FINALS ON THEORETICAL

FOUNDATION IN NURSING
On March 13, 1919, Faye Abdellah was born in New York to a father of
Algerian heritage and a 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 fire
after the ignited hydrogen-fueled airship killed many people.
That incident became the turning point in Abdellah’s life.
It was that time when she realized that she would never again be
powerless to assist when people were in such a dire need of
assistance.
It was at that moment she vowed that she would learn to nurse and
become a professional nurse
 EDUCATION
Faye Abdellah earned a nursing diploma from Fitkin Memorial
Hospital’s School of Nursing, now known as Ann May School of Nursing.

It was sufficient to practice nursing during her time in the 1940s, but
she believed that nursing care should be based on research, not hours
of care.
Abdellah went on to earn three degrees from Columbia University: a
bachelor of science degree in nursing in 1945, a master of arts degree
in physiology in 1947, and a doctor of education degree in 1955.

Faye Abdellah, Dean, Graduate School of Nursing, USUHS

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.
AS AN EDUCATOR
In her early twenties, Faye Abdellah worked as a health nurse at a
private school, and her first administrative position was on the faculty
of Yale University from 1945-1949.
At that time, she was required to teach a class called “120 Principles of
Nursing Practice,” using a standard nursing textbook published by the
National League for Nursing.
The book included guidelines that had no scientific basis, which
challenged Abdellah to explain everything she called the “brilliant”
students
AS AN RESEARCHER
In 1949, she met Lucile Petry Leone, the first Nurse Officer, and decided
to join the Public Health Service.
Her first assignment was with the division of nursing that focused on
research and studies.
They performed studies with numerous hospitals to improve nursing
practice.
In another innovation within her field, Abdellah developed the Patient
Assessment of Care Evaluation (PACE), a system of standards used to
measure the relative quality of individual health-care facilities that
were still used in the healthcare industry into the 21st century.
She was also one of the first people in the healthcare industry to
develop a classification system for patient care and patient-oriented
records.
She served as Chief Nurse Officer from 1970 to 1987 and was the first
nurse to achieve the rank of a two-star Flag Officer 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 (USUHS).
Also, she has been active in professional nursing associations and is a
prolific author, with more than 150 publications.
Her publications include Better Nursing Care Through Nursing Research
and Patient-Centered Approaches to Nursing.
She also developed educational materials in many areas of public
health, including AIDS, hospice care, and drug addiction.
Abdellah considers her greatest accomplishment being able to “play a
role in establishing a foundation for nursing research as a science.”
Her book, Patient-Centered Approaches to Nursing, emphasizes
nursing science and has elicited changes throughout nursing curricula.
Her work, which is based on the problem-solving method, serves as a
vehicle for delineating nursing (patient) problems as the patient moves
toward a healthy outcome
Abdellah considers her greatest accomplishment being able to “play a
role in establishing a foundation for nursing research as a science.”
Her book, Patient-Centered Approaches to Nursing, emphasizes nursing
science and has elicited changes throughout nursing curricula.
Her work, which is based on the problem-solving method, serves as a
vehicle for delineating nursing (patient) problems as the patient moves
toward a healthy outcome
 Abdellah’s Typology of 21 Nursing
Problems
Faye Abdellah is well known for developing the “Twenty-One Nursing
Problems Theory” that has interrelated the concepts of health, nursing
problems, and problem-solving.

She views nursing as an art and a science that molds the attitude,
intellectual competencies, and technical skills of the individual nurse
into the desire and ability to help individuals cope with their health
needs, whether they are ill or well.
• Helped change the profession’s focus from a disease –
centered approach to a patient-centered approach
• She introduced the progressive patient care
example from critical care, immediate care to home
care
 10 STEPS TO IDENTIFY THE PATIENT
‘S PROBLEM
1. Learn to know the patient.
2. Sort out relevant and significant data.
3. Make generalizations about available data concerning similar nursing
problems presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional
generalizations.
6. Validate the patient’s conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time
to identify any attitudes and clues affecting this behavior.
8. Explore the patient’s and family’s reaction to the therapeutic plan
and involve them in the plan.
9. Identify how the nurse feels about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.
The 21 nursing problems fall into three categories:
1. Physical, sociological, and emotional needs of patients
2. Types of interpersonal relationships between the patient and nurse
3. common elements of patient care.
She used Henderson’s 14 basic human needs and nursing research

to establish the classification of nursing problems.

