Problem/Need Theories

Nursing Process

 It is a systematic guide to client-centered care.

 It is an evidence-based, five-step scientific method
used to ensure that the patient is assessed, diagnosed
and receives continuity of care
 Assessment is the first step and involves critical
thinking skills and data collection both subjective
and objective observation of sign and symptoms.
 Subjective data are information from the
client's point of view (“symptoms”),
including feelings, perceptions, and
concerns obtained through interviews.
 Objective data are observable and
measurable data (“signs”) obtained through
observation, physical examination, and
laboratory and diagnostic testing.

1. Assessment

 Identify the patient’s health problem(s) as well as thei physiological data, psychological,
sociocultural, spiritual, economic, and life-style factors.
 Interaction with the patient is essential during the assessment phase. The nurse should talk to the
patient and conduct an interview with the patient to ensure their medical history is complete. This
should include family history and past medical events.
o Nurses should use their core values of patience and understanding to maximize the likelihood
of finding out relevant information.
o While the nurse is conducting the interview, this is also a good opportunity to be making
general observations. The nurse may perform a physical examination or reference the exam as
performed by a physician.
 Attention to detail and critical thinking skills are essential skills to use during this phase as they allow
the nurse to identify issues and prioritize the treatments that the patient requires.
 For example, a nurse’s assessment of a hospitalized patient in pain includes not only the
physical causes and manifestations of pain, but the patient’s response—an inability to get out of
bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or
request for more pain mediation.

2. Diagnosis

 It is the nurse’s clinical judgment about the client’s response to actual or potential health
conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain
has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has
the potential to cause complications
 o For example, respiratory infection is a potential hazard to an immobilized patient. The
diagnosis is the basis for the nurse’s care plan.
 There may be more than one diagnosis if the patient has a complicated health condition.
o If a patient has a broken limb, they could also have an infection at the site of the break if the
bone has come through the skin.
 The diagnosis should be a detailed description of the issue and include any associated complications,
such as extreme pain that causes a lack of appetite and subsequent weight loss.
 The diagnosis is the foundation for the health care plan and course of treatment for the patient
and should outline how ready the patient is to move towards health improvement.

3. Planning

 The planning phase may also be known as the outcomes phase and it is the stage that involves
formulating a plan of action. It can only occur once the nurse or healthcare team and the patient, if
practical, agree on a diagnosis.
 Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and
long-range goals for this patient that might include moving from bed to chair at least three
times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving
conflict through counseling, or managing pain through adequate medication.
 Most treatment plans will include interventions conducted by the medical staff (e.g., suturing,
medication prescription, IV fluids) followed by steps taken by the patient to ensure proper
recovery.

4. Implementation

 Nursing care is implemented according to the care plan, so continuity of care for the patient
during hospitalization and in preparation for discharge needs to be assured.
 As a nurse, you will be expected to monitor the implementation to ensure the patient is
following through. If they aren’t—or if the follow-through is ineffective—you’ll want to
reevaluate the plan.

5. Evaluation

 The final phase of the nursing process is the evaluation phase. It takes place following the
interventions to see if the goals have been met.
 Once a patient completes their treatment, you and the rest of the medical staff should
review the steps taken, determine whether they worked as expected, and identify any
problems that can be corrected in the future.
 There are three possible outcomes that the nurse can use to classify the intervention:
o Patient's condition improved
o Patient's condition stabilized
o Patient's condition deteriorated, died or discharged
 If the patient has not shown improvement and the goals set were not met, a new plan must
be created by beginning the nursing process from the first step once again.

Nursing Theories
  Nursing theory provides a systematic knowledgeable apptoach to patient care and serves as a tool for
critical thinking and decision making in nursing practice

 They express beliefs about nursing and nursing related values by providing global explanation of
phenomena of interest that contribute to the nursing knowledge

Metaparadigm

 Person - Focuses on the patient, the recipient of care

 Environment - Both internal and external factors related to the patient; Either positive/negative
conditions that affects client
 Health - Degree of wellness/wellbeing client experiences; Wellness: state of best mental/physical
health
 Nursing - Refers to the nurse and how they will apply their knowledge and skills when caring for
patients; Actions of nurse providing care

Nursing Need/Problem Theories

 It is theoretical by nature with hypotheses but not necessarily based on real life or meant to be applied
to real life.
 Theoretical thinking can be really helpful when one tries to imagine a problem that needs solution and
then theories are or be tested/applied out in the practical world.
 When to use: When the problem can be seen and needs immediate response

Need/Problem Theorists and their Theories

1. Florence Nightingale (1820-1910) – Environmental Theory Founder of Modern Nursing

2. Virginiga Henderson (1897-1996) – 14 Components of Need Theory

3. Faye Abdellah (1919-2017) – 21 Nursing Problems Theory

4. Jean Watson (1940-2018) – Theory of Human Caring

5. Dorothea Orem (1914-2007) – The Theory of Self Care Deficit

6. Joyce Travelbee (1926-1973) – Human to Human Relationship Model

Metaparadigm of Problem/Need Theorists

Theorists Person Nursing Health Environment

1. Florence Recipient of care Responsibility for Holistic level of Internal & external
Nightingale someone wellness aspect of life that
influence a person
2. Virginia Patient Care both ill & well Quality of life Manage
Henderson surroundings
3. Faye Abdellah Beneficiary of care Comprehensive Healthy state of Room, home,
 service mind and body community
4. Jean Watson A functioning whole Meaningful & Unique experience Holistic healing
harmonic
connective bond
5. Dorothea Orem State of being Community service Progressive Physical, chemical,
whole development biologic, & social
6. Joyce Travelbee Unique Interpersonal Enjoyment of Not defined
irreplaceable process between 2 highest attainable
individual individuals standard

1. Florence Nightingale - "Environmental Theory"

 Health reflects the patient’s capacity for self-healing facilitated by nurses’ ability to create an
environment conducive to health.
 The focus of this nursing activity is the proper use of fresh air, light, warmth, cleanliness, quiet, proper
selection and administration of diet, monitoring the patient’s expenditure of energy, and observing. This
activity was directed toward the environment and the patient.
 A nurse’s role is to prevent an interruption of the reparative process and to provide optimal conditions
for its enhancement through careful observation and committed action to support a calm and
reparative environment.

