FLORENCE NIGHTINGALE

Introduction Health

Born - 12 May 1820 is “not only to be well, but to be able to use well every power we
Founder of mordern nursing. have”.
The first nursing theorist. Disease is considered as dys-ease or the absence of comfort.
Also known as "The Lady with the Lamp"
She explained her environmental theory in her famous book Notes Environment
on Nursing: What it is, What it is not .
She was the first to propose nursing required specific education and "Poor or difficult environments led to poor health and disease".
training. "Environment could be altered to improve conditions so that the
Her contribution during Crimean war is well-known. natural laws would allow healing to occur."
She was a statistician, using bar and pie charts, highlighting key
points. Nightingale's Theory and Nursing Practice
International Nurses Day, May 12 is observed in respect to her
contribution to Nursing. Application of Nightingale's theory in practice:
Died - 13 August 1910
"Patients are to be put in the best condition for nature to act on them,
Assumpations of Nightingale's Theory it is the responsibility of nurses to reduce noise, to relieve patients’
anxieties, and to help them sleep."
Natural laws As per most of the nursing theories, environmental adaptation
Mankind can achieve perfection remains the basis of holistic nursing care.
Nursing is a calling
Nursing is an art and a science Criticisms
Nursing is achieved through environmental alteration
Nursing requires a specific educational base She emphasized subservience to doctors.
Nursing is distinct and separate from medicine She focused more on physical factors than on psychological needs of
patient.
Nightingale’s Canons: Major Concepts
Applications of Nightingale's Theory
Ventilation and warming
Light, Noise Nightingale theory and intentional comfort touch in management of
Cleanliness of rooms/walls tinea pedis in vulnerable populations
Health of houses Incorporating Florence Nightingale's theory of nursing into teaching a
Bed and bedding group of preadolescent children about negative peer pressure.
Personal cleanliness
Variety Conclusion
Chattering hopes and advices
Taking food. What food? Florence Nightingale provided a professional model for nursing
Petty management/observation organization.
She was the first to use a theoretical founation to nursing.
Nursing Paradigms Her thoghts have influenced nursing significantly.

