THEORIES ON THE CARE OF

THE HUMAN SPIRIT

Maydilyn M. Gultiano, RN, MAN
THEORIES ON THE CARE OF THE HUMAN SPIRIT
1. “The Nature of Nursing “by Virginia Henderson
2. “Interpersonal Aspect of Nursing” by: Joyce Travelbee
3. “Patient Centered Approaches” by: Faye Abdellah
4. “Philosophy and Science of Caring” by : Jean Watson
5. Health as Expanding Consciousness” by: Margaret
Newman
6. “Theory of Human Becoming” by: Rosemarie Rizzo Parse
7. “Humanistic Nursing Theory” by: Josephine Patterson and
Loretta Zderad
 The Nature of Nursing
by: Virginia Henderson
• Henderson emphasized the importance of increasing the
patient’s independence 4 so that progress after
hospitalization would not be delayed (Henderson,1991)
• The work of the nurse is "assisting individuals to
gain independence 5 in relation to the performance
of activities contributing to health or its
recovery" (Henderson, 1966).
• Henderson categorized nursing activities into 14
components, based on human needs.
• She described the three roles of the nurse as :
1. substitutive (doing for the person), 6
2. supplementary (helping the person), 7
3. complementary (working with the person) 8
…and the goal of nursing is helping the person
become as independent as possible.
 The major assumptions of the
theory are:
•"Nurses care for patients until they can care
for themselves once again.
•Nurses are willing to serve and that they will
devote themselves to the patient “day and
night”
•Nurses should be educated at the university
level in both arts and sciences.
Definition of Nursing
• "The unique function of the nurse is to assist the
individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he
had the necessary strength, will or knowledge. And to
do this in such a way as to help him gain
independence as rapidly as possible" (Henderson,
1966).
 THE 14 BASIC HUMAN NEEDS
1. Breathe normally. 10. Communicate with others in
2. Eat and drink adequately. expressing emotions, needs, fears, or
3. Eliminate body wastes. opinions.
4. Move and maintain desirable 11. Worship according to one’s faith.
postures. 12. Work in such a way that there is a
5. Sleep and rest. sense of accomplishment.
6. Select suitable clothes-dress and 13. Play or participate in various forms
undress. of recreation.
7. Maintain body temperature within 14. Learn, discover, or satisfy the
normal range by adjusting clothing curiosity that leads to normal
and modifying environment development and health and use the
8. Keep the body clean and well
available health facilities.
groomed and protect the
integument
9. Avoid dangers in the environment
and avoid injuring others.
 Values and beliefs of Henderson’s theory
• The nurse should be the substitute for the patient, the
helper and partner to the patient.
• The nurse is temporarily the consciousness of the
unconscious, the love of life for the suicidal, the leg
of the amputee, the eyes of the newly blind, a
means of locomotion for the infant and the
knowledge and confidence for the young mother.
• Nursing primarily supplements the patient by providing
what he/she needs in knowledge, will or strength to
perform his daily activities and to carry out the treatment
prescribed by the physician.
 Henderson’s theory and the four
major concepts

1. Person
• Have basic needs that are component of health.
• Requiring assistance to achieve health and
independence or a peaceful death.
• Mind and body are inseparable and interrelated.
• Has biological, psychological, sociological, and spiritual
components.
Henderson’s theory and the four major
concepts
2. Environment
• Settings in which an individual learns unique pattern
for living.
• All external conditions and influences that affect life
and development.
 Henderson’s theory and the four major
concepts
3. Health
• Definition based on individual’s ability to
function independently as outlined in the
14 components.
• Nurses need to stress promotion of health
and prevention and cure of disease.
Henderson’s theory and the four major
concepts
4. Nursing
• Temporarily assisting an individual who lacks
the necessary strength, will and knowledge to
satisfy 1 or more of 14 basic needs.
• Assists and supports the individual in life
activities and the attainment of
independence.
• Nurse serves to make patient “complete”
“whole", or "independent."
 Patient Centered Approaches to Nursing
by Faye Glenn Abdellah

