HELDEGARD PEPLAU – THEORY OF INTERNATIONAL

RELATIONSHIP

APPLICATION OF INTERPERSONAL THEORY IN NURSING PRACTICE

INTRODUCTION
 Peplau’s theory focuses on the interpersonal processes and therapeutic relationship that
develops between the nurse and client.
 The interpersonal focus of Peplau’s theory requires that the nurse attend to the interpersonal
processes that occur between the nurse and client.
 Interpersonal process is maturing force for personality. Interpersonal processes include the
nurse- client relationship, communication, pattern integration and the roles of the nurse.
 Psychodynamic nursing is being able to understand one’s own behavior to help others
identify felt difficulties and to apply principles of human relations to the problems that arise
at all levels of experience.
 This theory stressed the importance of nurses’ ability to understand own behavior to help
others identify perceived difficulties.

THE FOUR PHASES OF NURSE-PATIENT RELATIONSHIPS

1. ORIENTATION
 During this phase, the individual has a felt need and seeks professional assistance.
  The nurse helps the individual to recognize and understand his/ her problem and determine
the need for help.

2. IDENTIFICATION
 The patient identifies with those who can help him/ her.
 The nurse permits exploration of feelings to aid the patient in undergoing illness as an
experience that reorients feelings and strengthens positive forces in the personality and
provides needed satisfaction.

3. EXPLOITATION
 During this phase, the patient attempts to derive full value from what he/ she are offered
through the relationship.
 The nurse can project new goals to be achieved through personal effort and power shifts
from the nurse to the patient as the patient delays gratification to achieve the newly formed
goals.

4. RESOLUTION
 The patient gradually puts aside old goals and adopts new goals. This is a process in which
the patient frees himself from identification with the nurse.

PEPLAU’S THEORY AND NURSING PROCESS

Peplau defines Nursing Process as a deliberate intellectual activity that guides the professional
practice of nursing in providing care in an orderly, systematic manner.
Peplau explains 4 phases such as:
 Orientation: Nurse and patient come together as strangers; meeting initiated by patient
who expresses a “felt need”; work together to recognize, clarify and define facts related to
need.
 Identification: Patient participates in goal setting; has feeling of belonging and selectively
responds to those who can meet his or her needs.
 Exploitation: Patient actively seeks and draws knowledge and expertise of those who can
help.
 Resolution: Occurs after other phases are completed successfully. This leads to termination
of the relationship.

In Nursing Process, the orientation phase parallels with assessment phase where both the patient
and nurse are strangers; meeting initiated by patient who expresses a felt need.
Conjointly, the nurse and patient work together, clarifies and gathers important information.
Based on this assessment the nursing diagnoses are formulated, outcome and goal set.
The interventions are planned, carried out and evaluation done based on mutually established
expected behaviors.
NURSING PROCESS
A SSESSMENT
D IAGNOSIS
P LANNING
I MPLEMENTION
E VALUATION

PEPLAU’S THEORY APPLICATION NURSING PROCESS:

The nursing process for Mrs. JL based on Peplau’s theory is as follows:
 Mrs. BELEN REYES
 27 years
 Diagnosis: Inter vertebral disc prolapse
EXAMPLE 1

Assessment Planning Implementation Evaluation

Nursing
(Orientation (Identification (Exploitation (Resolution
diagnosis
phase) phase) phase) phase)

Mrs. Belen Reyes is Impaired physical Goal setting was done Carried out plans Mrs. Belen Reyes
on pelvic traction mobility related to along with patient mutually agreed upon. was free to express
and she is restricted the presence of problems regarding
to bed. pelvic traction. Patient will have difficulty in
improved physical mobilizing.
The need for bed mobility as evidenced
rest and restriction by participating in She expressed
was discussed. self-care within the satisfaction when
limits.
 Provided active and able to move
Provide active and passive exercises to without difficulty.
passive exercises to all the extremities
all the extremities to
improve the muscle
tone and strength.
Made the patient to
Make the patient to perform breathing
perform the breathing exercises
exercises which will
strengthen the
respiratory muscle.
Massaged the upper
Massage the upper and lower extremities
and lower extremities Provided article
which help to within the reach of
improve the the patient
circulation.
Provided positive
Provide articles near reinforcement to the
to the patient and patient
encourage doing
activities within
limits.

