INTRODUCTION TO NURSING THEORY

Gives you concepts to your nursing practice

Week#2 Reviewer/ Handouts/ NOTES/ avriannotes:>

As a nursing student, you are expected to be equipped with the basic knowledge of theories,
particularly in nursing practice. The more you gain understanding, the better the outcome
of being a nurse, you are going to be. Plus, nursing is a dynamic process and always changing,
so it is better to continuously update yourself with the theoretical knowledge required.

Introduction to Nursing Theory Provides you discussions about the basic conceptsthat make
up a nursing theory. Also included are the characteristics of a theory, four ways of knowing, and
metaparadigm concepts of nursing. Learning to understand and apply them is fun.

So let’s get started.

Summary
➔Overview of Nursing Theory(Definition of Terms
➔Metaparadigm Concepts(Person, Health, Environment, and Nursing)
➔Characteristics of a Theory
➔Four Ways of Knowing(Empirical, Aesthetic, Ethical, and Personal)

Upon completion of this module, you are expected to:

● 1.define the foundational body of knowledge of the concepts that make up a nursing
theory
● 2.classify the four ways of knowing in various nursing situations.
● 3.apply the nursing theoretical concepts and its relationships in viewing a particular
nursing phenomena..
● 4.defend a stand as to why nursing theory is as important as practice

Why learn nursing theory?

You are expected to be equipped with the basic knowledge of theories, particularly in
nursing practice.

What is a theory?
It is a Concept, Prepositions, Assumptions, Definitions organized systematically to view a certain
Phenomena.

A theory is something that (D.E.P.P)

● DESCRIBES
● EXPLAINS
● PREDICT
● PRESCRIBE

All of that equates to NURSING CARE.

We adapt theory in the context of nursing, with the intended goal of developing and enhancing
nursing practice.

1
DEFINITION OF NURSING
#Need itong isapuso at isabaga.

American Nursing Association (ANA)

Nursing is the “diagnosis and treatment of human responses to actual or potential health
problems.”

International Council of Nurses (ICN)

"Nursing encompasses autonomous and collaborativecareof individuals of all ages, families,
groups, andcommunities, sick or well and in all settings. Nursing also includes health promotion,
prevention of illness, and the care of the ill, disabled, and dying people."

Association of Deans of Philippine Colleges of Nursing (ADPCN)

Nursing is “a dynamic discipline. It is an art and science of caring for individuals, families,
groups, and communities geared toward promoting and restoration of health, preventing
illness, alleviating suffering, and assisting clients in facing death with dignity and peace”.

Philippine Nurses Act of 2002 (PNA)

Nursing is the initiation and performance of nursing services, singly or in collaboration with
another, to individuals, families, communities, and any health care setting.

Virginia Henderson
Nursing is to “assist clients in the performance of activities contributing to health, its recovery or
peaceful death that clients will perform unaided if they have the necessary will, strength or
knowledge.

METAPARADIGMS
According to google [met″ah-par´ah-dīm] a set of concepts and propositions that sets forth the phenomena
with which a discipline is concerned. A metaparadigm is the most general statement of a discipline and
functions as a framework in which the more restricted structures of conceptual models develop.

These are patterns to show a relationship between the existing theoretical works in nursing.In
the context of nursing, these are known as metaparadigm concepts.

NURSING PARADIGMS
Metaparadigm Concepts
PERSON
ENVIRONMENT
HEALTH
NURSING

Different Types of Theories

Descriptive Theories
Also known as Factor-isolating Theories. Identify and describe the central concepts of
phenomena.

Example:
Descriptive research to determine the percentage of patientsreceiving intravenous (IV)
therapy who experience IV infiltration.

2
Explanatory Theories
Also known as Factor-Relating Theories.Present relationship among concepts and propositions.
(Cause and effect relationships are well explained)

Example: A research study about the factors affecting the quality of life of pregnant women.

Predictive Theories
They are otherwise known as Situation-Relating Theories. Relationships of concepts can
describe future outcomes consistently. (Use of experimental research)

Example: A theoretical model based on theobservation of the effects of unsanitary

environmental condition on the recoveryof post-operative patients

Prescriptive Theories
Also known as Situation-Producing Theories. Deal with nursing action, test the validity and
certainty of a specific nursing intervention.

Example:
Kolcaba’s Theory of Comfort validates and explains the different nursing interventions in an
acute care hospital in relieving anxiety among patients.

PHILOSOPHY OF NURSING
It is the next knowledge level after the metaparadigm.It sets forth the meaning of
phenomenathrough analysis, reasoning, and logical argument.

CONCEPTS
These are the building blocks of theories that could either be empirical or abstract in
particular phenomena.

Two types are : Abstract and Concrete

Abstract : General (Transport,Vascular Diseases,Loss of relationship)

Concrete : Specific (Wheelchair, Stroke, Divorce)

Conceptual and Operational Definition

Conceptual definition is the meaning of a word based on how relevant literature perceives it.

EXAMPLE: PE DEFINITION
Conceptual is a bodily movement thatrequires energy with the aid of the skeletal muscles.

Operational definition is the meaning of a concept based on the method of how it was
measured by the person who came up with that perception.

EXAMPLE: PE DEFINITION
Operational is the frequency of activityin terms of being mild, moderate, andintense.

3
FRAMEWORK OR MODELS
CONCEPTUAL MODELS OR FRAMEWORKS - are concepts representing a body of
knowledge based on a researcher's perception of a particular phenomenon.

THEORETICAL MODELS OR FRAMEWORKS - are a ready-made map for the study that is
testable in the literature.

4
WORD BREAK!
Came from the Latin word, scientia, which means knowledge. It is systematic of the body of
knowledge used in a discipline of study. - SCIENCE

Considered as facts of information gained from experiences of a phenomenon known in a discipline or

field of study. - KNOWLEDGE

Compose empirical data and perceived as physically tangible experiences such as guarding behavior
when in pain.Ex. Disease process, Care, pain, etc. - PHENOMENON

An educated guess that is a testable relationship statement. - HYPOTHESIS

A systematic method of studying a phenomenon that creates and enhances a body of knowledge.-
RESEARCH

It refers to the relationship between various concepts. For example, Children refuse to stay in the hospital
because of the fear of injections. - PREPOSITION

It is something a researcher believes that is true, but there is no universal proof. - ASSUMPTION

CHARACTERISTICS OF THEORY
● Theories can correlate concepts in such a way as togenerate a different way of looking at a certain
fact of phenomenon.
● Theories must be logical in nature.
● Theories should be simple but generally broad in nature.
● Theories can be the source of hypotheses that can be tested for it to be elaborated.
● Theories can be used by practitioners to direct and enhance their practice.
● Theories must be consistent with other validated theories, laws and principles but will leave open
unanswered issues that need to be tested.
● Theories contribute in enriching the general body of knowledge through the studies implemented
to validate them.

