NURSING THEORIES

1. ENVIRONMENTAL THEORY by Florence

Nightingale
Getting to Know the THEORIST
(FLORENCE NIGHTINGALE)
Born in FLORENCE, ITALY
On May 12, 1820 (International
Nurses Day)
1st Nurse Educator- she entered
FLEIDNER SCHOOL OF
NURSING (1st nsg school in
Kaiserswerth, Germany)
The Lady with the Lamp (Crimean
War)- during the battle of English
vs Turkish, she looked for the
wounded soldiers healed them w/
her consoling hands
1st Nurse Statistician
1st Nurse Researcher
Excellent writer (Notes on Matters
Affecting the Health, Efficiency and
Hospital Administration of the
British Army, Notes on Hospitals,
Report on Measures Adopted for
Sanitary Improvements in India,
and NOTES ON NURSING)
Died at the age of 90 (August 13,
1910)
Mother of Modern Nursing
Theoretical Sources Of
Nightingales Theory
EDUCATION- her mastery in
mathematics and philosophy from her
father provided her w/ knowledge and
conceptual thought
LITERATURE- her influence with
Dickens served as a factor in her
definitions of NURSING and
Healthcare
INTELLECTUALS- political leaders,
intellectuals and social reformers of
her time influenced her theoretical and
rational thinking; inspired her to
change the things she viewed as
unacceptable in the society
RELIGIOUS BELIEFS- action for the
benefit of others is a primary way of
serving God; is a basis for defining her
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nursing work as a RELIGIOUS

CALLING; her faith provided her w/
conviction that education was a
significant factor in establishing the
profession of nursing.
THE CONCEPTS of NIGHTINGALES
THEORY (METAPARADIGM in
Nursing)
1. PERSON: the one receiving care; a
dynamic and complex being
she envisioned the person as
comprising
PHYSICAL,
INTELLECTUAL,
EMOTIONAL,
SOCIAL and SPIRITUAL components.
patient is passive (nurse should ask
the pt for his/ her preference)- nurse is
in control of the pts environment
2. HEALTH: being well and using
every power that the person has to the
fullest extent
she believed in the PREVENTION
and HEALTH PROMOTION in addition
to nursing pts from illness to health.
3. ENVIRONMENT: anything that can
be manipulated to place a pt in the
best possible condition for nature to
act.
has physical and psychological
components
PHYSICAL: ventilation, warmth, light,
nutrition, medicine, stimulation, room
temperature and activity.
PSYCHOLOGICAL:
avoiding
chattering hopes and advices and
providing variety
4. NURSING: a spiritual calling.
Nurses were to assist NATURE to
repair the patient.
NURSING PROCESS: assess pts
situation, identify need, implements a
plan of care, re-evaluates the situation,
and changes the plan accordingly.
expected nurses to use their powers
of observation in caring for pts
advocated for nurses to have
educational
background
and
knowledge different from those of
physicians

nursing
education:
clinical
experience+classroom learning
OVERVIEW
of
NIGHTINGALES
THEORY
MANIPULATION
OF
PHYSICAL
ENVIRONMENT is a major component
of nursing care
o MAJOR AREAS of Physical,
Social, and Psychological
environment:
Health of Houses
Ventilation and Warming
Light
Noise
Variety
Bed and Bedding
Cleanliness of Rooms and
Walls
Personal Cleanliness
Nutrition and Taking Food
Chattering Hopes and Advices
Observation of the Sick
Petty Management
When one or more aspects of the
environment are out of balance, the
client must use increased energy to
counter the environmental stress
(drain the pt of energy needed for
healing)
NIGHTINGALES 13 CANONS and
Nursing Process and Thought.
Is Nightingales theory accepted by the
Nursing community?
PRACTICE
- Sick Building Syndromenurses need to ask whether
buildings and constructions
meet Nightingales principle of
good ventilation and lighting.
EDUCATION
- Nightingales principles of nursing
training developed a universal pattern
for early nurse training schools
beginning with St. Thomas Hospital
and Kings College Hospital in
London
RESEARCH
- Her expertise in scientific
inquiry and statistics continues
to assist and define Nursing
Research
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She also used brief case

studies, and possible patterns
to
demonstrate
various
concepts she discussed in
Notes on Nursing.