Provide positive
reinforcement for
even a small
improvement to
increase the
frequency of the
desired activity.
EXAMPLE 2

Assessment Planning Implementation Evaluation

Nursing
(Orientation (Identification (Exploitation (Resolution
diagnosis
phase) phase) phase) phase)

Mrs. Belen Reyes Pain related to the Goal setting was done Carried out plans Mrs. Belen Reyes
expresses pain in degenerative along with patient mutually agreed upon. was free to express
the low back region. changes in the Mrs. Belen Reyes will problems of pain.
lumbar region. have reduction in
Regarding pain, pain as evidenced by
discussion was her verbalization of
made to assess the reduction in pain
severity and the responses.
type and duration of Provided non-
pain. Also the Provide non- pharmacological
measures to reduce pharmacological measures like
pain were measures for pain diversion, massaging,
discussed. relief such as and pelvic traction.
diversional activity
which diverts the
patients mind. Provided supine
position to the client
Give the client a
neutral position Supported the back
during position
Always use back change
support while turning
the patient that
reduces the strain on
the back. Used pillows to
support the back.
Support the areas
with extra pillow to
allow the normal
 alignment and to Administered Tab.
prevent strain. Hifenac P and Cap.
Myoril 4mg as
Administer analgesics prescribed.
as prescribed by the Given pelvic traction
physician. and explained the
Provide pelvic need for traction
traction to the patient

ORLANDO'S NURSING PROCESS THEORY

INTRODUCTION

ABOUT THE THEORIST

 Ida Jean Orlando - born in 1926.
 Wrote about the nursing process.
 Nursing diploma - New York Medical College
 BS in public health nursing - St. John's University, NY,
 MA in mental health nursing - Columbia University, New York.
 Associate Professor at Yale School of Nursing and Director of the Graduate Program in
Mental Health Psychiatric Nursing.
  Project investigator of a National Institute of Mental Health grant entitled: Integration of
Mental Health Concepts in a Basic Nursing Curriculum.
 Published in her 1961 book, The Dynamic Nurse-Patient Relationship and revised 1972 book:
The Discipline and Teaching of Nursing Processes
 A board member of Harvard Community Health Plan.

MAJOR DIMENSIONS
 The role of the nurse is to find out and meet the patient's immediate need for help.
 The patient's presenting behavior may be a plea for help, however, the help needed may not be
what it appears to be.
 Therefore, nurses need to use their perception, thoughts about the perception, or the feeling
engendered from their thoughts to explore with patients the meaning of their behavior.
 This process helps nurse find out the nature of the distress and what help the patient needs.

TERMS
 Distress is the experience of a patient whose need has not been met.
 Nursing role is to discover and meet the patient’s immediate need for help.
 Patient’s behavior may not represent the true need.
 The nurse validates his/her understanding of the need with the patient.
 Nursing actions directly or indirectly provide for the patient’s immediate need.
 An outcome is a change in the behavior of the patient indicating either a relief from distress or
an unmet need.
 Observable verbally and nonverbally.

CONCEPTS

 Function of professional nursing - organizing principle

 Presenting behavior - problematic situation
 Immediate reaction - internal response
 Nursing process discipline – investigation
 Improvement – resolution

FUNCTION OF PROFESSIONAL NURSING - ORGANIZING PRINCIPLE

 Finding out and meeting the patients immediate needs for help
"Nursing….is responsive to individuals who suffer or anticipate a sense of helplessness, it is
focused on the process of care in an immediate experience, it is concerned with providing direct
assistance to individuals in whatever setting they are found for the purpose of avoiding, relieving,
diminishing or curing the individuals sense of helplessness." - Orlando

PRESENTING BEHAVIOR - PROBLEMATIC SITUATION

 To find out the immediate need for help the nurse must first recognize the situation as
problematic
 The presenting behavior of the patient, regardless of the form in which it appears, may represent
a plea for help
 The presenting behavior of the patient, the stimulus, causes an automatic internal response in the
nurse, and the nurses behavior causes a response in the patient

IMMEDIATE REACTION - INTERNAL RESPONSE

 Person perceives with any one of his five sense organs an object or objects
 The perceptions stimulate automatic thought
 Each thought stimulates an automatic feeling
 Then the person acts
 The first three items taken together are defined as the person’s immediate reaction
 NURSING PROCESS DISCIPLINE – INVESTIGATION
 Any observation shared and explored with the patient is immediately useful in ascertaining and
meeting his need or finding out that he is not in need at that time
 The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or
appropriate until she checks the validity of it in exploration with the patient
 The nurse initiates a process of exploration to ascertain how the patient is affected by what she
says or does .
 When the nurse does not explore with the patient her reaction it seems reasonably certain that
clear communication between them stops

IMPROVEMENT - RESOLUTION
 It is not the nurse’s activity that is evaluated but rather its result: whether the activity serves to
help the patient communicate her or his need for help and how it is met.
 In each contact the nurse repeats a process of learning how to help the individual patient.

