Theoretical Foundation of Nursing
CHAPTER 1
INTRODUCTION TO NURSING THEORY
NURSING THEORIES
➢ organized bodies of knowledge to define what nursing is,
what nurses do, and why they do it
➢ provide a way to define nursing as a unique discipline that
is separate from other disciplines (e.g., medicine)
➢ a framework of concepts and purposes intended to guide
the practice of nursing at a more concrete and specific level
DEFINING TERMS
▪ PHILOSOPHY - Beliefs and values that define a way of
thinking and are generally known and understood by a group
or discipline.
▪ THEORY - A belief, policy, or procedure proposed or followed
as the basis of action.
▪ CONCEPT - often called the building blocks of theories.
They are primarily the vehicles of thought that involve
images.
▪ MODELS - representations of the interaction among and
between the concepts showing patterns.
▪ CONCEPTUAL FRAMEWORK - is a group of related ideas,
statements, or concepts.
▪ DOMAIN - is the perspective or territory of a profession or
discipline.
▪ PROCESS - are series of organized steps, changes or
functions intended to bring about the desired result.
▪ PARADIGM - refers to a pattern of shared understanding
and assumptions about reality and the world; worldview or
widely accepted value system.
▪ METAPARADIGM - is the most general statement of
discipline and functions as a framework in which the more
restricted structures of conceptual models develop.
Much of the theoretical work in nursing focused on articulating
relationships among four major concepts:
1. PERSON
▪ referred to as Client or Human Being
▪ the recipient of nursing care
▪ e.g., individuals, patients, groups, families, communities
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2. ENVIRONMENT
▪ defined as the internal and external surrounding that
affect the client.
▪ It includes all positive or negative conditions that affect
the patient, the physical environment, such as families,
friends, and significant others, and the setting for where
they go for their healthcare.
3. HEALTH
▪ defined as the degree of wellness or well-being that the
client experiences.
▪ It may have different meanings for each patient, the
clinical setting, and the health care provider.
4. NURSING
▪ The attributes, characteristics, and actions of the
nurse providing care on behalf of or in conjunction with,
the client.
▪ There are numerous definitions of nursing, though
nursing scholars may have difficulty agreeing on its
exact definition.
▪ The ultimate goal of nursing theories is to improve
patient care.
RELATIONAL STATEMENTS
❖ define the relationship between two or more concepts.
They are the chains that link concepts to one another.
ASSUMPTIONS
❖ accepted truths and are based on the values and
beliefs. These are statements that explain the nature of
concepts, definitions, purpose, relationships, and
structure of a theory.
COMPONENTS OF NURSING THEORIES
Phenomenon
▪ A term given to describe an idea or responses about an
event, a situation, a process, a group of events, or a
group of situations.
▪ may be temporary or permanent
▪ Nursing theories focus on the phenomena of nursing.
Concepts
▪ Interrelated concepts define a theory.
▪ words or phrases that identify, define, and establish
structure and boundaries for ideas generated about a
particular phenomenon.
▪ used to help describe or label a phenomenon; may be
abstract or concrete
1
 Chapter 1: Introduction to Nursing Theory

1971 Imogene King (Theory of Goal Attainment)

➢ Abstract Concepts - Defined as mentally
▪ Imogene King ‘s Theory of Goal Attainment states that the
constructed independent of a specific time or place.
nurse is considered part of the patient’s environment and
➢ Concrete Concepts - Are directly experienced and
the nurse-patient relationship is for meeting goals towards
related to a particular time or place.
good health.

1972 Betty Neuman

Definition ▪ states that many needs exist, and each may disrupt client
▪ Are used to convey the general meaning of the concepts balance or stability. Stress reduction is the goal of the
of the theory. system model of nursing practice.
➢ Theoretical Definitions- Define a particular concept
1979 Sr. Callista Roy
based on the theorist’s perspective.
▪ viewed the individual as a set of interrelated systems who
➢ Operational Definitions- States how concepts are
strives to maintain the balance between these various
measured.
stimuli.

