Florence Nightingale ma’am lazarraga

• Born May 12, 1820 in Florence, Italy

• Grew up in England as a wealthy and well educated woman
• Lady with the lamp
Meaning of the lamp:
Compassion, reliability, goodwill and everything significant to nursing practice

1851
• Trained in nursing in Kaiserwerth, Germany
• Pioneered the concept of formal education
• Germany – was First nursing school
Protestant pastor
• opened hospital, 1pt, 1 nurse, 1 cook & realized there was no staff
• Decided to design a school of nursing
1854
• Crimean war of Russia vs Turkey
• People in England soldiers were poorly treated in hospitals
Oct 21, 1854
• Florence was invited to take 38 group of females to work in hospitals
in Crimea.
• Served during the crimean war treat sick & injured soldiers
• Influence her philosophy
Nov 1854
• Insufficient medicine • Nightingale reorganized patient care
• Poor hygiene • 4077 soldiers died due to infection than
• Infections Wound from battlefield wounds
• Her first winter in scutari
 6 D’s of dys-ease
• Dirt
• Drink
• Diet
• Damp
• Draught
• Drains

March 1855
• Britain sends sanitary commission to Scutari
• Sewers were flushed , ventilation was improved
• Death rates were reduced

1856
• War was finished
• Florence wanted to improve hospitals in this country
• Conditions in hospital began to improve
1860
• Nightingale published Notes on Nursing
• Considered the first “nursing theorist”
• Information of her theory has been obtained through interpretation of
here writings
Saint Thomas Hospital in London
– Nightingale school and home for nurses
1896
• Bedridden due to bacteria infection
• Got chronic fatigue syndrome
• Died August 13, 1910 , age 90 yrs old Due to heart attack and old age

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 Florence Nightingale
➢ Remembered today as responsible for improving conditions in
hospitals & making nursing a acceptable job
➢ Pioneered in the field of hospital planning
Influence:
➢ Education, observation, & hands on experience

Theory Basis
• Inter relationship of a healthful environment with nursing
• External influences & conditions can prevent , suppress or contribute
to diseases or death
Theory Goal
• Nurses help patients retain their own vitality by meeting their
basic needs through control of the environment

Nursing’s focus
• Control of the environment for individuals, families, & the community

PHYSICAL ENVIRONMENT
• consist of physical elements where the patient is being treated
• affects all other aspects of the environment
• cleanliness of environment relates directly to disease
prevention and patient mortality
• VENTILATION, WARMTH, CLEANLINESS, LIGHT, NOISE AND
DRAINAGE

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 PSYCHOLOGICAL ENVIRONMENT
• providing a positive stress free surrounding
• can be affected by a negative physical environment which then causes
STRESS
• Requires various activities to keep the mind active
• Involve communication with the person, about the person, and about
other people

SOCIAL ENVIRONMENT
• Involves collecting data about illness and diseases prevention
• Consists of a person’s home or hospital room, as well as the total
community that affects the patients specific environment
• Stress free surroundings

Nightingale’s Nursing Theory

• ENVIRONMENTAL THEORY define nursing
“ The act of utilizing the patients environment to assist him in his
recovery”

5 Major Components of a Healthful Environment

1. Proper ventilation
2. Adequate light
3. Sufficient warmth
4. Control of noise
5. Control of effluvia ( noxious odors)

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Nightingales 13 Canons
1. Ventilation and warming
- keeping the air that the patients breathe as pure as the
external air, without chilling them

2. Health of Houses
- pure air, pure water, efficient drainage, cleanliness, light;
without these, no house can be healthy, and it will be
unhealthy just in proportion as they are deficient

3. Petty Management
- all the results of good nursing may be negated by one defect: not knowing
how to manage what you do when you are there and what shall be done
when you are not there

• Based on the idea that nurses must ensure that care is provided
efficiently to promote recovery

4. Noise
- unnecessary noise, or noise that creates as expectation in the mind, is
that which hurts patients. Anything that wakes patients suddenly will
invariably put them into a state of greater excitement and do them more
serious and lasting mischief than any continuous noise.

