NCM 200 - SEPT 2021
THEORETCAL FOUNDATION OF NURSING
INTRODUCTION TO NURSING THEORY: IT’S HISTORY AND
SIGNIFICANCE
History of Nursing Theory
 History of Professional nursing began w/ Florence
Nightingale
 Development of nursing knowledge apart from medical
knowledge to guide nursing practice
 Develop a body of specialized knowledge on w/c to base
nursing practice
 Strong emphasis on practice and worked throughout the
century toward the development of nursing as a
profession
Curriculum Era
 Address the question of what contents a nurse should
study to learn how to be a nurse
 Emphasis was on what course nursing students should
take, w/ the goal of arriving at a standardized curriculum
 The idea of moving nursing education from hospital-
based diploma programs into colleges and universities
began to emerge during this era
 Emphasized course selection and content for nursing
programs and gave way to the research era
Research Emphasis Era
 Focused on the research process and the long-range
goal of acquiring substantive knowledge to guide
nursing practice
 The need to do research in order to seek higher
education began in this era
 Research courses were included in nursing curricula
 Awareness for the need of concept and theory
development coincided w/ two other milestones in the
evolution of nursing theory:
1. The standardized curricula for nursing
master’s education by the National League for
Nursing accreditation criteria for
baccalaureate and high-degree programs
2. The decision that doctoral education for
nurses should be in nursing
Graduate Education Era
 Developed in tandem w/ the research era
 Master’s degree programs in nursing emerged to meet
the public need for specialized clinical nursing practice
 Included concepts in:
1. Concept development
2. Nursing models
3. Early nursing theorist
4. Knowledge development process
 Baccalaureate degree began to gain wider acceptance
as:
A. Educational level for professional nursing
B. Academic discipline in higher education
 Nurse researchers worked to develop and clarify a
specialized body of nursing knowledge w/ the ff. goals:
A. Improving the quality of patient care
B. Providing a professional style of practice
C. Achieving recognition as a profession
 Transition from vocation to profession
 Meleis (2007) noted, “theory is not a luxury in the
discipline of nursing…but an integral part of the nursing
lexicon in education, administration and practice
 Important precursor was the acceptance of nursing as a
profession and an academic discipline in its own right
Theory Era
 A natural outgrowth of the research and graduate
education eras
 Emphasis on theory development and testing
 Accelerated as early works develop as frameworks
for curricula and advanced practice guides began to
be recognized as theory
 Transition from pre-paradigm to paradigm period in
nursing
 Fawcett’s seminal proposal of four global nursing
concepts as a nursing metaparadigm served as an
organizing structure for existing nursing
frameworks and introduced a way of organizing
individual theoretical works in meaningful structure
 Classification of nursing models as paradigms w/in
metaparadigm concepts are the ff:
A. Person
B. Environment
C. Health
D. Nursing
 The said classification united nursing theoretical works
for the discipline
 Emphasis shifted from learning about the theorist to use
of the theoretical works to generate
A. Research questions
B. Guide practice
C. Organize curricula
 Theory development emerged as a process and product
of professional scholarship and growth and sought
higher education among:
A. Nurse leaders
B. Administrators
C. Educators
D. Practitioners
 The use of theory to convey an organizing structure and
meaning for these processes to the convergence of
ideas
 Fitzpatrick and Whall (1983) had said, “Nursing is on the
brink of an exciting new era”
Theory Utilization Era
 Emphasis shifted to theory application in nursing
practice, research, education and administration
 Restored balance between research and practice for
knowledge development in the discipline of nursing
 Emphasis to produce evidence for quality professional
practice
 Types of nursing theoretical works:
1. Nursing philosophy
o Sets forth the meaning of nursing phenomena
through analysis, reasoning and logical
presentation
o Basis for subsequent development
2. Nursing conceptual methods
 o Comprises nursing works by the theorist who
also are referred to as pioneers in nursing
3. Nursing Theory
o Derived from nursing philosophies, conceptual
models or more abstract nursing theories, or
from works of other disciplines
o Developed from some conceptual framework
and is more specific than the framework
o Theories may be specific to a particular aspect
or setting of nursing practice
4. Middle Range Theory
o More specific focus and is more concrete than
nursing theory in its level of abstraction
o More precise, with a focus on answering
specific nursing practice questions
o Address the specifics of nursing situations
within the perspective of the model or theory
from which they are derived
o They specify each factor as:
A. The age group of the patient
B. The family situation
C. The health condition
D. The location of the patient
E. The action of the nurse
Historical Eras Of Nursing’s Search For Specialized Knowledge
Significance of Nursing Theory
 DISCIPLINE- refers to a branch of education, a
department of learning, or domain of knowledge
 PROFESSION - refers to a specialized field of practice,
founded upon the theoretical structure of the science or
knowledge of the discipline and accompanying practice
abilities
Significance for the Discipline
 This emphasis led into theory development era that
moved nursing toward the goal developing nursing
knowledge to guide nursing practice
 The discipline and the profession are inextricably linked
and failure to recognize and separate them from each
other anchors nursing in a vocational rather than a
professional view
 The significance of theory for the discipline of nursing -
the discipline is dependent on theory for its continued
existence
 Nurses moved from the functional focus, with an
emphasis on what nurses do, to patient focus,
emphasizing what nurse know for thought, decision
making and action
 Forms of basis in recognizing nursing as discipline:
A. Knowledge of person
