Nursing Theories

Nursing Theories
INSTRUCTIONAL MATERIALS 6
Learning Objectives:
Appreciate the value of evidence-based nursing
practice in the application of nursing and related
models/theories.
THEORETICAL FOUNDATION IN NURSING | Nursing Theories 112

Nursing Theories
1. Hildegard Peplau
Theory of Interpersonal Relationship
2. Ida Jean Orlando
Theory of Deliberative Nursing Process
3. Joyce Travelbee
Human to Human Relationship
4. Lydia Hall
Core, Care, Cure
5. Faye Glen Abdellah
21 Nursing Problems
6. Virginia Henderson
Need Theory
7. Nola Pender
Health Promotion Model
8. Madeleine Leininger
Theory of Culture Care Diversity & Universality
9. Margaret Newman
Theory of Health as Expanding Consciousness
10. Rosemarie Parse
Theory of Human Becoming
11. Ernestine Weidenbach
Helping Art of Clinical Nursing
12. Katharine Kolcaba
Theory of Comfort
THEORETICAL FOUNDATION IN NURSING | Nursing Theories 113

1.HILDEGARD PEPLAU’S
THEORY OF INTERPERSONAL RELATIONSHIP
I. BACKGROUND OF THE THEORIST
Hildegard E. Peplau was born 1.

_________________ in 2.
___________________. She died
peacefully in her sleep 89 years later on
March 17, 1999 in her home in Sherman
Oaks, California. She was the second
daughter of six children born to immigrant
parents, Gustav and Ottylie Peplau, Peplau
began her nursing career in 1931 after
graduating from 3.
__________________________________.
She received a B.A. in interpersonal
psychology from Bennington College,
Vermont, in 1943; an M.A, in psychiatric nursing from 4.
___________________________________, in 1947; and an Ed.D. in curriculum
development from Columbia University in 1953. Peplau received honorary doctoral
degrees during her prestigious career from the following universities: Alfred, Duke,
Indiana, Ohio State, Rutgers, and the University of Ulster in Ireland.
Hildegard Peplau is considered to be the 5.
__________________________; however, her contributions to the
professionalization of nursing transcends her psychiatric nursing specialty. She
influenced the advancement of professional, educational, and practice standards
in nursing. A pioneer in her field, she emphasized the importance of professional
self-regulation through credentialing and introduced the concept of advanced
nursing practice. Peplau's most significant contribution to nursing science,
professional nursing, and the psychiatric nursing specialty may be the
development of the Theory of Interpersonal Relations, a midrange theory focusing
on the relationship between the nurse and the patient.
THEORETICAL FOUNDATION IN NURSING | Nursing Theories

Hildegard Peplau 114
Peplau's life work was built upon her personal and practice experiences.
Peplau's understanding of the influence of illness and death on individuals and
families was influenced by her early experiences during the great influenza
epidemic. Peplau's theorizing was largely inductive and based on keen
observations of her clinical work and her environment. Her professional and
teaching experiences have been broad and varied. She was the operating room
supervisor at Pottstown Hospital and later headed the staff of the Bennington
infirmary while pursuing her undergraduate degree.
II. PHILOSOPHICAL UNDERPINNINGS

OF THEORY
Peplau was committed to incorporating established knowledge into her

conceptual framework, ________________________________. Peplau's Theory
of Interpersonal Relations integrated existing theories into her model at a time
when nursing theory development was relatively new.
The nature of science in nursing refers to the “body of verified knowledge
found within the discipline of nursing . . . (that is) mainly knowledge from the
biological and behavioral sciences.” The “synthesis, reorganization, or extension
of concepts drawn from the basic and applied sciences, which in their reformation
tend to become new concepts," have led to the growth of nursing science.
Peplau used knowledge borrowed from behavioral science and what can
be termed the psychological model to develop her Theory of Interpersonal
Relations. Borrowing from the psychological model “enabled the nurse to begin to
move away from a disease on to one whereby the psychologic meaning of events,
feelings, and behaviors could be explored and incorporated into nursing
interventions. It gave nurses an opportunity to teach patients how to experience
their feelings and to explore with clients how to bear their feelings. The conceptual
framework of interpersonal relations seeks to develop the nurse’s skill in using
these concepts. Sullivan, Symonds, Maslow and Mittleman and Miller are some of
the major sources Peplau used in developing her conceptual framework. Some of
the therapeutic conceptions that these theorists devised arose directly from the
works of Freud and Fromm.

III. MAJOR ASSUMPTIONS, CONCEPTS
AND RELATIONSHIPS
PSYCHODYNAMIC NURSING
Peplau defines psychodynamic nursing because her model evolves
through this type of nursing. "Psychodynamic nursing is being able to understand
one's own behavior to help others identify felt difficulties, and to apply principles
of human relations to the problems that arise at all levels of experience”. Peplau
develops the model by describing the structural concepts of the interpersonal
process, which are the phases of the nurse patient relationship. She holds this
to be basic to psychodynamic nursing.
PHASES OF NURSE-PATIENT RELATIONSHIPS
Peplau describes four phases of the nurse-patient relationship. Although

separate, they overlap and occur over the time of the relationship:
Overlapping phases of Nurse-patient relationships

Directions: Fill in the crossword puzzle with the words missing from the
sentences below. Match the number of the sentence to the boxes placed
across or down the grid. If filled out correctly, the words will fit neatly into
the puzzle.

NURSING ROLES
Peplau describes six nursing roles that emerge in the various phases of
the nurse-patient relationship: (1) role of the stranger, (2) role of the resource
person, (3) teaching role. (4) leadership role, (5) surrogate role, and (6)
counseling role.
__________________ 1. Peplau states that because the nurse and

patient are strangers to each other, the nurse
should treat the patient with ordinary courtesy.
In other words, the nurse should not prejudge
the patient, but accept him or her as a person.
During this nonpersonal phase, the nurse
should treat the patient as emotionally able
unless evidence indicates otherwise. This
coincides with the identification phase."
__________________ 2. The nurse provides specific answers to

questions, especially health information, and
interprets to the patient the treatment or
medical plan of care. These questions often
arise within the context of a larger problem. The
nurse determines what type of response is
appropriate for constructive learning, either
giving straightforward factual answers or
providing counseling.
__________________ 3. Combination of all roles and "always proceeds
from what the patient knows and ... develops
around his interest in wanting and ability to
use... information." Peplau expands on the role
of teacher in later writings.
__________________ 4. Involves the democratic process. The nurse
helps the patient meet the tasks at hand
through a relationship of cooperation and active
participation."
__________________ 5. The nurse's attitudes and behaviors create
feeling tones in the patient that reactivate
feelings generated in a previous relationship.
The nurse's function is to help the patient
recognize similarities between the nurse and

the person recalled by the patient. The nurse
then helps the patient see the differences
between the nurse's role and that of the
recalled person. In this phase, the patient and
nurse define areas of dependence,
independence and interdependence.
__________________ 6. Greatest emphasis in psychiatric nursing. It
functions in the nurse-patient relationship by
the way nurses respond to patients’ demands.
MODEL/DIAGRAM/PARADIGM

V. USEFULNESS, TESTABILITY, PARSIMONY &
VALUE IN EXTENDING NURSING SCIENCE
INTERPERSONAL RELATIONS IN NURSING
Peplau formulated theories on interpersonal relations in nursing (1952)

and the art and science of nursing (1988).
Imagine yourself working in a hospital-based setting, such as an

outpatient department. The common scenario would be that of a patient coming
in because of a felt need related to his health. You as a nurse will assess the
reasons for this consultation. At this point, the process of nursing begins - it is
both an interpersonal and a therapeutic process. It is both an art and a science,
as you apply the scientific knowledge you have acquired for the therapeutic
component of care.
Peplau’s theory focuses on the interpersonal processes and therapeutic

relationship that develops between the nurse and client. The interpersonal focus
of Peplau’s theory requires that the nurse attend to the interpersonal processes
that occur between the nurse and client. Interpersonal process is maturing
force for personality. Interpersonal processes include the nurse- client
relationship, communication, pattern integration and the roles of the
nurse. Psychodynamic nursing is being able to understand one’s own behavior
to help others identify felt difficulties and to apply principles of human relations
to the problems that arise at all levels of experience. This theory stressed the
importance of nurses’ ability to understand own behavior to help others identify
perceived difficulties.
Peplau believes “the behavior of the nurse-as-a-person interacting with the

patient as-a-person has significant impact on the patient’s well-being and the
quality and outcome of nursing care”.

2.IDA JEAN ORLANDO’S THEORY OF
DELIBERATIVE NURSING PROCESS
Ida Jean Orlando’s nursing theory
stresses the reciprocal relationship between
patient and nurse. It emphasizes the critical
importance of the patient’s participation in the
nursing process. Orlando also considered
nursing as a distinct profession. He separated it
from medicine, where nurses determining
nursing action rather than being prompted by
physician’s orders, organizational needs, and
past personal experiences. She believed that
the physician’s orders are for patients and not
for nurses.
She proposed that “patients have their
own meanings and interpretations of situations and therefore nurses must
validate their inferences and analyses with patients before concluding.”
Ida Jean Orlando was born August 12, 1926. In 1947, she received a
diploma in nursing from New York Medical College, Flower Fifth Avenue Hospital
School of Nursing, in New York. She received a B.S. in public health nursing from
St. John's University in Brooklyn, New York in 1951 and an M.A. in mental health
consultation from Columbia University Teachers College in 1954. While pursuing
her education, Orlando worked intermittently, and sometimes concurrently, as a
staff nurse in obstetrical, medical, surgical, and emergency nursing services. She
also worked as a supervisor in a general hospital. In addition, as an assistant
director of nursing, she was responsible for a general hospital's nursing service
and for teaching several courses in the hospital's nursing school.

Ida Jean Orlando 121
After receiving her master's degree in 1954, Orlando was employed for
eight years at the Yale School of Nursing in New Haven, Connecticut. At Yale, she
was a research associate and principal investigator of a federal project grant
entitled “Integration of Mental Health Concepts in a Basic Curriculum” until 1958.
The project focused on identifying factors influencing the integration of mental
health principles in a basic nursing curriculum. Orlando conducted this project by
observing and participating in student experiences with patients and medical,
nursing, and instructional personnel throughout the students' basic curriculum. For
three years, she recorded her observations and spent a fourth year analyzing the
accumulated data. Orlando reported her findings in 1958 in her first book.
Orlando's nursing theory stresses the reciprocal relationship between
patient and nurse. What the other says and does affects both nurse and patient.
She was one of the first nursing leaders to identify and emphasize the elements of
nursing process and the critical importance of the patient's participation in the
nursing process. Orlando” viewed nursing as a distinct profession, separate from
medicine. Orlando believed physicians' orders were for patients, not for nurses.
However, the nurse helps the patient carry out the order or, if the patient is unable,
the nurse does it for patient. Likewise, the nurse may help patients from adhering
to physicians' orders if data supports it. The nurse would communicate the
rationale for this to the physician. Orlando may have facilitated the development of
nurses as logical thinkers. Orlando viewed nurses as determining nursing action
rather than being prompted by physician's orders, organizational needs, and past
personal experiences. Therefore, nursing action is derived from the patient's
immediate experience and immediate needs for help.