5
FOUR WAYS OF KNOWING
Nurses are highly trained personnel who have specialized with knowledge and skills to
address their patients' needs.

Their works must be challenging and often exhausting.

But how do they manage it? What does a nurse possess that others don't have?

Do you see yourself as a nurse that can overcome every challenge and possess sound
decision-making skills?

Empirical Knowing - is the principal form relating factual and descriptive knowing aimed at the
expansion of abstract and theoretical explanations.
Nana, a nursing student answers a question posed by the clinical instructor based on what she learned from school.
Ethical Knowing - requires knowledge of different philosophical positions regarding what is good and
right in making moral actions and decisions, particularly in the theoretical and clinical components of
nursing.​
Nurse Moses presents himself as a patient advocate and defends his client’s right to choose care
Personal Knowing - encompasses knowledge of the self in relation to others and to self. It involves the
entirety of the Nurse-Patient Relationship.​
Charles, a nursing student, strives to promote a meaningful personal relationship with his elderly patient

Aesthetics or Esthetics Knowing - is related to understanding what is of significance to particular patients

such as feelings, attitudes, points of view (Carper, 1978). It is also the manifestation of the creative and
expressive styles of the nurse (Kenney, 1996).​
Nurse Carl places himself in the “patient’s shoes” when communicating, giving judgment and providing care.

6
Brief of History of Nursing
HANDOUTS/NOTES/averynotes

Lesson 1 Influence of Florence Nightingale

Historical Era

● Florence Nightingale (1820 - 1910)

● History of professional nursing started with her; known as “Lady with the lamp”.
● Cared for the wounded soldiers during the Crimean war.
● Her pioneering activities and profound writings became the basis of establishing nursing schools and
hospitals.
● 1800’s Nightingale’s recognition of nursing knowledge as distinct to medical knowledge.

Unique Focus of Nursing Knowledge distinct from Medical Knowledge

Appeal took 100 years to seriously took Florence Nightingle appeal to get into their heads

“How did nursing theory start?

What is its goal?
How did it become a profession that began from vocational to professional practice?

For example a COFFEE BEAN:

History - Energizing Effect

Through the use of knowledge, transform bean into a liquid form as the main goal.
As the search goes on, dynamic change.
It became now as the Coffee.

Note: Without Florence Nightingle there will be no nursing theory and healthcare so far.

SO CHEERS TO FLORENCE NIGHTINGLE!

Curriculum Era (1900-1940s)

Curriculum Era took 40 years

Standardized curriculum as to what content the nurses should study.
Nursing programs integrated into colleges and universities.
● There is already a subject to learn

Research Era
Research Era (1950 - 1970s) took 20 years
Known as the scientific age; the path of new nursing knowledge
Nursing Research integrated into the nursing curriculum
Enrich theory development due to lacking conceptual and theoretical frameworks

Graduate Era
Graduate Era (1950 - 1970s) took 20 years

A Master’s degree program was established.

Progression in the theory development process
Evolution of a specialized body of knowledge

Theory Era
Theory Era (1980-1990s) took 10 years

Through a combination of research and the graduate era, comes Theory Era as a natural
development.

Research and theory produce nursing science.

Classifying metaparadigm concepts in nursing were established by J. Fawcett - Person,

Environment, Health, and Nursing THEORY OF NURSING KNOWLEDGE - Jacqueline Fawcett
(PHEN) Person,Health,Environment, and Nursing

Theory Utilization Era .

RAPE - research,administration,practice and Education

Focus on theory application in the areas of Education, Practice, and Research and
Administration. (Middle Range Theory)

This shift in focus is vital for the development of theory-based nursing and evidenced-based
practice that would serve as a basis for critical judgment and decision making.
Lesson 2 Significance of Nursing Theory

Discipline refers to academia ; particularly to the branch of education. On the other hand,

Profession is a specialized field of practice firmly established with the theoretical structure of
science.

Significance for the Discipline

● Baccalaureate and master's programs in nursing increase in number.
● Nursing theoretical works were published to improve nursing practice and quality care.
● Doctoral programs were beginning to open, discussing the nature of nursing science.
● Fawcett’s works recognize other nursing theorists’ conceptual framework and definitions
of their metaparadigm concepts.
● Major significance : “The discipline is dependent upon theory.”

Significance for the Profession

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 by the use of the scientific method.
3. Entrusts the education of its practitioners to institutions of higher education.
4. Applies its body of knowledge in practical services that are vital to human and social
welfare
5. Functions autonomously in the formulation of professional policy and in the control of
professional activity thereby.
6. Attracts individuals of intellectual and personal qualities who exalt service above
personal gain and who recognizes 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
Lesson 3 Structural Levels of Nursing Knowledge
In this lesson, you will observe that the different theorists' theoretical nursing frameworks are
categorized into types.

The profound nursing works are classified according to the level of abstraction.

Another aspect is to define the analysis of theory. This analysis is used to critique and evaluate
nursing theoretical works.

NOTE: The higher it is, the specific the topic.

Metaparadigm
Is the broad conceptual boundaries of nursing knowledge, human beings, health, nursing and environment
(Fawcett, 1984)

Philosophy
Sets forth the meaning of nursing phenomena through analysis, reasoning, and logical presentation.
(Alligood, 2014)

Conceptual Models
Set of concepts that address phenomena central to nursing in propositions that explain relationships
among them. (Fawcett & DeSanto-Madeya, 2013)

Grand Theory
Concepts that derive from a conceptual model and propose a testable proposition that tests the major
premise of the model.
Nursing Theory
Testable propositions from philosophies, conceptual models, grand theorise, abstract nursing theories or
theories from other disciplines. Theories are less abstract than grand theory and less specific than
middle-range theory.

Middle Range Theory

Concepts most specific to practice that propose precies testable nursing practice questions and other
details (ex. patient’s age group, family situation, etc.)

Analysis of Theory Definition and Questions for

analysis and evaluation of Theoretical works
Clarity
Speak to the consistent structural form of terms in the theory.
How clear is this theory?

Simplicity
discuss the degree and call for simple forms of theory.
How simple is this theory?

Generality
Speaks to the scope of application and the purpose within the theory.
How general is this theory?

Accessibility
Addresses the extent to which empiric indicators for the concepts can be identified and attained.
How accessible is this theory?

Importance
Speaks of the outcome that creates understanding which is important to nursing.
How important is this theory?
Lesson 4 Nursing Theory Development - Contributions of Nursing Theorists

The development of nursing theory is solely to improve the quality of nursing care.

