Naga College Foundation, Inc.

College of Health Sciences

NURSING THEORIES PART 1

MODULE 4

JOHANNA MARIA DJ. CASTILLO, RN, MN

Clinical Instructor
Course Code: NCM 100

Course Title: Theoretical Foundations in Nursing

Credit Units: 3 units lecture (54 hours)

Prerequisite: NONE

Duration: 1st Semester S/Y 2020-2021

Delivery Mode: Blended

Course Description:

This course deals with the meta- concepts of person, health, environment, and
nursing as viewed by the different theorists. Likewise, it includes non-nursing theories sub
systems, developmental and change theories. It presents how these concepts and theories
serve as guide in nursing practice. It further deals with health as multi factorial phenomenon
and necessary core competencies that the nurse need to develop.

Learning Objectives:

By the end of the lecture, students will be able to:

 Describe the various non-nursing theories as applied to nursing.

 Utilize selected nursing theories and non-nursing theories in the care of clients.

Learning Plan:

Schedule Description Time Frame

Invitation to join the Google Classroom

A. Write your expectation in Nursing Theories.

B. Nursing Theories 4 hrs/meeting

Week 4
1. Peplau’s Theory of Interpersonal Relationship
Total: 8 hrs
2. Orlando’s Theory of Deliberative Nursing Process
3. Travelbee’s Human to Human Relationship
4. Hall’s CORE, CARE, CURE
5. Abdellah’s 21 Nursing Problems
6. Henderson’s Need Theory
Pre Test:

Identification

1. Theorist who formulated interpersonal relationship.

2. Theorist who formulated human to human relationship.
3. Theorist who formulated the needs theory.
4. Author of CORE, CARE, and CURE.
5. Author of 21 Nursing Problems.

Lesson Proper:

Theory of Interpersonal Relations

 Theorist -Hildegard. E. Peplau

 Born in Reading, Pennsylvania [1909], USA
 Diploma program in Pottstown, Pennsylvania in 1931.
 BA in interpersonal psychology - Bennington College in 1943.
 MA in psychiatric nursing from Colombia University New York in 1947.
 EdD in curriculum development in 1953.
 Professor emeritus from Rutgers university
 Started first post baccalaureate program in nursing
 Published Interpersonal Relations in Nursing in 1952
 1968 :interpersonal techniques-the crux of psychiatric nursing
 Worked as executive director and president of ANA.
 Worked with W.H.O, NIMH and Nurse Corps.
 Died in 1999.
 Theory of interpersonal relations is a middle range descriptive classification theory.
 The theory was influenced by Harry Stack Sullivan's theory of inter personal
relations (1953).
 The theorist was also influenced by Percival Symonds, Abraham Maslow's and Neal
Elger Miller.
 Peplau's theory is also refered as psychodynamic nursing, which is the
understanding of ones own behavior.
Major Concepts
 The theory explains the purpose of nursing is to help others identify their felt
difficulties.
 Nurses should apply principles of human relations to the problems that arise at all
levels of experience.
 Peplau's theory explains the phases of interpersonal process, roles in nursing
situations and methods for studying nursing as an interpersonal process.
 Nursing is therapeutic in that it is a healing art, assisting an individual who is sick
or in need of health care.
 Nursing is an interpersonal process because it involves interaction between two or
more individuals with a common goal.
 The attainment of goal is achieved through the use of a series of steps following a
series of pattern.
  The nurse and patient work together so both become mature and knowledgeable in
the process.
Definitions
 Person: A developing organism that tries to reduce anxiety caused by needs.
 Environment: Existing forces outside the organism and in the context of culture
 Health: A word symbol that implies forward movement of personality and other
ongoing human processes in the direction
of creative, constructive, productive, personal and community living.
 Nursing: A significant therapeutic interpersonal process. It functions cooperatively
with other human process that make health possible for individuals in communities.
Roles of nurse
 Stranger: receives the client in the same way one meets a stranger in other life
situations provides an accepting climate that builds trust.
 Teacher: who imparts knowledge in reference to a need or interest
 Resource Person : one who provides a specific needed information that aids in the
understanding of a problem or new situation
 Counselors : helps to understand and integrate the meaning of current life
circumstances ,provides guidance and encouragement to make changes
 Surrogate: helps to clarify domains of dependence interdependence and
independence and acts on clients behalf as an advocate.
 Leader : helps client assume maximum responsibility for meeting treatment goals
in a mutually satisfying way
Additional Roles include:
1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10. Recorder observer
11. Researcher
Phases of interpersonal relationship
Identified four sequential phases in the interpersonal relationship:
1. Orientation
2. Identification
3. Exploitation
4. Resolution
Orientation phase
 Problem defining phase
 Starts when client meets nurse as stranger
 Defining problem and deciding type of service needed
 Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and
expectations of past experiences
 Nurse responds, explains roles to client, helps to identify problems and to use
available resources and services
Factors influencing orientation phase
 Identification phase
 Selection of appropriate professional assistance
 Patient begins to have a feeling of belonging and a capability of dealing with the
problem which decreases the feeling of helplessness and hopelessness