 Nursing Problems

The client’s health needs can be viewed as problems

Overt as an apparent condition
Covert as a hidden or concealed one.
Covert problems can be emotional, sociological, and interpersonal in
nature, they are often missed or misunderstood.
Yet, in many instances, solving the covert problems may solve the overt
problems as well.
Divided into four categories
1.Basic to all patients
2. Sustenance care needs
3.Remedial care needs
4. Restorative care needs.
 21 NURSING PROBLEMS
BASIC TO ALL PATIENTS
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, sleep
3. To promote safety by preventing accidents, injuries, or other trauma
and preventing the spread of infection.
4. To maintain good body mechanics and prevent and correct the
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 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 to disease
conditions—pathologic, physiologic, and compensatory.
10. To facilitate the maintenance of regulatory mechanisms and
functions.
11. To facilitate the maintenance of sensory function
 REMEDIAL CARE NEEDS
To identify and accept positive and negative expressions, feelings, and
reactions.
To identify and accept interrelatedness of emotions and organic illness.
To facilitate the maintenance of effective verbal and nonverbal
communication.
To promote the development of productive interpersonal relationships.
To facilitate progress toward achievement and personal spiritual goalTo
create or maintain a therapeutic environment.
To facilitate awareness of self as an individual with varying physical,
emotional, and developmental needs.
 RESTORATIVE CARE NEEDS
To accept the optimum possible goals in the light of limitations, physical
and emotional.
To use community resources as an aid in resolving problems that arise
from an illness.
To understand the role of social problems as influencing factors in the
cause of illness.
 11 NURSING SKILLS
1.observation of health status
2.skills of communication
3.application of knowledge
4. the teaching of patients and families
5. planning and organization of work
6.use of resource materials
7. use of personnel resources
8 problem-solving
9. the direction of work of others
10.therapeutic uses of the self
11.nursing procedure
FOCUS OF CARE
 21 Nursing Problems and The Nursing
Process
Assessment phase
Nursing diagnosis
Planning
Implementation
Evaluation
 Abdellah’s Metaparadigm
Person a holistic being that is composed of physical, psychological,
sociological and spiritual dimensions that re defined by their
corresponding needs as defined by the 21 nursing problems
Health viewed based on the individual ‘s ability to function
independently through the nurse’s efforts to address the 21 nursing
problems
‘’total health needs and a healthy state of mind and body
Environment Abdellah further delineates her ideas, the focus of
nursing service is clearly the individual

Nursing is viewed as solving the client’s health needs which can either
be overt as an apparent condition or covert as a hidden or concealed
one
 LIMITATION
• Very strong nursing centered orientation
• Little emphasis on what the client is to achieve
• Potential problem might be overlooked
 APPLICATION OF THE THEORY
Abdellah’s theory provides a basis for determining and organizing
nursing care
The problem also provides a basis for organizing appropriate nursing
strategies
was an internationally known educator, author, theorist,
administrator, researcher, consultant, public speaker, and the
developer of the concept of transcultural nursing that has a
great impact on how to deal with patients of different culture
and cultural background.
She is a Certified Transcultural Nurse, a Fellow of the Royal College of
Nursing in Australia, and a Fellow of the American Academy of Nursing.
Her theory is now a nursing discipline that is an integral part of how
nurses practice in the healthcare field today.
Madeleine Leininger was born on July 13, 1925, in Sutton, Nebraska.
She lived on a farm with her four brothers and sisters and graduated
from Sutton High School.
After graduation from Sutton High, she was in the U.S. Army Nursing
Corps while pursuing a basic nursing program.
Her aunt who had congenital heart disease, led her to pursue a career
in nursing.
The first professional nurse to earn a PhD in Anthropology(University of
Washington)
She received a Master of Science in Nursing from the Catholic
University of America in 1954.