5. Variety
- the nerves of the sick suffer from seeing the same walls, the same ceiling, the
same surroundings during a long confinement to one or two rooms. The
majority of cheerful cases are of those patients who are not confined to one
room. Most depressed cases will be subjected to a long monotony of objects
around them

6. Taking food
- the nurse should be conscious of patients' diets and remember how much
food each patient has had and ought to have each day

7. What food
- the nurse should be conscious of patients' diets and remember how much
food each patient has had and ought to have each day

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 8. Bed and Bedding
• patients' bed should have a clean beddings every 12 hours.
• The bed should be narrow, so that the patient does not feel
"out of humanity's reach."
• The bed should not be so high so that the patient cannot easily get in or out
of it.
• The bed should be in the lightest spot in the room, preferably near the
window.
• Pillows should be used to support the back below the breathing apparatus,
to allow shoulders room to fall back, and to support the head without
throwing it forward.

9. Light
• essentially direct sunlight, has a purifying effect upon the air of a room.

10. Cleanliness of room and walls

• preserving the cleanliness; the inside air can be kept clean only by excessive
care to aid rooms and their furnishings of the organic matter and dust with which
they become saturated. Without cleanliness, you cannot have all the effects of
ventilation; without ventilation, you can have no thorough cleanliness.

11. Personal Cleanliness-

• nurses should always remember that if they allow patients to remain unwashed
or to remain in clothing saturated with perspiration or other excretion, they are
interfering injuriously with the natural processes of health just as much as if they
were to give their patients a dose of slow poison..

12. Chattering hopes and advices

o Discussing patient care with those who did not need to know
o Not handing out advice that is without fact
o all friends, visitors, and attendants of the sick should avoid the practice of
attempting to cheer the sick by making light of their danger and by exaggerating
their probabilities of recovery.

13. Observation of the sick

o what to observe, how to observe, which symptoms indicate improvement, which
indicate the reverse, which are important, which are not, and which are evidence
of neglect and what kind of neglect.

Metaparadigm in Nursing

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 • Nursing
• Health
• Environment
• Person

Person
• The patient, a human being acted upon by a nurse or affected by the
environment who has reparative powers .
Recovery
• Is within the patients power as long as safe environmental for
recuperation exists.
Environmental
• Comprises the external conditions and forces that affect ones life and
development everything from persons food to a nurse’s verbal and
nonverbal interactions with the person.
5 Environmental Factors:
1. Fresh air
2. Pure water
3. Efficient drainage
4. Cleanliness/sanitation
5. Light or direct sunlight
Health
• Maintaining well being by using a persons powers to the fullest
extent; disease is viewed as a reparative process instituted by nature
• Maintained by controlling environmental factors to prevent diseases;
nurse helps the person throughout the healing process

Nursing

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 • Aims to provide fresh air, light, warmth, cleanliness, quiet and proper
diet; facilitates a persons reparative by ensuring the best possible
environment influences the environment to affect health.
Nightingale 11 assumptions
1. Nursing is separated from medicine
2. Nurses should be trained
3. The environment is important in nursing
4. The disease process is not important to nursing
5. Nursing should support the environment to assist the patient in
healing
6. Research should be utilized through observation and empirics to
define the nursing discipline
7. Nursing is both an empirical science and an art
8. Nursings concern is with the person in the environment
9. The person is interacting with the environment
10. Sick and well are governed by the same laws of health
11. The nurse should be observant and confidential

HISTORY OF NURSING THEORY

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• History of professional nursing began with Florence Nightingale

• Strong emphasis on practice and worked throughout the century toward the
development of nursing as a profession

TIMELINE

• 1900 - 1940s (Curriculum Era)

Emphasis: Courses included in nursing programs.
Outcomes: Standardized curricula for diploma programs.
Emerging Goal: Develop specialized knowledge and higher education.