Background: Florence Nightingale

 Born in May 12, 1820 at Florence, Italy—the city she was named for.
 She is the second daughter in a wealthy, well-educated, aristocratic English family.
 She lived during the Victorian era, an era when upper- and middle-class women were expected to either
marry a well-off gentleman or remain with relatives and tend to social and household duties.
 From a very young age, Florence Nightingale was active in philanthropy, ministering to the ill and poor
people in the village neighboring her family’s estate.
 First helped a sick dog with a broken leg
 By the time she was 16 years old, it was clear to her that nursing was her calling and believed it to be
her divine purpose.
 When Nightingale approached her parents and told them about her ambitions to become a nurse, they
were not pleased and her parents forbade her to pursue nursing.
 When Nightingale was 17 years old, she refused a marriage proposal from a “suitable” gentleman,
Richard Monckton Milnes.
 Determined to pursue her true calling despite her parents’ objections, in 1844, Nightingale enrolled as a
nursing student at the Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany.
 She studied medicine books herself for years and She was 30 when her parents let her go to Germany
and Paris to study nursing
 In October of 1853, the Crimean War broke out, Nightingale was 34 yearsold. The British Empire was at
war against the Russian Empire for control of the Ottoman Empire where no fewer than 18,000 soldiers
had been admitted into military hospitals.
  In late 1854, Nightingale received a letter from Secretary of War Sidney Herbert, asking her to organize
a corps of nurses to tend to the sick and fallen soldiers in the Crimea and Nightingale rose to her
calling.
 She had addressed environmental problems - lack of sanitation, presence of filth, and injuries from the
batle field.
 Nightingale herself spent every waking minute caring for the soldiers. In the evenings she moved
through the dark hallways carrying a lamp while making her rounds, ministering to patient after
patient. Her work reduced the hospital’s death rate by two-thirds.
 The soldiers, who were both moved and comforted by her endless supply of compassion, took to
calling her “the Lady with the Lamp.”
 International Nurses Day, May 12 is observed in respect to her contribution to Nursing.
 In Scutari, she contacted the Crimean fever - typhus or brucellosis and died in August 13, 1910, 90 years
of age.

Metaparadigm

 Nursing
 Responsible for someone
o Goal of nursing is to place the patient in the best possible condition for nature to act.
o Skilled in observing and reporting in patient's health status while providing care as the
patient recovered .
 Person
 Recipient of care
o People are multidimensional, composed of biological, psychological, social and spiritual
components.
o Respected and shoud not be judged
 Health
 Holistic level of wellness
o As a whole being of wellness
o “Not only to be well, but to be able to use well every power we have”.
o Disease is considered as dys-ease or the absence of comfort.
o Health was viewed as an additive process— the result of environmental, physical, and
psychological factors, not just the absence of disease.
 Environment
 Internal & external aspect of life that influence a person
o "Poor or difficult environments led to poor health and disease".
o "Environment could be altered to improve conditions so that the natural laws would
allow healing to occur."

Assumptions
  Natural laws - Sickness and wellness are governed by the same laws of health.
 Nursing is a calling - Nightingale viewed her involvement in nursing as a higher calling, or vocation, and
expressed the belief that other nurses should view the profession in the same way
 Nursing is an art and a science
 Nursing is achieved through environmental alternation
 Nursing requires a specific educational base - Nurses should be trained.
 Nursing is a distinct and separate from medicine - The disease process is not important to nursing.
 Nurses should be noble, disciplined, hard-working, and selfless
 Nursing could (and should) be a means of serving God through selfless service to humankind and that
this selfless service should permeate every aspect of a nurse’s existence
 Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to
reduce noise, to relieve patients’ anxieties, and to help them sleep.
 A nurse should take into account the total environment, client, other persons, the social situation, and
any other situationally related factors when providing care - The environment is important to the health
of the patient.
 The goal of nursing as described by Nightingale is assisting the patient in his or her retention of “vital
powers” by meeting his or her needs, and thus, putting the patient in the best condition for nature to act
upon
 Nursing is an independent, yet parallel, profession to medicine.
 Nursing activities should be based on the presumption that all factors within the patient’s environment
influence healing.
 Nurses should be highly trained and educated to ensure effective care.
 Nurses must be dignified, of the highest moral fiber, and selfless in the performance of their work.
 People who choose to become nurses should do so out of a desire to serve God and humanity.

Major Concepts

1. Ventilation and warming

 Recognized that the surroundings as as a source of disease and recovery.
 Check the patient's body temp, room temp, ventilation and foul odors.
 Create a plan to keep the room well- ventilated and free from odor while mainting the patient's
body temp.
2. Light and Noise
 Sunlight is beneficial to the patient
 Check room for adequate light without being direct to the source
 Noise must be prevented could harm patient.
 Check noise level in the room
 Attempt to keep noise level in minimum
3. Cleanliness of rooms/walls
 Dirty environment is a source of infection through inorganic matter it contained.
 Check room for dust, dampness and dirt
 keep room free from dust, dirt, and dampness.
4. Health of houses
 Check surrounding environment for fresh air, pure water, drainage, cleanliness, and light.
  Remove garbage, stagnant water, and ensure clean waterand fresh air.
5. Bed and bedding
 Check bed & bedding for dampness, wrinkles & soiling.
 Keep the bed dry, wrinkle-free& lowest height to ensure comfort.
6. Personal cleanliness
 Attempt to keep the patient dry & clean at all times.
 Frequent assessment of the patient’s skin is essential to maintain good skin integrity.
7. Variety
 Attempt to accomplish variety in the room & with the client.
 This is done with cards, flowers, pictures& books. Also encourage friends & relatives.
8. Chattering hopes and advices
 Avoid giving false advices
 Respect the patient as a person and avoid personal talk.
9. Taking food. What food?
 Meal scheduled and its effects on patients
 Check diet of thepatient. Note the amount of food and fluid ingested by the patient at every
meal
10. Petty management/observation
 nursing administration - nurse must have a control of the environment both physicially and
administratively.
 This ensures continuity of care.
 Document the plan of care & evaluate the outcomes to ensure continuity.
 Observe& record anything about the patient.
 Continue observation in the patient’s environment and make changes in the plan of care if
needed.
 Example: Protectig the patients of upsetting news, seeing visitors who would negatively affect
recovery, and experiencing sudden distruptions of sleep

Five Major Components of a Healing Environment

1. Ventilation
2. Light
3. Warmth
4. Control Noise
5. Control Odor

Major Premises of Environmental Adaptation Theory:

 Disease is more accurately portrayed as dys-ease or the absence of comfort.

 Symptoms alert nurses to the presence of illness.
 Breaking the natural laws will cause disease.
 Improvement in the health of individuals and families lead to the improved health of society.

Nightingale’s Six D’s of Disease

1. Dirt-refers to general hygiene, and interpersonal contact

 2. Drink—cleanliness of drinking water and the importance of drinking water
3. Diet—refers to proper and balanced diet
4. Damp—refers to a need for a dry, warm environment
5. Draughts-- can precipitate a disease episode
6. Drains—refers to proper drainage and sewage systems

Conceptual Model

The patient is at the center of the Nightingale model,

which incorporates a holistic view of the person as
someone with psychological, intellectual, and spiritual
components.

According to Nightingale’s model, nursing contributes to

the ability of persons to maintain and restore health
directly or indirectly through managing the environment.

The focus of the nursing activity is the proper

use of fresh air, light, warmth, cleanliness, quiet,
proper selection and administration of diet,
monitoring the patient’s expenditure of energy,
and observing. It puts the patient in the best
condition for nature to act upon.

