Theoretical Foundations of Nursing / Nursing Care Management
• Master’s degree programs in nursing
• History of professional nursing began with
Florence Nightingale.
• Development of nursing knowledge apart
from medical knowledge to guide nursing
practice.
• Develop a body of specialized knowledge
on which to base nursing practice.
• Strong emphasis on practice and worked
throughout the century toward the
development of nursing as a profession.
• Address the question of what content
nurse should study to learn how to be a
nurse.
• Emphasis was on what courses nursing
students should take, with 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.
• Focused on the research process and the
long-range goal of acquiring substantive
knowledge to guide nursing practice.
• Sought degrees in higher education began
to emerge.
• Began to participate in research and
research courses were included in nursing
curricula
• Awareness for the need of concept and
theory development coincided with two
other milestones in the evolution of nursing
theory:
1. The standardization of 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.
• Developed in tandem with the research
era.
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 with the following 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.
• A natural outgrowth of the research and
graduate education eras.
• Emphasis on theory development and
testing.
• Accelerated as early works developed as
frameworks for curricula and advanced
practice guides began to be recognized as
theory
• Transition from the preparadigm 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 within metaparadigm concepts
are ff:
Theoretical Foundations of Nursing / Nursing Care Management

a. Person nursing theories, or from works of other

b. Environment disciplines
c. Health ✔ Developed from some conceptual
d. Nursing framework and is more specific than the
• The said classification united nursing framework
theoretical works for the discipline ✔ Theories may be specific to a
• Emphasis shifted from learning about the particular aspect or setting of nursing
theorist to use of the theoretical works to practice.
generate: 4. Middle Range Theory
a. Research questions ✔ More specific focus and is more
b. Guide practice concrete than nursing theory in its level
c. Organize curricula of abstraction.
✔ More precise, with a focus on
Theory development emerged as a process
answering specific nursing practice
and product of professional scholarship and
questions
growth and sought higher education among:
1. Nurse leaders ✔ Address the specifics of nursing
2. Administrators situations within the perspective of the
3. Educators model or theory from which they are
4. Practitioners derived.
✔ They specify each factor as: a. The
age group of the patient b. The family
situation c. The health condition d. The
• The use of theory to convey an organizing
location of the patient e. The action of
structure and meaning for these processes
the nurse
to the convergence of ideas.
• Fitzpatrick and Whall (1983) had said,
“Nursing is on the brink of an exciting new
era”
• Emphasis shifted to theory application in
nursing practice, research, education and
administration.
• Restored balance between research and Nightingale Levine
practice for knowledge development in the Watson Rogers
discipline of nursing. Ray Orem
• Emphasis to produce evidence for quality Benner King
professional practice. Martinsen Neuman
Erikson Roy
Johnson
Types of nursing theoretical works:
1. Nursing philosophy
✔ Sets forth the meaning of nursing Boykin and Mercer
phenomena through analysis, Schoenhofer Mishel
Meleis Reed
reasoning and logical presentation
Pender Wiener and Dodd
✔ Basis for subsequent development Eakes, Burke and
2. Nursing conceptual methods Leininger
Hainsworth
Parse Barker
✔ Comprises nursing works by the
Erikson, Tomlin Kalkaba
theorist who also are referred to as
and Swain Beck
pioneers in nursing
Husted and Swanson
3. Nursing Theory
Husted Ruland and Moore
✔ derived from nursing philosophies,
conceptual models or more abstract
Theoretical Foundations of Nursing / Nursing Care Management

