Nursing Theories
University
Hildegard Peplau
Biography
Born: September 1, 1909, Reading, Pennsylvania
Died: March 17, 1999, Sherman Oaks, California
-Born of German descent to Gustav and Otyllie
Peplau
-2nd daughter among six siblings
Conceptual Model: “Interpersonal Relations
Theory” or Psychodynamic Nursing
Career Timeline
1931- Diploma program in Pottstown,
Pennsylvania
1943 - BA in interpersonal psychology,
Bennington College
1947- MA in psychiatric nursing from Columbia
University, New York
1952- Published Interpersonal Relations in
Nursing
1953- EdB in curriculum development in 1953
Professor emeritus from Rutgers university.
Started first post-baccalaureate program in
psychiatric nursing.
1968- interpersonal techniques - the crux of
psychiatric nursing
- Worked as executive director for ANA
- President of ANA from 1970-1972
- VP of ANA from 1972-1974
- Worked with WHO, NIMH, and Nurse Corps
- She was the first published nursing theorist
since Florence Nightingale
- Created the middle-range nursing theory of
interpersonal relations, which helped to
revolutionize the scholarly work of nurses.
- Staff Nurse in Pennsylvania and New York City
School Nurse at Bennington College, Vermont
- Certified in Psychoanalysis at the William
Alanson White Institute of New York City
- Faculty of the College of Nursing at Rutgers
- Created first graduate level program for the
preparation of clinical specialists in Psychiatric
Nursing
- Therapeutic Care vs. Custodial Care in mental
hospitals
- Strong advocate for graduate education and
research in nursing
- She is the primary contributor to mental
health law reform, leading the way towards the
humane treatment of patients with behavior
and personality disorders.
Interpersonal Relations in Nursing
Theory
- Stresses the importance of nurses’ ability to
understand their own behaviors to help others
identify perceived difficulties.
- Emphasizes the focus on the interpersonal
processes and therapeutic relationship that
develops between the nurse and client.
- Four phases of the nurse-patient relationship
are identified
- Six primary roles of the nurse
- Six secondary roles of the nurse
Major Concepts
- Nursing is an interpersonal process because it
involves interaction between two or more
individuals with a common goal.
- The attainment of a goal is achieved through
the use of a series of steps following a series of
patterns.
- The nurse and patient work together so both
become mature and knowledgeable in the
process.
Theoretical Source 6. Manager of environment
- The theory was influenced by Harry Stack 7. Mediator
Sullivan’s Theory of Interpersonal Relations 8. Administrator
(1953) 9. Recorder Observer
- The theorist was also influenced by Percival 10. Researcher
Symonds, Abraham Maslow, and Neal Elger
Miller Phases of the Interpersonal
- Peplau’s theory is also referred to as Relationship
psychodynamic nursing, which is the 1. Orientation
understanding of one's behavior. 2. Identification
3. Exploitation
Theoretical Source 4. Resolution
• Stranger- receiving the client, in the same way,
one meets a stranger in other life situations and Phases of the Interpersonal
provides an accepting climate that builds trust Relationship
• Teacher- who imparts knowledge in reference
to a need or interest Orientation Phase
• Resource Person- one who provides specific - Problem-defining phase
needed information that aids in the - Starts when the client meets the nurse as a
understanding of a problem or new situation stranger
• Counselor- helps to understand and integrate - Defining the problem and deciding the type of
the meaning of current life circumstances, service needed
provides guidance and encouragement to make - The client seeks assistance, coveys needs, asks
changes questions, shares preconceptions, and
• Surrogate- helps to clarify domains of expectations of past experiences
dependence, interdependence, and - Nurse responds, explains roles to the client,
independence and acts on client’s behalf as an helps to identify problems and to use available
advocate. resources and services
• Leader- helps client assume maximum
responsibility for meeting treatment goals in a Factors Affecting the Orientation
mutually satisfying way Phase
• Technical Expert- provides physical care by • Values
displaying clinical skills and operating • Culture or race
equipment • Beliefs
• Past experiences
Role of the Nurse • Expectations
1. Consultant • Preconceived ideas
2. Health teacher
3. Tutor
4. Socializing agent
5. Safety agent
Identification Phase Peplau’s Metaparadigm
- Selection of appropriate professional Person Health
assistance
- Patient begins to have a feeling of belonging - According to Peplau, - It is defined as a
and a capability of dealing with the problem it is defined as an word symbol that
which decreases the feeling of helplessness and organism that “strives implies the forward
hopelessness in its own way to movement of
- The client begins to identify problems to be reduce tension personality and other
worked on within relationship generated by needs.” ongoing human
- The goal of the hearse is to help the patient to processes in the
recognize his/her own “direction of creative,
interdependent/participation role and promote constructive,
responsibility for self productive, personal,
and community
Exploitation Phase living.”