ASSUMPTIONS
 When patients cannot cope with their needs without help, they become distressed with feelings of
helplessness
 Patients are unique and individual in their responses
 Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child
 Nursing deals with people, environment and health
 Patient need help in communicating needs, they are uncomfortable and ambivalent about
dependency needs
 Human beings are able to be secretive or explicit about their needs, perceptions, thoughts and
feelings
 The nurse – patient situation is dynamic, actions and reactions are influenced by both nurse and
patient
 Human beings attach meanings to situations and actions that are not apparent to others
 Nurses are concerned with needs that patients cannot meet on their own
DOMAIN CONCEPTS
Nursing – is responsive to individuals who suffer or anticipate a sense of helplessness
Process of care in an immediate experience – For avoiding, relieving, diminishing or curing
the individual’s sense of helplessness. Finding out meeting the patients immediate need for help
Goal of nursing – increased sense of wellbeing, increase in ability, adequacy in better care of
self and improvement in patients behavior
Health – sense of adequacy or wellbeing. Fulfilled needs. Sense of comfort
Environment – not defined directly but implicitly in the immediate context for a patient
Human being – developmental beings with needs, individuals have their own subjective
perceptions and feelings that may not be observable directly
Nursing client – patients who are under medical care and who cannot deal with their needs or
who cannot carry out medical treatment alone
Nursing problem – distress due to unmet needs due to physical limitations, adverse reactions to
the setting or experiences which prevent the patient from communicating his needs
Nursing process – the interaction of 1) the behavior of the patient, 2) the reaction of the nurse
and 3) the nursing actions which are assigned for the patients benefit
Nurse – patient relations – central in theory and not differentiated from nursing therapeutics or
nursing process
Nursing therapeutics – Direct function: initiates a process of helping the patient express the
specific meaning of his behavior in order to ascertain his distress and helps the patient explore the
distress in order to ascertain the help he requires so that his distress may be relieved.
Indirect function – calling for help of others, whatever help the patient may require for his need
to be met
Nursing therapeutics - Disciplined and professional activities – automatic activities plus
matching of verbal and nonverbal responses, validation of perceptions, matching of thoughts and
feelings with action
Automatic activities – perception by five senses, automatic thoughts, automatic feeling, action
 CHARACTERISTICS OF THE THEORY
 Orlando's theory interrelate concepts
 Orlando's theory has a logical nature
 Orlando's theory is simple and applicable in the daily practice.
 Orlando's theory contribute to the professional knowledge.
 Orlando's theory is applicable in clinical practice

STRENGTHS
 Use of her theory assures that patient will be treated as individuals and that they will have active
and constant input into their own care
 Prevents inaccurate diagnosis or ineffective plans because the nurse has to constantly explore her
reactions with the patient
 Assertion of nursing’s independence as a profession and her belief that this independence must be
based on a sound theoretical frame work
 Guides the nurse to evaluate her care in terms of objectively observable patient outcome

CONCLUSION TO THEORY
 Orlando's Deliberative Nursing Process Theory focuses on the interaction between the nurse
and patient, perception validation, and the use of the nursing process to produce
positive outcomes or patient improvement. Orlando's key focus was to define the function of
nursing. (Faust C., 2002)
 Orlando's theory remains one the of the most effective practice theories available.
 The use of her theory keeps the nurse's focus on the patient.
 The strength of the theory is that it is clear, concise, and easy to use.
 While providing the overall framework for nursing, the use of her theory does not exclude nurses
from using other theories while caring for the patient.
 JOYCE TRAVELBEE - HUMAN-TO-HUMAN
RELATIONSHIP MODEL
“The nurse is responsible for helping the patient avoid and alleviate the distress of
unmet needs.” - Travelbee

INTRODUCTION

 Joyce Travelbee (1926-1973) developed the Human-to-Human Relationship Model presented in

her book Interpersonal Aspects of Nursing (1966, 1971)
 She dealt with the interpersonal aspects of nursing.
 She explains “human-to-human relationship is the means through which the purpose of nursing if
fulfilled”

ABOUT THE THEORIST

A psychiatric nurse, educator and writer born in 1926.