Nightingale's documents contain her philosophical assumptions and

beliefs regarding all elements found in the metaparadigm of nursing. Florence nightingale’s environment theory
These can be formed into a conceptual model that has great utility in 1. Florence Nightingale’s Environment theory Shrooti Shah Lecturer
the practice setting and offers a framework for research National Medical College Nursing Campus, Birganj
conceptualization. (Selanders LC, 2010) 2. Introduction • Florence Nightingale was born on May 12, 1820,
while her parents were on an extended European tour. • Much
Nursing attention has been to the “Calling” that Nightingale recorded in her
diary in 1837, when she wrote that “ God spoke to me and called me
Nursing is different from medicine and the goal of nursing is to place to his service”. • Florence Nightingale began her nursing training in
the patient in the best possible condition for nature to act. 1851 in Germany.
Nursing is the "activities that promote health (as outlined in canons) 3. Introduction • She pioneered the concept of formal education for
which occur in any caregiving situation. They can be done by nurses. • She served the injured soldiers during the Crimean war
anyone." which strongly influenced her philosophy of nursing. • In 1859, she
published her views on nursing care in notes on nursing. • She is
Person considered the first nursing theorist.
4. Introduction • She stated in her nursing notes that nursing “is an
People are multidimensional, composed of biological, psychological, act of utilizing the environment of the patient to assist him in his
social and spiritual components. recovery.” • Her contribution during Crimean war is well-known. • She
Health was a statistician, using bar and pie charts, highlighting key points. •
International Nurses Day, May 12 is observed in respect to her 18. Social considerations • Nightingale supported the importance of
contribution to Nursing. • Died- 13 August 1910 looking beyond the persons to the social environments in which he or
5. Introduction • The foundation of Nightingale’s theory is the she lived. • She observed that generations of families lived and died
environment- all the external conditions and forces that influence the in poverty.
life and development of an organism. • According to her, external 19. Four major concepts of Nightingale’s theory
influences and conditions can prevent, suppress, or contribute to 20. Nursing • Nursing is different from medicine and the goal of
disease or death. • Her goal was to help the patient retain his own nursing is to place the patient in the best possible condition for nature
vitality by meeting his basic needs through control of the to act. • Nursing is the "activities that promote health which occur in
environment. any care giving situation. They can be done by anyone."
6. Types of Environment There are three types of environments. 21. Person • Nightingale referred person as a patient. Person is
Physical, Psychological and Social Physical Environment: • Physical affected by environment. • Person is multidimensional, composed of
Environment consists of physical elements where the patient is being biological, psychological, social and spiritual components. • He has a
treated. • It affects all other aspects of the environment. Cleanliness vital reparative power to deal with disease, recovery is within the
of environment relates directly to disease prevention and patient person’s power as long as a safe environment for recuperation
mortality. • Aspects of the physical environment influence the social exists.
and psychological environments of the person 22. Health/Disease • Health is “not only to be well, but maintaining
7. Types of Environment Psychological Environment: • Psychological well- being by using a person’s power to the fullest extent”. • Health
environment can be affected by a negative physical environment is maintained by controlling the environmental factors to prevent
which then causes STRESS. • It requires various activities to keep disease. • Disease is considered as dys-ease or the absence of
the mind active. • It involves communication with the person, about comfort. • Health and disease are the focus of nurse, who helps a
the person, and about other people. person through the healing process.
8. Types of Environment Social environment • It includes 23. Environment • "Poor or difficult environments led to poor health
components of the physical environment - clean air, clean water, and disease". • "Environment could be altered to improve conditions
proper drainage. • It consists of a person’s home or hospital room, as so that the natural laws would allow healing to occur."
well as the total community 24. Relevance of theory in nursing practice, education and research
9. Health of houses • The importance of the health of houses as Nursing Practice 1. Disease control 2. Sanitation and water treatment
being closely related to the presence of pure air, pure water, efficient 3. Utilized by modern architecture in the prevention of "sick building
drainage, cleanliness and light. • Cleanliness outside the house syndrome" applying the principles of ventilation and good lighting. 4.
effected the inside. Waste disposal 5. Control of room temperature 6. Noise
10. Ventilation and warming • Nurses was “ to keep the air he management.
breathes as pure as the external air, without chilling”. • Nightingale 25. Relevance of theory in nursing practice, education and research
was very concerned about “noxious air” or “effluvia” or foul odours Education 1. Principles of nursing training. Better practice result from
that came from excrement. • Nightingale stressed the importance of better education. 2. Skills measurement through licensing by the use
room temperature. The patient should not be too warm or too cold. of testing methods, the case studies. Research 1. Use of graphical
11. Light • She viewed that direct sunlight was what patients wanted. representations like the bar, pie diagrams. 2. Notes on nursing.
• Although acknowledging a lack of scientific rationale for it, she 26. Application of nightingale's theory in nursing process Assessment
noted that light has “ quite real and tangible effects upon the human The following information should be adequate. • Adequacy of
body”. ventilation • Cleanliness of environment • Presence of draft • Sudden
12. Noise • She stated that patient should never be waked noises • Amount of sunlight and artificial light
intentionally or accidentally during the first part of sleep. • She 27. Application of nightingale's theory in nursing process • Variety of
asserted that whispered or long conversations about patients are dietary offerings • Odors present in throughout ward • Methods of
thoughtless and cruel. • Nurses responsibility is to assess and stop disposal of human waste and sputum • Opportunity to communicate
different king of noise. with others • Insufficient warmth • company from family and other
13. Variety • She believed that variety in the environment was a patient • Insufficient knowledge regarding disease
critical aspect of affecting the patients recovery. • She discussed the 28. Nursing Diagnosis • Non-stimulating environment
need for changes in colour and form, including bringing the patient 29. Implementation • Provide adequate ventilation by opening doors
brightly coloured flowers or plants. and windows. • Keep the surrounding environment clean (linen, bed,
14. Bed and bedding • She stated that dirty carpets and walls utensils) • Keep the patient in warm and comfortable room, avoid
containing large quantities of organic matter and provided ready unnecessary noise. • Increase stimulus through a greater exposure
source of infection, just as dirty sheets and beds did. to sunlight and fresh air. • Provide nutritious diet and encourage for
15. Personal cleanliness • The need for cleanliness is extended to liquid diet frequently. • Proper disposal of sputum, human excreta
the patient, the nurse and the environment. • Nightingale viewed the and other waste to remove odors.
functions of the skin is important, believing that many disease 30. Implementation • Proper dress-up, maintain room temperature
“disorders” or caused breaks in the skin. and wear warm clothes. • Isolate the patient from the children from
16. Nutrition and taking food • Nightingale addressed the variety of the other patients but keep in touch and interaction with limited
food presented to the patients and discussed the importance of visitors. • Keep in stimulating environment such as listening to radio,
variety in the food presented. reading magazines and newspapers. • Provide sufficient advice,
17. Chattering hopes and advices • False hope was depressing to information about disease, it’s prognosis, course of treatment to the
patients, she felt and caused them to worry and become fatigued. • patient and family members.
She believed that sick persons should hear good news that would 31. Evaluation • It is based on observation on the effect of a changing
assist them in becoming healthier. environment on the health of a person specially focus on the vital
signs and adequate knowledge about disease condition.
32. Application of Nightingale’s work in the nursing process • 43. Critiques of the nightingale’s environment theory • Prevention of
Assessment: Nancy Smith, a 10 yrs old was injured in an accident disease would be achieved through environmental controls. • The
related to farm machinery. She had head injury then she was environmental aspects of her theory remain integral components of
admitted to PICU. Because of PICU envt., she had interrupted sleep current nursing care. • Yet it is not clear that Nightingale intended to
and she became increasingly confused. Her leg has become develop a theory of nursing, she did intend to define the science and
infected. • Analysis of data: includes data gap • Nursing Diagnosis: art of nursing and provide general rules with explanations.
Impaired sleep pattern related to environmental light and noise and 44. Critiques of the nightingale’s environment theory • The relation
separation from family. concepts-nurse, patient and environment are applicable in all nursing
33. Application of Nightingale’s work in the nursing process • today. • Nightingale rejected the germ theory and her inability to
Planning and implementation: nursing actions focus on changing the recognize a unified body of nursing knowledge that is testable. • She
environment to support more normal sleep patterns, that is, being was only relying on personal observation and experience.
awake during the day and sleeping at night. • Evaluation: After two 45. Nightingale and the characteristics of theory 1. What is the
nights of uninterrupted sleep, normal sounds, and parental historical context of theory? i. Florence Nightingale is the founder of
encouragement, Nancy will demonstrate increased orientation to modern nursing. ii. Her work in the mid 1800s provided the basis for
place being able to identify that she is in the hospital. much of modern nursing. iii. Nightingale’s environment model fits
34. Nightingale and the Characteristics of theory neither the totality nor the simultaneity paradigms.
35. Nightingale model and the characteristics of theory • Theories 46. What are the basic concepts and relationships presented by the
can interrelate concepts in such a way to create different way of theory? • Nightingale presented her ideas not as a theory but as
looking at phenomena: – Using her envt. Model, new insights into the strategies to help women care for the ill in the home and in hostels. •
phenomena of interest to nursing can be identified. – Examining Relationship of concepts are not clearly articulated. However she
envt.al aspects such as light, noise or warmth can provide new presents her ideas in a clear manner. • Using the basic concepts she
insights into human responses to health and illness, which means presents, new insights into phenomena of interest to nursing can be
that health and illness not only influenced by the pathophysiology identified.
and also psychosocial envt. 47. What major phenomena of concern to nursing are presented? •
36. Theories must be logical in nature • Her model is illogical. • She The manipulation of the environment by the nurse to put the patients
built her conclusion from observations, she made her case, drew her in the best place. • Nightingale does not address interpersonal
conclusions and then acted. She used logic to correct her conclusion. relations specifically but does talk about the need for the nurse to
37. Theories must be relatively simple yet generalizable • Her consider what she says when talking around the patient. •
writings are simple. • The beauty of her model is its generalizability, Cleanliness is also of major importance.
including its continued applicability today. 48. To whom does this theory apply? In what situations? In what
38. Theories can be bases for hypothesis that can be tested or for way? • Nightingale’s writing are simple. • Nightingale’s theory applies
theory to the explained • Nightingale has stimulated the development in all situations in which nursing care is provided. • Concepts related
of nursing science with her work. • She has had a profound effect on to pure air, light, noise and cleanliness can be applied across specific
many of the other nursing theorists. • The research related to the environments. • Reading her work raises a consciousness in the
impact of the envt. on client health has been influenced by nurse about how the environment influences client outcomes. It has
Nightingale. directed interventions toward modulating the environment.
39. Theories contribute to and assist in increasing the general body 49. To whom does this theory apply? In what situations? In what
of knowledge • This theory seems to have more relevance to way? • Works well with ecological, systems, adaptation and
practitioners today than ever before. • More and more data are interpersonal theories. • Her focus on the environment has relevance
becoming available to indicate the critical nature of the impact of the to practitioners in today’s global health care climate.
environment on the health and well-being of the individual. 50. By what method or methods can this theory be tested? • While
40. Theories can be used by practitioner to guide and improve them • direct testing of Nightingale’s theory has not been done, she has
Her work raises a consciousness on the nurse about how the stimulated the development of nursing science with her work. • For
environment influences client outcomes. • For example: controlling example: she did not believe in germ theory; however the practices
sound in the wards, mounting ventilation and light, put off light during she recommended were not inconsistent with scientific knowledge
nights all and all help in recovery from illness. we have today. • Both quantitative and qualitative methods of
41. Theories must be consistent with validated theories, laws and research could be used to test relationships in the environmental
principles but will have open unanswered questions that need to be model.
investigated • Works well with ecological, systems, adaptation and 51. Does this theory direct nursing actions that lead to favourable
interpersonal theories. • she did not believe in germ theory; however outcome? • Her work has not been tested in a manner that nursing
the practices she recommended were not inconsistent with scientific actions are prescribed. • However, her writings have helped nurses
knowledge we have today. • Many of her suggestions which she develop interventions that result in restructuring the environment.
based on observation of client response to their envt., have been 52. How contagious is this theory? • Examples of how nightingale
documented on scientifically sound when tested with rigorous continues to influence both modern nursing and health care can be
application of modern research methods. seen in a number of articles.
42. Critiques of the nightingale’s environment theory • Although four
major concepts are not explicit in Nightingale’s theory, they do offer
nursing a specific way of looking at particular phenomenon. • The
relationship between each concept is logical and consistent with
similar assumptions. • Nightingale’s theory, although limited, has a lot
of generalizability. • These ideas are basically simple to apply and
easy to measure in terms of outcomes.
 VIRGNIA HENDERSON  Keep the body clean and well groomed and protect the
integument
introduction  Avoid dangers in the environment and avoid injuring
 “The Nightingale of Modern Nursing” others.
 “Modern-Day Mother of Nursing.”  Communicate with others in expressing emotions, needs,
 "The 20th century Florence Nightingale." fears, or opinions.
 Born in Kansas City, Missouri, in 1897.  Worship according to one’s faith.
 Diploma in Nursing from the Army School of Nursing at  Work in such a way that there is a sense of
Walter Reed Hospital, Washington, D.C. in 1921. accomplishment.
 Worked at the Henry Street Visiting Nurse Service for 2  Play or participate in various forms of recreation.
years after graduation.  Learn, discover, or satisfy the curiosity that leads to normal
 In 1923, started teaching nursing at the Norfolk Protestant development and health and use the available health
Hospital in Virginia facilities.
 In 1929, entered Teachers College at Columbia University The first 9 components are physiological. The tenth and fourteenth
for Bachelor’s Degree in 1932, Master’s Degree in 1934. are psychological aspects of communicating and learning The
 Joined Columbia as a member of the faculty, remained eleventh component is spiritual and moral The twelfth and thirteenth
until 1948. components are sociologically oriented to occupation and recreation
 Since 1953, a research associate at Yale University School Assumption
of Nursing. The major assumptions of the theory are:
 Recipient of numerous recognitions.  "Nurses care for patients until patient can care for
 Honorary doctoral degrees from the Catholic University of themselves once again. Patients desire to return to health,
America, Pace University, University of Rochester, but this assumption is not explicitly stated.
University of Western Ontario, Yale University  Nurses are willing to serve and that “nurses will devote
 In 1985, honored at the Annual Meeting of the Nursing and themselves to the patient day and night” A final assumption
Allied Health Section of the Medical Library Association. is that nurses should be educated at the university level in
 Died: March 19, 1996. both arts and sciences.
 In 1939, she revised: Harmer’s classic textbook of nursing Henderson’s theory and the four major concepts
for its 4th edition, and later wrote the 5th; edition, 1. Individual
incorporating her personal definition of nursing  Have basic needs that are component of health.
(Henderson,1991)  Requiring assistance to achieve health and independence
Theory Background or a peaceful death.
 She called her definition of nursing her “concept”  Mind and body are inseparable and interrelated.
(Henderson1991)  Considers the biological, psychological, sociological, and
 She emphasized the importance of increasing the patient’s spiritual components.
independence so that progress after hospitalization would  The theory presents the patient as a sum of parts with
not be delayed (Henderson,1991) biopsychosocial needs.
 "assisting individuals to gain independence in relation to 2. Environment
the performance of activities contributing to health or its  Settings in which an individual learns unique pattern for
recovery" (Henderson, 1966). living.
 She categorized nursing activities into 14 components,  All external conditions and influences that affect life and
based on human needs. development.
 She described the nurse's role as substitutive (doing for the  Individuals in relation to families
person), supplementary (helping the person),  Minimally discusses the impact of the community on the
complementary (working with the person), with the goal of individual and family.
helping the person become as independent as possible.  Basic nursing care involves providing conditions under
 Her definition of nursing was: which the patient can perform the 14 activities unaided
"The unique function of the nurse is to assist the individual, sick or 3. Health
well, in the performance of those activities contributing to health or its  Definition based on individual’s ability to function
recovery (or to peaceful death) that he would perform unaided if he independently as outlined in the 14 components.
had the necessary strength, will or knowledge. And to do this in such  Nurses need to stress promotion of health and prevention
a way as to help him gain independence as rapidly as possible" and cure of disease.
(Henderson, 1966).  Good health is a challenge -affected by age, cultural
The 14 components background, physical, and intellectual capacities, and
 Breathe normally. Eat and drink adequately. emotional balance Is the individual’s ability to meet these
 Eliminate body wastes. needs independently.
 Move and maintain desirable postures. 4. Nursing
 Sleep and rest.  Temporarily assisting an individual who lacks the
 Select suitable clothes-dress and undress. necessary strength, will and knowledge to satisfy 1 or more
 Maintain body temperature within normal range by of 14 basic needs.
adjusting clothing and modifying environment  Assists and supports the individual in life activities and the
attainment of independence.
  Nurse serves to make patient “complete” “whole", or
"independent." Avoid environmental dangers and avoid
 The nurse is expected to carry out physician’s therapeutic Safety Needs
injuring other
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.” Belongingness Communicate with others
 In the Nature of Nursing Nurse role is,” to get inside the and love needs worship according to one's faith
patient’s skin and supplement his strength will or
knowledge according to his needs.”
Henderson’s and Nursing Process Work at something providing a sense of
”Summarization of the stages of the nursing process as applied accomplishment
to Henderson’s definition of nursing and to the 14 components Esteem needs Play or participate in various forms of
of basic nursing care. recreation
Learn, discover, or satisfy curiosity
Nursing Process Henderson’s 14 components and definition of
nursing Characteristic of Henderson’s theory
Nursing Henderson’s 14 components  There is interrelation of concepts.
Assessment  Concepts of fundamental human needs, biophysiology,
Nursing Analysis: Compare data to knowledge base of culture, and interaction, communication are borrowed from
Diagnosis health and disease. other discipline.Eg.. Maslow’s theory.
 Her definition and components are logical and the 14
Nursing plan Identify individual’s ability to meet own needs components are a guide for the individual and nurse in
with or without assistance, taking into reaching the chosen goal.
consideration strength, will or knowledge.  Relatively simple yet generalizable.
Nursing Document how the nurse can assist the  Applicable to the health of individuals of all ages.
implementation individual, sick or well.  can be the bases for hypotheses that can be tested.
Nursing Assist the sick or well individual in to  assist in increasing the general body of knowledge within
implementation performance of activities in meeting human the discipline.
needs to maintain health, recover from  Her ideas of nursing practice are well accepted.
illness, or to aid in peaceful death.  can be utilized by practitioners to guide and improve their
practice.
Nursing process Implementation based on the physiological
Limitations
principles, age, cultural background,
 Lack of conceptual linkage between physiological and
emotional balance, and physical and
other human characteristics.
intellectual capacities.
 No concept of the holistic nature of human being.
Carry out treatment prescribed by the
physician.  If the assumption is made that the 14 components
prioritized, the relationship among the components is
Nursing Henderson’s 14 components and definition of unclear.
evaluation nursing  Lacks inter-relate of factors and the influence of nursing
Use the acceptable definition of ;nursing and care.
appropriate laws related to the practice of  Assisting the individual in the dying process she contends
nursing. that the nurse helps, but there is little explanation of what
The quality of care is drastically affected by the nurse does.
the preparation and native ability of the  “Peaceful death” is curious and significant nursing role.
nursing personnel rather that the amount of Conclusion
hours of care.
 Henderson provides the essence of what she believes is a
Successful outcomes of nursing care are
definition of nursing.
based on the speed with which or degree to
 Her emphasis on basic human needs as the central focus
which the patient performs independently the
of nursing practice has led to further theory development
activities of daily living
regarding the needs of the person and how nursing can
Comparison with Maslow's Hierarchy of Need assist in meeting those needs.
Maslow's Henderson  Her definition of nursing and the 14 components of basic
nursing care are uncomplicated and self-explanatory.
Breathe normally
Eat and drink adequately Eliminate by all
avenues of elimination Move and maintain
Physiological
desirable posture Sleep and rest Select
needs
suitable clothing Maintain body temperature
Keep body clean and well groomed and
protect the integument
 7. 7. CHARACTERISTICS OF HENDERSON’S THEORY •
There is interrelation of concepts. • Concepts of
Virginia henderson's theory of nursing fundamental human needs are borrowed from other
1. 1. CLASS PRESENTATION ON VIRGINIA discipline e.g. Maslow’s theory. • Her definition and
HENDERSON’S NURSING THEORY PRESENTER: components are logical and the 14 components are a guide
Mandeep Kaur M.Sc.1st Year Roll No. 1 1 for the individual and nurse in reaching the chosen goal. •
2. 2. 2 Relatively simple yet generalizable. • Applicable to the
3. 3. EVOLUTION OF THEORY Virginia Henderson was the health of individuals of all ages. 7
nurse-theorist who devoted her career to defining nursing 8. 8. Contd….. • Can be the bases for hypotheses that can be
practice. She believed that an occupation that affects tested. • Assist in increasing the general body of
human life must outline its functions particularly if it is to be knowledge within the discipline. • Her ideas of nursing
regarded as profession. Her ideas about definition of practice are well accepted. • Can be utilized by
nursing were influenced by her nursing education and practitioners to guide and improve their practice. 8
practice by her students and colleagues at Columbia 9. 9. FUNDAMENTAL NEEDS OF HUMAN ACCORDING TO
University School of Nursing, and by distinguished nursing VIRGINIA HENDERSON 9
leaders of her time. Two events are the basis for her 10. 10. FUNDAMENTAL NEEDS OF HUMAN 10
development of definition of nursing and these are: • First, 11. 11. 11
she participated in the revision of a nursing text book. 12. 12. 12 Play or participate in various forms of recreation.
During revision of the “Textbooks of the principles and Learn, discover, or satisfy the curiosity that leads to normal
practice of nursing” written with Bertha Harmer (1922) development and health and use the available health
Henderson realized the need to be clear about the facilities.
functions of the nurse. • Second, she was concerned that 13. 13. MATAPARADIGM OF HENDERSON’S THEORY
the many states had no provision for nursing licensure to INDIVIDUAL:  Have basic needs that are component of
ensure safe and competent care for the consumers. 3 health.  Requiring assistance to achieve health and
4. 4. She examined the earlier statements of the nursing independence or a peaceful death.  Mind and body are
functions by American Nurses Association and viewed inseparable and interrelated.  Considers the biological,
these statements as non specific and unsatisfactory psychological, sociological, and spiritual components. 
definition of nursing practice. In 1966, Henderson’s first The theory presents the patient as a sum of parts with
definition of nursing was published in Bertha harmer’s biopsychosocial needs. 13
revised nursing text book. It reads as “the unique function 14. 14. Environment:  Settings in which an individual learns
of the nurse is to assist the individual (sick or well) in the
unique pattern for living.  All external conditions and
performance of those activities contributing to health or its
influences that affect life and development.  Individuals in
recovery (or peaceful death) that he would perform unaided
if he had the necessary strength, will or knowledge. And to relation to families.  Minimally discusses the impact of the
do this in such a way as to help him gain independence as community on the individual and family.  Basic nursing
rapidly as possible.” 4 care involves providing conditions under which the patient
5. 5. CONCEPTS USED BY HENDERSON Henderson called can perform the 14 activities unaided. 14
her definition of nursing as concept. Henderson viewed 15. 15. Health:  Definition based on individual’s ability to
human being, health, environment and nursing as follow: function independently as outlined in the 14 components.
Human being: The patient as an individual who requires  Nurses need to stress promotion of health and
assistance to achieve health and independence or peaceful prevention and cure of disease.  Good health is a
death. The mind and the body are inseparable. The patient challenge -affected by age, cultural background, physical,
and his family are viewed as a unit. Health: She views and intellectual capacities, and emotional balance Is the
health in terms of patient’s ability to perform unaided the 14 individual’s ability to meet these needs independently. 15
components of nursing care. She says it is “the quality of 16. 16. Nursing:  Temporarily assisting an individual who
the health rather than life itself, that margins of mental lacks the necessary strength, will and knowledge to satisfy
physical vigor that allows a person to work most effectively 1 or more of 14 basic needs.  Assists and supports the
to reach his highest potential of satisfaction in life.” individual in life activities and the attainment of
Contd…… 5 independence.  Nurse serves to make patient “complete”
6. 6. Environment: She used Webster dictionary, which “whole", or "independent."  The nurse is expected to
defines environment as “the aggregate of all the external carry out physician’s therapeutic plan. Individualized care is
conditions and influences affecting the life and the result of the nurse’s creativity in planning for care. 
development of an organism.” Nursing: In1966, Henderson “Nurse should have knowledge to practice individualized
ultimate statements in the definition of nursing were and human care and should be a scientific problem solver.”
published of her ideas it reads as follows: “The unique  In the Nature of Nursing Nurse role is,” to get inside the
function of the nurse is to assist the individual (sick or well) patient’s skin and supplement his strength will or
in the performance of those activities contributing to health knowledge according to his needs.” 16
or its recovery (or peaceful death) that he would perform 17. 17. HENDERSON’S THEORY AND NURSING PROCESS
unaided if he had the necessary strength, will or  Nursing assessment: Assess needs of human being
knowledge. And to do this, in such a way as to help him based in the 14 components of basic nursing care. 
gain independence as rapidly as possible.” 6 Nursing Diagnosis: Identify individual’s ability to meet own
needs with or without assistance, taking into consideration
 strength, will or knowledge.  Nursing Plan: Document how 25. 25. Research • Research questions arise from each of the
the nurse can assist the individual, sick or well. 17 14 components of basic nursing care. • Henderson
18. 18.  Nursing Implementation Assist the sick or well concluded no profession, occupation or industry in this age
individual in to performance of activities in meeting human can evaluate adequately or improve it practice without
needs to maintain health, recover from illness, or to aid in research. • Offer a framework for generating knowledge
peaceful death. Implementation based on the physiological and new ideas. • She emphasized the importance of
principles, age, cultural background, emotional balance, research in evaluating and improving the nurses’ practice.
and physical and intellectual capacities.Carry out treatment 25
prescribed by the physician. 18 26. 26. VIRGINIA HENDERSON’S THEORY 26
19. 19. Nursing Evaluation Use the acceptable definition of 27. 27. STRENGTHS  The concept of nursing formulated by
nursing and appropriate laws related to the practice of Henderson in her definition of nursing and the 14
nursing. The quality of care is drastically affected by the components of basic nursing is uncomplicated and self-
preparation and native ability of the nursing personnel explanatory. Therefore, it can be used without difficulty as
rather that the amount of hours of care.Successful a guide for nursing practice by most nurses.  Henderson’s
outcomes of nursing care are based on the speed with work is relatively simple yet generalizable with some
which or degree to which the patient performs limitations.  Her work can be applied to the health of