Exploitation phase
 Use of professional assistance for problem solving alternatives
 Advantages of services are used is based on the needs and interests of the patients
 Individual feels as an integral part of the helping environment
 They may make minor requests or attention getting techniques
 The principles of interview techniques must be used in order to explore, understand
and adequately deal with the underlying problem
 Patient may fluctuates on independence
 Nurse must be aware about the various phases of communication
 Nurse aids the patient in exploiting all avenues of help and progress is made
towards the final step
Resolution phase
 Termination of professional relationship
 The patients needs have already been met by the collaborative effect of patient and
nurse
 Now they need to terminate their therapeutic relationship and dissolve the links
between them.
 Sometimes may be difficult for both as psychological dependence persists
 Patient drifts away and breaks bond with nurse and healthier emotional balance is
demonstrated and both becomes mature individuals
Interpersonal theory and nursing process
 Both are sequential and focus on therapeutic relationship
 Both use problem solving techniques for the nurse and patient to collaborate on,
with the end purpose of meeting the patients needs
 Both use observation communication and recording as basic tools utilized by
nursing
Assessment Orientation
 Data collection and analysis  Non continuous data collection
[continuous]  Felt need
 May not be a felt need  Define needs
Nursing diagnosis Identification
Planning  Interdependent goal setting
 Mutually set goals
Implementation Exploitation
 Plans initiated towards achievement  Patient actively seeking and drawing
of mutually set goals help
 May be accomplished by patient ,  Patient initiated
nurse or family
Evaluation Resolution
 Based on mutually expected  Occurs after other phases are
behaviors completed successfully
 May led to termination and initiation  Leads to termination a
of new plans
Peplau’s work and characteristics of a theory
 Interrelation of concepts
o Four phases interrelate the different components of each phase.
 Applicability
o The nurse patient interaction can apply to the concepts of human being,
health, environment and nursing.
 Theories must be logical in nature -
o This theory provides a logical systematic way of viewing nursing situations
o Key concepts such as anxiety, tension, goals, and frustration are indicated
with explicit relationships among them and progressive phases
 Generalizability
o This theory provides simplicity in regard to the natural progression of the NP
relationship.
 Theories can be the bases for hypothesis that can be tested
o Peplau's theory has generated testable hypotheses.
 Theories can be utilized by practitioners to guide and improve their practice.
o Peplau’s anxiety continuum is still used in anxiety patients
 Theories must be consistent with other validated theories, laws, and principles but
will leave open unanswered questions that need to be investigated.
o Peplau's theory is consistent with various theories
Limitations
 Personal space considerations and community social service resources are
considered less.
 Health promotion and maintenance were less emphasized
 Cannot be used in a patient who doesn’t have a felt need eg. With drawn patients,
unconscious patients
 Some areas are not specific enough to generate hypothesis

Orlando's Nursing Process Theory

 Ida Jean Orlando - born in 1926.