OF THEORY
Orlando does not acknowledge any theoretical sources for the development
of her theory. None of her publications include a bibliography. However,
Schmieding traced similarities of her formulations to those of John Dewey and to
some of the nurse colleagues and educators with whom Orlando was associated
at Columbia.
Orlando was the first nurse to develop her theory from actual nurse-patient
situations. Orlando recorded the content of 2000 nurse-patient contacts and
constructed her theory based on the analysis of these data. Orlando asserts that

her theory was valid and she applied it in her work with patients and nurses and
the teaching of students. She used a qualitative method to obtain data from which
she developed her theory. According to Meleis, 43:348 “Orlando used field
methodology before it became a world view in research."
At McLean Hospital, Orlando implemented the nursing process theory that
she had developed at Yale. During her last three years there, she received a
research grant to do evaluative research of the training program to test her
formulations. She published these results in her second book, The Discipline and
Teaching of Nursing Process: An Evaluative Study." In it, Orlando clearly and
succinctly presents the components of her theory, describes a person's process of
action, and specifies what types of action facilitate or hinder the nurse from finding
out the patient's immediate need for help. Orlando's theory was used by several
Yale faculty as a basis for discussing and developing a nursing practice theory."

AND RELATIONSHIPS
Ida Jean Orlando’s goal is to develop a theory of effective nursing practice.

The theory explains that the nurse’s role is to find out and meet the patient’s
immediate needs for help. According to the theory, all patient behavior can be a
cry for help. Through these, the nurse’s job is to determine the nature of the
patient’s distress and provide the help he or she needs.
PERSON. Unique individual behaving verbally and nonverbally. Assumption is

that individuals are at times able to meet their own needs and at other times
unable to do so.
ENVIRONMENT. Orlando completely disregarded the environment in her theory,

only focusing on the patient’s immediate need, chiefly the relationship and
actions between the nurse and the patient (only an individual in her theory; no
families or groups were mentioned). The effect that the environment could have
on the patient was never mentioned in Orlando’s theory.
HEALTH. In Orlando’s theory, health is replaced by a sense of helplessness as

the initiator of a necessity for nursing. She stated that nursing deals with
individuals who require help.

NURSING. Orlando speaks of nursing as unique and independent in its concerns
for an individual’s need for help in an immediate situation. The efforts to meet the
individual’s need for help are carried out in an interactive situation and in a
disciplined manner that requires proper training.
SUBCONCEPTS
Ida Jean Orlando described her model as revolving around the following
five major interrelated concepts: the function of professional nursing,
presenting behavior, immediate reaction, nursing process discipline, and
improvement.
Directions: Match the subconcepts of the deliberative nursing

process with the corresponding item in Column B. Write the letter of
your answer for each number.
COLUMN A. COLUMN B.
a. Include both the nurse and
1. Presenting Behavior of patient's individual
________
Patient perceptions, thoughts, and
feelings
b. was called deliberative
________ 2. Immediate Reactions nursing process in
Orlando's first book
c. Any observable verbal or
________ 3. Nursing Process Discipline
nonverbal behavior.
d. "Supply the help a patient
________ 4. Improvement requires in order for his
needs to be met."
e. Those actions decided
upon after ascertaining a
________ 5. Purpose Of Nursing
need and then meeting
this need."
f. "Means to grow better, to
________ 6. Automatic Nursing Action turn to profit, to use to
advantage."

g. "Those (nursing actions)
7. Deliberative Nursing decided upon for reasons
________
Action other than the patient's
immediate need.":
5 STAGES OF DNP
The Deliberative Nursing Process has five stages: assessment, diagnosis,
planning, implementation, and evaluation.
Directions: Fill in the crossword puzzle with the words missing from
the sentences below. Match the number of the sentence to the boxes
placed across or down the grid. If filled out correctly, the words will fit
neatly into the puzzle.

IV. MODEL/DIAGRAM/PARADIGM

Orlando's theory remains effective and efficient in achieving valued

outcome. Identifying the patient's immediate needs for help and the nurse's ability
to meet these needs are critically important to patient outcomes and the
advancement of nursing practice.
Incorporating validation into the nursing process discipline, as Orlando
suggests, allows for maximum participation by the patient in his or her care.
Numerous researchers have also demonstrated that the use of a disciplined
professional response enables the nurse to find out and meet the patient's
immediate needs for help. The study of what nurses say and do in their practice,
and the resulting effect manifested by the patient, is valuable content for use in
nursing education and developing further research studies. The nursing process
discipline allows nurses to view the patient from a nursing perspective than from a
medical disease orientation." Orlando's theory benefits the patient, enhances the
nurse's professional identity, and helps to advance the nursing profession.

3. JOYCE TRAVELBEE’S
HUMAN-TO-HUMAN RELATIONSHIP
MODEL
Joyce Travelbee was a

psychiatric nurse practitioner,
educator, and writer. Born in 1926,
she completed her basic nursing
preparation in 1946 at 1.
___________________ in New
Orleans. She earned a B.S. degree in
nursing education from 2.
___________________________ in
1956 and an M.S. degree in nursing
from Yale in 1959. In the summer of
1973, Travelbee began a doctoral
program in Florida; however, she
was unable to complete the program
because she died later that year. She
died at the age of 47 after a brief
illness, leaving no survivors.
Travelbee began her career as a nursing educator in 1952, teaching
psychiatric nursing at 3. ________________________________, New Orleans,
while working on her baccalaureate degree. She also taught psychiatric nursing
at Charity Hospital School of Nursing, Louisiana State University, New York
University in New York City, and the University of Mississippi in Jackson. In 1970,
she was named Project Director at Hotel Dieu School of Nursing in New Orleans.
At the time of her death, Travelbee was the director of graduate education at
Louisiana State University School of Nursing.

Joyce Travelbee 127
II. PHILOSOPHICAL UNDERPINNINGS OF
THEORY
Travelbee's experiences in her basic nursing education and initial practice

in Catholic charity institutions greatly influenced the development of her theory.
Travelbee believed that the nursing care given to patients in these institutions
lacked compassion. She felt that nursing needed "a humanistic revolution-a
return to focus on the 'caring' function of the nurse in the caring for (and) the
caring about ill persons and predicted if this did not occur, consumers would
demand the 'services of a new and different kind of health worker.
Directions: Read the questions

carefully. Answer the following
question and put your answer on the
ACTIVITY blank provided.
1. Who influenced Joyce Travelbee? And how do they become similar in the
model?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
2. Who influenced Travelbee as she based her assumptions of her theory on

the concepts of logotherapy?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
3. A former student and colleague of Travelbee, remembers Travelbee as a

Joyce Travelbee 128
prolific reader whose office was often crammed with files of bibliography
cards. Apparently, Travelbee's theory is based on her cumulative nursing
experiences and her readings rather than the evidence of a particular
research study.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

AND RELATIONSHIPS
HUMAN-TO-HUMAN RELATIONSHIP MODEL

Human-to-human relationship
• an experience or series of experiences between nurse and patient

• means thru which the purpose of nursing is accomplished
Directions: Match the five phases of encounter with the

corresponding item in Column B. Write the letter of your answer for
each number.
COLUMN A COLUMN B
a. perceiving each other’s
____________ 1. Original Encounter
uniqueness
2. Emerging Identities
____________ b. therapeutic use of self
c. relation as human being
____________ 3. Empathy
to human being
4. Sympathy
____________ d. first impressions
e. ability to share in the
____________ 5. Rapport
person’s experience

Joyce Travelbee 129
Directions: Complete the conceptual model of Travelbee’s Human-to-

Human Relationship below.

Joyce Travelbee 130
Travelbee's theory does not possess simplicity because there are many
variables. The theory is designed to help nurses appreciate not only the patient's
humanness, but also the nurse's humanness. To be human is to be unique, so the
variables present in each phase of the human-to-human relationship are
numerous.
Travelbee's theory has a wide scope of application. She generated it

primarily as a result of her experience with psychiatric patients, but it is not limited
to use in this setting. It is applicable whenever the nurse encounters patients in
distress. It seems to be most useful when working with those who are chronically
ill, those who are undergoing long-term rehabilitation, or those who are terminally
ill.
Travelbee's theory appears to have a low degree of empirical validity, most
of which can be traced to the lack of simplicity in the theory. She defines concepts
theoretically, but she does not define them operationally. The model has not been
tested; therefore, it has no empirical support.
The usefulness of a theory is related to its ability to describe, explain,

predict, and control phenomena. Travelbee's theory does describe some variables
that may affect the establishment of a therapeutic relationship between the nurse
and patient. However, the lack of empirical precision also creates a lack of
derivable consequences. Travelbee's theory focuses on the development of the
attribute of caring. In this respect, the theory can be useful because caring is a
major characteristic of the nursing profession.

Joyce Travelbee 131
4.LYDIA HALL’S
CORE, CARE, CURE
Hall’s Care, Cure, Core Theory assumptions are as follows: (1) The
motivation and energy necessary for healing exist within the patient rather than in
the healthcare team. (2) The three aspects of nursing should not be viewed as
functioning independently but as interrelated. And lastly, (3) The three aspects
interact, and the circles representing them change the size, depending on the
patient’s total course of progress.
Lydia Hall began her prestigious career in nursing as a graduate of the 1.

____________________________________________ in York, Pennyslavania.
She then earned her B.S. and M.A. degrees from 2.
______________________________________________, in New York.
Hall held faculty positions at the York Hospital School of Nursing and the 3.
________________________ and was a consultant in nursing education to the
nursing faculty at 4.
____________________________________________________. She also was
an instructor of nursing education at Teachers College.

Lydia Hall 132
Hall's career interests revolved around public health nursing, cardiovascular
nursing, pediatric cardiology, and nursing of long-term illnesses. She authored 21
publications and the bulk of the articles and addresses regarding her nursing
theory were published in the early to middle 1960s. In 1967, she received the 5.
_________________________________________________ from Columbia
University.