- Use of professional assistance for
Environment Nursing
problem-solving alternatives
- Advantages of services are used is based on
- Peplau defined it “in - “It is a significant,
the needs and interests of the patients
terms of existing therapeutic,
- Individual feels as an integral part of the
forces outside the Interpersonal
helping environment
organism and in the process.”
- They may make minor requests or attention
context of culture - She defines it as a
getting techniques
from where customs human relationship
- The principles of interview techniques must be
and beliefs are between an
used in order to explore, understand, and
acquired.” individual who is sick
adequately deal with the underlying problem
or in need of health
services, and a nurse
Resolution’s Phase
specially educated to
- Termination of professional relationship
recognize and to
- The patient’s needs have already been met by
respond to the need
the collaborative effect of patient and nurse
for help.”
- Now, they need to terminate their therapeutic
relationship and dissolve the links between
them
- Sometimes may be difficult for both as
psychological dependence persists
- Patient drifts away and breaks the bond with
the nurse and healthier emotional balance is
demonstrated and both becomes mature
individuals.
Florence Nightingale - Her goal was to help the patient retain his own
Biography vitality by meeting his basic needs through
Born: May 12, 1820, while her parents were on control of the environment.
an extended European tour.
Died: August 13, 1910 Types of Environment
Conceptual Model: “Florence Nightingale’s Psychological Environment
Environmental Theory” -Psychological Environment can be affected by a
negative physical environment which then
causes STRESS.
Career - It requires various activities to keep the mind
-Much attention has been to the “Calling: that active.
Nightingale recorded in her diary in 1837 when - It involves communication with the person,
she wrote that “God spoke to me and called me about the person, and about other people.
to his service.”
- She began her nursing training in 1851 in Social Environment
Germany -It includes components of the physical
- She pioneered the concept of formal environment – clean air, clean water, proper
education for nurses. drainage, cleanliness, and light.
- She served the injured soldiers during the - It consists of a person’s home or hospital
Crimean War which strongly influenced her room, as we as the total community.
philosophy of nursing and her contribution
during this time is well-known. Physical Environment
- In 1859, she published her views on nursing Physical Environment
Cleanliness
care in notes on nursing. Ventilation
- She is considered the first nursing theorist. Air
Light
- She stated in her nursing notes that “nursing is Noise
an act of utilizing the environment of the Water
Bedding
patient to assist him in his recovery.” Drainage
- She was a statistician, using bar and pie charts, Diet

highlighting key points. Patient Condition & Nature

- May 12 - International Nurses Day in respect to
Communication Mortality Data
her contribution in Nursing.
Advice Prevention of Disease
Psychological Social Environment
Foundation of Nightingale’s Theory Environment
- The foundation of Nightingale’s theory is the
environment. All the external conditions and
forces that influence the life and development
of an organism.
- According to her, external influences and
conditions can prevent, suppress, or contribute
to disease or death.
Ventilation and Warming
- The nurse was “to keep the air he breathes as
pure as the external air, without chilling.”
- Nightingale was very concerned about
“noxious air” or “effluvia” or foul odors that
came from excrement.
- She stressed the importance of room
temperature. The patient should not be too
warm or too cold.
Health of Houses
- The importance of the health of houses as
being closely related to the presence of pure air,
pure water, efficient drainage, cleanliness, and
light.
- Cleanliness outside the house affected the
inside.
Light
- She viewed that directed sunlight was what
patients wanted.
- Although acknowledging a lack of scientific
rationale for it, she noted that light has “quite
real and tangible effects upon the human body.”
Noise
- She stated that patients should never be
waked intentionally or accidentally during the
first part of sleep.
- She asserted that whispered or long
conversations about patients are thoughtless
and cruel.
- Nurses' responsibility is to assess and stop
different kinds of noise.
Variety
- She believed that variety in the environment
was critical in affecting patients' recovery.
- She discussed the need for changes in color
and form, including bringing the patient brightly
colored flowers or plants.