And in 1965, Leininger embarked upon a doctoral program in Cultural

and Social Anthropology at the University of Washington in Seattle and
became the first professional nurse to earn a Ph.D. in anthropology.
Leininger opened a psychiatric nursing service and educational program
at Creighton University in Omaha, Nebraska.
She earned the equivalent of a BSN through her studies in biological
sciences, nursing administration, teaching, and curriculum
On August 10th, 2012, Leininger passed away at her home in Omaha,
Nebraska.
She was buried in Sutton’s Calvary Cemetery.
Her concept of Nursing
A substantive area of study and practice focused on comparative
cultural care( caring) values, beliefs and practices of individuals or
groups of similar or different cultures with the goal of providing culture-
specific and universal nursing care practices in promoting health or
well-being or to help people face unfavorable human conditions, illness
or death in culturally meaningful ways
Concept”culturally congruent care”
Initiated and promoted worldwide certification of Transcultural nurses
(CTN)
 Transcultural Nursing
Also known as Culture Care Theory
Is both a specialty and a general practice area
Involves knowing and understanding different cultures with respect to
nursing and health-illness caring practices, beliefs and values with the
goal tom provide meaningful and efficacious nursing care
First appeared in her theory book Culture Care Diversity and
Universality(1991)
Transcultural Nursing (2002)
 TRANSCULTURAL CONCEPTS
DEFINED
Culture is the learned, shared and transmitted values, beliefs, norms
and life way practices of a particular group that guide thinking decisions
and actions in patterned ways

CULTURAL IDENTITY the sense of being part of an Ethnic group or

culture

Culture Universals commonalities of values,norms of behavior and life

patterns that are similar among different cultures.
Culture –specifies values beliefs and patterns of behavior that tend to be
culture
Material culture refers to object(dress, art, religious artifacts)
Non-material culture refers and beliefs, customs, languages, social
institution
Cultural shock the state of being disoriented or unable to respond to a
different cultural environment because of its sudden
Strangeness, unfamiliarity and incompatibility to the stranger’s
perceptions and expectations at is differentiated from others by symbolic
markers(culture, biology, territory, religion)
Diversity refers to the fact or state of being deifferent.
can occur between cultures and within a cultural group

Acculturation people of a minority group tend to assume the attitudes,

beliefs, find practices of the dominant society resulting
in a blended cultural pattern
 Generic (Folkor Lay) Care Systems
These are culturally learned and transmitted indigenous (or traditional),
folk(home-based) knowledge and skills used to provide assistive,
supportive, enabling or facilitataive acts to ameliorate or improve a
human life way , health conditions(or well being) or to deal with
handicaps and death situations
 PROFESSIONAL CARE SYSTEM
These are defined as formally taught, learned and transmitted
professional care ,health, illness, wellness and related knowledge and
practice skills that prevail in professional institutions usually
multidisciplinary personnel to serve consumers
EMIC knowledge gained from direct experience or directly from those
who have experienced.
It is generic or folk knowledge

ETIC knowledge which describes the professional perspective .

It is professional care knowledge
Cultural awareness – it is an in depth self examination of one’s own
background, recognizing biases and prejudices and assumptions about
other people