The foundations of theory development are inherited in the following areas - practice, education,
and research. Through nursing theories, theory development is enhanced in the following areas.

EDUCATION
● Establish and develop nursing education
● Terms were uniquely develop to enhance the curriculum, such as
program objectives, course objectives, course description and
clinical performance criteria
● Equip students with knowledge in preparation for practice

PRACTICE
● Guides nursing professionals in their critical thinking and decision
making Better understanding of the nature of their work Nurses
work with professional independence

RESEARCH
● Research improves the practice of nurses by answering questions
encountered in their practice. Provides a theory-based practice
for clinical decision making Provides answers to a wide variety of
human responses, experiences and other related nursing
phenomena

Interdependence of Theory and Research

It is said that the relationships of theory, practice, and research are cyclical
and reciprocal. The association helps in enhancing the specialized body of
knowledge in the preparation of nursing. It practically means that approach
is the basis for developing a nursing theory, whereas the nursing theory must
be practiced and validated in practice.
Week 4 Different views of Non-Nursing Theory

HANDOUTS/NCM notes/averynotes

LESSON 1 Maslow’s Hierarchy of Needs

Proposed by Abraham Maslow in his work “A Theory of Human Motivation” in 1943

Basic Assumption :
“A person will not feel a higher need,until the needs of lower levels are satisfied.”

His work was used in nursing to guide nursing care prioritization.

Represented by a pyramid with five levels of needs represented below by a

diagram.

1. Self-actualization represents self-fulfillment needs.

2. Esteem , Love and Belongingness represents psychological needs
3. Safety needs and Physiologic needs pertain to Basic needs.

5 hierarchy of need Acronyms made by avery to better understand -

Sa, Es,LoBe,SnPn
 Lesson 2 Erikson’s Theory of Psychosocial Development

Erik Erikson was a psychoanalyst who proposed the theory.

Born on June 15, 1902, in Karlsruhe, Germany Believed in his theory

THEORY : “That the achievements and failures of earlier stages will affect later stages
of development, whereas later stages transform the earlier ones.”

View psychosocial development as occurring in stages.

Expected results in the eight stages could either be: psychological regression or
development of“inherent strength” (virtues).

The diagram below shows the eight stages of psychosocial growth.

1.Trust vs Mistrust (Infancy 0-2 years old)

- The infant is experiencing the world through mouth, eyes, ears, and sense
of touch.
- As infants, trusting the world means a lot to them.
- Inherent Strengths : SENSE OF HOPE
- If infants experience fear, they will develop doubt and mistrust.
- Psychological regression or growth : Psychosis, Addictions, Depression.

Note: The role of the mother is the key to the psychosocial development of the infant.
2. Autonomy vs Shame and Doubt (Early Childhood 2 - 4 years old)

- As Erikson said, "At this stage, therefore, becomes decisive for the ratio between
loving goodwill and hateful self-insistence, between cooperation and willfulness,
and between self-expression and compulsive self-restraint or meek compliance."
- In early childhood, a child may experience and discover about themselves.
- If they are allowed to find themselves, the development of self-confidence
occurs.
- Inherent Strengths : WILL
- If they are not allowed to this discovery, they will develop shame and self-doubt.
- Psychological regression or growth: Paranoia, Obsessions,
Compulsions,Impulsivity.

Note: Both parents have a significant role.

3. Initiative vs Guilt (Preschool age 4-5 years old)

- A child in this stage of growth is to develop a sense of initiative. The last

phase of this development is a sense of purpose.
- In preschool, children’s participation in new skills expands when exposed to the
outside world. If the child is encouraged, he will develop a sense of initiative. or, if
a child is held back or if they learn that what they are doing is wrong, they will
develop a sense of guilt.
- Inherent Strengths: VIRTUE
- Psychological regression or growth : Conversion Disorder, Phobia
Psychosomatic disorder, Inhibition
4. Industry vs Inferiority (School age 5-12 years old)

- also known as stage of latency, wherein the child is in school age.

- Discovering one’s interest
- Inherent Strengths : COMPETENCE
- Recognition received from teachers or peers helps you become a hard-working
child (Industrious)
- However, if the child is poured out with negative feedback, they will feel inferior to
other children and begin to lose their motivation.
- Psychological regression or growth : Inferiority complex

Note: Schools and communities influence the child the most.

5. Identity vs Role Confusion (Adolescence 13-19 years old)

- The puberty stage, wherein the teenager explores their identity crisis and
struggles within a degree of role confusion
- In the adolescent stage, a person may have different social roles. If the person’s
parents allow him to go out and explore ourselves, the person will find his
identity.
- If the person is pushed to conform by their parents’ view, the person may feel lost
and experience role confusion.
- Inherent Strengths (Virtue):FIDELITY
- Psychological regression or growth :Delinquent Behavior, Gender-related identity
disorder, Borderline psychotic disorder

NOTE: Key to their learning are role models and peers.

6. Intimacy vs Isolation (Early adulthood 20 - 40 years old)

- At this stage, young adults experience the crisis of intimacy versus isolation;
capacity for love is the achievement of this growth.
- If the person is pushed to conform by their parents’ view, the person may feel lost
and experience role confusion.
- Inherent Strengths (Virtue) : LOVE
- However, if we cannot make an intimate relationship, we will end up being
isolated or alone.
- Psychological regression or growth: Schizoid Personality Disorder,Distantiation

NOTE: Our partners and friends are central to the growth of this psychosocial
development.

7. Generativity vs Stagnation (Adulthood 40-65 years old)

- According to Erikson, "Generativity is primarily the concern for establishing and

guiding the next generation."
- If we can lead, especially the next generation, we will be happy.Contributing to
society makes your world a better place.
- Inherent Strengths (Virtue): CARE
- However, failure to contribute to society or resolve conflicts, the person will
feel negativity and stagnation.
- Psychological regression or growth : Middle Crisis

NOTE: People at work and in our homes influence us the most.

8. Ego Integrity vs Despair (Maturity 65 years old to Death)

- This stage reflects one’s life and either experience a feeling of satisfaction
or regret/despair.
- If we look back in our lives and reflect on your experiences, you will begin to feel
a sense of contentment and satisfaction if you did well.
- Inherent Strengths (Virtue) : Wisdom
- If not, you will experience a feeling of despair. You may get angry and bitter with
your life.
- Psychological regression or growth :Extreme alienation

NOTE: You compare yourself with humankind.

 LESSON 3 Systems Theory

- Proposed by Ludwig von Bertalanffy by calling it General Systems Theory

- He is a professor of Biology and the author of Science and Philosophy of

Synthesis.

- Systems theory may be thought of as “specialization of systems thinking and a

generalization of system science.

The general science of ‘wholeness.’