Bed and Bedding
- She stated that dirty carpets and walls
contained large quantities of organic matter and
provided a ready source of infection.
- e.g. dirty sheets and beds
Personal Cleanliness
- The need for cleanliness is extended to the
patient, the nurse, and the environment.
- Nightingale viewed the functions of the skin as
important, believing that many diseases were
“disorders” or caused breaks in the skin.
Nutrition and Food Taking
- Nightingale addressed the variety of food
presented to the patients and discussed the
importance of variety in the food presented.
Chattering Hopes and Advice
- False hope was depressing to patients, she felt,
and caused them to worry and become
fatigued.
- She believed that sick persons should hear the
good news that would assist them in becoming
healthier.
Social considerations
- Nightingale supported the importance of
looking beyond the person to the social
environments in which he or she lived.
- She observed that generations of families died
in poverty.
Nightingale’s Metaparadigm
Person
- Nightingale referred person
as a patient. The person is
affected by the environment.
- Person is multidimensional,
composed of biological,
psychological, social, and
spiritual components.
- He has a vital reparative
power to deal with disease,
recovery is within the
person’s power as long as a
safe environment for
recuperation exists.
Environment
- “Poor or difficult
environments led to poor
health and disease.”
- “Environment could be
altered to improve conditions
so that the natural laws would
allow healing to occur.”
Assumption of Florence Nightingale’s
Health Theory
- Florence Nightingale believed that five points
- Health is “not only to be were essential in achieving a healthful house:
well but to be able to use well
every power we have or using
“pure air, pure water, efficient drainage,
the person’s power to the cleanliness, and light.”
fullest extent”
- A healthy environment is essential for healing.
- A healthy body can
recuperate (recover) and She stated that “nature alone cures.”
undergo the reparative - Nurses must make accurate observations of
process.
- Environmental control
their patients and be able to report the state of
uplifts the maintenance of the patient to the physician in an orderly
health and prevention of manner.
disease.
- Disease is considered a
- Nursing is an art, whereas medicine is a
dys-ease or the absence of science. Nurses are to be loyal to the medical
comfort.
plan, but not servile.
- Health and disease are the
focus of the nurse who helps
a person through the healing
process.
Nursing
- Nursing is different from
medicine and the goal of
nursing is to place the patient
in the best possible condition
for nature to act.
- Nursing is the “activities that
promote health which occurs
in any given situation. They
can be done by anyone.”
Faye Glenn Abdellah
Biography
Born: March 13, 1919, New York City
Conceptual Model: “Abdellah’s Typology of 21
Nursing Problems”
-Faye Glenn Abdellah was one of the most
influential nursing theorists and public health
scientists. It is extremely rare to find someone
who has dedicated all her life to the
advancement of the nursing profession and
accomplish this feat with so much distinction
and merit.
Education
- In 1942, Abdellah earned a nursing diploma
from Fitkin Memorial Hospital’s School of
Nursing, New Jersey (Now Ann May School of
Nursing)
- She Received her B.Sc. degree in 1945
- Master of Arts degree in 1947
- Doctor of Education in Teachers College
Columbia University
Career
- Abdellah went on to become a nursing
instructor and researcher and helped transform
the focus of the profession from
disease-centered to patient-centered. She
explained the role of nurses to include the care
of families and the elderly.
- She worked in many settings. She had been a
staff nurse, a head nurse, a faculty member at
Yale University and at Columbia University, a
public health nurse, a researcher, and an author
of more than 147 articles and books.
-She was selected as Deputy Surgeon General in
1982
- She retired in 1989
Nursing
•1937- She wanted to be a nurse on the day she
saw Hindenburg explode.
•1949- She spent 40 years in Public Health
Service where she first became involved in
research, being assigned to perform studies to
improve nursing practices.
•1960- she was influenced by the desire to
promote client-centered comprehensive nursing
care.
Abdellah’s Typology of 21 Nursing
Problems
Basic to all Patients
1. To maintain good hygiene and physical
comfort.
2. To promote optimal activity; exercise, rest,
and sleep.
3. To promote safety through prevention of
accident, injury, or other trauma and through
the prevention of the spread of infection.
4. To maintain good mechanics and prevent and
correct the deformity.
Sustenal Care Needs
5. Facilitate the maintenance of a supply of
oxygen to all body cells.
6. To facilitate the maintenance of nutrition of
all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and
electrolyte balance.
9. To recognize the physiological responses of
the body to diseases condition– pathological,
physiological, and compensatory.