B. Health
C. Environment
 Every discipline or field of knowledge includes
theoretical knowledge
 Nursing as academic discipline depends on the
existence of nursing knowledge
Significance for the Profession
 Theory is essential for the existence of nursing as an
academic discipline
 Theory is also vital to the practice of professional
nursing
 Higher degree nursing is recognized as a profession
today
 Nursing was the subject of numerous studies by
sociologist who used the criteria for a profession
 Criteria for development of the professional status of
nursing:
1. Utilizes in its practice a well-defined and well-
organized body of specialized knowledge (that) is
on the intellectual level of higher learning
2. Constantly enlarges the body of knowledge it uses
and improves its techniques of education and
service through use of the scientific method
3. Entrust the education of its practitioners to
institutions of higher education…
4. Applies its body of knowledge in practical services
vital to human and social welfare
5. Functions autonomously in the formulation of
professional policy and thereby in the control of
professional activity
6. Attracts individuals with intellectual and personal
qualities of exalting service above personal gain
who recognize their chosen occupation as a life
work
7. Strives to compensate its practitioners by providing
freedom of action, opportunity for continuous
professional growth and economic security
 Nursing is recognized as a profession and emphasis is
placed on the relationship between nursing theoretical
works and achievement of status as a profession
 The use of substantive knowledge for the theory-based
evidence for nursing is a quality that is characteristic of
their practice
  The commitment to the theory-based evidence for
practice is beneficial to patients in that it guides
systematic, knowledgeable ca
 EX. all patients who are not able to take good care of
themselves need nurses
Phenomenon
 A fact or occurrence that can be observed
 Something notable; excites people’s interest and
curiosity

Philosophy
 A statement of beliefs and values about human beings
TERMINOLOGIES and their world
 Is concerned with the purpose of human life, the nature
Science of being and reality, the theory and limits of knowledge
 From the latin “scientia” meaning knowledge
 A systematically organized body of knowledge about a
particular subject
 Is performing the process of observation, description,
experimental, investigation and theoretical explanation
of natural phenomenon
Knowledge
 general awareness, understanding or possession of
information, facts, ideas, truths or principles
 Information, skills and expertise acquired by a person
through various experiences or through formal/informal
learning
Sources of Knowledge
1. Tradition - nursing practice which is passed down from
generation to generation
2. Authoritative - is an idea by a person of authority which
is perceived as true because of his or her expertise
3. Scientific - knowledge came from a scientific method
through research
Theory
 Knowledge came from a scientific method through
research
 A group of related concepts that propose actions that
guide practice
 A system of ideas that is proposed to explain a given
phenomena
Concept
 Idea, belief, view, notion, thought, perception,
impression
 Are building blocks of theories
 Enhances one’s capacity to understand phenomena as it
helps define the meaning
Abstract Concept
 Are indirectly observed
 It is independent on time and place
 EX. love, care, and freedom
Concrete Concept
 Are directly observed
 Specific to time and place
 EX. Nurse, mother, and chair
Proposition
 Statements that explain the relationships of different
concepts
 EX. Children don’t want to stay in the hospital because
of their fear of injections
Definition
 Is composed of various descriptions which convey a
general meaning and reduces the vagueness in
understanding a set of concepts
Assumption
 A statement that specifies the relationship or
connection of factual concepts or phenomena
 THEORY
Characteristics of a Theory
1. Theory can correlate concepts in such a way as to
generate a different way of looking at a certain fact or
phenomenon
o EX. the relationship between self-care deficit and
nursing
2. Theories must be logical in nature
o Logic – an orderly reasoning
o Interrelationships of concepts must be sequential
and consistently used within the theory
3. Theories should be simple but generally broad in nature
o Parsimonious – simple terms that describes,
explains, or predicts a wide range of phenomena
4. Theory can be the source of hypotheses that can be
tested for it to be elaborated
5. Theories contribute in enriching the general body of
knowledge through the studies implemented to validate
them
6. Theories can be used by practitioners to direct or
enhance their practice
7. Theories must be consistent with other validated
theories, laws, and principles but will leave open
unanswered questions that need to be tested
Types of Theories
1. Descriptive or factor isolating theories
o To know the properties and workings of a discipline
o Do not explain the relationship of concepts
o EX. Filipino nursing practices like using herbal
medicines and other alternative treatment
2. Explanatory or factor relating theories
o To examine how properties relate and thus affect
the discipline
o EX. research study about the factors affecting
newborns in failing to thrive
3. Predictive or situation relating theories
o To calculate relationships between properties and
how they occur
o EX. effects of unsanitary environment on the
recovery of post operative patients
4. Prescriptive or situation producing theories
o To identify under which conditions relationships
occur
o EX. explaining the difference in nsg. management in
the ER in relieving anxiety
Components of a Theory
1. Context - resembles environment to which nursing act
takes place
2. Content - subject of the theory
3. Process - method by which nurse acts in using nursing
theory
Nursing Theory
 The term given to the body of knowledge used to
support nursing practice
 A group of related concepts that derive from the nursing
models
Examples of Nursing Theories:
1. Environmental Theory
2. Theory of Human Caring
3. “Nurses have to provide care when patients cannot take
care of themselves.”