Contribution to nursing research and formulation of nursing theories

What is a System?
- It is any set of distinct parts that form a relationship between them to create a
whole complex.

- An excellent example in the context of our human body is a cell. Our body
comprises tiny cells functioning together to form the complex structure of a
human body as part of wholeness.

2 TYPES OF SYSTEM

OPEN SYSTEM
● Contains inputs that are influenced by the environment being transformed
through a process to create services or products known as outputs.It contains
feedback throughout the process to make sure that the improvement of the
outputs

● EXAMPLE: An example of an open system in the context of nursing is:

Documenting a patient’s temperature of 37.8-degrees Celsius (Input); nurse
process the data and interprets that a patient has a fever (Process); Nursing
intervention is given to lower the fever (Output)
CLOSE SYSTEM

● is not influenced by the environmental factors and focuses only on the internal
functions and provides no feedback.

● EXAMPLE: An example of a closed system is the function of the secure

circulatory system. It focuses only on the human body's internal functions
wherein blood flows within a system of tubes and vessels, thus providing
nutrients for our cells.

LESSON 4 Change Theory

Proposed by Kurt Lewin,born in Germany, also known as the “father of social psychology.

He was known for his writings in group dynamics, group therapy, and social psychology.

Emphasized that group from the simple sum of its parts.

It is expanding the theoretical discipline of Nursing as its goal.

His most influential theory was his model of change in human systems.

Consisting of the 3-stage models known as:

1. Unfreezing - Create the right Environment
2. Change - Support Change to a desired State
3. Refreeze - Reinforce to anchor change (that requires prior learning to be rejected
or replaced.)

Unfreezing
- Process of which involves finding a way for people to let go of patterns that are
not productive

Moving
- Process of change in thoughts, feelings, and behavior (or all three), leading to a
more significant change.

Refreezing
- establishing change as ‘a new habit’, without going back to old ways.
Driving Forces
● are forces that are pushed in a direction in which change is to occur

EQUILIBRIUM
● driving forces are equal, and no change occurs.

Restraining Forces
● opposes the driving Force; hinder change and push the person towards the opposite
direction
Week 5 :Nursing Theorists of Historical Significance
part 1
#notes #handouts #averynotes #bordador_ac

Unit 4 is divided into 3 lessons:

Lesson 1 Hildegard Peplau - Interpersonal Relations Theory

Hildegard Peplau (1909 - 1999)

Born on September 1, 1909, Pennsylvania

1. “Psychiatric nurse of the Century”
2. Bachelor of Arts in Interpersonal Psychology, Master of
3. Arts in Psychiatric Nursing, and Doctor of Education
4. in Curriculum Development.
5. First book published in 1952, “Interpersonal Relations
6. in Nursing”
7. Hold numerous awards.

Experiences with professionals in the areas of psychiatry, medication, education, and

sociology

Theoretical Sources
Influenced by Maslow, Freud, and Sullivan’s interpersonal relationship theories and other
psychoanalytical models.

Metaparadigm Concepts of Peplau

Person
Is defined as a being who is an organism that thrives in an unstable balance of a given system.

Health
Reflects the flow of the personality and other human processes that leads a human being in a
way that is creative, constructive, productive community, and society.

Environment
refers to the external forces that influence a being and socially define a way of living in which
human social processes are achieved, such as norms, customs, and beliefs.

Nursing
Is defined as an essential, therapeutic nurse-patient relationship.
Major concepts of Peplau

Orientation
- The initial interaction of the nurse and the patient; the patient expresses a need for
assistance from the nurse.
Identification
- A feeling of relatedness takes place as the patient and the nurse explores the
experience and the needs of the patient
Exploitation
- The patient values the relationship and moves on from a dependent role to an
independent role. New goals are planned by the nurse, but these goals would be
achieved through the patient’s effort as an independent being.
Resolution
- The patient learns to be independent, and it is where the relationship ends between the
patient and the nurse. It leaves a lasting impression on the patient as it values the
unique human experience of the nurse-patient relationship.

ROLES OF A NURSE

Stranger
✔ Attempts to know the patient better
✔ Treat him with utmost courtesy (acceptance of the patient as a person and due respect into
his individuality)
✔ Thus roles coincidence with the Identification Phase

Resource Person
✔ Patient assumes a dependent role.
✔ Nurse provision specific answers to his queries.
✔ It is the responsibility of the nurse to appropriately change her responses to the patient's level
of understanding.

Teacher
✔ Teaching self-care and helping the patient to understand the therapeutic plan.
✔ The nurse must develop a plan according to the patient’s interest and his ability to use such
information needed for the plan.

Leader
✔ The patient is still able to decide regarding his plan of care.
✔ A nurse, as a leader, must act on behalf of the patient’s best interest and allow the patient to
decide for his own care.
Surrogate
✔ The patient’s dependency regarding his care gives the nurse a surrogate role, which means
a temporary care only.
✔ The nurse must assist the patient to make sure that her surrogate role is different and only
temporary.

Counselor
✔ Counseling role has the greatest importance.
✔ This role strengthens nurse-patients relationships.
✔ The very core of the interpersonal technique is to value the nurse-patient relationship and
apply it in his life.

Lesson 2 Virginia Henderson - 14 Basic Human Needs Theory

Background and Credentials Born in 1897, Kansas City

(1897- 1996)

● Known as the “First Lady of Nursing” and the “First Truly International Nurse.”
● “Henderson was to the 20th century as Nightingale was to the 19th century.”
● Identified 14 proposed basic human needs on which nursing care is based.
● Her vision, “practice of nursing as independent from the practice of physicians”

HENDERSON DEFINES NURSING

“The unique function of the nurse is to assist the individual, sick or well, in the performance of
those activities contributing to health or its recovery (or to peaceful death) that he would perform
unaided if he had the necessary strength, will, knowledge; and to do this in such a way as to
help him gain independence as rapidly as possible.”

14 Basic Human Needs

1. Breathe Normally
2. Eat and Drink Adequately
3. Eliminate Body Wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes - dress and undress
7. Maintain body temperature within normal range by adjusting
clothing and modifying environment
8. Keep the body clean and well groomed and protect the Integument
9. Avoid dangers in the environment and avoid injuring others
10. Communicate with others in expressing emotions, needs, fears
or opinions.
11. Worship according to one’s faith
12. Work in such a way that there is a sense of accomplishment
13. Play or participate in various forms of recreation.
14. Learn, discover, and satisfy the curiosity that leads to normal development and health and
use the available health facilities.

Theoretical sources Her works were based on :

1. Thorndike, an American Psychologist.
2. Her student experiences with Henry House Visiting nurse Agency
3. Her experience in rehabilitation nursing
4. Orlando’s conceptualization of deliberative nursing action

Metaparadigm concepts

Person
She referred to a person as a patient. an individual who requires assistance to achieve health
and independence or, in some cases, a peaceful death. must maintain physiological and
emotional balance to be able to function.