10. To facilitate the maintenance of regulatory
mechanisms and functions.
11. To facilitate the maintenance of sensory
function.
Remedial Care Needs Abdellah’s Metaparadigm
12. To identify and accept positive and negative Person
expressions, feelings, and reactions.
13. To identify and accept the interrelatedness - Abdellah describes people as
having physical, emotional,
of emotions and organic illness. and sociological needs. These
14. To facilitate the maintenance of effective needs may be overt,
verbal and non-verbal communication. consisting largely of physical
needs, or covert, such as
15. To promote the development of productive emotional, sociological, and
interpersonal relationships. interpersonal needs– which
are often missed and
16. To facilitate progress toward the
perceived incorrectly.
achievement of personal spiritual goals. -The individuals (and families)
17. To create and/or maintain a therapeutic are the recipients of nursing,
and health, or achieving of it,
environment. is the purpose of nursing
18. To facilitate awareness of self as an service.
individual with varying physical, emotional, and
Environment
developmental needs.
- The environment is
Restorative Care Needs implicitly defined by Abdellah
19. Accept the optimum possible goals in the
as the home or community
light of limitations, physical, and emotional. from which the patient
comes.
20. To use community resources as an aid in - Society is included in
resolving problems arising from illness. “planning for optimum
health.”
21. To understand the role of social problems as
-However, as Abdellah further
influencing factors in the cause of illness. delineated her ideas, the
focus of nursing service is
clearly the individual.
11 Nursing Skills
1. Observation of health status
2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel resources
8. Problem-solving
9. Direction of work of others
10. Therapeutic use of the self
11. Nursing procedure
Health
- In patient-centered
approaches to nursing,
Abdellah describes health as
a state mutually exclusive of
illness.
- Although Abdellah does not
give a definition of health,
she speaks to ‘total health
needs’ and ‘a healthy state of
mind and body’ in her
description of nursing as a
comprehensive service.
Nursing
- Nursing is a helping
profession.
- These would mean a
comprehensive nursing
service, which would include:
1. Recognizing the nursing
problems of the patient.
2. Deciding the appropriate
actions taken in terms of
relevant nursing principles.
3. Providing continuous care
of the individual’s total health
needs.
4. Providing continuous care
to relieve pain and
discomfort.
5. Adjusting the total nursing
care plan to meet the
patient’s individual needs.
6. Helping the individual to
become more self-directing in
attaining or maintaining a
healthy state of mind and
body.
7. Instruct nursing personnel
and family to help the
individual.
8. Helping the individual to
adjust to his limitations and
emotional problems.
9. Working with allied health
professionals in planning for
optimum health.
Purposes
Nursing Practice
- Abdellah’s main goal is the improvement of
nursing education.
- The most important impact of Abdellah’s
theory on the nursing practice is that it helped
transform the focus of the profession from
being ‘disease-centered’ to ‘patient-centered’
- The steps of the nursing process are
assessment, diagnosis, planning,
implementation, and evaluation.

Nursing Education
- Professors and educators realized the
importance of client-centered care rather than
focusing on medical interventions.
- Nursing education then slowly deviated its
concentration from the complex, medical
concepts, to exercising better attention to the
client as the primary concern.
- It's very strong nurse-centered orientation is,
on the other hand, it’s a major contribution to
nursing education.
Ernestine Wiedenbach
Biography
Born: August 18, 1900, Hamburg, Germany
Died: March 8, 1998
Conceptual Model: “The Helping Art of Clinical
Nursing”
Education
- BA from Wellesley, College in 1922
- RN from John Hopkins School of Nursing in
1925
- MA from Teachers College Columbia University
in 1934
- Certificate in nurse-midwifery from the
Maternity Center Association School for
Nurse-Midwives in NY in 1946
Career
- She joined the Yale faculty in 1952 as an
instructor in maternity nursing.
-Assistant professor of obstetric nursing in 1954
and an associate professor in 1956
- She wrote Family-Centered Maternity Nursing
in 1958
- She was influenced by Ida Orlando in her
works on the framework.
The Helping Art of Clinical Nursing
- Philosophy or metatheory
Theoretical Sources
•Ida Orlando Pelletier- understanding of the use
of self and the effect the nurse’s thoughts and
feelings have on the outcome of his action
•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
Prescriptive Theory
- Wiendenbach’s prescriptive theory is based on
three factors:
•The central purpose which the practitioner
recognizes as essential to the particular
discipline.
