INTRODUCTION TO NURSING THEORY: IT’S HISTORY ND SIGNIFIC NCE
HISTORY OF NURSING THEORY B. Providing a professional style of practice
• History of professional nursing began with Florence
Nightingale.
• Development of nursing knowledge apart from medical
knowledge to guide nursing practice.
• Nursing was based on principles and traditions that were
handed down through an apprenticeship model of education
and individual hospital procedure manual.
• Nursing practice reflected it’s vocational heritage more than
it’s professional vision.
• 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.
CURRICULUM ERA
• 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 or 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.
• 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.
GRADUATE EDUCATION ERA
• Developed in tandem with 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 with the following goals:
A. Improving the quality of patient care
C. Achieving recognition as a profession.
• Transition from vocation to profession.
• Meleis (2007) noted, “theory is not a luxuryin 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
• natural outgrowth of the research and graduate education
eras.
• Emphasis on theory development and testing.
• ccelerated as early works developed as frameworks for
curricula and advanced practice guides began to be rec as
theory.
• Transition from the 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 within
metaparadigm concepts are 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:
1. Nurse leaders
2. Administrators
3. Educators
4. Practitioners
NURSING THEORY ERA
• 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: HISTORICAL ERAS OF NURSING’S SEARCH FOR SPECIALIZED
KNOWLEDGE
1. Nursing philosophy
• Sets forth the meaning of nursing phenomena through
analysis, reasoning and logical presentation
• Basis for subsequent development

2. Nursing conceptual methods

• Comprises nursing works by the theorist who also are
referred to as pioneers in nursing

3. Nursing Theory
• derived from nursing philosophies, conceptual models or
more abstract nursing theories, or from works of other
disciplines
• Developed from some conceptual framework and is more
specific than the framework
• Theories maybe specific to a particular aspect or setting of
nursing practice.

4. Middle Range Theory

• More specific focus and is more concrete than nursing theory
in its level of abstraction.
• More precise, with a focus on answering specific nursing
practice questions
• ddress the specifics of nursing situations within the
perspective of the model or theory from which they are
derived.
• They specify each factor as:
SIGNIFICANCE OF NURSING THEORY
a. The age group of the patient
• DISCIPLINE-specific to academia and refers to a branch of
b. The family situation
education, a
c. The health condition
Department of learning, or domain of knowledge
d. The location of the patient
• PROFESSION-refers to a specialized field of practice, founded
e. The action of the nurse
upon the theoretical structure of the science or knowledge of
• Types of nursing theoretical works:
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 avocational rather than a professional view.
• The significance of theory for the discipline of nursing the
discipline is dependent on theory for its continued existence.
- Nursing can be vocational or nursing can be discipline with a
professional style of theory-based practice.
• 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 care
 TERMINOLOGIES

SCIENCE
- 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
SOURCE OF KNOWLEDGE
• 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
THEORY
- 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.
CONCEPT
- idea, belief, view, notion, thought, perception, impression
- Are building blocks of theories
- concept enhances one’s capacity to understand phenomena
as it helps define the meaning.
DEFINITION
- Is composed of various descriptions which convey a general
meaning and reduces the vagueness in understanding a set of
concepts
ASSUMPTION
- Is a statement that specifies the relationship or connection of
factual concepts or phenomena.
- 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 notable͖ excites people’s interest and curiosity
PHILOSOPHY
- 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
Concept, Proposition, Assumption, Definitions
Theory
Phenomena
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
 Ex. 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

ABSTRACT CONCEPT 3. THEORIES SHOULD BE SIMPLE BUT GENERALLY BROAD IN

- are indirectly observed. NATURE
- it is independent on time and place • Parsimonious - simple terms that describes, explains,
- Examples are love, care and freedom. or predicts a wide range of phenomena
CONCRETE CONCEPT 4. THEORY CAN BE THE SOURCE OF HYPOTHESES THAT CAN BE
- are directly observed. TESTED FOR IT TO BE ELABORATED
- Specific to time and place
- Examples are nurse, mother, chair
5. THEORIES CONTRIBUTE IN ENRICHING THE GENERAL BODY
OF KNOWLEDGE THROUGH THE STUDIES IMPLEMENTED TO
PROPOSITION
VALIDATE THEM
- Statements that explains the relationships of different
concepts.
- Ex. Children don’t want to stay in the hospital because of their 6. THEORIES CAN BE USED BY PRACTITIONERS TO DIRECT OR
fear of injections. 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

