NURSING THEORIES

1. Florence Nightingale
MOTHER OF MODERN NURSING
By: Ezra Viktoria R. Haduca

2. “Lady with the Lamp”
o
o
Place: Florence, Italy
Birth: May 12, 1820 (International Nurses Day)
o
o
o
o
Her father provided her with reputable education
which was uncommon for a Victorian woman.
According to Sir Thomas Cook, she was a linguist.
She was a wife of an aristocrat.
She was a Unitarian Christian and believed she had a
religious calling.
o Death: August 13, 1910

3. First Nurse Educator
Germany: a place of the first nursing school
Pastor Theodor Fleidner: a protestant pastor who opened a hospital in
Kaiserswerth, Germany with no staff and thus designed a school of nursing.
Nightingale applied with a 12-page handwritten curriculum and became the
134th nursing student to
attend school.
She developed skills in both nursing care and management and used her
gained knowledge as a reformer for the well-being of the citizens.

4. Crimean War
English VS. Turkish
-Hospital barracks were infested with fleas and rats.
-Sewage flowed under the wards
-Mortality rate at the hospital was 42.7% of those treated; higher from disease than
from war injuries
-Six months later, mortalityrate dropped to 2.2% and was achieved by attending to
the environment of the soldiers.
-Heroine in Great Britain
-Awarded with Order of Merit by Great Britain

5. Writings
Notes on Matters Affecting Health Notes on
Hospital
Efficiency and Hospital Administration of the British
Army
Report on MeasuresAdopted for Sanitary Improvements in
India
Notes on Nursing

6. Nightingale’s
Environmental Theory
Theory basis: the inter-relationship of a healthful environment with nursing
External influences and conditions can prevent, suppress, or contribute to
disease or death
Theory goal: Nurses help patients retain their own vitality by meeting their basic
needs through control of the environment
Nursing’s Focus: control of the environment for individuals, families & the
community

7. Nightingale’s
Environmental Theory
The first published nursing theory (1860) Persons are in
connection with the environment Gives emphasis on the
healing properties of the
physical environment (fresh air, light, warmth, and
cleanliness)
Nursing puts patients in the “best conditions” for nature to
act upon them
Health is “the positive of which the pathology is negative”

8. Nightingale’s
Environmental Theory
“Nature alone cures”
When aspects of the environment are out of balance,
the client must use energy to counter these
environmental stresses
Viewed disease as a reparative process
The health of the home/community are critical
components in an individual’s health

9. Environmental Factors
Affecting Health
Ventilation and warmth
-check the patient’s body temperature, room temperature,
ventilation and foul odors
Light
-check room for adequate light (sunlight is beneficial to the
patient)
-create and implement adequate light in the room without
placing the patient in direct sunlight

10. Environmental Factors
Affecting Health
Cleanliness
-check and keep room from dust, dampness and dirt
Health of houses
-check surrounding for fresh air, pure water, drainage,
cleanliness and light
-remove garbage and stagnant water
Noise
-check and attempt to keep noise level in minimum

11. Environmental Factors
Affecting Health
Bed and Bedding
-keep the bed dry, wrinkle-free and lowest height to ensure
comfort
Personal Cleanliness
-keep the patient dry and clean at all times
Variety
-attempt to accomplish variety in the room
Chattering hopes and advices
-respect the patient and avoid personal talk

12. Environmental Factors
Affecting Health
Taking food
-document the plan of care and evaluate the outcome to
ensure continuity of care
Petty Management
-check the diet of the patient
-note the amount of food and liquid ingested by the
patient
in every meal
Observation of the Sick
-observe the patient’s environment and record anything
about the patient

13. Metaparadigm in Nursing
(PERSON)
-Referred to by Nightingale as “the patient”
-Recipient of nursing care
-Ahuman being acted upon bya nurse, or affected
by the environment
-Has reparative powers to deal with disease
-Recovery is in the patient’s power as long as a safe
environment exists

14. Metaparadigm in Nursing
(HEALTH)
-Holistic level of wellness that the person
experiences
-Maintained by using a person’s healing powers to
their fullest extent
-Maintained bycontrolling the environmental
factors so as to prevent disease
-Disease is viewed as a reparative process instituted
by nature
-Health and disease are the focus of the nurse
-Nurses help patients through their healing process