 wrote about the nursing process.
 Nursing diploma - New York Medical College
 BS in public health nursing - St. John's University, NY,
 MA in mental health nursing - Columbia University, New York.
 Associate Professor at Yale School of Nursing and Director of the Graduate Program
in Mental Health Psychiatric Nursing.
 Project investigator of a National Institute of Mental Health grant entitled:
Integration of Mental Health Concepts in a Basic Nursing Curriculum.
 published in her 1961 book, The Dynamic Nurse-Patient Relationship and revised
1972 book: The Discipline and Teaching of Nursing Processes
 A board member of Harvard Community Health Plan.
Major Dimensions
 The role of the nurse is to find out and meet the patient's immediate need for help.
 The patient's presenting behavior may be a plea for help, however, the help needed
may not be what it appears to be.
 Therefore, nurses need to use their perception, thoughts about the perception, or
the feeling engendered from their thoughts to explore with patients the meaning of
their behavior.
 This process helps nurse find out the nature of the distress and what help the
patient needs.
Terms
  Distress is the experience of a patient whose need has not been met.
 Nursing role is to discover and meet the patient’s immediate need for help.
o Patient’s behavior may not represent the true need.
o The nurse validates his/her understanding of the need with the patient.
 Nursing actions directly or indirectly provide for the patient’s immediate need.
 An outcome is a change in the behavior of the patient indicating either a relief
from distress or an unmet need.
o Observable verbally and nonverbally.
CONCEPTS
 Function of professional nursing - organizing principle
 Presenting behavior - problematic situation
 Immediate reaction - internal response
 Nursing process discipline – investigation
 Improvement - resolution
Function of professional nursing - organizing principle
 Finding out and meeting the patients immediate needs for help
"Nursing….is responsive to individuals who suffer or anticipate a sense of helplessness, it
is focused on the process of care in an immediate experience, it is concerned with
providing direct assistance to individuals in whatever setting they are found for the
purpose of avoiding, relieving, diminishing or curing the individuals sense of
helplessness." - Orlando
Presenting behavior - problematic situation
 To find out the immediate need for help the nurse must first recognize the situation
as problematic
 The presenting behavior of the patient, regardless of the form in which it appears,
may represent a plea for help
 The presenting behavior of the patient, the stimulus, causes an automatic internal
response in the nurse, and the nurses behavior causes a response in the patient
Immediate reaction - internal response
 Person perceives with any one of his five sense organs an object or objects
 The perceptions stimulate automatic thought
 Each thought stimulates an automatic feeling
 Then the person acts
 The first three items taken together are defined as the person’s immediate reaction
Nursing process discipline – investigation
 Any observation shared and explored with the patient is immediately useful in
ascertaining and meeting his need or finding out that he is not in need at that time
 The nurse does not assume that any aspect of her reaction to the patient is correct,
helpful or appropriate until she checks the validity of it in exploration with the
patient
 The nurse initiates a process of exploration to ascertain how the patient is affected
by what she says or does .
 When the nurse does not explore with the patient her reaction it seems reasonably
certain that clear communication between them stops
Improvement - resolution
 It is not the nurses activity that is evaluated but rather its result : whether the
activity serves to help the patient communicate her or his need for help and how it
is met.
 In each contact the nurse repeats a process of learning how to help the individual
patient.
ASSUMPTIONS
 When patients cannot cope with their needs without help, they become distressed
with feelings of helplessness
 Patients are unique and individual in their responses
 Nursing offers mothering and nursing analogous to an adult mothering and
nurturing of a child
 Nursing deals with people, environment and health
 Patient need help in communicating needs, they are uncomfortable and ambivalent
about dependency needs
  Human beings are able to be secretive or explicit about their needs, perceptions,
thoughts and feelings
 The nurse – patient situation is dynamic, actions and reactions are influenced by
both nurse and patient
 Human beings attach meanings to situations and actions that are not apparent to
others
 Nurses are concerned with needs that patients cannot meet on their own
DOMAIN CONCEPTS
1. Nursing – is responsive to individuals who suffer or anticipate a sense of
helplessness
2. Process of care in an immediate experience….. for avoiding, relieving,
diminishing or curing the individuals sense of helplessness. Finding out meeting the
patients immediate need for help
3. Goal of nursing – increased sense of well being, increase in ability, adequacy in
better care of self and improvement in patients behavior
4. Health – sense of adequacy or well being . Fulfilled needs. Sense of comfort
5. Environment – not defined directly but implicitly in the immediate context for a
patient
6. Human being – developmental beings with needs, individuals have their own
subjective perceptions and feelings that may not be observable directly
7. Nursing client – patients who are under medical care and who cannot deal with
their needs or who cannot carry out medical treatment alone
8. Nursing problem – distress due to unmet needs due to physical limitations,
adverse reactions to the setting or experiences which prevent the patient from
communicating his needs
9. Nursing process – the interaction of 1)the behavior of the patient, 2) the reaction
of the nurse and 3)the nursing actions which are assigned for the patients benefit
10.Nurse – patient relations – central in theory and not differentiated from nursing
therapeutics or nursing process
11.Nursing therapeutics – Direct function : initiates a process of helping the patient
express the specific meaning of his behavior in order to ascertain his distress and
helps the patient explore the distress in order to ascertain the help he requires so
that his distress may be relieved.
12.Indirect function – calling for help of others , whatever help the patient may
require for his need to be met
13.Nursing therapeutics - Disciplined and professional activities – automatic
activities plus matching of verbal and nonverbal responses, validation of
perceptions, matching of thoughts and feelings with action
14.Automatic activities – perception by five senses, automatic thoughts, automatic
feeling, action
CHARACTERISTICS OF THE THEORY
 Orlando's theory interrelate concepts
 Orlando's theory has a logical nature
 Orlando's theory is simple and applicable in the daily practice.
 Orlando's theory contribute to the professional knowledge.
 Orlando's theory is applicable in clinical practice
STRENGTHS
 Use of her theory assures that patient will be treated as individuals and that they
will have active and constant input into their own care
 Prevents inaccurate diagnosis or ineffective plans because the nurse has to
constantly explore her reactions with the patient
 Assertion of nursing’s independence as a profession and her belief that this
independence must be based on a sound theoretical frame work
 Guides the nurse to evaluate her care in terms of objectively observable patient
outcome
NURSING PROCESS
 Assessment
 Diagnosis
 Planning
 Implementation
 Evaluation
CONCLUSION TO THEORY
 Orlando's Deliberative Nursing Process Theory focuses on the interaction between
the nurse and patient, perception validation, and the use of the nursing process to
produce positive outcomes or patient improvement. Orlando's key focus was to
define the function of nursing. (Faust C., 2002)
 Orlando's theory remains one the of the most effective practice theories available.
 The use of her theory keeps the nurse's focus on the patient.
 The strength of the theory is that it is clear, concise, and easy to use.
 While providing the overall framework for nursing, the use of her theory does not
exclude nurses from using other theories while caring for the patient.