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 Affilliate School, New Orleans.
Later in Charity Hospital School of Nursing in Louisiana State University, New York University and
University of Mississippi.
Travelbee died at age 47.
DEVELOPMENT OF THE THEORY
 Travelbee based the assumptions of her theory on the concepts of existentialism by Soren
Kierkegaard and logotherapy by Viktor Frankl.
 Existential theory believes that that humans are constantly faced choices and conflicts and is
accountable to the choices we make in life
 Logotherapy theory was first proposed by Viktor Frankel, a survivor of Auschwitz, in his
book Man's Search for Meaning (1963).
 Logotherapy

BASIC CONCEPTS

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
 Meaning is the reason as oneself attributes

NURSING
 Is to help man to find meaning in the experience of illness and suffering.
 Has a 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
 Nurse's job is to help the patient to maintain hope and avoid hopelessness.
 Hope is a faith that can and will be change that would bring something better with it.
  Hope's core lies in a fundamental trust the outside world, and a belief that others will help
someone when you need it.

Six important factors characteristics of hope are:

1. It is strongly associated with dependence on other people.
2. It is future oriented.
3. It is linked to elections from several alternatives or escape routes out of its situation.
4. The desire to possess any object or condition, to complete a task or have an experience.
5. Confidence that others will be there for one when you need them.
6. The hoping person is in possession of courage to be able to acknowledge its shortcomings
and fears and go forward towards its goal

Communications
 "a strict necessity for good nursing care"

Using himself therapeutic

 “One is able to use itself therapeutic."
 Self-awareness and self-understanding, understanding of human behavior, the ability to
predict one's own and others' behavior are important in this process.

Targeted intellectual approach

 Nurse must have a systematic intellectual approach to the patient's situation.
NURSING METAPARADIGMS

PERSON
 Person is defined as a human being.
 Both the nurse and the patient are human beings.

HEALTH
 Health is subjective and objective.
 Subjective health is an individually defined state of wellbeing in accord with self-appraisal of
physical-emotional-spiritual status.
 Objective health is an absence of discernible disease, disability of defect as measured by
physical examination, laboratory tests and assessment by spiritual director or psychological
counselor.

ENVIRONMENT
 Environment is not clearly defined.

NURSING
 "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.”

DESCRIPTION OF THE THEORY

 Travelbee believed nursing is accomplished through human-to-human relationships that
begin with the original encounter and then progress through stages of emerging identities,
developing feelings of empathy, and later feelings of sympathy.
  The nurse and patient attain a rapport in the final stage. For meeting the goals of nursing it
is a prerequisite to achieving a genuine human-to-human relationships.
 This relationship can only be established by an interaction process.
 It has five phases.
 The inaugural meeting or original encounter
 Visibility of personal identities/ emerging identities.
 Empathy
 Sympathy
 Establishing mutual understanding and contact/ rapport
 Travelbee's ideas have greatly influenced the hospice movement in the west.

CONCLUSION
Travelbee's theory has significantly influenced nursing and health care.
Travelbee's ideas have greatly influenced the hospice movement in the west.
 THE THREE C’S OF LYDIA HALL - CARE, CURE AND
CORE
LYDIA HALL AND HER THEORY

Lydia Hall was born in New York City on September 21, 1906.

She promoted involvement of the community in health-care issues.

She derived from her knowledge of psychiatry and nursing experiences in the Loeb Center the
framework she used in formulating her theory of nursing.

The theory contains of three independent but interconnected circles:

The core, THE

CORE

The care, THE THE

CARE CURE
The cure
The core is the person or patient to whom nursing care is directed and needed. The core has
goals set by himself and not by any other person. The core behaved according to his feelings, and
value system.

The cure is the attention given to patients by the medical professionals.

The theory contains of three independent but interconnected circles—the core, the care and the
cure.

.According to the theory, the core is the person or patient to whom nursing care is directed and
needed. The core has goals set by himself and not by any other person, and that these goals need
to be achieved.

The core, in addition, behaved according to his feelings, and value system.