• 1950 - 1970's – (Research Era)

Emphasis: Role of nurses and what to research.
Outcomes: Problem studies and studies of nukes
Emerging Goal: Isolated studies do not yield unified knowledge.

• 1950 – 1970s – (Graduate Education Eve)

Emphasis: Carving out an advanced role and basis for nursing practice
Outcomes: Norses rave an important role in health care
Emerging Goal: Focus graduate education on knowledge

• 1980 - 1990's – (Theory Era)

Emphasis: There are many ways to think about nursing.
Outcomes: Nursing theoretical works shift the focus to the patient.
Emerging Goal: Theories guide nursing research and practice.

• 21st century – (Theory utilization Era)

Emphasis: Nursing theory guides research, practice, education, administration.

Outcomes: Middle range theory may be from quantitative or qualitative approach
Emerging Goal: Nursing frameworks produce knowledge(evidence) for quality care.

SIGNIFICANCE OF NURSING THEORY

• DISCIPLINE

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- A branch of education, a department of Hearing, or domain of knowledge

•PROFESSION
- Refers to a specialized field of practice, founded upon
the theoretical structure of the science or knowledge of the discipline and
accompanying practice abilities.

TERMINOLOGIES

SCIENCE – From the latin "scientia" meaning knowledge

• A systematically organized body of knowledge about particular subject.
• Performing the process of observation, description, experimental, investigation,
and theoretical explanation of natural phenomenon.

KNOWLEDGE
• General awareness, understanding or possession of information, faces, ideas,
truths, or principles
• Information, skills, and expertise acquired by a person through various
experiences

SOURCES OF KNOWLEDGE

• TRADITIONAL
- Nursing practice which is passed down from
generation to generation

• AUTHORITATIVE
- An idea by a person of authority which is perceived as true because of his/her
expertise.

• SCIENTIFIC
- Knowledge came from a scientific method through research.

• THEORY-
- An organized system of accepted knowledge that is composed of
concepts, propositions, definitions, and assumptions to explain a set of fact

- Group of related concepts that propose actions that guide Practice

- A system of ideas that is proposed to explain a given phenomena

• CONCEPT-
• Idea, belief, view, notion, thought, perception, impression
• Are building blocks of theories

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 • Enhances one's capacity to understand phenomena

ABSTRACT CONCEPT
• are indirectly observed.
• it is independent on time and place. Examples are love, care and freedom.

CONCRETE CONCEPT
• are directly observed.
• Specific to time and place examples are nurse, mother, chair

PROPOSITION
- Statements that explains the relationships of different concepts.

EXAMPLE
- Children don't want to stay in the hospital because of their fear of injections.

ASSUMPTION
o Is a statement that specifies the relationship or connection of factual
concepts or phenomena.
o All patients who are not able to take good care of themselves

PHENOMENON

- A fact or occurrence that can be observed

- something notable; excites people's interest and curiosity

PHILOSOPHY
o A statement of beliefs and values about human beings and their world
o ls concerned with the purpose of human life, the nature of being and reality, the
theory and limits of knowledge

CONCEPTS, PROPOSITION, ASSUMPTION, DEFINITION

THEORY
⬇️
PHENOMENA

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 NIGHTINGALE

INTRODUCTION

Martha Roger’s
• Theory of science of unitary Human beings
Mainly focusing on the 4 concepts & 3 principles of homeodynamic:
• Energy fields
▪ it is the inevitable part of life. Human and environment both have
energy field which is open i.e. energy can freely flow between
human and environment.
• Openness
▪ there is no boundary or barrier that can inhibit the flow of energy
between human and environment which leads to the continuous
movement or matter of energy.
• Pattern
▪ is the distinguishing character of the energy
field.
• Pandimensioal
▪ Undeviating field which is not constricted by space or time, it is an
infinite domain without boundary
• Integrality
▪ Energy fields are dynamic and constantly interact with the human and
environment, which affects our environment and vice versa.
▪ This is the principle on which meditation and humor works to produce a
positive environment.