Joyce Travelbee’s Human-To-Human Relationship Model

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

presented in her bookInterpersonal Aspects of Nursing (1966, 1971).
 She dealt with the interpersonal aspects of nursing.
 She explains “human-to-human relationship is the means through which the
purpose of nursing if fulfilled”
About the Theorist
 A psychiatric nurse, educator and writer born in 1926.
 1956, she completed her BSN degree at Louisiana State University
 1959, she completed her Master of Science Degree in Nursing at Yale University.
 1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate School, New
Orleans.
 Later in Charity Hospital School of Nursing in Louisiana State University, New York
University and University of Mississippi.
 Travelbee died at age 47.
Development of the Theory
 Travelbee based the assumptions of her theory on the concepts of existentialism by
Soren Kierkegaard and logotherapy by Viktor Frankl.
 Existential theory believes that that humans are constantly faced choices and
conflicts and is accountable to the choices we make in life
 Logotherapy theory was first proposed by Viktor Frankel, a survivor of Auschwitz, in
his book Man's Search for Meaning (1963).
 Logotherapy
Basic Concepts
 Suffering
o "An experience that varies in intensity, duration and depth ... a feeling of
unease, ranging from mild, transient mental, physical or mental discomfort
to extreme pain and extreme tortured ..."
 Meaning
o Meaning is the reason as oneself attributes
 Nursing
o is to help man to find meaning in the experience of illness and suffering.
o has a responsibility to help individuals and their families to find meaning.
o The nurses' spiritual and ethical choices, and perceptions of illness and
suffering, is crucial to helping to find meaning.
 Hope
o Nurse's job is to help the patient to maintain hope and avoid hopelessness.
 o Hope is a faith that can and will be change that would bring something better
with it.
o Hope's core lies in a fundamental trust the outside world, and a belief that
others will help someone when you need it.
o Six important factors charecteristics of hope are:
 It is strongly associated with dependence on other people.
 It is future oriented.
 It is linked to elections from several alternatives or escape routes out
of its situation.
 The desire to possess any object or condition, to complete a task or
have an experience.
 Confidence that others will be there for one when you need them.
 The hoping person is in possession of courage to be able to
acknowledge its shortcomings and fears and go forward towards its
goal
 Communications
o "a strict necessity for good nursing care"
 Using himself therapeutic
o " one is able to use itself therapeutic."
o Self-awareness and self-understanding, understanding of human behavior,
the ability to predict one's own and others' behavior are imporatnt in this
process.
 Targeted intellectual approach
o Nurse must have a systematic intellectual approach to the patient's situation.
Nursing Metaparadigms
 Person
o Person is defined as a human being.
o Both the nurse and the patient are human beings.
 Health
o Health is subjective and objective.
o Subjective health is an individually defined state of well being in accord with
self-appraisal of physical-emotional-spiritual status.
o Objective health is an absence of discernible disease, disability of defect as
measured by physical examination, laboratory tests and assessment by
spiritual director or psychological counselor.
 Environment
o Environment is not clearly defined.
 Nursing
o "an interpersonal process whereby the professional nurse practitioner assists
an individual, family or community to prevent or cope with experience or
illness and suffering, and if necessary to find meaning in these experiences.”
Description of the theory
 Travelbee believed nursing is accomplished through human-to-human relationships
that begin with the original encounter and then progress through stages of
emerging identities, developing feelings of empathy, and later feelings of sympathy.
 The nurse and patient attain a rapport in the final stage. For meeting the goals of
nursing it is a prerequisite to achieving a genuine human-to-human relationships.
 This relationship can only be established by an interaction process.
 It has five phases.
o The inaugural meeting or original encounter
o Visibility of personal identities/ emerging identities.
o Empathy
o Sympathy
o Establishing mutual understanding and contact/ rapport
 Travelbee's ideas have greatly influenced the hospice movement in the west.
Conclusion
 Travelbee's theory has significantly influenced nursing and health care.
 Travelbee's ideas have greatly influenced the hospice movement in the west.
Hall’s Care, Core, Cure Theory