15. Metaparadigm in Nursing
(ENVIRONMENT)
-The foundational component of Nightingale’s
theory
-The external and internal aspects of life that
influence the person
-Includes everything from a person’s food to a
nurse’s verbal and nonverbal interactions with
the patient

16. Metaparadigm in Nursing
(NURSING)
-Nursing is essential for everybody’s well-being
-It is having the responsibility for someone else’s health.
-NotesonNursing:provides women with guidelines for
caring for their loved ones at home and gives advice
on how to “think like a nurse”
*Trained nurses however, applies additional scientific
principles to their work and more skilled in
observing their patients.

17. Acceptance ByThe Nursing
Community
EDUCATION
Nightingale’s principles of Nursing training
provided a universal template for early
nurse training school beginning with St.
Thomas Hospital

18. Acceptance ByThe Nursing
Community
RESEARCH
Nightingale’s interest in scientific inquiry
and statistics continues to define the
scientific inquiry used in nursing research.
Concepts that Nightingale identified served
as the basis of research to test modern
theories

19. Acceptance ByThe Nursing
Community
PRACTICE
The environmental aspects of her theory
(ventilation, warmth, quiet, diet and
cleanliness) remain integral components of
nursing care.

20. CRITIQUE
SIMPLICITY
Three Major Relationships:
A. Environment to Patient
Environment was the main factor creating
illness in a patient
B. Nurse to Environment
Nurses need to manipulate the
environment to enhance the patient’s recovery

21. CRITIQUE
C. Nurse To Patient
Suggests collaboration and cooperation
between the nurse and the patient
 The protection of the patient from emotional
distress
 Conservation of energy while allowing the
patient to participate in self-care

22. CRITIQUE
GENERALITY
Nightingale’s theory has been used to provide
general guidelines for all nurses
The universality and timelessness of her concepts
remain pertinent
The relation concepts (nurse, patient and
environment) are applicable in all nursing settings
today

23. CRITIQUE
EMPIRICALPRECISION
Nightingale’s theory are presented as truths rather
than tentative, testable statements
She advised nurses that their practice should be
based on their observation and experiences rather
than systematic, empirical research

24. CRITIQUE
DERIVABLE CONSEQUENCES
Deeply religious, she viewed nursing as a means of
doing the will of God (Nursing is a divine calling)
Her encouragement for a measure of independence
and precision guides and motivates nurses today as
the profession continues to evolve

25. FIN ~

26. Presented By: MEERA (INTERN)
LHMC, CON
OREM’S GENERAL THEORY OF NURSING
NURSING
THEORIES
Presentation

27. What is
Theory?
“A set of concepts, definitions,
relationships, and assumptions
that project a systematic view of
a phenomena”.

28. Components
of theory
• CONCEPTS :- Ideas and mental images
that help to describe phenomena
• DEFINITIONS :- Convey the general
meaning of the concepts
• ASSUMPTIONS :- Statements that
describes concepts
• PHENOMENON :- Aspects of reality that
can be consciously sensed or
experienced

30. NURSING THEORY
• Nursing theory is developed to describe Nursing.
• Defined as a belief, policy, or procedure proposed or followed as the basis of
action.
• It is an organized framework of concepts and purposes designed to guide the
practice of nursing.
• It serves the purposes of describing, explaining, predicting, and controlling
desired outcomes of nursing care.

31. DOMAINS OF NURSING THEORY
DOMAIN: The view or perspective of the discipline.
Nursing has identified its domain in a paradigm that includes
above linkages
Person
/ client Environment
Health Nursing

33. WHY TO STUDY NURSING THEORY?
Theory guides use of ideas
and techniques
thinking about nursing
Theory can close the gap btw
theory and research
To envision potentialities
It guides nursing practice and
generates knowledge
Theory helps to reframe out
Enables nurses to know WHY
they doing, WHAT they are
doing
Everyday practice enriches
theory
Both practice and theory are
guided by values and beliefs

34. So How do Nurses Use Theory in Everyday Practice
Make decisions
about nursing
interventions
Analyze
patient data
Understand
patient data
Organize
patient data
Evaluate
patient
outcomes
Predict
outcomes of
care
Plan patient
care

35. “The act of assisting others in the
provision and management of self-care to
maintain/ improve human functioning at
home level of effectiveness”
(1914-2007)
 First published in 1959, later modified & published in
1971.