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

METAPARADIGM
- Greek “Meta”- with͖ “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

PERSON
- refers to the recipient of nursing care, including physical,
spiritual, psychological, socio-cultural components

ENVIRONMENT
- refers to all internal and external conditions and
circumstances, and influences affecting the person

HEALTH
- refers to the degree of wellness or illness experienced by the
person

NURSING
- refers to the actions, characteristics, and attributes of the
individual providing the nursing care
 FLORENCE NIGHTINGALE: ENVIRONMENTAL THEORY

FLORENCE NIGHTINGALE NIGHTING LE’S 13 CANONS:

• Florence is remembered today as the Person responsible • Observation of the Sick
for improving conditions in hospitals and making nursing an • Personal Cleanliness
acceptable job • Petty management
• Strongest influence: education, observation and hands-on • Light
experience • Health of Houses
• Cleanliness of Rooms
NIGHTING LE’S NURSING THEORY • Ventilation and warming
• Theory basis: the inter-relationship of a healthful • Bed and Bedding
environment with nursing • Taking Food
- External influences and conditions can prevent, • What food
suppress, or contribute to disease or death • Noise
• Theory goal: Nurses help patients retain their own vitality • Chattering Hopes and
by meeting their basic needs through control of the • Advices Variety
environment
•Nursing’s Focus: control of the environment for individuals, METAPARADIGM IN NURSING
families & the community • Nursing
• Health
THREE TYPES OF ENVIRONMENTS • Environment
• Psychological • Person
• Physical
• Social PERSON
- The patient, a human being acted upon by a nurse or
Physical Environment affected by the environment who has reparative powers.
• Consists of physical elements where the patient is being - Recovery is within the patient’s power as long as safe
treated environment for recuperation exists.
• Affects all other aspects of the environment
• Cleanliness of environment relates directly to disease ENVIRONMENT:
prevention and patient mortality - Comprises the external conditions and forces that affect
• Ventilation, warmth, cleanliness, light, one’s life and development
Noise and drainage - Everything from person’s food to a nurse’s verbal and
nonverbal interactions with the person.
Psychological Environment
• Providing a positive stress-free surrounding HEALTH
• Can be affected by a negative physical environment which - Maintaining well-being by using a person’s powers to the
then causes STRESS fullest extent; disease is viewed as a reparative process
• Requires various activities to keep the mind active (i.e, instituted by nature
manual work, appealing food, a pleasing - Maintained by controlling environmental factors to prevent
environment) disease; nurse helps the person through the healing process.
• Involves communication with the person, about the
person, and about other people NURSING
- Aims to provide fresh air, light, warmth, cleanliness, quiet
Social Environment and proper diet; facilitates a person’s reparative by ensuring
• Involves collecting data about illness and disease the best possible environment; influences the environment
prevention to affect health.
• Consists of a person’s home or hospital room, as well as
the total community that affects the patient’s specific NIGHTINGALE’S ASSUMPTION
environment 1. Nursing is separate from medicine.
• Stress free surroundings 2. Nurses should be trained.
3. The environment is important in nursing.
5 MAJOR COMPONENTS OF A HEALTHFUL ENVIRONMENT 4. The disease process is not important to nursing.
1. Proper ventilation 5. Nursing should support the environment to assist the
2. Adequate light patient in healing.
3. Sufficient warmth 6. Research should be utilized through observation and
4. Control of noise empirics to define the nursing discipline.
5. Control of effluvia(noxious odors) 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.
 MARGARET JEAN WATSON: PHILOSOPHY AND SCIENCE OF CARING
NURSING METAPARADIGM
PERSON
• Human being to be valued, cared for, respected, nurtured,
understood and assisted
• Must be viewed according to the client’s development &
the conflicts arising in this development
ENVIRONMENT
• Defined as society with all its influences
• It provides the values that determine how one should
behave and what goals one should strive toward.
• Encompasses social, cultural & spiritual aspect
HEALTH
• Refers to unity & harmony within the mind, body & soul
• Watson, in addition to WHO’s definition, include these
three elements:
- A higher level of over-all physical, mental & social
functioning
- A general adaptive-maintenance level of daily
functioning; and
- The absence of illness (or the presence of efforts that
lead to its absence)
NURSING
• Providing holistic healthcare
• A human science of people & human health-illness
• experiences that are mediated by professional, personal,
scientific, aesthetic & ethical human care transactions
MAJOR ASSUMPTIONS
• 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
• Occurs early in life but can be greatly influenced by nursing
educators
• Can be accomplished by examining one’s views, beliefs, &
interactions with various cultures as, well as personal
growth experiences
• Provides satisfaction through giving & extending oneself
2. Instillation of faith-hope
• Describes the nurse’s role in developing effective nurse-
patient interrelationships & in promoting wellness
• Is accomplished by helping a client adopt health seeking
behaviors, by positively using the powers of suggestion &
positively supporting the client
3. Cultivating sensitivity to self and others
• The recognition of feelings leads to self-actualization
through self-acceptance for both the nurse & the patient
• As Nurses acknowledge their sensitivity & feelings, they
become
• more genuine, authentic & sensitive to others
4. Development of a helping-trust relationship
• Establishes rapport & caring
• Helps promote expression of positive & negative feelings
• Is accomplished through congruence, empathy, non
possesive warmth, & effective communication
5. Promotion & acceptance of the expression of positive &
negative feelings
• Involves sharing of feelings
• Includes being prepared for negative as well as positive
feelings
6. Systematic use of the scientific problem-solving method for
decision making
• is important for research, defining the discipline &
developing a scientific knowledge base for nursing
• Brings scientific, problem solving approach to nursing care
7. Promotion of interpersonal teaching-learning
• Gives a client maximum health control because it provides
information & alternatives
• •Distinguishes caring from curing by assigning
responsibility for health to the client
• 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
• Involves assessing & facilitating a client’s coping abilities to
support& protect mental & physical well-being
• Requires understanding that a person’s environment
includes internal & external independent variables
 • Includes providing comfort, privacy, safety & a clean, aesthetic
surroundings