Nursing Theories and Models
 Provide information on:
o Definitions of nursing and nursing practice
o Principles that form the basis of practice
o Goals and functions of nursing
 Derived from concepts
 Based on the nursing metaparadigm
Nursing Paradigm
 Patterns or models used to show a clear relationship
among the existing theoretical works in nursing
Metaparadigm
 Greek “Meta”- with; “Paradeigma”- pattern
 Main concepts encompassing the subject matter and the
scope of discipline
 Organizing conceptual or philosophical framework of a
discipline or profession
 It defines and describes relationships among major ideas
and values
Metaparadigm of Nursing
 Person
o Refers to the recipient of nursing care, including
physical, spiritual, psychological, socio-cultural
components
 Environment
o Refers to all internal and external conditions and
circumstances, and influences affecting the person
 Health
o Refers to the degree of wellness or illness
experienced by the person
 Nursing
o Refers to the actions, characteristics, and attributes
of the individual providing the nursing care
Importance of nursing theory
 Helps to decide what nurses know and what nurses
need to know
 Theory analyzes and explains what nurses do
 Better patient care, enhanced professional status for
nurses and improved communication between nurses
 Guides nursing research and nursing education
Purposes of nursing theory
1. Education
o Provide a general focus for curriculum design
o Guide curricular decision-making process
2. Research
o Offers framework for generating knowledge and
new ideas
o Assist in the discovery of knowledge in a specific
field of study
o Offer a systematic approach to identify questions
for scaling, selection of variables and interpretation
of findings
 3. Clinical practice
o Assist nurses to describe, explain, and predict
everyday experiences
o Serve to guide assessment, implementation and
evaluation of nursing care
o Provide rationale for collecting reliable and valid
data about the health status of clients which are
important for effective decision making and
implementation Helps establish criteria to measure
the quality of nursing care
o Helps build common nursing terms in
communicating with other health programs
o Assist in clarifying beliefs, values and goals
o Help define the unique contributions of nursing
care to clients
o Enhance autonomy in nursing

Relationships between…
1. Theory & Research
o Research validates & modifies theory
o Theory stimulates exploration
2. Theory & Practice
o Theory guides practice
o Theory provides insights about nursing practice
situations
o Practice shapes theory
3. Research & Practice
o Research develops practice
 MARTHA ROGER: SCIENCE OF UNITARY HUMAN BEING
Martha Roger’s theory science of unitary human beings
 Mainly focusing on the 4 concepts and 3 principles of
homeodynamics that are energy fields, openness,
pattern, pandimensional, integrality, resonancy, and
helicy respectively
Assumptions
 Human being is considered as a whole w/c cannot be
viewed as subparts
 The life process of human is irreparable and one way i.e.
from birth to death
 Health and illness are the continuous expression of the
life process
 The energy flows freely between the individual and
environment
 Human being possesses the ability to think, imagine,
sense, feel, and use language for expression
 Human being has the ability to adapt according to the
new changes in the environment
Concepts
 All human beings are viewed as an integral part of
universe
 Human beings and the environment have energy field,
nursing action is directed towards patterning and
maintaining these energy fields
Energy Fields
 It is the inevitable part of life
 Human and environment both have energy fields w/c
are open i.e. energy can freely flow between human and
environment
Openness
 There is no boundary or barrier that can inhibit the flow
of energy between human and environment w/c leads
to the continuous movement or matter of energy
Pattern
 The distinguishing character of the energy field
Pandimensional
 Undeviating field w/c is not constricted by space or
time, it is an infinite domain w/out boundary
Principles of homeodynamics
 Refers to the balance between the dynamic life process
and environment
 These principles help to view human unitary human
being
 The 3 separate principles are integrality, resonancy, and
heliecy
Principles of Integrality
 Energy fields are dynamic and constantly interact w/ the
human and environment, w/c affects our environment
and vice versa
 This is the principle on w/c meditation and humor works
to produce a positive environment
Principles of Resonancy
 An ordered arrangement of rhythm characterizing both
human field and environmental field
 Constant change in the way or pattern of the energy
field from a lower to higher frequency
 This movement of energy can be made by human touch,
guided imagery activities, drawing, storytelling and
other active use of imagination
Principles of Heliecy
 Any minute change in the environment w/c leads to
ripple effect i.e. results in a larger changes in other field
 This change is constant, unpredictable and there many
factors w/c mutually interact and interact and cause the
change
Metaparadigm of Nursing
 Person
o Unitary human being is open systems w/c
continuously interact w/ environment
o A person cannot be viewed as parts it should be
considered as a whole
 Environment
o It includes the entire energy field other than a
person
o These energy fields are irreducible, not limited by
space and time, identified by its pattern and
organization
 Health
o Not clearly defined by Roger
o It is determined by the interaction between energy
fields i.e. human environment
o Bad interaction or misplacing of the energy leads to
illness
 Person
o It is both science and art
o It constantly maintains the energy field w/c is
conducive for the px
o Nursing action – directs the interaction of person
and environment to maximize health potential
Application of SUBH
Clinical Practice
 Nursing action is always focused on unitary human being
and change the energy field between human and
environment
 Nursing interventions include all noninvasive actions
such as guided imaginary, humor, therapeutic touch,
 music, etc. w/c are used to increase the potential of
human being
 More importance should be on the management of
pain, supportive psychotheraphy and rehabilitation of
the human being

Nursing Education
 Emphasis should be given on the understanding of the
px and self, energy field, and environment
 Training should lay more focus on teaching non-invasive
modalities such as therapeutic touch, meditation,
humor, regular in-service education programme etc.