Culturally congruent care –care that fits the people valued life patterns
and set of meanings which is generated from the people themselves
rather than based on predetermined criteria
 Culturally Competent Care
Is the ability of the practitioner to bridge gaps in caring, work with
cultural differences and enable clients and families to achieve
meaningful and supportive
THREE MODES OF NURSING CARE
DECISIONS
Leininger identified three nursing decisions and action modes to
achieve culturally congruent care
1. Cultural preservation or maintenance
2. Cultural care accommodation or negotiation
3. Cultural Care repatterning or restructuring
Cultural care Preservation or Maintenance
Assist, supports, enables and facilitates the help needed by clients to
retain or maintain meaningful care values and lifeways for their
wellbeing and to recover from illness or to deal with handicaps or death
Cultural care Accomodation or
Negotiation
Assist, supports , enables and facilitates the help needed by clients to
adap or negotiate with others for meaningful, beneficial and congruent
health care
Cultural care repatterning or
Restructuring
Assist, supports, enables and facilitates the help needed by clients to
reorder, change or modify their lifeways for new , different and
beneficial outcomes
 APPLICATION OF THE THEORY
Nurses whose primary purpose in entering a nursing discipline is that of
the opportunity to work overseas will do wee to understand the basic
tenets of Leininger’s Theory.
Students learn well from your subjects on culture
Dorothea Orem was born on July 15, 1914, in Baltimore, Maryland. Her
father was a construction worker, and her mother is a homemaker. She
was the youngest among two daughters.

In the early 1930s, she earned her nursing diploma from the Providence
Hospital School of Nursing in Washington, D.C. She completed her
Bachelor of Science in Nursing in 1939 and her Master’s of Science in
Nursing in 1945, both from the Catholic University of America in
Washington, D.C.
 EDUCATION
Dorothea Orem attended Seton High School in Baltimore and graduated
in 1931.
She received a diploma from the Providence Hospital School of Nursing
in Washington, D.C., in 1934.
She went on to the Catholic University of America to earn a B.S. in
Nursing Education in 1939 and an M.S. in Nursing Education in 1945.
She had a distinguished career in nursing. She earned several Honorary
Doctorate degrees.
She was given Honorary Doctorates of Science from Georgetown
University in 1976 and Incarnate Word College in 1980.
She was given an Honorary Doctorate of Humane Letters from Illinois
Wesleyan University in 1988 and a Doctorate Honoris Causa from the
University of Missouri in Columbia in 1998.
Published her first formal articulation of her ideas in Nursing: Concepts
of practice in 1971, second in 1980 and in 1995.
Orem died on June 22, 2007 at 92
According to Dorothea Orem
‘’There are instances when patient are encouraged to bring out the
best in them despite being ill for a period of time. This is very particular
in rehabilitation settings in which patients are entitled to be more
independent after being cared for by physicians and nurses.
It is considered a GRAND NURSING THEORY which means the theory
covers a abroad scope with general concepts that can be applied to all
instances of nursing
Orem’s theory defined NURSING as ‘’The act of assisting others in the
provision and management of self care to maintain or improve human
functioning at home level of effectiveness.
‘’It focuses on each individuals ability to perform SELF CARE, defined as
‘’ the practice of activities that individuals initiate and perform on their
own behalf in life, health and well being.
The Self-Care or Self-Care Deficit Theory of Nursing is
composed of three interrelated theories:
(1) the theory of self-care
(2) the self-care deficit theory
(3) the theory of nursing systems,
 DEFINITION OF TERMS
SELF CARE practice of activities that individual initiates and perform on
their behalf in maintaining life, health and well being
SELF CARE AGENCY is a human ability which is ‘’the ability for engaging
in self care’’
conditioned by age development state, ,life experience sociocultural
orientation health and available resources
THERAPEUTIC SELF CARE DEMAND
Totality of self care actions to be performed for some duration in order
to meet self care requisites