9. Assisting with gratification of human needs

• Addresses the needs of both the nurse & the client
• Requires meeting lower order needs before attaining higher-
order needs

10. Allowance for existential-phenomenological forces

• Permits one to understand people from the way things appear
to them; their experiences shape their individual
• perceptions
• Leads to better understanding of oneself & of others
 IMMOGEN 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:
- administrator, an educator, and a practitioner
Nursing Metaparadigm
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
3 Fundamentals of Human Being:
• Need for information
• Need for care for illness prevention
• Need for total care when a person doesn’t have the
capacity to help themselves.
HEALTH
- Is a dynamic state in the life cycle; illness is an interference
in the life cycle
- Is a dynamic state in the life cycle; illness is an interference
in the life cycle
Goal attainment Theory (King's 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
• Focus
- man as a dynamic human being whose perceptions of
objects, persons, and events influence his behavior, social
interaction, and health
Man is an important focus of King's framework.
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.
3 Interacting systems of the theory:
1. PERSONAL SYSTEM
2. INTERPERSONAL SYSTEM
3. SOCIAL SYSTEM
KING’S CONCEPTU L SYSTEM

ENVIRONMENT
- 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
1. PERSONAL SYSTEM
- The nurse helps the client identify the existing health
• Individuals
condition, exploring & agreeing on activities that promote
• How the nurse views & integrates self-based from personal
health
goals & beliefs
- The goal of the nurse in King’s theory is to help the client
maintain health through health promotion & maintenance,
Concept of Personal system:
restoration & caring for the sick & dying
• 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 perceive 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
• Two or more interacting individuals.
• How the nurse interrelates with a co-worker or patient,
particularly in a nurse-patient relationship
Concept of Interpersonal system
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;
objects , persons & events can serve as stressors
3. SOCIAL SYSTEM
• 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
• Ex. families, religious groups, schools, workplaces, and peer
groups
• A social system comprises the:
1.social roles
2.behaviors
3. practices
Concept 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 CHARACTERS OF A 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.
6. The ability to select means of accomplishing goals.
Propositions of King’s Goal ttainment Theory
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 nurse-client interactions will occur
8. If nurses with special knowledge & skills communicate
appropriate information to clients, mutual goal setting &
goal attainment will occur
 DOROTHEA E. OREM: SELF DEFICIT THEORY

CREDENTIALS AND BACKGROUND • NURSING

• Bornon1914 in Baltimore, Maryland - helping clients to establish or identify ways to perform self-
• Began her nursing education at Providence Hospital School care activities.
of Nursing in Washington, DC - Nursing actions are geared towards the independence of
• 1939 -she earned her BSN education at the Catholic the client.
University of America - Nursing is a human service-its focus is on persons with
• 1946 -earned her M.S. N. from Catholic University of inabilities to maintain continuous provision of healthcare.
America. - Nursing is based on values
• Her nursing experiences included
a. operating room nursing, MAJOR CONCEPTS & DEFINITIONS
b. private duty nursing (home & hospital), • Self -Care
c. hospital staff nursing on pediatric and adult medical • Self -Care Requisites
and surgical units, • Universal Self-Care Requisites
