WEEK 1: THEORETICAL
FOUNDATIONS IN NURSING
DEFINITIONS OF NURSING
Nursing as an Art
 Is the art of caring for the sick and
well individual.
 It refers to the dynamic skills and
methods in assisting sick and well
individual in their recovery and in the
promotion and maintenance of health.
 There is a rationale, and it is
systematic
 It is the way nursing knowledge is
expressed
 It is the heart of nursing
 It involves feeling gained by
experience
 Sensitivity and empathy is
important facet of this definition
 Enable the nurse to be aware of
the client’s perspective and be
attentive to verbal and non-verbal
cues to the client’s physiologic state
Nursing as a Science
 Is the scientific knowledge and skills
in assisting individual to achieve optimal
health.  
 It is the diagnosis and treatment of
human responses to actual or potential
problem.
 Cognitive brain of nursing
 Include knowledge from nursing
research
 Facts and information necessary for
performing technical skills
 Interpersonal relationships and
communication is a part
 Sociocultural and developmental
factors affect client’s behavior
 A - Assessment
 D - Diagnosis
 P - Planning
 I - Intervention
 E – Evaluation
ERA IN NURSING
1. Period of Intuitive Nursing
2. Period of Apprentice Nursing
3. Period of Educative/ Educated
Nursing
4. Period of Contemporary Nursing
PERIOD OF INTUITIVE
NURSING
 Practiced since pre-historic times
among primitive tribes and lasted
through the early Christian era.
 Nursing was untaught and
instinctive.
 Performed out of compassion for
others and helping others.
Trephining
 (6500 BC) The first known surgery
was probably Trephining, or drilling
the skull. This may have been a cure
for headache. The remains of skulls
where the hole has healed suggest
that some patients even survived the
operation.
He was a nomad > the best
for the most > law of self-
preservation
 Nursing was a function that
belonged to women > sick,
aged, children
 Illness is caused by the
invasion of the victim’s body
by evil spirit through the use
of black magic or voodoo
 Medicine man called
“shaman: > white magic,
trephining (drilling of the hole
into the skull with a rock or
 stone without the benefit of
anesthesia as a last resort to
drive evil spirits from the
body.
Important Events During Intuitive
Nursing
1. Growth of Religion
2. Growth of Civilization
a. Near East
b. Far East
c. Ancient Greece
d. Ancient Rome
Nursing in the Near East
 Mode of Nomadic life > Agrarian
society > Gradual development of
urban community life
 Existence of means of
communication and start of scientific
knowledge
 Nursing as a duty of SLAVES and
WIVES.  C. ISRAEL
 Birth of 3 religious ideologist:
 Judaism
 Christianity
 Mohammedism or Islam
 NURSING DID NOT CHANGE
but there was progress in the
practice of Medicine.
 Care of the sick was still closely
allied with superstitions, religion
and magic
Contributions to Medicine and
Nursing
A. BABYLONIA
 CODE OF HAMMURABI
 1 recording on the
st
medical practice
 Established the medical
fees
 Discouraged
experimentation
 Specific doctor for each
disease
 Right of patient to choose
treatment between the
use of charms, medicine,
or surgical procedure
B. EGYPT
 ART OF EMBALMING
 Mummification,
removing the internal
organs of the dead
body, instillation of herbs
and salt to the dead.
 Used to enhance their
knowledge of the human
anatomy.
 Documentation about
250 diseases and
treatments.
 Slaves and patient’s
families nursed the sick.
 TEACHING OF MOSES
 Practice of
HOSPITALITY and
CHARITY.
 Laws of control of
spread of communicable
disease and the ritual of
circumcision of male
child.
 Referred to nurses as
midwives, wet nurse or
child’s nurse.
 Moses was recognized
as the “Father of
Sanitation”
Nursing in the Near East
Contributions to Medicine and Nursing 
A. CHINA
 MATERIA MEDICA
(pharmacology)
     Book that indicates the
pharmacologic drug used for
treatment

 No knowledge on
anatomy
 Use of wax to preserve
the body of the dead
 Use of pharmacologic
drugs.
 Believed that in using
girl’s clothes for male
babies keep evils away
from them  healing power). At the apex of the
FACTOR THAT HAMPERED THE
ADVANCEMENT OF MEDICINE:
Prohibits dissecting of human body as a
worship to ancestors thus thwarting
scientific study
A. INDIA
 SUSHURUTU    standards for clients, established
 Sushurutu made a list of function
and qualifications of nurses. This
was the first reference to nurse’s
taking care of the patient’s.
 Hampered by Taboos
due to social structures
and practices of animal
worship.
 Medicine men built
hospitals.
 They use intuitive
form of asepsis
 There was
proficient practice
of Medicine and
Surgery
Asepsis – “a” means absence, absence or
presence of microorganisms.
NURSES QUALIFICATIONS:  the Christian World.
 Lay Brothers, Priest Nurses,
combination of Pharmacist,
Masseurs, PT, cooks
 There was also decline in Medical
practice due to fall of Buddhism
Nursing in Ancient Greece - Nursing
was a task of untrained slave.
Caduceus
 Insignia of medical profession
today
 Composed of staff of travelers
intertwined with 2 serpent (the
symbol of Aesculapius and his
staff are two wings of Hermes
(Mercury) for speed
Hippocrates
 Father of Scientific/Modern
Medicine.
 1st to reject the idea that diseases
are caused by evil spirits. 
 He also developed assessment
overall medical standards,
recognized a need for nurses. 