2. Virginia Henderson - "Need Theory"

 Nursing is primarily assisting 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. It is likewise the unique contribution of nursing to help
people be independent of such assistance as soon as possible.
 Nurses temporarily assist an individual who lacks the necessary strength, will, and knowledge to satisfy
one or more of the 14 basic needs.
 Henderson’s Needs Theory can be applied to nursing practice as a way for nurses to set goals based
on Henderson’s 14 components. Meeting the goal of achieving the 14 needs of the client can be a great
basis to further improve one’s performance towards nursing care.

Background: Virginia Henderson

 The Nightingale of Modern Nursing

  Born in Kansas City, Missouri, in 1897; Died: March 19, 1996.
 Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington, D.C. in 1921.
It was there that she began to question the regimentation of patient care and the concept of nursing as
ancillary to medicine
 This wartime experience forever influenced her ethical understanding of nursing and her appreciation
of the importance and complexity of the nurse–patient relationship.
 Henderson wrote about nursing the way she lived it: focusing on what nurses do, how nurses function,
and nursing’s unique role in health care.

Metaparadigm

 Nursing
 Care both ill & well
o The nurse’s goal is to make the patient complete, whole, or independent.
o Nurses care for patients until patient can care for themselves once again.
 Person
 Patient
o An individual who requires assistance to achieve health and independence or in some
cases, a peaceful death.
o Able to maintain physiological and emotional balance.
o Individuals have basic needs that are component of health and require assistance to
achieve health and independence or a peaceful death.
o An individual achieves wholeness by maintaining physiological and emotional balance.
o Someone who needs nursing care but did not limit nursing to illness care.
 Health
 Quality of life
o Requires independence and interdependence
o Multifactor phenomenon → Influenced by both internal and external factors.
o Health was taken to mean balance in all realms of human life.
o It is equated with the independence or ability to perform activities without any aid in the
14 components or basic human needs.
o A good health is a challenge because it is affected by numerous factors such as age,
cultural background, emotional balance, and others
 Environment
 Manage surroundings or control the envirnonment
o Maintaining a supportive environment conducive for health is one of the elements of 14
activities for client assistance.

Assumptions

 Patients desire to return to health, but this assumption is not explicitly stated.
 Functions pertaining to patient care could be categorized as nursing and nonnursing. She believed that
limiting nursing activities to “nursing care” was a useful method of conserving professional nurse
power.
 o She defined nonnursing functions as those that are not a service to the person (mind and body).
For Henderson, examples of nonnursing functions included ordering supplies, cleaning and
sterilizing equipment, and serving food.
 The nurse is temporarily the consciousness of the unconscious, the love life for the suicidal, the leg of
the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge, and
confidence of the young mother, the mouthpiece for those too weak or withdrawn to speak.
 The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is the result of
the nurse’s creativity in planning for care.
 The nurse’s role is “to get inside the patient’s skin and supplement his strength, will or knowledge
according to his needs.”
 The theory focuses on the importance of increasing the patient’s independence to hasten their
progress in the hospital. 

14 Components of Basic Nursing Care

 The 14 components of Virginia Hendersons Need Theory show a holistic approach to nursing that
covers the physiological, psychological, spiritual and social needs.

Phsyiological Components

1. Breathe normally.
2. Eat and drink adequately.
3. Eliminate body wastes.
4. Move and maintain desirable postures.
5. Sleep and rest.
6. Select suitable clothes-dress 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.

Psychological

10. Communicate with others in expressing emotions, needs, fears, or opinions.

11. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the
available health facilities.

Spiritual & Moral

12. Worship according to one’s faith.

Sociologically oriented to occupation and recreation

13. Work in such a way that there is a sense of accomplishment.

14. Play or participate in various forms of recreation.

Conceptual Model
Henderson’s Summary of Nursing Process

Nursing Process Henderson’s 14 components and definition of

nursing
Nursing Assessment Henderson’s 14 components
Nursing Diagnosis Analysis: Compare data to knowledge base of health
and disease.
Nursing plan Identify individual’s ability to meet own needs with or
without assistance, taking into consideration
strength, will or knowledge.
Nursing implementation Document how the nurse can assist the individual,
sick or well.
Assist the sick or well individual in to performance of
activities in meeting human needs to maintain
health, recover from illness, or to aid in peaceful
death.
Nursing process Implementation based on the physiological
principles, age, cultural background, emotional
balance, and physical and intellectual capacities.
Carry out treatment prescribed by the physician.
Nursing evaluation Henderson’s 14 components and definition of
nursing
Use the acceptable definition of nursing and
appropriate laws related to the practice of nursing.
The quality of care is drastically affected by the
preparation and native ability of the nursing
personnel rather than the amount of hours of care.
Successful outcomes of nursing care are based on
the speed with which or degree to which the patient
performs independently the activities of daily living
3. Faye Abdellah – “ The 21 Nursing Problems Theory”
  Abdellah’s theory provides a basis for determining and organizing nursing care. The problems also
provide a basis for organizing appropriate nursing strategies.
 Using Abdellah’s concepts of health, nursing problems, and problem solving, the theoretical statement
of nursing that can be derived is the use of the problem solving approach with key nursing problems
related to health needs of people. From this framework, 21 nursing problems were developed.
 “Nursing is based on an art and science that mold the attitudes, intellectual competencies, and
technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with
their health needs”

Background

 Birth: March 13, 1919 in New York City

 “First woman to become a surgeon general as a nurse”
 Columbia University • Bachelors Degree in Nursing 1945 • Masters Degree in Physiology 1947 •
Doctorate in Education 1955
 German hydrogen-fueled airship Hindenburg exploded over Lakehurst, New Jersey on May 6, 1937. "I
could see people jumping from the zeppelin and I didn't know how to take care of them, so it was then
that I vowed that I would learn nursing."
 U.S. Public Health Service (Branch of Military) • Chief Nurse Officer • Deputy U.S. Surgeon General •
Uniformed Services University of Health Sciences • Founder and First Dean, Graduate School of Nursing
• Yale University School of Nursing • Nursing Instructor
 Abdellah’s patient - centered approach to nursing was developed inductively from her practice and is
considered a human needs theory.
 The theory was created to assist with nursing education and is most applicable to the education of
nurses.
 Although it was intended to guide care of those in the hospital, it also has relevance for nursing care in
community settings.

Metapardigm

 Nursing
 Nursing is a helping profession.
o Nursing care is doing something to or for the person or providing information to the
person with the goals of meeting needs, increasing or restoring self-help ability, or
alleviating impairment.
o Nursing is broadly grouped into the 21 problem areas to guide care and promote use
of nursing judgment.
o Nursing to be comprehensive and all-inclusive service.
o Nursing is based on an art and science that mold the attitudes, intellectual
competencies, and technical skills of the individual nurse into the desire and ability
to help people , sick or well, cope with their health needs."
 Person
 Benificiary of care as individuals
o Abdellah describes people as having physical, emotional, and sociological needs.
 o Needs may be OVERT➔ largely physical needs • COVERT ➔ emotional, sociological
and interpersonal needs - which are often missed and perceived incorrectly.
o Patient is described as the only justification for the existence of nursing.
o Individuals (and families) are the recipients of nursing
o Health, or achieving of it, is the purpose of nursing services.
 Health
 Healthy state of mind and body
o A state mutually exclusive of illness.
o 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.
 Environment
 Room, home, community
o The environment is the home or community from which patient comes.
o Society is included in “planning for optimum health on local, state, national, and
international levels”.