independently the activities of daily living. 19 individuals of all ages.  Each of the 14 activities can be
20. 20. THEORETICAL ASSERTIONS The Nurse-Patient the basis for research. 27
Relationship: Henderson stated that there are three levels 28. 28. WEAKNESS A major shortcoming in her work is the
compromising the nurse-patient relationship: The nurse lack of a conceptual linkage between physiological and
as a substitute for the patient. The nurse as a helper to other human characteristics. No concept of the holistic
the patient. The nurse as a partner with the patient. 20 nature of human being. Lacks inter-relate of factors and
21. 21. The Nurse-Physician Relationship Henderson asserted the influence of nursing care. 28
that nurses function independently from physicians. 29. 29. BIBLIOGRAPHY • Basavanthappa BT. Nursing
Though the nurse and the patient, as partners, formulate theories. 1st ed. New Delhi: Jaypee Brothers Medical
the plan of care, it must be implemented in such a way that Publisher; 2007.p. 61-65. • Basavanthappa BT.
will promote the physician’s prescribed therapeutic plan. Fundamentals of nursing. 2nd ed. New Delhi: Jaypee
She also insisted that nurses do not follow doctor’s orders; Brothers Medical Publisher; 2007.p. 52. • Kozier and erb’s.
rather they follow in a philosophy which allows physicians Fundamental of nursing. 8th ed. New Delhi: Pearson; 2009.
to give orders to patients or other healthcare team p. 43-44. • Sr. Nancy. Principles and practice of nursing.
members. 21 6th ed. Indore: N.R. Brothers; 2007.p. 602-603. •
22. 22. The Nurse as a Member of the Healthcare Team: For a http://currentnursing.com/nursing_theory/Henderson.html •
team to work together in harmony, every member must http://vhenderson2011.blogspot.in/p/major-concepts.html •
work interdependently. The nurse, as a member of the http://currentnursing.com/nursing_theory/Henderson.html •
healthcare team, works and contributes in carrying out the http://nursing-theory.org/theories-and-models/henderson-
total program of care. However, working interdependently, need-theory.php 29
as Henderson indicated, does not include taking other 30. 30. 30
member’s roles and responsibilities. 22
23. 23. APPLICATIONS Practice: • The nurse can help the
patient move to an independent state by  Assessment-
assess the patients for 14 fundamental needs and
determine what are lacking.  Planning- plan to meet the
needs fit to the doctors prescribed plan.  Implementation-
uses the 14 basic needs in answering the factors contribute
to the illness. Assist the sick or well individual to maintain
health or recover from illness.  Evaluation phase- decides
whether goals are met or not. • Provide a rationale for
collecting reliable and valid data about the health status of
clients. • Help build a common nursing terminology to use
in communicating with other health professionals. 23
24. 24. Education Development of 3 phases of curriculum
development that students should progress in their
learning. The focus in all three phases remains the same
these are: • Assisting the patient when he needs strength,
will or knowledge in performing his daily activities or in
carrying out prescribed therapy with the ultimate goal of
independence. • Develop a habit of inquiry; take courses in
biological, physical, and social sciences and in the
humanities; study with students in other fields, observe
effective care, and give effective care in a variety of
settings. • Involve students in the complete study of the
patient and all his needs. 24
Faye Glenn Abdellah's Theory patients, and refers to the object of nursing as ‘patient’
Twenty-One Nursing Problems rather than client or consumer.
This page was last updated on October 31, 2011 She referred to Nursing diagnosis during a time when
nurses were taught that diagnosis was not a nurses’
INTRODUCTION.
prerogative.
"Nursing is based on an art and science that mould the
Assumptions were related to
attitudes, intellectual competencies, and technical skills of
change and anticipated changes that affect nursing;
the individual nurse into the desire and ability to help
the need to appreciate the interconnectedness of social
people , sick or well, cope with their health needs." -
enterprises and social problems;
Abdellah
the impact of problems such as poverty, racism, pollution,
Abdellah explained nursing as a comprehensive service,
education, and so forth on health care delivery;
which includes:
changing nursing education
Recognizing the nursing problems of the patient
continuing education for professional nurses
Deciding the appropriate course of action to take in terms
development of nursing leaders from under reserved
of relevant nursing principles
groups
Providing continuous care of the individuals total needs
Abdellah and colleagues developed a list of 21 nursing
Providing continuous care to relieve pain and discomfort
problems.They also identified 10 steps to identify the
and provide immediate security for the individual
client’s problems. 11 nursing skills to be used in
Adjusting the total nursing care plan to meet the patient’s
developing a treatment typology
individual needs
10 steps to identify the client’s problems
Helping the individual to become more self directing in
Learn to know the patient
attaining or maintaining a healthy state of mind & body
Sort out relevant and significant data
Instructing nursing personnel and family to help the
Make generalizations about available data in relation to
individual do for himself that which he can within his
similar nursing problems presented by other patients
limitations
Identify the therapeutic plan
Helping the individual to adjust to his limitations and
Test generalizations with the patient and make additional
emotional problems
generalizations
Working with allied health professions in planning for
Validate the patient’s conclusions about his nursing
optimum health on local, state, national and international
problems
levels
Continue to observe and evaluate the patient over a
Carrying out continuous evaluation and research to
period of time to identify any attitudes and clues affecting
improve nursing techniques and to develop new
his behavior
techniques to meet the health needs of people
Explore the patient’s and family’s reaction to the
(In 1973, the item 3, - “providing continuous care of the
therapeutic plan and involve them in the plan
individual’s total health needs” was eliminated.)
Identify how the nurses feels about the patient’s nursing
ABOUT THE THEORIST AND THEORETICAL SOURCES
problems
Birth:1919
Discuss and develop a comprehensive nursing care plan
Abdellah’s patient - centred approach to nursing was
11 nursing skills
developed inductively from her practice and is considered
Observation of health status
a human needs theory.
Skills of communication
The theory was created to assist with nursing education
Application of knowledge
and is most applicable to the education of nurses.
Teaching of patients and families
Although it was intended to guide care of those in the
Planning and organization of work
hospital, it also has relevance for nursing care in
Use of resource materials
community settings.
Use of personnel resources
MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS
Problem-solving
She uses the term ‘she’ for nurses, ‘he’ for doctors and
Direction of work of others To use community resources as an aid in resolving
Therapeutic use of the self problems arising from illness
Nursing procedure To understand the role of social problems as influencing
21 NURSING PROBLEMS factors in the case of illness
Three major categories ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS
Physical, sociological, and emotional needs of clients NURSING
Types of interpersonal relationships between the nurse Nursing is a helping profession.
and patient Nursing care is doing something to or for the person or
Common elements of client care providing information to the person with the goals of
BASIC TO ALL PATIENTS meeting needs, increasing or restoring self-help ability, or
To maintain good hygiene and physical comfort alleviating impairment.
To promote optimal activity: exercise, rest and sleep Nursing is broadly grouped into the 21 problem areas to
To promote safety through the prevention of accidents, guide care and promote use of nursing judgment.
injury, or other trauma and through the prevention of the Nursing to be comprehensive service.
spread of infection PERSON
To maintain good body mechanics and prevent and Abdellah describes people as having physical, emotional,
correct deformity and sociological needs.
SUSTENAL CARE NEEDS Patient is described as the only justification for the
To facilitate the maintenance of a supply of oxygen to all existence of nursing.
body cells Individuals (and families) are the recipients of nursing
To facilitate the maintenance of nutrition of all body cells Health, or achieving of it, is the purpose of nursing
To facilitate the maintenance of elimination services.
To facilitate the maintenance of fluid and electrolyte HEALTH
balance In Patient–Centered Approaches to Nursing, Abdellah
To recognize the physiological responses of the body to describes health as a state mutually exclusive of illness.
disease conditions Although Abdellah does not give a definition of health, she
To facilitate the maintenance of regulatory mechanisms speaks to “total health needs” and “a healthy state of
and functions mind and body” in her description of nursing as a
To facilitate the maintenance of sensory function. comprehensive service.
REMEDIAL CARE NEEDS SOCIETY AND ENVIRONMENT
To identify and accept positive and negative expressions, Society is included in “planning for optimum health on
feelings, and reactions local, state, national, and international levels”. However,
To identify and accept the interrelatedness of emotions as she further delineated her ideas, the focus of nursing
and organic illness service is clearly the individual.
To facilitate the maintenance of effective verbal and non The environment is the home or community from which
verbal communication patient comes.
To promote the development of productive interpersonal CHARACTERISTICS OF THE THEORY
relationships Abdellah’s theory has interrelated the concepts of health,
To facilitate progress toward achievement of personal nursing problems, and problem solving.
spiritual goals Problem solving is an activity that is inherently logical in
To create and / or maintain a therapeutic environment nature.
To facilitate awareness of self as an individual with varying Framework focus on nursing practice and individuals.
physical , emotional, and developmental needs The results of testing such hypothesis would contribute to
RESTORATIVE CARE NEEDS the general body of nursing knowledge
To accept the optimum possible goals in the light of Easy to apply in practice.
limitations, physical and emotional USE OF 21 PROBLEMS IN THE NURSING PROCESS
ASSESSMENT PHASE 1942, Abdellah earned a nursing diploma from Fitkin
Memorial Hospitals School of Nursing New Jersey (now
Nursing problems provide guidelines for the collection of
Ann May School of Nursing). She received her Bachelor of
data. Science Degree in 1945, a Master of Arts degree in 1947
A principle underlying the problem solving approach is and Doctor of Education in Teacher’s College, Columbia
University. In 1947 she also took Master of Arts Degree in
that for each identified problem, pertinent data are
Physiology.
collected. 4. 4. Abdellah went on to become a nursing instructor and
The overt or covert nature of the problems necessitates a researcher and helped transform the focus of the
profession from disease centered to patient centered. She
direct or indirect approach, respectively.
expanded the role of nurses to include care of families and
NURSING DIAGNOSIS the elderly.She worked in many settings. She had been a
The results of data collection would determine the client’s staff nurse, a head nurse, a faculty member at Yale
specific overt or covert problems. University and at Columbia University, a public health
nurse, a researcher and an author of more than 147
These specific problems would be grouped under one or articles and books.She was selected as Deputy Surgeon
more of the broader nursing problems. General in 1982. She retired in 1989.
This step is consistent with that involved in nursing 5. 5. 1937 – She wanted to be a nurse on the day she saw
Hindenburg explode.1949 – She spent 40 years in Public
diagnosis Health Service where she first became involved in
PLANNING PHASE research, being assigned to perform studies to improve
The statements of nursing problems most closely nursing practices.1960 – She was influenced by the
desire to promote client- centered comprehensive nursing
resemble goal statements. Once the problem has been care.
diagnosed, the nursing goals have been established. 6. 6. BASIC TO ALL PATIENTS1. To maintain good hygiene
IMPLEMENTATION and physical comfort –After colonoscopy, patients are
usually soiled from theprocedure. It is therefore important
Using the goals as the framework, a plan is developed and to clean themproperly. Physical comfort through proper
appropriate nursing interventions are determined. positioningin bed.2. To promote optimal activity: exercise,
EVALUATION rest, andsleep – Patients who were sedated during
theprocedure stay in the unit until the effect of thesedation
The most appropriate evaluation would be the nurse has decreased to a safe level. As anurse, make sure the
progress or lack of progress toward the achievement of patients are able to rest andsleep well by providing a
the stated goals.. conducive environment forrest, such as decreasing
environmental noise anddimming the light if necessary.
Progressive Patient Care :: Models of Nursing Care 7. 7. 3. To promote safety through prevention ofaccident,
Delivery injury, or other trauma and through theprevention of the
CONCLUSION spread of infection – Making surethe side rails are always
up when leaving the patient .one way we prevent the
Using Abdellah’s concepts of health, nursing problems, spread of infection is throughproper disinfection of the
and problem solving, the theoretical statement of nursing equipments .4. To maintain good body mechanics and
that can be derived is the use of the problem solving prevent andcorrect deformity – Positioning the
patientproperly, allowing for the normal anatomical
approach with key nursing problems related to health positionof body parts.
needs of people. From this framework, 21 nursing 8. 8. 5. facilitate the maintenance of a supply of oxygen to all
body cells –when patients manifest breathing problems,
problems were developed.
oxygen is attached tothem, usually via nasal cannula.
Abdellah’s theory provides a basis for determining and Sedated patients are attached tocardiac monitor and pulse
organizing nursing care. The problems also provide a basis oxi meter while having the oxygendelivered. When the
oxygen saturation falls below the normallevels, the rate of
for organizing appropriate nursing strategies.
oxygen is increased accordingly, as per physiciansorder.6.
To facilitate the maintenance of nutrition of all body cells –
Abdellah’s theory patients undergoing endoscopic procedures are on NPO.
1. 1. PRESENTED BYMr. NAVJYOT SINGH ChoudharyM.SC For thisreason it is important to monitor the blood glucose
NURSING 1st YEARDept. of Pediatric Nursing level. When thepatients blood glucose falls from the normal
2. 2. Faye Glenn Abdellah was one of the most influential value, we inject D50Wto the patient or we change the
nursing theorist and public health scientists . It is extremely patients IVF to a dextrose containingfluid.
rare to find someone who has dedicated all her life to the 9. 9. 7. To facilitate the maintenance of elimination –
advancement of the nursing profession and accomplish this Providingbedpans or urinals to patients and at times,
feat with so much distinction and merit. insertion of Foleycatheter when the patient is not able to
3. 3. Faye Glenn Abdellah was born on March 13, 1919, in void.8. To facilitate the maintenance of fluid and
New York City.EDUCATIONAL ACHIEVEMENTSIn electrolytebalance – Proper regulation of the intravenous
 solutions as wellas proper incorporations it may have. An 17. 17. 21. To understand the role of social problems as
example is whenpatients have low serum potassium; KCl is influencingfactors in the cause of illness – Some patients
incorporated in thesolution. who arediagnosed with amoebic colitis for instance are
10. 10. 9. To recognize the physiological responses of the advised to avoidbuying street foods to which the
body todisease conditions—pathological, physiological, preparation they are not sureof, and also avoid drinking
andcompensatory – it is important to check the patients for water that are not safe.
signs ofinternal gastrointestinal bleeding by monitoring the 18. 18. Abdellah describes people as having physical,
bloodpressure and cardiac rate.10.To facilitate the emotional, and sociological needs. These needs may overt,
maintenance of regulatory mechanisms andfunctions – consisting of largely physical needs, or covert, such as
When a patient has a difficulty in breathing and isshowing emotional, sociological and interpersonal needs- which are
an increase respiratory rate, elevating the head part ofthe often missed and perceived incorrectly The individuals
bed is done to facilitate the respiratory function. (and families) are the recipients of nursing, and health, or
11. 11. 11. To facilitate the maintenance of sensory function – achieving of it, is the purpose of nursing services.
Sometimes there are semi-conscious patients, in these 19. 19.  Emphasis should be placed upon prevention and
cases, itis still necessary to talk to them while performing rehabilitation. Holistic approach must be taken by the nurse
nursinginterventions to maintain their auditory sense. to help the client achieve state of health. However the
12. 12. 12. To identify and accept positive and nurse must accurately identify the lacks or deficits
negativeexpressions, feelings, and reactions – most regarding health that the client is experiencing. These lacks
patients feel anxiousbefore undergoing the procedures. It is or deficits are the client’s health needs.
necessary to listen to thepatients expressions and allow 20. 20. The environment is implicitly defined by Abdellah as
them to ask questions. To decreasetheir anxiety, proper the home or community from which patient comes. Society
instructions are given, what they are toexpect, how long the is included in “planning for optimum health.” However, as
procedure will take, what they should doduring and after Abdellah further delineated her ideas, the focus of nursing
the procedure as well as other concerns.13. To identify and service is clearly the individual.
accept interrelatedness of emotions and organicillness – 21. 21. These would mean a comprehensive nursing service,
Encourage patients to verbalize their feelings and this would include:1. Recognizing the nursing problems of
allowthem to cry when they have the need to do so will thepatient.2. Deciding the appropriate actions to takein
help thememotionally. Some patients are diagnosed with terms of relevant nursing principles.3. Providing continuous
malignancy afterthe procedure and during this time the care of theindividual’s total health needs.4. Providing
emotional needs of thepatient is a priority. continuous care to relieve painand discomfort.5. Adjusting
13. 13. 14. To facilitate the maintenance of effective verbal total nursing care plan to meetthe patient’s individual
andnonverbal communication – when patients are not able needs.
toexpress themselves verbally, it is important to assess 22. 22. 6. Helping the individual to become more self directing
fornonverbal cues. For instance when patients are in pain, inattaining or maintaining a healthy state of mind and
assessingfor facial grimacing.15. To promote the body.7. Instructing nursing personnel and family to help
development of productive interpersonalrelationships – theindividual8. Helping the individual to adjust to his
allow the patients significant others to stay withthe patient limitations andemotional problems.9. Working with allied
before and after the procedure. This allows forbonding and health professional in planning foroptimum health10.
promotes interpersonal relationship. Carrying out continuous evaluation and research to
14. 14. 16. To facilitate progress toward achievement of improvenursing techniques and to develop new techniques
personalspiritual goals – nurse usually visits the patients in to meet allthe health needs of the people.
the unit.Patients may benefit from this, allowing them time 23. 23. 1. Observation of health status2. Skills of
to practicetheir faith.17. To create and/or maintain a communication3. Application of knowledge4. Teaching of
therapeutic environment -providing proper lighting, proper patients and families5. Planning and organization of work6.
room temperature, a quietenvironment are done to patients Use of resource materials7. Use of personnel resources8.
staying in the unit. Problem-solving9. Direction of work of others10.
15. 15. 18. To facilitate awareness of self as an individual with Therapeutic use of the self11. Nursing procedures
varyingphysical, emotional, and developmental needs – 24. 24. Physical, Sociological, emotional NeedsCommon
care topatients vary according to their developmental Elements Of Patient Interpersonal Relationship Area
needs. Allowingthe parents to stay during the procedure 25. 25. Nursing PracticeAbdeallah’s main goal is the
help the pediatricpatients in their emotional and
improvement of the nursing education.The most
developmental needs.
important impact of Abdellah’s theory to the nursing
16. 16. 19. To accept the optimum possible goals in the light
practice is that it helped transform the focus of the
oflimitations, physical, and emotional – The goals for each
profession from being “disease- centered” to “patient-
patientvary depending on the capability of the patient. The
centered.”The steps of the nursing process are
nutritionalgoal for a patient with a PEG tube for instance
assessment, diagnosis, planning, implem entation and
will bedifferent, knowing that the patient has limited feeding
evaluation
options.20. To use community resources as an aid in
resolving problemsarising from illness – Some patients live 26. 26. Professors and educators realized the importance of
far from the city andthus referral to health centers is client centered care rather than focusing on medical
sometimes done. interventions. Nursing education then slowly deviated its
concentration from the complex, medical concepts, into
exercising better attention to the client as the primary
 concern. It’s very strong nurse-centered orientation—is, on attempts to create a different way of viewing nursing
the other hand, it’s major contribution to nursing education. phenomenon.
27. 27. Her theories continue to guide researchers to focus 39. 39. The major limitation of Abdellah theory and the
on the body of nursing knowledge itself, the identification of twenty one nursing problems is their very strong nursing
patient problems, the organization of nursing interventions, centered orientation. With the orientation appropriate use
the improvement of nursing education, and the structure of might be the organization of teaching content for nursing
the curriculum. The extensive research done regarding students, the evaluation of a students, performance in the
the patient’s needs and problems has served as a clinical area or both. But in terms of client care there is little
foundation for the development of what is now known as emphasis on what the client is to achieve.
nursing diagnoses. 40. 40. Using Abdellah’s concepts of health, nursing
28. 28. Nursing problems provide guidelines for the collection problems, and problem solving, the theoretical statement of
of data.A principle underlying the problem solving nursing that can be derived is the use of the problem
approach is that for each identified problem, pertinent data solving approach with key nursing problems related to
are collected.The overt or covert nature of the problems health needs of people. From this framework, 21 nursing
necessitates a direct or indirect approach, respectively. problems were developed.Abdellah’s theory provides a
29. 29. NURSING DIAGNOSISThe results of data basis for determining and organizing nursing care. The
collection would determine the client’s specific overt or problems also provide a basis for organizing appropriate
covert problems.These specific problems would be nursing strategies.
grouped under one or more of the broader nursing
problems.This step is consistent with that involved in
nursing diagnosis
30. 30. PLANNING PHASEThe statements of nursing
problems most closely resemble goal statements. Once the
problem has been diagnosed, the nursing goals have been
established.
31. 31. IMPLEMENTATIONUsing the goals as the
framework, a plan is developed and appropriate nursing
interventions are determined.
32. 32. EVALUATIONThe most appropriate evaluation
would be the nurse progress or lack of progress toward the
achievement of the stated goals..
33. 33. The case of SimarHe experienced severe chest
pain. In addition he experienced shortness of breadth,
tachycardia and profuse diaphoresis.
34. 34. Assessmentreveals: cardiac Past History : He damage
had gone through similar episodes since past 2 years.
35. 35. PAIN IMPAIRED CARDIAC FUNCTIONING` WORK
RELATED STRESS FAILURE TO SEEK MEDICAL
ATTENTION
36. 36. STAGES OF Abdellah nsg Nsg intervensions
NsgILLNESS problem intervensionsBasic to care 1. To
maintain good 1. Administer oxygen Amount of pain
hygiene and 2. Elevate headrest physical comfort 3.
Reposition of client 4. Administer analgesics as
advisedSusternal care 5 to facilitate the 1 promote rest
Vital signs.needs maintenance of 2 Place in sitting supply
of oxygen to position body cells 3 Promote deep breathing
and coughing exercises 4 Implement exercises as
toleratedRemedial care 13 To identify and 1 to find the
nature of his knowledge ofneeds accept the job.
relationship interrelatedness of 2 explore his work related
between stress emotional and goal and his illness organic
illness 3 stress associated with jobs.
37. 37. Stages of illness Abdellah nsg Nsg intervensions
Criterion measure problemsRestorative care 20 to use 1.
Teach early Knowledge aboutneeds community signs and
the use of resources as an symptoms of community aid in
resolving cardiac resources. problems arising distress.
from illness 2. Teach course of action .
38. 38. Abdellah’s theory has interrelated the concepts of
health, nursing problems and problem solving as she
 Watson served as chairperson and assistant dean of the
undergraduate program at the University of Colorado School of
Nursing. She was involved in planning and implementation of the
Biography of Jean Watson nursing PhD program and served as coordinator and director of the
Jean Watson (June 10, 1940 – present) is an American nurse PhD program between 1978 and 1981. From 1983 to 1990, she was
theorist and nursing professor who is well known for her “Philosophy Dean of University of Colorado School of Nursing and Associate
and Theory of Transpersonal Caring.” She has also written numerous Director of Nursing Practice at University Hospital. During her
texts, including Nursing: The Philosophy and Science of Caring. deanship, she was instrumental in the development of a post-
Watson’s study on caring has been integrated into education and baccalaureate nursing curriculum in human caring, health, and
patient care to various nursing schools and healthcare facilities all healing that led to a Nursing Doctorate (ND), a professional clinical
over the world. doctoral degree that in 2005 became the Doctor of Nursing Practice
Early Life (DNP) degree.
Jean Watson was born Margaret Jean Harmon and grew up in the Between 1993 and 1996, Watson served as a member of the
small town of Welch, West Virginia, in the Appalachian Mountains. Executive Committee and the Governing Board, and as an officer for
She was the youngest of eight children and was surrounded by an the NLN, and she was elected president from 1995 to 1996.
extended family–community environment. Watson attended high In 2005, she took a sabbatical for a walking pilgrimage in the Spanish
school in West Virginia and then the Lewis Gale School of Nursing in El Camino. And in 2008, Watson created a non-profit foundation:
Roanoke, Virginia, where she graduated in 1961. Watson Caring Science Institute, to further the work of Caring
ADVERTISEMENT Science in the world.
Personal Life Philosophy and Theory of Transpersonal Caring
Jean Watson, RN, PhD, FAAN, AHN-BC Watson’s Philosophy and Science of Caring is concerned on how
After her graduation in 1961, Jean Watson married her husband, nurses express care to their patients. Her theory stresses humanistic
Douglas, and moved west to his native state of Colorado. In 1997, aspects of nursing as they intertwine with scientific knowledge and
she experienced an accidental injury that resulted in the loss of her nursing practice.
left eye and soon after, in 1998, her husband, whom she considers International Hiroshima Conference on Caring and Peace
as her physical and spiritual partner, and her best friend passed The nursing model states that “nursing is concerned with promoting
away and left Watson and their two grown daughters, Jennifer and health, preventing illness, caring for the sick, and restoring health.” It
Julie, and five grandchildren. focuses on health promotion, as well as the treatment of diseases.
Watson states that she is “attempting to integrate these wounds into According to Watson, caring is central to nursing practice, and
my life and work. One of the gifts through the suffering was the promotes health better than a simple medical cure. She believes that
privilege of experiencing and receiving my own theory through the a holistic approach to health care is central to the practice of caring in
care from my husband and loving nurse friends and colleagues.” nursing.
These two personal life-altering events contributed to writing her third According to her theory, caring can be demonstrated and practiced
book, Postmodern Nursing and Beyond. by nurses. Caring for patients promotes growth; a caring environment
Education accepts a person as he or she is, and looks to what he or she may
Jean Watson ardently and quickly progressed through her nursing become.
education earning her bachelor’s degree in nursing in 1964, a master Watson also defined three of the four metaparadigm concepts in
of science in nursing in psychiatric and mental health nursing in nursing including person or human being, health, and nursing. She
1966, and a Ph.D. in educational psychology and counseling in 1973, referred human being as a valued person in and of him or herself to
all from the University of Colorado at Boulder. be cared for, respected, nurtured, understood and assisted; in
Career and Appointments general a philosophical view of a person as a fully functional
Lecture series celebration, Taken at St Peter’s College, New Jersey integrated self. Human is viewed as greater than and different from
After Jean Watson concluded her doctoral degree, she has served in the sum of his or her parts. Health, meanwhile, is defined as a high
both faculty and administrative positions in the School of Nursing level of overall physical, mental, and social functioning; a general
faculty, University of Colorado Health Sciences Center in Denver. In adaptive-maintenance level of daily functioning; and the absence of
1981 and 1982, she pursued international sabbatical studies in New illness, or the presence of efforts leading to the absence of illness.
Zealand, Australia, India, Thailand, and Taiwan. And nursing as a science of persons and health-illness experience
In the 1980s, Watson and colleagues established the Center for that are mediated by professional, personal, scientific, and ethical
Human Caring at the University of Colorado, the nation’s first care interactions.
interdisciplinary center committed to using human caring knowledge She does not define the fourth metaparadigm concept
for clinical practice, scholarship, and administration and leadership. of environment but instead devised 10 caring needs
At the center, Watson and others sponsor clinical, educational, and specific carative factors critical to the caring human experience that
community scholarship activities and projects in human caring. need to be addressed by nurses with their patients when in a caring
These activities involve national and international scholars in role.
residence, as well as international connections with colleagues 10 Carative Factors
around the world, such as Australia, Brazil, Canada, Korea, Japan, Watson’s 10 carative factors are: (1) forming humanistic-altruistic
New Zealand, the United Kingdom, Scandinavia, Thailand, and value systems, (2) instilling faith-hope, (3) cultivating a sensitivity to
Venezuela, among others. Activities such as these continue at the self and others, (4) developing a helping-trust relationship, (5)
University of Colorado’s International Certificate Program in Caring promoting an expression of feelings, (6) using problem-solving for
Healing, where Watson offers her theory courses for doctoral decision-making, (7) promoting teaching-learning, (8) promoting a
students. supportive environment, (9) assisting with gratification of human