The cure, on the other hand is the attention given to patients by the medical professionals. The
model explains that the cure circle is shared by the nurse with other health professionals. These
are the interventions or actions geared on treating or “curing” the patient from whatever illness or
disease he may be suffering from.

The care circle explains the role of nurses, and focused on performing that noble task of nurturing
the patients, meaning the component of this model is the “motherly” care provided by nurses,
which may include limited to provision of comfort measures, provision of patient teaching
activities and helping the patient meet their needs where help is needed.

It is easy to understand from the model that in all of the circles of the model, the nurse is always
presents the bigger role she takes belongs to the care circle where she acts a professional in
helping the patient meet his needs and attain a sense of balance.
 FAYE GLENN ABDELLAH'S THEORY
Twenty-One Nursing Problems
INTRODUCTION.
"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." - Abdellah

Abdellah explained nursing as a comprehensive service, which

includes:
1. Recognizing the nursing problems of the patient
2. Deciding the appropriate course of action to take in terms of relevant nursing principles
3. Providing continuous care of the individuals total needs
4. Providing continuous care to relieve pain and discomfort and provide immediate security
for the individual
5. Adjusting the total nursing care plan to meet the patient’s individual needs
6. Helping the individual to become more self-directing in attaining or maintaining a healthy
state of mind & body
7. Instructing nursing personnel and family to help the individual do for himself that which
he can within his limitations
8. Helping the individual to adjust to his limitations and emotional problems
9. Working with allied health professions in planning for optimum health on local, state,
national and international levels
 10. 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.)

ABOUT THE THEORIST AND THEORETICAL SOURCES

 Birth:1919
 Abdellah’s patient - centred 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.

MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS

 She uses the term ‘she’ for nurses, ‘he’ for doctors and patients, and refers to the object of nursing
as ‘patient’ rather than client or consumer.
 She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a
nurses’ prerogative.
Assumptions
Assumptions were related to:
 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;
 changing nursing education
 continuing education for professional nurses
 development of nursing leaders from under reserved groups
Abdellah and colleagues developed a list of 21 nursing problems. They also identified 10 steps
to identify the client’s problems. 11 nursing skills to be used in developing a treatment
typology

10 STEPS TO IDENTIFY CLIENTS' PROBLEMS

 Learn to know the patient
 Sort out relevant and significant data
 Make generalizations about available data in relation to similar nursing problems presented by other
patients
 Identify the therapeutic plan
 Test generalizations with the patient and make additional generalizations
 Validate the patient’s conclusions about his nursing problems
  Continue to observe and evaluate the patient over a period of time to identify any attitudes and
clues affecting his behavior
 Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan
 Identify how the nurses feels about the patient’s nursing problems
 Discuss and develop a comprehensive nursing care plan

11 NURSING SKILLS
 Observation of health status
 Skills of communication
 Application of knowledge
 Teaching of patients and families
 Planning and organization of work
 Use of resource materials
 Use of personnel resources
 Problem-solving
 Direction of work of others
 Therapeutic use of the self
 Nursing procedure
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

1. To maintain good hygiene and physical comfort
2. To promote optimal activity: exercise, rest and sleep
3. To promote safety through the prevention of accidents, injury, or other trauma and
through the prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformity

SUSTENAL CARE NEEDS

5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition of all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiological responses of the body to disease conditions
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function.

REMEDIAL CARE NEEDS

12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept the interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
 16. To facilitate progress toward achievement of personal spiritual goals
17. To create and / or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs
RESTORATIVE CARE NEEDS
19. To accept the optimum possible goals in the light of limitations, physical and emotional
20. To use community resources as an aid in resolving problems arising from illness
21 To understand the role of social problems as influencing factors in the case of illness

ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS

NURSING
 Nursing is a helping profession.
 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.
 Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment.
 Nursing to be comprehensive service.

PERSON
 Abdellah describes people as having physical, emotional, and sociological needs.
 Patient is described as the only justification for the existence of nursing.
 Individuals (and families) are the recipients of nursing
 Health, or achieving of it, is the purpose of nursing services.

HEALTH
 In Patient–Centered Approaches to Nursing, Abdellah describes health as a state mutually exclusive of illness.
 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.
SOCIETY AND ENVIRONMENT
 Society is included in “planning for optimum health on local, state, national, and international levels”.
However, as she further delineated her ideas, the focus of nursing service is clearly the individual.
 The environment is the home or community from which patient comes.