’ Outcomes Nursing theoretical

works shift the focus
to the patient.
Emerging Goal Theories guide
nursing research and
Historical Era Curriculum Era: practice.
1900-1940s
Major Question What curriculum Historical Era Theory Utilization Era:
content should 21st century
student nurses’ study Major Question What new theories are
to be nurses? needed to produce
Emphasis Courses included in evidence for quality
nursing programs. care?
Outcomes Standardized curricula Emphasis Nursing theory guides
for diploma programs. research, practice,
Emerging Goal Develop specialized education and
knowledge and higher administration.
education Outcomes Middle-range theory
may be from
Research Era: quantitative or
Historical Era
1950-1970s qualitative approaches
What is the focus for Emerging Goal Nursing frameworks
Major Question
nursing research? produce knowledge
Role of nurses and (evidence) for quality
Emphasis
what to research. care.
Outcomes Problem studies and
studies of nurses.
Emerging Goal Isolated studies do not
yield unified • DISCIPLINE- specific to academia and
knowledge. refers to a branch of education, a
department of learning, or domain of
Historical Era Graduate Education knowledge
Era: 1950-1970s • PROFESSION- refers to a specialized field
Major Question What knowledge is of practice, founded upon the theoretical
needed for the structure of the science or knowledge of
practice of nursing? the discipline and accompanying practice
Emphasis Carving out an abilities
advanced role and
basis for nursing
practice.
Outcomes Nurses have an • This emphasis led into theory development
important role in era that moved nursing toward the goal
health care. developing nursing knowledge to guide
Emerging Goal Focus graduate nursing practice.
education on • The discipline and the profession are
knowledge inextricably linked and failure to recognize
and separate them from each other
Historical Era Theory Era: anchors nursing in a vocational rather than
1980-1990s a professional view.
Major Question How do these • The significance of theory for the discipline
frameworks guide of nursing- the discipline is dependent on
research and theory for its continued existence.
practice?
• Nurses moved from the functional focus,
Emphasis There are many ways
to think about nursing
with an emphasis on what nurses do, to
patient focus, emphasizing what nurse
 Theoretical Foundations of Nursing / Nursing Care Management
know for thought, decision making and •
action.
• Forms of basis in recognizing nursing as
discipline: • The use of substantive knowledge for the
a. Knowledge of person
b. Health
c. Environment • The commitment to the theory-based evidence
• Every discipline or field of knowledge
includes theoretical knowledge.
• Nursing as academic discipline depends
on the existence of nursing knowledge.
• 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
theory-based evidence for nursing is a quality
that is characteristic of their practice.
for practice is beneficial to patients in that it
guides systematic, knowledgeable care.
1. THEORY CAN CORRELATE CONCEPTS
IN SUCH A WAY AS TO GENERATE A
DIFFERENT WAY OF LOOKING AT A
CERTAIN FACT OR PHENOMENON
EXAMPLE: The relationship between self-care
deficit and nursing
2. THEORIES MUST BE LOGICAL IN
NATURE
(LOGIC – an orderly reasoning)
Interrelationships of concepts must be
sequential and consistently used within the
theory
3. THEORIES SHOULD BE SIMPLE BUT
GENERALLY BROAD IN NATURE
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
Theoretical Foundations of Nursing / Nursing Care Management

• Based on the nursing metaparadigm

NURSING PARADIGM
DESCRIPTIVE Or Factor Isolating Theories • are patterns or models used to show a
• to know the properties and workings of a clear relationship among the existing
discipline. do not explain the relationship of theoretical works in nursing
concepts.
Ex. Filipino nursing practices like using
herbal medicines and other alternative • Greek “Meta”- with; “Paradeigma”- pattern
treatment. • Main concepts encompassing the subject
EXPLANATORY - or factor relating theories matter and the scope of discipline
• to examine how properties relate and thus • Organizing conceptual or philosophical
affect the discipline framework of a discipline or profession
Ex. A research study about the factors
affecting newborns in failing to thrive
• It defines and describes relationships
PREDICTIVE or situation relating theories among major ideas and values
• to calculate relationships between properties
and how they occur
Ex. effects of unsanitary environment on
the recovery of post operative patients
PRESCRIPTIVE or situation producing theories PERSON
• to identify under which conditions relationships refers to the recipient of nursing care, including
occur physical, spiritual, psychological, socio-
Ex. explaining the difference in nsg. cultural components
management in the ER in relieving anxiety
ENVIRONMENT
refers to all internal and external conditions
CONTEXT and circumstances, and influences affecting
Resembles environment to which nursing act the person
takes place.
CONTENT HEALTH
Subject of the theory refers to the degree of wellness or illness
PROCESS experienced by the person
Method by which nurse acts in using nursing
theory NURSING
refers to the actions, characteristics, and
attributes of the individual providing the
nursing care
• 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 a nursing theory:
• Environmental Theory
• Theory of Human Caring
• “Nurses have to provide care when
patients cannot take care of themselves.”