Henry Ford Hospital research conference needs, and (10) allowing for existential-phenomenological forces.
The first three factors form the “philosophical foundation” for the measurements address quality of care, patient, client, and nurse
science of caring, and the remaining seven come from that perceptions of caring, and caring behaviors, abilities, and
foundation. efficacy.This is Watson’s fourth book.
Charles Drew University Medicine Dymally School of Nursing, Los Caring Science as Sacred Science (2005)
Angeles Watson’s fifth book describes her personal journey to enhance
Within assisting with the gratification of human needs, Watson’s understanding about caring science, spiritual practice, the concept
hierarchy of needs begins with lower-order biophysical and practice of care, and caring-healing work. In this book, she leads
needs or survival needs, which include the need for food and fluid, the reader through thought-provoking experiences and the
elimination, and ventilation. Next are the lower-order sacredness of nursing by emphasizing deep inner reflection and
psychophysical needs or functional needs, which include the personal growth, communication skills, use of self-transpersonal
need for activity, inactivity, and sexuality. The higher order growth, and attention to both caring science and healing through
psychosocial needs or integrative needs include the need for forgiveness, gratitude, and surrender. It received the American
achievement, and affiliation. And finally the higher order Journal of Nursing 2005 Book of the Year Award.
intrapersonal-interpersonal need or growth-seeking need which Recent books include Measuring Caring:
is self-actualization.
The nursing process outlined in Watson’s model contains the same International Research on Caritas as Healing (Nelson & Watson,
steps as the scientific research process: assessment, plan, 2011), Creating a Caring Science Curriculum (Hills & Watson, 2011),
intervention, and evaluation. The assessment includes observation, and Human Caring Science: A Theory of Nursing (Watson, 2012).
identification, and review of the problem, as well as the formation of a Awards and Honors
hypothesis. Creating a care plan helps the nurse determine how Molloy College Division of Nursing’s third annual doctoral forum
variables would be examined or measured, and what data would be research lecture and poster sessions
collected. Intervention is the implementation of the care plan and Jean Watson has been active and hardworking in many community
data collection. Finally, the evaluation analyzes the data, interprets programs during her career. She has been a founder and a member
the results, and may lead to an additional hypothesis. of the Board of Boulder County Hospice, and numerous other
Works collaborations with area health care facilities. She has received
Watson has authored 11 books, shared in authorship of six books, several research and advanced education federal grants and awards
and has written countless articles in nursing journals. The following and numerous university and private grants and extramural funding
publications reflect the evolution of her theory of caring from her for her faculty and administrative projects and scholarships in human
ideas about the philosophy and science of caring. caring.
Nursing: The Philosophy and Science of Caring (1979) In 1992, the University of Colorado School of Nursing honored
Watson as a distinguished professor of nursing. She received
Watson’s first book was developed from her notes for an six honorary doctoral degrees from universities in the United States
undergraduate course taught at the University of Colorado. Her early and three Honorary Doctorates in international universities, including
work embraced the 10 carative factors but evolved to include Göteborg University in Sweden, Luton University in London, and the
“caritas,” making explicit connections between caring and love. This University of Montreal in Quebec, Canada. She received the National
book was reprinted in 1985 and translated into Korean and French. League for Nursing (NLN) Martha E. Rogers Award, which
Human Science and Human Care – A Theory of Nursing (1985) recognizes nurse scholars’ significant contributions to advancing
This book, published in 1985 and reprinted in 1988 and 1999, nursing knowledge and knowledge in other health sciences in 1993.
addressed her conceptual and philosophical problems in nursing. Her In 1997, the NLN awarded her an honorary lifetime certificate as a
second book has been translated into Chinese, German, Japanese, holistic nurse. Finally, in 1999, Watson assumed the nation’s first
Korean, Swedish, Norwegian, Danish, and probably other languages Murchison-Scoville Endowed Chair of Caring Science and currently
by now. is a distinguished professor of nursing.
Postmodern Nursing and Beyond (1999) Qatar Conference Unified Caring Model for Gulf Countries UAE
Watson’s third book was presented as a model to bring nursing Watson was recognized as a Distinguished Nurse Scholar by New
practice into the twenty-first century. York University in 1998. And in 1999, she received the Fetzer
Watson describes two personal life-altering events that contributed to Institute’s National Norman Cousins Award in recognition of her
her writing. In 1997, she experienced an accidental injury that commitment to developing, maintaining, and exemplifying
resulted in the loss of her left eye and soon after, in 1998, her relationship-centered care practices.
husband died. Watson states that she is “attempting to integrate She is a Distinguished and/or Endowed Lecturer at national
these wounds into my life and work. One of the gifts through the universities, including Boston College, Catholic University, Adelphi
suffering was the privilege of experiencing and receiving my own University, Columbia University-Teachers College, State University of
theory through the care from my husband and loving nurse friends New York, and at universities and scholarly meetings in numerous
and colleagues.” This book has been translated into Portuguese and foreign countries.
Japanese. Her international activities also include an International Kellogg
Instruments for Assessing and Measuring Caring in Nursing and Fellowship in Australia in 1982, a Fulbright Research and Lecture
Health Sciences (2002) Award to Sweden and other parts of Scandinavia in 1991, and a
This is a collection of 21 instruments to assess and measure caring, lecture tour in the United Kingdom in 1993. Watson has been
received the American Journal of Nursing Book of the Year Award. involved in international projects and has received invitations to New
This book provides all the essential research tools for assessing and Zealand, India, Thailand, Taiwan, Israel, Japan, Venezuela, Korea,
measuring caring for those in the caring professions. Watson’s text is and other places. She is featured in at least 20 nationally distributed
the only comprehensive and accessible collection of instruments for audiotapes, videotapes, and/or CDs on nursing theory.
care measurement in clinical and educational nursing research. The
In 2010, Watson received an Honorary Doctor of Sciences in of overall physical, mental, and social functioning; a general
Nursing from the University of Victoria in British Columbia, Canada. adaptive-maintenance level of daily functioning; and the absence of
Theory of Human Caring of Jean Watson illness, or the presence of efforts leading to the absence of illness.
Nowadays, a lot of people choose nursing as a profession. There are Nursing
many reasons to consider in becoming a professional nurse, but Nursing is a human science of persons and human health-illness
compassion is often a trait required of nurses. This is for the reason experiences that are mediated by professional, personal, scientific,
that taking care of the patients’ needs is its primary purpose. Jean esthetic, and ethical human care transactions.
Watson’s “Philosophy and Theory of Transpersonal Actual Caring Occasion
Caring” mainly concerns on how nurses care for their patients, and Actual caring occasion involves actions and choices by the nurse and
how that caring progresses into better plans to promote health and the individual. The moment of coming together in a caring occasion
wellness, prevent illness and restore health. presents the two persons with the opportunity to decide how to be in
In today’s world, nursing seems to be responding to the various the relationship – what to do with the moment.
demands of the machinery with less consideration of the needs of the Transpersonal
person attached to the machine. In Watson’s view, the disease might The transpersonal concept is an intersubjective human-to-human
be cured, but illness would remain because, without caring, health is relationship in which the nurse affects and is affected by the person
not attained. Caring is the essence of nursing and connotes of the other. Both are fully present in the moment and feel a union
responsiveness between the nurse and the person; the nurse co- with the other; they share a phenomenal field that becomes part of
participates with the person. Watson contends that caring can assist the life story of both.
the person to gain control, become knowledgeable, and promote Subconcepts
health changes Phenomenal field
ADVERTISEMENTS The totality of human experience of one’s being in the world. This
What is Watson’s Theory of Transpersonal Caring? refers to the individual’s frame of reference that can only be known to
According to Watson’s theory, “Nursing is concerned with promoting that person.
health, preventing illness, caring for the sick, and restoring health.” It Self
focuses on health promotion, as well as the treatment of diseases. The organized conceptual gestalt composed of perceptions of the
According to Watson, caring is central to nursing practice, and characteristics of the “I” or “ME” and the perceptions of the
promotes health better than a simple medical cure. relationship of the “I” and “ME” to others and to various aspects of
The nursing model also states that caring can be demonstrated and life.
practiced by nurses. Caring for patients promotes growth; a caring Time
environment accepts a person as he or she is, and looks to what he The present is more subjectively real and the past is more objectively
or she may become. real. The past is prior to, or in a different mode of being than the
Assumptions present, but it is not clearly distinguishable. Past, present, and future
Watson’s model makes seven assumptions: (1) Caring can be incidents merge and fuse.
effectively demonstrated and practiced only interpersonally. (2) 10 Carative Factors
Caring consists of carative factors that result in the satisfaction of Watson devised 10 caring needs specific carative factors critical to
certain human needs. (3) Effective caring promotes health and the caring human experience that need to be addressed by nurses
individual or family growth. (4) Caring responses accept the patient with their patients when in a caring role. As carative factors evolved
as he or she is now, as well as what he or she may become. (5) A within an expanding perspective, and as her ideas and values
caring environment is one that offers the development of potential evolved, Watson offered a translation of the original carative factors
while allowing the patient to choose the best action for him or herself into clinical caritas processes that suggested open ways in which
at a given point in time. (6) A science of caring is complementary to they could be considered.
the science of curing. (7) The practice of caring is central to nursing. The first three carative factors are the “philosophical foundation” for
Major Concepts the science of caring, while the remaining seven derive from that
The Philosophy and Science of Caring has four major concepts: foundation. The ten primary carative factors with their corresponding
human being, health, environment or society, and nursing. translation into clinical caritas processes are listed in the table below.
Society Carative Factors and Caritas Processes
Society provides the values that determine how one should behave Watson’s Hierarchy of Needs
and what goals one should strive toward. Watson states: Within assisting with the gratification of human needs, Watson’s
“Caring (and nursing) has existed in every society. Every society has hierarchy of needs begins with lower-order biophysical needs or
had some people who have cared for others. A caring attitude is not survival needs, the lower-order psychophysical needs or functional
transmitted from generation to generation by genes. It is transmitted needs, the higher order psychosocial needs or integrative needs, and
by the culture of the profession as a unique way of coping with its finally the higher order intrapersonal-interpersonal need or growth-
environment.” seeking need.Watson’s Hierarchy of Needs
Human being Lower Order Biophysical Needs or Survival Needs
Human being is a valued person to be cared for, respected, nurtured, Watson’s hierarchy of needs begins with lower-order biophysical
understood, and assisted; in general a philosophical view of a person needs or survival needs. These include the need for food and fluid,
as a fully functional integrated self. Human is viewed as greater than elimination, and ventilation.
and different from the sum of his or her parts. Lower Order Psychophysical Needs or Functional Needs
Health Next in line are the lower-order psychophysical needs or functional
Health is the unity and harmony within the mind, body, and soul; needs. These include the need for activity, inactivity, and sexuality.
health is associated with the degree of congruence between the self Higher Order Psychosocial Needs or Integrative Needs
as perceived and the self as experienced. It is defined as a high level
The higher order psychosocial needs or integrative needs include the Conclusion
need for achievement, and affiliation. Watson began developing her theory while she was assistant dean of
Higher Order Intrapersonal-Interpersonal Need or Growth- the undergraduate program at the University of Colorado, and it
seeking Need evolved into planning and implementation of its nursing Ph.D.
The higher order intrapersonal-interpersonal need or growth-seeking program.
need is the need for self-actualization. The Philosophy and Science of Caring addresses how nurses
Watson’s Theory and The Nursing Process express care to their patients. Caring is central to nursing practice,
The nursing process in Watson’s theory includes the same steps as and promotes health better than a simple medical cure.
the scientific research process: assessment, plan, intervention, and Watson believes that a holistic approach to health care is central to
evaluation. The assessment includes observation, identification, and the practice of caring in nursing.
review of the problem, as well as the formation of a hypothesis. This led to the formulation of the 10 carative factors: (1) forming
Creating a care plan helps the nurse determine how variables would humanistic-altruistic value systems, (2) instilling faith-hope, (3)
be examined or measured, and what data would be collected. cultivating a sensitivity to self and others, (4) developing a helping-
Intervention is the implementation of the care plan and data trust relationship, (5) promoting an expression of feelings, (6) using
collection. Finally, the evaluation analyzes the data, interprets the problem-solving for decision-making, (7) promoting teaching-
results, and may lead to an additional hypothesis. learning, (8) promoting a supportive environment, (9) assisting with
Analysis gratification of human needs, and (10) allowing for existential-
It is undeniable that technology has already been part of nursing’s phenomenological forces. The first three factors form the
whole paradigm with the evolving era of development. Watson’s “philosophical foundation” for the science of caring, and the
suggestion of purely “caring” without giving much attention to remaining seven come from that foundation.
technological machinery cannot be solely applied but then her Describing her theory as descriptive, Watson acknowledges the
statement is praiseworthy because she dealt with the importance of evolving nature of the theory and welcomes input from others.
the nurse-patient interaction rather than a practice confined with Although the theory does not lend itself easily to research conducted
technology. through traditional scientific methods, recent qualitative nursing
Watson stated the term “soul-satisfying” when giving out care for the approaches are appropriate.
clients. Her concepts guide the nurse to an ideal quality nursing care
provided for the patient. This would further increase the involvement Watson’s theory continues to provide a useful and important
of both the patient and the nurse when the experience is satisfying. metaphysical orientation for the delivery of nursing care. Watson’s
ADVERTISEMENTS theoretical concepts, such as use of self, patient-identified needs, the
In providing the enumerated clinical Caritas processes, the nurse caring process, and the spiritual sense of being human, may help
becomes an active co-participant with the patient. Thus, the quality of nurses and their patients to find meaning and harmony during a
care offered by the nurse is enhanced. period of increasing complexity. Watson’s rich and varied knowledge
Strengths of philosophy, the arts, the human sciences, and traditional science
Although some consider Watson’s theory complex, many find it easy and traditions, joined with her prolific ability to communicate, has
to understand. The model can be used to guide and improve practice enabled professionals in many disciplines to share and recognize her
as it can equip healthcare providers with the most satisfying aspects work.
of practice and can provide the client with holistic care.
Watson considered using nontechnical, sophisticated, fluid, and Watson theory
evolutionary language to artfully describe her concepts, such as 1. 1. Presented by- Ms. Nidhi Shukla M .Sc. Nursing 1st year
caring-love, carative factors, and Caritas. Paradoxically, abstract and 2. 2. “Too often we underestimate the power of a touch, a smile,
simple concepts such as caring-love are difficult to practice, yet a kind word, a listening ear, an honest compliment, or the
practicing and experiencing these concepts leads to greater smallest act of caring, all of which have the potential to turn a
understanding. life around.”
Also, the theory is logical in that the carative factors are based on 3. 3. Jean Watson • Born in West Virginia, currently living in
broad assumptions that provide a supportive framework. The carative Colorado. • She earned a B.Sc. in 1964, MS in Psychiatric
factors are logically derived from the assumptions and related to the Nursing in 1966 and PhD in Educational Psychology and
hierarchy of needs. Counseling in 1973. • Founder of the Center for Human
Watson’s theory is best understood as a moral and philosophical Caring in Colorado.
basis for nursing. The scope of the framework encompasses broad 4. 4. JEAN WATSON’S THEORY OF HUMANCARING
aspects of health-illness phenomena. In addition, the theory 5. 5.  Watson's philosophy of caring attempts to define
addresses aspects of health promotion, preventing illness and outcome of nursing activity in regard to the humanistic
experiencing peaceful death, thereby increasing its generality. The aspects of life. Her theory and philosophy of caring is based
carative factors provide guidelines for nurse-patient interactions, an on the values of kindness, concern, love of self and others
important aspect of patient care. and respect for the spiritual dimensions of the person.  The
Weakness foundation of Jean Watsons’s theory of nursing was
The theory does not furnish explicit direction about what to do to published in 1979 in nursing- The philosophy and science of
achieve authentic caring-healing relationships. Nurses who want caring.
concrete guidelines may not feel secure when trying to use this 6. 6.  Watson’s defined nursing as a human science of
theory alone. Some have suggested that it takes too much time to persons and human health- illness experiences that are
incorporate the Caritas into practice, and some note that Watson’s mediated by professional, personal, scientific, esthetic and
personal growth emphasis is a quality “that while appealing to some ethical human care transactions.
may not appeal to others.”
7. 7. Watson’s defined human caring in nursing as “an act and a methods of knowing to provide a holistic perspective.  The
science in which caring is a human to human process science of caring should not be always neutral and objective.
demonstrated through a therapeutic interpersonal 17. 17. 7.Promotion of interpersonal teaching- learning-  The
interactions. caring nurse must focus on the learning process as much as
8. 8. MAJOR ELEMENTS OF WATSON’S THEORY OF the teaching process.  Understanding the person’s
HUMAN CARING ELEMENTS CARATIVE FACTORS perception of the situation assist the nurse to prepare a
TRANSPERSONAL CARING RELATIONSHIP CARING cognitive plan.
OCCASION/ CARING MOVEMENTS 18. 18. 8. Provision for a supportive, protective and /or corrective
9. 9. CARATIVE FACTORS- The structure for the science of mental, physical, socio-cultural and spiritual environment- 
caring is built upon the ten carative factors, these are- 1. Watson divides these into external and internal variables,
Formation of a humanistic- altruistic system of values. 2. The which the nurse manipulates in order to provide support and
installation of faith-hope. 3. The cultivation of sensitivity to protection for the persons mental and physical well being. 
one’s self and to others. 4. The development of helping- trust The external and internal environments are interdependent. 
relationship. 5. The promotion and acceptance of the Watson suggests that the nurse also must provide comfort,
expression of positive and negative feelings. privacy and safety as a part of this carative factors.
10. 10. Conti….. 6.The systematic use of the scientific problem-
19. 19. 9.Assistance with the gratification of human needs-  It is
solution method for decision making. 7.The promotion of
grounded in a hierarchy of need similar to that of the
interpersonal teaching- learning. 8. The provision for a
Maslow’s.  She has created a hierarchy which she believes
supportive, protective and/or corrective mental, physical,
socio-cultural and spiritual environment. 9. Assistance with is relevant to the science of caring in nursing.  According to
the gratification of human need. 10. The allowance for her, each need is equally important for optimal health. All the
existential- phenomenological forces. needs deserve to be attended to and valued.
11. 11. 1.The formation of a humanistic-altruistic system of 20. 20. Watson’s ordering of needs- Lower order needs
values-  Begins developmentally at an early age with values (biophysical needs, psychological need)-  The need for food
shared with the parents.  Mediated through ones own life and fluid.  The need for elimination  The need for
experiences, the learning one gains and exposure to the ventilation  The need for sexuality Watson’s ordering of
humanities.  Is perceived as necessary to the nurses own needs- Higher order needs ( psychosocial needs).  The
maturation which then promotes altruistic behavior towards need for achievement.  The need for affiliation.  The need
others. for self- actualization.
12. 12. 2.Faith hope-  Is essential to both the carative and the 21. 21. 10. Allowance for existential- phenomenological forces- 
curative processes.  When modern science has nothing Phenomenology is a way of understanding people from the
further to offer the person, the nurse can continue to use way things appear to them, from their frame of reference. 
faith- hope to provide a sense of well- being through beliefs Existential psychology is the study of human existence using
which are meaningful to the individual. phenomenological analysis.  This factor helps the nurse to
13. 13. 3.Cultivation of sensitivity to one’s self and to others-  reconcile and mediate the incongruity of viewing the person
Development of one’s own feeling is needed to interact holistically while at the same time attending to the hierarchical
genuinely and sensitivity with others.  Striving to become ordering of needs.  Thus the nurse assists the person to find
sensitive, makes the nurse more authentic, which encourages the strength of courage to confront life or death.
self-growth and self actualization, in both the nurse and those 22. 22. TRANSPERSONAL CARING RELATIONSHIP 
with whom the nurse interacts.  The nurse promote health Transpersonal describes an intersubjective, human to human
and higher level functioning only when they form person to relationship that encompasses two individuals, both the nurse
person relationship. and the patient in a given moment.  Describes how the
14. 14. 4.Establishing a helping- trust relationship-  Strongest nurse goes beyond the objective assessment to show
tool is the mode of communication, which establishes rapport concern toward the person’s subjective/deeper meaning of
and caring.  She has defined the characteristics needed to their healthcare situation.  Involves mutuality between the
develop the helping- trust relationship. They are congruence, two individuals involved
empathy and warmth.  Communication includes verbal, 23. 23. Is protects, enhances and preserve human dignity,
nonverbal and listening in a manner which express empathy, humanity, wholeness and inner harmony Goal of
understanding. transpersonal caring relationship
15. 15. 5.The expression of feelings, both positive and negative- 24. 24. Transpersonal caring relationship is a special kind of
 According to Watson, “feelings alter thoughts and behavior, human relationship that depends on-  Nurse’s commitment
and they need to be considered and allowed for in a caring on protecting and enhancing human dignity .  The nurses
relationship.”  According to her such expression improves caring and connection have potential to heal since
one’s level of awareness.  Awareness of the feelings helps experience, intension and perception are taking place. 
to understand the behavior its engenders. Nursing goals beyond an objective assessment and shows
16. 16. 6.The systematic use of the scientific problem- solving concern for the patients own health care.
method for decision making-  According to Watson, the 25. 25. CARING OCCASION / MOMENT  A caring occasion is
scientific problem solving method is the only method that the moment when the nurse and another person come
allows for control and prediction, and that permits self together in such a way that an occasion for human caring is
correction.  She also values the relative nature of nursing created.  Both persons come together in a human-human
and supports the need to examine and develop the other transaction.  The one caring for and the one being cared for
 are influenced by the choices and actions decided within the 36. 36. Conti..  Watson’s also indicates that needs are
relationship. interrelated.  The science of caring suggests that the nurse
26. 26. WATSON’S THEORY AND THE FOUR MAJOR recognize and assist with each of the interrelated needs in
CONCEPTS CONCEPTS HUMAN BEING HEALTH order to reach the highest order need of self- actualization.
ENVIRONM ENTAL/ SOCIETY NURSING 37. 37. Theories must be logical in nature-  Watson’s work is
27. 27. Human being- She adopts a view of the human being as a logical in that the factors are based on broad assumptions
valued person in and of him or herself to be cared for which provide a supportive framework.  With these carative
respected, nurtured, understood and assisted. In general a factors she delineates nursing from other professions. 
philosophical view of a person as a fully functional integrated These carative factors are logically derived from the
self. assumptions and related to the hierarchy of needs.
28. 28. Health- Watson believes that there are other factors that 38. 38. Theories should be relatively simple yet generalizable- 
are needed to be included in the WHO definition of health. The theory is relatively simple as it does not use theories from
She adds the following three elements-  A high level of other disciplines that are familiar to nursing.  She discusses
overall physical, mental and social functioning.  A general on the “trim” and the “core” of nursing.  She defines trim as
adaptative - maintenance level of daily functioning.  The the clinical focus, the procedure and the techniques.  The
absence of illness (or the presence of efforts that leads its core of the nursing is that which is intrinsic to the nurse-client
absence). interaction that produces a therapeutic result. Core
29. 29.  Environment / society- according to Watson caring (and mechanism are the carative factors.
nursing) has existed in every society. A caring attitudes is not 39. 39. Theories can be the basis for hypothesis that can be
transmitted from generation to generation. It is transmitted by tested-  Watsons theory is based on phenomenological
the culture of the profession as a unique way of coping with studies that generally ask questions rather than state
its environment. hypothesis. Its purpose is to describe the phenomena to
30. 30. Nursing –  according to Watson “nursing is concerned analyse and to gain an understanding.  According to
with promoting health, preventing illness, caring for the sick Watson the best method to test this theory is through field
and restoring health.”  It focuses on health promotion and study.
treatment of disease. She believes that holistic health care is 40. 40. Theories can be utilized by practitioners to guide and
central to the practice of caring in nursing.  She defines improve their practice-  Watson’s work can be used to guide
nursing as- a human science of persons and human health- and improve practice.  It can provide the nurse with the
illness experiences that are mediated by professional, most satisfying aspects of practice and can provide the client
personal, scientific, esthetic and ethical human transaction. with the holistic care so necessary for human growth and
31. 31. WATSON’S THEORY AND NURSING PROCESS
development.  Theories must be consistent with other
Watson’s points out that nursing process contains the same
validated theories, laws and principles but will leave upon
steps as the scientific research process. They both try to
unanswered questions that need to be investigated.
solve a problem, both provide a framework for decision
41. 41. STRENGTHS  Besides assisting in providing the quality
making. Assessment-  Involves observation, identification
of care that client ought to receive, it also provides the soul
and review of the problem, use of applicable knowledge in
satisfying care for which many nurses enter the profession. 
literature.  Also includes conceptual knowledge for the
As the science of caring ranges from the biophysical through
formulation and conceptualization of framework.  Includes the intrapersonal, each nurse becomes an active co-
the formulation of hypothesis, defining variables that will be
participant in the clients struggle towards self- actualization. 
examined in solving the problem.
The client is placed in the context of the family, the
32. 32.  Plan- It helps to determine how variables would be
community and the culture.  It places the client as the focus
examined or measured, includes a conceptual approach or
of practice rather than the technology.
design for problem solving. It determines what data would be
42. 42. LIMITATIONS  Given the acuity of illness that leads to
collected and how on whom.
hospitalization, the short length stay, such quality of care may
33. 33.  Intervention- it is the direct action and implementation
be deemed impossible to give in the hospital.  While Watson
of the plan. It involves the collection of data.
acknowledge the need for biophysical basis to nursing, the
34. 34. Evaluation-  Analysis of the data as well as the
area receives little attention in her writings.  The ten carative
examination of the effects of interventions based on the data.
factors primarily delineate the psychosocial needs of the
 Includes the interpretation of the results, the degree to
person.  While the carative factors have a sound foundation
which positive outcome has occurred and whether the result
based on other disciplines, they need further research in
can be generalized.  It may also generate additional
nursing to demonstrate their application to practice.
hypothesis or may ever lead to the generation of a nursing
43. 43. HOW TO INTEGRATE JEAN WATSON’S THEORY OF
theory.
CARING INTO NURSING PRACTICE  Establishing a caring
35. 35. WATSON’S WORK AND THE CHARACTERISTICS OF A
relationship with patients.  Treat patients as holistic beings.
THEORY  According to Watson’s “a theory is an imaginative
grouping of knowledge, ideas and experiences that are  Display unconditional acceptance.  Treat patients with
represented symbolically and seek to illuminate a given positive regard.  Promote health through knowledge and
phenomenon.  The basic assumptions for the science of intervention.  Spend uninterrupted time with patient.
caring in nursing and the ten carative factors that form the
structure for that concepts in unique in Watson’s theory.
Carative Factors Caritas Process