THEORY
Hall drew extensively from the schools of psychiatry and psychology in

theorizing about the nurse-patient relationship. She was a proponent of Carl
Rogers' philosophy of client-centered therapy. This method of therapy entails
establishing a relationship of warmth and safety and conveying a sensitive
empathy with the patient's feelings and communications." A major premise Hall
borrowed from Rogers is that patients achieve their maximal potential through a
learning process. Rogers states that psychotherapy facilitates significant learning
by:
1. ___________________________________________
2. ___________________________________________
3. __________________________________________
In client-centered therapy, changes occur when:

1. ___________________________________________
2. ___________________________________________
3. ___________________________________________
4. ___________________________________________
Extensive documentation indicates that physiological and psychological

tensions are reduced and the change lasts as a result of this treatment. Hall also
advocates the Rogerian therapeutic approach. This approach is the use of
reflection, a nondirective method of helping the patient clarify, explore, and validate
what he or she says. Rogers states, “The therapist procedure which (clients) had
found most helpful was that the therapist clarified and openly stated feelings which
the client had been approaching hazily and hesitantly."

Lydia Hall 133
Hall derived her postulates regarding the nature of feeling-based behavior
from Rogers, who repeatedly speaks to the interaction of known feelings and
feelings-out-of-awareness. Rogers hypothesizes that in a client-centered
relationship, the patient "will reorganize himself at both the conscious and deeper
levels of his personality in such a manner as to cope with life more constructively.

AND RELATIONSHIPS
Directions: Match the major concepts of Lydia Hall’s Theory with the
each number.
COLUMN A COLUMN B
___________ 1. Behavior a. Defines as the nonacute
recovery phase of illness.
___________ 2. Reflection b. Everything that is said or done.
Dictated by feelings, both
conscious and unconscious
___________ 3. Self-Awareness c. Receives intensive medical
care and multiple diagnostic
tests.
___________ 4. 1st phase of d. A Rogerian method of
medical care communication in which
selected verbalizations of
patients are repeated back to
them with different
phraseology, to invite them to
explore feelings further.
___________ 5. 2nd Phase of e. Refers to the state of being that
medical care nurse’s endeavor to help their
patients achieve.

Lydia Hall 134
Directions: Lydia Hall’s theory has three components which are
represented by three independent but interconnected circles.
Identify the following statements if it describes the core, the care
and the cure.
COLUMN A COLUMN B
______ 1. According to the theory, nurses are a. Core
focused on performing the noble task
of nurturing patients.
______ 2. The patient receiving nursing care. b. Care
______ 3. Involves the administration of c. Cure
medications and treatments
______ 4. This circle solely represents the role of
nurses and is focused on performing
the task of nurturing patients.
______ 5. has goals set by him or herself rather

than by any other person and behaves
according to their feelings and values.
______ 6. the nurse shares the cure circle with

other health professionals, such as
physicians or physical therapists.
______ 7. It defines a professional nurse’s

primary role, such as providing bodily
care for the patient and helping the
patient complete such basic daily
biological functions as eating, bathing,
elimination, and dressing.
______ 8. This involves the therapeutic use of
self and is shared with other members
of the health team
______ 9. During this aspect of nursing care, the

nurse is an active advocate of the
patient.
______ 10. When providing this care, the nurse’s
goal is the comfort of the patient.

Lydia Hall 135
Directions: Complete the conceptual model of Hall’s Three Aspects of

Nursing below.

The theory provides a general framework for nursing and the concepts are
within the domain of nursing, although the aspects of Cure and Core are shared
with other health professionals and family members. Although the theory does not
provide for the resolution of specific issues and problems, it does address itself to
the pertinent and contemporary issues of accountability, responsibility, and
professionalism. Application of the theory in practice has produced valued
outcomes in all three areas. In addition, the theory demonstrates a great impact
on the educational preparation of nursing students. Hall stated, “With early field
experience in a' center where nursing rather than medicine is emphasized, the
student may emerge a nurse first.”

Lydia Hall 136
5.FAYE GLENN ABDELLAH’S
21 NURSING PROBLEMS
Fave Abdellah was one of the first nursing

theorists. In one of her earliest writings (Abdellah,
Beland, Martin, & Matheney, 1960), she referred to
the model created by her colleagues and herself as
a framework. Her writings spanned the period from
1954 to 1992 and include books, monographs, book
chapters, articles, reports, forewords to books, and
conference proceedings.
Abdellah earned her bachelor's

degree in nursing, master's degree, and
doctorate from 1. ________________,
and she completed additional graduate
studies in science at 2.
_________________. She served as
the chief nurse officer and deputy 3.
_______________________________
before retiring in 1993 with the rank of
Rear Admiral. She has been awarded
many academic honors from both
civilian and military sources (Abdellah &
Levine, 1994). She retired from her
position as dean of the Graduate School
of Nursing, Uniformed Services
University of the Health Sciences in
2000.

Faye Glenn Abdellah 137
THEORY
Abdellah's patient-centered approach to nursing was developed inductively

from her practice and is considered a human needs theory (Abdellah et al., 1960).
The theory was created to assist with nursing education and is most applicable to
education and practice (Abdellah et al., 1960). Although it was intended to guide
care of those in the hospital, it also has relevance for nursing care in community
settings.

AND RELATIONSHIPS
THE TWENTY-ONE NURSING PROBLEMS
The crucial element within Abdellah’s theory is the correct identification of nursing
problems. These 21 nursing problems focus on the physical, biological, and socio-
psychological needs of the patient and attempt to provide a more meaningful basis
for organization than the categories of the systems of the body.
ABDELLAH’S 21 NURSING PROBLEM

Three major categories
• Physical, sociological, and emotional needs of clients
• Types of interpersonal relationships between the nurse and patient
• Common elements of client care

Directions: Match the 21 Nursing Problem according to Abdellah
with the corresponding item in Column B. Write the letter of your
answer for each number.
COLUMN A COLUMN B
______ 1. To maintain good a. Making sure the side rails are

hygiene and physical always up when leaving the patient.

comfort one way we prevent the spread of
infection is through proper
disinfection of the equipment.
______ 2. To promote optimal b. Encourage patients to verbalize

activity; exercise, their feelings and allow them to cry
rest and sleep when they have the need to do so
will help them emotionally. Some
patients are diagnosed with
malignancy after the procedure and
during this time the emotional
needs of the patient is a priority.
______ 3. To promote safety c. when patients manifest breathing

though the problems, oxygen is attached to
prevention of them, usually via nasal cannula.
accident, injury, or Sedated patients are attached to
other trauma and cardiac monitor and pulse oximeter
through the while having the oxygen delivered.
prevention of the When the oxygen saturation falls
spread of infection below the normal levels, the rate of
oxygen is increased accordingly,
as per physician's order.
______ 4. To maintain good d. when patients are not able to

body mechanics and express themselves verbally, it is
prevent and correct important to assess for nonverbal
deformities cues. For instance, when patients
are in pain, assessing for facial
grimacing.
______ 5. To facilitate the e. allow the patient's significant others

maintenance of a to stay with the patient before and
supply of oxygen to after the procedure. This allows for
all body cells bonding and promotes
interpersonal relationship.
______ 6. To facilitate the f. Some patients live far from the city
maintenance of and thus referral to health centers
nutrition of all body is sometimes done.

cells
______ 7. To facilitate the g. nurse usually visits the patients in
maintenance of the unit. Patients may benefit from
elimination this, allowing them time to practice
their faith.
______ 8. To facilitate the h. Positioning the patient properly,

maintenance of fluid allowing for the normal anatomical
and electrolyte position of body parts.
balance
______ 9. To identify and i. Providing bedpans or urinals to
accept the patients and at times, insertion of
interrelatedness of Foley catheter when the patient is
emotions and not able to void.
organic illness
______ 10. To facilitate the j. it is important to check the patients
maintenance of for signs of internal gastrointestinal
effective verbal and bleeding by monitoring the blood
non-verbal pressure and cardiac rate.
communication.
______ 11. To promote the k. Sometimes there are semi-
development of conscious patients, in these cases,
productive it is still necessary to talk to them
interpersonal while performing nursing
relationships interventions to maintain their
auditory sense.
______ 12. To facilitate progress l. Some patients who are diagnosed

toward achievement with amoebic colitis for instance are
of personal spiritual advised to avoid buying street
goals foods to which the preparation they
are not sure of, and also avoid
drinking water that are not safe.
______ 13. To create and/or m. providing proper lighting, proper

maintain a room temperature, a quiet
therapeutic environment is done to patients
environment staying in the unit.
______ 14. To facilitate n. Proper regulation of the

awareness of self as intravenous solutions as well as
an individual with proper incorporations it may have.
varying physical,
emotional, and
developmental
needs
______ 15. To accept the o. When a patient has a difficulty in
optimum possible breathing and is showing an
goals in the light of increase respiratory rate, elevating
limitations, physical the head part of the bed is done to
and emotional facilitate the respiratory function.
______ 16. To use community p. patients undergoing endoscopic

resources as an aid procedures are on NPO. For this
in resolving problems reason, it is important to monitor
arising from illness the blood glucose level. When the
patient's blood glucose falls from
the normal value, we inject D50W
to the patient or we change the
patient's IVF to a dextrose
containing fluid.
______ 17. To understand the q. Patients who were sedated during

role of social the procedure stay in the unit until
problems as the effect of the sedation has
influencing factors in decreased to a safe level. As a
the cause of illness nurse, make sure the patients are
able to rest and sleep well by
providing a conducive environment
for rest, such as decreasing
environmental noise and dimming
the light if necessary.
______ 18. To facilitate r. care to patients vary according to

awareness of self as their developmental needs.
an individual with Allowing the parents to stay during
varying physical, the procedure help the pediatric
emotional, and patients in their emotional and
developmental developmental needs.
needs

______ 19. To accept the s. most patients feel anxious before
optimum possible undergoing the procedures. It is
goals in the light of necessary to listen to the patients'
limitations, physical expressions and allow them to ask
and emotional questions. To decrease their
anxiety, proper instructions are
given, what they are to expect, how
long the procedure will take, what
they should do during and after the
procedure as well as other
concerns.
______ 20. To use community t. The goals for each patient vary
resources as an aid depending on the capability of the
in resolving problems patient. The nutritional goal for a
arising from illness patient with a PEG tube for
instance will be different, knowing
that the patient has limited feeding
options.
______ 21. To understand the u. After colonoscopy, patients are

role of social usually soiled from the procedure.
problems as It is therefore important to clean
influencing factors in them properly. Physical comfort
the cause of illness through proper positioning in bed.
Directions: Enumerate the what is asked for each item.
10 STEPS TO IDENTIFY CLIENTS' PROBLEMS

1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________
5. _________________________________________________
6. _________________________________________________
7. _________________________________________________
8. _________________________________________________
9. _________________________________________________
10. _________________________________________________

KEY CONCEPTS IN NURSING
Directions: Fill in the crossword puzzle with the words missing from the
sentences below. Match the number of the sentence to the boxes
placed across or down the grid. If filled out correctly, the words will fit
neatly into the puzzle.
DOWN
1 Describes the recipients of nursing as individuals (and families, and

thus, society), but does not delineate her beliefs.
2 “A healthy state of mind and body” in her description of nursing as
comprehensive service.
4 Comprehensive service that is based on an art and science and
aims to help people, sick or well, cope with their health needs.
ACROSS
3 Included in “planning for optimum health on local, state, national,
and international levels”.