Nursing Research
 Rogerian theory has been used in many research works
and has always been found testable and applicable in
research
Nursing Process According to SUBH

Pattern appraisal
 It is an inclusive assessment of human and environment
energy fields, its organization of energy field, and
identification of areas of dissonance
 Nurses validate the entire appraisal along w/ the client

Mutual patterning
 It is the proper patterning of energy fields between the
human and environment
 It is the mutual interaction between the client and nurse
 Patterning can be done by suggesting the various
alternatives, educating, empowering, encouraging etc.
depending on the client’s condition and needs
 Pattern appraisal include appraisal of nutrition, rest and
sleep, exercises, discomfort, and relation w/ other
 Pattering activities can be therapeutic, touch,
meditation, humor, imaginary etc.
Evaluation
 Done by repeating the pattern appraisal after the
mutual patterning to determine the extents of
dissonance and harmony
 MARGARET JEAN WATSON: PHILOSOPHY AND SCIENCE OF
CARING
Background
 Born in Southern West Virginia
 1964 – BSN in Colorado
 1966 – MS in Psychiatric – Mental Health Nsg
 1973 – PhD in Educational Psychology
Metaparadigm of Nursing
 Person
o Human being to be valued, cared for, respected,
nurtured, understood and assisted
o Must be viewed according to the client’s
development & the conflicts arising in this
development
 Environment
o Defined as society with all its influences
o It provides the values that determine how one
should behave and what goals one should strive
toward
o Encompasses social, cultural & spiritual aspect
 Health
o Refers to unity & harmony with in the mind, body &
soul
o Watson, in addition to WHO’s definition, include
these three elements:
1. A higher level of over-all physical, mental &
social functioning
2. A general adaptive- maintenance level of daily
functioning; and
3. The absence of illness (or the presence of
efforts that lead to its absence)
 Nursing
o Providing holistic health care
o A human science of people & human health-illness
experiences that are mediated by professional,
personal, scientific, aesthetic & ethical human care
transactions
Major Assumption
 Caring can be demonstrated and practiced only
interpersonally
 Caring consists of carative factors that result in the
satisfaction of certain human needs
 Effective caring promotes health & individual or family
growth
 A caring environment accepts a person as he is and
looks to what the person may become
 A caring environment offers development of potential
while allowing the person to choose the best action for
himself/herself at a given time
 Caring is more “healthogenic” than is curing
 The practice of caring integrates biophysical knowledge
with knowledge of human behavior to generate or
promote health & to provide ministrations of those who
are ill
 A science of caring is therefore complementary to the
science of curing
 Caring is central to nursing
Watson’s 10 Carative Factors
1. Forming humanistic-altruistic value system
o Occurs early in life but can be greatly influenced by
nursing educators
o Can be accomplished by examining one’s views,
beliefs, and interactions with various cultures as
well as personal growth experiences
o Provides satisfaction through giving & extending
oneself
o Begins developmentally at an early age with values
shared with the parents
o Mediated through one’s own life experiences, the
learning one gains, and exposure to the humanities
o Perceived as necessary to the nurse’s own
maturation which then promotes altruistic behavior
towards others
2. Instillation of faith-hope
o Describes the nurse’s role in developing effective
nurse-patient interrelationships& in promoting
wellness
o Is accomplished by helping a client adopt health
seeking behaviors, by positively using the powers of
suggestion & positively supporting the client
o This is essential to both the carative and curative
processes
o When modern science has nothing further too offer
the person, the nurse can continue to use faith-
hope to provide a sense of well-being through
beliefs which are meaningful to the individual
3. Cultivating sensitivity to self and others
o The recognition of feelings leads to self-
actualization through self-acceptance for both the
nurse & the patient
o As Nurses acknowledge their sensitivity and
feelings, they become more genuine, authentic,
and sensitive to others
o Striving to become sensitive, makes the nurse more
authentic, which encourages self-growth and self-
actualization in both the nurse and those with
whom the nurse interacts
o The nurse promote health and higher level
functioning only when they form person to person
relationship
4. Development of a helping-trust relationship
o Establishes rapport & caring
o Helps promote expression of positive and negative
feelings
o Is accomplished through congruence, empathy,
nonpossesive warmth, and effective
communication
 o Strongest tool is the mode of communication,
which establishes rapport and caring
o She has defined the characteristics needed to
develop the helping –trust relationship
5. Promotion & acceptance of the expression of positive
& negative feelings
o Involves sharing of feelings
o Includes being prepared for negative as well as
positive feelings
o Feelings alter the thoughts and behavior, they need
to be considered and allowed for in a caring
relationship
o Awareness of feelings helps to understand the
behavior
6. Systematic use of the scientific problem-solving
method for decision making
o Is important for research, defining the discipline &
developing a scientific knowledge base for nursing
o Brings scientific, problem-solving approach to
nursing care
7. Promotion of interpersonal teaching-learning
o Gives a client maximum health control because it
provides information & alternatives
o Distinguishes caring from curing by assigning
responsibility for health to the client
o Enables a client to provide self-care, determine
personal needs & provide opportunities for their
personal growth
8. Provision for supportive, protective & corrective
