,TFN/NCM REVIEWER advanced practice guides began to be
recognized as theory.
History of Nursing Theory-History of
professional nursing began with Florence
Nightingale.
-Develop a body of specialized knowledge
on which to base nursing practice.
-Strong emphasis on practice and worked
throughout the century toward the
development of nursing as a profession.
Curriculum Era-Address the question of
what contents a nurse should study to learn
how to be a nurse.
-Emphasis was on what courses nursing
students should take, with the goal of
arriving at a standardized curriculum.
Research Emphasis Era-Focused on the
research process and the long-range goal of
acquiring substantive knowledge to guide
nursing practice. The need to do Research
in order to seek higher education began in
this Research Emphasis Era. Research
courses were included in nursing curricula
Graduate Education Era-Developed in
tandem with the research era. Master’s
degree programs in nursing emerged to
meet the public need for specialized clinical
nursing practice.
Included concepts in:
Concept development
Nursing models
Early nursing theorist
Knowledge development process
Theory Era-A natural outgrowth of the
research and graduate education eras.
Emphasis on theory development and
testing. Accelerated as early works
developed as frameworks for curricula and
Fawcett’s- seminal proposal of four global
nursing concepts as a nursing
metaparadigm served as an organizing
structure for existing nursing frameworks
and introduced a way of organizing
individual theoretical works in meaningful
structure.
Classification of nursing models as
paradigms within metaparadigm concepts
are ff:
Person
Environment
Health
Nursing
Emphasis shifted from learning about the
theorist to use of the theoretical works to
generate:
Research questions
Guide practice
Organize curricula
Theory development emerged as a process
and product of professional scholarship
and growth and sought higher education
among:
Nurse leaders
Administrators
Educators
Practitioners
Fitzpatrick and Whall (1983)- had said,
“Nursing is on the brink of an exciting new
era”
Theory Utilization Era-Emphasis shifted to
theory application in nursing practice,
research, education and administration.
Restored balance between research and
practice for knowledge development in the
discipline of nursing. Emphasis to produce
evidence for quality professional practice.
SIGNIFICANCE OF NURSING THEORY
DISCIPLINE- refers to a branch of education,
a department of learning, or domain of
knowledge
PROFESSION- refers to a specialized field of
practice, founded upon the theoretical
structure of the science or knowledge of the
discipline and accompanying practice
abilities.
Significance For The Discipline-This
emphasis led into theory development era
that moved nursing toward the goal
developing nursing knowledge to guide
nursing practice. The discipline and the
profession are inextricably linked and
failure to recognize and separate them from
each other anchors nursing in a vocational
rather than a professional view.
Forms of basis in recognizing nursing as
discipline:
a. Knowledge of person
b. Health
c. Environment
TERMINOLOGIES
SCIENCE-From the latin “scientia” meaning
knowledge.
A systematically organized body of
knowledge about a particular subject .
Is performing the process of observation,
description, experimental, investigation and
theoretical explanation of natural
phenomenon.
KNOWLEDGE-general awareness,
understanding or possession of information,
facts, ideas, truths or principles.
Information, skills and expertise acquired by
a person through various experiences or
through formal/informal learning.
SOURCES OF KNOWLEDGE
TRADITIONAL - nursing practice which is
passed down from generation to generation
AUTHORITATIVE - is an idea by a person of
authority which is perceived as true
because of his or her expertise.
SCIENTIFIC - knowledge came from a
scientific method through research
THEORY-Is an organized system of accepted
knowledge that is composed of concepts,
propositions, definitions and assumptions
intended to explain a set of fact, event or
phenomena.
CONCEPT-idea, belief, view, notion,
thought, perception, impression.
Are building blocks of theories
ABSTRACT CONCEPT- are indirectly
observed.
- it is independent on time and place.
Examples are love, care and freedom.
CONCRETE CONCEPT- are directly observed.
Specific to time and place
Examples are nurse, mother, chair
PROPOSITION-Statements that explains the
relationships of different concepts.