Directions: Complete the conceptual model of Hall’s Three Aspects

of Nursing below.

Value in Extending Nursing Science
Abdellah's model has contributed to nursing science as an early effort to

change nursing education. In the early years of its application, it helped to bring
structure and organization to what was often a disorganized collection of lectures
and experiences. She categorized nursing problems based on the individual's
needs and developed a typology of nursing treatment and nursing skills. Finally,
she posited a list of characteristics that described what was distinctly nursing,
thereby differentiating the profession from other health professions. Hers was a
major contribution to the discipline of nursing, bringing it out of the era of being
considered simply an occupation into Nightingale's ideal of becoming a profession.

6.VIRGINIA AVENEL HENDERSON’S
NEED THEORY
Virginia Henderson was a well-known

nursing educator and a prolific author. In 1937,
Henderson and others created a basic nursing
curriculum for the National League for Nursing in
which education was “patient centered and
organized around nursing problems rather than
medical diagnoses" (Henderson, 1991, p. 19). In
1939, she revised Harmer's classic textbook of
nursing for its fourth edition and later wrote the fifth
edition, incorporating her personal definition of
nursing (Henderson, 1991). Although she was
retired, she was a frequent visitor to nursing
schools well into her 90s. O'Malley (1996) states that Henderson was known as
the modern-day mother of nursing. Her work influenced the nursing profession in
America and throughout the world.
Henderson was born in 1. ______________ but spent her formative years

in 2. ___________. She received a diploma in nursing from the 3.
_______________________ at 4. ___________________ in 1921 and worked at
the 5. ____________________________ for 2 years after graduation. In 1923,
she accepted a position teaching nursing at the 6.
__________________________________ in Virginia, where she remained for
several years. In 1929, Henderson determined that she needed more education
and entered 7. _______________________________________, where she
earned her bachelor's degree in nursing in 1932 and a master's degree in 1934.
Subsequently, she joined 8. _______________ as a member of the faculty, where
remained until 1948 (Herrmann, 1998). 9. ______________, as she was known to
THEORETICAL FOUNDATION IN NURSING | Nursing

VirginiaTheories
Avenel Henderson 145
her friends, died in 1996 at the age of 98 (Allen, 1996). Because of her importance
to modern nursing, the 10. _______________________________________ is
named in her honor.

THEORY
Henderson was educated during the 11.

_________________________________, which focused on patient needs, but
she believed that her theoretical ideas grew and matured through her experiences
(Henderson, 1991). Henderson was introduced to 12.
________________________ during her graduate education, and the
understanding of these principles was the basis for her patient care (Henderson,
1965, 1991). The theory presents the 13.
_______________________________________________, and the patient is
neither client nor consumer. Henderson stated that 14.
_________________________________ (Henderson, 1991, p. 16) had an
influence on her beliefs.
Although her major clinical experiences were in medical-surgical hospitals,

she worked as a visiting nurse in New York City. This experience enlarged
Henderson's view to recognize the importance of increasing the patient's
independence so that progress after hospitalization would not be delayed
(Henderson, 1991). Henderson was a 15. _________________, and the major
thrust of her theory relates to the education of nurses.

AND RELATIONSHIPS
Henderson's concept of nursing was derived from her practice and

education; therefore, her work is inductive. Henderson did not manufacture
language to elucidate her theoretical stance; she used correct, scholarly English
in all of her writings. She called her definition of nursing her “concept” (Henderson,

VirginiaTheories
1991, pp. 20-21).
Henderson believed that “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 a peaceful death) 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” (Henderson, 1991, P. 21). She defined
the patient as someone who needs nursing care but did not limit nursing to illness
care. She did not define environment, but maintaining a supportive environment is
one of the elements of her 14 activities.
Directions: Match the 14 Activities for Client Assistance according to

Henderson with the corresponding item in Column B. Write the letter
of your answer for each number.
COLUMN A COLUMN B
_______ 1. Breathe normally. a. Every organism requires fluids and
nutrients for survival. The nurse should be
aware of the type of diet and hydration,
according to the nutritional requirements of
the patient and the treatment ordered by the
doctor.
_______ 2. Eat and drink b. It is important to know and evaluate very
adequately. well if the patient can be left alone for a long
time, with enough confidence that he will
not hurt himself when moving or trying to
carry out activities, nor compromise the
safety of others.
_______ 3. Eliminate body c. Keeping the patient developing skills, skills
wastes. and knowledge is favorable for health.
_______ 4. Move and maintain d. The nurse must be able to promote and
desirable position. motivate healthy and proper
communication of the patient, to help their
emotional balance.
_______ 5. Sleep and rest. e. A patient will feel more or less independent
to the extent that he can move on his own
to carry out his day-to-day activities.

VirginiaTheories
_______ 6. Select suitable f. Respect the values and particular beliefs of
clothes -- dress and the patient. Based on these he makes his
undress. decisions and exercises certain actions or
thoughts.
_______ 7. Maintain g. The nurse must know the tastes and
temperature within interests of the person and motivate him to
normal range by participate in activities that are motivating.
adjusting clothing
and modifying the
environment.
_______ 8. Keep the body clean h. very important for the quick recovery of the
and well-groomed d person. Every organism recovers physical
protect the and mental forces while it sleeps
integument.
_______ 9. Avoid dangers in the i. Part of the proper functioning of the body is
environment and the normal elimination of feces, urine,
avoid injuring sweat, phlegm and menstruation.
others.
_______ 10. Communicate with j. The normal body temperature is between
others expressing 36.5 and 37 ° C. The nurse should be aware
emotions, needs, of the factors that influence the patient's
fears or opinions, cold or heat.
_______ 11. Worship according k. The way the patient's body is seen, felt and
to one's faith. smelled are external signs of his hygiene.
_______ 12. Work in such a way l. If a patient feels productive and useful, he
that there is a sense will have a sense of personal fulfillment that
of accomplishment. will influence his self-esteem and mental
health.
_______ 13. Play or participate in m. Being able to select and wear the clothing
various forms of that is desired also influences a patient's
recreation. sense of independence.
_______ 14. Nursing n. The gaseous exchange of the body is
essential for patient health and for life itself.
_______ 15. Person o. the unique function is “to assist the
individual, sick or well, in the performance
of those activities contributing to health or
its recovery (or to a peaceful death), that he
would perform unaided if he had the
necessary strength, will or knowledge.
_______ 16. Environment p. “Quality of health rather than life itself, that

VirginiaTheories
margin of mental physical vigor that allows
a person to work most effectively and to
reach his highest potential level of
satisfaction in life.”
_______ 17. Health q. The effects of 7 components (light,
temperature, air movement, atmospheric
pressure, proper waste disposal, absence
of injurious chemicals, cleanliness of
surroundings) on the life and development
of a person
_______ 18. Learn, discover, or r. A complete and independent being with
satisfy the curiosity biological, sociological and spiritual
that leads to normal components. Considered the person to be
development and of primary importance and that is the
health, and use the reason why we categorize her theory as
available health client-centered
facilities.
Directions: Utilizing Maslow’s Hierarchy of Needs, distribute the

14 Activities for Client Assistance according to Henderson.

VirginiaTheories
Nursing education has been deeply affected by Henderson's clear vision of

the functions of nurses. The principles of Henderson's theory were published in
the major nursing textbooks used from the 1930s through the 1960s, and the
principles embodied by the 14 activities are still important in evaluating nursing
care in the 21st century. Waller-Wise (2013), for example, found that Henderson's
theory assisted him in attaining excellence in childbirth education.
From a historical standpoint, Henderson's concept of nursing enhanced

nursing science: this has been particularly important in the area of nursing
education. Her contributions to nursing literature extended from the 1930s
through the 1990s. Her work has had an international impact on nursing research
by strengthening the focus on nursing practice and confirming the value of tested
interventions in assisting individuals to regain health. Internationally, researchers
continue to direct their work with Virginia Henderson's model as a framework. For
example, Scott, Matthews, and Kirwan (2014) found that internationally,
Henderson's model was the most often used in evaluating the need for and the
practice of nurses. In their reported case study, Younas and Sommer 5) found
Henderson's model “close to realism and applicable to Pakistani context” (p. 443)
because of its relevance in developing nursing plans, and Lazenby (2013) argued
for the importance of the patient experience using Henderson's model in multiple
contexts.

VirginiaTheories
7.NOLA PENDER’S
HEALTH PROMOTION MODEL
Pender’s model focuses on three areas: individual characteristics and

experiences, behavior-specific cognitions and affect, and behavioral outcomes.
The theory notes that each person has unique personal characteristics and
experiences that affect subsequent actions. The set of variables for behavior
specific knowledge and affect have important motivational significance. The
variables can be modified through nursing actions. Health promoting behavior is
the desired behavioral outcome, which makes it the end point in the Health
Promotion Model. These behaviors should result in improved health, enhanced
functional ability and better quality of life at all stages of development. The final
behavioral demand is also influenced by the immediate competing demand and
preferences, which can derail intended actions for promoting health.

Nola Pender 151
Nola J. Pender's first encounter

with professional nursing occurred at the
age of seven when she observed the
nursing care given to her hospitalized
aunt. This experience and her
subsequent education instilled a desire
to care for others in her and influenced
her belief that the goal of nursing was to
help people care for themselves. Pender
contributes to nursing knowledge of
health promotion through her research,
teaching, presentations, and writings.
Pender was born in 1941 in
Lansing, Michigan. She was the only
child
of parents who were advocates of
education for women. Family
encouragement for her goal of becoming
a registered nurse led her to attend the
School of Nursing at West Suburban Hospital in Oak Park, Illinois. This school was
chosen for its ties with Wheaton College and its strong Christian foundation. She
received her nursing diploma in 1962 and began working on a medical-surgical
unit and subsequently in a pediatric unit in a Michigan hospital.
In 1964, Pender completed her B.S.N.at Michigan State University in East

Lansing. She credits Helen Penhale, the assistant to the dean, for helping to
streamline her program and foster her options for further education. As was
common in the 1960s, Pender changed her major from nursing as she pursued
her graduate degrees. She earned her M.A.in human growth and development
from Michigan State University in 1965.She completed her Ph.D.in psychology and
education in 1969 at Northwestern University in Evanston, Illinois. Pender's
dissertation' investigated developmental changes in encoding processes of short-
term memory in children. Several years later, she completed master's level work
in community health nursing at Rush University in Chicago.