“Practice of loving-kindness and equanimity within the context of caring

1. “The formation of a humanistic-altruistic system of values”
consciousness”

“Being authentically present and enabling and sustaining the deep belief
2. “The instillation of faith-hope”
system and subjective life-world of self and one being cared for”

“Cultivation of one’s own spiritual practices and transpersonal self going

3. “The cultivation of sensitivity to one’s self and to others”
beyond the ego self”

4. “Development of a helping-trust relationship” became “development of a

“Developing and sustaining a helping trusting authentic caring relationship”
helping-trusting, human caring relation” (in 2004 Watson website)

“Being present to, and supportive of, the expression of positive and
5. “The promotion and acceptance of the expression of positive and
negative feelings as a connection with deeper spirit and self and the one-
negative feelings”
being-cared for”
6. “The systematic use of the scientific problem solving method for
“Creative use of self and all ways of knowing as part of the caring process;
decision making” became “systematic use of a creative problem solving
to engage in the artistry of caring-healing practices”
caring process” (in 2004 Watson website)

“Engaging in genuine teaching-learning experience that attends to unity of

7. “The promotion of transpersonal teaching-learning”
being and meaning, attempting to stay within others’ frame of reference”

“Creating healing environment at all levels (physical as well as

8. “The provision of supportive, protective, and (or) corrective mental,
nonphysical, subtle environment of energy and consciousness, whereby
physical, societal, and spiritual environment”
wholeness, beauty, comfort, dignity, and peace are potentiated)”

“Assisting with basic needs, with an intentional caring consciousness,

9. “The assistance with gratification of human needs” administering ‘human care essentials,’ which potentiate alignment of mind
body spirit, wholeness, and unity of being in all aspects of care”