Health
According to Henderson, health is considered as a quality of life and is a fundamental need of a
person to function. She added that it requires independence and interdependence.

Environment
emphasized the importance of the patient’s controlling his/her environment. However, as illness
occurs, this ability is diminished. responsibility of the nurse to manage the surroundings by
protecting the safety of the patient.

Nursing
Nurses function independently from the physician. Empower the patient to gain independence
as rapidly as possible

Major Concepts
Three levels of nurse-patient relationship

Substitute for a patient

Doing everything for the client

Helper to the patient

Helping the client
Partner with the patient
Working with the client

❑ The nurse in a sense get “inside the skin” of each of her patients in order to know what help
is needed

❑ Henderson asserted that the nurse works in interdependence with other health professionals
and with the patients.

Lesson 3 Faye Glenn Abdellah - 21 Nursing Problems

Born on March 13, 1919, in New York City. (1919 - 2017)

● Her family moved to New Jersey where she attended High school.
● A leader in the development of nursing research and nursing as a profession
● “She believed that nursing care should be based on research, not hours of care”.
● Named “LIVING LEGEND” by the American Academy of Nursing in 1994.

● Inducted into the National women’s Hall of Fame in 2000

● In 2012, ANA Hall of Fame for a lifetime of contributions to nursing (60 years)
● Formulated 21 nursing problems based on research

Theoretical sources
- Adapted Henderson’s 14 basic human needs and nursing research for the classification
of nursing problems.
- Her work differs from that of Henderson in that Abdellah’s problems are formulated in
terms of nursing-centered services, which are used to determine the patient’s needs.
Systematic analysis of research reports conducted to formulate the 21 nursing problems.

Metaparadigm Concept of Abdellah

Person
is defined as beneficiary of care as individuals.
the 21 nursing problems related with biological, psychological, and social aspects of individuals.

Health
In this theory, the concept of health is defined as the center and purpose of nursing services. No
definition of health, but she speaks of the totality of health needs and indicative of a healthy
state of mind and body.
Environment
“Planning for optimum health on local, state, national and International levels.” However,
Abdellah elaborates her ideas, the apex (core) of Nursing service is the individual.

Nursing
The concept of nursing is generally grouped into 21 problem areas for nurses to work out their
judgment and appropriate care.

Major Concepts

Health needs are seen as problems, which may be:

Overt
which is obvious or can-be-seen condition

Covert
which is an unseen or masked one

The problem - solving process

1. identifying the problem

2. selecting relevant data
3. devising hypothesis
4. testing hypothesis through the assortment of data
5. revising hypothesis when necessary on the basis of conclusion obtained from the data

21 Nursing Problems
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, sleep
3. To promote safety by preventing accidents, injuries, or other trauma and preventing the
spread of infection.
4. To maintain good body mechanics and prevent and correct the deformity.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition for all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiologic responses of the body to disease conditions—pathologic,
physiologic, and compensatory.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory function.
12. To identify and accept positive and negative expressions, feelings, and reactions.
13. To identify and accept interrelatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement and personal spiritual goals.
17. To create or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs.
19. To accept the optimum possible goals in the light of limitations, physical and emotional.
20. To use community resources as an aid in resolving problems that arise from an illness.
21. To understand the role of social problems as influencing factors in the cause of illness.
 Ernestine Wiedenbach (The Helping Art of Clinical Nursing)

Week 6 : Nursing Theorists of Historical Significance part 2

Lesson 1:
Ernestine Wiedenbach
(The Helping Art of Clinical Nursing)

Ernestine Wiedenbach 1900-1998

The Helping Art of Clinical Nursing Born on August 18, 1900, Germany
Educated from John Hopkins School of Nursing, Wellesley College, Columbia University
Ernestine Wiedenbach is known for her work in theory development and maternal-infant nursing.
Wiedenbach’s orientation is a philosophy of nursing that guides the nurse’s actions in the art of
nursing.
She wrote Family-Centered Maternity Nursing in 1958.

Theoretical Sources of WIEDENBACH

Ida Orlando Pelletier

● Understanding of the use of self and the effect of the nurse’s thoughts and feelings has on
the outcome of her actions.
Patricia James and William Dickoff
● Identified elements of a prescriptive theory in Wiedenbach’s work, which she developed
more fully in Meeting the Realities in Clinical teaching.

Metaparadigm concepts of WIEDENBACH

Person
Each person is endowed with a unique potential to develop self- sustaining resources. Persons
generally tend towards independence and fulfillment of responsibilities

Health
Not defined in Wiedenbach’s Model.

Environment
Did not discuss the concept of the environment; however, she recognized the potential effects of
the environment

Nursing
Wiedenbach's philosophy in nursing are the following:
1. Reverence for the gift of life
2. Respect for the dignity, worth, autonomy, and individuality of each Human being.
3. Resolution to act dynamically in relation to one’s belief.

Major Concepts Prescriptive Theory Wiedenbach’s prescriptive theory is based on three factors :
(1) The central purpose which the practitioner recognizes as essential to the particular discipline
(2) The prescription for the fulfillment of central purpose.
(3) The realities in the immediate situation that influence the central purpose.
 Ernestine Wiedenbach (The Helping Art of Clinical Nursing)

Major Concepts of WIEDENBACH

The Patient
Any person who receives help might be care, instruction, or advice from a team member who
gives care.

A . Need-for-help To ask what was the need of the patient.

● A need-for-help is a desire from the patient that would help him restore or help him cope with
situations experienced in his or her life that would affect his health and wellness.

● It is essential in nursing that a need-for-help must be based on the patient's perspectives of the
situation

NURSE uses the critical thinking.

The nurse is a functioning individual who helps the patient who has a need-for-help.
The nurse not only acts but also uses her or his thinking and feelings as well.

Major Concepts OF WIEDENBACH

Knowledge
Defined as "encompassing all that has been perceived and understood by the mind of a human."

Judgment abc judgement - airway,breathing,cardiac.

Represents a nurse's ability to make a good clinical judgment, that is a good sound decision.

Nursing skills it should be patient centered.

These are skills carried out by the nurses in accomplishing the task that is considered
patient-centered rather than completing the skill itself as the final goal.

Key elements

Four main elements to clinical nursing.

● a philosophy
● a purpose
● a practice and
● The art.