Major Concepts
The patient is a unity composed of the following three overlapping parts: (1) a person
(the core aspect), (2) a pathologic condition and treatment (the cure aspect), (3) and a
body (the care aspect).
Rehabilitation.
Self-actualization and self-love.
Nurturance.
Patient learning.

Typology
Theoretical Framework

Brief Description (with illustration)

The nurse is a bodily caregiver. Provision of bodily care allows the nurse to comfort and
learn the patient’s pathologic condition, treatment aspect, and person. Understanding,
resulting from the integration of all three areas, allows the nurse to be an effective
teacher and nurturer. The patient learns and is nurtured in the person (i.e., in the core
aspect). Nurturance leads to effective rehabilitation, greater levels of self-actualization,
and self-love.
Nursing occurs during one of two phases of medical care. Phase 1 medical care is the
diagnostic and treatment phase; phase 2 is the evaluative, follow-up phase. The
professional nurse’s role is in phase 2, and professional nursing practice requires a setting
in which patients are free to learn. In phase 2 the nurse’s goal is to help the patient learn.
Motivation to learn is ensured by advocating the patient’s learning goals and not the
doctor’s curative goals. Once patient learning goals are co-determined with the nurse and
motivation is therefore ensured, the patient will learn, and nurturance, rehabilitation, and
self-love will follow. The overall goal for the patient is rehabilitation, which inspires a
greater measure of self-actualization and self-love. (adapted from Chinn, P. L., & Kramer,
M. (2018). Knowledge Development in Nursing: Theory and Process (10th ed.). St Louis:
Elsevier.)

Author
Lydia E. Hall (1906-1969)
Lydia Hall was always interested in rehabilitative nursing and the role that the professional
nurse played in the patient’s recovery and welfare. She spent her early years as a
registered nurse working for the Life Extension Institute of the Metropolitan Life Insurance
Company in Pennsylvania and New York where the main focus was on preventative health.
She also had the opportunity to work for the New York Heart Association from 1935 to
1940. In 1941, she became a staff nurse with the Visiting Nurses Association of New York
and stayed there until 1947. Hall also managed to be an advocate of community
involvement in public health issues. And in 1950, she became a professor at Teacher’s
College at Columbia, where taught nursing students to function as medical consultants.
She was also a research analyst in the field of cardiovascular disease. She became
involved in the establishment of the Loeb Center for Nursing and Rehabilitation at the
Montefiore Medical Center (MMC) in the Bronx, New York, and served as its first Director.
From her experience at Loeb Center, she developed her “care, core, cure” framework,
which also emerged formally as the model upon when rehabilitative care was based.