 Practice medical ethics.
Nursing in Ancient Rome
 Paganism → Christian philosophy
 Romans’ Motto: “If you’re strong,
you’re healthy.”
 The Romans attempted to maintain
vigorous health, because illness was
a sign of weakness.
 Care of the ill was left to the slaves
or Greek physician
Fabiola
 Converted to Christianity by Marcella
and Paula
 Made her home the first hospital in
PERIOD OF APPRENTICE
NURSNG
 11th century -1836
  “On The Job” Training Period
 It ended in 1836, when Pastor
Fliedner and his wife established the
Kaiserweth Institue for Training of
Deaconesses in Germany.
 Performed out of compassion for
others and helping others.
 Nursing care was performed without
any formal education and by people
who were directed by more
experienced nurses.
 Religious orders of the Christian
Church were responsible for the
development of this kind of nursing.
The Crusades
 Where Holy wars waged in
attempt to recapture the Holy Land
from the Turks who denied Christ’s
pilgrims permission to visit the Holy
Sepulcher.
 Military religious orders
established hospitals staffed with
men.
Military Religious Orders and their
Works
Knight of St. John of Jerusalem (Italian)
 Also called as “Knights of the
Hospitalers”
 Established to give care
Teutonic Knights (German)
 Took subsequent wars in the Holy
Land
 Cared for the injured and
established ten hospitals in the
military camps
Knights of St. Lazarus
 Care for those who suffered
Leprosy, syphilis, and chronic skin
diseases
 was founded and primarily for the
nursing care of lepers in Jerusalem
after the Christians had conquered
the city.
Alexian Brothers
 founded in 1348. 
 established the Alexian Brothers
School of Nursing, the largest
School under religious auspices
exclusively in US and it closed down
in 1969.
The Rise of Secular Orders
 Queens, princesses and other ladies
of royalty founded many religious
orders.
 Christianity = Men, women still
concentrated as wives and mothers.
Only by entering convent that she
could:
 Follow a career
 Obtain an education
 Perform acts of charity
 Religious taboos and social
restrictions influenced nursing
Founded Secular Orders
1. Order of St. Francis of Assisi
(1200 – present)
Believed in devoting lives to poverty and
service to the poor
Franciscan Order 
 First Order . Founded by St. Francis
Assisi
 Second Order (Poor Clares).
Founded by St. Clare of Assisi
 Third Order (Tertiary Order).
Devoted in performance of acts of
mercy and provided nursing care in
homes and hospitals.
2. The Beguines
 Composed of lay nurses who
devoted their lives in the service of
suffering humanity. Founded in 1170
by priest Lambert Le Begue.
3. The Oblates
 4. Benedectines
5. Ursulines
6. Augustinians
Important Nursing Personages
St. Clare
 Took vows of poverty, obedience to
service and chastity
 Founded the 2nd order of St. Francis
of Assisi
St. Elizabeth of Hungary
 The patroness of Nursing
 A princess, daughter of a Hungarian
king
 Sees her calling to give care for the
sick
 Fed thousands of hungry people
St. Catherine of Siena
 25th child of a humble Italian parents
 “Little Saint” – took care of the sick
as early as 7y/o
 “1st Lady with a Lamp” 
St. Vincent De Paul
 He organized the charity group
called the “La Charite” and the
“Community of Sisters of
Charity”  Martin Luther, the war was a
 He founded the “Sisters of Charity
School of Nursing” in Paris,
France where Florence Nightingale
had her 2nd formal education in
Nursing.
Louise de Gras
 Was the 1st Superior and co-founder
of the Community of Sisters of
Charity
THE CRUSADES
 The masses of people huddled in
slums as a result of famine, wars
and industrial revolution
 Living in slum areas is the brutal
and immoral way of living.
 Ambition for power and the
antagonism replaced human
empathy
 Class lines were established
 Skepticism 
 Older nuns prayed with and took
good care of the sick, while
younger nuns washed soiled
linens, usually in the rivers. 
 In 16th century, hospitals were
established for the care of the
sick where hospitals were
gloomy, cheerless, airless and
unsanitary. People entered
hospitals only under compulsion
or as a last resort.
The “Community of Sisters of
Charity” composed of women
dedicated in caring for the sick, the
poor, orphaned, and the widowed.
The Dark Period of Nursing
 17th century – 19th century
 Also called the Period of
Reformation until the American Civil
War.
 The American Civil War was led by
religious upheaval that resulted to
the destruction in the unity of
Christians.
 The conflict swept everything
connected to Roman Catholicism in
schools, orphanages, and hospitals.
 Hospitals were closed
 Nursing were the works of the least
desirable people (criminals,
prostitutes, drunkards, slaves, and
opportunists)
 Nurses were uneducated, filthy,
harsh, ill-fed, overworked
Nursing in America
 Nursing During the Civil War
 The American Medical Association
created the Committee on Training
of Nurse. 
  It was designated to study and make
recommendations with regards to
the training of nurses.
 Important Personages
 Dorothea Lynde Dix. Established
the Nurse Corps of the US Army.
 Clara Barton. Founded the
American Red Cross.
PERIOD OF EDUCATED
NURSING
 Began on June 15, 1860 when the
Florence Nightingale School of
Nursing opened at St. Thomas
Hospital in London.
The development of nursing from this
period was strongly influenced by:
 Trends resulting from wars
 From an arousal of social
consciousness
 From the emancipation of women
 From the increased educational
opportunities offered to women.