Philosophy
The philosophy of nurses are their attitudes and beliefs of what life is and how these would affect
them

Three (3) essential components associated with a nursing philosophy:

1. Reverence for life
2. Respect for the dignity, worth, autonomy and individuality of each human being and
3. Resolution to act on personally and professionally held beliefs. the purpose
 Ernestine Wiedenbach (The Helping Art of Clinical Nursing)

The Purpose Nursing interventions to complete the goal.

refers to the nurse's activities in the accomplishment of the goals towards the patient.

The practice
The practice is considered empirical or observable nursing actions that influence beliefs and
feelings in meeting the patient's need-for-help.

The art Nursing

is considered as an art because it tends to :
1. understand the patient's needs and concerns,
2. develop goals and actions intended to improve patients' ability, and
3. direct the activities related to the medical plan to improve the patient's condition.

The theory suggested that nurses must identify the need-for-help of the patient in the
following ways : The qualities you should see and assess as a
nurse to the comfort of your patient
1. Observing patients' behaviors that are consistent or inconsistent with their comfort.
2. Exploring the meaning of their behavior
3. Determining the cause of their discomfort or incapability
4. Determining whether they can resolve their problems or have a need for help.

Conceptual Framework
for the study based on Ernestine Wiedenbach helping art of clinical nursing theory - for coping
and quality of life among perimenopausal women

Background of the study

Nursing theories contribute significantly to the advancement of the nursing profession and its
explaining phenomena important to clinical practice. Utilization of nursing theories will
empower the nurse to assess the need of the patient and to recognize the necessities of the patient

Common PeriMenopause Symptoms proposed by WIEDENBACH

Physiological
Anger,Anxiety,Depression,Irritibality,Dizziness,Difficulty Concentration,Fatigue,Mood Swings

Physical
Hot Flashes,Night Sweats,Reduced Libido. Weight Gain, Urinary Incontinence.Vaginal Dryness,Bloating

CONCLUSION
This theory helps the researcher for the better assessment of perimenopausal symptoms and to
prepare coping strategies to improve the quality of life during the perimenopausal period.

Ernistine theory of (The Helping Art of Clinical Nursing) to recognize what needs to be
done in patients who have PeriMenopause Symptoms.

Base on the diagram . Central Purpose (Goal), Coping Strategies (Prescriptions) Realities (The agent,the
women,receiver of care)
 Lydia Hall (Core, Care, and Cure Model)

Lesson 2
Lydia Hall
(Core, Care, and Cure Model)

Born on September 21, 1906, New York City

● Earned her Nursing Diploma at York Hospital School of Nursing in 1927

● Received Bachelor of Science degree in public health nursing in 1932
● Received her Master’s degree from Columbia University in 1942
● Her interest in the field of research in the rehabilitation of chronic patients led her to the
development of her theory.
● Involved in the establishment of Loeb Center for Nursing in New York.

THEORETICAL SOURCE OF LYDIA HALL

Hall's experience in psychiatry and rehabilitative nursing experience in the Loeb Center helped
her in the formulation of her theory.

METAPARADIGM CONCEPTS OF LYDIA HALL

Person
A person whose age is 16 y.o or older and in the stage of chronic illness ;
Individual care recipient - the source of motivation and energy for healing

Health found in phsychiatric nursing since Lydia Hall came from phsychiatric course
Is a state of an individual’s self-awareness in exploring the meaning of his or her behavior to
identify and overcome problems.

Environment Environment can affect the patient.

In Hall’s case, The Loeb Center became the hospital environment that provides a place for the
individual conducive to their self-development, not a problematic psychological experience.
The nursing actions in relation to the environment are for the purpose of helping the individual.

Nursing
Nursing is visible in the participation of her concepts of care, core, and cure model in caring for
an individual. Major Concepts

The three (3) C’s :

● Core - The Person Therapeutic use of self Asking the patient if she or he was okay after the surgery.
● Care - The Body Intimate Body Care Surgical Wounds - Lilinisan.
● Cure - The Disease Seeing the patient and family through medical care Doctor's Prescription,
medicines,Surgery
 Lydia Hall (Core, Care, and Cure Model)

MAJOR CONCEPTS OF LYDIA HALL

Core Kausapin si Patient, Permission.

● Therapeutic use of self
● Patient care is based on social science
● The patient is able to develop a maturity level when the nurse listens to them
● Make informed decisions

Cure Pagbibigay ng gamot.

● Care is focused on pathological and therapeutic sciences
● Seeing the patient and family through the medical care
● Application of medical knowledge by nurses
● Nurses assisting doctors
● A nurse is a patient advocate

Care Being a stand in mother to patients

● Nurturing component of care
● It is exclusive to nursing
● “Mothering”
● A nurse is concerned with intimate bodily care
● Nurses goal is to care and provide comfort for the patient
● A patient may explore and share feelings with the nurse

Note:

Hall’s theory is represented by interconnected circles - core, care, and cure.

The size of each circle depends on the condition of the patient and continuously varies.
Can vary in sizes (3C'S) based on the situation of patient.
Bakit nagiiba ang priority?
Kasi based on the NEED of the patient.

SAMPLE CLINICAL SCENARIO (Wiedenbach and Hall’s Theory)

Applicaiton of Lydia Hall's Theory

Alex is cooking but she got burned, Paolo assisted her and assess her wounds. BY
SUBJECTIVE MEANS (kung ano yung nakikita sa panlabas and panloob - CORE - asking
the patient - THE LEAST LIKELY TO BECOME A SMALL CIRCLE.

Second CURE - paolo recommended her to take medicines to decrease the chances of
getting an infection.

THIRD CARE - linisin ang wound,dress it and betadine it.

Nursing Theories of Hall’s application

 Lesson 3
Joyce Travelbee
Human-to-Human Relationship Model
1926-1973
Born in 1926, New Orleans, United States

● A writer, psychiatric nurse, and educator

● Completed her BSN (1956) at Louisiana State University and Master of Science Degree in
Nursing at Yale University
● Psychiatric nursing instructor at Depaul Hospital Affiliate School in New Orleans in 1952 and
later In Charity Hospital School of Nursing, New York University and the University of
Mississippi.

THEORETICAL SOURCES OF JOYCE TRAVELBEE

Humans are responsible to their choices and actions.
> Travelbee based her theory's assumptions with the following authors, Soren Kierkegaard
(existentialism) and Viktor Frankl (logotherapy).Therapautic Approach or communication this is how you'll find
out what was needed and happening in people's lives.
>The existentialist approach believes that humans are always faced with trials and choices, and
humans are responsible for their life choices.
> Logotherapy theory was first proposed by Viktor Frankl, a survivor of Auschwitz, in Man's
Search for Meaning (1963)

Metaparadigm concepts of JOYCE TRAVELBEE

Person
Defined as a human being.
The nurse and the patient are considered human beings.