Provide information on:

• the definitions of nursing and nursing
practice • Helps to decide what nurses know and
• principles that form the basis of practice what nurses need to know
• goals and functions of nursing
• Derived from concepts
Theoretical Foundations of Nursing / Nursing Care Management
• Better patient care, enhanced professional
status for nurses and improved
communication between nurses
• Guides nursing research and nursing
education
• EDUCATION
• RESEARCH
• CLINICAL PRACTICE
a. Offers framework for generating knowledge
and new ideas
b. Assist in the discovery of knowledge in a
specific field of study
c. Offer a systematic approach to identify
questions for scaling, selection of variables
and interpretation of findings
1. Assist nurses to describe, explain, and
predict everyday experiences
2. Serve to guide assessment, implementation
and evaluation of nursing care.
3. Provide rationale for collecting reliable and
valid data about the health status of clients
which are important for effective decision
making and implementation
4. Helps establish criteria to measure the
quality of nursing care.
5. Helps build common nursing terms in
communicating with other health programs.
6. Assist in clarifying beliefs, values and goals
7. Help define the unique contributions of
nursing care to clients.
8. Enhance autonomy in nursing.
1. Provide a general focus for curriculum
design.
2. Guide curricular decision-making process.
…
Theory & Research
a. Research validates & modifies theory
b. Theory stimulates exploration
Theory & Practice
a. Theory guides practice
b. Theory provides insights about nursing
practice situations
c. Practice shapes theory
Research & Practice
a. Research develops practice
’
Mainly focusing on the four concepts and three
principles of homeodynamic that are: Energy
fields, openness, pattern, pan dimensional,
integrality, resonance and helicy respectively.
• human being is considered as whole which
cannot be viewed as subjects
• 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
thinks, imagine, sense, feel, and can use
language for expression.
• Human beings have the ability to adapt
according to the new changes in the
environment.
Theoretical Foundations of Nursing / Nursing Care Management
• All the 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.
• The inevitable part of life
• Human and environment both have energy
field which is open i.e., energy can freely
flow between human and environment.
• There is no boundary or barrier that can
inhibit the flow of energy between human
and environment which leads to the
continuous movement or matter of energy
• The distinguishing character of the energy
field
• Undeviating field which is not constricted
by space or time, it is an infinite domain
without boundary
Refers to the balance between the dynamic life
process and environment
These principles help to view human as unitary
human being. The three separate principles
are integrality, resonance, and heliecy.
• Energy fields are dynamic and constantly
interact with human and environment,
which affects our environment and vice
versa.
• This is the principle on which meditation
and humor works to produce a positive
environment
• An ordered arrangement of rhythm
characterizing both human field and
environmental field
• Constant change in the ways 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
• Any minute change in the environment
which leads to ripple effect i.e., results in a
larger change in other field
• This change is constant, unpredictable and
there are many factors which mutually
interact and cause the change
• A unitary human being is open systems
which continuously interact with
environment. A person cannot be viewed
as parts, it should be considered as a
whole
Theoretical Foundations of Nursing / Nursing Care Management

• It includes the entire energy field other than

a person
• These energy fields are irreducible, not
limited by space and time, identified by its
pattern and organization

• Not clearly defined by roger.

• Determined by the interaction between
energy fields i.e., human and environment • Emphasis should be given on the
understanding of the patient and self,
energy field and environment
• Training should lay more focus on teaching
• Is both science and art
non-invasive modalities such as
• Constantly maintains the energy field
therapeutic, touch, meditation, humor,
which is conducive for patient
regular in-service education programme
• Nursing action directs the interaction of etc.
person and environment to maximize
health potential

• Rogerian theory has been used in many

research works and has always been
found testable and applicable in research.