Abdellah explained nursing as a comprehensive service, which includes:

 Recognizing the nursing problems of the patient

 Deciding the appropriate course of action to take in terms of relevant nursing principles
 Providing continuous care to relieve pain and discomfort and provide immediate security for the
individual
 Adjusting the total nursing care plan to meet the patient’s individual needs
 Helping the individual to become more self directing in attaining or maintaining a healthy state of mind
& body
 Instructing nursing personnel and family to help the individual do for himself that which he can within
his limitations
 Helping the individual to adjust to his limitations and emotional problems
 Working with allied health professions in planning for optimum health on local, state, national and
international levels
 Carrying out continuous evaluation and research to improve nursing techniques and to develop new
techniques to meet the health needs of people.
 (In 1973, the item 3, - “providing continuous care of the individual’s total health needs” was eliminated.)

Assumptions (are related to:)

 The change and anticipated changes that affect nursing.

 The need to appreciate the interconnectedness of social enterprises and social problems;
 The impact of problems such as poverty, racism, pollution, education, and so forth on health care
delivery.

10 Steps To Identify Clients' Problems

1. Learn to know the patient

2. Sort out relevant and significant data
 3. Make generalizations about available data in relation to similar nursing problems presented by other
patients
4. Identify the therapeutic plan
5. Test generalizations with the patient and make additional generalizations
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
affecting his behavior
8. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan
9. Identify how the nurses feels about the patient’s nursing problems
10. Discuss and develop a comprehensive nursing care plan

11 Nursing Skills

1. Observation of health status

2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel resources
8. Problem-solving
9. Direction of work of others
10. Therapeutic use of the self
11. Nursing procedure

Requirements of Care + 21 Nursing Problems = NURSING DIAGNOSIS

Four Categories of Patient Needs

1. Basic to all patients

 Maintain good hygiene and physical comfort
 Promote optimal activity (exercise, rest and sleep)
 Promote safety (prevention of accidents, injury or other trauma and through the prevention of
the spread of infection)
 Maintain good body mechanics and prevent or correct deformity.
2. Sustenal care needs
 Facilitate the maintenance of a supply of oxygen to all body cells
 Facilitate the maintenance of nutrition of all body cells
 Facilitate the maintenance of elimination
 Facilitate the maintenance of fluid and electrolyte balanceRecognize the physiological
responses of the body to disease conditions
 Facilitate the maintenance of regulatory mechanisms and functions
 Facilitate the maintenance of sensory function.
3. Remedial care needs
 Needs identify and accept positive and negative expressions, feelings, and reactions
  Identify and accept the interrelatedness of emotions and organic illness
 Facilitate the maintenance of effective verbal and non-verbal communication
 Promote the development of productive interpersonal relationships
 Facilitate progress toward achievement of personal spiritual goals
 Create and maintain a therapeutic environment
 Facilitate awareness of the self as an individual with varying physical, emotional, and
developmental needs

4. Restorative care needs.

 Needs include the acceptance of the optimum possible goals in light of limitations, both
physical and emotional
 Use of community resources as an aid to resolve problems that arise from illness
 Understanding of the role of social problems as influential factors in the case of illness.

21 Nursing Problems

Acknowledging the influence of Henderson. She expanded Henderson's 14 needs, which served as a
knowledge base for nursing.

Three major categories:

 Physical, sociological, and emotional needs of clients

 Types of interpersonal relationships between the nurse and patient
 Common elements of client care
 Basic to All Patients
 To maintain good hygiene and physical comfort
 To promote optimal activity: exercise, rest and sleep
 To promote safety through the prevention of accidents, injury, or other trauma and through the
prevention of the spread of infection
 To maintain good body mechanics and prevent and correct deformity
 Sustenal Care Needs
 To facilitate the maintenance of a supply of oxygen to all body cells//
 To facilitate the maintenance of nutrition of all body cells
 To facilitate the maintenance of elimination
 To facilitate the maintenance of fluid and electrolyte balance
 To recognize the physiological responses of the body to disease conditions
 To facilitate the maintenance of regulatory mechanisms and functions
 To facilitate the maintenance of sensory function.
 Remedial Care Needs
 To identify and accept positive and negative expressions, feelings, and reactions
 To identify and accept the interrelatedness of emotions and organic illness
 To facilitate the maintenance of effective verbal and non verbal communication
 To promote the development of productive interpersonal relationships
 To facilitate progress toward achievement of personal spiritual goals
  To create and / or maintain a therapeutic environment
 To facilitate awareness of self as an individual with varying physical , emotional, and
developmental needs
 Restorative Care Needs
 To accept the optimum possible goals in the light of limitations, physical and emotional
 To use community resources as an aid in resolving problems arising from illness
 To understand the role of social problems as influencing factors in the case of illness

Nursing Process Use of 21 Problems in the Nursing Process

Nursing Assessment  Nursing problems provide guidelines for the
collection of data.
 A principle underlying the problem solving
approach is that for each identified problem,
pertinent data are collected.
 The overt or covert nature of the problems
necessitates a direct or indirect approach,
respectively.
Nursing Diagnosis  Nursing problems provide guidelines for the
collection of data.
 A principle underlying the problem solving
approach is that for each identified problem,
pertinent data are collected.
 The overt or covert nature of the problems
necessitates a direct or indirect approach,
respectively.
Nursing plan The statements of nursing problems most closely
resemble goal statements. Once the problem has
been diagnosed, the nursing goals have been
established.

Nursing implementation Using the goals as the framework, a plan is

developed and appropriate nursing interventions are
determined.
 Nursing evaluation The most appropriate evaluation would be the nurse
progress or lack of progress toward the achievement
of the stated goals.

4. Jean Watson – “Theory of Human Caring”

 Nursing is defined by caring. By actively engaging in caring through authentic

presence and intentionality, the nurse is able to optimize her patient’s ability to heal from within.
 Caring is a mutually beneficial experience for both the patient and the nurse, as well as between all
health team members. In addition, it is important to remember that Watson emphasizes that we must
care for ourselves to be able to care for other.
 The theory is focused on “the centrality of human caring and on the caring-to-caring transpersonal
relationship and its healing potential for both the one who is caring and the one who is being cared for.
 In Watson’s view, the disease might be cured, but illness would remain because, without caring, health
is not attained. 
 Time must be spent with the patient in order to understand “their” story and Time is needed to listen,
and understand each unique situation and find out what’s important to each individual patient.

Background

 Born in West Virginia, US in the 1940s.

 Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD, University of
Colorado, 1973
 Distinguished Professor of Nursing and Chair in Caring Science at the University of Colorado Health
Sciences Center.
 Dean of Nursing at the University Health Sciences Center and President of the National League for
Nursing
 Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in
educational psychology and counseling.
  Six (6) Honorary Doctoral Degrees.