Health
Health is both subjective and objective.
Subjective health is defined by self-appraisal of individuals' physical, emotional, spiritual status.
Objective health is the absence of disabilities and diseases measured by physical examination,
health care provider's assessments, and laboratory tests.
It is measured (JT) OBJECTIVE NA PWEDENG MAKITA sa patient. (Physical Assesment)
Environment
The environment is not clearly defined. Walang definition of environment si Joyce Travelbee

Nursing INTERPERSONAL RELATIONSHIP!

Health is an interpersonal process in which the nurse helps an individual, family, or society cope
with illness and suffering experiences and find meaning with these experiences
 Joyce Travelbee : Human-to-Human Relationship Model

Major Concepts of JOYCE TRAVELBEE

Suffering
A feeling of uneasiness ranging from mild to extreme physical or mental
discomfort, pain, or torture. This experience varies in duration, intensity, and
depth.
The nurse can find it's meaning to her patient's feelings (Therapautic Communication)
Meaning ex: Cancer/ MISFORTUNE)
Meaning is the reason as oneself attributes

Nursing TO ASSIST and help

Is assisting the patient in helping to find meaning in the experiences of suffering
and illness. Is responsible for helping not only the patient but include their families
as well in finding meaning.

Hope Can be addressed by supporting in mental or physiological

The nurse assists the patient to develop hope instead of being hopeless. Hope is a
faith that helps the patient bring change to something better.

Communications Therapautic Communication (an ability to engage a conversation to a patient) it is a skill.

"a strict necessity for good nursing care."

Therapeutic use of self Self Understanding is important to approach and predict the patients
Is the ability of the nurse to use therapeutic communication to the patient
The perception of self-awareness and self-understanding is crucial in perceiving
human behavior, including predicting one's own and other's behavior.

Targeted intellectual approach Approaching a patient intellectually

the ability of the nurse to use a systematic approach to the patient's situation
intellectually

Human-to-human relationship model

In her human-to-human relationship model, the nurse and the patient undergo the
following series of interactional phases

1. Original Encounter
2. Emerging Identities
3. Empathy
4. Sympathy
5. Rapport
 Joyce Travelbee : Human-to-Human Relationship Model

Empathy 3rd sharing the experiences

The ability to share in the other person’s experience

Emerging Identities 2nd encounter (Engaging through therapautic Communication)

A bond begins to form wherein the nurse and the patient perceive each other as a
unique being.

Original Encounter 1st Encounter

The first encounter of the nurse and the patient

RAPPORT (Patient and the Nurse) the terminal point (the main goal)

Sympathy 4th Nursing Action to alleviate the bad feelings of your patient
Nurse alleviating the cause of a patient’s illness or suffering.
 Joyce Travelbee : Human-to-Human Relationship Model

TRAVEL BEE CLINICAL SCENARIO :

PROFILE:
Josefina, a 25 y.o consulted a psychiatric outpatient unit requesting for a therapy.
Subjective: "ayokong maging malapit sa ibang tao maliban sa pamilya ko."
a sensitive problem
Family background
She had loving parents and had a happy childhood. Her family attended and was active in
religious Catholic activities and had a lot of friends too. That night, her friend started to
caress her, and she interpreted it as something sexual. She felt a sense of guilt and fear.
She told no one before he entered the session therapy. Josefina never dated someone or
even participated in social gatherings. This behavior continued in her twenties; thus, she
decided to seek help. During the counseling session, nurse Jen, who is at the same age as
Josefina, asked her some questions. At first, Josefina was shy and reluctant to tell the
nurse, but Nurse Jen built a sense of friendship and security as if they were best friends.
At the end of the session, Nurse Jen noticed that Josefina was now at ease talking to her.
Josefina even shared her feelings and thoughts about what's happening to her.

ORIGINAL ENCOUNTER
This phase shows the first impression of Nurse Jen and Josefina to each other.
Both are not yet comfortable talking and expressing deep thoughts and feelings.

EMERGING IDENTITIES
This phase depicts Josefina’s experiences that were shared with Nurse Jen. Travelbee
emphasized that the similarities of the experiences will help the nurse understand her
client (i.e., Age and gender). Such similarities will help the relationship to become more
therapeutic. This would help Nurse Jen to better understand Josefina’s behavior and
establish a better interaction.

EMPATHY
In this phase, the closeness of Nurse Jen and Josefina is being established. Consciousness
awareness that both of them have different thoughts and feelings. Nurse Jen must develop
understanding and a valuing of the uniqueness of others.
“Putting oneself is someone else’s shoes”.

SYMPATHY
Nurse Jen progresses further than empathy and has the intention of lessening Josefina’s
distress. Nurse Jen, using a combined intellectual approach as a psychiatric nurse and her
therapeutic self, will help Josefina to cope and adapt to her unpleasant experience.

RAPPORT
This phase is the end goal of all nursing endeavors. All actions that lessen Josefina’s
distress have been implemented. Thus the result would be a good and trusting
relationship and achievement of the therapeutic goal by nurse Jen.
 Kathryn Barnard - Parent-Child Interaction Model

Week 7 : Nursing Theorists of Historical Significance part 3

Lesson 1
Kathryn Barnard - Parent-Child Interaction Model

Background and Credentials Born on April 16, 1938, Omaha, United States
● Wanted to be a nurse since first grade
● Received her diploma in Nursing from the University of Nebraska in 1960
● Received her master’s degree in Boston University and recruited in University of Washington
in 1963 until her retirement in 2006
● Began her studies in infants and their parents in the 1970s
● Received her Ph.D. in Ecology of Early Childhood Development at the University of
Washington, in 1972.

Theoretical Sources of BERNARD Influenced by the nursing theorists

Florence Nightingale, Martha Rogers, and Virginia Henderson. Barnard's theory borrows from
psychology and human development and focuses on mother-infant interaction with the
environment. Influenced by other scholars.

METAPARADIGMS OF BERNARD

Person
To comprehend auditory, visual, and tactile stimuli; and then put this information to fair use.

Health
A dynamic state of wellbeing ; viewed health as both illness and wellness. metaparadigms

Environment
Relates to places, people, objects, sounds, and sights.

Nursing
Education to the caregivers to facilitate change.

Major Concepts OF BERNARD

Healthy child development depends on the parent/caregiver who responds to the signals from the
child with a dependable and loving manner even at the moment of child's birth (Qaiser, 2014).