Popularization of the Philosophy of the
Nightingale System
 Importance of nursing education  technological development, social
 Nurses teaching students  changes occurring after the war.
 Specialization developed
Florence Nightingale
 Mother of Modern Nursing
 Lady with the Lamp
Born on May 12, 1820 in Florence,
Italy
 Her SELF-APPOINTED GOAL – to
change the profile of Nursing
 She compiled notes of her visits to
hospitals, her observations of
sanitation practices and entered
Deaconesses School of Nursing
at Kaiserwerth, Germany for 3
months.
 Became the Superintendent of the
Establishment for Gentle Women
during the Illness
 She disapproved restriction on
admission of patient and considered
this unchristian and contrary to
health care.
 Upgraded the practice of Nursing
and made Nursing a honorable
profession
 Led other nurses in taking care of
the wounded and sick soldiers
during the Crimean War
 She was designated as
Superintendent of the Female
Establishment of English General
Hospital in Turkey during the
Crimean War
She reduced the casualties of war by 42%-
2% thru her effort by improving the practice
of sanitation techniques and procedure in
the military barracks
PERIOD OF CONTEMPORARY
NURSING
 World War II – present
 This refers to the period after World
War I and the changes and
development in the trends and
practice of Nursing occurring since
1945 after World War II.
 Includes scientific and
 Nursing is offered in College and
Universities
Development and Trends
 W.H.O established by U.N to fight
diseases by providing health
information, proper nutrition, living
standard, environmental conditions.
 The use of Atomic energy for
diagnosis and treatment.
 Space Medicine and Aerospace
Nursing
 Medical equipment and machines for
diagnosis and treatment
 Health related laws
 Primary Health Care – Nurses
involvement in CHN
 Utilization of computers
  Technology advances such as
development of disposable
equipment and supplies that relieved
the tedious task of Nurses.
 Development of the expanded role
of Nurses  “Planned Parenthood”
 Use of sophisticated equipment for
diagnosis and therapy 
 Health is perceived as a
fundamental human right  
 Nursing involvement in community
health is greatly intensified
 Professionalization of nursing  Service (FNS)”
Nursing Leaders
Florence Nightingale
 She was the 1st nurse to exert
political pressure on government
 Notes on Nursing: What It is and
What It Is Not – her greatest
achievement ; made her be
recognized as nursing’s 1st scientist-
theorist
 She was given an honorarium of
4500 and used it to develop
Nightingale Training School for
Nurses, which was opened in 1860.
Clara Barton
 A school teacher who volunteered
as nurse during the American Civil
War
 Established the American Red Cross
Lavinia L. Dock
 She participated in protest
movements for women’s rights
which granted women to vote.
 Campaigned for legislation to allow
nurses rather than physicians to
control their professions.
 Founded the American Society of
Superintendents of Training Schools
for Nurses on the United States and
Canada – precursor to the current
National League for Nursing.
Margaret Higgins Sanger
 Public health nurse in New York
 Had a lasting impact on women’s
health care
 Imprisoned for opening the 1st birth
control information clinic in America
 Considered to be the founder of
Mary Breckinridge
 Notable pioneer nurse
She was a nurse who practice
midwifery
 Established “Frontier Nursing
 She worked with the American
Committee for Devastated France,
distributed food, clothing, and
supplies to rural villages and taking
care of the sick children.
HISTORY OF NURSING IN
THE PHILIPPINES
EARLY BELIEFS, PRACTICES AND
CARE FOR THE SICK
 Beliefs about causation of disease
(evil spirits, enemy or a with) 
 People believed that evil spirits
could be driven away by persons
with powers to expel demons 
 People believed in special gods of
healing, with the priest-physician
and Herbolarios 
 Superstitious beliefs and practices in
relation to health and sickness such
as Herbmen or Herbicheros as one
who practiced witchcraft 
 Persons suffering from diseases
without identified cause were
believed to be bewitched by
“mangkukulam”
The religious orders exerted their efforts
to care for the sick by building hospitals
in the different parts of the Philippines
HEALTH CARE DURING THE
SPANISH REGIME
EARLIEST HOSPITALS
Hospital Real de Manila – 1577
 1st hospital established
 Founded by Gov. Francisco de
Sande
 To give service to king’s Spaniard
soldiers
San Lazaro Hospital – 1578
 Fray Juan Clemente
 Named after the Knights of St.
Lazarus
 Hospital for the lepers
Hospital de Indios – 1586
 Franciscan Orders
 Hospital for the poor Filipino people
Hospital de Aguas Santas – 1590
 Fray Juan Bautista
 Named after its location (near
spring) because people believed that
spring has a healing power.
San Juan de Dios Hospital – 1596
 Brotherhood of Miserecordia
 For poor people 
 Located at Roxas Boulevard
Prominent Personages during the
Philippine Revolution
Josephine Bracken
 wife of Jose Rizal installed a field
hospital in an estate in Tejeros that
provided nursing care to the
wounded night and day.
Rosa Sevilla de Alvaro
 Converted their house into quarters
for Filipino soldiers during the Phil-
American War in 1899.
Maria Agoncilla de Aguinaldo
 Second wife of Emilio Aguinaldo.
 Provided nursing care to Filipino
soldiers during revolution.  Sisters of St. Paul de Chartes.
 President of Filipino Red Cross
branch in Batangas  provided general hospital services
Hilaria De Aguinaldo
 wife of Emilio Aguinaldo organized
the Filipino Red Cross under the
inspiration of Apolinario Mabini 
Melchora Aquino
 nursed the wounded Filipino
soldiers, gave them shelter and
food.