mental, physical, sociocultural & spiritual environment
o Involves assessing & facilitating a client’s coping
abilities to support & protect mental & physical
well-being
o Requires understanding that a person’s
environment includes internal & external
independent variables
o Includes providing comfort, privacy, safety & a
clean, aesthetic surroundings
9. Assisting with gratification of human needs
o Addresses the needs of both the nurse & the client
o Requires meeting lower-order needs before
attaining higher-order needs
10. Allowance for existential-phenomenological forces
o Permits one to understand people from the way
things appear to them; their experiences shape
their individual perceptions
o Leads to better understanding of oneself & of
others
 FLORENCE NIGHTINGALE: ENVIRONMENTAL THEORY
Background
 1851 – trained in nursing (Kaiserwerth, Germany)
 Pioneered the concept of formal education
Crimean War
 October 21, 1854
 Florence was invited to take a group of 34 female nurses
to work in hospitals in the Crimea
 Served during the Crimean war treating sick and injured
soldiers – influenced her philosophy
November 1854
 Nightingale reorganized patient care
 Discovered the condition of the hospital
 Insufficient medicines
 Poor hygiene
 Infections are rampant
 4077 soldiers died on her first winter in Scutari
 More deaths due to infections than from battlefield
wounds
 “dirt, damp, drains, drink, and diet”
 Scutari, the British base hospital in Constantinople
The Lady with the Lamp
 In the evenings she moved through the dark hallways
carrying a lamp while making her rounds, ministering to
patient after patient
 The soldiers, who were both moved and comforted by
her endless supply of compassion, took to calling her
“the Lady with the Lamp”
 Others simply called her “the Angel of the Crimea” Her
work reduced the hospital’s death rate by two-thirds
March 1855
 Britain sends Sanitary Commision to Scutari
 Sewers were flushed; ventilation was improved
 Death rates were reduced
 Created a kitchen – supply of appealing food and foods
specific to those with certain dietary constrictions
 Laundry – which provided clean linens for the hospital
beds
 Also instituted a classroom and a library for patients’
intellectual stimulation and entertainment
War Finished in 1856
 Florence wanted to improve hospitals in this country
 Conditions in hospitals began to improve
1860
 Nightingale decided to use the money to further her
cause
 She funded the establishment of St. Thomas’ Hospital,
and within it, the Nightingale Training School for Nurses
 Nightingale published Notes on Nursing
 Considered the first “nursing theorist”
 Information on her theory has been obtained through
interpretation of her writings
1883
 Royal Red Cross
1907
 Order of Merit
Bedridden 1896
 Chronic Fatigue Syndrome
 Pioneered in the field of Hospital Planning
 Died in August 13, 1910
 While at Scutari, Nightingale had contracted “Crimean
fever” and would never fully recover
 By the time she was 38 years old, she was homebound
and bedridden, and would be so for the remainder of
her life
 Fiercely determined and dedicated as ever to improving
health care and alleviating patients’ suffering,
Nightingale continued her work from her bed
Florence Nightingale’s Grave
 St Margaret’s Church, East Wellow, Great Britain
Florence Nightingale
 Florence is remembered today as the person
responsible for improving conditions in hospitals and
making nursing an acceptable job
 Strongest influence: education, observation and hands-
on experience
Nightingale’s Nursing Theory
 Theory basis: the inter-relationship of a healthful
environment with nursing
o External influences and conditions can
prevent, suppress, or contribute to disease or
death
 Theory goal: Nurses help patients retain their own
vitality by meeting their basic needs through control of
the environment
 Nursing’s Focus: control of the environment for
individuals, families & the community
Three Types of Environments
1. Physical
2. Psychological
3. Social
Physical Environment
 Consists of physical elements where the patient is being
treated
 Affects all other aspects of the environment
 Cleanliness of environment relates directly to disease
prevention and patient mortality
 Ventilation, warmth, cleanliness, light, noise, and
drainage
Psychological Environment
 Providing a positive stress-free surrounding
 Can be affected by a negative physical environment
which then causes STRESS
 Requires various activities to keep the mind active (i.e,
manual work, appealing food, a pleasing environment)
 Involves communication with the person, about the
person, and about other people
Social
 Involves collecting data about illness and disease
prevention
 Consists of a person’s home or hospital room, as well as
the total community that affects the patient’s specific
environment
 Stress free surroundings
5 Major Components of a Healthful Environment
1. Proper ventilation
2. Adequate light
3. Sufficient warmth
4. Control of noise
5. Control of effluvia
(noxious odors)
Nightingale’s 13 Canons:
1. Ventilation and warming
 o Keeping the air that the patients breathe as pure as
the external air, without chilling them
2. Health of houses
o Pure air, pure water, efficient drainage, cleanliness,
light; without these, no house can be healthy, and
it will be unhealthy jus int proportion as they are
deficient
3. Petty Management
o All the results of good nursing may be negated by
one defect: not knowing how to manage what you
do when you are there and what shall be done
when you are not there
4. Observation of the sick
o What to observe, how to observe, which symptoms
indicate improvement, which indicate the reverse,
which are important, which are not, and which are
evidence of neglect and what kind of neglect
5. Personal Cleanliness
o Nurses should always remember that if they allow
patients to remain unwashed or to remain in
clothing saturated with perspiration or other
excretion, they are interfering injuriously with the
natural processes of health just as much as if they
were to give their patients a dose of slow poison