HISTORY OF NURSING THEORIES 1979 Jean Watson (Philosophy of Caring)

▪ developed the philosophy of caring highlighted humanistic
1800s aspects of nursing as they intertwine with scientific
▪ The first nursing theories appeared in the late 1800s when knowledge and nursing practice.
a strong emphasis was placed on nursing education.

1860 Florence Nightingale (Environmental Theory)

▪ defined nursing in her “Environmental Theory” as “the act
of utilizing the environment of the patient to assist him in his
recovery.”

1952 Hildegard Peplau (Theory of Interpersonal Relations)

▪ introduced her Theory of Interpersonal Relations that puts
emphasis on the nurse-client relationship as the foundation
of nursing practice.

1955 Virginia Henderson (Nursing Need Theory)

▪ conceptualized the nurse’s role as assisting sick or healthy
individuals to gain independence in meeting 14
fundamental needs, thus her Nursing Need Theory was
developed.

1960 Faye Abdellah (“Typology of 21 Nursing Problems”)

▪ published her work “Typology of 21 Nursing Problems” that
shifted the focus of nursing from a disease-centered
approach to a patient-centered approach.

1962 Ida Jean Orlando

▪ emphasized the reciprocal relationship between patient and
nurse and viewed the professional function of nursing as
finding out and meeting the patient’s immediate need for
help.

1968 Dorothy Johnson (Behavioral System Model)

▪ pioneered the Behavioral System Model and upheld the
fostering of efficient and effective behavioral functioning in
the patient to prevent illness.

1970 Martha Rogers

▪ viewed nursing as both a science and an art as it provides
a way to view the unitary human being, who is integral with
the universe.

1971 Dorothea Orem

▪ states in her theory that nursing care is required if the client
is unable to fulfill biological, psychological, developmental,
or social needs.

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CHAPTER 2
NURSING THEORY IN CLINICAL PRACTICE

NURSING PROCESS
❖ The nursing process functions as a systematic guide to 3. PLANNING
client-centered care with 5 sequential steps.
1. Assessment ▪ The third phase of the nursing process
2. Nursing Diagnosis ▪ Here, the nurse refers to the client’s assessment data and
3. Planning diagnostic statements for direction in formulating client
4. Implementing goals and designing the nursing interventions required to
5. Evaluating prevent, reduce, or eliminate the client’s health problems.

1. ASSESSMENT TYPES OF PLANNING

▪ The first phase of the nursing process 1. Initial planning – planning done as soon as possible after
▪ It is the systematic and continuous collection, the initial assessment.
organization, validation, and documentation of data. 2. Ongoing planning – done by all nurses who work with
▪ It is a continuous process carried out during all phases of the client; also occurs at the beginning of a shift as the
the nursing process. nurse plans the care to be given that day.
▪ It must include the client’s perceived needs, health 3. Discharge planning – process of anticipating or planning
problems, related experience, health practices, values, for needs after discharge.
and lifestyles.
THE NURSING PROCESS
TYPES OF DATA 1. Setting priorities
2. Establishing client goals and desired outcomes
1. Subjective Data – referred to as “symptoms” or 3. Selecting nursing interventions
covert data; apparent only to the person affected 4. Writing nursing orders
and can be described or verified only by the person.
2. Objective Data - referred to as “signs” or overt data;
detectable by an observer and can be measured or
tested against an acceptable standard.
4. IMPLEMENTING (Nursing Interventions)

SOURCES OF DATA ▪ Nursing Interventions are actions a nurse takes to

implement their patient care plan.
o Client
o Support people ▪ include any treatments, procedures, or teaching moments
o Client records intended to improve the patient's comfort and health.
o Health care professionals
TYPES OF PLANNING