Abdellah's Typology of 21 Nursing

Problems:
1. To promote good hygiene and physical comfort
2. To promote optimal activity, exercise, rest, and
#1-4 sleep
Basic to 3. To promote safety through prevention of
all
accidents, injury, or other trauma and through
the prevention of the spread of infection
4. To maintain good body mechanics and prevent
and correct deformities
Abdellah's Typology of 21 Nursing Problems:
5. To facilitate the maintenance of a supply of
oxygen to all body cells
6. To facilitate the maintenance of nutrition of all
body cells
7. To facilitate the maintenance of elimination
#5-11 8. To facilitate the maintenance of fluid and
Sustenal electrolyte balance
care
needs 9. To recognize the physiologic responses of
the body to disease conditions
10. To facilitate the maintenance of
regulatory mechanisms and functions
11. To facilitate the maintenance of sensory
function
 Patient Centered Approaches to Nursing
by Faye Glenn Abdellah
Abdellah's Typology of 21 Nursing Problems:
12. To identify and accept positive and negative
expressions, feelings, and reactions
13. To identify and accept the interrelatedness of
emotions and organic illness
#12-18 14. To facilitate the maintenance of effective verbal and
Remedial nonverbal communication
care 15. To promote the development of productive
needs interpersonal relationships
16. To facilitate progress toward achievement of personal
spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with
varying physical, emotional, and developmental needs
 Patient Centered Approaches to Nursing
by Faye Glenn Abdellah
Abdellah's Typology of 21 Nursing
Problems:
19. To accept the optimum possible goals in light of
physical and emotional limitations
#19-21
Restorative 20. To use community resources as an aid in resolving
care needs problems arising from illness
21. To understand the role of social problems as
influencing factors in the cause of illness
Nursing problems
• Nursing problems are conditions faced by the
patient or family that the nurse through the
performance of professional functions can
assist them to meet.
• Can either be overt or covert
• Nursing is the use of problem solving approach
to solve key nursing problems related to
health needs of people.
10 services given by nurses
1. Recognizing the nursing problems of the
patient.
2. Deciding the appropriate actions to take in
terms of relevant nursing principles.
3. Providing continuous care of the individual’s
total health needs.
4. Providing continuous care to relieve pain and
discomfort and provide immediate security for
the individual.
5. Adjusting total nursing care plan to meet the
patient’s individual needs.
6. Helping the individual to become more self directing in
attaining or maintaining a healthy state of body, mind and
spirit.
7. Instructing nursing personnel and family to help the
individual do for himself that which he can with his
limitations.
8. Helping the individual to adjust to his limitations and
emotional problems.
9. Working with allied health professional in planning for
optimum health on local, state, national and international
needs.
10. Carrying out continuous evaluation and research to
improve nursing techniques and to develop new
techniques to meet all the health needs of the people.
10 steps to identify client’s problems
1. Know the patient
2. Sort out relevant and significant data
3. Make generalizations about available data.
4. Identify the therapeutic plan
5. Test generalizations with the patient and make additional
generalization.
6. Validate the patient’s conclusions about his nursing
problems
7. Continue to observe and evaluate the patient over a period
of time to identify any attitudes and clues regarding his
behavior
8. Explore the patient’s and family’s reaction to the
therapeutic plan.
9. Identify how the nurse feel about the patient's nursing
problems.
10. Discuss and develop a comprehensive nursing care plan.
 11 Skills that a Nurse Must Possess
1. Observation of health status
2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel resources
8. Problem-solving
9. Direction of work of others
10. Therapeutic use of the self
11. Nursing procedures
Abdellah’s theory and the four major concepts
1. PERSON
• Have physical, emotional, and sociological needs. These
needs maybe overt, consisting of largely physical needs,
or covert, such as emotional, sociological and
interpersonal needs- which are often missed and
perceived incorrectly.
• The patient is the only justification for the existence of
nursing. The individuals (and families) are the recipients
of nursing.
Abdellah’s theory and the four major concepts
2. Health
• health is a state mutually exclusive of illness. Emphasis
should be placed upon prevention and rehabilitation with
wellness as a lifetime goal.
• Although Abdellah does not give a definition of health,
she speaks to “total health needs” and “a healthy state of
mind and body” in her description of nursing as a
comprehensive service.
• The purpose of nursing service
Abdellah’s theory and the four major concepts
3. Environment
• Environment is the home or community from which
patient comes. Society is included in “planning for
optimum health on local, state, national and international
levels.”
• However, as Abdellah further delineated her ideas, the
focus of nursing service is clearly the individual. Society is
integrated when the nurse discusses the
implementation.
Abdellah’s theory and the four major concepts
4. Nursing
Nursing is a service to individuals, to families and therefore to
society.
The goal of nursing is the fullest physical, emotional, intellectual,
social and spiritual functioning of the client which pertains to
holistic care.
Nursing care is doing something to or for the person or providing
information to the person with the goals of meeting needs,
increase or restoring self-help ability or alleviating impairment.
INTERPERSONAL ASPECTS OF NURSING
BY JOYCE TRAVELBEE
 INTERPERSONAL ASPECTS OF NURSING
BY JOYCE TRAVELBEE