SELF CARE REQUISITES

Action directed towards provision of self care
3 CATEGORIES OF SELF CARE
REQUISITES
A. UNIVERSAL SELF CARE REQUISITES
Common to all, ADL(needs that all people have)
Identifies these requisites as :
a. Maintenance of sufficient intake of air ,water and food
b. Provision of care associated with elimination process
c. Balance between activity and rest , between solitude and social
interaction
d. Prevention of hazards to human life well being and
e. Promotion of Human Functioning
 NURSING AGENCY
Is a complex property or attribute of people educated and trained as
nurses that enables them to act to help others meet their therapeutic
self care demands by exercising or developing their own self-care
agency
3 CATEGORIES OF SELF CARE
REQUISITES
• Universal
• Developmental
• Health Deviation
A. UNIVERSAL SELF CARE REQUISITES
• Common to all, ADL(needs that people have)
• Identifies these requisites as
a. Maintenance of sufficient intake of air, food and water
b. Provision of care associated with elimination process
c. Balance between activity and rest, between solitude and social
interaction
d. Prevention of hazards to human life well being
e. Promotion of human being
B. DEVELOPMENTAL SELF CARE REQUISITES
Needs associated with developmental processes/ derived from a
condition…. Or associated with an event
EXAMPLE
Adjusting to a new job
Adjusting to body changes
C. HEALTH DEVIATION SELF CARE REQUISITES
Required in conditions of illness, injury or disease :
Seeking and securing appropriate medical assistance
Being aware and attending to the effects and results of pathologic
conditions
Effectively carrying out medically prescribed measures
Learning to live with effects of pathologic conditions
B. THEORY OF SELF CARE DEFICIT
Specific when nursing is needed because the person cannot carry out
self –care activities
Nursing is required when an adult(or in the case of a dependent, the
parent) is incapable or limited in the provision of continuous effective
self care
OREM IDENTIFIES 5 METHODS OF
HELPING
1. Acting for and doing for others
2. Guiding others
3. Supporting another
4. Providing an environment promoting personal development
5. Teaching another
C. THEORY OF NURSING SYSTEMS
Describes how the patients self care needs will be met by the nurse,
the patient or both
Identifies 3 classifications of nursing system to meet the self care
requisite of the patient:
a. Wholly compensatory
b. Partly compensatory system
c. Supportive-educative system
 WHOLLY COMPENSATORY SYSTEM
• Patient is DEPENDENT
• Nurses accomplish ALL the patient’s therapeutic self care
• Nurses compensate for the patient’s inability to engage in self care
• EXAMPLE: Newborn Care, care of the client recovering from surgery in
a post anesthesia care unit
Example: WHOLLY COMPENSATORY
• The patient is unconscious because he had stroke(CVA). The nurse
provides total care for the patient feeding, hygiene, turning,
elimination, suctioning of secretions to maintain effective respiration,
promoting safety, providing exercises of joints and body parts.
PARTIALLY COMPENSATORY
NURSING SYSTEM
• Patient can meet SOME needs
• Patient NEEDS NURSING assistance
• Both the nurse and the patient engage in meeting self care :needs
• EXAMPLE: Nurse can assist postoperative client to ambulate, Nurse
can bring a meal tray for client who can feed himself
Example: PARTIALLY COMPENSATORY
• The patient had undergone appendectomy a day ago. He has slight
fever(37.9 C), still in pain and need analgesic to relieve pain. He is
advised to remain in bed but may be out of bed this afternoon. He is
still on NPO. The patient can do self care activities like changing
position in bed but need nursing care for relief of pain and fever
assistance for ambulation and hygienic measures
 SUPPORTIVE-EDUCATIVE SYSTEM
• Patient CAN MEET self care requites but needs assistance with
decision making or knowledge and skills to learn self care
• Example: Nurse guides a mother to breastfeed her baby
Counseling a psychiatric client on more adaptive coping
strategies
Example: SUPPORTIVE -EDUCATIVE
• The patient had been newly diagnosed to have Diabetes Mellitus.
The patient is capable of self care but she needs self care knowledge
on how to live well with Diabetes like diet, activity/exercise, self
monitoring of blood glucose, foot care, prevention of complications,
medication.
 APPLICATION OF OREM’S THEORY
It emphasizes the need to understand the importance of self care in
promotion of health
Focus on the patient’s capacity to perform self-care activities
It also becomes clear that nurses today should not move away
education and supportive measures.HEALTH TEACHINGS
 EARLY LIFE
Imogene King was born on Jan. 30, 1923, in West Point, Iowa.
During her early high school years, she decided to pursue a career in
teaching.
However, her uncle, the town surgeon, offered to pay her tuition to
nursing school.
She eventually accepted the offer, seeing nursing school as a way to
escape life in a small town.
Thus began her remarkable career in nursing
 EDUCATION
While working in various staff nurse roles, King started coursework
toward a Bachelor of Science in Nursing Education, which she received
from St. Louis University in 1948. In 1957, she received a Master of
Science in Nursing from St. Louis University.