d. evening supervisor in the E.R. • Developmental Self - Care Requisites
e. biological science teacher • Health Deviation Self - Care Requisites
• 1958-1960 curriculum consultant • Therapeutic Self -Care Demand
• 1959 - “Guides for developing the curricula for the • Self-Care Agency
Education of Practical Nurses” was published • Agent
• 1971 - “Nursing Concepts of Practice” which is Orem’s first • Dependent-Care Agent
book was published. • Self-Care Deficit
• Orem’s theory addresses client’s self-care needs • Nursing Agency
• Nursing Design
• It is defined as Goal-oriented activities that are set towards
• Nursing System
generating interest in the part of the client to maintain life &
• Helping Methods
health development
• The theory is aimed towards making the clients perform self-
care activities in order to live independently

METAPARADIGM
• PERSON
- 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 indeliberate
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

• HEALTH SELF-CARE DEFICIT THEORY AS A GENERAL THEORY IS

- 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
COMPOSED OF 3 RELATED THEORIES:
1. THE THEORY OF SELF-CARE
- 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

• ENVIRONMENT Self-Care agency: the complex acquired ability of mature &

- Consists of environmental factors, environmental maturing persons to know & meet their continuing
elements, environmental conditions (external physical & requirements for deliberate, purposive action to
psychosocial surroundings) & developmental environment regulate their own functioning & development
- consists of two agents: An agent (individual who is engage
(promotion of personal development through motivation
to establish appropriate goals & to adjust behavior to meet in meeting the need of a person; like bridges that facilitate
these goals; includes formation of or change in attitudes & what has been done and what needs to be done)
values, creativity, self-concept & physical development) • 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.
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 wellbeing;
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 selfcare demand is needed.
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
- which describes & explains why people can be helped
through nursing
Self-care deficit: arises when the selfcare 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
3. THEORY OF NURSING SYSTEMS
- 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 healthcare demand.
Nursing Design: these are professional functions that must be
performed by the nurse in order to meet clients
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
-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
MAJOR ASSUMPTIONS
1. Human beings require continuous, deliberate inputs to
them selves 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 other sin identifying needs
and making needed inputs.
3. Mature human beings experience privation sin 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
Wholly compensatory system c. Cardiac research
• Partial compensatory system d. Oncology -focus cancer prevention, self-care after
being diagnosed with malignancies.
e. Psychiatry etc.
Nurse action
• Education
- “Guides for Developing Curriculum for the Education of
Practical Nurses”
a. Orem worked on a book “Foundations of Nursing
Practice” (Morris Harvey College)
Patient action
• Research
a. First instrument to measure the exercise of Self-care
agency(ESCA) was published in 1979

• Supportive-educative system
Further Development
Patient action • Orem is presently working with a group of scholars, known
as Orem study Group
• International Orem Society for Nursing scholarships(IOS est.
Nurse action 1993)
• The Sixth International Self-Care deficit theory Conference
which was held in Bangkok, Thailand in February 2000.