• Nursing Is accomplished through human to human

relationship that has several phases:
1. Original encounter – initial interaction
2. Emerging identities – identify that each one has unique
characteristics
3. Empathy- nurse understands patient’s condition
4. Sympathy – nurse having the desire to alleviate the cause of
patient’s distress
5. Rapport – both patient and nurse establish mutual understanding
1. developed through communication and
2. when both parties perceives the uniqueness of each other.
 INTERPERSONAL ASPECTS OF NURSING
BY JOYCE TRAVELBEE

• Person – a unique and irreplaceable individual who is in a continuous

process of becoming, evolving and changing.
• Nursing – an interpersonal process where the professional assist an
individual family or community to prevent or cope with the
experience of illness or suffering and to find meaning to these
experiences.
• Health – the individual’s perception of health and absence of disease.
 PHILOSPHY AND SCIENCE OF CARING
BY JEAN WATSON
• Caring is the essence of nursing.
• Care of the soul is the most powerful aspect of the
art of nursing
• The three major elements of the theory:
• Carative factors/caritas factors
• Interpersonal caring relationship
• Caring occasion
The Ten Caritas Factors:
1. Embrace altruistic values and Practice loving kindness with self
and others.
2. Instill faith and hope and honor others.
3. Be sensitive to self and others by nurturing individual beliefs and
practices.
4. Develop helping – trusting- caring relationships.
5. Promote and accept positive and negative feelings as you
authentically listen to another’s story.
6. Use creative scientific problem-solving methods for caring
decision making.
7. Share teaching and learning that addresses the individual needs
and comprehension styles.
8. Create a healing environment for the physical and spiritual self
which respects human dignity.
9. Assist with basic physical, emotional, and spiritual human needs.
10. Open to mystery and Allow miracles to enter
 FOUR MAJOR CONCEPTS OF WATSON’S THEORY IN THE NURSING PARADIGM:
• Person –
• is a being in the world who holds three spheres of being –mind, body and spirit
influenced by the concept of self and who is unique and free to make choices.
• There is unity of the mind, body and spirit
• The mind is the point of access to the body and spirit. The spirit relates to the
person’s soul. It is the spirit that allows a person to transcend.
• Environment –
• Health –
• is not merely the absence of disease. It is a subjective experience corresponding to
the person’s harmony or balance with the mind body and spirit
• Nursing –
• Both a science and an art. A science of persons and human health. It also an art of
transpersonal caring-healing modalities such as providing comfort measures,
helping the cared for to alleviate pain, stress and suffering as well as promote
wellbeing and healing.
 HEALTH AS EXPANDING CONSCIOUSNESS THEORY
BY MARGARET NEWMAN