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 • Resonancy
▪ is an ordered arrangement of rhythm characterizing both human field and
environmental field
Constant change in the way or pattern of the energy field from a lower to higher
frequency.
▪ This movement of energy can be made by human touch, guided imagery
activities, drawing, storytelling and other active use of imagination.

• Helicy
▪ Any minute change in the environment which leads to ripple effect i.e. results in a
larger changes in other field.
▪ This change is constant, unpredictable and there are many factors which
mutually interact and cause the change.

Principle of Homeodynamics:
o Homeodynamics refers to the balance between the dynamic life process and
environment.
o These principles help to view human as unitary human being. The three separate
principles are integrality, resonancy, and heliecy.

• Born on May 12, 1914 (sharing bday with Florence nightingale)

• Eldest child of 4 siblings
• her parents is Mr Bruce Taylor Rogers & Mrs. Lucy Mulholland keener
Rogers.

1936 – Received her nursing diploma from Knoxville General Hospital School of
Nursing
1937 – Earned her public Health nursing degree from George Peabody College
in Tennessee
• sold her first car to pay her tuition and entered a masters degree program full
time
1945 – got her masters degree from Teachers College at Columbia University

1954 – Doctorate of nursing was given to her from John Hopkins University in
Baltimore

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 • she also completed her studies in 1954
• Title of her dissertation –
“ The association of maternal and fetal factors with the development of
behavior problems among elementary school children.”
March 13, 1994 – she died

Assumptions

• Human being is considered as – whole which cannot be viewed as subparts

• The life process of human is – irreparable and one way from birth to death
• Health and illness – are the continuous expression of the life process
• the energy flows freely between the individual and environment
• Human being – possesses the ability to think, imagine, sense, feel, and can
use language for expression
• Human beings have the ability to adapt according to the new changes in the
environment.

Concepts
o All the human beings are viewed as an integral part of universe.
o Human beings and the environment have energy field, nursing action is directed
towards patterning and maintaining these energy fields.

Metaparadigm in Nursing
▪ Person
- a unitary human being is open systems which continuously interact with environment. A
person cannot be viewed as parts, it should be considered as a whole.

▪ Environment
- it includes the entire energy field other than a person.
These energy fields are irreducible, not limited by space and time, identified by its
Pattern and organization

▪ Health
- Not clearly defined by Roger. It is determined by the interaction between energy
fields i.e. human and environment.

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 - Bad interaction or misplacing of the energy leads to illness.

▪ Nursing
▪ Is both science and art.
▪ It constantly maintains the energy field which is conducive for patient.
▪ Nursing action directs the interaction of person and environment to maximize health
potential.

APPLICATION OF SUBH:
• practice
• education
• research

Clinical Practice:
o Nursing action is always focused on unitary human being and change the energy
field between human and environment.
o Nursing interventions include all the noninvasive actions such as guided
imaginary, humor, therapeutic touch, music etc. which are used to increase the
potential of human being.

Clinical practice cont...

- The more importance should be on the management of pain, supportive
psychotherapy and rehabilitation of the human being

Nursing Education:
o Emphasis should be given on the understanding of the patient and self, energy
field and environment.

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 o Training should lay more focus on teaching noninvasive modalities such as
therapeutic touch, meditation, humor, regular in-service education programme
etc.

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

Nursing process according to SUBH:

- Pattern
- Mutual pattering
- Evaluation

Pattern appraisal:
o It is an inclusive assessment of human and environment energy fields, its
organization of energy field, and identification of areas of dissonance.
o Nurses validate the entire appraisal along with the client

Mutual patterning:

• It is the proper patterning of the energy fields between the human and environment.
o It is the mutual interaction between the client and nurse
o Patterning can be done by suggesting the various alternatives, educating,
empowering, encouraging etc. depending on the client's condition and needs.

