961) from Teachers
external interactions inside the social system.
College, Columbia University, New York.
— reactions from the interaction between the
➤ Awarded an honorary PhD from Southern Illinois
internal and external environment can be
University in 1980.
biological, psychological, physical, social or
➤ From 1961 - 1966, King was an Associate
spiritual.
Professor of Nursing at Loyola University in
Chicago, where she developed a Master’s • External environment - the factor that exists
outside the boundary of the open system.
Degree program in Nursing based on a nursing
conceptual framework. • Internal environment - the exact opposite as
adapted by Neuman’s System Model.
➤ She served as Assistant Chief of research Grants
— the environment has a direct exchange of
Branch, Division of Nursing in the United States
information between the internal and external
Department of Health, Education and Welfare.
environment.
➤ From 1968 - 1972, King was the director of the
➣ Nursing
School of Nursing at Ohio State University in
— an act wherein the nurse interacts and
Columbus.
communicates with the client.
➤ In 1972, she returned as a professor in the
— the nurse helps the client identify the existing
Loyola University graduate programs.
health condition, exploring and agreeing on
➤ She served as the Coordinator of Research in
activities to promote health.
Clinical Nursing at the Loyola Medical Center,
— the goal of the nurse in King’s theory is to help
Department of Nursing, from 1978 - 1980.
the client maintain health through health
➤ From 1972 - 1975, she was a member of the
promotion and maintenance, restoration and
Defense Advisory Committee on Women in the
caring for the sick and dying.
Services for the United States Department of
Defense.
❈ INTERACTING SYSTEM FRAMEWORK
➤ In 1981, the manuscript for her second book
King proposed that the nurse interacts in the
entitled A Theory for Nursing: Systems,
system simultaneously at three different levels.
Concepts, Process was published.
These levels are independent and at the same
➤ King retired in 1990 and is currently professor
time co-exist to influence over-all nursing practice.
emeritus at the University of South Florida, where
Personal — how the nurse views and integrates
she continue to lecture.
self based from personal goals and belief.
Interpersonal — how the nurse interrelates with a
❈ METAPARADIGM IN NURSING
co-workers or patient, particularly in a nurse-client
King’s model is composed of three interacting
relationship.
systems; these are Personal, Interpersonal and
Social — how the nurse interacts with co-workers,
Social Communication.
superiors, subordinates and the client environment
— these are used to establish a nurse-client
in general.
relationship and utilized by the nurse to form a
strong foundation for a dynamic and interactive
❈ GOAL ATTAINMENT THEORY
environment.
Action
Three Health Needs of Human Being:
— is a means of behavior or activities that are
1. Need for information
towards the accomplishment of certain act.
2. Need for care for illness prevention and
— it is both physical and mental.
3. Need for total care when a person doesn’t have
— actions are aimed towards setting goals
the capacity to help themselves.
through communication between the nurse and
The theory focuses on creating a positive the client then exploring and agreeing means to
behavior that can be adapted both by the nurse and perform them thereby achieving the set goal.
client to achieve goals established by the client with Reaction
the help of a nurse. — in King’s theory, reaction is not specified but
➣ Person somehow relates reaction as part of action.
— King described a person existing in an open — according to her reaction is a form reacting or
system as a spiritual being and rational thinker response to a certain stimuli.
who makes choices, selects alternative courses of Interaction
 — is any situation wherein the nurse relates and
deals with a clientele or patient.
Open System
— is the absence of boundary existence, where a
dynamic interaction between the internal and
external environment can exchange information
without barriers or hindrances.
❈ PROPOSITION OF KING’S GOAL ATTAINMENT
THEORY
King gave a proposal wherein goal attainment
is possible if the nurse will fulfill several conditions:
If a continuous accuracy is currently is a nurse-
patient interactions, a transaction will happen
If nurse and patient will build a transaction, goal
will be achieved
If goals are achieved, satisfaction will happen
If goals are met, efficient nursing care will happen
If transactions are done in a nurse-client
interaction, growth and development will be
increase
If role anticipation and performance in the nurse
and patient are the same, transaction will happen.
If role disagreement happens in both nurse and
patient, stress would be the result
If nurse with exceptional skill and knowledge
correspond adequate information to patient, the
same goals and accomplishment will happen
HILDEGARD PEPLAU
INTERPERSONAL RELATIONS THEORY
➤ The “Psychiatric Nurse of the Century”
➤ Born on September 1, 1909 at Reading,
Pennsylvania.
➤ Successfully graduated from Pottstown,
Pennsylvania Hospital School of Nursing in 1931.