6. Light
o Essentially direct sunlight, has a purifying effect
upon the air of a room
7. Cleanliness of room and walls
o Preserving the cleanliness; the inside air can be
kept clean only by excessive care to aid rooms and
their furnishings of the organic matter and dust
with which they become saturated
o Without cleanliness, you cannot have all the effects
of ventilation; without ventilation, you can have no
thorough cleanliness
8. Bed and Bedding
o Patients’ bed should have a clean bed every 12
hours
o The bed should be narrow, so that the patient does
not feel “out of humanity’s reach”
o The bed should not be so high so that the patient
cannot easily get in or out of it
o The bed should be in the lightest spot in the room,
preferably near the window
o Pillows should be used to support the back below
the breathing apparatus, to allow shoulders room
to fall back, and to support the head without
throwing it forward
9. Taking food
o The nurse should be conscious of patients’ diets
and remember how much food each patient has
had and ought to have each day
10. What food
o Watch for the opinions the patients’ stomach gives,
rather than to read “analyses of foods,” is the
business of all those who have to decide what the
patient should eat
11. Noise
o unnecessary noise, or noise that creates as
expectation in the mind, is that which hurts
patients
o Anything that wakes patients suddenly will
invariably put them into a state of greater
excitement and do them more serious and lasting
mischief than any continuous noise
12. Chattering hopes and advices
o All friends, visitors, and attendants of the sick
should avoid the practice of attempting to cheer
the sick by making light of their danger and by
exaggerating their probabilities of recovery
13. Variety
o The nerves of the sick suffer from seeing the same
walls, the same ceiling, the same surroundings
during a long confinement to one or two rooms
o The majority of cheerful cases are of those patients
who are not confined to one room
o Most depressed cases will be subjected to a long
monotony of objects around them
Metaparadigm of Nursing
 Person
o The patient, a human being acted upon by a nurse
or affected by the environment who has reparative
powers
o Recovery is within the patient’s power as long as
safe environment for recuperation exists
 Environment
o Comprises the external conditions and forces that
affect one’s life and development
o Everything from person’s food to a nurse’s verbal
and nonverbal interactions with the person
 Health
o Maintaining well-being by using a person’s powers
to the fullest extent; disease is viewed as a
reparative process instituted by nature
o Maintained by controlling environmental factors to
prevent disease; nurse helps the person through
the healing process
 Nursing
o Aims to provide fresh air, light, warmth,
cleanliness, quiet and proper diet; facilitates a
person’s reparative by ensuring the best possible
environment; influences the environment to affect
health
Nightingale’s Assumption
1. Nursing is separate from medicine
2. Nurses should be trained
3. The environment is important in nursing
4. The disease process is not important to nursing
5. Nursing should support the environment to assist the
patient in healing
6. Research should be utilized through observation and
empirics to define the nursing discipline
7. Nursing is both an empirical science and an art
8. Nursing’s concern is with the person in the environment
9. The person is interacting with the environment
10. Sick and well are governed by the same laws of health
11. The nurse should be observant and confidential
DOROTHEA E. OREM: SELF-CARE DEFICIT THEORY
Credentials and Background
 Born on 1914 in Baltimore, Maryland
 Began her nursing education at Providence Hospital
School of Nursing in Washington, DC
 1939 – she earned her BSN education at the Catholic
University of America
 1946 – earned her M.S.N. from Catholic University of
America.
  Her nursing experiences included
a. operating room nursing,
b. private duty nursing (home & hospital),
c. hospital staff nursing on pediatric and adult
medical and surgical units, evening supervisor in
the E.R.
d. biological science teacher
 1958-1960 curriculum consultant
 1959 – “Guides for developing the curricula for the
Education of Practical Nurses” was published
 1971 – “Nursing Concepts of Practice” which is Orem’s
first book was published.
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 & health development
 The theory is aimed towards making the clients perform
self-care activities in order to live independently
Metaparadigm of Nursing
 Person
o Defined as the patient- a being who functions
biologically, symbolically & socially & who has the
potential for learning & development
o Is an individual subject to the forces of nature, with
a capacity for self-knowledge, who can engage in
deliberate action, interpret experiences & perform
beneficial actions
o Is an individual who can learn to meet self-care
requisites; if for some reason, the person cannot
learn self-care measures, others must provide the
care
 Environment
o Consists of environmental factors, environmental
elements, environmental conditions (external
physical & psychosocial surroundings) &
developmental environment (promotion of
personal development through motivation to
establish appropriate goals & to adjust behavior to
meet these goals; includes formation of or change
in attitudes & values, creativity, self-concept &
physical development)
 Health
o Orem supports 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”
o Consists of physical, psychological, interpersonal &
social aspects; according to Orem, these aspects
are inseparable
o Includes promotion & maintenance of health,
treatment of illness & prevention of complications
 Nursing
o Helping clients to establish or identify ways to
perform self-care activities
o Nursing actions are geared towards the
independence of the client
o Nursing is a human service-its focus is on persons
with inabilities to maintain continuous provision of
healthcare
o Nursing is based on values