EXAMPLE
Children don’t want to stay in the hospital
because of their fear of injections.
DEFINITION-Is composed of various
descriptions which convey a general
meaning and reduces the vagueness in
understanding a set of concepts.
ASSUMPTION-Is a statement that specifies
the relationship or connection of factual
concepts or phenomena.
Example
All patients who are not able to take good
care of themselves need nurses.
PHENOMENON-a fact or occurrence that
can be observed
something notable; excites people’s interest
and curiosity
PHILOSOPHY-A statement of beliefs and
values about human beings and their world.
Is concerned with the purpose of human
life, the nature of being and reality, the
theory and limits of knowledge.
THEORY
CHARACTERISTICS OF A THEORY
THEORY CAN CORRELATE CONCEPTS IN
SUCH A WAY AS TO GENERATE A
DIFFERENT WAY OF LOOKING AT A
CERTAIN FACT OR PHENOMENON
EXAMPLE
The relationship between self-care deficit
and nursing
THEORIES MUST BE LOGICAL IN NATURE
(LOGIC – an orderly reasoning)-
Interrelationships of concepts must be
sequential and consistently used within the
theory
THEORIES SHOULD BE SIMPLE BUT
GENERALLY BROAD IN NATURE
Parsimonious – simple terms that
describes, explains, or predicts a wide range
of phenomena
THEORY CAN BE THE SOURCE OF
HYPOTHESES THAT CAN BE TESTED FOR IT
TO BE ELABORATED
THEORIES CONTRIBUTE IN ENRICHING THE
GENERAL BODY OF KNOWLEDGE
THROUGH THE STUDIES IMPLEMENTED TO
VALIDATE THEM
THEORIES CAN BE USED BY
PRACTITIONERS TO DIRECT OR ENHANCE
THEIR PRACTICE
THEORIES MUST BE CONSISTENT WITH
OTHER VALIDATED THEORIES, LAWS, AND
PRINCIPLES BUT WILL LEAVE OPEN
UNANSWERED QUESTIONS THAT NEED TO
BE TESTED
TYPES OF THEORIES
DESCRIPTIVE or Factor Isolating Theories -
to know the properties and workings of a
discipline. Do not explain the relationship of
concepts.
Ex. Filipino nursing practices like using
herbal medicines and other alternative
treatment.
EXPLANATORY - or factor relating theories -
to examine how properties relate and thus
affect the discipline
Ex. A research study about the factors PERSON - refers to the recipient of nursing
affecting newborns in failing to thrive care, including physical, spiritual,
psychological, socio-cultural components
PREDICTIVE or situation relating theories -
to calculate relationships between ENVIRONMENT- refers to all internal and
properties and how they occur external conditions and circumstances, and
Ex. effects of unsanitary environment on influences affecting the person
the recovery of post operative patients
HEALTH- refers to the degree of wellness or
PRESCRIPTIVE or situation producing illness experienced by the person
theories - to identify under which
NURSING - refers to the actions,
conditions relationships occur
characteristics, and attributes of the
Ex. explaining the difference in nsg.
individual providing the nursing care
management in the ER in relieving anxiety
COMPONENTS OF A THEORY
CONTEXT-Resembles environment to which
nursing act takes place
CONTENT-Subject of the theory
PROCESS-Method by which nurse acts in
using nursing theory
NURSING THEORY-The term given to the
body of knowledge used to support nursing
practice. A group of related concepts that THE IMPORTANCE OF NURSING THEORY
derive from the nursing models
Helps to decide what nurses know and
NURSING PARADIGM-are patterns or what nurses need to know
models used to show a clear relationship
among the existing theoretical works in Theory analyzes and explains what nurses
nursing do

METAPARADIGMS-Greek “Meta”- with; Better patient care, enhanced professional

“Paradeigma”- pattern status for nurses and improved
Main concepts encompassing the subject communication between nurses
matter and the scope of discipline Guides nursing research and nursing
Organizing conceptual or philosophical education
framework of a discipline or profession
It defines and describes relationships PURPOSES OF NURSING THEORY
among major ideas and values EDUCATION
THE METAPARADIGM OF NURSING: RESEARCH
CLINICAL PRACTICE
PURPOSES OF NURSING THEORY
NURSING RESEARCH-Offers framework for
generating knowledge and new ideas. Assist
in the discovery of knowledge in a specific
field of study.