CHARACTERISTICS OF THE THEORY

 Abdellah’s theory has interrelated the concepts of health, nursing problems, and problem solving.
 Problem solving is an activity that is inherently logical in nature.
 Framework focus on nursing practice and individuals.
 The results of testing such hypothesis would contribute to the general body of nursing knowledge
 Easy to apply in practice.

USE OF 21 PROBLEMS IN THE NURSING PROCESS

ASSESSMENT PHASE
 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
 The results of data collection would determine the client’s specific overt or covert problems.
 These specific problems would be grouped under one or more of the broader nursing problems.
  This step is consistent with that involved in nursing diagnosis
PLANNING PHASE
 The statements of nursing problems most closely resemble goal statements. Once the problem has
been diagnosed, the nursing goals have been established.
IMPLEMENTATION
 Using the goals as the framework, a plan is developed and appropriate nursing interventions are
determined.
EVALUATION
 The most appropriate evaluation would be the nurse progress or lack of progress toward the
achievement of the stated goals..

CONCLUSION
 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.
 Abdellah’s theory provides a basis for determining and organizing nursing care. The problems also
provide a basis for organizing appropriate nursing strategies.
 VIRGINIA HENDERSON'S NEED THEORY
“Nursing theories mirror different realities, throughout their development; they reflected the
interests of nurses of that time.”
INTRODUCTION
 “The Nightingale of Modern Nursing”
 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."
 Born in Kansas City, Missouri, in 1897.
 Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington,
D.C. in 1921.
 Worked at the Henry Street Visiting Nurse Service for 2 years after graduation.
 In 1923, started teaching nursing at the Norfolk Protestant Hospital in Virginia
 In 1929, entered Teachers College at Columbia University for Bachelor’s Degree in 1932,
Master’s Degree in 1934.
 Joined Columbia as a member of the faculty, remained until 1948.
  Since 1953, a research associate at Yale University School of Nursing.
 Recipient of numerous recognitions.
 Honorary doctoral degrees from the Catholic University of America, Pace University,
University of Rochester, University of Western Ontario, Yale University
 In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section of the
Medical Library Association.
 Died: March 19, 1996.
 In 1939, she revised: Harmer’s classic textbook of nursing for its 4th edition, and later wrote
the 5th; edition, incorporating her personal definition of nursing (Henderson,1991)
THEORY BACKGROUND
 She called her definition of nursing her “concept” (Henderson1991)
 She emphasized the importance of increasing the patient’s independence so that progress
after hospitalization would not be delayed (Henderson,1991)
 "assisting individuals to gain independence in relation to the performance of activities
contributing to health or its recovery" (Henderson, 1966).
 She categorized nursing activities into 14 components, based on human needs.
 She described the nurse's role as substitutive (doing for the person), supplementary (helping
the person), complementary (working with the person), with the goal of helping the person
become as independent as possible.
 Her definition of nursing was:
"The unique function of the nurse is to assist the individual, sick or well, in the performance of
those activities contributing to health or its recovery (or to peaceful death) that he would perform
unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to
help him gain independence as rapidly as possible" (Henderson, 1966).
THE 14 COMPONENTS
 Breathe normally. Eat and drink adequately.
 Eliminate body wastes.
 Move and maintain desirable postures.
 Sleep and rest.
 Select suitable clothes-dress and undress.
 Maintain body temperature within normal range by adjusting clothing and modifying
environment
 Keep the body clean and well groomed and protect the integument
 Avoid dangers in the environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fears, or opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of accomplishment.
 Play or participate in various forms of recreation.
 Learn, discover, or satisfy the curiosity that leads to normal development and health and use
the available health facilities.
The first 9 components are physiological. The tenth and fourteenth are psychological aspects of
communicating and learning The eleventh component is spiritual and moral The twelfth and
thirteenth components are sociologically oriented to occupation and recreation
ASSUMPTIONS
The major assumptions of the theory are:
 "Nurses care for patients until patient can care for themselves once again. Patients desire to
return to health, but this assumption is not explicitly stated.
 Nurses are willing to serve and that “nurses will devote themselves to the patient day and
night” A final assumption is that nurses should be educated at the university level in both
arts and sciences.
HENDERSON’S THEORY AND THE FOUR MAJOR CONCEPTS
1. INDIVIDUAL
 Have basic needs that are component of health.
 Requiring assistance to achieve health and independence or a peaceful death.
 Mind and body are inseparable and interrelated.
 Considers the biological, psychological, sociological, and spiritual components.
 The theory presents the patient as a sum of parts with biopsychosocial needs.
2. ENVIRONMENT
 Settings in which an individual learns unique pattern for living.
 All external conditions and influences that affect life and development.
  Individuals in relation to families
 Minimally discusses the impact of the community on the individual and family.
 Basic nursing care involves providing conditions under which the patient can perform the 14
activities unaided
3. HEALTH
 Definition based on individual’s ability to function independently as outlined in the 14
components.
 Nurses need to stress promotion of health and prevention and cure of disease.
 Good health is a challenge -affected by age, cultural background, physical, and intellectual
capacities, and emotional balance Is the individual’s ability to meet these needs
independently.
4. NURSING
 Temporarily assisting an individual who lacks the necessary strength, will and knowledge to
satisfy 1 or more of 14 basic needs.
 Assists and supports the individual in life activities and the attainment of independence.
 Nurse serves to make patient “complete” “whole", or "independent."
 The nurse is expected to carry out physician’s therapeutic plan Individualized care is the
result of the nurse’s creativity in planning for care.
 “Nurse should have knowledge to practice individualized and human care and should be a
scientific problem solver.”
  In the Nature of Nursing Nurse role is,” to get inside the patient’s skin and supplement his
strength will or knowledge according to his needs.”
HENDERSON’S AND NURSING PROCESS
”Summarization of the stages of the nursing process as applied to Henderson’s
definition of nursing and to the 14 components of basic nursing care.
Nursing Process Henderson’s 14 components and definition of nursing