Major Concepts & Definitions
 Self – Care
 Self – Care Requisites
 Universal Self-Care Requisites
 Developmental Self – Care Requisites
 Health Deviation Self – Care Requisites
 Therapeutic Self – Care Demand
 Self-Care Agency
 Agent
 Dependent-Care Agent
 Self-Care Deficit
 Nursing Agency
 Nursing Design
 Nursing System
 Helping Methods
Self-care Deficit Theory as a General Theory is Composed of 3
Related Theories:
1. The theory of self-care
o Describes why & how people care for themselves
o Self- Care: refers to those activities an individual
performs independently throughout life to
promote & maintain personal well-being
o Self- Care agency: the complex acquired ability of
mature & maturing persons to know & meet their
continuing requirements for deliberate, purposive
action to regulate their own functioning &
development
Consists of two agents: An agent (individual
who is engage in meeting the need of a
person; like bridges that facilitate what has
been done and what needs to be done)
a. Self-care agent – person who provides
the self-care
b. Dependent care agent – person other
than the individual who provides cares
o Self-care requisites or Self-care needs: are insights of
actions or requirements that a person must be able to
meet and perform in order to achieve well-being
Categories of Self-care requisites:
a. Universal Self-care requisites
 these are universally set goals that
must be undertaken in order for an
individual to function in scope of
healthy living
1. Maintenance of sufficient intake of
air
2. Maintenance of sufficient intake of
food
 3. Maintenance of sufficient intake of
water
4. Provision of care associated with
elimination
5. Maintenance of balance between
activity and rest
6. Maintenance of balance between
solitude and social interaction
7. Prevention of hazards to human life,
human functioning and human well-
being
8. Promotion of human functioning and
development
b. Developmental Self-care requisites
 Result from maturation or
associated with conditions or events
such as adjusting to a change in body
image or loss of a spouse
 They promote processes for life &
maturation & prevent conditions
deleterious to maturation or those
that lessens those effects
c. Health deviation self-care requisites
 Requisites that result from illness,
injury or disease or its treatment;
they include such actions as seeking
medical assistance, carrying out a
prescribed treatment or learning to
live with the effects of illness or
treatment
 These health care deviations set
standards to which the degree of
self-care demand is needed
o Therapeutic Self-Care Demand
 Refers to all self-care activities required to
meet existing self-care requisites
 Involves the use of actions to maintain health
& well-being, each patient’s therapeutic self-
care demands varies throughout life
2. The theory of self-care deficit
o Which describes & explains why people can be
helped through nursing
o Self-care deficit: arises when the self-care agency
cannot meet self-care requisites
o Helping Methods:
a. Acting or doing for another
b. Guiding and directing
c. Providing physical or psychological support
d. Teaching
e. Providing and maintaining an environment
that supports personal development
3. Theory of nursing systems
o Describes and explains relationships that must be
brought about & maintained for nursing to be
produced
o Refers to the series of actions a nurse takes to meet
a patient’s self-care requisites
o Nursing Agency: set of established capabilities of a
nurse who can legitimately perform activities of
care for a client
o Helps a person achieve their health care demand
o Nursing Design: these are professional functions
that must be performed by the nurse in order to
meet client needs, it serves as a guideline of
needed & foreseen results in the production of
nursing toward the achievement of nursing goals
3 Types of Nursing Systems
 Each system describes nursing responsibilities, roles of
the nurse & patient, rationales for the nurse-patient
relationship & types of actions needed to meet the
patient’s self-care agency & therapeutic self-care
demand
1. A wholly compensatory nursing system
o is used when a patient’s self-care agency is so
limited that the patient depends on others for
well-being
2. A partly compensatory nursing system
o Is used when a patient can meet some self-
care requisites but needs a nurse to help meet
others
o The nurse & the patient play major roles in
performing self-care
3. Supportive – Educative Nursing System
o Is used when a patient can meet self-care
requisites but needs assistance with decision
making, behavior control or knowledge
acquisition skills
Major Assumptions
1. Human beings require continuous, deliberate inputs to
themselves and their environments to remain alive and
function in accordance with natural human
endowments.
2. Human agency, the power to act deliberately, is
exercised in the form of care for self and others in
identifying needs and making needed inputs
3. Mature human beings experience privations in the form
of limitations for action in care for self and others
involving and making of life sustaining and function-
regulating inputs
4. Human agency is exercised in discovering, developing,
and transmitting ways and means to identify needs and
make inputs to self and others
5. Groups of human beings with structured relationship
cluster tasks and allocate responsibilities for providing
care to group members who experience privations for
making required, deliberate input to self and others
Basic Nursing Systems
Acceptance by the Nursing Community
 Practice - the first documented use of Orem’s theory as
the basis for structuring practice is found in descriptions
of nurse-managed clinics at John Hopkins Hospital in
1973.
Research articles on the use of SCDNT or components in
clinical practice include:
a. Teaching self-care to individuals with DM, ESRD,
hemodialysis, peritoneal dialysis, renal transplant
b. Pain assessment
c. Cardiac research
d. Oncology – focus cancer prevention, self-care after
being diagnosed with malignancies
e. e. Psychiatry etc.