Metaparadigm

 Person
 A functioning whole
o Human being is a valued person to be cared for, respected, nurtured, understood, and
assisted
o A person as a fully functional integrated self. Human is viewed as greater than and
different from the sum of his or her parts.
 Nursing
 Meaningful & harmonic connective bond
o Actual caring occasion involves actions and choices by the nurse and the individual. The
moment of coming together in a caring occasion presents the two persons with the
opportunity to decide how to be in the relationship – what to do with the moment.
o The transpersonal concept is an intersubjective human-to-human relationship in which
the nurse affects and is affected by the person of the other. Both are fully present in the
moment and feel a union with the other; they share a phenomenal field that becomes
part of the life story of both.
o A caring moment consists of actions and choices made by both the nurse and the
patient. The moment of coming together presents each with the opportunity to decide
how to participate in the relationship. If the caring moment is transpersonal, the client
and nurse feel connected with one another at the spiritual level, and thus the moments in
the interaction transcend time and space and open up new possibilities for healing and
human connection at a deeper level than physical, social, or verbal interaction
 Health
 Unique experience
o Health is the unity and harmony within the mind, body, and soul. It is associated with the
degree of congruence (compatibility) between the self as perceived and the self as
experienced. It is defined as a high level of overall physical, mental, and social
functioning, a general adaptive-maintenance level of daily functioning, and the absence
of illness, or the presence of efforts leading to the absence of illness.
o Health is viewed as overall functioning and distress and disharmony can be caused by
more than just disease processes
 Environment
 Holistic healing
o Society provides the values that determine how one should behave and what goals one
should strive toward.
o A caring environment accepts a person as he or she is, and looks to what he or she may
become.
o Watson states: “Caring (and nursing) has existed in every society. Every society has had
some people who have cared for others. A caring attitude is not transmitted from
generation to generation by genes. It is transmitted by the culture of the profession as a
unique way of coping with its environment.”
7 Assumption

1. Caring can be effectively demonstrated and practiced only interpersonally.

2. Caring consists of carative factors that result in the satisfaction of certain human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept person not only as he or she is now but as what he or she may become.
5. A caring environment is one that offers the development of potential while allowing the person to
choose the best action for himself or herself at a given point in time.
6. Caring is more “ healthogenic” than is curing.
7. A science of caring is complementary to the science of curing.The practice of caring is central to
nursing.

10 Primary Carative Factors

(Simplified)

1. Embrace: Altruistic Values and Practice Loving Kindness with Self and Others
2. Inspire: Faith and Hope and Honor Others
3. Trust: Self and Others by Nurturing Individual Beliefs, Personal Growth and Practices
4. Nurture: Helping, Trusting, Caring Relationships
5. Forgive: and Accept Positive and Negative Feelings – Authentically Listen to Another’s Story
6. Deepen: Scientific Problem Solving Methods for Caring Decision Making
7. Balance: Teaching and Learning to Address the Individual Needs, Readiness and Learning Styles
8. Co-Create: a Healing Environment for the Physical and Spiritual Self which Respects Human Dignity
9. Minister: To Basic Physical, Emotional and Spiritual Human Needs
10. Open: to Mystery and Allow Miracles to Enter

1. The formation of a humanistic- altruistic system of values.

 Altruistic system of values becomes the practice of loving kindness and equanimity within the
context of caring consciousness.
 Begins developmentally at an early age with values shared with the parents.
 Mediated through ones own life experiences, the learning one gains and exposure to the
humanities.
 Is perceived as necessary to the nurse’s own maturation which then promotes
altruistic(unselfish) behavior towards others.
2. The installation of faith-hope.
 Hope becomes being authentically present and enabling and sustaining the deep belief system
and subjective life world of self and one being cared for.
 Is essential to both the carative and the curative processes.
 When modern science has nothing further to offer the person, the nurse can continue to use
faith-hope to provide a sense of well-being through beliefs which are meaningful to the
individual.
3. The cultivation of sensitivity to one’s self and to others.
  Cultivation of sensitivity to one’s self and to others becomes cultivation of one’s own spiritual
practices and transpersonal self, going beyond ego self, opening to others with sensitivity and
compassion
 Explores the need of the nurse to begin to feel an emotion as it presents itself.
 Development of one’s own feeling is needed to interact genuinely and sensitively with others.
 Striving to become sensitive, makes the nurse more authentic, which encourages self-growth
and self-actualization, in both the nurse and those with whom the nurse interacts.
 The nurses promote health and higher level functioning only when they form person to person
relationship.
4. The development of a helping-trust relationship
 Development of a helping–trusting, human caring relationship becomes developing and
sustaining a helping–trusting, authentic caring relationship.
 Strongest tool is the mode of communication, which establishes rapport and caring.
 Characteristics needed to in the helping-trust relationship are:
 Congruence
 Empathy
 Warmth
 Communication includes verbal, nonverbal and listening in a manner which connotes
empathetic understanding.
5. The promotion and acceptance of the expression of positive and negative feelings.
 Promotion and acceptance of the expression of positive and negative feelings becomes being
present to, and supportive of, the expression of positive and negative feelings as a connection
with deeper spirit of self and the one being cared for (authentically listening to another’s story).
 “Feelings alter thoughts and behavior, and they need to be considered and allowed for in a
caring relationship”.
 Awareness of the feelings helps to understand the behavior it engenders.
 The systematic use of the scientific problem-solving method for decision making
 The scientific problem- solving method is the only method that allows for control and prediction,
and that permits self-correction.
 The science of caring should not be always neutral and objective.

6. The promotion of interpersonal teaching-learning.

 Systematic use of a creative problemsolving caring process becomes creative use of self and
all ways of knowing as part of the caring process; to engage in the artistry of caring-healing
practices (creative solution seeking becomes caritas coach role).
 The caring nurse must focus on the learning process as much as the teaching process.
 Understanding the person’s perception of the situation assist the nurse to prepare a cognitive
plan.
7. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and
spiritual environment.
  Promotion of transpersonal teachinglearning becomes engaging in genuine teaching-learning
experience that attends to unity of being and meaning, attempting to stay within others’ frames
of reference.
 Watson divides these into eternal and internal variables, which the nurse manipulates in order to
provide support and protection for the person’s mental and physical well-being.
 The external and internal environments are interdependent.
 Nurse must provide comfort, privacy and safety as a part of this carative factor.
8. Assistance with the gratification of human needs.
 Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual
environment becomes creating a healing environment at all levels (a physical and nonphysical,
subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity,
and peace are potentiated).
 It is based on a hierarchy of need similar to that of the Maslow’s.
 Each need is equally important for quality nursing care and the promotion of optimal health.
 All the needs deserve to be attended to and valued.
9. Watson’s ordering of needs
 Assistance with gratification of human needs becomes assisting with basic needs, with an
intentional caring consciousness, administering “human care essentials,” which potentiate
wholeness and unity of being in all aspects of care; sacred acts of basic care; touching
embodied spirit and evolving spiritual emergence.
 Lower order needs (biophysical needs)
o The need for food and fluid
o The need for elimination
o The need for ventilation
 Lower order needs (psychophysical needs)
o The need for activity-inactivity
o The need for sexuality
 Higher order needs (psychosocial needs)
o The need for achievement
o The need for affiliation
 Higher order need (intrapersonal-interpersonal need)
o The need for self-actualization
10. The allowance for existential-phenomenological forces. 
 Allowance for existential–phenomenological–spiritual forces becomes opening and attending
to spiritual-mysterious and existential dimensions of one’s own life-death; soul care for self and
the one being cared for. “Allowing for miracles.”
 Phenomenology is a way of understanding people from the way things appear to them, from
their frame of reference.
 Existential psychology is the study of human existence using phenomenological analysis.
 This factor helps the nurse to reconcile and mediate the incongruity of viewing the person
holistically while at the same time attending to the hierarchical ordering of needs.
 Thus the nurse assists the person to find the strength or courage to confront life or death.
Watson’s theory and nursing process

 Nursing process contains the same steps as the scientific research process. They both try to solve a
problem. Both provide a framework for decision making.