• Nursing action is always focused on unitary

human being and change the energy field
between human and environment
• Nursing interventions include all the
noninvasive actions such as guided • An inclusive assessment of human and
imaginary, humor, therapeutic touch, environment energy fields, its organization
music etc. which are used to increase the of energy field, and identification of areas
potential of human being of dissonance.
• The more importance should be on the • Nurses validate the entire appraisal along
management of pain, supportive with the client
psychotherapy and rehabilitation of the
human being
Theoretical Foundations of Nursing / Nursing Care Management
• The proper patterning of the energy fields
between the human and environment
• The mutual interaction between the client
and nurse
• Can be done by suggesting the various
alternatives, educating, empowering,
encouraging, etc. depending on the client’s
condition and needs
• Includes appraisal of nutrition, rest and
sleep, exercises, discomfort, and relation
with others.
• The patterning activities can be therapeutic
touch, meditation, humor, imaginery etc.
• Done by repeating the pattern appraisal
after the mutual patterning to determine the
extents of dissonance and harmony
• 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
• 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
• TRADITIONAL - nursing practice which is
passed down from generation to
generation
• AUTHORITATIVE - is an idea by a person
of authority which is perceived as true
because of his or her expertise.
• SCIENTIFIC - knowledge came from a
scientific method through research
• Is an organized system of accepted
knowledge that is composed of concepts,
propositions, definitions and assumptions
intended to explain a set of fact, event or
phenomena.
• a group of related concepts that propose
actions that guide practice
• is a system of ideas that is proposed to
explain a given phenomena
• idea, belief, view, notion, thought,
perception, impression
• Are building blocks of theories
• A concept enhances one’s capacity to
understand phenomena as it helps define
the meaning.
• are indirectly observed.
• it is independent on time and place.
• Examples are love, care and freedom.
• are directly observed.
• Specific to time and place Examples are
nurse, mother, chair
Statements that explain the relationships of
different concepts.
EXAMPLE:
Children don’t want to stay in the hospital
because of their fear of injections
Is composed of various descriptions which
convey a general meaning and reduces the
vagueness in understanding a set of concepts.
Is a statement that specifies the relationship or
connection of factual concepts or phenomena.
EXAMPLE
All patients who are not able to take good care
of themselves need nurses.
Theoretical Foundations of Nursing / Nursing Care Management
a fact or occurrence that can be observed
something notable; excites people’s interest
and curiosity
A statement of beliefs and values about
human beings and their world Is concerned
with the purpose of human life, the nature of
being and reality, the theory and limits of
knowledge
• youngest of 3 children, born in 1923
• St. John's Hospital School of Nursing in St.
Louis, Missouri (1945)
• 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: a. administrator, an educator,
and a practitioner
PERSON
• Individuals are spiritual being
• have the capacity to think, know, make
choices & select alternative courses of
action
• have the ability through their language &
other symbols to record their history &
preserve their culture
• open system in transaction with the
environment
• unique & holistic, are of intrinsic worth &
are capable of rational thinking & decision
making in most situations
• Individuals differ in their needs, wants &
goals
➢ Need for health information
➢ Need for care for illness prevention
➢ Need for total care when a person doesn’t
have the capacity to help themselves
• Is a dynamic state in the life cycle; illness
is an interference in the life cycle
• Implies continuous adjustment to stress in
the internal and external environments,
using personal resources to achieve
optimal daily living
Theoretical Foundations of Nursing / Nursing Care Management
• The process of balance involving internal &
external interactions inside the social
system
• Interpreted from the general systems
theory as an open system with permeable
boundaries that allow the exchange of
matter, energy, and information
NURSING
• Is an act wherein the nurse interacts &
communicates with the client
• The nurse helps the client identify the
existing health condition, exploring &
agreeing on activities that promote health
• 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
• 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
man as a dynamic human being whose
perceptions of objects, persons, and events
influence his behavior, social interaction, and
health.
She proposes three basic premises; man is:
1. A reactive being
2. A time oriented being
3. A social being
• Man as a reactive being
is aware of other things; persons and
events in the environment
• Man as a time-oriented being is influenced
by time orientation.
Each person is influenced by his past
actions.
• Man as a social being has a continuous
exchange with persons in the environment.
Language is a social link and facilitates
interpersonal communication.
1. PERSONAL SYSTEM
2. INTERPERSONAL SYSTEM
3. SOCIAL SYSTEM
’
• INDIVIDUALS
• It is how the nurse views & integrates self-
based from personal goals & beliefs
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
• Two or more interacting individuals.
• How the nurse interrelates with a co-worker or
patient, particularly in a nurse-patient
relationship
Theoretical Foundations of Nursing / Nursing Care Management
A. Interaction – any situation wherein the
nurse relates & deals with a patient
B. Communication – refers to the
transmission of information from one person to
another; either directly or indirectly