Analysis
and
Evaluation
Nightingales Theory
SIMPLICITY
- 3 major relationships:
1. Environment to Patient
2. Nurse to Environment
3. Nurse to Patient
GENERALITY
- Her theory has been used to
provide general guidelines
for all nurse practitioners for
a number of years
- The concept of the nurse,
patient, and environment is
still applicable and relevant
in all nursing settings today
EMPIRICAL PRECISION
- Nurses should base their
practice on observations
and experiences rather
than systematic, empirical
research.
- Her concepts are stated
completely
and
are
presented as truths rather
than tentative, testable
statements.
DERIVABLE CONSEQUENCES
- Her writings continue to
motivate creative thinking
nurses and her works give
food
for
thought
that
continues to encourage the
profession

2. INTERACTIVE THEORIES
A.
THEORY
of
INTERPERSONAL
RELATIONS by HILDEGARD PEPLAU
Getting to Know the Theorist
Psychiatric Nurse of the Century
Born on September 1, 1909
Reading, Pennsylvania

at

 Graduated from a diploma program in

Pottstown, Pennsylvania in 1931
Then worked as an Operating Room
Supervisor at Pottstown Hospital
Later received a Bachelor of Arts in
Internal Psychology from Bennington
College in 1943
Finished Master of Arts in Psychiatric
Nursing from Columbia University,
New York in 1947
Achieved
EdD
in
Curriculum
Development in 1953
Had been Professor emeritus from
Rutgers University
Published
her
first
book
Interpersonal Relations in Nursing
in 1952
In 1968, introduced interpersonal
techniques- the crux of psychiatric
nursing
Was an Executive Director and
President of ANA.
Worked with WHO, NIMH, and nurse
corps.
Died peacefully at the age of 89 on
March 7, 1999
METAPARADIGM in NURSING
PERSON
a man who is an organism that lives in
an unstable balance of a given system.
tries to reduce anxiety caused by needs
HEALTH
a word that symbolizes forward
movement of personality and other
ongoing human processes in the direction
of creative, constructive, productive,
personal and community living
PHYSIOLOGICAL DEMANDS and
INTERPERSONAL CONDITIONS must
be met for ones health to be achieved
and maintained
ENVIRONMENT
Existing forces outside the organism
and in the context of culture.
NURSING
a significant therapeutic interpersonal
process (2 or more persons w/ a
common goal).

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Functions cooperatively w/ other human

processes that make health possible for
individuals in communities
therapeutic because it is a healing art,
assisting individual who is sick or in
need of health care.
OVERVIEW of PEPLAUS THEORY
1. There are 3 sequential phases in the
INTERPERSONAL
NURSE-PATIENT
RELATIONSHIP:
1. ORIENTATION PHASE
2. WORKING PHASE
a. IDENTIFICATION PHASE
b. EXPLOITATION PHASE
3. RESOLUTION PHASE
ORIENTATION PHASE
Nurse and pt come together as
strangers
Meeting initiated by patient who
expresses a FELT NEED, work
together to recognize, clarify, and
define facts related to the need
(define problem or needs)
Important to explain roles to client
and relationship with client
WORKING PHASE
a. IDENTIFICATION PHASE
pt
participates
in
GOAL
SETTING
has
a
feeling
of
BELONGINGNESS
and
selectively responds to those
who can meet his/ her needs
b. EXPLOITATION PHASE
pt actively seeks and draws
knowledge and expertise of
those who can help
nurse should be prepare the
client for termination
RESOLUTION PHASE
Occurs after other phases are
completed successfully.
Terminates the relationship
Pt should not regress and show
independence
2. Peplau advocates that the roles of the
nurse in the nurse-patient interpersonal
relationship are as follows:
STRANGER (provides acceptance
of the pt as a person and due
respect over his identity to build
TRUST)

RESOURCE PERSON (provides a

specific needed information that
aids in the understanding of a
problem or new situation)
TEACHER (imparts knowledge in
reference to a need or interest)
LEADER (helps client assume
maximum responsibility for meeting
treatment goals in a mutually
satisfying way)
SURROGATE (temporary care
giver)
COUNSELOR (nurse becomes a
listening friend and provides
guidance and encouragement to
make changes)

3. PSYCHOLOGICAL MOTHERING
includes the ff steps:
The
pt
is
ACCEPTED
UNCONDITIONALLY
as
a
participant in a relationship that
satisfies his needs
There is recognition of and
response to the pts readiness
for growth, as his initiative; and
Power in the relationship shifts to
the patient, as the pt is able to
delay gratification and to invest in
goal achievement
ACCEPTANCE BY THE NURSING
COMMUNITY
PRACTICE- Peplaus ideas paved
way for integrating other scientific
disciplines into nursing especially
formulating the paradigm of psychiatric
nursing in its early days. Her theory is
very useful in helping Psychiatric
patients.
EDUCATION- her first book is being
used as a manual of instruction to help
graduate nurses and nursing students
in creating a significant nurse-patient
relationship.
RESEARCH- lead to newer studies
that indicate that broader sets of
relationships could also affect a
person in many ways; helped nursing
experts identify ways to reduce anxiety
and stress in patients.
ANALYSIS and EVALUATION
SIMPLICITY
her theory is easily understood; basic
assumptions and key concepts were
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clearly given, explained, broken down and