Evaluation:
• Evaluation is done by repeating the pattern appraisal after the mutual patterning to
determine the extents of dissonance and
harmony.
Home

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 SELF-CARE DEFICIT THEORY
DOROTHEA E. OREM

• Born on 1914 in Baltimore, Maryland

• Began her nursing education at Providence Hospital School of Nursing
in Washington, DC

• 1939
o she earned her BSN education at the Catholic University of
America

• 1946
o earned her M.S.N. from Catholic University of America.
o Nursing Experiences
A. operating room nursing,
B. private duty nursing (home & hospital),
C. hospital staff nursing on pediatric and adult medical and surgical
units,
D. evening supervisor in the E.R.
E. . biological science teacher

Died- June 22,2007

Orem’s theory addresses client’s self-care needs:

It is defined as Goal-oriented activities that are set towards generating

interest in the part of the client to maintain life & health development.
The theory is aimed towards making the clients perform self-care
activities in order to live independently.

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METAPARADIGM:

PERSON
• Defined the patient as a being who functions biologically,
symbolically & socially & who has the potential for learning
& development.

• Is an individual subject to the forces of nature, with a

capacity for self-knowledge, who can engage in
deliberate action, interpret experiences & perform
beneficial actions.

• Is an individual who can learn to meet self-care requisites;

if for some reason, the person cannot learn self-care
measures, others must provide the care.

HEALTH:
• Orem supports the WHO’s definition of health as “the state of
physical, mental, and social well-being and not merely the
absence of disease or infirmity”.Consists of physical,
psychological, interpersonal & social aspects; these aspects
are inseparableIncludes promotion & maintenance of health,
treatment of illness & prevention of complications.

ENVIRONMENT
• Consists of environmental factors, environmental elements,
environmental conditions (external physical & psychosocial
surroundings) & developmental environment (promotion of
personal development through motivation to establish
appropriate goals & to adjust behavior to meet these goals;
includes formation of or change in attitudes & values,
creativity, self-concept & physical development).

NURSING:
• helping clients to establish or identify ways to perform self-
care activities.
• Nursing actions are geared towards the independence of the
client.
• a human service, its focus is on persons with inabilities to
maintain continuous provision of healthcare.
• Nursing is based on values.

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MAJOR CONCEPTE AND DEFINITIONS:
• Self- care
• Self- care Requisites
• Universal self- care Requisites
• Development self- care Requisites
• Health Deviation self – care Requisites
• Therapeutic self – care demand
• Self- care Deficit
• Nursing Agency
• Nursing Design
• Nursing system
• Helping methods

Self-care deficit theory as a general theory:

composed of 3 related theories

1. THEORY OF SELF-CARE
2. THEORY OF SELF-CARE DEFICIT
3. THEORY OF NURSING SYSTEMS

1. THE THEORY OF SELF-CARE

• Describes why & how people care for themselves

Self- Care:
• refers to those activities an individual performs independently
throughout life to promote & maintain personal well-being.

Self- Care agency

• the complex acquired ability of mature & maturing persons to know &
meet their continuing requirements for deliberate, purposive action to
regulate their own functioning & development.

• consists of two agents: An agent is an individual who is engaged in

meeting the need of a person; like bridges that facilitate what has been
done and what needs to be done).

1. . self-care agent – person who provides the self-care

2. . Dependent care agent – person other than the individual who
provides cares

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Self-care requisites or Self-care needs:

• are insights of actions or requirements that a person must be able to

meet and perform in order to achieve well-being.
• Categories

A. UNIVERSAL SELF-CARE REQUISITES

B. DEVELOPMENTAL SELF-CARE REQUISITES

C. HEALTH DEVIATION SELF-CARE REQUISITES

A.Universal Self-care requisites

• These are universally set goals that must be undertaken in order for an
individual to function in scope of healthy living.

1. Maintenance of sufficient intake of air.

2. Maintenance of sufficient intake of food.

3. Maintenance of sufficient intake of water.

4. Provision of care associated with elimination.

5. Maintenance of balance between activity and rest.

6. Maintenance of balance between solitude and social interaction.

7. Prevention of hazards to human life, human functioning, and human well-

being.