▪ Independent interventions - are those activities that

2. NURSING DIAGNOSIS nurses are licensed to initiate on the basis of their
knowledge and skills.
▪ It is the second phase of the nursing process. ▪ Dependent interventions – are activities carried out under
▪ In this phase, the nurse uses critical thinking skills to the physician’s orders or supervision, according to specified
interpret assessment data and identify client’s strengths routines.
and problems. ▪ Collaborative/Interdependent interventions – are
▪ It is different from diagnosis, because diagnosis is a actions the nurse carries out in collaboration with other
statement or conclusion regarding the nature of a health team members.
phenomenon, while diagnosing refers to the reasoning
process. PROCESS OF IMPLEMENTING
1. Reassessing the client
2. Determining the nurse’s need for assistance
3. Implementing the nursing interventions
OUTCOME IDENTIFICATION 4. Supervising the delegated care
▪ An outcome is a “measurable behavior demonstrated by 5. Documenting nursing activities
the patient responsive to nursing interventions.”[2]
Outcomes should be identified before nursing
interventions are planned. After nursing interventions are
implemented, the nurse will evaluate if the outcomes were
met in the time frame indicated for that patient.
▪ Outcome identification includes setting short- and long-
term goals and then creating specific expected outcome
statements for each nursing diagnosis.
 Chapter 2: Nursing Theory in Clinical Practice

▪ EVALUATION

▪ Evaluation, the final step of the nursing process, is crucial

to determine whether, after application of the nursing
process, the client's condition or well-being improves.
▪ The nurse conducts evaluation measures to determine if
expected outcomes are met, not the nursing
interventions.

FIVE COMPONENTS OF THE

EVALUATION PROCESS

1. Collecting data related to the desired

outcomes
2. Comparing data with the outcomes
3. Relating nursing activities to outcome
4. Drawing conclusions about problem status
5. Continuing, modifying, or terminating the
nursing care plan