➤ In 1943, she received a Bachelor of Arts in
Interpersonal Psychology from Bennington
College, Vermont.
➤ A Master’s of Arts in Psychiatric Nursing from
Teacher’s College, Columbia, New York, in 1947.
➤ A Doctoral of Education in Curriculum
Development from Columbia in 1953.
➤ She became a member of the Army Nurse Corps
and worked in a neuropsychiatric hospital in
London, United Kingdom during World War II.
➤ She worked at Bellevue and Chestnut lodge
Psychiatric Facilities and worked with renowned
psychiatrists Freida Fromm-Riechman and Harry
Stack Sullivan.
➤ Hildegard Peplau had been considered as one of
the renowned nursing leader of her time that her
writings and research are repeatedly featured at
the American Journal of Nursing from 1951 to
1960.
➤ Her first book, “Interpersonal relations in
Nursing” published in 1952, was one of the first
book that stated the need to emphasize
importance of the nurse-patient relationship in
providing health care.
❈ METAPARADIGM IN NURSING
➣ Person
— a man who is organism that lives in an unstable
balance of a given system.
➣ Health
— a word that symbolizes movement of the
personality and other outgoing human processes
that directs the person towards creative,
constructive, productive, and community living.
— one’s health to be achieved and maintained,
his needs must be met. These needs are
physiological demands and interpersonal
conditions.
➣ Environment
— forces outside the organism and in the context
of the socially-approved way of living.
➣ Nursing
— as a significant, therapeutic interpersonal
process.
— it functions cooperatively with human
processes the present health as a possible goal
for individuals.
❈ INTERPERSONAL RELATIONS THEORY
Peplau 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
relationship.
Phases of Nurse-Patient Relationship
The initial interaction between
the nurse and the patient
wherein the latter has a felt need
and expresses the desire for
1. ORIENTATION
professional assistance.
The nurse assist the patient in
recognizing and understanding
the “patient” experience.
The patient and the nurse
explore the experience and the
needs of the patient which leads
to a feeling of relatedness. It is
2. IDENTIFICATION very important in the relationship
that the nurse assist the patient
on reorienting his feelings and
sustaining a constant positive
environment.
In this phase, the patient derives
the full value of the relationship
as he moves on from a
dependent role to an
3. EXPLOITATION independent one. New goals are
projected by the nurse, but the
power is shifted to the patient as
these goals would be achieved
through personal or self-effort.
In its final stages, the patient
earns independence over his
care as he gradually puts aside
old goals and formulates new
ones. Even though the patient
and the nurse end the
4. RESOLUTION
relationship, it is very apparent
that the experience leaves a
lasting impressions on the
patient since illness and
assuming a dependent role is a
unique human experience.
 The Interpersonal Therapeutic Process is
based on the theory proposed by Peplau and
particularly useful in helping psychiatric patients
become receptive for therapy.
Often referred by Peplau as “Psychological
Mothering”, it includes the following steps:
• The patient is accepted unconditionally as a
participant in a relationship that satisfies his needs
• There is recognition of and response to the
patient’s readiness for growth, as his initiative; and
• Power in the relationships shifts to the patient, as
the patient is able to delay gratification and to
invest in goal achievement.
JOYCE TRAVELBEE
HUMAN-TO-HUMAN RELATIONSHIP MODEL
➤ Born in 1926
➤ She was a psychiatric nurse, educator and writer.
➤ She completed her Bachelor of Science degree
in nursing education at Louisiana State University
& her Master of Science Degree in Nursing from
Yale University in 1959.
➤ She started a doctoral program in Florida in
1973. Unfortunately, she was not able to finish
the program because she died later that year.
➤ In 1952, Travelbee started to be an instructor
focusing in Psychiatric Nursing at Depaul
Hospital Affiliate School, New Orleans.
➤ She also taught Psychiatric Nursing at Charity
Hospital School of Nursing in Louisiana State
University, New York University and University of
Mississippi.
➤ In 1970, she was named Project Director at Hotel
Dieu School of Nursing in New Orleans.
➤ Travelbee was the director of Graduate
Education at Louisiana State University School of
Nursing until her death.
➤ In 1963, Travelbee started to publish various
articles in nursing journals.
➤ Her first book entitled Interpersonal Aspects of
Nursing was published in 1966 and 1971.
➤ In 1969, she had her second book published
entitled Intervention in Psychiatric Nursing:
Process in the One-to-One Relationship.
❈ METAPARADIGM IN NURSING
➣ Person
— defined as a human being. Both the nurse
and patient are human being.
— a human being is a unique, irreplaceable
individual who is in the continuous process of
becoming, evolving and changing.
➣ Health
— measured by subjective and objective
health.
• Subjective health — is an individually defined
state of well-being in accord with self-appraisal of
physical-emotional-spiritual status.