CLINICAL PRACTICE-Assist nurses to
describe, explain, and predict everyday
experiences. Serve to guide assessment,
implementation and evaluation of nursing
care.
NURSING EDUCATION-Provide a general
focus for curriculum design.
Guide curricular decision-making process.
RELATIONSHIPS BETWEEN
Theory & Research-Research validates &
modifies theory. Theory stimulates
exploration
Theory & Practice-Theory guides practice.
Theory provides insights about nursing
practice situations. Practice shapes theory.
Research & Practice-Research develops
practice
MARTHA ROGER SCIENCE OF UNITARY
HUMAN BEING-theory of science of unitary
human beings is mainly focusing on the four
concepts and three principles of
homeodynamic that are energy fields,
openness, pattern, pandimensioal,
integrality, reasonancy, and helicy
respectively.
ENERGY FIELDS -it is the inevitable part of
life.
OPENNESS- there is no boundary or barrier
that can flow of energy between human
and environment which leads to the
continuous movement or matter of energy.
PATTERN- is the distinguishing character of
the energy field.
PANDIMENTIONAL-undeviating field which
is not constricted by space or time, it is an
infinite domain without boundary.
HOMEODYNAMICS- refers to the balance
between the dynamic life process and
environment.
PRINCIPLES OF INTEGRALITY- Energy fields
are dynamic and constantly interact with
the human and environment, which affect
our environment and vice versa.
PRINCIPLES OF REASONANCY-is an ordered
arrangement of rhythm characterizing both
human field and environmental field.
PRINCIPLES OF HELIECY- any minute change
in the environment which leads to ripple
effect, results in a larger changes in other
field.
METAPARADIGM IN NURSING
PERSON-a unitary human being is open
systems which continuously interact with
environment.
ENVIRONMENT-it includes the entire
energy field other than person.
HEALTH-not clearly defined by Roger. It is
determined by the interaction between
energy fields, human and environment.
Bad interaction or misplacing of the energy
leads to illness.
NURSING-is both science and art. It
constantly maintains the energy field which
is conductive for patient.
APPLICATION OF SUBH
CLINICAL PRACTICE-nursing action is always
focused on unitary human being and
change the energy field between human
and environment.
-nursing interventions include all the
noninvasive actions.
NURSING EDUCATION-emphasis should be
given on the understanding of the patient
and self, energy field and environment.
-Training should lay more focus on teaching
noninvasive modalities.
NURSING RESEARCH-Rogerian theory has
been used in many research works and has
always been found testable and applicable
in research.
NURSING PROCESS ACCORDING TO SUBH
PATTERN APPRAISAL- it is an inclusive
assessment of human and environment
energy fields, its organization of energy
field, and identification of areas of
dissonance.
-Nurses validate the entire appraisal along
with the client.
MUTUAL PATTERNING-it is the mutual
interaction between the client and the
nurse. Patterning can be done by suggesting
the various alternatives, educating,
empowering, encouraging etc. depending
on the client’s condition and needs.
EVALUATION- is done by repeating the
pattern appraisal after the mutual
patterning to determine the extents of
dissonance and harmony.
Philosophy and Science of Caring by
Margaret Jean Watson
Born in Southern West Virginia
1964 – BSN in Colorado
1966 – MS in Psychiatric – Mental Health
Nsg
1973 – PhD in Educational Psychology
PERSON-Human being to be valued, cared
for, respected, nurtured, understood and
assisted. Must be viewed according to the
client’s development & the conflicts arising
in this development.
ENVIRONMENT-Defined as society with all
its influences. It provides the values that
determine how one should behave and
what goals one should strive toward.