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CHAPTER 3
NURSING THEORISTS OF HISTORICAL SIGNIFICANCE
HILDEGARD PEPLAU
Theory of
Interpersonal
Relations
▪ A remarkable nurse, educator, and administrator and a
pioneer in nursing
▪ Born in Reading, Pennsylvania
▪ Received B.A.degree in Interpersonal Psychology
▪ Had M.A. degree in Psychiatric Nursing and Ed.D in
Curriculum Development
▪ Peplau’s nursing experience included private and general
duty hospital nursing, the U.S. Army Nurse Corps, nursing
research, and a private practice in Psychiatric Nursing.
▪ Teach for 20 years and held the title of Professor Emeritus
▪ Peplau influenced the development of many nursing
programs, including the creation of the first
postbaccalaureate nursing program in Belgium
▪ Peplau published the book, Interpersonal Relations in
Nursing in 1952
▪ Dr. Peplau long held national and international recognition
as a nurse and leader in health care
▪ She is a remarkable person articipated in the development
of the National Mental Health Act of 1946
▪ Served with many organizations, including WHO, National
Institute of Mental Health, and the Nurse Corps
▪ Inducted into a Hall of Fame by the ANA being an Executive
Director and past President
▪ Peplau died March 17, 1999
THEORY OF INTERPERSONAL RELATIONS
▪ Published Interpersonal Relations in Nursing, referring to
her book as a “partial theory for the practice of nursing”.
▪ She discussed the phases of the interpersonal process.
▪ According to Peplau, nursing is therapeutic because it is
a healing art, assisting an individual who is sick or in need
of health care
▪ The theory explains the purpose of nursing is to help
others identify their felt difficulties.
▪ Nurses should apply principles of human relations to the
problems that arise at all levels of experience.
▪ Peplau's theory explains the phases of interpersonal
process, roles in nursing situations and methods for
studying nursing as an interpersonal process.
DIFFERENT CONCEPTS OF NURSING
Nursing…
1. Therapeutic in that it is a healing art, assisting an individual who
is sick or in need of health care.
2. An interpersonal process because it involves interaction
between two or more individuals with a common goal.
3. The attainment of goal is achieved through the use of a series
of steps following a series of pattern.
4. The nurse and patient work together so both become mature
and knowledgeable in the process.
COMPONENTS OF NURSING THEORIES
Teacher
▪ one who imparts knowledge concerning a need or interest.
Resource Person
▪ one who provides specific, needed information that aids in
understanding a problem or new situation.
Counselor
▪ one who, through the use of certain skills and attitudes, aids
another in recognizing, facing, accepting, and resolving
problems.
Leader
▪ one who carries out the process of initiation and
maintenance of group goals through interaction.
Technical Expert
▪ one who provides physical care by displaying clinical skills
and operating equipment in this care.
Surrogate
▪ one who takes the place of another.
According to Peplau (1952/1988), nursing is
therapeutic because it is a healing art, assisting an individual
who is sick or in need of health care.
In nursing, this common goal provides the incentive for
the therapeutic process in which the nurse and patient respect
each other as individuals, both of them learning and growing as
a result of the interaction.
THERAPEUTIC NURSE-CLIENT RELATIONSHIP
- relationship-relationship between client and nurse that focuses
on the client’s needs, feelings, problems, and ideas.
 Chapter 3: Nursing Theorists of Historical Significance
FOUR PHASES OF THERAPEUTIC NURSE-CLIENT
RELATIONSHIP
1. Pre-interaction Phase
▪ The only phase of the therapeutic nurse-client relationship in
which the client does not directly participate.
▪ During this phase, the nurse prepares to meet the client by
gathering relevant client information and anticipating client
concerns prior to the first interaction.
▪ Being aware of potential client concerns before meeting with
the client is helpful.
2. Orientation Phase
▪ Defines the purpose, roles, and rules of the process, and
provides a framework for assessing client’s needs. The
nurse begins to build a sense of trust by providing the client
with basic information (introduction).
▪ A client’s dignity, autonomy (decision of one’s own self) and
privacy are kept safe within the nurse-client relationship.
For example, “Hello, may name is Nurse Christina, I am a
Registered Nurse, and I will be taking care of you until 3:00
p.m.”
▪ This information would be presented in a respectful
manner.
3. Working Phase
▪ The problem-solving phase of the therapeutic nurse-client
relationship.
▪ Engaging clients as an active partners for mutual planning of
decisions about their care.
▪ Relevant treatment goals are established to guide nursing
interventions and client actions.
▪ Focuses on self-direction and self-management
4. Termination Phase
▪ The nurse and client evaluate the client’s response to
treatment and explore the meaning of the relationship and
what goals have been achieved.
▪ Discussing the achievements, how the client and nurse feel
about concluding the relationship, and plans for the future are
an important part of the termination phase.
▪ Termination of a meaningful nurse-client relationship should
be final in any setting.
SUMMARY
Peplau conceptualized clear sets of nurse’s roles that
can be used by each and every nurse with their practice.
It implies that a nurse’s duty is not just to care but the
profession encompasses every activity that may affect
the care of the patient.
VANANACUE
VIRGINIA
HENDERSON
Nursing Need
Theory
▪ “First Lady of Nursing”
▪ “First Truly International Nurse”
▪ An accomplished author, avid researcher and a visionary.
▪ She identified fourteen basic needs.
▪ “The nurse is temporarily the consciousness of the
unconscious, the love of life for the suicidal, the leg of the
amputee, the eyes of the newly blind, a means of
locomotion for the infant, knowledge and confidence for the
mother, the mouthpiece for those too weak or withdrawn to
speak and so on.”
CREDENTIALS AND BACKGROUND
▪ Born in Kansas City, Missouri on Nov. 30, 1897, the 5th of
eight children of Daniel B., an attorney and Lucy Minor
(Abbot) Henderson, a native from state of Virginia.
▪ World War I developed her interest in nursing in 1918. She
was educated at the U.S. Army School of Nursing (1921)
then worked as a staff nurse of the Henry Street Visiting
Nurse Service in New York City.
▪ 1922, began teaching in Norfolk Protestant Hospital,
Virginia.
▪ She recognized early on the importance of an outcomes
orientation, health promotion, continuity of care, patient
advocacy, multidisciplinary scholarship, integration of the
arts and sciences, and boundary spanning.
▪ Her elegant definition of nursing, with its emphasis on
complementing the patient's capabilities, provides a clear
direction for what nursing should be.
▪ She was the incarnation of those Greek verities—the good,
the true, and the beautiful.
▪ Virginia Henderson was arguably the most famous nurse of
the 20th century. With her silky drawl, bright blue eyes,
wispy curls, and beautiful clothes, Miss Henderson was the
embodiment of an impish Southern gentlewoman.
▪ Died on March 19, 1996 at the age of 98.
NURSING NEED THEORY
➢ The Nursing Need Theory was developed to define the
unique focus of nursing practice.
➢ The theory focuses on the importance of increasing the
patient’s independence to hasten their progress in the
hospital.
➢ Henderson’s theory emphasizes on the basic human
needs and how nurses can assist in meeting those needs.
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 Chapter 3: Nursing Theorists of Historical Significance