Nola Pender 152
Directions: Answer the following
questions below at least 1 – 2 sentences
1. When was Nola J. Pender's first encounter with

professional nursing occurred?
ACTIVITY ______________________________________
______________________________________
______________________________________
2. What was Pender’s belief to nursing’s goal?
________________________________________________________________
________________________________________________________________
________________________________________________________________
3. How does Pender contribute to nursing knowledge of health promotion?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. When was Pender born?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Pender’s Family were advocate of what?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. Where did Pender take up Nursing?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. Where did Pender work subsequently?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
8. To whom Pender credited for helping to streamline her program and foster her
potions for further options?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Nola Pender 153
THEORY
Pender's background in nursing, human development, experimental

psychology, and education led her to use a holistic nursing perspective, social
psychology, and learning theory as the foundations for the HPM. The HPM
integrates several constructs. Central to the HPM is the Social Learning Theory of
Albert Bandura,' which postulates the importance of cognitive processes in the
changing of behavior. Social Learning Theory, now titled Social Cognitive Theory,
includes the following self-beliefs: self-attribution, self-evaluation, and self-efficacy.
Self-efficacy is a central construct of the HPM." In addition, the Expectancy-Value
Model of Human Motivation that Feather* described, which supports that behavior
is rational and economical, is important to the model's development.
The HPM is similar in construction to the Health Belief Model,2 but is not
limited to explaining disease-prevention behavior. The HPM differs from the Health
Belief Model because the HPM does not include fear or threat as a source of
motivation for health behavior." For this reason, the HPM expands to encompass
behaviors for enhancing health and potentially applies across the life span.

AND RELATIONSHIPS
Directions: Fill in the blanks with the correct answer. Write your
answer in the blank provided.
__________________________ 1. Defined as behavior motivated by the

desire to increase well-being and
actualize human health potential. It is
an approach to wellness.
__________________________ 2. Described as behavior motivated
desire to actively avoid illness, detect it

Nola Pender 154
early, or maintain functioning within
illness constraints
__________________________ 3. Prior related behavior and personal
factors
__________________________ 4. Perceived benefits of action, perceived
barriers to action, perceived self-
efficacy, activity-related affect,
interpersonal influences, and
situational influences.
__________________________ 5. Commitment to a plan of action,
immediate competing demands and
preferences, and health-promoting
behavior
__________________________ 6. are categorized as biological,
psychological, and socio-cultural.
These factors are predictive of a given
behavior and shaped by the target
behavior’s nature being considered.
__________________________ 7. Anticipated, imagined, or real blocks
and personal costs of understanding a
given behavior.
__________________________ 8. Include variables such as race,
ethnicity, acculturation, education, and
socioeconomic status.
__________________________ 9. The judgment of personal capability to
organize and execute a health-
promoting behavior. Perceived self-
efficacy influences perceived barriers
to action, so higher efficacy results in
lowered perceptions of barriers to the
behavior’s performance.
__________________________ 10. Include variables such as self-esteem,
self-motivation, personal competence,
perceived health status, and definition
of health.
__________________________ 11. Anticipated positive outcomes that will
occur from health behavior
__________________________ 12. Include variables such as age, gender,
body mass index, pubertal status,

Nola Pender 155
aerobic capacity, strength, agility, or
balance.
__________________________ 13. Subjective positive or negative feeling
occurs before, during, and following
behavior based on the stimulus
properties of the behavior itself.
__________________________ 14. Cognition concerning behaviors,
beliefs, or attitudes of others.
Interpersonal influences include norms
(expectations of significant others),
social support (instrumental and
emotional encouragement), and
modeling (vicarious learning through
observing others engaged in a
particular behavior). Primary sources
of interpersonal influences are families,
peers, and healthcare providers.
__________________________ 15. an endpoint or action-outcome directed
toward attaining positive health
outcomes such as optimal wellbeing,
personal fulfillment, and productive
living.
__________________________ 16. Personal perceptions and cognitions of
any given situation or context can
facilitate or impede behavior. Include
perceptions of options available,
demand characteristics, and aesthetic
features of the environment in which
given health-promoting is proposed to
take place. Situational influences may
have direct or indirect influences on
health behavior.
__________________________ 17. The concept of intention and
identification of a planned strategy
leads to the implementation of health
behavior.

Nola Pender 156
Directions: Match the key concepts in nursing according to Pender
with the corresponding item in Column B. Write the letter of your
answer for each number.
COLUMN A COLUMN B
_________ 1. PERSON a. can be manipulated by the

individual to create a positive
context of cues and facilitators for
health- enhancing behaviors
_________ 2. ENVIRONMENT b. Collaboration with individuals,

families, and communities to
create the most favorable
conditions for the expression of
optimal health and high-level
well-being.
_________ 3. NURSING c. The actualization of inherent and
acquired human potential
through goal-directed behavior,
competent self-care, and
satisfying relationships with
others, while adjustments are
made as needed to maintain
structural integrity and harmony
with relevant environments.
Health is an evolving life
experience.
_________ 4. HEALTH d. the relationship between person

and environment is reciprocal.
Individual characteristics as well
as life experiences shape
behaviors including health
behaviors.

Nola Pender 157
Directions: Complete the conceptual paradigm of Pender’s Health

Promotion Model below.

Nola Pender 158
Pender has identified health promotion as a goal for the twenty-first century,
just as disease prevention was a task of the twentieth century. The model can
potentially influence the interaction between the nurse and the consumer. Pender
has responded to the political, social, and personal environment of her time to
clarify nursing's role in delivering health-promotion services to persons of all ages.
ACTIVITY
questions below at least 1 – 2
sentences
1. Choose one health-promoting behavior in

which you do not engage. Identify your own factors, as defined in the HPM,
which con-tribute to your decision not to participate. Include immediate
competing alternatives.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
2. Analyze the factors present in your life that contribute to your participation
in any health-promoting activity in which you currently engage. Place each
factor under the appropriate label from the HPM.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Nola Pender 159
3. Prepare your own description of wellness. Ask three friends, three family
members, and three co-workers to describe what wellness means to them.
Compare the descriptions given, by individuals with different ages and
backgrounds. How are they alike? Is absence of disease more prominent
than positive, active statements of health?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
4. Anticipate the health-promoting behaviors important at various stages of

development across the life span. In light of the nurse as a health educator,
what health-promotion topics would you include in your practice?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Nola Pender 160
8.MADELEINE LEININGER’S
TRANSCULTURAL THEORY
Transcultural Nursing is how professional

nursing interacts with the concept of culture. Based
in Anthropology and Nursing, it is supported by
theory, research, and practice. Leininger’s theory is
to provide care measures that are in harmony with
an individual or group’s cultural beliefs, practices,
and values. In the 1960’s she coined the term
culturally congruent care, which is the primary goal
of transcultural nursing practice. Culturally
congruent care is possible when the following
occurs within the nurse-client relationship.
Madeleine M. Leininger is the founder of transcultural nursing and a leader in

transcultural nursing and human care theory. She is the first professional nurse
with graduate preparation in nursing to hold a 1.
____________________________________________. She was born in 2.
________________ and began her nursing career after graduating from a diploma
program at 3. ____________________________________. She was a Cadet
Corps nurse while pursuing the basic nursing program. In 1950, she obtained a
B.S. degree in 4. _______________________________ in Atchison, Kansas with
a minor in philosophy and humanistic studies. After graduation, she served as an
instructor, staff nurse, and head nurse on a medical-surgical unit and opened a

Madeleine Leininger 161
new psychiatric unit as director of the nursing service at 5.
_______________________________. During this time, she did advanced study
in nursing, nursing administration, teaching and curriculum in nursing, and tests
and measurements at Creighton University in Omaha.
In 1954, Leininger obtained an M.S.N.in psychiatric nursing from the Catholic

University of America in Washington, DC. She was then employed at the College
of Health at the University of Cincinnati, where she began the first graduate clinical
specialist program (M.S.N.) in child psychiatric nursing in the world. She also
initiated and directed the first graduate-nursing program in psychiatric nursing at
the University of Cincinnati and the Therapeutic Psychiatric Nursing Center at the
University Hospital. During this time, she wrote one of the first basic psychiatric
nursing texts with Hofling, Basic Psychiatric Concepts in Nursing, which was
published in 1960 in 11 languages and used worldwide.
As the first professional nurse to complete a doctoral degree in anthropology

and to initiate several masters and doctoral nursing education programs, Leininger
has many areas of expertise and interests. She has studied 14 major cultures in
depth and has had experience with many different additional cultures. Besides
transcultural nursing with care as a central focus, her other areas of interest are
comparative education and administration, nursing theories, politics, ethical
dilemmas of nursing and healthcare, qualitative research methods, the future of
nursing and healthcare, and nursing leadership. Her Theory of Culture Care is now
used worldwide and is growing in relevance and importance to obtain grounded
cultural data from diverse cultures.

OF THEORY
Leininger's theory is derived from the disciplines of anthropology and nursing,

She has defined trans-cultural nursing as a major area of nursing that focuses on
a comparative study and analysis of different cultures and subcultures in the world
with respect to their caring values, expression, and health-illness beliefs and

pattern of behavior with the goal to develop a scientific and humanistic knowledge
to provide culture-specific nursing care practice and/or culture-universal nursing
care practice.
Transcultural nursing goes beyond an awareness state to that of using culture
care nursing knowledge to practice culturally congruent and responsible care.
Leininger has stated that in time, there will be a new kind of nursing practice that
reflects different nursing practices that are culturally defined and grounded and
specific to guide nursing care to individuals, families, groups, and institutions. She
con-tends that because culture and care are the broadest and the most holistic
means to conceptualize and understand people, this knowledge is central to and
imperative to nursing education and practice. In addition, she states that
transcultural nursing has become one of the most important, relevant, and highly
promising areas of formal study, research, and practice because people live in a
multicultural world. Leininger, predicts that for nursing to be meaningful and
relevant to clients and other nurses in the world, transcultural nursing knowledge
and competencies will be imperative to guide all nursing decisions and actions for
effective and successful outcomes.