2. Theory of Self-Care deficit

3. Theory of Self-Care
 M RTH ROGER’S SCIENCE OF UNITARY HUMAN BEING
INTRODUCTION:
• Martha Roger’s theory Science of Unitary Human Beings is
mainly focusing on the four concepts and three principles of
homeodynamics that are energy fields, openness, pattern,
pandimensioal, integrality, reasonancy, and helicy
respectively,
ASSUMPTIONS:
• Human being is considered as whole which cannot be viewed
as subparts.
• The life process of human is irreplaceable and one way i.e.
from birth to death.
• Health and illness order continuous expression of the
process.
• The energy flows freely between the individual and
environment.
• Human being possesses the ability to think imagine, sense,
feel, and can use language for expression.
• Human beings have the ability to adapt according to the new
changes in the environment
CONCEPTS:
• All the human beings are viewed as integral part of universe
• human beings and the environment have energy fields,
nursing action is directed towards patterning and
maintaining this energy fields.
ENERGY FIELDS:
• It is the inevitable part of life. Human and environment both
have energy fields which is 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 which leads to the
continuous movement or matter of energy.
PATTERN:
• Is the distinguishing character of the energy fields.
PANDIMENSIONAL
• Undeviating field which is not constructed by space or time,
it is an infinite domain without boundary
PRINCIPLE OF HOMEODYNAMICS:
• Homeodynamics refers to the balance between dynamic life
process and environment
• these principles have to view human as unitary human being.
the three separate principles are integrality, resonancy, and
heliecy
PRINCIPLE OF INTEGRALITY:
• Energy fields are dynamic and constantly interact with the
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
PRINCIPLE OF RESONANCY:
• It's an ordered arrangement of rhythm characterizing both
human fields and environmental fields
• Constant change in the way of 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, another
active use of imagination
PRINCIPLE OF HELIECY:
• Any minute change in the environment which leads to ripple
effect i.e. result in larger changes in other field.
• This change is constant, unpredictable and there are many
factors which mutually interact and cause the change
METAPARADIGM IN NURSING
• Person
• Environment
• Health
• Nursing
PERSON:
• A unitary human being is open system which continuously
interactive environment. a person cannot be viewed as parts,
it should be considered as a whole.
ENVIRONMENT:
• it includes the entire energy field other than a person.
• this energy fields are irreducible, not limited by space and
time, identified by its pattern and organization
HEALTH:
• not clearly defined by Roger. it is determined by the
interaction between energy fields i.e. human and
environment
• but interaction or misplacing of the energy leads to illness.
NURSING:
• it's both science and art
• it constantly maintains the energy field which is conductive
for patient.
• nursing action directs the interaction of person an
environment to maximize health potential.
Application of SUBH: • The patterning activities can be therapeutic touch,
• Practice meditation, humor, imaginary etc
• Education
• Research Evaluation:
• Evaluation is done by repeating the pattern appraisal after
Clinical Practice: the mutual to determine the extents of dissonance and
• Nursing action is always focused on unitary human being and harmony.
change and energy field between human and environment
• nursing interventions include all the noninvasive action such
as guided imaginary, humor, therapeutic touch, music etc.
which are used to increase the potential of human being
• the more important should be on the management of pain,
supportive psychotherapy and rehabilitation of the human
being.

Nursing Education:
• emphasis should be given on the understanding of the
patient and self, energy fields and environment.
• Training should be more focused on teaching non-invasive
modalities such as therapeutic touch, meditation, humor,
regular in-service education program etc.

Nursing Research:
• Rogerian theory has been used in many usage works and
has always been found testable and applicable in research.