10. “The allowance for existential-phenomenological forces” became

“Opening and attending to spiritual-mysterious and existential dimensions
“allowance for existential-phenomenological spiritual forces” (in 2004
of one’s own life-death; soul care for self and the one-being-cared for”
Watson website)
2.Caring consists of carative factors that result in the satisfaction of certa
human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept person not only as he or she is now but as
what he or she may become.
5. A caring environment is one that offers the development of potential
Jean Watson's Philosophy of Nursing while allowing the person to choose the best action for himself or hers
This page was last updated on January 26, 2012 at a given point in time.
6. Caring is more “ healthogenic” than is curing. A science of caring is
Introduction complementary to the science of curing.
 Theorist - Jean Watson was born in West Virginia, US 7. The practice of caring is central to nursing.
 Educated: BSN, University of Colorado, 1964, MS, University of The ten primary carative factors
Colorado, 1966, PhD, University of Colorado, 1973 1. The formation of a humanistic- altruistic system of values.
 Distinguished Professor of Nursing and Chair in Caring Science at the 2. The installation of faith-hope.
University of Colorado Health Sciences Center. 3. The cultivation of sensitivity to one’s self and to others.
 Fellow of the American Academy of Nursing. 4. The development of a helping-trust relationship
 Dean of Nursing at the University Health Sciences Center and President 5. The promotion and acceptance of the expression of positive and
of the National League for Nursing negative feelings.
 Undergraduate and graduate degrees in nursing and psychiatric-mental 6. The systematic use of the scientific problem-solving method for decisi
health nursing and PhD in educational psychology and counseling. making
 Six (6) Honorary Doctoral Degrees. 7. The promotion of interpersonal teaching-learning.
 Research has been in the area of human caring and loss. 8. The provision for a supportive, protective and /or corrective mental,
 In 1988, her theory was published in “nursing: human science and physical, socio-cultural and spiritual environment.
human care”. 9. Assistance with the gratification of human needs.
The seven assumptions 10. The allowance for existential-phenomenological forces.
1. Caring can be effectively demonstrated and practiced only
interpersonally. The first three carative factors form the “philosophical foundation” for the science
of caring. The remaining seven carative factors spring from the foundation laid b
these first three.  Lower order needs (biophysical needs)
1. The formation of a humanistic- altruistic system of values o The need for food and fluid
 Begins developmentally at an early age with values shared with the o The need for elimination
parents. o The need for ventilation
 Mediated through ones own life experiences, the learning one gains and  Lower order needs (psychophysical needs)
exposure to the humanities. o The need for activity-inactivity
 Is perceived as necessary to the nurse’s own maturation which then o The need for sexuality
promotes altruistic behavior towards others.  Higher order needs (psychosocial needs)
2. Faith-hope o The need for achievement
 Is essential to both the carative and the curative processes. o The need for affiliation
 When modern science has nothing further to offer the person, the nurse o Higher order need (intrapersonal-interpersonal need)
can continue to use faith-hope to provide a sense of well-being through o The need for self-actualization
beliefs which are meaningful to the individual. 10. Allowance for existential-phenomenological forces
3. Cultivation of sensitivity to one’s self and to others  Phenomenology is a way of understanding people from the way things
 Explores the need of the nurse to begin to feel an emotion as it presents appear to them, from their frame of reference.
itself.  Existential psychology is the study of human existence using
 Development of one’s own feeling is needed to interact genuinely and phenomenological analysis.
sensitively with others.  This factor helps the nurse to reconcile and mediate the incongruity of
 Striving to become sensitive, makes the nurse more authentic, which viewing the person holistically while at the same time attending to the
encourages self-growth and self-actualization, in both the nurse and hierarchical ordering of needs.
those with whom the nurse interacts.  Thus the nurse assists the person to find the strength or courage to
 The nurses promote health and higher level functioning only when they confront life or death.
form person to person relationship. Watson’s theory and the four major concepts
4. Establishing a helping-trust relationship 1. Human being
 Strongest tool is the mode of communication, which establishes rapport  Human being refers to “….. a valued person in and of him or herself to
and caring. be cared for, respected, nurtured, understood and assisted; in general
 Characteristics needed to in the helping-trust relationship are: philosophical view of a person as a fully functional integrated self. He,
o Congruence human is viewed as greater than and different from, the sum of his or
o Empathy her parts”.
o Warmth 2. Health
 Communication includes verbal, nonverbal and listening in a manner  Watson adds the following three elements to WHO definition of health
which connotes empathetic understanding. o A high level of overall physical, mental and social functioning
5. The expression of feelings, both positive and negative o A general adaptive-maintenance level of daily functioning
 “Feelings alter thoughts and behavior, and they need to be considered o The absence of illness (or the presence of efforts that leads
and allowed for in a caring relationship”. absence)
 Awareness of the feelings helps to understand the behavior it 3. Environment/society
engenders.  According to Watson, caring (and nursing) has existed in every society
6. The systematic use of the scientific problem-solving method for decision  A caring attitude is not transmitted from generation to generation.
making  It is transmitted by the culture of the profession as a unique way of
 The scientific problem- solving method is the only method that allows for coping with its environment.
control and prediction, and that permits self-correction. 4. Nursing
 The science of caring should not be always neutral and objective.  “Nursing is concerned with promoting health, preventing illness, caring
7. Promotion of interpersonal teaching-learning for the sick and restoring health”.
 The caring nurse must focus on the learning process as much as the  It focuses on health promotion and treatment of disease. She believes
teaching process. that holistic health care is central to the practice of caring in nursing.
 Understanding the person’s perception of the situation assist the nurse  She defines nursing as…..
to prepare a cognitive plan. “a human science of persons and human health-illness experiences th
8. Provision for a supportive, protective and /or corrective mental, physical, are mediated by professional, personal, scientific, esthetic and ethical
socio-cultural and spiritual environment human transactions”.
 Watson divides these into eternal and internal variables, which the nurse Watson’s theory and nursing process
manipulates in order to provide support and protection for the person’s  Nursing process contains the same steps as the scientific research
mental and physical well-being. process. They both try to solve a problem. Both provide a framework f
 The external and internal environments are interdependent. decision making.
 Nurse must provide comfort, privacy and safety as a part of this carative 1. Assessment
factor.  Involves observation, identification and review of the problem; use of
9. Assistance with the gratification of human needs applicable knowledge in literature.
 It is based on a hierarchy of need similar to that of the Maslow’s.  Also includes conceptual knowledge for the formulation and
 Each need is equally important for quality nursing care and the conceptualization of framework.
promotion of optimal health.  Includes the formulation of hypothesis; defining variables that will be
 All the needs deserve to be attended to and valued. examined in solving the problem.
Watson’s ordering of needs 2. Plan
  It helps to determine how variables would be examined or measured;
includes a conceptual approach or design for problem solving. It
determines what data would be collected and how on whom.
3. Intervention
 It is the direct action and implementation of the plan.
 It includes the collection of the data.
4. Evaluation
 Analysis of the data as well as the examination of the effects of
interventions based on the data.
 Includes the interpretation of the results, the degree to which positive
outcome has occurred and whether the result can be generalized.
 It may also generate additional hypothesis or may even lead to the
generation of a nursing theory.
Watson’s theory and the characteristic of a theory
1. Logical in nature.
2. Relatively simple
3. Generelizable
4. Based on phenomenological studies that generally ask questions rather
than state hypotheses.
5. Can be used to guide and improve practice.
6. Supported by the theoretical work of numerous humanists, philosophers,
developmentalists and psychologists.
Strengths
 This theory places client in the context of the family, the community and
the culture.
 It places the client as the focus of practice rather than the technology.
Limitations
 Biophysical needs of the individual are given less important.
 The ten caratiive factors primarily delineate the psychosocial needs of
the person.
 Needs further research to apply in practice.
Research related to Watson’s theory
The effectiveness of Watson's Caring Model on the quality of life and blood
pressure of patients with hypertension. J Adv Nurs. 2003 Jan;41(2):130-9.
 This study demonstrated a relationship between care given according to
Watson's Caring model and increased quality of life of the patients with
hypertension. Further, in those patients for whom the caring model was
practised, there was a relationship between the Caring model and a
decrease in patient's blood pressure. The Watson Caring Model is
recommended as a guide to nursing patients with hypertension, as one
means of decreasing blood pressure and increase in quality of life.
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406 .
Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual caring
occasions to treat depressed women . Journal of Holistic Nursing, 18(2), 129-142
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406
Conclusion
 Watson provides many useful concepts for the practice of nursing.
 She ties together many theories commonly used in nursing education.
 The detailed descriptions of the carative factors can give guidance to
those who wish to employ them in practice or research.
Biography of Dorothea E. Orem and to the Director of Nursing, Wilmer Clinic, The Johns Hopkins
Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one Hospital, 1975-1976.
of America’s foremost nursing theorists who developed the Self- She was a member of the group of nurse theorists who presented
Care Deficit Nursing Theory, also known as the Orem Model of Patterns of Unitary Man (Humans), the initial framework for nursing
Nursing. diagnosis, to the North American Nursing Diagnosis Association in
Her theory defined Nursing as “The act of assisting others in the 1982.
provision and management of self-care to maintain or improve Works of Dorothea Orem
human functioning at home level of effectiveness.” It focuses on each Dorothea Orem helped publish the “Guidelines for Developing
individual’s ability to perform self-care, defined as “the practice of Curricula for the Education of Practical Nurses” in 1959.
activities that individuals initiate and perform on their own behalf in The 6th edition of Nursing: Concepts of Practice, published by Mosby
maintaining life, health, and well-being.” in January 2001.
ADVERTISEMENT In 1971 Orem published Nursing: Concepts of Practice, the work in
Early Life which she outlines her theory of nursing, the Self-care Deficit Theory
Dorothea Orem was born in July 15, 1914 in Baltimore, Maryland. of Nursing. The success of this work and the theory it presents
Her father was a construction worker and her mother is a established Orem as a leading theorist of nursing practice and
homemaker. She was the youngest among two daughters. education.
In the early 1930s, she earned her nursing diploma from the She also served as chairperson of the Nursing Development
Providence Hospital School of Nursing in Washington, D.C. She went Conference Group, and in 1973 edited that group’s work in the book
on to complete her Bachelor of Science in Nursing in 1939 and her Concept Formalization in Nursing.
Master’s of Science in Nursing in 1945, both from the Catholic She authored many other papers and during the 1970s and 1980s
University of America in Washington, D.C. spoke at numerous conferences and workshops around the world.
Education The International Orem Society was founded to foster research and
Dorothea Elizabeth Orem the continued development of Orem’s theories of nursing.
Dorothea Orem attended Seton High School in Baltimore, and The second edition of Nursing: Concept of Practice was published in
graduated in 1931. She received a diploma from the Providence 1980. Orem retired in 1984 but she continued to work on the third
Hospital School of Nursing in Washington, D.C. in 1934 and went on edition which was published in 1985; fourth edition of her book was
to the Catholic University of America to earn a B.S. in Nursing completed in 1991. She continued to work on the conceptual
Education in 1939, and an M.S. in Nursing Education in 1945. development of Self-Care Deficit Nursing Theory.
She had a distinguished career in nursing. She earned several Orem continued to be active in theory development. She completed
Honorary Doctorate degrees. She was given Honorary Doctorates of the 6th edition of Nursing: Concepts of Practice, published by Mosby
Science from both Georgetown University in 1976 and Incarnate in January 2001.
Word College in 1980. She was given an Honorary Doctorate of Awards and Honors of Dorothea Orem
Humane Letters from Illinois Wesleyan University in 1988, and a Orem’s grave
Doctorate Honoris Causae from the University of Missouri in Dorothea Orem was also given many awards during her career: the
Columbia in 1998. Catholic University of America Alumni Achievement Award for
Self-Care Theory Nursing Theory in 1980, the Linda Richards Award from the National
Dorothea Orem’s Self-Care Deficit Theory focuses on League for Nursing in 1991, and was named an Honorary Fellow of
each “individual’s ability to perform self-care, defined as ‘the practice the American Academy of Nursing in 1992.
of activities that individuals initiate and perform on their own behalf in She also received accolades for her contributions to the field of
maintaining life, health, and well-being.'” The Self-Care or Self-Care nursing, including honorary degrees from Georgetown University,
Deficit Theory of Nursing is composed of three interrelated theories: Incarnate Word College, Illinois Wesleyan University, and the
(1) the theory of self-care, (2) the self-care deficit theory, and University of Missouri-Columbia.
(3) the theory of nursing systems, which is further classified into She was inducted into the American Academy of Nursing, and
wholly compensatory, partial compensatory and supportive- received awards from the National League for Nursing and the Sigma
educative. It is discussed further below. Theta Tau Nursing Honor Society.
Appointments of Dorothea Orem Death
Photo of Dorothea Orem Dorothea Orem died on June 22, 2007 in Savannah, Georgia, where
by Lynne Nickle, 1988 she had spent the last 25 years of her life as a consultant and author.
Dorothea Orem occupied important nursing positions, like the She was 92.
directorship of both the nursing school and the department of nursing Dorothea Orem’s Self-Care Deficit Theory
at Providence Hospital, Detroit from 1940 to 1949, where she also There are instances wherein patients are encouraged to bring out the
taught biological sciences and nursing from 1939 to 1941. At the best in them despite being ill for a period of time. This is very
Catholic University of America, Orem served as Assistant Professor particular in rehabilitation settings, in which patients are entitled to be
from 1959 to 1964, Associate Professor from 1964 to 1970, and more independent after being cared for by physicians and nurses.
Dean of the School of Nursing from 1965 to 1966. Through these, the Self-Care Nursing Theory or the Orem Model
She also served as curriculum consultant to The Office of Education, of Nursing was developed by Dorothea Orem between 1959 and
United States Department of Health, Education and Welfare, 2001. It is considered a grand nursing theory, which means the
Practical Nurse Section in 1958, 1959, and 1960, to the Division of theory covers a broad scope with general concepts that can be
Hospital and Institutional Services, The Indiana State Board of Health applied to all instances of nursing.
from 1949 to 1957, and to the Center for Experimentation and Description
Development in Nursing, The Johns Hopkins Hospital, 1969-1971, Dorothea Orem’s Self-Care Deficit 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 Therapeutic Self-care Demand is the totality of “self-care actions to
effectiveness.” It focuses on each individual’s ability to perform self- be performed for some duration in order to meet known self-care
care, defined as “the practice of activities that individuals initiate and requisites by using valid methods and related sets of actions and
perform on their own behalf in maintaining life, health, and well- operations.”
being.” Self-Care Deficit
“The condition that validates the existence of a requirement for Self-care Deficit delineates when nursing is needed. Nursing is
nursing in an adult is the absence of the ability to maintain required when an adult (or in the case of a dependent, the parent or
continuously that amount and quality of self-care which is therapeutic guardian) is incapable of or limited in the provision of continuous
in sustaining life and health, in recovering from disease or injury, or in effective self-care.
coping with their effects. With children, the condition is the inability of ADVERTISEMENTS
the parent (or guardian) to maintain continuously for the child the Nursing Agency
amount and quality of care that is therapeutic.” (Orem, 1991) Nursing Agency is a complex property or attribute of people educated
Assumptions of the Self-Care Deficit Theory and trained as nurses that enables them to act, to know, and to help
The assumptions of Dorothea Orem’s Self-Care Theory are: (1) In others meet their therapeutic self-care demands by exercising or
order to stay alive and remain functional, humans engage in constant developing their own self-care agency.
communication and connect among themselves and their Nursing System
environment. (2) The power to act deliberately is exercised to identify Nursing System is the product of a series of relations between the
needs and to make needed judgments. (3) Mature human beings persons: legitimate nurse and legitimate client. This system is
experience privations in the form of action in care of self and others activated when the client’s therapeutic self-care demand exceeds
involving making life-sustaining and function-regulating actions. (4) available self-care agency, leading to the need for nursing.
Human agency is exercised in discovering, developing, and Theories
transmitting to others ways and means to identify needs for, and The Self-Care or Self-Care Deficit Theory of Nursing is composed of
make inputs into, self and others. (5) Groups of human beings with three interrelated theories: (1) the theory of self-care, (2) the self-
structured relationships cluster tasks and allocate responsibilities for care deficit theory, and (3) the theory of nursing systems, which
providing care to group members. is further classified into wholly compensatory, partial
Major Concepts of the Self-Care Deficit Theory compensatory and supportive-educative.
In this section are the definitions of the major concepts of Dorothea Theory of Self-Care
Orem’s Self-Care Deficit Theory: This theory focuses on the performance or practice of activities that
Nursing individuals initiate and perform on their own behalf to maintain life,
Nursing is an art through which the practitioner of nursing gives health and well-being.
specialized assistance to persons with disabilities which makes more Self-Care Requisites
than ordinary assistance necessary to meet needs for self-care. The Self-care Requisites or requirements can be defined as actions
nurse also intelligently participates in the medical care the individual directed toward the provision of self-care. It is presented in three
receives from the physician. categories:
Humans Universal Self-Care Requisites
Humans are defined as “men, women, and children cared for either Universal self-care requisites are associated with life processes and
singly or as social units,” and are the “material object” of nurses and the maintenance of the integrity of human structure and functioning.
others who provide direct care.  The maintenance of a sufficient intake of air
Environment  The maintenance of a sufficient intake of water
The environment has physical, chemical and biological features. It  The maintenance of a sufficient intake of food
includes the family, culture, and community.  The provision of care associated with elimination process
Health and excrements
Health is “being structurally and functionally whole or sound.” Also,  The maintenance of a balance between activity and rest
health is a state that encompasses both the health of individuals and  The maintenance of a balance between solitude and social
of groups, and human health is the ability to reflect on one’s self, to interaction
symbolize experience, and to communicate with others.  The prevention of hazards to human life, human
Self-Care functioning, and human well-being
Self-care is the performance or practice of activities that individuals
 The promotion of human functioning and development
initiate and perform on their own behalf to maintain life, health, and
within social groups in accord with human potential, known
well-being.
human limitations, and the human desire to be normal
Self-Care Agency
Normalcy is used in the sense of that which is essentially human
Orem’s Self-Care Theory: Interrelationship among concepts. Click to
and that which is in accord with the genetic and constitutional
enlarge.
characteristics and the talents of individuals.
Self-care agency is the human’s ability or power to engage in self-
Developmental self-care requisites
care and is affected by basic conditioning factors.
Developmental self-care requisites are “either specialized
Basic Conditioning Factors
expressions of universal self-care requisites that have been
Basic conditioning factors are age, gender, developmental state,
particularized for developmental processes or they are new
health state, socio-cultural orientation, health care system factors,
requisites derived from a condition or associated with an event.”
family system factors, patterns of living, environmental factors, and
Health deviation self-care requisites
resource adequacy and availability.
Health deviation self-care requisites are required in conditions of
Therapeutic Self-Care Demand
illness, injury, or disease or may result from medical measures
Orem’s Self-Care Theory – Conceptual Framework. Click to enlarge.
required to diagnose and correct the condition.
  Seeking and securing appropriate medical assistance  Design of a nursing system and plan for delivery of care.
 Being aware of and attending to the effects and results of  Production and management of nursing systems.
pathologic conditions and states Step 1 – Collect Data in Six Areas
 Effectively carrying out medically prescribed diagnostic, 1. The person’s health status
therapeutic, and rehabilitative measures 2. The physician’s perspective of the person’s health status
 Being aware of and attending to or regulating the 3. The person’s perspective of his or health health
discomforting or deleterious effects of prescribed medical 4. The health goals within the context of life history, lifestyle,
measures and health status.
 Modifying the self-concept (and self-image) in accepting 5. The person’s requirements for self-care
oneself as being in a particular state of health and in need 6. The person’s capacity to perform self-care
of specific forms of health care Nursing Diagnosis & Care Plans
 Learning to live with the effects of pathologic conditions Step 2
and states and the effects of medical diagnostic and  The nurse designs a system that is wholly or partly
treatment measures in a lifestyle that promotes continued compensatory or supportive-educative.
personal development  The two actions are: (1) Bringing out a good organization of
Theory of Self-Care Deficit the components of patients’ therapeutic self-care demands.
This theory delineates when nursing is needed. Nursing is required (2) Selection of combination of ways of helping that will be
when an adult (or in the case of a dependent, the parent or guardian) effective and efficient in compensating for/overcoming
is incapable of or limited in the provision of continuous effective self- patient’s self-care deficits.
care. Orem identified 5 methods of helping: Implementation & Evaluation
 Acting for and doing for others Step 3
 Guiding others  Nurse assists the patient or family in self-care matters to
 Supporting another achieve identified and described health and health-related
 Providing an environment promoting personal development results. Collecting evidence in evaluating results achieved
in relation to meet future demands against results specified in the nursing system design.
 Teaching another  Actions are directed by etiology component of nursing
Theory of Nursing System diagnosis.
This theory is the product of a series of relations between the Analysis of the Self-Care Deficit Theory
persons: legitimate nurse and legitimate client. This system is There is a superb focus of Orem’s work which is self-care. Even
activated when the client’s therapeutic self-care demand exceeds though there is a wide range of scope seen in the encompassing
available self-care agency, leading to the need for nursing. theory of nursing systems, Orem’s goal of letting the readers view
Wholly Compensatory Nursing System nursing care as a way to provide assistance to people was apparent
This is represented by a situation in which the individual is unable “to in every concept presented.
engage in those self-care actions requiring self-directed and ADVERTISEMENTS
controlled ambulation and manipulative movement or the medical From the definition of health which is sought to be rigid, it can now be
prescription to refrain from such activity… Persons with these refined by making it suitable to the general view of health as a
limitations are socially dependent on others for their continued dynamic and ever-changing state.
existence and well-being.” The role of the environment to the nurse-patient relationship,
Example: care of a newborn, care of client recovering from surgery in although defined by Orem was not discussed.
a post-anesthesia care unit The role of nurses in maintaining health for the patient was set by
Partial Compensatory Nursing System Orem with great coherence in accordance with the life-sustaining
This is represented by a situation in which “both nurse and perform needs of every individual.
care measures or other actions involving manipulative tasks or Although Orem viewed the importance of the parents or guardian in
ambulation… [Either] the patient or the nurse may have a major role providing for their dependents, the definition of self-care cannot be
in the performance of care measures.” directly applied to those who need complete care or assistance with
Example: Nurse can assist postoperative client to ambulate, Nurse self-care activities such as the infants and the aged.
can bring a meal tray for client who can feed himself Strengths
Supportive-Educative System  A major strength of Dorothea Orem’s theory is that it is
This is also known as supportive-developmental system, the person applicable for nursing by the beginning practitioner as well
“is able to perform or can and should learn to perform required as the advanced clinicians.
measures of externally or internally oriented therapeutic self-care but  Orem’s theory provides a comprehensive basis for nursing
cannot do so without assistance.” practice. It has utility for professional nursing in the areas
Example: Nurse guides a mother how to breastfeed her baby, of nursing practice, nursing education and administration.
Counseling a psychiatric client on more adaptive coping strategies.  The terms self-care, nursing systems, and self-care
Dorothea Orem’s Theory and The Nursing Process deficit are easily understood by the beginning student
The Nursing Process presents a method in determining self-care nurse and can be explored in greater depth as the nurse
deficits and to define the roles of persons or nurse to meet the self- gains more knowledge and experience.
care demands.  She specifically defines when nursing is needed: Nursing is