• Objective health — “an absence of discernible
disease, disability or defect as measured by
physical examination, laboratory tests assessment
by a spiritual director, or by psychological
counselor.
➣ Environment
— Environment was not clearly defined in
Travelbee’s theory.
— she defined human conditions and life
experiences encountered by all men as sufferings,
hope, pain and illness. These conditions are
associated to the environment.
➣ Nursing
— is “an interpersonal process whereby the
professional nurse practitioner assists an individual,
family or community to prevent or cope with the
experience of illness and suffering and, if necessary,
to find meaning in these experiences.”
— nursing is an interpersonal process
because it is an experience that occurs between the
nurse and an individual or group of individuals.
❈ HUMAN-TO-HUMAN RELATIONSHIP MODEL
Original Encounter
— described as the first impression by the
nurse of the sick person and vice-versa.
— the nurse and patient see each other in
stereotyped or traditional roles.
Emerging Identities
— described by the nurse and patient
perceiving each other as unique individuals.
— at this time, the link of relationship begins
to form.
Empathy
— The two qualities that enhance the
empathy process are similarities of experience and
the desire to understand another person.
— This phase is described as the ability to
share in the person’s experience.
— The result of the empathic process is the
ability to expect the behavior of the individual with
whom he or she empathized.
Sympathy
— happens when the nurse wants to lessen
the cause of the patient’s suffering.
— it goes beyond empathy.
— “when one sympathizes, one is involved
but not incapacitated by the involvement.”
— the nurse should use a disciplined
intellectual approach together with therapeutic use
of self to make helpful nursing actions.
Rapport
— described as nursing interventions that
lessen the patient’s suffering.
— “A nurse is able to establish rapport
because she possesses the necessary knowledge
and skills required to assist ill persons, and because
she is able to perceive, respond to, and appreciate
the uniqueness of the ill human being.
Note: The above stated interactional phases are in
consecutive order and developmentally achieved by
the nurse and the patient as their relationship with
one another goes deeper and more therapeutic.
MADELEINE LEININGER
TRANSCULTURAL THEORY IN NURSING
➤ The creator of the Transactional Subfield of
Nursing.
➤ She obtained her basic nursing education at St.
Anthony School of Nursing, Denver, Colorado,
and graduated in 1948.
➤ She merited her Bachelor of Science degree from
Benedictine College, Atchison, Kansas.
➤ She obtained her degree of Master of Science
(Doctor of Philosophy) in Anthropology from the
University of Washington, Seattle.
➤ She was conferred an PhD (Doctor of Humane
Letters, honorably given) from Benedictine
College.
➤ Leininger first used the terms “transcultural
nursing,” “ethnonursing,” and “cross-cultural
nursing” in the 1960s.
❈ METAPARADIGM IN NURSING
➣ Person
— Human beings are best explained in her
assumptions.
— Humans are believed to be caring and capable
of being concerned about the desires, welfare and
continued existence of others.
— Human care is collective
— Leininger indicates that nursing as a caring
science should focus ahead of traditional nurse-
patient interactions to include “families, groups,
communities, total cultures, institutions” as well as
worldwide health institution and ways to expand
international nursing care policies and practices.
➣ Health
— She discussed about components of health,
specifically:
• Health systems
• Health care practices
• Changing health patterns
• Health promotions
• Health maintenance
— Health is a key concept in transcultural nursing.
— Health is both universal and diverse.
➣ Environment
— Leininger speaks about worldview, social
structure, and environmental context.
— Environment framework is defined as being
the totality of an event, situation, or experience.
— Her description of culture centers on a
particular group (society) and the patterning of
actions, thoughts and decisions that occurs as the
result of “learned, shared, and transmitted values,
beliefs, norms, and life ways”.
— This learning, sharing, transmitting and
patterning takes place within a group of people
who function in an identifiable setting or
environment.
— Leininger does not use the specific terms of
society or environment, the concept of culture is
closely related to society/environment, and is a
central matter of her theory.
➣ Nursing
— Leininger showed her concern to nurses who
do not have sufficient preparation for a Transac-
tional perspective.
— She gave three types of nursing actions that
are culturally-based and thus consistent with the
needs and values of the clients. These are:
• Cultural care preservation/maintenance
• Cultural care accommodation/negotiation
• Cultural care repatterning/restructuring
— These three modes of action can lead to the
deliverance of nursing care that best fits with the
client’s culture and thus reduce cultural stress and
chance for conflict between client and caregiver.
❈ TRANSACTIONAL THEORY IN NURSING