Conceptual Model

Watson’s hierarchy of
needs begins with lower-order
biophysical needs or survival
needs, which include the need for
food and fluid, elimination, and
ventilation. Next are the lower-
order psychophysical
needs or functional needs, which
include the need for activity,
inactivity, and sexuality. The higher
order psychosocial
needs or integrative needs include
the need for achievement, and
affiliation. And finally the higher
order intrapersonal-interpersonal
need or growth-seeking
need which is self-actualization.

5. Dorothea Orem: “Self-Care Model/ Self Care Deficit Theory”

  Nursing is needed when the individual cannot maintain continuously that amount and quality of self-
care necessary to sustain life and health, recover from disease or injury, or cope with their effects.
 The theory signifies that all patients want to care for themselves, and they are able to recover more
quickly and holistically by performing their own self-care as much as they’re able. This theory is
particularly used in rehabilitation and primary care or other settings in which patients are encouraged
to be independent.
 Self-care is the performance or practice of activities that individuals initiate and perform on their own
behalf to maintain life, health, and well-being.
 Though this theory greatly influences every patient’s independence, the definition of self-care cannot be
directly applied to those who need complete care or assistance with self-care activities such as the
infants and the aged.
 With children, the condition is the inability of the parent (or guardian) associated with the child’s health
state to maintain continuously for the child the amount and quality of care that is therapeutic.

Background: Dorothea Orem

 Born in Baltimore, Maryland, in 1914.

 Orem earned her diploma in nursing in the 1930s.
 In 1939, she earned her Bachelor of Science degree in nursing education, which was followed by a
Master of Science degree in nursing education in 1945 from the Catholic University of America.
 Over her long professional career, Orem has worked as a staff nurse, a private duty nurse, a nursing
faculty member, an administrator, and a consultant.
 Orem’s nursing concept of self-care was first published in 1959. She continued to develop this theory
and in 1980 published the first edition of Nursing: Concepts of Practice, the sixth edition appearing in
2001.
 Orem worked as a nurse consultant in Savannah, Georgia, until her death on June 22, 2007, at the age
of 92.
 Dorothea E. Orem (1914–2007) dedicated her life to creating and developing a theoretical structure to
improve nursing practice.
 Orem worked independently and then collaboratively until her death at age 93. For a lifetime of
contributions to nursing science and practice, Orem received honors from organizations such as Sigma
Theta Tau, the American Academy of Nursing, the National League for Nursing, and Catholic University
of America as well as four honorary doctorates.

Metaparadigm

 Nursing
 Community service
o Nursing is an art through which the practitioner of nursing gives specialized assistance
to persons with disabilities which makes more than ordinary assistance necessary to
meet needs for self-care.
o Skilled professional who evaluates and acknowledges a patient’s health deficit.
o Nursing plans and implements care based : actual and potential self-care deficits
 Humans
 State of being whole
 o Humans are defined as “men, women, and children cared for either singly or as social
units,” and are the “material object” of nurses and others who provide direct care.
o Individual or group of individuals who have the ability to acquire the knowledge
necessary to perform tasks of self care
 Environment
 Physical, chemical, biologic, & social
o The environment has physical, chemical and biological features. It includes the family,
culture, and community.
o Physical - Shelter Security- internal and external Climate Amenities eg. Heat, electricity,
indoor plumbing, sanitation
o Chemical - Pollutants: Air, Water
o Biological – Molds, Pollens, Allergens, Mites, Animal waste and its by-products
o Socioeconomic - Family income, Education level, Occupation, Social status, Resources
 Health
 Progressive development
o Health is “being structurally and functionally whole or sound.”
o Also, health is a state that encompasses both the health of individuals and of groups,
and human health is the ability to reflect on one’s self, to symbolize experience, and to
communicate with others.
o Promotes function and development within social groups in accordance with human
potential, known human limitation, and the human desire to return to normal

Formalized three (3) Nursing theories which are interconnected into one model

1. Theory of Self-care
2. Theory of self-care deficit
3. Theory of nursing system

1. Self-care

“Self –care comprises the practice of activities that maturing and mature persons initiate and perform, within
time frames, on their own behalf in the interest of maintaining life, healthful functioning, continuing personal
development and well-being through meeting known requisites for functional and developmental regulations”

Theory of Self-Care (TSC) The central idea describes self-care in contrast to other forms of care. Self-care, or
care for oneself, must be learned and be deliberately performed for life, human functioning, and well-being.
Self-care involves the four aspects of self-care, self-care agency, basic conditioning factors, and therapeutic
self-care demand.