Assessment needed when the individual cannot maintain continuously
 Diagnosis and prescription; determine why nursing is that amount and quality of self-care necessary to sustain
needed. Analyze and interpret by making a judgment life and health, recover from disease or injury, or cope with
regarding care. their effects.
  Her self-care approach is contemporary with the concepts nursing, comprised of three related theoretical constructs:
of health promotion and health maintenance. self-care, self-care deficit and nursing system • 4th edition:
 Three identifiable nursing systems were clearly delineated fully developed the ideas presented • 5th edition: Provided
and are easily understood. an increased emphasis on multiperson situation • 6th
Limitations edition: continued development of orem’s ideas
 Orem’s theory, in general, is viewed as a single whole thing 6. 6. Orem’s general theory of nursing Orem’s general theory
while Orem defines a system as a single whole thing. of nursing in three related parts:- • Theory of self care •
 Orem’s theory is simple yet complex. The use of self-care Theory of self care deficit • Theory of nursing system
in multitudes of terms, such as self-care agency, self-care 7. 7. Relationship of Orem’s concept to the three theories
demand, self-care deficit, self-care requisites, and Theory of self - care Theory of self- care deficit Theory of
universal self-care, can be very confusing to the reader. nursing system Self-care When therapeutic self-care
 Orem’s definition of health was confined in three static demand exceeds self-care agency, a self-care deficit exists
conditions which she refers to a “concrete nursing system,” and nursing is needed. Nursing agency Self-care agency
which connotes rigidity. Nursing systems Wholly compensatory Partly
 Throughout her work, there is limited acknowledgement of compensatory Supportive education Self care requisites
the individual’s emotional needs. Universal Developmental Health Deviation Therapeutic
 Health is often viewed as dynamic and ever-changing. self- care demand
Conclusion 8. 8. Theory of self-care • Self –care is the performance or
Orem’s theory is relatively simple, but generalizable to apply to a practice of activities that individuals initiate and perform on
wide variety of patients. It explains the terms self-care, nursing their own behalf to maintain life, health and well- being. •
systems, and self-care deficit which are very essential to students When self-care is effectively performed, it helps to maintain
who plan to start their career in nursing. structural integrity and human functioning and contributes
Moreover, this theory signifies that all patients want to care for to human development.
themselves, and they are able to recover more quickly and 9. 9. Self care agency • Self-care agency is the human’s
holistically by performing their own self-care as much as they’re able. acquired powers and capabilities to engage in self care. •
This theory is particularly used in rehabilitation and primary care or The ability to engage in self-care is affected by basic
other settings in which patients are encouraged to be independent. conditioning factors. • The basic conditioning factors are
Though this theory greatly influences every patient’s independence, age, gender, developmental stat, health state, socio-
the definition of self-care cannot be directly applied to those who cultural orientations, health care system factors, pattern of
need complete care or assistance with self-care activities such as the living etc.
infants and the aged. 10. 10. Therapeutic self-care demand • Total of care activities
needed, either at an identified moment or over a period of
time, to meet a person’s known requirements for self-care.
11. 11. Self-care requisites • Actions directed towards provision
Orem's theory of self- care. • Three categories of self-care requisites are:
1. 1. Self-Care Deficit Nursing Theory Dorothea Elizabeth – Universal self care requisites – Developmental self care
Orem Shrooti shah Lecturer National Medical College requisites – Health deviation self care requisites
Nursing Campus 12. 12. Universal self care requisites • Associated with life
2. 2. Introduction to the theorist • Theorist : Dorothea Orem processes and the maintenance of the integrity of human
(1914-2007) • Born 1914 in Baltimore, US • Received her structure and functioning. • A common term for these
diploma at Providence Hospital – Washington, DC in 1934 requisites is activities of daily living.
• 1939 – BSN Ed. And Master of science in nursing 13. 13. Universal self care requisites Orem identifies self-care
education (1945) from Catholic University of America, requisites as follows: • The maintenance of a sufficient
Washington D.C. intake of air. • The maintenance of a sufficient intake of
3. 3. Introduction cont… • Her clinical practice included staff water. • The maintenance of a sufficient intake of food. •
nurse in the operating room, paediatrics and adult medical The provision of care associated with elimination
surgical units. • She also did private-duty nursing in private processes and excrements • The maintenance of a balance
homes and the hospital and was an emergency room between activity and rest.
supervisor. • She taught biological sciences and later 14. 14. Universal self care requisites • The maintenance of a
served as director of nursing service and director of the balance between solitude and social interaction. • The
school of nursing at Providence Hospital, Michigan. • prevention of hazards to human life, human functioning,
Received several honorary degrees. and human well-being • The promotion of human
4. 4. Introduction… • Orem’s concept of nursing as the functioning and development within social groups in accord
provision of self- care was first published in 1959. • Orem with human potential. Known human life, human
continued to develop her nursing concepts and her self- functioning and human well-being.
care deficit theory of nursing. In 1971 she published 15. 15. Developmental self-care requisites • More specific to
Nursing: Concepts of practice. • The second, third, fourth, the processes of growth and development and are
fifth and sixth editions of this book were published in 1980, influenced by what is happening during the life cycle
1985, 1991, 1995 and 2001 respectively. stages; such influence may be positive or negative. • Ex:
5. 5. Introduction • 1st edition: focus on individual • 2nd Adjusting to new job or adjusting to body changes.
edition: include multiperson units (families, groups and 16. 16. Health deviation self-care requisites • Changes in
communities) • 3rd edition: Orem’s general theory of human structure and function, out of the range of normal,
 and may be associated with genetic variations or other 26. 26. Partly compensatory system • It is used when a patient
defects. • May deal with the effects of defects or deviations can meet some self-care requisites but needs a nurse to
and the effects of efforts to diagnose and treat them. help meet other needs; the nurse and the patient play
17. 17. Health deviation self-care requisites The health major role in performing self- care. • For example: a patient
deviation self-care requisites are as follows: • Seeking and undergone abdominal surgery.
securing appropriate medical assistance • Being aware of 27. 27. Supportive – educative system • It is used when a
and attending to the effects and results of pathologic patient can meet self- care requisites but needs assistance
condition and states • Effectively carrying out medically with decision making, behavior control, or knowledge
prescribed diagnostic, therapeutic and rehabilitative acquisition skills. • For e.g, patient with controlled HTN who
measures seeks additional diet information from the nurse: in this
18. 18. • Modifying the self-concept in accepting oneself as system, the nurse attempts to promote the self-care
being in a particular state of health and in need of specific agency.
forms of health care. • Learning to live with the effects of 28. 28. Orem states that one or more of these three types of
pathologic conditions and states and the effect of medical nursing systems may be used with a single patient over a
diagnostic and treatment measures in a life-style that period of time
promotes continued personal development. 29. 29. Major Assumptions • All patients wish to care for
19. 19. Theory of self care deficit • It is the central focus of themselves. • Humans are capable and willing to engage in
Orem’s general theory of nursing. • It describes how people self-care and care for dependent members of the family. •
can be helped through nursing. • Orem identifies 5 Self-care and dependent care are learned behaviors
methods of helping: – Acting for and doing for others – through human communication and interaction with each
Guiding and directing – Providing physical or psychological other. • Nursing is a deliberate helping actions performed
support – Providing an environment promoting personal by nurses for the benefits of others over a certain period of
development – Teaching time.
20. 20. Theory of self-care deficit • Orem has identified work 30. 30. Major Assumptions • Humans are supposed to be self-
operations of nurses in clinical nursing practice: – Entering reliant and responsible for their self-care needs and care
into and maintaining nurse-patient relationships with needs for dependent members of the family. • Humans are
individuals, families, or groups – Designing, planning for, unique individuals that are separated from each other and
instituting, and managing systems of nursing care – from their environment.
Responding to patients’ requests, desires and needs for 31. 31. Four Major Concepts of Orem’s Theory • Person •
nurse contact and assistance. Health • Environment • Nursing
21. 21. Theory of self-care deficit • Coordinating nursing care • 32. 32. Person • Person is defined by Orem as the patient (a
Establishing the kind and amount of immediate and recipient of nursing care)- a being who functions
continuing care needed • Coordinating the care with other biologically, symbolically, and socially and who has the
services, such as other health care, social, or educational potential for learning and development. • Person is an
services, needed or being received. • Discharging patients individual, who is with the capacity for self knowledge, who
from nursing care when they have regained their abilities to can engage in deliberate action, interpret experiences, and
perform their own self-care needs perform beneficial actions
22. 22. C. Theory of Nursing Systems • This theory describes 33. 33. Health • A state characterized by soundness or
how the patient’s self care needs will be met by the nurse, wholeness of bodily structure and function; illness is its
the patient, or both. • If there is a self-care deficit- that is, if opposite. • It consists of physical, psychological,
there is a difference between what the individual can do interpersonal and social aspects; these aspects are
(self-care agency) and what needs to be done to maintain inseparable. • Health includes promotion and maintenance
optimum functioning (therapeutic self- care demand)- of health, treatment of illness, and prevention of
nursing is required. complications.
23. 23. Classification of nursing system It identifies 3 34. 34. Environment • Environment consists of environmental
classifications of nursing system to meet the self care factors, environment elements, environmental conditions
requisites of the patient:- • Wholly compensatory system • (external physical and psychological surrounding), and
Partly compensatory system • Supportive – educative developmental environment. • Environment can positively
system or negatively affects the person’s ability to provide self
24. 24. Wholly compensatory system • Represented by a care.
situation in which the individual is unable to carry out 35. 35. Nursing • Orem defines the art of nursing as an
needed self-care actions, either through inability to be self- intellectual quality of the individual nurse; this quality is
directed or due to medical prescription. • Those who have related to creativity as well as analysis and synthesis of
such limitations are dependent upon others for their well- information, all of which contribute to development of
being and even their very existence. nursing systems to assist individuals or multiperson units.
25. 25. Wholly compensatory system • Subtypes of this system 36. 36. Nursing • Orem further defines nursing as a human
are: o unable to engage in self care(person in coma). o service. • Nursing is distinguished from other human
aware but could not engage in self-care(person with C3-C4 services by its focus on persons with inabilities to maintain
vertebral fracture) o Include persons who are severely the continuous provision of health care.
mentally impaired (senile persons, some forms of mental 37. 37. Nursing cont… Goal of nursing is: • to render the
retardation). patient or members of his family capable of meeting the
patient’s self care needs • to maintain a state of health • to
 regain normal or near normal state of health in the event of area, items for ADL not in easy reach, no special
disease or injury • to stabilize ,control ,or minimize the precautions to prevent injuries Resources Husband,
effects of chronic poor health or disability daughter, son
38. 38. Comparison of Orem’s Nursing Process and Nursing 46. 46. UNIVERSAL SELF-CARE REQUISITES Air Breaths
process Nursing Process Orem’s Nursing Process 1. without difficulty, no pallor cyanosis Water Fluid intake is
Assessment 2. Nursing Diagnosis 3. Plans with scientific sufficient. Edema present over ankles. Turgor normal for
Rationale 4. Implementation 5. Evaluation Step I: the age Food Food intake is not adequate. Elimination
Diagnosis and prescription, determine why nursing is Voids and eliminates bowel without difficulty. Activity/ rest
needed. Analyze and interpret- make judgment regarding Frequent rest is required due to pain. Pain not completely
care. Step II: Design of a nursing system and plan for relieved, Activity level has come down. Social interaction
delivery of care. Step III: Production and management of Communicates well with neighbors and calls the daughter
nursing systems. by phone, need for medical care is communicated to the
39. 39. Orem’s Theory and the Nursing Process The steps of daughter. Prevention of hazards Need instruction on care
Orem’s nursing process may be as followed. • Step I: of joints and prevention of falls. Need instruction on
nursing diagnosis and prescription: the initial and improvement of nutritional status. Prefer to walk bare foot.
continuing determination of why a person should be under Promotion of normalcy Has good relation with daughter
nursing care. • Step II: the designing of the nursing system 47. 47. Developmental self-care requisites Maintenance of
and planning for the delivery of nursing care • Step III: The developmental environment Able to feed self , Difficult to
production and management of nursing systems, also perform the dressing, toileting etc Prevention/ management
labelled planning and controlling. of the conditions threatening the normal development Feels
40. 40. Orem’s Theory and the Nursing Process Step 1-collect that the problems are due to her own behaviours and
data in six areas:- • The person’s health status • The discusses the problems with husband and daughter.
physician’s perspective of the person’s health status • The 48. 48. Health deviation self care requisites Adherence to
person’s perspective of his or her health • The health goals medical regimen Reports the problems to the physician
within the context of life history ,life style, and health status when in the hospital. Cooperates with the medication, Not
• The person’s requirements for self care • The person’s much aware about the use and side effects of medicines
capacity to perform self care Awareness of potential problem associated with the
41. 41. Orem’s Theory and the Nursing Process • Nurse regimen Not aware about the actual disease process. Not
designs a system that is wholly or partly compensatory or compliant with the diet and prevention of hazards. Not
supportive-educative. The two actions are:- 1. Bringing out aware about the side effects of the medications
a good organization of the components of patients’ Modification of self image to incorporates changes in health
therapeutic self care demands 2. Selection of combination status Has adapted to limitation in mobility. The adoption of
of ways of helping that will be effective and efficient in new ways for activities leads to deformities and
compensating for/ overcoming patient’s self care deficits progression of the disease. Adjustment of lifestyle to
42. 42. Orem’s Theory and the Nursing Process • Nurse accommodate changes in the health status and medical
assists the patient or family in self care matters to achieve regimen. Adjusted with the deformities. Pain tolerance not
identified and described health and health related results . • achieved
Collecting evidence in evaluating results achieved against 49. 49. Priority of nursing problems according to orem’s theory
results specified in the nursing system design of self care deficit • Air • Water • Food • Elimination •
43. 43. Patient Profile Areas Patient details Name Age Sex Activity/ Rest • Solitude/ Interaction • Prevention of hazards
Education Occupation Marital status Religion Diagnosis • Promotion of normalcy • Maintain a developmental
Theory applied Mrs. Yaita Maya Limbu 56 years Female environment.
No formal education House hold Married Buddhist 50. 50. Priority of nursing problem according to Orem’s theory
Rheumatoid arthritis Orem’s theory of self care deficit. of self care deficit • Prevent or manage the developmental
44. 44. History • She came to the hospital with complaints of threats • Maintenance of health status • Awareness and
pain over all the joints, stiffness which is more in the management of the disease process. • Adherence to the
morning and reduces by the activities. • She has these medical regimen • Awareness of potential problem. •
complaints since 5 years and has taken treatment from Modify self image • Adjust life style to accommodate health
local hospital. • The symptoms were not reducing and status changes
came to NMCTH for further management. • Patient was 51. 51. Nursing Diagnosis • Altered nutrition less than body
able to do the ADL by herself but the way she performed requirement related to inadequate intake and knowledge
and the posture she used was making her prone to develop deficit • Self-care deficit: dressing, toileting related to
the complications of the disease. • She also was restricted joint movement, secondary to the inflammatory
malnourished and was not having awareness about the process in the joints. • Pain related to lack of utilization of
deficiencies and effects. pain relief measures • Risk for fall and injury related to joint
45. 45. Basic conditioning factors Age 56 years Gender pain. • Risk for impaired skin integrity related to edema •
Female Health state Disability due to health condition Knowledge deficit regarding disease condition and
Development state Ego integrity vs despair Socio-cultural treatment related to lack of information.
orientation No formal education, Nepali, Buddhist Health 52. 52. Application of Orem’s self-care deficit theory in nursing
care system Treatment from local hospital and Medical practice, education and research Practice • Many articles
College Family system Married, husband Labourer document the use of the self-care theory as a basis for
Patterns of living At homewith partner Environment Rural clinical practice. • Orem’s self-care deficit theory has been
 used in the context of the nursing process to teach patients
to increase their self-care agency to evaluate nursing
practice and to differentiate nursing from medical practice.
53. 53. Application of Orem’s self-care deficit theory in nursing
process Education • Orem’s self-care deficit theory has
been the focus of the curriculum in nursing education at
many schools of nursing. Research • The self-care theory
provided conceptual framework for many researches.
54. 54. Orem’s work and characteristics of theory
55. 55. Theories can interrelate concepts in such a way as to
create a difference • Orem’s theoretical constructs of self-
care, self- care deficits and nursing systems are
interrelated in her general comprehensive theory of nursing
which is unique phenomena.
56. 56. Theories must be logical in nature • Orem’s theory
follows a logical thought process. She states her general
theory, that presents the central idea of each of the three
interrelated theories. • Statements that describe a concept
or explain and predict relationship between two concept.
57. 57. Theories should be relatively simple yet generalizable •
The theory is used by several colleges of nursing as a
theoretical foundation for students’ basic preparation for
practice. • The theory can be applied to all individual
patients and with further adaptation, to multiperson units.
58. 58. Theories can be the bases for the hypothesis that can
be tested or for theory to be explained • Several
researchers tested Orem’s theory in the area of self-care
agency including studies focused on the development of
tools to measure aspects of self-care.
59. 59. Theories can be used by practitioner to guide and
improve their practice • Theory focuses on nursing a
helping art that assists an individual to meet self-care
needs and that is the foundation for nursing practice. •
Adds nursing’s body of knowledge.
60. 60. Theories must be consistent with other validated
theories, laws, principles but leave unanswered questions
that need to be investigated. • Consistent with role theory,
need theory, field theory and health promotional concepts.
61. 61. Critiques of Orem’s Theory
62. 62. Strengths • Provides a comprehensive base to nursing
practice • It has utility for professional nursing in the areas
of nursing practice, curricula, education, administration,
and research • Specifies when nursing is needed • Her self-
care approach is contemporary with the concepts of health
promotion and health maintenance • Expanded her focus of
individual self-care to include multiperson units
63. 63. Limitations • In general system theory, a system is
viewed as a single whole thing while Orem defines a
system as a single whole, thing. • Appears that the theory
is illness oriented rather with no indication of its use in
wellness settings.
Biography of Martha E. Rogers Her Master’s degree was from Teachers College at Columbia
Martha Elizabeth Rogers (May 12, 1914 – March 13, 1994) was an University in 1945, and her Doctorate in Nursing was given to her
American nurse, researcher, theorist, and author widely known for from Johns Hopkins University in Baltimore in 1954. She completed
developing the Science of Unitary Human Beings and for her her studies in 1954 and the title of her dissertation was “The
landmark book, An Introduction to the Theoretical Basis of Nursing. association of maternal and fetal factors with the development of
She believes that a patient can never be separated from his or her behavior problems among elementary school children.”
environment when addressing health and treatment. Her knowledge Career and Appointments
about the coexistence of the human and his or her environment After Martha Rogers graduated from George Peabody College in
contributed a lot in the process of change toward better health. Tennessee in 1937, she worked for the Children’s Fund of Michigan
ADVERTISEMENT for two years as public health nurse.
Early Life Rogers in her Teens via E.A.M. Barrett &
Martha Rogers was born on May 12, 1914; sharing a birthday V.M. Malinski, 1994
with Florence Nightingale. She was the eldest of four children of In 1940, she accepted a position in Hartford, CT at the Visiting Nurse
Bruce Taylor Rogers and Lucy Mulholland Keener Rogers. Association. She worked at the Association for five years, first as an
Portrait of Martha E. Rogers Assistant Supervisor, then as the Assistant Education Director, and
She had a thirst for knowledge at an early age. She found lastly as the acting Director of Education. At the same time she was
Kindergarten to be “terribly exciting” and had a love and passion for completing her coursework at Teacher’s College and completed her
books that was fostered by her parents. Her father introduced her to degree requirements (Master of Arts) in 1945.
the public library at the age of 3 where she loved story time. She After completing her degree in 1945, she sent out a number of job
liked to go off by herself with a book. And by the fourth grade, she inquiry letters, considered staying in Hartford, but settled on a
had read every book in her school library. She used to go to the position as the Executive Director at the Visiting Nurse Service in
public library before I was 6 even before she could read. She was Phoenix, Arizona. She believed she may have been the first nurse in
well acquainted with the public library and started reading eight Arizona with a masters degree and for 1945 to 1951, she built up the
books at a time. Her father used to be bothered if she was just Visiting Nursing Service in Phoenix.
skimming but he later on discovered that the young Rogers was While a doctoral student, she did spend a year as a visiting lecturer
learning fast. at a Catholic University in Washington, DC.
In fact, Rogers already knew the Greek alphabet by age 10. By the Rogers and her predecessor Vera Fry at NYU circa 1954
sixth grade, she already finished reading all 20 volumes of The Rogers was then appointed Professor and Head of the Division of
Child’s Book of Knowledge and was into the Encyclopedia Britannica. Nursing at New York University right after graduating from Hopkins.
Four Generations, Left to right: Lucy K Rogers, mother; Martha E. She was encouraged to accept the position by Ruth Freeman. When
Rogers; Laura B. Keener, grandmother; Lucy M. Brownlee, great- Rogers arrived at NYU, Vera Fry was the previous Division Head and
grandmother. via V. M. Malinski & E.A.M. Barrett, 1994 Joan Hoexter stated that all of the nursing faculty left except her. She
She also loved to read various topics like anthropology, archaeology, was also a Fellow for the American Academy of Nursing.
cosmology, ethnography, astronomy, ethics, psychology, eastern Rogers officially retired as Professor and Head of the Division of
philosophy, and aesthetics. By her senior year she had completed all Nursing in 1975 after 21 years of service. Following her retirement,
the high school math courses and was taking a college level algebra she continued to teach at NYU, was a frequent presenter at scientific
course where she was the only female in the class. conferences throughout the world, and consistently worked to refine
Education her conceptual system.
Initially, Martha Rogers wanted to do something that would, hopefully Rogers with John Phillips
contribute to social welfare like law and medicine. However, she only Rogers was also actively involved in professional nursing
studied medicine for a couple of years because women in medicine organizations and associations concerned with education and
were not particularly desirable during her time. Instead, Rogers along scholarship. In 1979, she became Professor Emerita and continued
with her friend entered a local hospital that had a school of nursing. to have an active role in the development of nursing and the Science
But just like Nightingale, her parents weren’t really any happier over of Unitary Human Beings.
that decision than they had between over medicine. Theory
Bruce T. Rogers (Father), Martha, Keener (Brother), Laura (Sister), The Science of Unitary Human Beings
Lucy K. Rogers (Mother), via E.A.M. Barrett & V.M. Malinski, 1994 Rogers with Sr. Callista Roy (right)
She then transferred to Knoxville General Hospital’s nursing program Martha Rogers’ theory is known as the Science of Unitary Human
and was one of 25 students in her class. She described her training Beings (SUHB). The theory views nursing as both a science and an
as at times as being miserable because the training was like the art as it provides a way to view the unitary human being, who is
“Army, pre-Nightingale.” She even spent a week at home, thinking of integral with the universe. The unitary human being and his or her
not returning to school but eventually enjoyed working with people environment are one. Nursing focuses on people and the
and patients. manifestations that emerge from the mutual human-environmental
Rogers received her nursing diploma from the Knoxville General field process.
Hospital School of Nursing in 1936, then earned her Public SUHB contains two dimensions: the science of nursing, which is the
Health Nursing degree from George Peabody College in Tennessee knowledge specific to the field of nursing that comes from scientific
in 1937. She sold her car to pay for tuition and entered a Masters research; and the art of nursing, which involves using the science of
degree program full-time. nursing creatively to help better the life of the patient.
Rogers Family, circa 1945. Jane L. Coleman, Martha E. Rogers, Rogers wearing “Just visiting this planet!” cap, Photo by M Bramlett,
Lucy K. Rogers, (Mother) Keener (Brother) , Laura B. Whihte (sister) 1991
via E.A.M. Barrett & V.M. Malinski, 1994 Her model addresses the importance of the environment as an
integral part of the patient, and uses that knowledge to help nurses