ASSUMPTIONS OF THE NEED THEORY 14 COMPONENTS

(1) Nurses care for patients until they can care for
A. Physiological Components
themselves once again. Although not precisely explained.
1. Breathe normally
(2) Patients desire to return to health. 2. Eat and drink adequately
3. Eliminate body wastes
(3) Nurses are willing to serve and that “nurses will devote 4. Move and maintain desirable postures
themselves to the patient day and night.” 5. Sleep and rest
6. Select suitable clothes – dress and undress
(4) Henderson also believes that the “mind and body are 7. Maintain body temperature within normal range by
inseparable and are interrelated.”. adjusting clothing and modifying environment
8. Keep the body clean and well-groomed and protect
the integument
HENDERSON’S DEIFINITION OF NURSING
9. Avoid dangers in the environment and avoid injuring
others
▪ She defined nursing as “the unique function of the nurse
is to assist the individual, sick or well, in the performance
B. Psychological Aspects of Communicating and
of those activities contributing to health or its recovery that
Learning
he would perform unaided if he had the necessary
strength, will or knowledge. And to do this in such a way 10. Communicate with others in expressing emotions,
as to help him gain independence as rapidly as possible.” needs, fears, or opinions
▪ The nurse’s goal is to make the patient complete, whole, C. Spiritual and Moral
or independent. In turn, the nurse collaborates with the
physician’s therapeutic plan. 11. Worship according to one’s faith

D. Sociologically Oriented to Occupation and

Recreation

12. Work in such a way that there is a sense of

accomplishment
13. Play or participate in various forms of recreation

E. Psychological Aspects of Communicating and

Learning

14. Learn, discover, or satisfy the curiosity that leads to

normal development and health and use the
available health facilities.

VANANACUE 7
 Chapter 3: Nursing Theorists of Historical Significance
FAYE GLENN
ABDELLAH
Twenty-One
Nursing
Problems
Theory
CREDENTIALS AND BACKGROUND
▪ Faye Abdella is a celebrated nurse theorist, military nurse,
and a leader in nursing research.
▪ Is a pioneer in nursing research who developed
the “Twenty-One Nursing Problems.”
▪ First nurse officer to earn the ranking of a two-star rear
admiral and the first nurse and the first woman to serve
as a Deputy Surgeon General.
▪ Born on March 13, 1919 in New York to a father of
Algerian heritage and Scottish mother.
▪ Her family subsequently moved to New Jersey where she
attended high school. Years later, on May 6, 1937, the
German hydrogen-fueled airship Hindenburg exploded
over Lakehurst. Abdellah and her brother witnessed the
explosion, destruction and the fire subsequent to the
ignited hydrogen that killed many people.
▪ That incident became the turning point in Abdellah’s life.
It was at that moment she vowed that she would learn
nursing and become a professional nurse.
▪ Faye Abdellah earned a nursing diploma from Fitkin
Memorial Hospital’s School of Nursing, now known as
Ann May School of Nursing.
▪ Abdellah went on to earn three degrees from Columbia
University:
o Bachelor of Science degree in Nursing in
1945
o Master of Arts degree in Physiology in 1947
o Doctor of Education degree in 1955.
▪ With her advanced education, Abdellah could have
chosen to become a doctor.
▪ However, as she explained in one of her interviews
that she wanted to be an M.D. because she could do
all she wanted to do in nursing… which is a caring
profession.
CAREER AS MILITARY NURSE
▪ She served as Chief Nurse Officer from 1970 to 1987
▪ Was the first nurse to achieve the rank of a two-star Flag
Officer and was named by U.S. Surgeon General C.
Everett Koop as the first woman and nurse Deputy
Surgeon General from 1982 to 1989
▪ After retirement, Abdellah founded and served as the first
dean in the Graduate School of Nursing, GSN, Uniformed
Services University of the Health Sciences.
VANANACUE
AWARDS AND HONORS
▪ Recognized as a leader in the development of nursing
research and nursing as a profession within the Public
Health Service (PHS).
▪ An international expert on health problems and was
named a “living legend” by the American Academy of
Nursing in 1994.
▪ National Women’s Hall of Fame in 2000 for a lifetime
spent establishing and leading essential health care
programs for the United States.
▪ Inducted into the American Nurses Association Hall of
Fame for a lifetime of contributions to nursing in 2012.
▪
21 NURSING PROBLEMS THEORY
• Faye Glenn Abdellah also made a name in the nursing
profession with the formulation of her “21 Nursing
Problems Theory.”
• Her theory changed the focus of nursing from
disease-centered to patient-centered and began to
include the care of families and the elderly in nursing care.
• The Patient Assessment of Care Evaluation developed by
Abdellah is now the standard used in the United States.
• According to Faye Glenn Abdellah’s theory, “Nursing is
based on an art and science that moulds 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.”
• The patient-centered approach to nursing was developed
from Abdellah’s practice, and the theory is considered a
human needs theory.
FOCUS OF CARE PENDULUM
• Focus of Care Pendulum of Faye Abdellah’s Theory. The
nursing-centered orientation to client care seems contrary
to the client-centered approach that Abdellah professes
to uphold. The apparent contradiction can be explained
by her desire to move away from a disease-centered
orientation. In her attempt to bring nursing practice to its
proper relationship with restorative and preventive
measures for meeting total client needs, she seems to
swing the pendulum to the opposite pole, from the
disease orientation to nursing orientation, while leaving
the client somewhere in the middle.
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 Chapter 3: Nursing Theorists of Historical Significance