•The prescription for the fulfillment of central
purpose.
•The realities in the immediate situation that
influence the central purpose.
Use of Empirical Evidence
1994- At this time, there is no specific research
supporting Wiedenbach’s work
- Little research has been done using her
theory.
Major Concepts and Definitions
The Patient
- Any person who has entered the healthcare
system and is receiving help of some kind, such
as care, teaching, or advice.
- need not be ill since someone receiving
health-related education would qualify as a
patient.
A-Need-For-Help
- “Any measure or action required and desired
by the patient that has the potential to restore
or extend the ability to cope with the demand
implicit in his situation.”
- It is crucial to the nursing profession that
a-need-for-help be based on the individual
perception of his own situation.
Nurse
- The nurse is a functioning human being.
- The nurse not only acts but thinks and feels as well.
- For the nurse whose action is directed toward the
achievement of a specific purpose, thoughts and
feelings have a disciplined role to play.
The Purpose Practice: Judgement
Purpose- is that which the nurse wants to - Clinical Judgement represents the nurse’s
accomplish through what she does. likeliness to make sound decisions.
- is the overall goal toward which she is - Sound decisions are based on differentiating
striving, and so is constant. fact from assumption and relating them to
- The nurse’s reason for being and for doing. cause and effect.
- It is all of the activities directed towards the - Decisions resulting from the exercise of
overall good of the patient. judgment will be sound or unsound according to
whether or not the nurse has disciplined the
The Philosophy functioning of her emotions and of her mind.
- An attitude toward life and reality that evolves
from each nurse’s beliefs and code of conduct, Practice: Skills
motivates the nurse to act, guides her thinking - Skills represent the nurse’s potential for
about what she is to do, and influences her achieving desired results.
decisions. - Skills compromise numerous and varied acts,
- Philosophy underlies purpose, and purpose characterized by the harmony of movement,
reflects philosophy. expression, intent, precision, and adroit use of
self.
The Practice - May be classified as
- Overt action, directed disciplined thoughts and • Procedural Skills
feelings toward meeting the patient’s • Communication Skills
need-for-help, constitutes the practice of clinical
nursing. Components of Practice Directly
- It is goal-directed, deliberately carried out and Related to Patient’s Care
patient-centered. • Identification
- Knowledge, Judgement, and Skills are three • Ministration
aspects necessary for effective practice. • Validation
- Identification, ministration, and validation are •Coordination of Resources
three components of practice directly related to • Reporting
the patient’s care. • Consulting
- Coordination of resources is indirectly related • Conferring
to it.
The Art
Practice: Knowledge - Application of knowledge and skills to bring
- Knowledge encompasses all that has been about desired results.
perceived and grasped by the human mind; its - Four Main Goals:
scope and range are infinite. • Understanding patient's needs and concerns.
- Knowledge may be • Developing goals and actions intended to
•Factual enhance the patient’s ability.
•Speculative or • Directing the activities related to the medical
•Practical plan to improve the patient’s condition.
• Nursing art involves three initial operations:
• Stimulus
• Preconception
• Interpretation
- The nurse reacts based on those operations.
Her actions may be
• Rational action
• Reactionary action
• Deliberative action
Wiedenbach’s Metaparadigm/ Major
Assumption
Person
- Each Person is endowed with
a unique potential to develop
self-sustaining resources.
- People generally tend
towards independence and
fulfillment of responsibilities.
- Self-awareness and
self-acceptance are essential
to personal integrity and
self-worth.
- Whatever an individual does
at any given moment
represents the best available
judgment for the person at
that time.
Environment
- Wiedenbach does not
specifically address the
concept of environment.
However, she recognized the
potential effects of the
environment.
Theoretical Assertions
Clinical Nursing-the relationship between its
focus and constituents.
Logical Form
• Induction
• Situation-producing prescription theory
Acceptance of the Nursing Theory
Practice
- More acceptable today than in the 1950s and
1960s
- In the 1980s the healthcare industry provided
the supposedly unique concept of Family
Centered Care, which Wiedenbach addressed
Health some 20 years ago.
- Not defined nor discussed Education
in Wiedenbach’s model. - Wiedenbach proposed that nursing education
serves the practice in four major ways:
1. It is responsible for the preparation of future
practitioners of nursing.
2. It arranges for nursing to gain experience in
clinical areas of hospitals or the homes of their
patients.