AND RELATIONSHIPS
Directions: Leininger has developed many terms relevant to the

theory; the major ones are defined here. Match Column A to the
each number.
COLUMN A COLUMN B
_____ 1. Care a. Refers to a learned humanistic and
scientific profession and discipline that
is focused on human care phenomena
and activities to assist, support,
facilitate, or enable individuals or
groups to maintain or regain their well-

being (or health) in culturally
meaningful and beneficial ways, or to
help people face handicaps or death.
_____ 2. Caring b. Refers to the common, similar, or
dominant uniform care meanings,
patterns, values, lifeways, or symbols
that are manifest among many
cultures and reflect assistive,
supportive, facilitative, or enabling
ways to help people.
_____ 3. Culture c. Refers to the variabilities and/or
differences in meanings, patterns,
values, lifeways, or symbols of care
within or between collectivities that are
related to assistive, supportive, or
enabling human care expressions.
_____ 4. Cultural Care d. Refers to the subjectively and
objectively learned and transmitted
values, beliefs, and patterned life-
ways that assist, support, facilitate, or
enable an-other individual or group to
maintain their well-being and health,
to improve their human condition and
lifeway, or to deal with illness,
handicaps, or death.
_____ 5. Cultural Care e. Refers to the learned, shared, and
Diversity transmitted values, beliefs, norms,
and lifeways of a particular group that
guides their thinking, decisions, and
actions in patterned ways.
_____ 6. Cultural Care f. Refers to actions and activities
Universality directed toward assisting, supporting,
or enabling another individual or group
with evident or anticipated needs to
ameliorate or improve a human
condition or lifeway, or to face death.
_____ 7. Nursing g. Refers to abstract and concrete
phenomena related to assisting,
supporting, or enabling experiences or
behaviors toward or for others with
evident or anticipated needs to
condition or lifeway.
_____ 8. Worldview h. Refers to those cognitively based
assistive, supportive, facilitative, or
enabling acts or decisions that are

tailor made to fit with individual, group,
or institutional cultural values, beliefs,
and life-ways to provide or support
meaningful, beneficial, and satisfying
healthcare or well-being services.
_____ 9. Cultural And i. Refers to those assistive, supporting,
Social Structure facilitative, or enabling professional
Dimensions actions and decisions that help clients
reorder, change, or greatly modify
their lifeways for new, different, and
beneficial healthcare patterns while
respecting the clients' cultural values
and beliefs and still providing a
beneficial or healthier lifeway than
before the changes were co-
established with the clients.
_____ 10. Environmental j. Refers to those assistive, supporting,
Context facilitative, or enabling creative
professional actions and decisions
that help people of a designated
culture to adapt to, or to negotiate
with, others for a beneficial or
satisfying health outcome with
professional care providers.
_____ 11. Ethnohistory k. Refers to those assistive, supporting,
facilitative, or enabling professional
actions and decisions that help people
of a particular culture to retain and/or
preserve relevant care values so that
they can maintain their well-being,
recover from illness, or face
handicaps and/or death.
_____ 12. Generic (Folk or l. Refers to a state of well-being that is
Lay) Care culturally de-fined, valued, and
System practiced and reflects the ability of
individuals (or groups) to perform their
daily role activities in culturally
expressed, beneficial, and patterned
lifeways.
_____ 13. Professional m. Refers to culturally learned and
Care System transmitted, indigenous (or
traditional), folk (home based)
knowledge and skills used to provide
assistive, supportive, enabling, or
facilitative acts toward or for another
individual, group, or institution with

evident or anticipated needs to
lifeway or health condition (or well-
being), or to deal with handicaps and
death situations.
_____ 14. Health n. Refers to formally taught, learned, and
transmit-ted professional care, health,
illness, wellness, and related
knowledge and practice skills that
prevail in professional institutions
usually with multidisciplinary
personnel to serve consumers.
_____ 15. Cultural Care o. Refers to those past facts, events,
Preservation or instances, and experiences of
Maintenance individuals, groups, cultures, and
institutions that are primarily people
centered (ethno) and that describe,
explain, and interpret human lifeways
within particular cultural contexts and
over short or long periods.
_____ 16. Cultural Care p. Refers to the totality of an event,
Accommodation situation, or particular experience that
or Negotiation gives meaning to human expressions,
interpretations, and social
interactions, particularly physical,
ecological, sociopolitical, and/or
cultural settings
_____ 17. Cultural Care q. Refers to the dynamic patterns and
Repatterning or features of interrelated structural and
Restructuring organizational factors of a particular
culture (subculture or society), which
includes religious, kinship (social),
political (and. legal), economic,
educational, technological, and
cultural values and ethnohistorical
factors, and how these factors may be
interrelated and function to influence
human behavior in different
environmental contexts.
_____ 18. Cultural r. Refers to the way people tend to look
Congruent out on the world or their universe to
(Nursing) Care form a picture or a value stance about
their life or world around them.


9.MARGARET NEWMAN’S
THEORY OF HEALTH AS EXPANDING
The theory asserts that every person in every situation, no matter how
disordered and hopeless it may seem, is part of the universal process of expanding
consciousness – a process of becoming more of oneself, of finding greater
meaning in life, and of reaching new dimensions of connectedness with other
people and the world.
BACKGROUND OF THE THEORIST
As a young woman, Margaret Newman was

involved in caring for her mother, who suffered from 1.
__________________________. She explained that
it was during this period that she came to know her
mother in ways that would have been impossible
otherwise (Newman, 1986). This experience led
Newman to study nursing, and she enrolled at the 2.
______________, where she completed her
bachelor’s degree in 1962. She earned her master’s
degree from the 3. _________________________,

Margaret Newman 168
San Francisco, in 1964 and a doctorate from 4. _____________________ in 1971.
Newman has served on the faculty at the University of Tennessee (which

named her an outstanding alumna), NYU, Pennsylvania State University, and the
University of Minnesota. She is currently professor emeritus at the 5.
________________________, Minneapolis. Her work has been recognized
internationally, and she has received numerous awards and honors both in the
United States and abroad (Jones,2007).

OF THEORY
While at NYU, Newman attended seminars taught by Martha Rogers, and

she stated that Rogers's Science of Unitary Human Beings was the basis of her
theory of Health as Expanding Consciousness. She also noted that, among others,
Itzhak Bentov's explanation of the concept of expanding consciousness, Arthur
Young's work on pattern recognition, and David Bohm's theory of implicate order
brought perspective to her thoughts and ideas (Newman, 2008b).

AND RELATIONSHIPS
As a student of Rogers, Newman believed that “the human is unitary, that

is,cannot be divided into parts, and is inseparable from the larger unitary field"
(Newman, 1994, p. xviil). She saw humans as open energy systems in continual
contact with a universe of open systems (i.e., the environment). Additionally,
humans are continuously active in evolving their own pattern of the whole (i.e.,
health) and are intuitive as well as cognitive and affective beings. She further
posited that “persons as individuals, and human beings as a species, are identified

Margaret Newman 169
by their patterns of consciousness” and that “the person does not possess
consciousness-the person is consciousness” (Newman, 1999, p. 33).
In describing health, Newman (1994) explained that health encompasses

illness or pathology and that pathologic conditions can be considered
manifestations of the pattern of the individual. In addition, the pattern of the
individual that eventually manifests itself as pathology is primary and exists prior
to structural or functional changes; removal of the pathology in itself will not change
the pattern of the individual. Finally, she noted an assumption that changes occur
simultaneously and not in linear fashion (Newman, 1994).
Newman built on Rogers's definitions for human and environment, but she
rede fined nursing and health. Health is an essential component of the theory of
Health as Expanding Consciousness and is seen as a process of developing
awareness of self and the environment together with increasing the ability to
perceive alternatives and respond in a variety of ways. Nursing is described as
“caring in the human health experience"(Newman,1994, p.139). Other central
concepts in Newman's theory are pattern, pattern recognition, movement, and time
and space.
Directions: Read the following questions below. Choose the best

answer and write the answer for every number.
_____ 1. The act of assisting people to use the power within them to evolve toward
higher levels of consciousness. Nursing is directed toward recognizing the patterns
of the person in interaction with the environment and accepting the interaction as
a process of evolving consciousness.
a. Nursing c. Person
b. Health d. Environment
_____ 2. The expanding of consciousness; an evolving pattern of the whole of life.

A unitary process; a fluctuating pattern of rhythmic phenomena that includes illness
within the pattern of energy. Sickness can "be the shock that reorganizes the
relationships of the person's pattern in a more harmonious way" (Newman, 1999,
p. 11).
a. Nursing b. Health

Margaret Newman 170
c. Person d. Environment
_____ 3. A dynamic pattern of energy and an open system in interaction with the
environment. Persons can be defined by their patterns of consciousness.
a. Nursing c. Person
b. Health d. Environment
_____ 4. The information of the system; consciousness refers to the capacity of

the system to interact with the environment and includes thinking, feeling, and
processing the information embedded in physiologic systems.
a. Time and space c. Consciousness
b. Conscience d. Expanding consciousness
_____ 5. The evolving pattern of the whole. The increasing complexity of the living
system and is characterized by illumination and pattern recognition resulting in
transformation and discovery.
a. Time and space c. Consciousness

b. Conscience d. Expanding consciousness
_____ 6. The natural condition of living creatures. Consciousness is expressed in

movement, which is the way that the organism interacts with the environment and
exerts control over it. Movement patterns reflect and communicate the person's
inner pattern and organization. Changes in the person's health patterns may be
reflected in changes in their movement rhythms.
a. Integration via c. Pattern

movement d. Consciousness
b. Time and space
_____ 7. Relatedness, which is characterized by movement, diversity, and rhythm.

A scheme, design, or framework and is seen in person-environment interactions.
Pattern is recognized on the basis of variation and may not be seen all at once, it
is manifest in the way one moves, speaks, talks, and relates with others.
a. Integration via c. Pattern

movement d. Consciousness
b. Time and space

Margaret Newman 171
_____ 8. The insight or recognition of a principle, realization of a truth, or
reconciliation of a duality. Pattern recognition illuminates the possibilities for action
and is the key to the process of evolving to a higher level of consciousness.
a. Pattern recognition c. Pattern

b. Time and space d. Integration via movement
_____ 9. Temporal patterns that are specific to individuals and define their ways
of being within their world. Patterns of health may be detected in temporal patterns.
a. Pattern recognition c. Pattern

b. Time and space d. Integration via movement
Directions: Complete the conceptual paradigm of Newman’s Health as

an Expanding Consciousness below. Write your answer on the space
provided.

Margaret Newman 172
Newman (1994) believed that theory must be derived from practice and
theory must inform practice. To illustrate this relationship, she proposed a model
for practice that she derived from her theory.
Her work has been used by nurses in a number of settings, providing care
for different types of clients and for a variety of interventions. For example, Arcari
and Flanagan (2015) described the development of a post-master's certificate
program in Mind-Body-Spirit nursing certification which was heavily influenced by
Newman's Theory of Health as Expanding Consciousness. In another recent
example, Sethares and Gramling (2014) described how Newman's theory was
used by under graduate nursing students to enhance clinical learning experiences
by focusing on student-client partnerships. Stec (2016) also used Newman's
theory to describe patterns of relating, knowing, and clinical decision making in a
group of senior-level nursing students.
The focus of Newman's work is on the person, client, individual, and family.
It places the client and nurse as integrated actors in understanding the client's
health as consciousness. It also requires the understanding that health and
disease are integral and not separate in the life of the individual (Newman, 2008b).
Directions: Answer the following questions.