blend the science and art of nursing to ensure patients have a manifesting characteristics that are more than and different from the
smooth recovery and can get back to the best health possible. sum of his parts. (2) Man and environment are continuously
There are eight concepts in Rogers’ nursing theory: energy field, exchanging matter and energy with one another. (3) The life process
openness, pattern, pan-dimensionality, homeodynamic principles, evolves irreversibly and unidirectionally along the space-time
resonance, helicy, and integrality. continuum. (4) Pattern and organization identify the man and reflect
Rogers’ development of the said theory has become an influential his innovative wholeness. And lastly, (5) Man is characterized by the
nursing theory in the United States. When first introduced, it was capacity for abstraction and imagery, language and thought
considered profound, and was too ambitious, but now is simply sensation and emotion.
thought to be ahead of its time. Her conceptual framework has Major Concepts
greatly influenced all aspects of nursing by offering an alternative to The following are the major concepts and metaparadigm of Martha
traditional approaches of nursing. Rogers’ nursing theory:
Her theory is discussed further below. Human-unitary human beings
Works A person is defined as an indivisible, pan-dimensional energy field
Front cover of Reveille in Nursing (1964) identified by a pattern, and manifesting characteristics specific to the
Martha Rogers wrote three books that enriched the learning whole, and that can’t be predicted from knowledge of the parts. A
experience and influenced the direction of nursing research for person is also a unified whole, having its own distinct characteristics
countless students: Educational Revolution in Nursing that can’t be viewed by looking at, describing, or summarizing the
(1961), Reveille in Nursing (1964). parts.
In about 1963 Rogers edited a journal called Nursing Science. It was Health
during that time that Rogers was beginning to formulate ideas about Rogers defines health as an expression of the life process. It is the
the publication of her third book, An Introduction to the Theoretical characteristics and behavior coming from the mutual, simultaneous
Basis of Nursing (1970), the last of which introduced the four interaction of the human and environmental fields, and health and
Rogerian Principles of Homeodynamics. illness are part of the same continuum. The multiple events occurring
Her publications include: Theoretical Basis of Nursing (1970), during the life process show the extent to which a person is achieving
Nursing Science and Art: A Prospective (1988), Nursing: Science of his or her maximum health potential. The events vary in their
Unitary, Irreducible, Human Beings Update (1990), and Vision of expressions from greatest health to those conditions that are
Space Based Nursing (1990). incompatible with the maintaining life process.
Roger’s third book “An Introduction to the Theoretical Basis of ADVERTISEMENTS
Nursing” (1970) Nursing
Awards and Honors It is the study of unitary, irreducible, indivisible human and
Martha Rogers was honored with numerous awards and citations for environmental fields: people and their world. Rogers claims that
her sustained contributions to nursing and science. In 1996, she was nursing exists to serve people, and the safe practice of nursing
posthumously inducted into the American Nurses Association’s Hall depends on the nature and amount of scientific nursing knowledge
of Fame. the nurse brings to his or her practice
Death Scope of Nursing
Martha Rogers died on March 13, 1994 and was buried in Knoxville, Nursing aims to assist people in achieving their maximum health
Tennessee. She has a memorial placed in the sidewalk near her potential. Maintenance and promotion of health, prevention of
childhood home in Knoxville. disease, nursing diagnosis, intervention, and rehabilitation
Memorial placed in the sidewalk near her childhood home in encompass the scope of nursing’s goals.
Knoxville by Gamma Chi, Sigma Theta Tau, International. Photo by Nursing is concerned with people-all people-well and sick, rich and
Martha Alligood poor, young and old. The arenas of nursing’s services extend into all
Rogers’ Theory of Unitary Human Beings areas where there are people: at home, at school, at work, at play; in
The belief of the coexistence of the human and the environment has hospital, nursing home, and clinic; on this planet and now moving
greatly influenced the process of change toward better health. In into outer space.
short, a patient can’t be separated from his or her environment when Environmental Field
addressing health and treatment. This view lead and opened Martha “An irreducible, indivisible, pandimensional energy field identified by
E. Rogers’ theory, known as the “Science of Unitary Human pattern and integral with the human field.”
Beings,” which allowed nursing to be considered one of the scientific Energy Field
disciplines. The energy field is the fundamental unit of both the living and the
Rogers’ theory defined Nursing as “an art and science that is non-living. It provides a way to view people and the environment as
humanistic and humanitarian. It is directed toward the unitary human irreducible wholes. The energy fields continuously vary in intensity,
and is concerned with the nature and direction of human density, and extent.
development. The goal of nurses is to participate in the process of Subconcepts
change.” Openness
According to Rogers, the Science of Unitary Human Beings contains There are no boundaries that stop energy flow between the human
two dimensions: the science of nursing, which is the knowledge and environmental fields, which is the openness in Rogers’ theory. It
specific to the field of nursing that comes from scientific research; refers to qualities exhibited by open systems; human beings and their
and the art of nursing, which involves using the science of nursing environment are open systems.
creatively to help better the life of the patient. Pandimensional
Assumptions Pan-dimensionality is defined as “non-linear domain without spatial
The assumptions of Rogers’ Theory of Unitary Human Beings are as or temporal attributes.” The parameters that humans use in language
follows: (1) Man is a unified whole possessing his own integrity and
to describe events are arbitrary, and the present is relative; there is  offering choices
no temporal ordering of lives.  empowering the patient
Synergy is defined as the unique behavior of whole systems,  fostering patterning
unpredicted by any behaviors of their component functions taken  evaluation
separately.  repeat pattern appraisal, which includes nutrition,
Human behavior is synergistic. work/leisure activities, wake/sleep cycles,
Pattern relationships, pain, and fear/hopes
Rogers defined the pattern as the distinguishing characteristic of an  identify dissonance and harmony
energy field seen as a single wave. It is an abstraction and gives  validate appraisal with the patient
identity to the field.
 self-reflection for the patient
Principles of Homeodynamics
Strengths
Homeodynamics should be understood as a dynamic version
Martha Rogers’ concepts provide a worldview from which nurses
of homeostasis (a relatively steady state of internal operation in the
may derive theories and hypotheses and propose relationships
living system).
specific to different situations.
Homeodynamic principles postulate a way of viewing unitary human
Rogers’ theory is not directly testable due to lack of concrete
beings. The three principles of homeodynamics are resonance,
hypotheses, but it is testable in principle.
helicy, and integrality.
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Principle of Reciprocy
Weaknesses
Postulates the inseparability of man and environment and predicts
Rogers’ model does not define particular hypotheses or theories for it
that sequential changes in life process are continuous, probabilistic
is an abstract, unified and highly derived framework.
revisions occurring out of the interactions between man and
Testing the concepts’ validity is questionable because its concepts
environment.
are not directly measurable.
Principle of Synchrony
The theory was believed to be profound and was too ambitious
This principle predicts that change in human behavior will be
because the concepts are extremely abstract.
determined by the simultaneous interaction of the actual state of the
Rogers claimed that nursing exists to serve people, however, nurses’
human field and the actual state of the environmental field at any
roles were not clearly defined.
given point in space-time.
The purpose of nurses is to promote health and well-being for all
Principle of Integrality (Synchrony + Reciprocy)
persons wherever they are. However, Rogers’ model has no
Because of the inseparability of human beings and their environment,
concrete definition of health state.
sequential changes in the life processes are continuous revisions
Conclusion
occurring from the interactions between human beings and their
The Science of Unitary Human Beings is highly generalizable as the
environment.
concepts and ideas are not confined with a specific nursing approach
Between the two entities, there is a constant mutual interaction and
unlike the usual way of other nurse theorists in defining the major
mutual change whereby simultaneous molding is taking place in both
concepts of a theory.
at the same time.
Rogers gave much emphasis on how a nurse should view the
Principle of Resonancy
patient. She developed principles which emphasize that a nurse
It speaks to the nature of the change occurring between human and
should view the client as a whole.
environmental fields. The life process in human beings is a
Her statements, in general, made us believe that a person and his or
symphony of rhythmical vibrations oscillating at various frequencies.
her environment are integral to each other. That is, a patient can’t be
It is the identification of the human field and the environmental field
separated from his or her environment when addressing health and
by wave patterns manifesting continuous change from longer waves
treatment. Her conceptual framework has greatly influenced all
of lower frequency to shorter waves of higher frequency.
aspects of nursing by offering an alternative to traditional approaches
Principle of Helicy
of nursing.
The human-environment field is a dynamic, open system in which
change is continuous due to the constant interchange between the
human and environment.
This change is also innovative. Because of constant interchange, an
open system is never exactly the same at any two moments; rather,
Science of Unitary Human Beings
the system is continually new or different.
This page was last updated on January 26, 2012
Science of Unitary Human Beings and Nursing Process
The nursing process has three steps in Rogers’ Theory of Unitary
Human Beings: assessment, voluntary mutual patterning, Introduction
and evaluation.  Theorist - Martha E Rogers
The areas of assessment are: the total pattern of events at any given  Born :May 12, 1914, Dallas, Texas, USA
point in space-time, simultaneous states of the patient and his or her
 Diploma : Knoxville General Hospital School of Nursing(1936)
environment, rhythms of the life process, supplementary data,
 Graduation in Public Health Nursing : George Peabody Colleg
categorical disease entities, subsystem pathology, and pattern
1937
appraisal. The assessment should be a comprehensive assessment
 MA :Teachers college, Columbia university, New York, 1945
of the human and environmental fields.
Mutual patterning of the human and environmental fields  MPH :Johns Hopkins University, Baltimore, MD, 1952
includes:  Doctorate in nursing :Johns Hopkins University, Baltimore, 195
 sharing knowledge  Fellowship: American academy of nursing
  Position: Professor Emerita, Division of Nursing, New York University,Helicy
Consultant, Speaker  Helicy describes the unpredictable, but continuous, nonlinear
 Died : March 13 , 1994 of energy fields as evidenced by non repeating rhythmicties
Publications of Martha Rogers  The principle of Helicy postulates an ordering of the humans
 Theoretical basis of nursing (Rogers 1970) evolutionary emergence
 Nursing science and art :a prospective (Rogers 1988) Integrality
 Nursing :science of unitary, irreducible, human beings update (Rogers  The mutual, continuous relationship of the human energy field
1990) environmental field .
 Vision of space based nursing (Rogers 1990)  Changes occur by by the continuous repatterning of the huma
Overview of Rogerian model environmental fields by resonance waves
 Rogers conceptual system provides a body of knowledge in nursing.  The fields are one and integrated but unique to each other
 Rogers model provides the way of viewing the unitary human being. Nursing Paradigms
 Humans are viewed as integral with the universe. Unitary Human Being (person)
 The unitary human being and the environment are one, not  A unitary human being is an "irreducible, indivisible, pan dimen
dichotomous (four-dimensional) energy field identified by pattern and manife
 Nursing focus on people and the manifestations that emerge from the characteristics that are specific to the whole and which cannot
mutual human /environmental field process predicted from knowledge of the parts" and "a unified whole ha
 Change of pattern and organization of the human field and the own distinctive characteristics which cannot be perceived by lo
environmental field is propagated by waves at, describing, or summarizing the parts"
 The manifestations of the field patterning that emerge are observable Environment
events  The environment is an "irreducible, pan dimensional energy fie
 The identification of the pattern provide knowledge and understanding identified by pattern and integral with the human field"
of human experience  The field coexist and are integral.
 Basic characteristics which describes the life process of human:  Manifestation emerge from this field and are perceived.
energy field, openness, pattern, and pan dimensionality Health
 Basic concepts include unitary human being, environment, and  "an expression of the life process; they are the "characteristics
homeodynamic principles behavior emerging out of the mutual, simultaneous interaction
Concepts of Rogers model human and environmental fields"
Energy field  Health and illness are the part of the sane continuum.
 The energy field is the fundamental unit of both the living and nonliving  The multiple events taking place along life's axis denote the ex
 This energy field "provide a way to perceive people and environment which man is achieving his maximum health potential and very
as irreducible wholes" expressions from greatest health to those conditions which are
 The energy fields continuously varies in intensity, density, and extent. incompatible with the maintaining life process
Openness Nursing
 The human field and the environmental field are constantly exchanging  Two dimensions Independent science of nursing
their energy 1. An organized body of knowledge which is specific to
is arrived at by scientific research and logical analys
 There are no boundaries or barrier that inhibit energy flow between
2. Art of nursing practice:
fields
 The creative use of science for the betterm
Pattern
the human
 Pattern is defined as the distinguishing characteristic of an energy field
 The creative use of its knowledge is the ar
perceived as a single waves
practice
 "pattern is an abstraction and it gives identity to the field"
 Nursing exists to serve people.
Pan dimensionality
 It is the direct and overriding responsibility to the society
 Pan dimensionality is defined as "non linear domain without spatial or
 The safe practice of nursing depends on the nature and amou
temporal attributes"
scientific nursing knowledge the individual brings to practice…
 The parameters that human use in language to describe events are
imaginative, intellectual judgment with which such knowledge
arbitrary.
in service to the man kind.
 The present is relative, there is no temporal ordering of lives. Rogerian theories-Grand theories
Homeodynamic principles
 The theory of paranormal phenomena
 The principles of homeodynamic postulates the way of perceiving
 The theory of rhythmicities
unitary human beings
 The theory of accelerating evolution
 The fundamental unit of the living system is an energy field
Theory of paranormal phenomena
 Three principle of homeodynamics
 This theory explains precognition, déjàvu, clairvoyance, telepa
o Resonancy
therapeutic touch
o Helicy
 Clairvoyance is rational in a four dimensional human field in
o integrality
continuous mutual, simultaneous interaction with a four dimen
Resonance
world; there is no linear time nor any separation of human and
 Resonance is an ordered arrangement of rhythm characterizing both
environmental fields
human field and environmental field that undergoes continuous
The theory of accelerating evolution
dynamic metamorphosis in the human environmental process
 Theory postulates that evolutionary change is speeding up an
 range of diversity of life process is widening. process. • The energy flows freely between the individual
 Higher wave frequencies are associated with accelerating human and environment. • Human being possesses the ability to
development think, imagine, sense, feel, and can use language for
Theory of Rhythmicity expression. • Human beings have the ability to adapt
 Focus on the human field rhythms (these rhythms are different from according to the new changes in the environment.
the biological, psychological rhythm) 7. 7. Major Concepts:
 Theory deals with the manifestations of the whole unitary man as 8. 8. Concepts: • All the human beings are viewed as an
changes in human sleep wake patterns, indices of human field motion, integral part of universe. • Human beings and the
perception of time passing, and other rhythmic development environment have energy field, nursing action is directed
Theories derived from the science of unitary human beings towards patterning and maintaining these energy fields.
 The perspective rhythm model (Patrick 1983) Energy fields Pandime nsioal Openness Patter n
 Theory of health as expanding consciousness (Neuman, 1986) 9. 9. Energy fields: • it is the inevitable part of life. Human and
 Theory of creativity, actualization and empathy (Alligood 1991) environment both have energy field which is open i.e.
 Theory of self transcendence (Reed1997) energy can freely flow between human and environment.
10. 10. Openness: • there is no boundary or barrier that can
 Power as knowing participation in change (Barrett 1998)
inhibit the flow of energy between human and environment
which leads to the continuous movement or matter of
energy.
NURSING THEORY Martha Rogers - The Science of Unitary Human
11. 11. Pattern: • is the distinguishing character of the energy
Beings
field.
1. 1. NURSING THEORY MARTHA ROGERS - THE
12. 12. Pandimensioal: • Undeviating field which is not
SCIENCE OF UNITARY HUMAN BEINGS AJESH KUMAR
constricted by space or time, it is an infinite domain without
ASSISTANT PROFESSOR M.M COLLEGE OF NURSING
boundary.
M.M UNIVERSITY, MULLANA PICTURE COURTESY
13. 13. Principle of Homeodynamics
http://images.google.com
14. 14. Principle of Homeodynamics: • Homeodynamics refers
2. 2. Introduction: • Martha Roger’s theory Science of Unitary
to the balance between the dynamic life process and
Human Beings is mainly focusing on the four concepts and
environment. • These principles help to view human as
three principles of homeodynamic that are energy fields,
unitary human being. The three separate principles are
openness, pattern, pandimensioal, integrality, resonancy,
integrality, resonancy, and heliecy.
and helicy respectively.
15. 15. Principles of integrality: • Energy fields are dynamic and
3. 3. Biography: • She was born in Dallas, Texas May 12,
constantly interact with the human and environment, which
1914; sharing her birthday with Florence Nightingale. • Her
affects our environment and vice versa. • This is the
family moved to Knoxville, Tennessee before she turned
principle on which meditation and humor works to produce
one. • As a young child she was very inquisitive to gain
a positive environment.
more and more knowledge, she had passion of reading
16. 16. Principles of resonancy: • is an ordered arrangement of
books • In 1936 She attended nursing diploma programme
rhythm characterizing both human field and environmental
at Knoxville General Hospital • She continued her
field • Constant change in the way or pattern of the energy
schooling at George Peabody College and completed
field from a lower to higher frequency. • This movement of
Bachelors of Science in Public Health Nursing in 1937. •
energy can be made by human touch, guided imagery
She worked as a Public Health Nurse for two years after
activities, drawing, storytelling and other active use of
obtaining degree in Public Health Nursing.
imagination.
4. 4. Biography: • After completeing her Masters in Public
17. 17. Principles of heliecy: • Any minute change in the
Health Nursing from Teachers College Columbia University
environment which leads to ripple effect i.e. results in a
in 1946, she started working as a public health nurse. • She
larger changes in other field. • This change is constant,
worked as director of Visiting Nurses Association in
unpredictable and there are many factors which mutually
Phoenix, Arizona. • In 1951 she joined Johns Hopkins
interact and cause the change.
University, Baltimore and completed Doctor of Science in
18. 18. Metaparadigm in Nursing Person Environment Health
1954 while she was working at Catholic University. • After
Nursing
completing her Doctor of Science she served as the Head
19. 19. Person: • a unitary human being is open systems which
of the Division of nursing at New York University • In 1963
continuously interact with environment. A person cannot be
she edited the second journal in Nursing i.e. Nursing
viewed as parts, it should be considered as a whole.
Science
20. 20. Environment: • it includes the entire energy field other
5. 5. Biography: • An Introduction to the Theoretical Basis of
than a person. • These energy fields are irreducible, not
Nursing was the most famous work of Rogers which was
limited by space and time, identified by its pattern and
published in 1970. • In 1975 she retired as Head of the
organization
Division of nursing from New York University • She joined
21. 21. Health: • Not clearly defined by Roger. It is determined
Emeritus University in 1979 as a Professor and continued
by the interaction between energy fields i.e. human and
to work on The Science of Unitary Human Beings till the
environment. • Bad interaction or misplacing of the energy
time of her demise in March 13, 1994.
leads to illness.
6. 6. Assumptions: • Human being is considered as whole
22. 22. Nursing: • Is both science and art. • It constantly
which cannot be viewed as subparts. • The life process of
maintains the energy field which is conducive for patient. •
human is irreparable and one way i.e. from birth to death. •
Health and illness are the continuous expression of the life
 Nursing action directs the interaction of person and withdrawn, nutritional status is impaired, crying spells, sad
environment to maximize health potential. mood, and risk for committing suicide.
23. 23. Application of SUBH: PRACTICE EDUCATION 36. 36. Assessment(PatternAppraisal) • Mr. X is experiencing
RESEARCH Monday, April 20, 2015 23 the pattern of dissonance. i.e. depression with suicidal
24. 24. Clinical Practice: • Nursing action is always focused on ideation, MI, pain, fear , sleep pattern disturbances,
unitary human being and change the energy field between impaired nutritional status, tendencies to commit suicide
human and environment. • Nursing interventions include all and appraisal is essential for all of these symptoms.
the noninvasive actions such as guided imaginary, humor, MutualPatterning: • It is the mutual interaction between Mr.
therapeutic touch, music etc. which are used to increase X and nurse for changing the pattern and making his all
the potential of human being. emerging pattern as unitary pattern. • Therapeutic touches,
25. 25. Clinical practice cont… • The more importance should meditation, guided imagery, are the pattering activities
be on the management of pain, supportive psychotherapy planned for Mr. X. • Therapeutic touch is implemented
and rehabilitation of the human being. which will cure the pain, promote the speedy recovery and
26. 26. Clinical practice cont… Nursing Assessment & building trust on nurse. • Social withdrawn can be managed
Diagnosis Interventions and Rehabilitation Prevention of by using humor, participating in small group activities and
Illness Maintennace of Health Promotion of Health this will help him to develop self confidence. • Advices are
27. 27. Nursing Education: • Emphasis should be given on the given for changing the dietary pattern and improving the
understanding of the patient and self, energy field and personal hygiene. • Involvement of family for the
environment. • Training should lay more focus on teaching environment pattering. Evaluation • Repeating the pattern
non- invasive modalities such as therapeutic touch, appraisal after the mutual patterning to determine the
meditation, humor, regular in-service education programme extents of dissonance and harmony. • Current symptoms
etc. experiencing by Mr. X is shared with him and if changes is
28. 28. Nursing Research: • Rogerian theory has been used in needed in the mutual patterning that can be incorporated or
many research works and has always been found testable implement the same.
and applicable in research. 37. 37. Critique of the SUBH:
29. 29. Nursing process according to SUBH: Monday, April 20, 38. 38. Simplicity: • although the concepts seems to quite
2015 29 Pattern appraisal Mutual patterning Evaluation difficult to understand. • It’s a parsimonious theory. •
30. 30. Pattern appraisal: • It is an inclusive assessment of Parsimony refers to theory based on simple assumption
human and environment energy fields, its organization of but proves to be very valuable.
energy field, and identification of areas of dissonance. • 39. 39. Clarity: • overall Rogerian SUBH is considered as
Nurses validate the entire appraisal along with the client. complex but still efforts are going on to clarify the complex
31. 31. Mutual patterning: • It is the proper patterning of the concepts.
energy fields between the human and environment. • It is 40. 40. Generality: • The uses on non- invasive modalities are
the mutual interaction between the client and nurse • very useful and important to nursing even today. • SUBH is
Patterning can be done by suggesting the various the foundation of many theories and it can be apply in a
alternatives, educating, empowering, encouraging etc. variety of setting and all spheres of life.
depending on the client’s condition and needs. 41. 41. Empirical precision: • Rogerian theory has been used in
32. 32. Mutual patterning cont.. • Pattern appraisal include many research works and has been found testable and
appraisal of nutrition, rest and sleep, exercises, discomfort, applicable in research. • But, many limitations have also
and relation with others. • The pattering activities can be been identified by the researchers such as difficult to
therapeutic touch, meditation, humor, imaginery etc. understand the concepts, lack of operational definitions
33. 33. Evaluation: • Evaluation is done by repeating the and instruments for the proper evaluation of the
pattern appraisal after the mutual patterning to determine instruments.
the extents of dissonance and harmony. • 42. 42. Conclusion: • SUBH leads to a new way of seeing the
34. 34. Clinical scenario: • Mr. X is a 54 years old male person as a unitary human being and new style of nursing
admitted in the Male Psychiatric ward with the diagnosis of practice. • This model is applicable in all the setting and
major depression secondary to the diagnosis of Myocardial every spheres of life. • Rogers emphasized the need for
Infraction (MI). • He was very tense and sobbing during the noninvasive nursing modalities in achieving the health
history collection. • He was accompanied by his wife and potential, it is very evident in today’s situation that there is
son. Even though his wife was anxious but still she was more focus on the alternative system of medicine and
supportive and helpful. • Mr. X was diagnosed with MI four noninvasive nursing actions are in getting much
months back and underwent the angioplasty three months importance.
ago. • Currently he is on Statins and Antihypertensives. 43. 43. References • Margaret Ruddy; Model & Theories of
35. 35. Clinical scenario: • He started to show the sings and Nursing; Cardinal Stritch University Library; 2007; p. 34-35.
symptoms of depression from the past one month. • He • Tomey, A.M. & Alligood,M.R.; Nursing Theorist & their
used to sit alone, diminished the activities of daily living, work; 5th edition; 2006; p. 226-249. • George B. Julia,
regular crying spells, decreased chat, self muttering, Nursing Theories, The base for Professional Nursing
insomnia, anorexia, body aches, least bothered about Practice, 5th Edition 2002
personal hygiene, two days before he attempted suicide by 44. 44. Thank you….
hanging on ceiling fan. • His present findings based on the
assessment shows that he is very tearful, socially