FAYE GLENN ABDELLAH'S THEORY - Twenty-One Nursing Problems

"Nursing is based on an art and science that mold the attitudes, intellectual competencies,
and technical skills of the individual nurse into the desire and ability to help people , sick
or well, cope with their health needs." - Abdellah
Abdellah explained nursing as a comprehensive service, which includes:
1. Recognizing the nursing problems of the patient
2. Deciding the appropriate course of action to take in terms of relevant nursing
principles
3. Providing continuous care of the individuals total needs
4. Providing continuous care to relieve pain and discomfort and provide immediate
security for the individual
5. Adjusting the total nursing care plan to meet the patient’s individual needs
6. Helping the individual to become more self directing in attaining or maintaining a
healthy state of mind & body
7. Instructing nursing personnel and family to help the individual do for himself that
which he can within his limitations
8. Helping the individual to adjust to his limitations and emotional problems
9. Working with allied health professions in planning for optimum health on local,
state, national and international levels
10.Carrying out continuous evaluation and research to improve nursing techniques and
to develop new techniques to meet the health needs of people.
(In 1973, the item 3, - “providing continuous care of the individual’s total health needs”
was eliminated.)
ABOUT THE THEORIST AND THEORETICAL SOURCES
 Birth:1919
 Abdellah’s patient - centred approach to nursing was developed inductively from
her practice and is considered a human needs theory.
 The theory was created to assist with nursing education and is most applicable to
the education of nurses.
 Although it was intended to guide care of those in the hospital, it also has relevance
for nursing care in community settings.
MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS
 She uses the term ‘she’ for nurses, ‘he’ for doctors and patients, and refers to the
object of nursing as ‘patient’ rather than client or consumer.
 She referred to Nursing diagnosis during a time when nurses were taught that
diagnosis was not a nurses’ prerogative.
Assumptions
Assumptions were related to
 change and anticipated changes that affect nursing;
 the need to appreciate the interconnectedness of social enterprises and social
problems;
 the impact of problems such as poverty, racism, pollution, education, and so forth
on health care delivery;
 changing nursing education
 continuing education for professional nurses
 development of nursing leaders from under reserved groups
Abdellah and colleagues developed a list of 21 nursing problems.They also identified 10
steps to identify the client’s problems. 11 nursing skills to be used in developing a
treatment typology
10 STEPS TO IDENTIFY CLIENTS' PROBLEMS
 Learn to know the patient
 Sort out relevant and significant data
 Make generalizations about available data in relation to similar nursing problems
presented by other patients
 Identify the therapeutic plan
 Test generalizations with the patient and make additional generalizations
 Validate the patient’s conclusions about his nursing problems
 Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting his behavior
 Explore the patient’s and family’s reaction to the therapeutic plan and involve them
in the plan
 Identify how the nurses feels about the patient’s nursing problems
 Discuss and develop a comprehensive nursing care plan
11 NURSING SKILLS
 Observation of health status
 Skills of communication
 Application of knowledge
 Teaching of patients and families
 Planning and organization of work
 Use of resource materials
 Use of personnel resources
 Problem-solving
 Direction of work of others
 Therapeutic use of the self
 Nursing procedure
21 NURSING PROBLEMS
Three major categories
 Physical, sociological, and emotional needs of clients
 Types of interpersonal relationships between the nurse and patient
 Common elements of client care
BASIC TO ALL PATIENTS
 To maintain good hygiene and physical comfort
 To promote optimal activity: exercise, rest and sleep
 To promote safety through the prevention of accidents, injury, or other trauma and
through the prevention of the spread of infection
 To maintain good body mechanics and prevent and correct deformity
SUSTENAL CARE NEEDS
 To facilitate the maintenance of a supply of oxygen to all body cells