Encompasses social, cultural & spiritual
aspect.
HEALTH-Refers to unity & harmony with in
the mind, body & soul.
NURSING-Providing holistic health care. A
human science of people & human health-
illness experiences that are mediated by
professional, personal, scientific, aesthetic
& ethical human care transactions
Watson’s 10 Carative Factors Promotion of interpersonal teaching-
learning- Gives a client maximum health
Forming humanistic-altruistic value
control because it provides information &
system-Occurs early in life but can be
alternatives. Distinguishes caring from
greatly influenced by nursing educators.
curing by assigning responsibility for health
Can be accomplished by examining one’s
to the client. Enables a client to provide
views, beliefs, & interactions with various
self-care, determine personal needs &
cultures as well as personal growth
provide opportunities for their personal
experiences Provides satisfaction through
growth.
giving & extending oneself.
Provision for supportive, protective &
Instillation of faith-hope- Describes the
corrective mental, physical, sociocultural
nurse’s role in developing effective nurse-
& spiritual environment- Involves
patient interrelationships& in promoting
assessing & facilitating a client’s coping
wellness.
abilities to support & protect mental &
Cultivating sensitivity to self and others- physical well-being.
The recognition of feelings leads to self-
Assisting with gratification of human
actualization through self-acceptance for
needs- Addresses the needs of both the
both the nurse & the patient. As Nurses
nurse & the client. Requires meeting lower-
acknowledge their sensitivity & feelings,
order needs before attaining higher-order
they become more genuine, authentic &
needs.
sensitive to others.
Allowance for existential -
Development of a helping-trust
phenomenological forces- Permits one to
relationship-Establishes rapport & caring
understand people from the way things
Helps promote expression of positive &
appear to them; their experiences shape
negative feelings. Is accomplished through
their individual perceptions. Leads to better
congruence, empathy, nonpossesive
understanding of oneself & of others.
warmth, & effective communication.
FLORENCE NIGHTINGALE: Environmental
Promotion & acceptance of the expression
Theory
of positive & negative feelings- Involves
sharing of feelings. Includes being prepared 1851 – trained in nursing (Kaiserwerth,
for negative as well as positive feelings. Germany)
Pioneered the concept of formal education
Systematic use of the scientific problem-
solving method for decision making- is November 1854-Nightingale reorganized
important for research, defining the patient care
discipline & developing a scientific
4077 soldiers died on her first winter in
knowledge base for nursing. Brings
Scutari
scientific, problem-solving approach to
nursing care. March 1855 – Britain sends Sanitary
Commission to Scutari
War finished in 1856
1860- Saint Thomas' Hospital in London.
Nightingale School and Home for Nurses
In 1860, Nightingale published Notes on
Nursing. Considered the first “nursing
theorist”. Information on her theory has
been obtained through interpretation of
her writings
Bedridden in 1896
Chronic Fatigue Syndrome
Pioneered in the field of Hospital Planning
Died in August 13, 1910
Nightingale’s Nursing Theory
Theory basis: the inter-relationship of a
healthful environment with nursing
External influences and conditions can
prevent, suppress, or contribute to disease
or death
Theory goal: Nurses help patients retain
their own vitality by meeting their basic
needs through control of the environment
Nursing’s Focus: control of the
environment for individuals, families & the
community
Three Types of Environments
Physical Environment- Consists of physical
elements where the patient is being
treated. Affects all other aspects of the
environment. Cleanliness of environment
relates directly to disease prevention and
patient mortality. Ventilation, warmth,
cleanliness, light, noise and drainage.
Psychological Environment- Providing a
positive stress-free surrounding. Can be
affected by a negative physical
environment which then causes STRESS.
Involves communication with the person,
about the person, and about other people
Social Environment- Involves collecting
data about illness and disease prevention.
Consists of a person’s home or hospital
room, as well as the total community that
affects the patient’s specific environment.