3. Its representatives may function in the clinical
area and may work closely with their staff.
4. It offers educational opportunities to the
nurse for special or advanced study.
Nursing
-Nurses ascribe to an explicit Practice
philosophy. Basic to this is - Before the development of Wiedenbach’s
1. Reverence for the gift of
model, nursing research focused more on the
life.
2. Respect for the dignity, medical model than on a nursing model
worth, autonomy, and - In her model, the focus of nursing research is
individuality of each human
being
to be related to the patient’s response to the
3. Resolution to act healthcare experience.
dynamically in relation to
one’s beliefs
Further Development
- Pioneer in the writing of nursing theory.
- Needs to be further developed by more clearly
defining the concepts of health and environment.
- The component of nursing art need to be identified
in an operational way.
Critique

Clarity Concepts and

definitions are clear,
consistent, and
intelligible

Simplicity Too many relational

statements

Generality Broad; Concept of

need-for-help is not
applicable to some
patients

Empirical Precision Partially met; Difficult

to test

Derivable Fulfills the purpose

Consequence for which it was
developed to
describe the
professional practice
Jean Watson
- Born in West Virginia and currently lives in
Colorado
- She earned B.Sc. in 1964, MS in Psychiatric
Nursing in 1966, and Ph.D. in Educational
Psychology and Counseling in 1973
- Founder of the Center for Human Caring in
Colorado.
- Watson’s Philosophy of caring attempts to
define the outcome of nursing activity regarding
the humanistic aspects of life. Her theory and
Philosophy of caring are based on the values of
kindness, concern, love of self and others, and
respect for the spiritual dimensions of the
person.
- The foundation of Jean Watson’s theory of
nursing was published in 1979 in nursing– The
Philosophy and Science of Caring
Major Elements of Watson’s Theory of
Human Caring
Elements
Carative Factors Transpersonal Caring Occasion,
Caring Caring
Relationship Movements
Carative Factors
The structure for the science of caring is built
upon the ten carative factors. These are
1. Formation of a humanistic-altruistic system of
values.
- Begins developmentally at an early age with
values shared with the parents.
- Mediated through one’s own life experiences,
the learning one gains, and exposure to the
humanities.
2. The instillation of faith-hope.
- Is essential to both the carative and curative
process.
- When modern science has nothing further to
offer the person, the nurse can continue to
faith-hope to provide a sense of well-being
through beliefs that are meaningful to the
individual.
3. The cultivation of sensitivity to oneself and to
others
- The development of one’s own feelings is
needed to interact genuinely and be sensitive
with others.
- Striving to become sensitive, makes the nurse
more authentic, which encourages self-growth
and self-actualization, in both the nurse and
those with whom the nurse interacts.
- The Nurse promotes health and higher level
functioning only when they form a
person-to-person relationship.
4. The development of a helping-trust
relationship
- Strongest tool is the mode of communication,
which establishes rapport and caring.
- She has defined the characteristics needed to
develop the helping-trust relationship. They are
congruence, empathy, and warmth.
- Communication includes verbal, nonverbal,
and listening in a manner that expresses
empathy and understanding.
5. The promotion and acceptance of the
expression of positive and negative feelings
- According to Watson, “feelings alter thoughts
and behavior, and they need to be considered
and allowed for in a caring relationship.”
- According to her such expression improves
one’s level of awareness.
- Awareness of the feelings helps to understand
the behaviors it endangers.
6. The systematic use of the scientific
problem-solution method for decision making
- According to Watson, the scientific
problem-solving method is the only method
that allows for control and prediction which
permits self- correction.
- She values the relative nature of nursing and
supports the need to examine and develop
other methods of knowing to provide a holistic
perspective.
- The science of caring should not be always
neutral and objective.
7. The promotion of interpersonal
teaching-learning
- The caring nurse must focus on the learning
process.
- Understanding the person’s perception of the
situation assists the nurse to prepare a cognitive
plan.
8. The provision for a supportive, protective,
and/or corrective mental, physical,
socio-cultural, and spiritual environment
- Watson divides these into external and
internal variables, which the nurse manipulates
in order to provide support and protection for
the person's mental and physical well-being.
- The external and internal environments are
interdependent.
- Watson suggests that the nurse also must
provide comfort, privacy, and safety as a part of
these carative factors.
9. Assistance with the gratification of human
need
- It is grounded in a hierarchy of needs like that
of Maslow’s.