a) Self-care is what people plan and do on their own behalf to maintain life, health, and well-being. When
selfcare is effectively performed, it helps maintain structural integrity and human functioning and
contributes to human development. Although engagement in purposeful self-care may not improve
health or well-being, a positive outcome is assumed. Dependent care is performed by mature,
responsible persons on behalf of socially dependent individuals or selfcare agents such as an infant,
child, or cognitively impaired person. The purpose is to meet the person’s health-related demands
and/or to develop their self-care capabilities
  In practice, the nurse’s understanding of each of these phases of investigating, deciding, and
producing self-care is essential for positive health outcomes. Take two situations: A pregnant
woman avoids alcohol for her fetus’s health and a woman with breast cancer requires
chemotherapy for life and health. Each woman must first know and understand the relationship
of self-care to life, health, and well-being. Decision making follows, such as deciding to avoid
alcohol or choosing to engage in chemotherapy. Finally, the individual must take action, such as
not drinking when offered alcohol or accepting chemotherapy treatment. Without each phase,
self-care does not occur The pregnant woman may know the dangers to her fetus and decide
not to drink but engage in drinking when pressured to do so. The woman with cancer may
understand the health outcome without treatment, decide to have treatment, then not follow
through because transportation to chemotherapy sessions disrupts her husband’s employment.
Because each phase of the action sequence has many components, nurses often provide partial
support to patients and self-care action does not occur. If skills related to the operation to avoid
alcohol when pressured or the operations necessary for transportation to a cancer center are
not anticipated by the nurse for these patients, the selfcare action sequences may not be
completed. Then outcomes related to life, health, and wellbeing are affected.
b) Self-care agency is a person’s acquired ability to engage in self-care. Self-care agency is therefore the
maturing individual’s capability for deliberate action to care for self. Dependent care agency is a
complex acquired ability of mature or maturing persons to know and meet some or all of the self-care
requisites of persons who have health-derived or health associated limitations of self-care agency. At
this concrete level, the capabilities of knowing, deciding, and acting or producing self-care are
necessary. If these capabilities do not exist, then the abilities of others are necessary, such as the
family member or the nurse.
c) Selfcare agency is affected by basic conditioning factors that include age, gender, developmental and
health states, sociocultural factors, healthcare system factors, family system factors, patterns of living,
environmental factors, and adequacy and availability of resources.
 For example, the family system factor such as living alone or with others may affect the
person’s ability (self-care agency) to care for self after hospital discharge. The self-care demand
(care requirements) of a person taking insulin for type 2 diabetes will vary based on availability
of resources and health system services (e.g., access to medications and care services).
d) Therapeutic self-care demand refers to what is needed at various times in a person’s life when health
care is required to meet self-care needs through the use of appropriate actions and interventions
(George, 2002). It summarizes all actions that should be performed over time for life, health, and well-
being. Constructing or calculating a TSCD requires extensive nursing knowledge of evidenced-based
practice, communication, and interpersonal skills. Both scientific nursing knowledge and knowledge of
the person and environment are merged to formulate what needs to be done in a particular nursing
situation. For example, a mental health patient will have different needs based on the type of mental
health condition (health state), family system factors, and health-care resources. Orem identified the
following primary needs that must be met by human beings to ensure adequate self-care.
1. Sufficient intake of air, water, and food
2. Adequate care and functioning of elimination
3. Balance between activity and rest
4. Balance between solitude and social interaction
 5. Prevention of hazards to human life, functioning, and well-being
6. Promotion of functioning and appropriate development within social groups in accord with
human potential, limitations, and the human desire to be normal
When a person is in the position of needing medical care to diagnose or correct an illness,
adequate self-care also includes the following (Orem, 2001):
1. Seeking and securing medical help when needed
2. Responsibly attending to the effects and results of pathologic conditions
3. Effectively carrying out prescribed interventions
4. Responsibly attending to the regulation of effects resulting from prescribed interventions
5. Accepting the fact that sometimes self or others need medical help when faced with certain
life challenges
6. Learning to live productively with the effects of pathologic conditions and treatments while
promoting continued personal development

2. Self-care deficit

 Theory of Self-Care Deficit The central idea describes why people need nursing.
 To engage in self-care, persons must have values and capabilities to learn (to know), to decide, and to
manage self (to produce and regulate care).
 Occurs when an individual cannot carry out self-care requisites
 Examples of self-care requisites are: Wound care, Activities of Daily Living, Bowel program, and Glucose
monitoring
 The Theory of SelfCare has three components: Universal, Developmental, and Health deviation
o Universal Self-Care Requisite: Air, Food, Water, Elimination/Excretion, Activity & Rest,
Solitude/Social interaction, Functioning/Well-being, Normalcy
o Developmental Self-Care Requisites - Composed of 3 needs, Promote development, Engage in
self-development, Preventing or overcoming adverse human conditions and life situations
o Health Deviation SelfCare Requisites - When a condition permanently or temporarily alters
structural, physiological or psychological function; Comatose states; Autism; Mental
Retardation
 Self-care deficit results when adults or parents with dependent children are incapable of providing
continuously effective self-care. Nursing care may be required if there is a need for education to
enhance self-care abilities, if there is a current deficit in self-care abilities, or if it is anticipated that self-
care abilities will decrease in the future. The five methods of helping, to be used alone or in
combination when there is concern over a self-care deficit, are as follows (Orem, 2001):

1. Acting for or doing for another

2. Guiding and directing

3. Providing physical or psychological support

4. Providing and maintaining an environment that supports personal development

5. Teaching

3. Nursing Systems
  The central focus is the product of nursing, establishing both structure and content for nursing practice
as well as the nursing role.
 Orem describes a nursing system as an action or a sequence of actions performed for a purpose. This
is a composite of all the nurse’s concrete actions to be completed with a self-care agent to promote
life, health, and well-being.
 Nursing systems are designed by nurses based on an assessment of the individual’s self-care needs.
“If there is a deficit between what the individual can do (self-care agency) and what needs to be done to
maintain optimum functioning (therapeutic self-care demand), then nursing is required” (George, 2002,
p. 131).
 Orem has described three kinds of nursing systems that are meant to meet the variable needs of
individual situations.

1. The wholly compensatory system is one in which patient

action is limited and the nurse accomplishes most of what
is required to maintain therapeutic self-care, compensates
for the patient’s inability to engage in self-care, and
supports and protects the patient; - patient is unable to
complete any self-care independently; nursing compensates
for patient’s inability to perform selfcare

Example: Nurse can assist postoperative client to ambulate, Nurse

can bring a meal tray for client who can feed himself

2. The partially compensatory system is one in which the

patient and nurse work together to meet self-care
requirements, with the patient performing some of the tasks
necessary for successful self-care and the nurse performing
whatever else is required; - patient is able to perform self-
care tasks with partial or no assistance from nursing.

Example: Nurse can assist postoperative client to ambulate, Nurse can

bring a meal tray for client who can feed himself

3. The supportive-educative system is one in which the

patient provides necessary self-care, and the nurse and patient work together to regulate the
exercise and development of self-care agency; patient able to perform tasks independently.
Nursing provides ongoing education and support.

Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive
coping strategies.

These three combined concepts of self-care, self-care deficit, and nursing systems make up a general Self-
Care Model with a three-step nursing process that can be compared with the widely used nursing process.
Orem’s three steps follow, with corresponding nursing process steps provided in parentheses (George, 2002):
 1. Diagnosis and prescription includes determining why nursing care is needed through careful analysis
and interpretation of information gathered while assessing the patient. This is the step when nurses
make professional judgments regarding what care to provide (assessment and nursing diagnosis,
including desired outcomes).

2. Design of a nursing system and plan for delivery of care to achieve desired outcomes (plans with
scientific rationale).

3. Production and management of nursing systems (implementation and evaluation)

In summary, Orem’s Self-Care Model describes a structure wherein the nurse assists the client, where needed,
to maintain an adequate level of self-care. The degree of nursing care and intervention depends on the degree
to which the client is able (or unable) to meet self-care needs. This theory is structured in such a way that the
concepts are straightforward to understand and apply. The simplicity of wording, coupled with an uncanny
resonance with everyday nursing activities, has ensured its broad popularity and use in many areas of nursing.