Stress free surroundings
5 Major Components of a Healthful
Environment
1. Proper ventilation
2. Adequate light
3. Sufficient warmth
4. Control of noise
5. Control of effluvia
(noxious odors)
Nightingale’s 13 Canons:
 Ventilation and warming
 Health of Houses
 Petty management
 Observation of the Sick
 Personal Cleanliness
 Light
 Cleanliness of Rooms
 Bed and Bedding
 Taking Food
 What food
 Noise
 Chattering Hopes and Advices
 Variety
Metaparadigm in Nursing
PERSON-The patient, a human being acted
upon by a nurse or affected by the
environment who has reparative powers.
Recovery is within the patient’s power as
long as safe environment for recuperation
exists.
ENVIRONMENT-Comprises the external
conditions and forces that affect one’s life
and development. Everything from person’s
food to a nurse’s verbal and nonverbal
interactions with the person.
HEALTH- Maintaining well-being by using a
person’s powers to the fullest extent;
disease is viewed as a reparative process
instituted by nature. Maintained by
controlling environmental factors to
prevent disease; nurse helps the person
through the healing process.
NURSING:-Aims to provide fresh air, light,
warmth, cleanliness, quiet and proper diet;
facilitates a person’s reparative by ensuring
the best possible environment; influences
the environment to affect health.
NIGHTINGALE’S ASSUMPTION
1. Nursing is separate from medicine.
2. Nurses should be trained.
3. The environment is important in
nursing.
4. The disease process is not
important to nursing.
5. Nursing should support the
environment to assist the patient in
healing.
6. Research should be utilized through
observation and empirics to define
the nursing discipline…
7. Nursing is both an empirical science
and an art.
8. Nursing’s concern is with the
person in the environment.
9. The person is interacting with the
environment.
10. Sick and well are governed by the
same laws of health.
11. The nurse should be observant and
confidential.
GOAL ATTAINMENT THEORY
IMOGENE
KING
Background
 youngest of 3 children, born in 1923
 St. John's Hospital School of
Nursing in St. Louis, Missouri (1945)
 St. Louis University
- BS in Nursing Education (1948) MS
in Nursing (1957)
> Teachers College, Columbia
University,
New York: - EdD (1961)
- Postdoctoral study in research
design, statistics, and computers.
 Expertise:
Adult medical-surgical nursing
 Experiences:
a. administrator, an educator, and a
practitioner
Nursing Metaparadigm
PERSON
-Individuals are spiritual being
-have the capacity to think, know,
make choices & select alternative
courses of action
-have the ability through their
language & other symbols to record
their history & preserve their culture
- open system in transaction with the
environment
- unique & holistic, are of intrinsic
worth & are capable of rational
 thinking & decision making in most
situations
- Individuals differ in their needs,
wants & goals
3 fundamental health needs
of human beings
 Need for health information
 Need for care for illness prevention
 Need for total care when a person
doesn’t have the capacity to help
themselves
HEALTH
>Is a dynamic state in the life cycle;
illness is an interference in the life
cycle
>Implies continuous adjustment to
stress in the internal and external
environments, using personal
resources to achieve optimal daily
living
Environment
 
>The process of balance involving
internal & external interactions
inside the social system
>Interpreted from the general
systems theory as an open system
with permeable boundaries that
allow the exchange of matter,
energy, and information
Nursing
> Is an act wherein the nurse interacts &
communicates with the client
>The nurse helps the client identify the
existing health condition, exploring &
agreeing on activities that promote health
>The goal of the nurse in King’s theory is to
help the client maintain health through
health promotion & maintenance,
restoration & caring for the sick & dying
GOAL ATTAINMENT THEORY
King's Goal Attainment Theory
>Involves the nurse and the patient
mutually communicating information,
establishing goals, and taking action to
obtain goals.
>Two people who are usually strangers
come together in a health care organization
to help or to be helped to a mutual state of
health.