21 NURSING PROBLEMS

1. To maintain good hygiene and physical comfort

ERNESTINE
2.
3.
To promote optimal activity: exercise, rest, sleep
To promote safety by preventing accidents, injuries,
WIEDENBACH
or other trauma and preventing the spread of
infection
4. To maintain good body mechanics and prevent and
correct the deformity
The Helping
5. To facilitate the maintenance of a supply of oxygen to Art of Clinical
all body cells Nursing
6. To facilitate the maintenance of nutrition for all body
cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte
balance
9. To recognize the physiologic responses of the body ▪ August 18, 1900 – March 8, 1998
to disease conditions— pathologic, physiologic, and ▪ Born in Hamburg, Germany
compensatory ▪ Family moved in New York in 1909
10. To facilitate the maintenance of regulatory ▪ She greatly admired the private duty nurse who cared for
mechanisms and functions her ailing grandmother.
11. To facilitate the maintenance of sensory function. ▪
12. To identify and accept positive and negative EDUCATION
expressions, feelings, and reactions 1922
13. To identify and accept interrelatedness of emotions ▪ B.A. from Wellesley College
and organic illness.
14. To facilitate the maintenance of effective verbal and 1925
nonverbal communication ▪ R.N. from Johns Hopkins School of Nursing
15. To promote the development of productive 1934
interpersonal relationships ▪ M.A. from Teachers College, Columbia University
16. To facilitate progress toward achievement and 1946
personal spiritual goals ▪ Certificate in nurse-midwifery from the Maternity Center
17. To create or maintain a therapeutic environment. Association School for Nurse-Midwives in New York
18. To facilitate awareness of self as an individual with
varying physical, emotional, and developmental
needs CREDENTIALS AND BACKGROUND
19. To accept the optimum possible goals in the light of
limitations, physical and emotional ▪ Known for her work in theory development and maternal infant
20. To use community resources as an aid in resolving nursing developed while teaching maternity nursing at the
problems that arise from an illness School of Nursing, Yale University.
21. To understand the role of social problems as ▪ She directed the major curriculum in maternal and newborn
influencing factors in the cause of illness. health nursing when the Yale School of Nursing established a
master’s degree program and authored books used widely in
nursing education.
▪ Her definition of nursing: “People may differ in their concept of
nursing, but few would disagree that nursing is nurturing or
caring for someone in a motherly fashion” (Wiedenbach, 1964,
p.1)
▪ Wiedenbach’s orientation is a philosophy of nursing that
guides the nurse’s action in the art of nursing.
▪ She specified four (4) elements of clinical nursing: philosophy,
purpose, practice and art.
▪ She postulated that clinical nursing is directed toward meeting
the patient’s perceived need for help in a vision of nursing that
reflects considerable emphasis on the art of nursing.
▪ In her book (1964), Clinical Nursing: A helping Art,
Wiedenbach outlines nursing steps in sequence.