 To facilitate the maintenance of nutrition of all body cells
 To facilitate the maintenance of elimination
 To facilitate the maintenance of fluid and electrolyte balance
 To recognize the physiological responses of the body to disease conditions
 To facilitate the maintenance of regulatory mechanisms and functions
 To facilitate the maintenance of sensory function.
REMEDIAL CARE NEEDS
 To identify and accept positive and negative expressions, feelings, and reactions
 To identify and accept the interrelatedness of emotions and organic illness
 To facilitate the maintenance of effective verbal and non verbal communication
 To promote the development of productive interpersonal relationships
 To facilitate progress toward achievement of personal spiritual goals
 To create and / or maintain a therapeutic environment
 To facilitate awareness of self as an individual with varying physical , emotional,
and developmental needs
RESTORATIVE CARE NEEDS
 To accept the optimum possible goals in the light of limitations, physical and
emotional
  To use community resources as an aid in resolving problems arising from illness
 To understand the role of social problems as influencing factors in the case of
illness
ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS
NURSING
 Nursing is a helping profession.
 Nursing care is doing something to or for the person or providing information to the
person with the goals of meeting needs, increasing or restoring self-help ability, or
alleviating impairment.
 Nursing is broadly grouped into the 21 problem areas to guide care and promote
use of nursing judgment.
 Nursing to be comprehensive service.
PERSON
 Abdellah describes people as having physical, emotional, and sociological needs.
 Patient is described as the only justification for the existence of nursing.
 Individuals (and families) are the recipients of nursing
 Health, or achieving of it, is the purpose of nursing services.
HEALTH
 In Patient–Centered Approaches to Nursing, Abdellah describes health as a state
mutually exclusive of illness.
 Although Abdellah does not give a definition of health, she speaks to “total health
needs” and “a healthy state of mind and body” in her description of nursing as a
comprehensive service.
SOCIETY AND ENVIRONMENT
 Society is included in “planning for optimum health on local, state, national, and
international levels”. However, as she further delineated her ideas, the focus of
nursing service is clearly the individual.
 The environment is the home or community from which patient comes.
CHARACTERISTICS OF THE THEORY
 Abdellah’s theory has interrelated the concepts of health, nursing problems, and
problem solving.
 Problem solving is an activity that is inherently logical in nature.
 Framework focus on nursing practice and individuals.
 The results of testing such hypothesis would contribute to the general body of
nursing knowledge
 Easy to apply in practice.
USE OF 21 PROBLEMS IN THE NURSING PROCESS
ASSESSMENT PHASE
 Nursing problems provide guidelines for the collection of data.
 A principle underlying the problem solving approach is that for each identified
problem, pertinent data are collected.
 The overt or covert nature of the problems necessitates a direct or indirect
approach, respectively.
NURSING DIAGNOSIS
 The results of data collection would determine the client’s specific overt or covert
problems.
 These specific problems would be grouped under one or more of the broader
nursing problems.
 This step is consistent with that involved in nursing diagnosis
PLANNING PHASE
 The statements of nursing problems most closely resemble goal statements. Once
the problem has been diagnosed, the nursing goals have been established.
IMPLEMENTATION
 Using the goals as the framework, a plan is developed and appropriate nursing
interventions are determined.
EVALUATION
 The most appropriate evaluation would be the nurse progress or lack of progress
toward the achievement of the stated goals..
CONCLUSION
  Using Abdellah’s concepts of health, nursing problems, and problem solving, the
theoretical statement of nursing that can be derived is the use of the problem
solving approach with key nursing problems related to health needs of people. From
this framework, 21 nursing problems were developed.
 Abdellah’s theory provides a basis for determining and organizing nursing care. The
problems also provide a basis for organizing appropriate nursing strategies.