Central focus of the theory
Focus:
man as a dynamic human being whose
perceptions of objects, persons, and events
influence his behavior, social interaction,
and health
She proposes three basic premises;
man is:
1. A reactive being
2. A time oriented being
3. A social being
>Man as a reactive being is aware of other
things; persons and events in the
environment
>Man as a time-oriented being is
influenced by time orientation.
Each person is influenced by his past
actions.
Man as a social being has a continuous
exchange with persons in the environment.
Language is a social link and facilitates
interpersonal communication.
3 Interacting systems of the theory:
1. PERSONAL SYSTEM
2. INTERPERSONAL SYSTEM
3. SOCIAL SYSTEM
PERSONAL SYSTEM
 INDIVIDUALS
 It is how the nurse views &
integrates self based from personal
goals & beliefs
Concepts of Personal system
a. The Individual's Perception- the
person's representation of reality and it
is unique to each individual
b. Self--The person's subjective
environment, values, ideas, attitudes,
and commitment.
c. Growth and Development--involves all
the changes that occur (cellular,
molecular, and behavioral). These
change are usually orderly and
predictable, but may vary with
individuals.
D. Body Image--The way a person perceive
their body and the reaction of others to
their body. Body image is subjective and
changes as the person changes physically or
emotionally.
E. Space--is the immediate physical territory
occupied by the person and person's
behavior.
F. Time--is the order of events and their
relationship to each other.
INTERPERSONAL SYSTEMS
>Two or more interacting individuals.
>How the nurse interrelates with a
co-worker or patient, particularly in a
nurse-patient relationship
Concepts of Interpersonal system:
A. Interaction – any situation wherein the
nurse relates & deals with a patient
B. Communication – refers to the
transmission of information from one
person to another; either directly or
indirectly
C. Transaction – refers to the interaction
between a person & the environment
for the purpose of goal attainment
D. Role – refers to the expected behaviors
of a person in a specific position & to
 the rules that govern the position &
affect interaction between two or more
persons
E. Stress – refers to an exchange of
energy, either positive or negative
between a person & the environment;
F. Stressors – Events that produce stress
SOCIAL SYSTEM
>Composed of larger group of
individuals with common interests or
goals.
>How the nurse interacts with co-
workers, superiors, subordinates &
the client environment in general
example:
1. families, religious groups, schools,
workplaces, and peer groups
A social system comprises the:
1.social roles
2.behaviors
3. practices
Concepts of Social System
A. Organization – refers to a group of
people with similar interest who have
prescribed roles & positions & who use
resources to achieve personal &
organizational goals
B. Authority – refers to the observable
behavior of providing guidance & order
& being responsible for actions
C. Power – is characterized by the ability
to use resources for goal achievement;
also a means by which one or more
persons can influence others
D. Status – refers to the position occupied
by a person in a group or the position
occupied by a group in relation to other
groups in an organization; it is
accomplished by certain duties,
privileges & obligations
E. Decision Making – results from
developing & acting on perceived
choices for goal attainment
6 CHARACTERISTICS OF MAN
1. The ability to perceive – perceptions
will influence behavior and thus life and
health.
2. The ability to think – thinking is based
upon the inquiring mind of man.
3. The ability to feel- have emotions.
4. The ability to perceive – perceptions
will influence behavior and thus life and
health.
5. The ability to think – thinking is based
upon the inquiring mind of man.
6. The ability to feel- have emotions.
Propositions of King’s Goal Attainment
Theory
1. If perceptual accuracy is present In
nurse-client interactions,
transactions will occur.
2. If nurse & client make transactions,
goals will be attained
3. If goals are attained, satisfactions
will occur
4. If goals are attained, effective
nursing care will occur
 5. If transactions are made in nurse-
client interactions, growth &
development will be enhanced
6. If role expectations & role
performance as perceived by nurse
& client are congruent, transactions
will occur
7. If role conflict is experienced by the
nurse & client or both, stress in
nurse-client interactions will occur
8. If nurses with special knowledge &
skills communicate appropriate
information to clients, mutual goal
setting & goal attainment will occur
Self-Care Deficit Nursing Theory
Dorothea Elizabeth Orem
Credentials and Background
 Born on 1914 in Baltimore, Maryland
 Began her nursing education at
Providence Hospital School of Nursing in
Washington,DC
 1939 – she earned her BSN education at
the Catholic University of America
 1946 – earned her M.S.N. from
Catholic University of America.