— Leininger first showed her presentation of the
theory in 1985.
— The concept of culture in Leininger’s theory
borrows its meaning from anthropology.
Culture is the “learned, shared, and transmitted
values, belief, norms, and life ways of a particular
group that guides their thinking, decisions, and
actions in patterned ways”.
— The key component of Leininger’s theory is that
of cultural diversity. This refers to the differences
or variations that can be found both between and
among different cultures.
— Universality, the opposite of diversity, which
refers to the commonalities or similarities that
exist in different cultures.
— these ideas have led to an important
achievement of the theory - that is, “to discover
similarities and differences about care and its
impact on the health and well-being of groups”.
Major Ideas of Cultural Care
The conceptual phenomena related
to helping, supporting, or
empowering experiences or
Care
behaviors to ward others with evident
or anticipated needs to improve a
human condition.
Behavior directed toward assisting
another individual or group with
Caring evident or anticipated needs to
improve the human condition either
to recover or to face death.
The studied, shared, and handed
values, beliefs, norms, and life ways
Culture of a certain group that directs their
thinking, decisions and actions in
certain ways.
The subjectively and objectively
obtained values, beliefs and outlines
of the life ways that assist, support,
Culture Care facilitate or empower another
individual/group to maintain well-
being, health, and deal with illness,
handicaps or death.
The changeable differences in
meanings, patterns, values, and
Culture Care
symbols that is observed among
Diversity
many cultures and reflect assistive
ways to help people.
The common, general definitions of
care with its patterns, values, and
Culture Care
symbols that is observed among
Universality
many cultures and reflect assistive
ways to help people.
 Studied scientific and humanistic
profession and discipline that centers
on human care activities that assist,
support, facilitate, or enable
Nursing individuals or group to maintain or
regain their well being (or health) in
culturally meaningful and beneficial
ways, or to help people face
handicaps or deaths.
The method people seem to look out
on the world and/or universe to form
Worldview
a picture or value perception about
their life or world around them.
The changing patterns related to the
arrangement/organizational factors of
Cultural and a particular culture (subculture or
Social society), which includes religious,
Structure kinship (social), political (and legal),
Dimensions economic, educational,
technological, and cultural values
and ethnohistorical factors.
The summation of an event, situation,
or particular experience that gives
Environmental meaning to human expressions,
Context particularly physical, ecological,
sociopolitical, and/or cultural
situations.
the supporting, facilitative, or
enabling specialized actions and
Cultural Care
decisions that help people of
Accommodati
designated culture to adapt to others
on or
for a beneficiary or satisfying health
Negotiation
outcome with professional care
providers
The assistive, sustaining, facilitative
or enabling professional actions and
decisions that help clients greatly
Cultural Care change their life ways for new,
Repatterning different, and beneficial healthcare
or patterns while regarding the client’s
Restructuring cultural values and beliefs and still
giving a beneficial or healthier life
way before the changes were laid out
with the clients.
the cognitively based assistive,
caring, facilitative, or empowering
acts or decisions that are made to fit
Cultural
with individual, group, or institutional
Congruent
cultural values, beliefs, life ways to
(nursing) Care
offer or carry meaningful, beneficial,
and satisfying healthcare or
well0being services.

Past facts, events, and experiences

of individuals, groups, and various
cultures and institutions that are
Ethnohistory mainly people-centered (ethnic) and
that explains, and interprets human
life ways within particular cultural
trends.

Culturally studied and given,

indigenous (or traditional), folk
(community and home-based)
knowledge and skills used to provide
assistive, supportive, enabling, or
Generic (Folk
facilitative acts toward or for another
or Lay) Care
individual, groups, or institution with
System
evident or anticipated needs to
ameliorate or improve a human life
way or health condition (or well
being), or to deal with handicaps and
death situations

Formally educated, and instructed

professional care, health, illness,
Professional
wellness and related knowledge and
Care System
practice skills that exist in
professional

The state of well-being that is defined

through cultures valued and
practiced, and reflects the ability of
Health
individuals to perform their daily role
activities in culturally expressed,
beneficial and patterned styles.

Caring skilled actions and decisions

Cultural Care that people of a certain culture retain
Preservation important care values so that they
or can keep up their well being, recover
Maintenance from illness, or face handicaps or
death