FOUR ELEMENTS OF CLINICAL NURSING

1. Philosophy
2. Purpose
3. Practice
4. Art

VANANACUE 9
 Chapter 3: Nursing Theorists of Historical Significance
Theory: THE HELPING ART OF CLINICAL NURSING
Wiedenbach proposes that nurses identify patient needs for
help in the following ways:
1. Observing behaviors consistent or inconsistent with
their comfort.
2. Exploring the meaning of their behavior.
3. Determining the cause of their discomfort or
incapability.
4. Determining whether they can resolve their
problems or have a need for help.
▪ Wiedenbach’s theory identifies the patient as “any
individual who is receiving help of some kind, be it care,
instruction or advice from a member of the health
profession or from a worker in the field of health.” A patient
is any person who has entered the healthcare system and
is receiving help, which means he or she does not need
to be ill.
▪ The nurse’s philosophy is his or her attitude and belief
about life, and how that affects reality for him or her.
▪ The three essential components Wiedenbach associated
with a nursing philosophy are reverence for life; respect
for the dignity, worth, autonomy, and individuality of each
human being; and the resolution to act on personally and
professionally held beliefs.
▪ The art of nursing includes understanding the patient’s
needs, developing goals and actions intended to enhance
the patient’s ability, and directing the activities related to
the medical plan to improve the patient’s condition. The
nurse’s focus is also on the prevention of complications
related to reoccurrence or the development of new
concerns.
▪ The theory explains that knowledge encompasses all that
has been perceived and grasped by the human mind.
VANANACUE
LYDIA
HALL
Care, Cure, Core
Theory
CREDENTIALS AND BACKGROUND
▪ Lydia Eloise Hall (September 21, 1906 – February 27,
1969) was a nursing theorist who developed the Care,
Cure, Core model of nursing.
▪ Her theory defined Nursing as “a participation in care, core
and cure aspects of patient care, where CARE is the sole
function of nurses, whereas the CORE and CURE are
shared with other members of the health team.”
▪ She was an innovator, motivator, and mentor to nurses in
all phases of their careers and an advocate for chronically
ill.
▪ Lydia Hall was born on September 21, 1906 in New York
City as Lydia Eloise Williams. She was the eldest child of
Louis V. Williams and Anna Ketterman Williams and was
named after her maternal grandmother. Her brother, Henry,
was several years younger. At a young age, her family
decided to move to York, Pennsylvania, where her father
was a physician in general practice.
▪ In 1945, she married Reginald A. Hall who was a native of
England.
▪ Lydia Hall graduated from York Hospital School of Nursing
in 1927 with a diploma in nursing and entered Teacher’s
College at Columbia University in New York.
▪ Bachelor of Science degree in public health nursing in
1932.
▪ Master’s degree in the teaching of natural life sciences from
Columbia University in 1942.
▪ Doctorate and completed all of the requirements except for
the dissertation.
▪ Spent her early years as a registered nurse working for the
Life Extension Institute of the Metropolitan Life Insurance
Company in Pennsylvania and New York.
▪ Work for the New York Heart Association from 1935 to
1940.
▪ In 1941, she became a staff nurse with the Visiting Nurses
Association of New York and stayed there until 1947.
▪ 1950, she became a professor at Teacher’s College at
Columbia and also a research analyst.
▪ Hall’s interest and research in the field of rehabilitation of
chronically ill patients brought her to develop her now-
famous Care, Cure, Core Theory.
▪ First director of the Loeb Center for Nursing. Through her
leadership, the center became a prime example of nursing-
led care, and many centers in the United States and
Canada followed its principles.
▪ During her time there, Hall authored 21 publications and a
bulk of articles and addresses regarding her theory.
10
 Chapter 3: Nursing Theorists of Historical Significance