outlined.
GENERALITY
her model could be effectively utilized
by all nurses in establishing a nurse-pt
relationship regardless of their area or
clinical setting; but is limited or impossible
with senile, comatose or newborn
patients.
EMPIRICAL PRECISION
her theory could be tested and
observed using pure observation, and
with
continued
research
and
development, the degree of precision
could be increased.
DERIVABLE CONSEQUENCES
Peplau is considered as one of the first
theorists after Nightingale to present a
theory in nursing. Her works have greatly
touched the lives of many patients and
nurses, from students to practitioners.
B. THE NATURE OF NURSING MODEL
by Virginia Henderson
Getting to Know the THEORIST
First Lady of Nursing
First Truly International Nurse
First Full-Time Instructor in
nursing in Virginia
a renowned teacher, researcher and
scholar
The first nursing library was named
after her by Sigma Theta Tau
International (Virginia Henderson
International Nursing Library)
Died at the age of 98 on March 19,
1996

Concepts of Hendersons Theory

(Metaparadigm in NURSING)
PERSON
an individual requiring assistance to
achieve health and independence or a
peaceful death.
mind and body are inseparable
person as PATIENT
With 14 fundamental or basic human
needs
Patient and family as a single unit
HEALTH
equated with INDEPENDENCE,
viewed in terms of the clients ability to
perform 14 components of nursing
care UNAIDED.

Basic to human functioning

Promotion of health is more important

than care of the sick

ENVIRONMENT
all external conditions and influences
that affect life ad development
Illness may interfere with the ability to
control the environment
Nurses function is to alter the
environment in such a way as to
support the patient (to aid the
physician in prescribing protective
devices, recommend changes,
construction of buildings, etc)
NURSING
assists and supports the individual in
life activities and the attainment of
independence
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 the
person would perform unaided given
the necessary strength, will or
knowledge, and to do this in such a
way as to help the individual gain
independence as rapidly as possible.
OVERVIEW of HENDERSONS
THEORY
1. Encompasses a definition of
NURSING
2. Provides description of the function
of a nurse
Nurse-patient relationship
a. as a SUBSTITUTE for the
patient
b. as a HELPER to the patient
c. as a PARTNER with the
patient
Nurse-physician relationship
Nurse as a member of the
Healthcare Team
3. Enumerates the 14 components
that make up basic nursing care
(14 basic needs)
14 BASIC NEEDS
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable
postures
5. Sleep and rest
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6. Select suitable clothesdress

and undress
7. Maintain body temperature
within normal range by adjusting
clothing and modifying
environment.
8. Keep the body clean and well
groomed and protect the
integument.
9. Avoid dangers in the
environment and avoid injuring
others.
10. Communicate with others in
expressing emotions, needs, fears,
or opinions.
11. Worship according to one's
faith.
12. Work in such a way that there
is a sense of accomplishment.
13. Play or participate in various
forms of recreation.
14. Learn, discover, or satisfy the
curiosity that leads to normal
development and health and use
the available health facilities.
Is Hendersons theory accepted by
the Nursing community?
PRACTICE
Hendersons approach focuses on
decision-making and deliberate in
such a way that in every step of the
NURSING PROCESS, it plays very
important roles (ADPIE).
EDUCATION
Henderson developed 3 phases of
curriculum
development
that
students should progress in their
learning
1st phase helping the pt perform
activities of the daily living (priority:
fundamental needs and planning of
care)
2nd phase assisting pts achieve
their needs in times of illness (more
medical approach and students
understands
the
rationale
of
physicians plans/ orders)
3rd phase centered on the pt and
family together w/ the dynamics
affecting the relationship inside the
unit.

 RESEARCH
various
research
questions
commonly arise from Hendersons 14
components of basic nursing care
Uplifted the standards of NURSING
through RESEARCH
Advocated the use of LIBRARY for
research purposes
ANALYSIS and EVALUATION
SIMPLICITY
her concept of nursing is COMPLEX
rather than simplistic.
Many
variables
and
several
descriptive interpretations could be
derived
and
other
explanatory
relationships could be seen.
GENERALITY
the
definitions
provided
by
Henderson are BROAD in scope
Cover ALL AREAS of NURSING
PRACTICE and could be APPLIED
in EVERY SETTING
DERIVABLE CONSEQUENCES
opened the doors for development
by upcoming nursing theorists
Emphasized
importance
of
NURSINGS INDEPENDENCE AND
INTERDEPENDENCE on different
healthcare professions.
Advocated curriculum development
and viewed research as an important
tool in improving clinical practice of
nursing
C. HUMAN-TO-HUMAN RELATIONSHIP BY
JOYCE TRAVELBEE
A nurse does not only seek to alleviate physical
pain or render physical care she ministers to
the whole person. The existence of the suffering
whether physical, mental or spiritual is the proper
concern
of
the
nurse.
- Joyce Travelbee