She went on to study with Mildred Montag as her dissertation chair at

Teacher’s College, Columbia University, New York and received her EdD
in 1961.
 CAREER
After receiving her diploma in 1945, Imogene King worked in a variety
of staff nurse roles. From 1947 to 1958, she worked as an instructor in
Medical-Surgical nursing and was an assistant director at St. John’s
Hospital School of Nursing. King developed a master’s degree program
in nursing based on a nursing conceptual framework from 1961 to 1966
at Loyola University in Chicago.
Her first theory article appeared in 1964 in the journal Nursing Science,
which nurse theorist Martha Rogers edited.
In 1980, King was appointed professor at the University of South Florida
College of Nursing in Tampa.
King continued to provide community service and help plan care
through her conceptual system and theory at various health care
organizations, including Tampa General Hospital
Despite King’s many awards and honors, she considered teaching
students to be her most important accomplishment. Over the years,
she enjoyed watching her nursing students become expert
practitioners, teachers, and researchers.
Imogene King died on December 24, 2007, two days after suffering
from a stroke
IMOGENE KING…………….
Some people consider their “success” after being hired in a great and
well-known institution.
But when someone decides to pursue a career in nursing, one should
set his or her mind that they should be an instrument in helping
patients get healthy.
And to achieve that, it’s important to set health goals with the patient,
then take steps to achieve those goals.
The Theory of Goal Attainment states that
“Nursing is a process of action, reaction, and interaction whereby
nurse and client share information about their perception in the
nursing situation’’and a process of human interaction between nurse
and client whereby each perceives the other and the situation and
through communication, they set goals , explore means and agree on
means to achieve goals
 THEORY OF GOAL ATTAINMENT
• Focuses on the attainment of certain life goals
• The nurse and patient go hand in hand in communicating information,
set goals together and then take actions to achieve those goals
• This is also the basic assumption of nursing process
• Theory describes dynamic , interpersonal in which person grows and
develops to attain certain life goals
PROPOSITIONS
• If perceptual interaction accuracy is present in nurse-patient interactions,
transaction will occur
• If the nurse and patient make transaction, the goal/goals will be achieved
• If the goal/goals are achieved satisfaction will occur
• If the goal/goals are achieved, effective nursing will occur
• If transactions are made in nurse-patient interactions, growth and
development will be enhanced
• If role expectations and role performance as perceived by the nurse and
patient are congruent transaction will occur
• If role conflict is experienced by either the nurse or patient(both)
stress in the nurse-patient interaction will occur
• If a nurse with special knowledge communicates appropriate
information to the patient, mutual goal setting and goal achievement
will occur
The theory stated that mutual goal setting
between a nurse and client is based on
1. The nurse’s assessment of a client’s concerns, problems and
disturbances in health
2. The nurse’s and clients perception of the interference
3. The nurse’s and client’s sharing of information wherein each
functions to help the client attain the goals identified
• If there is congruence between the nurse and client’s perceptions and
that disturbances are controlled then transaction take place
• TRANSACTION is a process of interactions in which human beings
communicate with the environment to achieve goals that are valued;
transactions are goal directed human behaviors
• Factors which affect the attainment of goal are: roles, stress, space
and time
 INTERACTING SYSTEMS
FRAMEWORK/CONCEPTUAL SYSTEM

• This subtheory emphasizes the importance of the interaction

between nurses and patients
• It views this interaction as an open system which is in constant
interaction with a variety of environmental factors
• Composed of personal, interpersonal and social systems
 PERSONAL SYSTEM
• Individuals are personal system
• Each individual is an open system in constant interaction with the
environment