8. Promotion of human functioning and development.

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 B. Developmental Self-care requisites
• result from maturation or associated with conditions or
events such as adjusting to a change in body image or
loss of a spouse.
• they promote processes for life & maturation & prevent
conditions deleterious to maturation or those that lessen
those effects.

C. Health deviation self-care requisites

• requisites that result from illness, injury or disease or its
treatment; they include such actions as seeking medical
assistance, carrying out a prescribed treatment or learning
to live with the effects of illness or treatment.

• These health care deviations set standards to which the

degree of self-care demand is needed.

THERAPEUTIC SELF-CARE DEMAND

• Refers to all self-care activities required to meet existing self-care

requisites
• Involves the use of actions to maintain health & well-being, each patient’s
therapeutic self-care demands vary throughout life.

3.THE THEORY OF SELF-CARE DEFICIT

• A theory which describes & explains why people can be helped through
nursing
Self-care deficit:
• arises when the self-care agency cannot meet self-care requisites.

Helping Methods:
1. Acting or doing for another
2. Guiding and directing
3. Providing physical or psychological support
4. Teaching
5. Providing and maintaining an environment that supports
personal development.

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3. THEORY OF NURSING SYSTEMS

• describes and explains relationships that must be brought about &

maintained for nursing to be produced
• refers to the series of actions a nurse takes to meet a patient’s self-care
requisites

Nursing Agency
• set of established capabilities of a nurse who can legitimately perform
activities of care for a client.
• helps a person achieve their health care demand.

Nursing Design
• these are professional functions that must be performed by the nurse in
order to meet the client’s needs.
• it serves as a guideline of needed & foreseen results in the production
of nursing toward the achievement of nursing goals

3 Types of Nursing Systems:

- Each system describes nursing responsibilities, roles of the nurse
& patient, rationales for the nurse-patient relationship & types of actions needed
to meet the patient’s self-care agency & therapeutic self-care demand.

BASIC NURSING SYSTEMS:

1. A wholly compensatory nursing system

• is used when a patient’s self-care agency is so limited that the patient
depends on others for well-being.

2. A partly compensatory nursing system

• is used when a patient can meet some self-care requisites but needs a
nurse to help meet others
• the nurse & the patient play major roles in performing self-care

3. Supportive – Educative Nursing System

• is used when a patient can meet self-care requisites but needs
assistance with decision making behavior control or knowledge
acquisition skills

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Partial compensatory system
• Nurse action
• Patient action

Supportive-educative system
• Patient action
• Nurse action

MAJOR ASSUMPTIONS:

1. Human beings require continuous, deliberate inputs to themselves and

their environments to remain alive and function in accordance with natural
human endowments.

2. Human agency, the power to act deliberately, is exercised in the form of

care for self and others in identifying needs and making needed inputs.

3. Mature human beings experience privations in the form of limitations for

action in care for self and others involving and making of life sustaining and
function-regulating inputs.

4. Human agency is exercised in discovering, developing, and transmitting

ways and means to identify needs and make inputs to self and others.

5. Groups of human beings with structured relationship cluster tasks and

allocate responsibilities for providing care to group members who
experience privations for making required, deliberate input to self and
others.

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ACCEPTANCE BY THE NURSING COMMUNITY

Practice
• The first documented use of Orem’s theory as the basis for structuring
practice is found in descriptions of nurse-managed clinics at John
Hopkins Hospital in 1973.

Research articles on the use of SCDNT or components in clinical

practice include:

a. Teaching self-care to individuals with DM, ESRD, hemodialysis,

peritoneal dialysis, renal transplant
b. Pain assessment
c. Cardiac research
d. Oncology – focus cancer prevention, self-care after being diagnosed with
malignancies.
e. Psychiatry etc.

• Education- “Guides for Developing Curriculum for the Education of

Practical Nurses”

a. Orem worked on a book. “Foundations of Nursing Practice” (Morris

Harvey College).

Research

a. First instrument to measure the exercise of Self-care agency (ESCA) was

published in 1979.

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

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