OTHER PERSONAGES
Capitan Salome
 A revolutionary leader in Nueva
Ecija; provided nursing care to the
wounded when not in combat.
Agueda Kahabagan
 Revolutionary leader in Laguna,
also provided nursing services to
her troops 
Trinidad Tecson
 “Ina ng Biac na Bato”, stayed in the
hospital at Biac na Bato to care for
the wounded soldiers.
Hospital and School of nursing
Iloilo Mission Hospital Training School of
Nursing (1906)
 Ran by the Baptist Foreign Mission
Society of America
 Miss Rose Nicolet  1st
superintendent
 March 1944 – 22 nurses graduated
 April 1944 – a board exam was held
outside of Manila. 
 It was held in the Iloilo Mission
Hospital thru the request of Ms.
Loreto Tupas, principal of the
school.
St. Paul’s Hospital School of
Nursing (1907)
 Established by the Archbishop of
Manila, the Most Reverend Jeremiah
Harty under the supervision of the
 
 It was located in Intramuros and it
 with free dispensary and dental
clinic   1st College who offered BSN –
 Rev. Mother Melanie –
Superintendent
 Miss E. Chambers – Principal
Philippine General Hospital (1907)
 1906, Mary Coleman Masters 
trained Filipino girls for nursing
 Elsie McCloskey-Gaches, became
the chief nurse
 Anastacia Giron-Tupas, the 1st
Filipino chief nurse and
superintendent
St. Luke’s Hospital School of Nursing  Nurses in the Philippines
(1907)
 Opened after four years as a   1st president of Filipino Nurses
dispensary clinic.
 Miss Helen Hicks – first principal
 Vitaliana Beltran – first Filipino
superintendent of nurses
 Jose Fores – first Filipino Medical
Director
Mary Johnston Hospital School of
Nursing – 1907
 Was called as Bethany Dispensary,
founded by the Methodist Mission   Pioneer in nursing education
 It became an emergency hospital
during Japanese occupation
 Burned down in 1945
Other Hospital
 Phil. Christian Mission Institute
School of Nursing
 San Juan de Dios Hospital School of
Nursing (1913)
 Emmanuel Hospital School of
Nursing (1913)
 Southern Islands Hospital School of
Nursing (1918)
College of Nursing
UST College of Nursing – 1946
 1947 – 21 Graduate Nurses
 1st College of Nursing in the
Philippines
MCU College of Nursing – 1947
4year program
UP College of Nursing – June 1948
 Miss Sotejo – first dean
Fatima College of Nursing – 1947
FEU Institute of Nursing – June 1955
NURSING LEADER IN THE
PHILIPPINES
Anastacia Giron Tupas
 Founder of Filipino Nurses
Association – established on
October 15, 1922
 1st Filipino chief nurse of PGH
 1st Filipino Superintendent of
Francisco Delgado
Association
Cesaria Tan
 1st Filipino to receive Master’s
Degree in Nursing abroad
Socorro Sirilan
 Pioneer in Social Service at and
Chief Nurse of San Lazaro Hospital
Rosa Militar
Socorro Diaz
 1st editor of PNA magazine called,
“The Message”
Conchita Ruiz
 Full time editor of the PNA newly
named magazine, “The Filipino
Nurse”
MILESTONES OF NURSING
1909
 3 females graduated as “qualified
medical-surgical nurses”
1919
 The 1st Nurses Law (Act # 2808)
was enacted regulating the practice
of the nursing profession in the
Philippine Islands.
1921
 Filipino Nurses Association (now
PNA) was established as the
National Organization of Filipino
Nurses.
1953
 Republic Act 877, known as the
“Nursing Practice Law” was
approved
Discipline vs. Profession
 Discipline is specific to academia
and refers to a branch of
education, a department of
learning, or a domain of
knowledge.
 Profession refers to a specialized
field of practice founded on the
theoretical structure of the
science or knowledge of that
discipline and accompanying
practice abilities.
Significance of Nursing Theory 
HISTORY AND PHILOSOPHY
OF SCIENCE (Week 2)
Rationalism
Rationalist epistemology
 (scope of knowledge)
emphasizes the importance of a
priori reasoning as the
appropriate method for advancing
knowledge
 It is the practice of believing one
reason.
 It focuses on supernatural beliefs
like black magic.
 Experience of humans.
Priori reasoning
 It uses deductive logic by
reasoning from the cause to an
effect or from generalization to a
particular instance.
 It uses logic, like a triangle has 3
sides.
Epistemology
It is the philosophical study of
nature, origin, and natural
knowledge.
Empiricism
 The empiricist view is based on
the central idea that scientific
knowledge can be derived only
from sensory experience. (ex.
Seeing, feeling, hearing facts.)
 It is knowledge based on
experience, senses, or evidence
 All of our knowledge comes
through the use of our senses.
Early Twentieth Century Views
Philosophers focused on the analysis of
theory structure, whereas scientist
focused on empirical research
(Brown,1977). There was minimal
interest in the history of science, the
nature of scientific discovery, or the
similarities between the philosophical
view of science and the scientific
methods.
“Theories evolve”
Positivism
 It is a term first used by Comte,
emerged as the dominant view of
modern science.
Scientist
 He/she answers specific
questions.