AWARDS AND HONORS

▪ In 1967, Lydia Hall received the Teacher’s College IDA JEAN

Nursing Education Alumni Association (TCNEAA)
achievement in Nursing Practice Award
ORLANDO
▪ Also in 1967, a Nursing Hall of Fame inductee.
▪ In 1984, American Nurses Association (ANA) Hall of
Fame.
Deliberative
▪ Hall died on February 27, 1969, at Queens Hospital in Nursing Process
New York. Theory

CARE, CURE, CORE THEORY

▪ In 1967, Lydia Hall received the Teacher’s College
Nursing Education Alumni Association (TCNEAA)
achievement in Nursing Practice Award
▪ Also in 1967, a Nursing Hall of Fame inductee.
▪ In 1984, American Nurses Association (ANA) Hall of
Fame.
▪ Hall died on February 27, 1969, at Queens Hospital in
New York.
THEORY OF DELIBERATIVE NURSING PROCESS
▪ Regardless of how well thought out a nursing care plan is
for a patient, obstacles to the patient’s recovery may come
up at any time. This may cause problems for the original
nursing care plan, and it’s the nurse’s job to know how to
deal with those obstacles so the patient can continue to
recover and stay on the path to health.
▪ Ida Jean Orlando’s Deliberative Nursing Process is a
nursing theory that allows nurses to create an effective
nursing care plan that can be easily adapted to prevent
complications.

CREDENTIALS AND BACKGROUND

▪ Ida Jean Orlando was a first-generation Irish American born

in 1926.

▪ A nursing diploma from New York Medical College.

▪ A Bachelor of Science in Public Health from St. John’s

University in Brooklyn, and her Master of Arts Degree in
Mental Health Nursing from Teachers College, Columbia
University.

▪ Married to Robert Pelletier and lives in the Boston area.

▪ Orlando was an associate professor at Yale School of

Nursing

▪ In 1961- served as the Director of the Graduate Program in

Mental Health Psychiatric Nursing that led to Orlando’s
development of the Deliberative Nursing Process published
in The Dynamic Nurse-Patient Relationship: Function,
Process, and Principles (NLN Classics in Nursing Theory).

▪ She also worked as the director of a research project at

McLean Hospital in Belmont, Massachusetts.

VANANACUE 11
 Chapter 3: Nursing Theorists of Historical Significance

▪ The goal of this model is for a nurse to act deliberately

rather than automatically. This way, a nurse will have a
meaning behind the action which means the patient gets
care geared specifically toward his or her needs at that
time.

▪ This nursing process is also one that can easily be

adapted to different patients with different problems, and
can be stopped at anytime, depending on the patient’s
progress or health. This makes Orlando’s theory universal
for the nursing field.

NURSING THEORY: DELIBERATIVE

NURSING PROCESS

VANANACUE 12
THEORETICAL FOUNDATION OF NURSING
ENUMERATION REVIEW

A. STEPS IN NURSING DIAGNOSIS F. PHASES OF THERAPEUTIC

NURSE-PATIENT RELATIONSHIP
1. Assessment
2. Nursing Diagnosis 1. Pre-interaction Phase
3. Planning 2. Orientation Phase
4. Implementing 3. Working Phase
5. Evaluating 4. Termination Phase

B. SOURCES OF DATA G. ELEMENTS OF CLINICAL NURSING

➢ Client ➢ Philosophy
➢ Support people ➢ Purpose
➢ Client records ➢ Practice
➢ Health care professionals ➢ Art

C. TYPES OF PLANNING
(28 points in total)
1. Initial planning
2. Ongoing planning
3. Discharge planning

D. TYPES OF NURSING INTERVENTION

1. Independent interventions
2. Dependent interventions
3. Collaborative/ Interdependent
Interventions

E. PROCESS OF IMPLEMENTING
1. Reassessing the client
2. Determining the nurse’s need for
assistance
3. Implementing the nursing interventions
4. Supervising the delegated care
5. Documenting nursing activities