Virginia Henderson's Need Theory

 “The Nightingale of Modern Nursing”

 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."
 Born in Kansas City, Missouri, in 1897.
 Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital,
Washington, D.C. in 1921.
 Worked at the Henry Street Visiting Nurse Service for 2 years after graduation.
 In 1923, started teaching nursing at the Norfolk Protestant Hospital in Virginia
 In 1929, entered Teachers College at Columbia University for Bachelor’s Degree in
1932, Master’s Degree in 1934.
 Joined Columbia as a member of the faculty, remained until 1948.
 Since 1953, a research associate at Yale University School of Nursing.
 Recipient of numerous recognitions.
 Honorary doctoral degrees from the Catholic University of America, Pace University,
University of Rochester, University of Western Ontario, Yale University
 In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section
of the Medical Library Association.
 Died: March 19, 1996.
 In 1939, she revised: Harmer’s classic textbook of nursing for its 4th edition, and
later wrote the 5th; edition, incorporating her personal definition of nursing
(Henderson,1991)
Theory Background
 She called her definition of nursing her “concept” (Henderson1991)
 She emphasized the importance of increasing the patient’s independence so that
progress after hospitalization would not be delayed (Henderson,1991)
 "assisting individuals to gain independence in relation to the performance of
activities contributing to health or its recovery" (Henderson, 1966).
 She categorized nursing activities into 14 components, based on human needs.
 She described the nurse's role as substitutive (doing for the person),
supplementary (helping the person), complementary (working with the person),
with the goal of helping the person become as independent as possible.
 Her definition of nursing was:
"The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful death)
that he would perform unaided if he had the necessary strength, will or knowledge. And to
do this in such a way as to help him gain independence as rapidly as possible"
(Henderson, 1966).
The 14 components
 Breathe normally. Eat and drink adequately.
 Eliminate body wastes.
 Move and maintain desirable postures.
 Sleep and rest.
 Select suitable clothes-dress and undress.
 Maintain body temperature within normal range by adjusting clothing and modifying
environment
 Keep the body clean and well groomed and protect the integument
 Avoid dangers in the environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fears, or opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of accomplishment.
  Play or participate in various forms of recreation.
 Learn, discover, or satisfy the curiosity that leads to normal development and
health and use the available health facilities.
The first 9 components are physiological. The tenth and fourteenth are psychological
aspects of communicating and learning The eleventh component is spiritual and moral The
twelfth and thirteenth components are sociologically oriented to occupation and recreation
Assumption
The major assumptions of the theory are:
 "Nurses care for patients until patient can care for themselves once again. Patients
desire to return to health, but this assumption is not explicitly stated.
 Nurses are willing to serve and that “nurses will devote themselves to the patient
day and night” A final assumption is that nurses should be educated at the
university level in both arts and sciences.
Henderson’s theory and the four major concepts
1. Individual
 Have basic needs that are component of health.
 Requiring assistance to achieve health and independence or a peaceful death.
 Mind and body are inseparable and interrelated.
 Considers the biological, psychological, sociological, and spiritual components.
 The theory presents the patient as a sum of parts with biopsychosocial needs.
2. Environment
 Settings in which an individual learns unique pattern for living.
 All external conditions and influences that affect life and development.
 Individuals in relation to families
 Minimally discusses the impact of the community on the individual and family.
 Basic nursing care involves providing conditions under which the patient can
perform the 14 activities unaided
3. Health
 Definition based on individual’s ability to function independently as outlined in the
14 components.
 Nurses need to stress promotion of health and prevention and cure of disease.
 Good health is a challenge -affected by age, cultural background, physical, and
intellectual capacities, and emotional balance Is the individual’s ability to meet
these needs independently.
4. Nursing
 Temporarily assisting an individual who lacks the necessary strength, will and
knowledge to satisfy 1 or more of 14 basic needs.
 Assists and supports the individual in life activities and the attainment of
independence.
 Nurse serves to make patient “complete” “whole", or "independent."
 The nurse is expected to carry out physician’s therapeutic plan Individualized care
is the result of the nurse’s creativity in planning for care.
 “Nurse should have knowledge to practice individualized and human care and
should be a scientific problem solver.”
 In the Nature of Nursing Nurse role is,” to get inside the patient’s skin and
supplement his strength will or knowledge according to his needs.”
Henderson’s and Nursing Process
”Summarization of the stages of the nursing process as applied to Henderson’s
definition of nursing and to the 14 components of basic nursing care.
Nursing Process Henderson’s 14 components and definition of nursing
Nursing Henderson’s 14 components
Assessment
Nursing Diagnosis Analysis: Compare data to knowledge base of health and disease.
Nursing plan Identify individual’s ability to meet own needs with or without
assistance, taking into consideration strength, will or knowledge.
Nursing Document how the nurse can assist the individual, sick or well.
implementation
Nursing Assist the sick or well individual in to performance of activities in
implementation meeting human needs to maintain health, recover from illness, or
to aid in peaceful death.
Nursing process Implementation based on the physiological principles, age, cultural
background, emotional balance, and physical and intellectual
capacities.
Carry out treatment prescribed by the physician.
Nursing Henderson’s 14 components and definition of nursing
evaluation Use the acceptable definition of ;nursing and appropriate laws
related to the practice of nursing.
The quality of care is drastically affected by the preparation and
native ability of the nursing personnel rather that the amount of
hours of care.
Successful outcomes of nursing care are based on the speed with
which or degree to which the patient performs independently the
activities of daily living
Comparison with Maslow's Hierarchy of Need
Maslow's Henderson
Breathe normally
Eat and drink adequately Eliminate by all avenues of elimination Move
Physiological
and maintain desirable posture Sleep and rest Select suitable clothing
needs
Maintain body temperature Keep body clean and well groomed and
protect the integument

Safety Needs Avoid environmental dangers and avoid injuring other

Belongingness Communicate with others

and love needs worship according to one's faith

Work at something providing a sense of accomplishment

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

Characteristic of Henderson’s theory

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

Activities

1. Who is your closest friend? What qualities does she/he have that makes your
friendship strong? Do you also have these qualities? What are the qualities that you
have in common?
2. How could you use the interpersonal theory in further deepening your friendship
with others?

Post Test

Identification

1. Theorist who formulated interpersonal relationship.

2. Theorist who formulated human to human relationship.
3. Theorist who formulated the needs theory.
4. Author of CORE, CARE, and CURE.
5. Author of 21 Nursing Problems.

Answer
References:

1. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd
ed. Norwalk, Appleton & Lange.
2. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Lippincott Williams& wilkins.
3. Travelbee, J. (1963). Humor survives the test of time. Nursing Outlook, 11(2), 128.
4. Hall, L. E. (1966). Another view of nursing care and quality. In K. M. Straub & K. S.
Parker (Eds.), Continuity in patient care: The role of nursing. Washington, DC:
Catholic University Press
5. https://nurseslabs.com/lydia-e-halls-care-cure-core-theory/
6. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N