- She has created a hierarchy that she believes is
relevant to the science of caring in nursing.
- According to her, each need is equally
important for optimal health. All the needs
deserve to be attended and valued.
Watson’s Ordering of Needs
Lower order needs (Biophysical needs,
psychological needs)
• Need for food and fluid,
• elimination,
• ventilation, and
• sexuality
Higher order needs (Psychosocial needs)
• Need for achievement,
• affiliation, and
• self-actualiztion
10.The allowance for
existential-phenomenological forces.
- Phenomenology is a way of understanding
people from the way things appear to them,
from their frame of reference.
- Existential psychology is the study of human
existence using phenomenological analysis.
- This factor helps the nurse to reconcile and
mediate the incongruity of viewing the person
holistically while at the same time attending to
the hierarchical ordering of needs.
- Thus the nurse assists the person to find the
strength of courage to confront life or death.
Transpersonal Caring Relationship
- Transpersonal describes an intersubjective,
human-to-human relationship that
encompasses two individuals, both the nurse
and the patient in a given moment.
- Describes how the nurse goes beyond the
objective assessment to show concern towards
the person’s subjective/deeper meaning of their
healthcare situation.
- Involves mutuality between the two
individuals involved
Goal of Transpersonal Caring Watson's Metaparadigm
Relationship
- To protect, enhance, and preserve human Person Health
dignity, humanity, wholeness, and inner
harmony. - She adopts a view of - Watson believes that
Transpersonal caring relationship is a special human beings as valued there are other factors
people in and of him or that are needed to be
kind of human relationship that depends on: themselves to be cared for included in the WHO
- Nurse’s commitment to protecting and respected, nurtured, definition of health. She
enhancing human dignity. understood, and assisted. adds the following three
- The nurses caring and connection have the In general, a philosophical elements:
view of a person as a • A high level of overall
potential to heal since the experience,
functional integrated self. physical, mental, and
intention, and perception are taking place. social functioning
- The nurse's goals beyond an objective • A general
assessment and shows concern for the patient’s adaptive-maintenance
own healthcare. level of daily functioning
• The absence of illness
(or the presence of efforts
Caring Occasion/Moment that leads its absence.)
- A caring occasion is a moment when the nurse
and another person come together in such a Environment/Society Nursing
way that an occasion for human caring is
- According to Watson, - According to Watson,
created. caring and nursing have “Nursing is concerned
- Both persons come together in a existed in every society. A with promoting health,
human-human transaction. caring attitude is not preventing illness, caring
- The one caring for and the one being cared for transmitted from for the sick, and restoring
generation to generation. health”.
are influenced by the choices and actions
It is transmitted by the - It focuses on health
decided within the relationship. culture of the profession promotion and treatment
as a unique way of coping of disease. She believes
with its environment that holistic health care is
central to the practice of
caring in nursing.
- She defines nursing as a
human science of persons
and human health-illness
experiences that are
mediated by the
professional, personal,
scientific, esthetic, and
ethical human
transaction.
Virginia Avenel Henderson
Biography
Born: November 30, 1897, Kansas City, Missouri
Died: March 19. 1996, at a hospice in Brandford,
Connecticut, at the age of 98
-Fifth of the eight children of Lucy Minor Abbot
and Daniel B. Henderson
-Her father was a former teacher at Bellevue
and was an attorney representing the Native
American Indians in disputes with the US
Government, winning a major case for the
Klamath tribe in 1937
-She was a nurse, theorist, and author known
for her Need Theory.
- She defines nursing as “The unique function of
the nurse is to assist individual, sick or well, in
the performance of those activities contributing
to health or its recovery (or to peaceful death)
that he would perform unaided if he had the
necessary strength, will or knowledge.”
- “The First Lady of Nursing”
- “The Nightingale of Modern Nursing”
- “Modern-Day Mother of Nursing” and
- “The 20th Century Florence Nightingale”
Education
- In 1921, she received her Diploma in Nursing
from the Army School of Nursing at Walter Reed
Hospital, Washington D.C.
- In 1923, she started teaching nursing at the
Norfolk Protestant Hospital in Virginia.
- In 1929, she entered Teachers College at
Columbia University for her Bachelor’s Degree
in 1932 and took her Master’s Degree in 1934
Career
- In 1921 after receiving her Diploma, she
worked at the Henry Street Visiting Nurse
Service for 2 years after graduation.