 her nursing experiences
included
a. operating room nursing,
b. private duty nursing (home &
hospital),
c. hospital staff nursing on pediatric
and adult medical and surgical units,
d. evening supervisor in the E.R.
e. biological science teacher
 1958-1960 curriculum consultant
 1959 – “Guides for developing the
curricula for the Education of
Practical Nurses” was published
- 1971 – “Nursing Concepts of
Practice” which is Orem’s first book
was published.1980,1995.
-died in June 22 ,2007 at age 92.
 Orem’s theory addresses client’s
self-care needs
 It is defined as Goal-oriented
activities that are set towards
generating interest in the part of the
client to maintain life & health
development
 The theory is aimed towards making
the clients perform self-care
activities in order to live
independently
METAPARADIGM
 PERSON
– Defined as the patient- a being who
functions biologically, symbolically &
socially & who has the potential for
learning & development
– Is an individual subject to the forces of
nature, with a capacity for self-
knowledge, who can engage in
deliberate action, interpret experiences
& perform beneficial actions
– Is an individual who can learn to meet
self-care requisites; if for some reason,
the person cannot learn self-care
measures, others must provide the care
  HEALTH Major Concepts & Definitions
– Orem supports the WHO’s definition of 1.Self – Care
health as “the state of physical, mental, 2.Self – Care Requisites
and social well-being and not merely the Universal Self-Care
absence of disease or infirmity”. Requisites
– Consists of physical, psychological, Developmental Self – Care
interpersonal & social aspects; Requisites
according to Orem, these aspects are Health Deviation Self Care
inseparable
Requisites
– Includes promotion & maintenance of 3.Therapeutic Self – Care
health, treatment of illness & Demand
prevention of complications
4.Self-Care Agency
ENVIRONMENT
Consists of environmental factors,
 Agent
environmental elements, environmental  Dependent-Care Agent
conditions (external physical & psychosocial
surroundings) & developmental b.Self-Care Deficit
environment (promotion of personal
development through motivation to  Nursing Agency
establish appropriate goals & to adjust  Nursing Design
behavior to meet these goals; includes
formation of or change in attitudes & c.Nursing System
values, creativity, self-concept & physical
development)  Helping Methods

 NURSING Self-care deficit theory as a general

theory is composed of 3 related
– helping clients to establish or identify
ways to perform self-care activities. theories:

– Nursing actions are geared towards the 1. THE THEORY OF SELF-CARE

independence of the client.
– Nursing is a human service-its focus is
on persons with inabilities to maintain
continuous provision of healthcare.
- Nursing is based on values
- Describes why & how people
care for themselves
Self- Care : refers to those activities
an individual performs independently
throughout life to promote &
maintain personal well-being
Self- Care agency: the complex
acquired ability of mature & maturing
persons to know & meet their
continuing requirements for
deliberate, purposive action to
regulate their own functioning &
development
- consists of two agents: An agent
(individual who is engage in meeting
the need of a person; like bridges
that facilitate what has been done
and what needs to be done)
 self-care agent – person who
provides the self-care
 Dependent care agent – person
other than the individual who
provides cares
Self-care requisites or Self-care
needs: are insights of actions or
requirements that a person must be
able to meet and perform in order to
achieve well-being.
Categories of Self-care requisites:
A. Universal Self-care requisites
- These are universally set goals that
must be undertaken in order for an
individual to function in scope of
healthy living
1. Maintenance of sufficient intake
of air.
2. Maintenance of sufficient intake
of food.
3. Maintenance of sufficient intake
of water.
4. Provision of care associated with
elimination.
5. Maintenance of balance between
activity and rest.
6. Maintenance of balance between
solitude and social interaction.