Philosopher
 He/she is interested in general
knowledge; asks questions about
everything
Theory of Nightingale
 Environmental Theory
Science Process
1. Create a question – investigate or
seek answer
2. Formulate hypothesis - make
predictions  professional style of theory-based
3. Gather data – interview, survey,
questionnaire
4. Analyze – data from participants
(either quantitative or qualitative)
5. Interpretation – results from the
statistics
6. Draw conclusions – summary of
your findings
7. Recommendations 
History of nursing theory
 The history of professional
nursing began with Florence
Nightingale. 
Florence Nightingale
 She envisioned nurses as a body
of educated women at a time
when women were neither
educated nor employed in public
service.
Curriculum Era
 Addressed the question of what
content nurses should study to learn
how to be a nurse.
 The idea of moving nursing
education from hospital-based
diploma programs into colleges and
universities began to emerge during
this era (Erwin,2015; Judd &
Sitzman, 2013)
 Theory Era 
 It was a natural outgrowth of the
research and graduate education
eras ( Alligood,2014; Im &
Chang,2012).
Significance for the Discipline
1. The significance of theory for the
discipline of nursing is that the
discipline is dependent on theory
for its continued existence.
2. Nursing can be a vocation, or
nursing can be a discipline with a
practice.
3. Commitment to theory-based
evidence for practice is beneficial
to patients in that it guides
systematic, knowledgeable care
NURSING THEORIES (Week 3 and 4)
THEORY
 A supposition or system of ideas that
is proposed to explain a given
phenomenon.
STRUCTURE OF NURSING
 KNOWLEDGE essential for
STRUCTURE LEVEL (Analysis of nurse scientist
theory, clarity, simplicity, generality, who intend to
accessibility, importance) test, expand, or
Structure  It presents the extend the
Level structure and works.
analysis of  Understanding
specialized nursing theoretical
knowledge. framework is
 It was used to vital to applying
organize the units it in practice.
of the text and the
definitions of the B. Clarity  It speaks to the
analysis criteria meaning of term
used for the review used, and
process of the definitional
theoretical works.  consistency and
structure speak
A. Analysi  Analysis, to the consistent
s of critique and structural form
Theory evaluation are of terms in the
methods used to theory. 
study nursing  Words have
theoretical multiple
works critically. meanings within
 Analysis of and across
theory is carried disciplines;
out to acquire therefore a word
knowledge of should be
theoretical defined
adequacy. specifically
 It is a important according to the
process and the framework
first step in (Philosophy,
applying nursing conceptual
theoretical model, theory,
works to or middle range
education theory).
research,
administration or C. Simplici  It is highly
practice. ty valued in
 Analysis nursing theory
process is development.
useful for  It discuss the
learning about degrees of
the works and is simplicity and
 call for simple B. Accessi “Accessible
forms of theory, bility addresses the
such as middle extent to which
range, to guide empiric
practice.  indicators for the
 Complex concepts can be
practice identified and to
situation may what extent the
call for more purposes of the
complex theory.  theory can be
 A theory should attained”
be sufficient,  It is vital to
comprehensive, developing
presented at a nursing
level of research to test
abstraction to theory. It
provide facilitate testing,
guidance, and because the
have as few empirical
concepts indicators
possible with a provide linkage
simplistic too practice for
relation as test ability and
possible to aid ultimate use of
clarity. theory to
describe and
A. General  It speaks to the test aspects of
ity  scope of practice
application and (Chinn&Kramme
the purpose r,2015).
within the theory
(Chinn &
Krammer, C. Importa “Does this theory
2015). nce create
 Understanding understanding
the levels of that is important
abstraction by to nursing?”
doctors students  Because
and nurse research,
scientist has theory, and
facilitated the practice are
use of abstract closely related,
frameworks and nursing theory
the development lends itself to
of middle-range research testing
theories. and research
testing leads
 itself to
knowledge of
practice.
PURPOSES OF NURSING THEORY
 The primary purpose of theory in
the profession of nursing is to
improve practice by positively
influence the health and quality of
life of patients.
 Nursing theories are also
developed to define and describe
nursing care, guide nursing
practice, and provide a basis for
clinical decision making.
 The accomplishments of nursing
in the past led to the recognition
of nursing in academic discipline,
research, and profession.
 In Academic Discipline
- Much of the earlier nursing
programs identified the major
concepts in one or two nursing
models, organized the concepts
and build an entire nursing
curriculum around the created
framework.
- The unique language in these
models was typically introduced
into program objectives, course
objectives, course descriptions,
and clinical performance criteria.  what they do provide an
- Purpose: To explain the
fundamental implications of the
profession and to enhance the
status of the profession.  and assumptions about reality and
 In Research
- Development of theory is
fundamental to the research
process where it is necessary to
use theory as a framework to
provide perspective and guidance
to the research study. 
- Theory can also be used to guide
the research process by creating
and testing phenomena of
interest. 
- To improve the nursing
profession’s ability to meet the
societal duties and
responsibilities, there need to be
a continuous reciprocal and
cyclical connection with theory,
practice, and research. 
- This will help connect the
perceived “gap” between theory
and practice and promote the
theory-guided practice.
 In Profession
- Clinical practice generates
research questions and
knowledge for theory.
-  In a clinical setting, its primary
contribution has been the
facilitation of reflecting,
questioning, and thinking about
what nurses do. Because nurses
and nursing practice are often
subordinate to powerful
institutional forces and traditions,
the introduction of any framework
that encourages nurses to reflect
on, question, and think about
invaluable service.
PARADIGM
• Pattern of shared understandings
the world.