Nursing
Assessment Henderson’s 14 components

Analysis: Compare data to knowledge base of health and

Nursing Diagnosis disease.

Identify individual’s ability to meet own needs with or without

assistance, taking into consideration strength, will or
Nursing plan 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

Nursing in meeting human needs to maintain health, recover from
implementation illness, or to aid in peaceful death.
 Implementation based on the physiological principles, age,
cultural background, emotional balance, and physical and
intellectual capacities.
Nursing process Carry out treatment prescribed by the physician.

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 that the amount of
hours of care.
Successful outcomes of nursing care are based on the speed
Nursing with which or degree to which the patient performs
evaluation independently the activities of daily living

COMPARISON WITH MASLOW'S HIERARCHY OF NEED

Maslow's Henderson

Breathe normally
Eat and drink adequately Eliminate by all avenues of elimination
Move and maintain desirable posture Sleep and rest Select
Physiological suitable clothing Maintain body temperature Keep body clean
needs and well groomed and protect the integument
 Safety Needs Avoid environmental dangers and avoid injuring other

Communicate with others

Belongingness
and love needs worship according to one's faith

Work at something providing a sense of accomplishment

Play or participate in various forms of recreation
Esteem needs Learn, discover, or satisfy curiosity

CHARACTERISTICS OF HENDERSON'S THEORY

 There is interrelation of concepts.
 Concepts of fundamental human needs, biophysiology, culture, and interaction,
communication are borrowed from other discipline.Eg.. Maslow’s theory.
 Her definition and components are logical and the 14 components are a guide for the
individual and nurse in reaching the chosen goal.
 Relatively simple yet generalizable.
 Applicable to the health of individuals of all ages.
 can be the bases for hypotheses that can be tested.
 assist in increasing the general body of knowledge within the discipline.
 Her ideas of nursing practice are well accepted.
  can be utilized by practitioners to guide and improve their practice.
LIMITATIONS
 Lack of conceptual linkage between physiological and other human characteristics.
 No concept of the holistic nature of human being.
 If the assumption is made that the 14 components prioritized, the relationship among the
components is unclear.
 Lacks inter-relate of factors and the influence of nursing care.
 Assisting the individual in the dying process she contends that the nurse helps, but there is
little explanation of what the nurse does.
 “Peaceful death” is curious and significant nursing role.
CONCLUSION
 Henderson provides the essence of what she believes is a definition of nursing.
 Her emphasis on basic human needs as the central focus of nursing practice has led to
further theory development regarding the needs of the person and how nursing can assist in
meeting those needs.
 Her definition of nursing and the 14 components of basic nursing care are uncomplicated and
self-explanatory.