7. Prevention of hazards to human
life, human functioning and
human well-being;
8. Promotion of human functioning
and development.
B. Developmental Self-care
requisites
- result from maturation or
associated with conditions or events
such as adjusting to a change in body
image or loss of a spouse
- they promote processes for life &
maturation & prevent conditions
deleterious to maturation or those
that lessens those effects
C. Health deviation self-care
requisites
- requisites that result from illness,
injury or disease or its treatment;
they include such actions as seeking
medical assistance, carrying out a
prescribed treatment or learning to
live with the effects of illness or
treatment
- These health care deviations set standards
to which the degree of self-care demand is
needed.
Therapeutic Self-Care Demand >Refers to
all self-care activities required to meet
existing self-care requisites
>Involves the use of actions to maintain
health & well-being, each patient’s
therapeutic self-care demands varies
throughout life.
2. THE THEORY OF SELF-CARE DEFICIT-
which describes & explains why people can
be helped through nursing
Self-care deficit: arises when the self-care
agency cannot meet self-care requisites
Helping Methods:
1. Acting or doing for another
2. Guiding and directing
3. Providing physical or psychological
support
4. Teaching
5. Providing and maintaining an
environment that supports personal
development
3.THEORY OF NURSING SYSTEMS--
describes and explains relationships that
must be brought about & maintained for
nursing to be produced
- refers to the series of actions a nurse takes
to meet a patient’s self-care requisites
Nursing Agency: set of established
capabilities of a nurse who can legitimately
perform activities of care for a client.
- helps a person achieve their health care
demand.
Nursing Design: these are professional
functions that must be performed by the
nurse in order to meet clients needs
- it serves as a guideline of needed &
foreseen results in the production of
nursing toward the achievement of nursing
goals
3 classifications of Nursing Systems:
 Each system describes nursing
responsibilities, roles of the nurse &
patient , rationales for the nurse-patient
relationship & types of actions needed
to meet the patient’s self-care agency &
therapeutic self-care demand
1. A wholly compensatory nursing system
- is used when a patient’s self-care
agency is so limited that the patient
depends on others for well-being
2. A partly compensatory nursing system -
is used when a patient can meet some
self-care requisites but needs a nurse to
help meet others
- the nurse & the patient play major
roles in performing self-care
3. Supportive – Educative Nursing System
- is used when a patient can meet self-
care requisites but needs assistance
with decision making , behavior control
or knowledge acquisition skills
Major Assumptions
1. Human beings require continuous,
deliberate inputs to themselves and
their environments to remain alive and
function in accordance with natural
human endowments.
2. Human agency, the power to act
deliberately, is exercised in the form of
care for self and others in identifying
needs and making needed inputs.
3. Mature human beings experience
privations in the form of limitations for
action in care for self and others
involving and making of life sustaining
and function-regulating inputs.
4. Human agency is exercised in
discovering, developing, and
transmitting ways and means to identify
needs and make inputs to self and
others.
5. Groups of human beings with structured
relationship cluster tasks and allocate
responsibilities for providing care to
group members who experience
privations for making required,
deliberate input to self and others.
2. Theory of Self-Care deficit
3. Theory of Self-Care
Acceptance by the Nursing
Community
 Practice
>The first documented use of Orem’s
theory as the basis for structuring
practice is found in descriptions of
nurse-managed clinics at John Hopkins
Hospital in 1973.
Research articles on the use of SCDNT or
components in clinical practice include
A. Teaching self-care to individuals with
DM,ESRD, hemodialysis, peritoneal
dialysis, renal transplant
B. Pain assessment
C. Cardiac research
d. Oncology – focus cancer prevention, self-
care after being diagnosed with
malignancies.
e. Psychiatry etc..
 Education
“Guides for Developing Curriculum for
the Education of Practical Nurses”
a. Orem worked on a book
“Foundations of Nursing Practice”
(Morris Harvey College)
Research
a. First instrument to measure the
exercise of Self-care agency (ESCA) was
published in 1979