• Representation or diagram
METAPARADIGM
• Specifies the main concepts that
encompass the subject matter and
scope of discipline.
• Literally means: meta = with,
paradigm = pattern
FOUR MAJOR CONCEPTS OF THEORY
1. PERSON
2. HEALTH
3. ENVIRONMENT
4. NURSING
Person
 also referred to as Client or Human
Beings-is the recipient of nursing
care and may include individuals,
patients, groups, families, and
communities.
 Nurses performed task to and for
the patient and controlled the
patient’s environment to enhance
recovery.
 Nightingale described a passive
patient in this relationship.
However, specific references are
made to the patient performing
self-care when possible and, in
particular, being involved in the
timing and substance of meals.
Environment
 (situation) is defined as the internal
and external surrounds that affect
the client.
 It includes all positive or negative
conditions that affect the patient, the
physical environment, such as
families, friends, and significant
others, and the setting for where
they go for their healthcare.
 It is the landscape and
geography of human social
experience, the setting or context
of experience as everyday life
and includes variations in space,
time and quality.
 Geography: Personal, social,
national, global, and beyond.
 Environment: Societal beliefs,
values, mores, customs, and
expectations.
 The environment is an energy
field in mutual process with the
human energy field and is
conceptualized as the arena in
which the nursing client
encounters aesthetic beauty,
caring relationships, threats to
wellness and the lived
experiences of health.
 Dimensions that may affect
health include physical,
psychosocial, cultural, historical
and developmental processes, as
well as the political and economic
aspects of the social world.
Health
 the degree of wellness or well-being
that the client experiences. It may
have different meanings for each
patient, the clinical setting, and the
health care provider.
Wellness It is the lived experience
of congruence between
one’s possibilities and
one’s realities and is
based on caring and
feeling cared for.
Illness It is defined as the lived
experience of loss or
dysfunction that can be
mediated by caring
relationships.
Degree or It is an expression of the
level of mutual interactive
health process between human
beings and their
environment.
Nursing
 the degree of wellness or well-being
that the client experiences. It may
have different meanings for each
patient, the clinical setting, and the
health care provider.
Nursing It is a body of knowledge
Science arrived at through theory
development, research,
and logical analysis.
Art of It is actualized through
Nursing therapeutic nursing
Practice interventions, is the
creative use of this
knowledge in human
care.
Nurses They use critical thinking
and clinical judgment to
provide evidence-based
care to individuals,
families, aggregates, and
communities to achieve
an optimal level of client
wellness in diverse
nursing
settings/contexts. 
Clinical These skills are essential
judgement for professional nursing
skills practice.
Components of nursing THEORIES
• For a theory to be a theory it has
to contain a set of concepts,
definitions, relational statements,
and assumptions that explain a
phenomenon. It should also
explain how these components
relate to each other.
PHENOMENON
 Describes an idea or responses
about an event, a situation, a
process, a group of events, or a
group of situations.
 Phenomena may be temporary or
permanent.
CONCEPTS
• BUILDING BLOCKS of a theory.
• IDEAS AND MENTAL IMAGES TO
DESCRIBE A THEORY.
2 Types
1. ABSTRACT - mentally constructed
independent of a specific time or
place.
2. CONCRETE - directly experienced
and related to a particular time or
place
Terminologies
CONCEPTUAL FRAMEWORK
• A group of related ideas, statements
or concepts.
• A broad frame of reference for
systematic approaches to the
phenomena
GRAND THEORY
 Theories that articulate a broad
range of the significant relationships
among the concepts of discipline.
Ex:
 Roy Adaptation Model - Sister
Callista Roy
 Self-Care Theory - Dorothea Orem
 Transcultural Nursing (formerly
Culture-Care) - Madeleine Leininger
MIDDLE-RANGE THEORY
• Theoretical knowledge that includes
details specific to nursing practice.
• Most middle-range theories are
based on the works of a grand
theorist, but they can be conceived
from research, nursing practice, or
the theories of other disciplines.
Ex:
 • Theory of Comfort - Katharine
Kolcaba
• Behavioral Systems Model - Dorothy
Johnson
• Health Belief Model - Blanche
Mikhail
PRACTICE LEVEL THEORIES
• Practice nursing theories are
situation specific theories that are
narrow in scope and focuses on a
specific patient population at a
specific time.
• Practice-level nursing theories
provide frameworks for nursing
interventions and suggest outcomes
or the effect of nursing practice.
• Theories developed at this level
have a more direct effect on nursing
practice as compared to more
abstract theories.
• These theories are interrelated with
concepts from middle-range
theories or grand theories
THEORIES BY GOAL ORIENTATION
• DESCRIPTIVE
• PRESCRIPTIVE
DEFINITIONS
• Definitions are used to convey the
general meaning of the concepts of
the theory.
• Definitions can be theoretical or
operational.
Relational Statements
• Relational statements define the
relationships between two or more
concepts.
• They are the chains that link
concepts to one another.
ASSUMPTIONS
• Assumptions are accepted as truths
and are based on values and beliefs.
• These are statements that explain
the nature of concepts, definitions,
purpose, relationships, and structure
of a theory.
EVOLUTION OF NURSING THEORY
1. Florence Nightingale
2. Curriculum Era
3. Research Era
4. Graduate Education Era
5. Theory Era
NURSING PHILOSOPHIES: Nightingale,
Henderson, and Abdellah (WEEK 5)
Florence Nightingale: Biography
Florence Nightingale (12 May 1820 – 13
August 1910)
▪ first nurse theorist well-known for
developing the Environmental
Theory
▪ founder of modern nursing.