Write your answer on the blank provided.
ACTIVITY 1. What dictates the change in paradigms of health,

healthcare practice, and nursing practice?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Margaret Newman 173
2. How is the process of health as expanding consciousness different from the
process of self-actualization?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
3. Where and how does Newman accept or depart from the Rogerian Unitary
Man Theory?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
4. How do you agree or disagree with her claims and explanations regarding
relatedness of her theory with the pragmatic expectations of the nursing
professions?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Margaret Newman 174
10. ROSEMARIE PARSE’S
THEORY OF HUMAN BECOMING
To focus on human as living unity and human’s qualitative participation with
health experience. She emphasized free choice of personal meaning in relating
value priorities, co-creating of rhythmical patterns, in exchange with the
environment and contranscending in many dimensions as possibilities unfold. She
also believed that each choice opens certain opportunities while closing others.
Thus, referred to revealing-concealing, enabling-limiting, and connecting-
separating. Since each individual makes his or her own personal choices, the role
of the nurse is that of guide, not decision maker.

MAJOR CONCEPTS
Parse was educated at Duquesne
University in Pittsburgh, Pennsylvania, and earned
her master's and doctoral degrees from the
University of Pittsburgh Some years later, she
became dean of the College of Nursing at
Duquesne, and she is currently Distinguished
Professor emeritus at Loyola University in Chicago,
Illinois. She is the founder and editor of Nursing
Science Quarterly and president of Discovery
International, which sponsors international nursing
theory conferences. She is also the founder of the
Institute of Human becoming, where she teaches
the ontologic, epistemologic, and methodologic
aspects of the Human becoming Paradigm. The Human becoming Paradigm is
honored and acknowledged in colleges of nursing worldwide. She has currently
realized that although a student of Martha Rogers, her work has developed into a
wholly new paradigm, and she has titled this the Human-becoming Paradigm
(Parse, 2014).

Rosemarie Parse 175
ACTIVITY 1. What is the educational background of

Rosemarie Parse?
_____________________________________
__________________________________________________
__________________________________________________
__________________________________________________
2. The assumptions underpinning the theory were synthesized from works by

the following theorist. Enumerate the theorist.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
3. What are her professional achievements?

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

OF THE THEORY
Parse synthesized the Human becoming Paradigm from principles and

concepts from Rogers's work. She also incorporated concepts and principles from
existential phenomenologic thought as expressed by Heidegger, Sartre, and
Merleau-Ponty (Parse, 2014). The theory comes from her experience in nursing
and from a synthesis of theoretical principles of human sciences.

Rosemarie Parse 176
IV. MAJOR ASSUMPTIONS, CONCEPTS
AND RELATIONSHIPS
As with many of the major concepts, the major assumptions of Parse's theory
originated with Rogers's Science of Unitary Human Beings and from existential
phenomenology. Parse's thinking has brought her to a new ontology. Kuhn (1996)
warned the scientific community that when the facts no longer support the current
paradigm has ascended.
Directions: Fill each blank with correct answer. Write your answer on
the blank provided.
1. Parse synthesized the nine assumptions of human becoming in four broad

statements:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
2. The Philosophical Assumptions of the Human becoming Paradigm
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
3. Three principles in the theory:
_____________________________________________________

Rosemarie Parse 177
_____________________________________________________
_____________________________________________________
Directions: Fill in the blanks with the correct equivalent of numbers to

letters.
Parse builds on previous concepts and provides concepts and paradoxes that are
found in this paradigm:
Ø Imaging: explicit - _ _ _ _ _; _ _ _ _ _ _ _ _ _ _–prereflective

20 1 3 9 20. 18 5 6 12 5 3 20 9 22 5
Ø _ _ _ _ _ _ _: confirming - not confirming

22 1 12 21 9 14 7
Ø Languaging: speaking- _ _ _ _ _ _ _ _ _ _ _; moving-_ _ _ _ _ _ _ _ _ _

2 5 9 14 7 19 9 12 5 14 20 2 5 9 14 7 19 20 9 12 12
• R _ _ _ _ _ _ _ _ -concealing: _ _ _ _ _ _ _ _ _ _ -not disclosing

5 22 5 1 12 9 14 7 4 9 19 3 12 15 19 9 14 7
• Enabling- _ _ _ _ _ _ _ _: _ _ _ _ _ _ _ _ _ _ _ _ - restricting
12 9 13 9 20 9 14 7 16 15 20 5 14 20 9 1 20 9 14 7
• _ _ _ _ _ _ _ _ _ _ -separating: attending – distracting

3 15 14 14 5 3 20 9 14 7
Ø Powering: pushing-_ _ _ _ _ _ _ _ _; affirming-not affirming; _ _ _ _ _ -

nonbeing
18 5 19 9 19 20 9 14 7 2 5 9 14 7
Ø Originating: _ _ _ _ _ _ _ _ _ -uncertainty; _ _ _ _ _ _ _ _ _ _-not conforming

3 5 18 20 1 9 14 20 25 3 15 14 6 15 18 13 9 14 7
Ø _ _ _ _ _ _ _ _ _ _ _ _ : familiar-not familiar
20 19 1 14 19 6 15 18 13 9 14 7
LETTERS
A B C D E F G H I J
1 2 3 4 5 6 7 8 9 10
K L M N O P Q R S T
11 12 13 14 15 16 17 18 19 20
U V W X Y Z
21 22 23 24 25 26

Rosemarie Parse 178
Nurses guide individuals and families in choosing possibilities in changing the
health process; this is accomplished by intersubjective participation with the
clients. Practice focuses on illuminating meaning, and the nurse acts as a guide to
choose possibilities in the changing health experiences (Parse,2013).
HUMAN BECOMING SYMBOL
Directions: Match Column A to the corresponding item in Column B.

Write the letter of your answer for each number.
COLUMN A COLUMN B
_____ 1. Black and white a. Human universe co creation
as an ongoing process of
becoming
_____ 2. Green b. Co-created mutual human
universe process at the
ontological level & nurse-
person process
_____ 3. Center joined c. Opposite paradox significant
to ontology of human
becoming
_____ 4. Swirls Intertwining d. Hope

Rosemarie Parse 179
THREE MAJOR ASSUMPTIONS OF HUMAN BECOMING
Directions: Identify the following statements below and write M if it is

MEANING, R for RHYTHMICITY and write T for TRANSCENDENCE.
_____ 1. One constantly transforms

2. Human Becoming is freely choosing personal meaning in
_____
situations in the intersubjective process of living value priorities
_____ 3. Refers to reaching out and beyond the limits that a person sets
_____ 4. Man’s reality is given meaning through lived experiences
5. Human Becoming is co-transcending multidimensionally with
_____
emerging possible.
_____ 6. Man, and environment co-create
7. Human Becoming is co-creating rhythmical patterns of relating in
_____
mutual process with the universe.
8. Man, and environment co-create (imaging, valuing, language) in
_____
rhythmical patterns.
Directions: Complete the conceptual paradigm of Parse’s Theory

of Human Becoming below. Write your answer on the space
provided

Rosemarie Parse 180
11. ERNESTINE WEIDENBACH
HELPING ART OF CLINICAL NURSING

MAJOR CONCEPTS
Ernestine Wiedenbach’s
affluent family immigrated from
Germany when she was a young
girl. Her interest in nursing began
with her childhood experiences with
nurses. She greatly admired the
private duty nurse who cared for her
ailing grandmother. She later
enjoyed hearing accounts of nurses’
roles in the hospital experiences of a
young intern her sister was dating.
Captivated by the role of the nurse,
Wiedenbach enrolled in the Johns
Hopkins Hospital School of Nursing
after graduating from Wellesley
College in 1922 with a bachelor’s
degree in liberal arts. After
completing her study at Johns
Hopkins, she held a variety of positions in hospitals and public health nursing
agencies in New York. She also continued her education by attending evening
classes at Teachers College at Columbia University, where she received a
master’s degree and a Certificate in Public Health Nursing. During this period,
Hazel Corbin, director of the Maternity Center Association of New York, persuaded
Wiedenbach to enroll in the association’s School for Nurse-Midwives. After
completing the program, Wiedenbach practiced as a nurse-midwife in the home
delivery service of the Maternity Center Association.
In addition to her practice, Wiedenbach also developed her academic career.

She taught an evening course in advanced maternity nursing at Teachers College,

Ernestine Weidenbach 181
wrote several articles for professional publications, and remained active in
professional nursing organizations. Then, in 1952, she moved from New York to
Connecticut, where she was subsequently appointed to the faculty of the Yale
University School of Nursing. She was the director of graduate programs in
maternal-newborn health nursing, which began in 1956.5 She wrote Family-
Centered Maternity Nursing, a text on clinical nursing that was published in 1958.
She published classic articles about theory in practice with William Dickoff and
Patricia James in 1968. Wiedenbach’ developed her model from her vast practical
experience and education and, after a long career at Yale, she retired and moved
to Florida. She passed away in 1996.
Directions: Answer the following questions

below at least 1 – 2 sentences
1. When did Weidenbach's interest in Nursing

begin?
ACTIVITY
________________________________________
__________________________________
__________________________________________________
__________________________________________________
2. What is the educational background of Ernestine Weidenbach?

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
3. Who was her significant influence to enroll in the association’s School for
Nurse-Midwives?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
4. What are her professional achievements?

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

OF THE THEORY
At Yale, Wiedenbach's theory development benefited from her contact with

other faculty members. _____________________________ stimulated
Wiedenbach's understanding of the use of self and the effect of a nurse's thoughts
and feelings on the outcome of her actions. In addition, __________ and
_________, philosophy professors who taught classes for nursing faculty on theory
related to research and philosophical concepts, reviewed the manuscript for
Wiedenbach's book,Clinical Nursing: A Helping Art.' In her text, they identified
elements of a prescriptive theory, which Wiedenbach developed more fully in
Meeting the Realities in Clinical Teaching.
Wiedenbach's model was developed on the basis of her years of experience

in clinical practice and teaching. Gustafson' did an exploratory study using a
naturalistic inquiry design that found a need-for-help in units of vocal and bodily
communications in stage one labor.