- From 1934 to 1948, 14 years of her career, she
worked as an instructor and associate professor
at Teachers College Columbia University in New
York. Since 1953, Henderson was a research
associate at Yale University School of Nursing
and as a research associate emeritus
(1971-1996)
Works of Virginia Henderson
- She was the author of three editions of
“Principles and Practices of Nursing,” a widely
used text.
- “Basic Principles of Nursing,” published in 1966
and revised in 1972, has been published in 27
languages by the International Council of
Nurses.
- Most formidable achievements was a research
project in which she gathered, reviewed,
cataloged, classified, annotated, and
cross-referenced every known piece of research
on nursing published in English, resulting in the
four-volume “Nursing Research: Survey and
Assessment,” written with Leo Simmons and
published in 1964, and her four-volume
“Nursing Studies Index,” completed in 1972.
Virginia Henderson’s Need Theory
- The Nursing Need Theory developed by
Virginia Henderson, defines the unique focus of
nursing practice. The theory focuses on the
importance of increasing the patient’s
independence to hasten their progress in the
hospital.
- Henderson’s theory emphasizes the basic
human needs and how nurses can assist in
meeting those needs.
- Henderson believed that the function the
nurse performs is primarily an independent
one– that of acting for the patient when he
lacks knowledge, physical strength, or the will to
act for himself as he would ordinarily act in
health, or in carrying out prescribed therapy.
14 Components of the Need Theory Henderson’s Metaparadigm
These components of this theory show a holistic
approach to nursing that covers the Person/ Individual
physiological, psychological, spiritual, and social
needs. - Henderson states that
1. Breathe normally individuals have basic
needs that are
2. Eat and drink adequately
components of health and
3. Eliminate body waste require assistance to
4. Move and maintain desirable posture achieve health and
5. Sleep and rest independence or a independence or ability to
peaceful death. Acc. to
6. Select suitable clothes, dress, and undress.
her, an individual achieves
7. Maintain body temperature within normal wholeness by maintaining
range by adjusting clothing and modifying the physiological and
environment. emotional balance.
8. Keep the body clean and well-groomed and -She defined that patient
as someone who needs
protect the integument.
nursing care but did not
9. Avoid dangers in the environment and avoid limit nursing to illness
injuring others. care. Her theory
10. Communicate with others in expressing presented the patient as a
sum of parts with
emotions, needs, fears, and opinions.
biophysical needs and the
11. Worship according to one’s faith. mind and body are
12. Work in such as way that there is a sense of inseparable and
accomplishment. interrelated.
13. Play it and participate in various forms of
Environment/Society
recreation.
14. Learn and discover or satisfy the curiosity - Although the Need
that leads to normal development and health Theory did not explicitly
and use the available health facilities. define the environment,
Henderson stated that
maintaining a supportive
environment conducive to
health is one of the
elements of her 17
activities for client
assistance.
Health
- Although not explicitly
defined in Henderson’s
theory health was taken
to mean balance in all
realms of human life. It is
equated with the
perform activities without
any aid in the 14
components or basic
human needs.
- Nurses, on the other
hand, are key persons in
promoting health,
preventing of illness, and
being able to cure. Acc. to
Henderson, good health is
a challenge because it is
affected by numerous
factors such as age,
cultural background,
emotional balance, and
others.
Nursing
- She defined nursing as
“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 that
he would perform
unaided if he had the
necessary strength, will or
knowledge. And to do this
in such a way as to help
him gain independence as
rapidly as possible.”
- The nurse’s goal is to
make the patient
complete, whole, or
independent, in turn, the
nurse collaborates with
the physician’s Role of the Nurse
therapeutic plan, but • Substitutive- acting for a person
individualized care is the • Supplementary- assisting a person
result of the nurse’s
• Complementary- working with the person
creativity in planning for
care.
- Nurses temporarily assist “...with the goal of helping the person become
an individual who lacks as independent as possible.”
the necessary strength,
will, and knowledge to
satisfy one or more of the
14 basic needs. She states
“The nurse is temporarily
the consciousness of the
unconscious, the love life
for the suicidal, the leg of
the amputee, the eyes of
the newly blind, a means
of locomotion for the
infant, knowledge, and
confidence of the young
mother, the mouthpiece
for those too weak or
withdrawn to speak.”
- She stated that “The
nurse does for others
what they would do for
themselves if they had the
strength, the will, and the
knowledge.”
- Her definition of nursing
distinguished the role of a
nurse in health care.