The parent-child interaction model (Child, The Mother/Caregiver, and The Environment)

CHILD
- Physical appearance
- Temperament
- Feeding and sleeping pattern
- Self-regulation

THE MOTHER/CAREGIVER
- Psychological assets
- Physical health
- Mental health
-Coping skills
- Life changes
 Kathryn Barnard - Parent-Child Interaction Model

- Expectations and concerns about the child

- Caregiving style -Educational level -Adaptation skills

THE ENVIRONMENT
- Social Support
- Financial Resources
- Safe Housing
- Adequate Food
- Community Involvement
 Evelyn Adam Conceptual Models of Nursing

Lesson 2
Evelyn Adam Conceptual Models of Nursing
Background and Credentials Born on April 9, 1929, in Ontario, Canada
● 1950, Graduated Nursing from the Hospital in Kingston, Ontario. 1966, Graduated Nursing
from the University of Montreal.
● 1971, Earned BA in Nursing from the University of California
● Received her Master’s degree from Columbia University in 1942
● A Canadian Nurse who applied her works of conceptual model in her book “Between Infirre”
in 1979 (To be a Nurse, 1980)

METAPARADIGM OF ADAM

Person
“Each person is a complex whole, made up of fundamental needs.”

Health
“the biological, physiological, and psychological needs of the person. metaparadigms

Environment
Adam only mentioned, “that the family environment must be taken into consideration when
carrying out the nursing practice.”

Nursing
”Maintaining and restoring the person’s independence in meeting the 14 basic fundamental
needs.”

Major concepts
● Goal of the profession - The profession wants to achieve.
● Beneficiary - an individual or group of people who gets direct care by the professionals.
● Role - the responsibilities and functions of the professionals
● Source of Difficulty - the source of the individual's problem in which the professional directs
his care to solve it.
● Intervention - The intervention of the professionals to their client.
● Consequences - The result of the effort of the professionals in meeting their professional goals.
 Roper-Logan-Tierney Model of Nursing Based on Activities of Living

Lesson 3
Roper-Logan-Tierney Model of Nursing Based on Activities of Living

NANCY ROPER 1918-2004

Born on September 29, 1918, in Wetheral, Cumberland

● Influenced by her mother to pursue a nursing career
● 1943, she completed nursing school and began working as a nurse instructor.
● 1970, began investigating the core of nursing
● 1976, her model was produced, most recent revision 1998

WINIFRED LOGAN RN, MA, DNS RNT (Nurse Teacher)

● 1966, MA in nursing from Columbia University

● 1960 to 1970’s - Nurse Educator at the Scottish Office
● Became an Executive Director of the International Council of Nurses (ICN)
● Consultant for the World Health Organization in Malaysia, Europe, and Iraq.

ALISON TIERNEY PhD BSc, RN, FRCN, CBE

● Involve actively in Research and health care activities Nationally and Internationally
● 1990’s UK Representative on World Education News and Reviews (WENR)
● CBE Award in Nursing Research and Education in 1992
● University of Adelaide - Professor, and Head of Department of Nursing Studies.

Theoretical sources Roper-Logan-Tierney Model was influenced by the works of Virginia

Henderson and also by the well-known hierarchy of human needs by Abraham Maslow.

In the Roper-Logan-Tierney model of Nursing, the activities of living include maintaining a:

safe environment communicating breathing eating and drinking eliminating personal cleansing
and dressing controlling body temperature mobilizing working and playing expressing sexuality
sleeping and dying.

Lifespan
is visualized on a continuum. Unlike the dependence-to-independence continuum, however, the
arrow points in only one direction to symbolize that life only goes forward and eventually ends.

In the dependence/independence continuum

the level of performance engaged by the patient is marked on a line with arrows pointing in both
directions to depict her or his degree of independence

Factors that influenced the AL’s

Biological
Psychological
Sociocultural
Environmental
Politico-Economic

Individualizing nursing The nursing process—assessing, planning, implementing, evaluating—is

collectively depicted as individualizing nursing.
 Ida Jean Orlando-Pelletier - The Nursing Process

Lesson 4
Ida Jean Orlando-Pelletier - The Nursing Process

Background and Credentials Born on August 1, 1926, New Jersey

● Graduated in Nursing in 1947

● Received a Bachelor of Science degree in public health nursing in 1951
● Completed Master of Arts in Mental Health Consultation in 1954
● Developed her theory from the study conducted at the Yale University School of Nursing.
● Her theory remains on of the most effective methods and helpful to nurses in their practice.
● Developed the “Deliberative Nursing Process Theory”.

Theoretical Sources of Pelletier

Orlando-Pelletier acknowledges no theoretical sources in developing her theory.

Metaparadigms of Pelletier

Person
considered as developmental individuals with needs; person may have subjective perceptions and
feelings that a nurse might not directly perceived.

Health
Sense of fulfilled needs, adequacy, and comfort. metaparadigms

Environment
The concept of environment was not mentioned in Orlando's theory. Orlando focused only on the
immediate need of the patient.

Nursing
Unique and independent nursing action concerning an individual's needs for help in an
immediate situation.

MAJOR CONCEPTS OF PELLETIER

Function of Professional Nursing

The function of professional nursing to find out and meet the immediate needs of the patient
requiring help. In other words, nursing is responsible for anticipating the patient's immediate
needs and providing direct assistance to a patient to relieve the patient's sense of helplessness.

Presenting Behavior
Is the patient’s situation wherein he or she needs help. Through this situation, the nurse will
provide assistance for the patient’s need for help

Distress
A patient's behavioral experience when a patient's need for help is not met, causing him or her to
experience distress
 Ida Jean Orlando-Pelletier - The Nursing Process

Immediate Reaction
It is the internal response wherein the patient perceives the situation using his or her five senses.
These perceptions will stimulate the production of thoughts, and each thought will produce a
feeling, which causes the patient to act.

● Nurse’s Reaction The patient's behavior will elicit a nurse's reaction. This stimulation is
the beginning of the nursing process.
● Nurse’s Action The nurse's action begins to transpire. Nurse-patient contact is known as
the nursing process. The action of the nurse could either be automatic or deliberative.

Deliberative Nursing Process (Five Stages)

Assessment
Diagnosis
Planning
Intervention
Evaluation

Assessment
● In this stage, the nurse completes a holistic assessment. By using a framework, the nurse
gathers information or data that would identify a patient's problem or need. Data includes
subjective and objective data

Diagnosis
● this stage, clinical health problems will be identified. This is confirmed by linking the
defining characteristics, related factors and risk factors during the assessment stage

Planning
● addresses the patient’s problem identified in the diagnosis stage. The problems identified
provided with proper nursing interventions with a desired outcome or goal. The nurse
will devise a nursing care plan.

Intervention
● In this stage, nursing actions or interventions are implemented. The nurse is using the
nursing care plan.

Evaluation
● This is the last stage. In this stage, the nurse evaluates the development of the patient in
relation to the goals set in the nursing care plan. Changes are expected to improve the
nursing care plan. If another problem arises, this can be addressed by doing again the
stages of the nursing care plan.