Conceptual Model

Assumption:

 Normal People who live in the community want to remian as independent and in control as possible
 Individuals are responsible for their own care
 In order to stay alive and remain functional, humans engage in constant communication and connect
among themselves and their environment. 
 The power to act deliberately is exercised to identify needs and to make needed judgments. 
 Mature human beings experience privations in the form of action in care of self and others involving
making life-sustaining and function-regulating actions.
 Human agency is exercised in discovering, developing, and transmitting to others ways and means to
identify needs for, and make inputs into, self and others.
 Groups of human beings with structured relationships cluster tasks and allocate responsibilities for
providing care to group members.
  There are instances wherein patients are encouraged to bring out the best in them despite being ill for a
period of time. This is very particular in rehabilitation settings, in which patients are entitled to be more
independent after being cared for by physicians and nurses.
  It is considered a grand nursing theory, which means the theory covers a broad scope with general
concepts that can be applied to all instances of nursing.

6. Joyce Travelbee – “Human to human Relationship Theory”

 Nursing is fulfilled by means of human-to-human relationship. She defined nursing as “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”.
 “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.”  
 It emphasized on the therapeutic human relationship beween the nurse and the patient.

Background: Joyce Travelbee

 A psychiatric nurse, educator, and writer.

 1956, she completed her BSN degree at Louisiana State University.
 1959, she completed her Master of Science Degree in Nursing at Yale University.
 1952, Psychiatric Nursing Instructor at Depaul Hospital Affiliate School, New Orleans. Later in Charity
Hospital School of Nursing in Louisiana State University, New York University and the University of
Mississippi.
 Joyce Travelbee started a 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

Metaparadigm

 Person
 Unique irreplaceable individual
 o Person is defined as a human being. Both the nurse and the patient are human beings.
 Health
 Enjoyment of highest attainable standard
o Health is subjective and objective.
o Subjective health is an individually defined state of well being in accord with self-
appraisal of physical-emotional-spiritual status.
o Objective health is an absence of discernible disease, disability or defect as measured
by physical examination, laboratory tests and assessment by a spiritual director or
psychological counselor.
 Environment
 NOT clearly defined.
 Nursing
 Interpersonal process between 2 individuals
o “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.”

Major Concepts

 Existential theory believes that that humans are constantly faced choices and conflicts and is
accountable to the choices we make in life
 Travelbee extended the interpersonal relationship theories of Peplau and Orlando.
 Suffering - "An experience that varies in intensity, duration and depth ... a feeling of unease, ranging
from mild, transient mental, physical or mental discomfort to extreme pain and extreme tortured ..."
 Meaning - Reason as oneself attributes
 Nursing - Help man to find meaning in the experience of illness and suffering. • Responsibility to help
individuals and their families to find meaning. The nurses' spiritual and ethical choices, and perceptions
of illness and suffering, is crucial to helping to find meaning.
 Hope
o Hope is a faith that can and will be change that would bring something better with it.
o Hope's core lies in a fundamental trust the outside world, and a belief that others will help
someone when you need it.
 6 important factors characteristics of hope are:
o Strongly associated with dependence on other people.
o Future oriented.
o Linked to elections from several alternatives or escape routes out of its situation.
o The desire to possess any object or condition, to complete a task or have an experience.
o Confidence that others will be there for one when you need them.
o The hoping person is in possession of courage to be able to acknowledge its shortcomings and
fears and go forward

Human-to-human relationship

She expressed that achieving the goal of nursing necessitates a genuine human-to-human relationship, which
can only be established by an interaction process, this process is further divided into five phases. The 5
interactional phases of Travelbee’s model are in consecutive order and developmentally achieved by the nurse
and the patient as their relationship with each other goes deeper and more therapeutic.

1. Phase of the Original Encounter: First impression by the nurse with the ill person.
 Emotional knowledge colors impressions and perceptions of both nurse and patient during initial
encounters.
 The task is “to break the bond of categorization in order to perceive the human being in the patient”
and vice versa.
 Patients are the same human beings as us and families; only, that they need other human beings
specifically nurses and doctors for maintaining health. Health, which, Travelbee defines in two
categories: subjective and objective.
o Subjective health is an individually defined state of well-being in accord with self-appraisal
of physical-emotional-spiritual status.
o Objective health is an absence of discernable disease, disability of defect as measured by
physical examination, laboratory tests and assessment by spiritual director or psychological
counselor.
2. Phase of Emerging Identities: Nurse and patient perceive each other as a unique person. Bonds begin
to form.
 Tasks in the second phase (visibility of personal or emerging identities) include separating oneself
and one’s experiences from others and recognizing the differing qualities that each possess,
transcending roles by separating self and experiences from one another – not using oneself to
judge others.
 The nurse nor the patient is not to stereotype the other as having a particular vexatious
characteristic as this is not facilitative to building a relationship.
 Tasks include and avoiding “using oneself as a yardstick”by which to evaluate others.
 Barriers to such tasks may be due to role envy, lack of interest in others, inability to transcend the
self, or refusal to initiate emotional investment.
 This phase is described by the nurse and patient perceiving each other as unique individuals. At this
time, the link of relationship begins to form.
3. Phase of Empathy: The ability to share in the other person‟s experience.
 This phase involves sharing another’s psychological state but standing apart and not sharing
feelings.
 It is characterized “by the ability to predict the behavior of another”.
4. Phase of Sympathy: The nurse has the desire to alleviate the cause of the patient‟s illness or suffering.
 Sharing, feeling and experiencing what others are feeling and experiencing is accomplished. This
phase demonstrates emotional involvement and discredits objectivity as dehumanizing.
 The task of the nurse is to translate sympathy into helpful nursing actions. Sympathy happens
when the nurse wants to lessen the cause of the patient’s suffering. It goes beyond empathy. “When
one sympathizes, one is involved but not incapacitated by the involvement.”
 The nurse should use a disciplined intellectual approach together with therapeutic use of self to
make helpful nursing actions.
5. Phase of Rapport: Nursing actions are done to relieve the patient‟s distress.
 Rapport is described as nursing interventions that lessens the patient’s suffering. The nurse and the
sick person are relating as human being to human being. The sick person shows trust and
confidence in the nurse.
  “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.”

The Human to Human Relationship Model of Nursing has seven basic concepts.

1. Suffering, which is “an experience that varies in intensity, duration and depth…a feeling of unease,
ranging from mild, transient mental, physical or mental discomfort to extreme pain….”
2. Meaning, which is the reason attributed to a person
3. Nursing, which helps a person find meaning in the experience of illness and suffering; has a
responsibility to help people and their families find meaning; and the nurse’s spiritual and ethical
choices, and perceptions of illness and suffering, which are crucial to help patients find meaning.
4. Hope, which is a faith that can and will be a change that would bring something better with it. Six
important characteristics of hope are: dependence on other people, future orientation, escape routes,
the desire to complete a task or have an experience, confidence that others will be there when needed,
and the acknowledgment of fears and moving forward towards its goal.
5. Communication, which is “a strict necessity for good nursing care.”
6. Self-therapy, which is the ability to use one’s own personality consciously and in full awareness in an
attempt to establish relatedness and to structure nursing interventions. This refers to the nurse’s
presence physically and psychologically.
7. Targeted intellectual approach by the nurse toward the patient’s situation.