▪ known as o “The Lady with the
Lamp.” 
Early Life
▪ born on May 12, 1820, in Florence,
Italy.
▪ From a British family belonged to
elite social circles.
▪ received her 3-month course of
study in nursing at Kaiserswerth
Institute in Germany.
Nightingale’s Environmental Theory
 defined Nursing as “the act of
utilizing the environment of the
patient to assist him in his
recovery.” 
 It involves the NURSE’S INITIATIVE
to configure environmental settings
appropriate for the gradual
 restoration of the patient’s health
and that external factors associated
with the patient’s surroundings affect
the life or biologic and physiologic
processes and his development.
MAJOR CONCEPTS of Florence
Nightingales Theory
 Nursing
- “What nursing has to do… is to
put the patient in the best
condition for nature to act upon
him” (Nightingale, 1859/1992)
- Nightingale stated that nursing
“ought to signify the proper
use of fresh air, light, warmth,
cleanliness, quiet, and the
proper selection and
administration of diet – all at the
least expense of vital power to
the patient.”
 Human Beings
- not defined by
Nightingale specifically.
- defined in relation to their
environment and the
impact of the
environment upon them.
 Environment
- Nightingale used the term
SURROUNDINGS in her
writing.
- She defined and
described the concepts of
ventilation, warmth, light,
diet, cleanliness, and
noise - components of
surroundings
 HEALTH
- did not define health
specifically.
- She stated, “We know
nothing of health, the
positive of which
pathology is negative,
except for the
observation and
experience.
- nursing should provide
care to the healthy and
the ill and discussed
health promotion as an
activity in which nurses
should engage
recognized and agreed
that cleanliness
prevents morbidity
(Nightingale, 1999).
SUBCONCEPTS OF THE
ENVIRONMENTAL THEORY
The following are the subconcepts of
Florence Nightingale’s theory:
Health of Houses
“Badly constructed houses do for the
healthy what badly constructed hospitals do
for the sick. Once ensure that the air is
stagnant and sickness is certain to follow.”
Ventilation and Warming
“Keep the air he breathes as pure as the
external air, without chilling him.”
▪ person who repeatedly breathed his
or her own air would become sick or
remain sick.
▪ stressed the importance of room
temperature. The patient should not
be too warm or too cold.
LIGHT
▪ second to fresh air, the sick needed
light.
▪ She noted that direct sunlight was
what patients wanted.
NOISE
 ▪ patients should never be “waked
intentionally” or accidentally during
the first part of sleep.
▪ She viewed unnecessary noise,
including noise from the female
dress, as cruel and irritating to the
patient.
Variety
SOCIAL CONSIDERATIONS
▪ She discussed the need for color
and form changes, including bringing
the patient brightly colored flowers or
plants.
Bed and Bedding
Environmental Factors
▪ 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 also reminded the caregiver
never to lean against, sit upon, or
unnecessarily shake the patient’s
bed.
Personal Cleanliness
▪ 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
▪ 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 a distraction.
VIRGINIA HENDERSON
CHATTERING HOPES AND ADVICE
November 30, 1897 – March 19, 1996
▪ to falsely cheer the sick by making
light of their illness; its danger is not
helpful.
▪ She encouraged the nurse to heed
what is being said by visitors,
believing that sick persons should
hear the good news that would help
them become healthier.
▪ Nightingale supported the
importance of looking beyond the
individual to the social environment
in which they lived.
▪ Pure fresh air – “to keep the air he
breathes as pure as the external air
without chilling him.”
▪ Pure water – “well water of a very
impure kind is used for domestic
purposes.
▪ And when the epidemic
disease shows itself, persons
using such water are almost
sure to suffer.”
▪ Effective drainage – “all the while
the sewer may be nothing but a
laboratory from which epidemic
disease and ill health are being
installed into the house.”
▪ Cleanliness – “the greater part of
nursing consists in preserving
cleanliness.”
▪ Light (especially direct sunlight) –
“the usefulness of light in treating
disease is very important.”
▪ known for her Need Theory
 ▪ Nightingale of Modern Nursing
▪ Modern-Day Mother of Nursing
▪ The 20th Century Florence
Nightingale.”
Virginia Henderson: “The 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.”
Virginia Henderson’s Need Theory
▪ FOCUSES on the importance of
increasing the patient’s
independence
▪ emphasizes the basic human
needs and how nurses can assist in
meeting those needs.
▪ I believe that the function the
nurse performs is primarily an
independent one – that of acting for
the patient when he lacks
knowledge, physical strength, or the
will to act for himself as he would
ordinarily act in health or in carrying
out prescribed therapy.
▪ This function is seen as
complex and creative, as
offering unlimited opportunity
to apply the physical,
biological, and social
sciences and the
development of skills based
on them.” (Henderson, 1960)
Virginia Henderson’s Need Theory
assumptions are:
▪ Nurses care for patients until they
can care for themselves once again.
▪ patients desire to return to health.
▪ Nurses are willing to serve, and that
“nurses will devote themselves to
the patient day and night.”
▪ Henderson also believes that the
“mind and body are inseparable and
are interrelated.”
Major Concepts of the Nursing Need
Theory
INDIVIDUAL
▪ Henderson states that individuals
have basic health needs and require
assistance to achieve health and
independence or a peaceful death.
▪ an individual achieves wholeness by
maintaining physiological and
emotional balance.