• This theory was patterned from Martha Roger’s

Theory OF Unitary Human Being.
• It assume that man interact with the environment
• Consciousness is the manifestation of this interaction.
• Consciousness not only being aware cognitively and
affectively but also being interconnected to the entire
living system.
There are nine patterns of interaction:
1. Choosing
2. Communicating These patterns of
3. Exchanging
4. Feeling interactions guide
5. Knowing nurses to make
6. Moving holistic assessment
7. Perceiving
8. Relating of the person
9. Valuing
• Nursing is a unique profession that helps
clients get in touch with the meaning of
their lives
• Nursing activities to enable patients to
realize the meaning of their lives include :
1. Providing nursing presence to assist client to
recognize his pattern of interacting with the
environment.
2. Being a partner in expanding consciousness
by connecting with the person.
3. Conducting meaningful nurse patient
interactions to facilitate knowing of patient’s
condition or health assessment:
Concepts:
• Health encompassing the disease and non-disease. It is viewed as
a process of developing awareness and environment together with an
increasing ability to perceive alternative and respond in a variety of
ways. Health is a pattern of the whole person and disease is a
manifestation of pattern of a whole.
• Pattern – understanding the meaning of all relationships
• Consciousness –viewed as the capacity to interact with the
environment.
 THEORY OF HUMAN BECOMING
BY Rosemarie Rizzo Parse
•The theory is structured around three themes:
1. Meaning – people co-participate in creating
what is real for them through self-expression in
living their values in a chosen way.
2. Rhythmicity – man can reveal or hide the person
he or she is becoming
3. Transcendence – moving beyond the “now” or
beyond what is normally expected.
Assumptions:
• Humans have a way of seeing things
(structuring) in situations they experience.
• Humans make patterns of relating with the
environment (co-creating) depending on the
personal meaning and value of their experience.
• Humans have a way of showing how they want
to become (co-transcending)
Principles of Parse’s theory:
1. Each person has a unique view of the world and this
governs his life choices. (Structuring meaning multi-
dimensionally)
2. Activities of each person is governed by what is meaningful
and valuable to him. (Co-creating rhythmical patterns)
3. A person has the choice of kind of person to become, what
attitude to have, whom to relate with & what concerns will
interest or bother him ( Co-transcending with possibilities)
Principles of Parse’s theory:
1. Each person has a unique view of the world and this
governs his life choices. (Structuring meaning multi-dimensionally)

• This principle includes three concepts:

• Personal interpretation (Imaging)
• Choosing what is important (Valuing)
• Expression of inner thoughts (Languaging)
Principles of Parse’s theory:
2. Activities of each person is governed by what is meaningful
and valuable to him. (Co-creating rhythmical patterns)
• It is manifested by:
• The way how the individual show or hide his thoughts,
feelings, values, concerns and hope (Revealing-concealing)
• What a person allow or not allow himself to do. (Enabling
limiting)
• Who are his personal associations and connections (
Connecting and separating)
Principles of Parse’s theory:
3. A person has the choice of what kind of person to
become , what attitude to have, who to relate with &
what concerns interests or bothers him ( Co-
transcending with possibilities)
• Manifested by:
• Powering -acting with purpose
• Originating – maintaining one’s uniqueness as a person
• Transforming –deliberately changing into what one wants
to become (fulfill hopes and dreams)
• Human beings have different ways of perceiving
situation and this is revealed in their actions.
They also have the capacity of becoming a
person he/she wants to be.
• Nurses should be able to value a person’s
uniqueness. Each patient has different view or
perception of a situation.
• Each person is in the process of becoming.
 HUMANISTIC NURSING THEORY
BY: JOSEPHINE PATTERSON AND LORETTA ZDERAD
• This theory reflects the experience between
people where all are influenced by their
interaction
• People are influenced by the interaction that
they make.
• Nursing works in the perspective of human
situation but sees beyond physical care.
• Concepts and definition:
1.Comfort – freedom from the
controlling effects of the past.
2.Authenticity –experiencing –
awareness of self and in relating with
others.
3.Value- offering of genuine presence
to others
The12 behaviors of the nurse that lead to patient
comfort:
1. Recognize patient by name by
introduction of one’s self
2. Educate and convey honest
information about patient’s
situation.
3. Verbalize expression of feeling and
acceptance when appropriate with
an explanation
4. Stay with or do for the patient
when verbalization of acceptance is
not appropriate.
5. Purposely express authentic and
tender feelings when acceptable
6. Support agape type love
relationship
7. Allow patient’s choices as current
capabilities allowed.
8. Assist patient understanding as current
capabilities allowed that in turn
showed respect for patient and their
right.
9. Patient expression to facilitate
understanding of behavioral messages
and respond therapeutically
10. Verify intuition of perception and
questions comments and responses
11. Realistically encourage hope through
discussion
12. Encourage and support appropriate
self-images.
Factors that affect attainment of comfort:
1. Relationships with other persons which confirms one as
an existent important person
2. Affective adaptation to the environment in accord with
knowledge potential and values
3. Awareness of and response to the reality of the now with
understanding of the influence of and separation from
the past.
4. Appreciation and recognition of both powers and
Limitations which enlighten the alternative of the future.