 Education
“Guides for Developing Curriculum for the Education of
Practical Nurses”
a. Orem worked on a book, “Foundations of Nursing
Practice” (Morris Harvey College)
 Research
a. First instrument to measure the exercise of Self-
care agency (ESCA) was published in 1979
Further Development
 Orem is presently working with a group of scholars,
known as Orem study Group
 International Orem Society for Nursing scholarships (IOS
est. 1993)
 The Sixth International Self-Care deficit theory
Conference which was held in Bangkok, Thailand in
February 2000
 IMOGENE KING: GOAL ATTAINMENT THEORY
Background
 Youngest of 3 children, born in 1923
 St. John's Hospital School of Nursing in St. Louis,
Missouri (1946)
 St. Louis University - BS in Nursing Education (1948) &
MS in Nursing (1957)
 Teachers College, Columbia University, New York: - EdD
(1961) - Postdoctoral study in research design, statistics,
and computers
 Expertise: adult medical-surgical nursing
 Experiences: an administrator, educator, and
practitioner
Nursing Metaparadigm
 Person
o Individuals are spiritual being
o have the capacity to think, know, make
choices & select alternative courses of action
o Have the ability through their language &
other symbols to record their history &
preserve their culture
o Open system in transaction with the
environment
o Unique & holistic, are of intrinsic worth & are
capable of rational thinking & decision making
in most situations
o Individuals differ in their needs, wants & goals
o 3 fundamental health needs of human beings:
1. Need for information
2. Need for care for illness prevention
3. Need for total care when a person
doesn’t have the capacity to help
themselves
 Environment
o The process of balance involving internal &
external interactions inside the social system
o Interpreted from the general systems theory
as an open system with permeable boundaries
that allow the exchange of matter, energy, and
information
 Health
o Is a dynamic state in the life cycle; illness is an
interference in the life cycle
o Implies continuous adjustment to stress in the
internal and external environments, using
personal resources to achieve optimal daily
living
 Nursing
o Is an act wherein the nurse interacts &
communicates with the client
o The nurse helps the client identify the existing
health condition, exploring & agreeing on
activities that promote health
o The goal of the nurse in King’s theory is to help
the client maintain health through health
promotion & maintenance, restoration &
caring for the sick & dying
Goal Attainment Theory
 Involves the nurse and the patient mutually
communicating information, establishing goals, and
taking action to obtain goals
 Two people who are usually strangers come together in
a health care organization to help or to be helped to a
mutual state of health
Central Focus of the Theory
 Man
o As a dynamic human being whose perceptions
of objects, persons, and events influence his
behavior, social interaction, and health
o Man is an important focus of King's framework
o She proposes three basic premises; man is:
1. A reactive being
2. A time oriented being
3. A social being
o Man as a reactive being is aware of other
things; persons and events in the environment
o Man as a time-oriented being is influenced by
time orientation, each person is influenced by
his past actions
o Man as a social being has a continuous
exchange with persons in the environment,
language is a social link and facilitates
interpersonal communication
3 Interacting Systems of the Theory
1. Personal system
o Individuals
o How the nurse views & integrates self-based
from personal goals & beliefs
o The personal interacting system consists of:
a. The Individual's Perception - the person's
representation of reality and it is unique
to each individual
b. Self - the person's subjective
environment, values, ideas, attitudes, and
commitment
c. Growth and Development - involves all
the changes that occur (cellular,
molecular, and behavioral). These
changes are usually orderly and
predictable, but may vary with individuals
d. Body Image -the way a person perceives
their body and the reaction of others to
their body. Body image is subjective and
changes as the person changes physically
or emotionally
e. Space -is the immediate physical territory
occupied by the person and person's
behavior
f. Time -is the order of events and their
relationship to each other
2. Interpersonal System
o Two or more interacting individuals
 o How the nurse interrelates with a co-worker 6. The ability to select means of accomplishing goals
or patient, particularly in a nurse-patient Propositions of King’s Goal Attainment Theory
relationship 1. If perceptual accuracy is present in nurse-client
o Concepts of interpersonal system: interactions, transactions will occur
a. Interaction – any situation wherein the 2. If nurse & client make transactions, goals will be
nurse relates & deals with a patient attained
b. Communication – refers to the 3. If goals are attained, satisfactions will occur
transmission of information from one 4. If goals are attained, effective nursing care will occur
person to another; either directly or 5. If transactions are made in nurse-client interactions,
indirectly growth & development will be enhanced
c. Transaction – refers to the interaction 6. If role expectations & role performance as perceived by
between a person & the environment for nurse & client are congruent, transactions will occur
the purpose of goal attainment 7. If role conflict is experienced by the nurse & client or
d. Role – refers to the expected behaviors both, stress in nurse-client interactions will occur
of a person in a specific position & to the 8. If nurses with special knowledge & skills communicate
rules that govern the position & affect appropriate information to clients, mutual goal setting &
interaction between two or more persons goal attainment will occur
e. Stress – refers to an exchange of energy,
either positive or negative between a
person & the environment; objects,
persons & events can serve as stressors
3. Social System
o Composed of larger group of individuals with
common interests or goals
o How the nurse interacts with co-workers,
superiors, subordinates & the client
environment in general
o EX. families, religious groups, schools,
workplaces, and peer groups
o  A social system comprises the:
a. Social roles
b. Behaviors
c. Practices
o Concepts of social system:
a. Organization – refers to a group of
people with similar interest who have
prescribed roles & positions & who use
resources to achieve personal &
organizational goals
b. Authority – refers to the observable
behavior of providing guidance & order &
being responsible for actions
c. Power – is characterized by the ability to
use resources for goal achievement; also
a means by which one or more persons
can influence others
d. Status – refers to the position occupied
by a person in a group or the position
occupied by a group in relation to other
groups in an organization; it is
accomplished by certain duties, privileges
& obligations
e. Decision Making – results from
developing & acting on perceived choices
for goal attainment
6 Characteristics of Man
1. The ability to perceive – perceptions will influence
behavior and thus life and health
2. The ability to think – thinking is based upon the
inquiring mind of man
3. The ability to feel - have emotions
4. The ability to choose between alternative course of
action
5. The ability to set goals