▪ She defined the patient as someone
who needs nursing care but did not
limit nursing to illness care.
ENVIRONMENT
▪ maintaining a supportive
environment conducive to health is
one of her 14 activities for client
assistance.
HEALTH
▪ Although not explicitly defined in
Henderson’s theory, health was
taken to mean balance in all realms
of human life.
▪ It is equated with the independence
or ability to perform activities without
any aid in the 14 components or
basic human needs.
▪ nurses are key persons in promoting
health, preventing illness, and being
able to cure.
 NURSING
▪ The nurse’s goal is to make the
patient complete, whole, or
independent.
▪ Nurses temporarily assist an
individual who lacks the necessary
strength, will, and knowledge to
satisfy one or more of the 14 basic
needs.
▪ She states: “The nurse is
temporarily the consciousness of the
unconscious, the love life for the
suicidal, the leg of the amputee, the
eyes of the newly blind, a means of
locomotion for the infant, knowledge,
and confidence of the young mother,
the mouthpiece for those too weak
or withdrawn to speak.”
Need Theory show a holistic nursing
approach covering the physiological,
psychological, spiritual, and social
needs.
14 COMPONENTS of the Need Theory
Physiological Components
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and
undress
7. Maintain body temperature within normal
range by adjusting clothing and modifying
environment
8. Keep the body clean and well-groomed
and protect the integument
9. Avoid dangers in the environment and
avoid injuring others
Psychological Aspects of
Communicating and Learning
10. Communicate with others in expressing
emotions, needs, fears, or opinions.
14. Learn, discover, or satisfy the curiosity
that leads to normal development and
health and use the available health facilities.
Spiritual and Moral
11. Worship according to one’s faith
Sociologically Oriented to Occupation and
Recreation
12. Work in such a way that there is a sense
of accomplishment
13. Play or participate in various forms of
recreation
Since there is much similarity,
Henderson’s 14 components can be
applied or compared to Abraham
Maslow‘s Hierarchy of Needs.
1. Components 1 to 9 are under
Maslow’s Physiological Needs
2. 9th component is under the
Safety Needs.
3. 10th and 11th components are
under the Love and
Belongingness category
4. 12th, 13th, and 14th components
are under the Self-Esteem Needs.
Faye Glenn Abdellah
March 13, 1919 – February 24, 2017)
▪ a nursing research pioneer
▪ developed the “Twenty-One
Nursing Problems.” 
 ▪ earned a nursing diploma from ▪ focus of nursing service is clearly the
Fitkin Memorial Hospital’s School individual.
of Nursing, now known as Ann
NURSING PROBLEMS
May School of Nursing.
▪ The client’s health needs can be
▪ earn three degrees from
viewed as problems, overt as an
Columbia University: a
apparent condition, or covert as a
bachelor of science degree
hidden or concealed one.
in nursing in 1945,
SUBCONCEPTS: 21 Nursing Problems
▪ a master of arts degree in
Theory
physiology in 1947
Abdellah’s Typology of 21 Nursing
▪ a doctor of education
Problems
degree in 1955.
▪ 21 nursing problems fall into
▪ It was sufficient to practice
categories: physical, sociological,
nursing during her time in the
and emotional needs of patients;
1940s, but she believed that
types of interpersonal relationships
nursing care should be based on
between the patient and nurse; and
research, not hours of care.
common elements of patient care.
MAJOR CONCEPTS of 21 Nursing
▪ She used Henderson’s 14 basic
Problems Theory
human needs and nursing research
The model has interrelated concepts of to establish the classification of
health and nursing problems and nursing problems.
problem-solving, which is inherently
Abdellah’s 21 Nursing Problems are the
logical in nature.
following:
▪ To maintain good hygiene and
INDIVIDUAL physical comfort.
▪ recipients of nursing care (and ▪ To promote optimal activity:
families) exercise, rest, sleep
HEALTH ▪ To promote safety by preventing
accidents, injuries, or other trauma
▪ Health, achieving it, is the purpose
and preventing the spread of
of nursing services.
infection.
▪ she speaks to “total health needs”
▪ To maintain good body mechanics
and “a healthy state of mind and
and prevent and correct the
body.”
deformity.
SOCIETY
▪ To facilitate the maintenance of a
▪ Society is included in “planning for supply of oxygen to all body cells.
optimum health on local, state, and
▪ To facilitate the maintenance of
international levels.”
nutrition for all body cells.
▪ To facilitate the maintenance of ▪ To use community resources as an
elimination. aid in resolving problems that arise
from an illness.
▪ To facilitate the maintenance of fluid
and electrolyte balance. ▪ To understand the role of social
problems as influencing factors in
▪ To recognize the physiologic
the cause of illness.
responses of the body to disease
conditions—pathologic, physiologic,
and compensatory.
▪ To facilitate the maintenance of
regulatory mechanisms and
functions.
▪ To facilitate the maintenance of
sensory function.
▪ To identify and accept positive and
negative expressions, feelings, and
reactions.
▪ To identify and accept
interrelatedness of emotions and
organic illness.
▪ To facilitate the maintenance of
effective verbal and nonverbal
communication.
▪ To promote the development of
productive interpersonal
relationships.
▪ To facilitate progress toward
achievement and personal spiritual
goals.
▪ To create or maintain a therapeutic
environment.
▪ To facilitate awareness of self as an
individual with varying physical,
emotional, and developmental
needs.
▪ To accept the optimum possible
goals in the light of limitations,
physical and emotional.