C. Transaction – refers to the interaction
between a person & the environment for the
purpose of goal attainment
D. Role – refers to the expected behaviors of
a person in a specific position & to the rules
that govern the position & affect interaction
between two or more persons
E. Stress – refers to an exchange of energy,
either positive or negative between a person &
the environment;
F. Stressors – Events that produce stress
• Composed of larger group of individuals
with common interests or goals.
• How the nurse interacts with co-workers,
superiors, subordinates & the client
environment in general
Example:
• families, religious groups, schools,
workplaces, and peer groups
A social system comprises the:
1.social roles
2.behaviors
3. practices
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
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.
6. The ability to select means of accomplishing
goals.
’
1. If perceptual accuracy is present in nurse-
client interactions, transactions will occur.
2. If nurse & client make transactions, goals
will be attained
3. If goals are attained, satisfactions will
occur
4. If goals are attained, effective nursing care
will occur
5. If transactions are made in nurse-client
interactions, growth & development will be
enhanced
6. If role expectations & role performance as
perceived by nurse & client are congruent,
transactions will occur
7. If role conflict is experienced by the nurse
& client or both, stress in nurseclient
interactions will occur
8. If nurses with special knowledge & skills
communicate appropriate information to
clients, mutual goal setting & goal attainment
will occur
• Born on 1914 in Baltimore, Maryland
• Began her nursing education at
Providence Hospital School of Nursing in
Washington, DC
Theoretical Foundations of Nursing / Nursing Care Management
• 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,
d. evening supervisor in the E.R.
e. 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.1980,1995.
• died in June 22 ,2007 at age 92
• 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
• Defined as the patient- a being who
functions biologically, symbolically &
socially & who has the potential for learning
& development
• 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
• 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
• 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”.
• Consists of physical, psychological,
interpersonal & social aspects; according
to Orem, these aspects are inseparable
• Includes promotion & maintenance of
health, treatment of illness & prevention of
complications
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)
• helping clients to establish or identify ways
to perform self-care activities.
• Nursing actions are geared towards the
independence of the client.
• Nursing is a human service-its focus is on
persons with inabilities to maintain
continuous provision of healthcare.
• Nursing is based on values
1.Self – Care
2.Self – Care Requisites
Universal Self-Care Requisites
Developmental Self – Care Requisites
Health Deviation Self Care Requisites
3.Therapeutic Self – Care Demand
4.Self-Care Agency
• Agent
• Dependent-Care Agent
b. Self-Care Deficit
• Nursing Agency
• Nursing Design
c. Nursing System
• Helping Methods
Theoretical Foundations of Nursing / Nursing Care Management
• Describes why & how people care for
themselves
Self- Care: refers to those activities an
individual performs independently throughout
life to promote & maintain personal well-being
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)
• self-care agent – person who provides the
self-care
• Dependent care agent – person other
than the individual who provides cares
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.
• 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.
• 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
• 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
• 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 vary throughout life.
• which describes & explains why people
can be helped through nursing
Self-care deficit: arises when the self-care
agency cannot meet self-care requisites
Helping Methods:
1. Acting or doing for another
2. Guiding and directing
3. Providing physical or psychological support
4. Teaching
5. Providing and maintaining an environment
that supports personal development
• describes and explains relationships that
must be brought about & maintained for
nursing to be produced
• refers to the series of actions a nurse takes
to meet a patient’s self-care requisites
Nursing Agency: set of established
capabilities of a nurse who can legitimately
perform activities of care for a client.
• helps a person achieve their health care
demand.
Nursing Design: these are professional
functions that must be performed by the nurse
in order to meet clients’ needs
Theoretical Foundations of Nursing / Nursing Care Management

• it serves as a guideline of needed & responsibilities for providing care to group

foreseen results in the production of members who experience privations for
nursing toward the achievement of nursing making required, deliberate input to self and
goals others.

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

• 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
• is used when a patient can meet some self-
care requisites but needs a nurse to help
meet others
• the nurse & the patient play major roles in
performing self-care
3. Supportive – Educative Nursing System
• is used when a patient can meet self-care
requisites but needs assistance with
decision making, behavior control or
knowledge acquisition skills

1. Human beings require continuous, 2. Theory of Self-Care deficit

deliberate inputs to themselves and their 3. Theory of Self-Care
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
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.
Theoretical Foundations of Nursing / Nursing Care Management

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
197