Getting to Know the Theorist

A psychiatric nurse, educator and
writer born in 1926.
1956, she completed her BSN degree
at Louisiana State University
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1959, she completed her Master of

Science Degree in Nursing at Yale
University
She started Doctoral program in
Florida in 1973. Unfortunately, she
was not able to finish it because she
died later that year. She passed away
at the prime age of 47 after a brief
sickness.
1952, Psychiatric Nursing Instructor
at Depaul Hospital Affilliate School,
New Orleans.
Also she taught at Charity Hospital
School of Nursing in Louisiana State
University, New York University and
University of Mississippi.
1970, the Project Director of
Graduate Education at Louisiana
State University School of Nursing
until her death.
Publications:
1963, started to publish articles and
journals in nursing.
1966 and 1971, publication of her first
book entitled Interpersonal Aspects
of Nursing.
1969, when she published her second
book Intervention in Psychiatric
Nursing: Process in the One-to-One
Relationship.
THEORETICAL
SOURCES
OF
TRAVELBEES THEORY
Catholic charity institutions
Ida Jean Orlando, her instructorThe
nurse is responsible for helping the
patient avoid and alleviate the distress
of unmet needs. The nurse and
patient interrelate with each other.
Viktor Frankl, a survivor of Auschwitz
and other Nazi concentration camps
proposed the theory of logotherapy
in which a patient is actually
confronted with and reoriented toward
the meaning of his life.
Concepts of Travelbees Theory
(Metaparadigm in NURSING)
PERSON

 Person is defined as a human

being.
Both the nurse and the patient are
human beings.
A human being is a unique,
irreplaceable individual who is in
continuous
process
of
becoming,
evolving
and
changing.
HEALTH
Health is subjective and
objective.
Subjective
healthis
an
individually defined state of well
being in accord with self-appraisal
of
physical-emotional-spiritual
status.
Objective healthis an absence
of discernible disease, disability
of defect as measured by physical
examination, laboratory tests and
assessment by spiritual director or
psychological counselor.
ENVIRONMENT
Environment is not clearly
defined.
She defined human conditions
and life experiences encountered
by all men as sufferings, hope, pain
and illness.
NURSING
Nursing is an interpersonal
process whereby the professional
nurse practitioner assists an
individual, family or community to
prevent or cope with experience
or illness and suffering, and if
necessary to find meaning in
these experiences.

Human-to-Human
Relationship
Model
-Humanistic revolution Interactional Phases of Humanto-Human Relationship Model:
1. Original Encounter
First impression by the nurse of
the sick person and vice-versa.
Stereotyped or traditional roles
2. Emerging Identities
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the time when relationship

begins
the nurse and patient perceives
each others uniqueness
3. Empathy
the ability to share in the persons
experience
4. Sympathy
when the nurse wants to lessen
the cause of patients suffering.
it goes beyond empathyWhen
one
sympathizes,
one
is
involved but not incapacitated
by
the
involvement.
therapeutic use of self
5. Rapport
Rapport is described as nursing
interventions that lessens the
patients
suffering.
Relation as human being to
human
being
A nurse is able to establish
rapport because she possesses
the necessary knowledge and
skills required to assist ill persons
and because she is able to
perceive,
respond
to
and
appreciate the uniqueness of the
ill human being.
Phases are in consecutive and
developmental
process.

Logical Form
- An inductive theory that uses
specific nursing situations to create
general ideas.
Is Travelbees Theory Accepted by
the Nursing Community?
PRACTICE
Hospice self-actualizing life
experience. Assumption of the sick
role. Meaning of life and sickness
and death.
EDUCATION

Teaches nurses to understand

the meaning of illness and
suffering.
RESEARCH
Applied in the theory of caring
cancer patients.
ANALYSIS and EVALUATION
Clarity
not consistent in clarity and
origin.
1. Definition of terms came from
dictionaries and books etc.
2. Used different terms for the same
definition.
3. Focus more on adult individuals
who are sick and the nurses role
in helping them to find meaning in
their sickness and suffering.
Deals in families and their needs
but not in the community
Simplicity
not simple.
1. contains different variables.
GENERALITY
Has wide scope of application
but applicable only to those
patients in distress and life
changing events.
EMPIRICAL PRECISION
Low measures of empirical
soundness.
1. Result of lack of simplicity.
2. Defines concepts theoretically
but does not define them
operationally.
3. The model has not been tested.
DERIVABLE CONSEQUENCES
development of quality of
caring.
1. It is useful because of its ability
to describe, explain, predict and
control
a
phenomena.
2. Explains the variables that affect
the establishment of a therapeutic
relationship between nurses and
patients.
3. Lack of empirical precision
also creates lack of usefulness.
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