AND RELATIONSHIPS
the blank provided.
1. 4 Main Elements to Clinical Nursing

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
2. 3 Essential Components associated with a Nursing Philosophy

__________________________________________________
__________________________________________________
__________________________________________________
3. Prescriptive Theory is based on 3 Factors:

__________________________________________________
__________________________________________________
__________________________________________________
4. Types of Knowledge
______________________________________________
______________________________________________
______________________________________________
Directions: Read the following questions below. Choose the best

answer and write the answer for every number.
_____ 1. Any individual who is receiving help of some kind, be it care, instruction
or advice from a member of the health profession or from a worker in the field of
health.
a. Patient c. Environment
b. A Need for help d. Judgment
_____ 2. Any measure desired by the patient that has the potential to restore or
extend the ability to cope with various life situations that affect health and wellness.
It is crucial to nursing profession that a need-for-help be based on the individual
perception of his own situation.
a. Patient c. Environment

_____ 3. Represents the nurse’s likeliness to make sound decisions.
a. Sound Judgment c. Sound Decisions
b. Clinical Judgment d. Judgment
_____ 4. Based on differentiating fact from assumption and relating them to cause
and effect.
a. Sound Judgment c. Sound Decisions
b. Clinical Judgment d. Judgment
_____ 5. Made up of a variety of actions, and characterized by harmony of

movement, precision, and effective use of self.
a. Patient c. Skills
_____ 6. Attitude and belief about life and how that effected reality for them.
a. Philosophy c. Art
b. Practice d. Purpose
_____ 7. The nurse wants to accomplish through what she does.

a. Philosophy c. Art
b. Practice d. Purpose
_____ 8. The practitioner recognizes as essential to the particular discipline. It

defines the quality of health she desires to effect or sustain in her patient and
specifies what she recognizes to be her special responsibility in caring for the
patient.
a. Realities c. Art
b. Prescription d. Central Purpose
______ 9. A directive to an activity. It specifies both the action that will most likely,
lead to fulfillment of the nurse’s central purpose and the thinking process that
determines it.
a. Realities c. Art
b. Prescription d. Central Purpose
______ 10. All of the following are realities, except:

a. Agent b. Action
c. Patient e. Framework
d. Goal

Directions: Complete the conceptual paradigm of Weidenbach’s

Theory of Helping Art in Clinical Nursing below.

Wiedenbach is a pioneer in the writing of nursing theory. Her model of

clinical nursing is one of the early attempts to systematically describe what nurses
do and what nursing is about. Wiedenbach's model needs to be further developed
by more clearly defining the concepts of health and environment. In addition, the
component of nursing art needs to be identified in an operational way.

Wiedenbach's model evolved out of a desire to describe the practice of
professional nursing. Pelletier influenced her theory, as did the philosophy of
Dickoff and James, her colleagues at Yale University. Wiedenbach's theory was
one of the earlier nursing theories developed.
Wiedenbach's model meets the criterion of clarity because the concepts and
definitions are clear, consistent, and intelligible. There are too many relational
statements for the theory to be classified as a simple theory. The concepts include
need-for-help, nursing practice, and nursing art. All of these concepts are
interrelated, equal in importance, and have no meaning aside from their
interaction. Relationships among the major components can be linked, but it is
difficult to diagram some of the concepts in the model. In addition, the concepts
describe or explain phenomena, but they do not predict.

ACTIVITY
1. Compare Wiedenbach's identification of a
need-for-help or no need-for-help to Virginia
Henderson's definition of nursing.
_________________________________________
___________________________________________________________
___________________________________________________________
2. Relate Wiedenbach's model to the nursing process. Determine similarities

and differences.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
3. Identify communication skills that are necessary to use Wiedenbach's

model. Practice these skills with a patient, coworker, or friend.

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
4. Write definitions for health and environment as they are inferred in

Wiedenbach's definitions of need-for-help and nursing art.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
5. Differentiate skills and actions as described in the Wiedenbach model.

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
6. Compare and contrast deliberative action with rational and reactionary

actions.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

12. KATHARINE KOLCABA’S
THEORY OF COMFORT

MAJOR CONCEPTS
Katharine Kolcaba was born in 1.
_________________, where she spent
most of her life. In 1965, she received a
diploma in nursing from 2.
____________________________ in
Cleveland. She practiced part time for
many years in medical-surgical nursing,
long-term care, and home care before
returning to school. In 1987, she graduated
in the first RN to MSN class at the 3.
_________________________________,
Case Western Reserve University
(CWRU), with a specialty in gerontology.
While going to school, Kolcaba job shared
a head nurse position on a dementia unit. In the context of that unit, she began
theorizing about the outcome of comfort.
Following graduation with her master's degree in nursing, Kolcaba joined the
faculty at 4. ________________________________________. Since that time,
she has maintained American Nurses Association (ANA) Certification in
Gerontology. She returned to CWRU to pursue her doctorate in nursing on a part-
time basis while continuing to teach full time. Over the next ten years, she used
course work from her doctoral program to develop and explicate her theory. During
that time, Kolcaba published a concept analysis of comfort with her philosopher-
husband, diagrammed the aspects of comfort, operationalized comfort as an
outcome of care, contextualized comfort in a midrange theory, and tested the
theory in an intervention study.

Katharine Kolcaba 189
Professors to whom Kolcaba is indebted include: 5.
___________________, 6. ___________, Wilma Phipps, 8.
__________________, Betty Adams, 9. _________________, Joanne Youngblut,
10. _________________, and Jaclene Zauszniewski. She also wanted to thank
her students who gave her valuable feedback over the years as they applied the
Theory of Comfort in their gerontological nursing courses.

OF THE THEORY
Kolcaba originally began her theoretical work when she diagrammed her
nursing practice early in her doctoral work. This is described in detail later in this
chapter. When Kolċaba presented her framework for dementia care, an audience
member asked, “Have you done a concept analysis of comfort?” Kolcaba's reply
was, “No, but that is my next step.” This began her long investigation into the
concept of comfort.

AND RELATIONSHIPS
the blank provided.
1. Types of Comfort
_________________________
_________________________
_________________________
2. Patient comfort occurs:

_________________________
_________________________
_________________________

_________________________
3. Intervening Variables
__________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
Directions: Match Column A to the corresponding item in Column B.

Write the letter of your answer for each number.
COLUMN A COLUMN B
1. when a particular need of a patient is
_____ a. Ease
satisfied.
2. Defines the attributes of comfort and is
_____ helpful in deriving the technical b. Relief
definition of comfort.
3. state whereby a person is calm and
_____ c. Transcendence
content.
4. a state in which one outgrows difficult d. Taxonomic
_____
situations or pain. Structure
COLUMN A COLUMN B
_____ 1. conducive work environment a. Physical
_____ 2. sexuality b. Psychospiritual
_____ 3. essence of one’s life c. Sociocultural
_____ 4. adequate staffing d. Environmental
_____ 5. benefits
_____ 6. Involves the interactions with families
_____ 7. Noise

_____ 8. Temperature
_____ 9. self- worth
_____ 10. traditions within one's family
Holistic comfort is defined as the immediate experience of being

strengthened through having the needs for relief, ease, and transcendence met in
four contexts of experience (physical, psychospiritual, social, and environmental)
(Kolcaba, 2010).
The theoretical structure of Kolcaba's comfort theory has real potential to

direct the work and thinking of all healthcare providers within one institution.
(March A & McCormack D, 2009).
TAXONOMIC STRUCTURE

Directions: Complete the conceptual paradigm of Kolcaba’s Theory of

Comfort below. Write your answers on the space provided.

Kolcaba has persisted in the development of her theory from its conception
as the root of her practice, to the concept analysis that provided taxonomic
structure of comfort, to the development of ways to measure the concept, and
currently in its use for practice, education, and research. She has used a full array
of approaches to develop her concept. Through qualitative work, Kolcaba identified
the concept’s historical use in nursing and strongly sup-ported her rationale for her
claim to its centrality for nursing. The three types of comfort that were synthesized
from Orlando (relief), Henderson (ease), and Paterson and Zderad
(transcendence) are integral to the theory and were validated through factor
analysis of the instrument developed with the guidance of the taxonomic structure.

Directions: Complete the taxonomic structure based on Katharine
Kolcaba. Write your answers on the table below.
MN a male client is operated on for

gallstones. On a postoperative night, the nurse finds
that the client is not sleeping and is tossing and
turning. He had colonoscopy two days ago, and is
suspicious of colon cancer because his sister
passed away two months ago with colon cancer. No
CASE family member has visited him yet since his
admission. Patient yells at the nurse as she
SCENARIO responds to his call light, “you guys will not shut up
for me to sleep and I have been in pain all night.
Which nursing action is most appropriate? Using the taxonomic structure,
formulate a plan of care for MN.
REFERENCES:
1. McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing (5th
ed.). Lippincott Williams and Wilkins.
2. Alligood, M. R. (2017). Nursing theorists and their work (9th ed.).

Elsevier - Health Sciences Division.


Nursing Theories

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Nursing Theories

THEORETICAL FOUNDATION IN NURSING | Nursing Theories 112

THEORETICAL FOUNDATION IN NURSING | Nursing Theories 113

I. BACKGROUND OF THE THEORIST

Hildegard E. Peplau was born 1.

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

II. PHILOSOPHICAL UNDERPINNINGS

Peplau was committed to incorporating established knowledge into her

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

PHASES OF NURSE-PATIENT RELATIONSHIPS

Peplau describes four phases of the nurse-patient relationship. Although

Overlapping phases of Nurse-patient relationships

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

__________________ 1. Peplau states that because the nurse and

__________________ 2. The nurse provides specific answers to

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

INTERPERSONAL RELATIONS IN NURSING

Peplau formulated theories on interpersonal relations in nursing (1952)

Imagine yourself working in a hospital-based setting, such as an

Peplau’s theory focuses on the interpersonal processes and therapeutic

Peplau believes “the behavior of the nurse-as-a-person interacting with the

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

I. BACKGROUND OF THE THEORIST

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

II. PHILOSOPHICAL UNDERPINNINGS

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

III. MAJOR ASSUMPTIONS, CONCEPTS

Ida Jean Orlando’s goal is to develop a theory of effective nursing practice.

PERSON. Unique individual behaving verbally and nonverbally. Assumption is

ENVIRONMENT. Orlando completely disregarded the environment in her theory,

HEALTH. In Orlando’s theory, health is replaced by a sense of helplessness as

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

Directions: Match the subconcepts of the deliberative nursing

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

V. USEFULNESS, TESTABILITY, PARSIMONY &

Orlando's theory remains effective and efficient in achieving valued

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

I. BACKGROUND OF THE THEORIST

Joyce Travelbee was a

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

Travelbee's experiences in her basic nursing education and initial practice

Directions: Read the questions

2. Who influenced Travelbee as she based her assumptions of her theory on

3. A former student and colleague of Travelbee, remembers Travelbee as a

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

III. MAJOR ASSUMPTIONS, CONCEPTS

HUMAN-TO-HUMAN RELATIONSHIP MODEL

• an experience or series of experiences between nurse and patient

Directions: Match the five phases of encounter with the

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

Directions: Complete the conceptual model of Travelbee’s Human-to-

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

Travelbee's theory has a wide scope of application. She generated it

The usefulness of a theory is related to its ability to describe, explain,

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

I. BACKGROUND OF THE THEORIST

Lydia Hall began her prestigious career in nursing as a graduate of the 1.

THEORETICAL FOUNDATION IN NURSING | Nursing Theories

II. PHILOSOPHICAL UNDERPINNINGS OF

Hall drew extensively from the schools of psychiatry and psychology in