NURSING PROCESS ACCORDING TO SUBH:

• Pattern appraisal
• Mutual patterning
• Evaluation

Pattern Appraisal:
• It is inclusive assessment of human and environment
energy fields, it's organization of energy field, and
identification of areas of dissonance.
• nurses validate the entire appraisal along with the client.

Mutual Patterning:
• it is a proper patterning of the 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 with others.
 PATRICIA BENNER’S FROM NOVICE TO EXPERT: EXCELLENCE ND POWER IN CLINICAL NURSING
PRACTICE
CREDENTIALS AND BACKGROUND OF THE THEORIST
• Patricia Benner, R.N., Ph.D., F.A.A.N.
• Professor, University of California-San Francisco
• obtained a Bachelor of Arts degree from Pasadena College in
1964
• Earned a master’s degree in nursing from the University of
California, San Francisco School of Nursing in 1970
• She published From Novice to Expert in 1984 and became a
Fellow in the American Academy of Nursing in 1985.
METAPARADIGM
•PERSON
- a self-interpreting being, that is, the person does not come
into the world predefined but gets defined in the course of
living a life.
- The three major aspects of understanding that the person
must deal with:
1. The role of the situation
2. The role of the body
3. The role of personal concerns
4. The role of temporality.
•HEALTH
- Health - what can be assessed
- Well-being - human experience of health or wholeness.
- Illness - the human experience of loss or dysfunction.
- Disease - is what can be assessed at the physical level
•ENVIRONMENT
- She used the word situation because it suggests a social
environment with social definition and meaning.
- Situation - defined by the person’s engaged interaction,
interpretation and understanding of the situation.
- Persons enter into situations with their own sets of meaning,
habits & perspectives.
•NURSING
- She described nursing as a caring relationship, an “enabling
condition of connection and concern.
- Viewed nursing practice as the care and study of the lived
experience of health, illness, and disease and the
relationships among these three elements.
BENNER'S STAGES OF CLINICAL COMPETENCE (1984; 2004)
Novice
- no experience of the situations in which they are expected to
perform
- Learn context-free rules to guide action (stimulus-response
thinking)
- Rule-governed behavior is typical, tends to be inflexible
- Has difficulty discriminating between relevant & irrelevant
aspects of a situation
Advanced Beginner
- Can demonstrate marginally acceptable performance
- Have begun to identify recurring meaningful situational
aspects and apply these in new situations
- Unable to see the entirety of a new situation (may miss some
critical details)
- They feel more responsible for managing patient care, yet
they still rely on the help of those who have more
experiences
Competent
- Considers consistency, predictability & time management as
essential components & gaining a sense of mastery
- There is an increased level of efficiency but the focus is on
time management & the nurses organization of the task are
more important rather than on timing in relation to the
patient’s needs
- This stage is critical because the nurse must know how to
recognize the patterns & identify which element of the
situation needs attention & which ones to ignore
Proficient
- Perceives situations as whole rather than in terms of aspects
- Performance is guided by maxims (cryptic instructions that
make sense only if there is already a deep understanding of
the situation)
- Perception is a key word
- Possesses a web of perspectives on a situation
- Demonstrate an increased confidence in their knowledge &
abilities
Expert
- No longer relies on an analytic principle (rule, guideline,
maxim) to connect understanding of a situation to
appropriate action
- Operates from a deep understanding of the total situation
- Possessing an intuitive grasp of the problem
- There is a qualitative change as the expert performer “knows
the patient”, which means that knowing typical patterns of
responses & knowing the patient as a person
•Key aspects of the expert nurse practice:
- Demonstrating a clinical grasp and resource
- based practice
- Possessing embodied knowledge
- Seeing the big picture
- Seeing the unexpected
SEVEN DOMAINS OF NURSING PRACTICE
•Helping role
•Diagnostic client-monitoring function
•Effective management of rapidly changing situations
•Administering & monitoring therapeutic interventions &
regimens
•Monitoring & ensuring quality health care practices
•Organizational & work-role performance
•Teaching or coaching function