36. BACKGROUND OF THEORIST
• Theorist : Dorothea Orem ( 1914- 2007)
• Born 1914 in Baltimore, US.
• Received her diploma at Providence Hospital-
Washington, DC in 1934
• 1934- BSN Ed. And Master of science in nursing
education (1945) from Catholic University ofAmerica,
Washington D.C.
• Her clinical practice included staff nurse in the operating
room, pediatrics and adult medical surgical units.
• She also did private duty nursing in private home and the
hospital and was an emergency room supervisor
• She taught biological sciences and later served as
Director of nursing services and director of the school of
nursing at Providence Hospital Michigan.
• Received several honorary degrees.

37. •DOMAIN OF OREM’S THEORY
HUMAN/CLIENT
Men, women, and children
cared for either singly or as
social units.
Material object of nurses
HEALTH
Being structurally and
functionally whole or
sound.
It’s the ability to reflect
on one’s self to
symbolize experience,
and to communicate
with others
ENVIRONMENT
Has physical, chemical
and biological features.
It includes the family,
culture and community
NURSING
An art through which nurse
gives specialized
assistance to persons with
disabilities which makes
more than ordinary
assistance necessary to
meet needs for self care.

38. THE THEORY OF SELF CARE
Activities an individual performs
independently throughout life to promote
and maintain personal well being
THE SELF CARE DEFICIT THEORY
Results when self care agency (individual’s ability)
is not adequate to meet the known self care
needs
THE THEORY OF NURSING SYSTEM
Nursing interventions needed when individual is
unable to perform the necessary self care activities.
COMPONENTS OF OREM’S THEORY

39. Self care is the
performance or
practice of activities
of activities that
individuals initiate
and perform on their
own behalf to
maintain life.
THEORY
OF
SELF
CARE
SELF
CARE
SELF
CARE
AGENCY
Self care agency is
the human’s ability or
power to engage in
self care and is
affected by basic
conditioning factors.
THERAPEUTIC
SELF CARE
DEMAND
Therapeutic self
care Demand is the
totality of self care
actions to be
performed for some
duration in order to
meet known self
care requisites by
using valid methods
and related sets of
actions and
operations.

40. Self care deficit
delineates when
nursing is needed.
Nursing is required
when an adult is
incapable of or limited
in the provision of
continuous effective
self care
THEORY
OF
SELF
CARE
SELF
CARE
DEFICIT
NURSING
AGENCY
Nursing agency is a
complex property or
attribute of people
educated and trained
as nurses that enables
them to act, to know,
and to help others
meet their therapeutic
self care demands by
exercising or
developing their own
self care agency.
NURSING
SYSTEM
Nursing system is the
product of a series of
relations between the
persons: legitimate
nurse and legitimate
client. This system is
activated when the
client’s therapeutic self
care demand exceeds
available self care
agency, leading to the
need for nursing.

41. Actions to be performed for human functioning and development.
• The maintenance of a sufficient intake of air, water and food
• The provision of care associated with elimination process
• The maintenance of balance between activity and rest
• Prevention of hazards to human life.
• The maintenance of balance between solitude and social
interaction.

42. • Conditions that promote development
• Maintenance of maturational body changes (Aging).
• Self development - New job, New family.
• Prevention of life situations that can adversely affect human
development. (Loss of spouse, change in Image)

43. • These self care requisites exist for persons who are ill or
injured, who have specific forms of pathological conditions or
disorders, including defects and disabilities.
• Physiological – care demand due to pathological conditions

44. THEORY OF SELF-CARE
DEFICIT
“Occurs when the self care
capabilities within the self-care
agency are not adequate to meet
the projected self-care demand”

46. METHODS OF HELPING
Acting for
and doing
for others
Guiding
others
Providing an environment
promoting personal
development in relation to
meet future demands
Supporting and
teaching others.

47. THEORY OF NURSING SYSTEMS
WHOLLY
COMPENSA
TORY
SYSTEM
PARTLY
COMPENSA
TORY
SYSTEM
SUPPORTIVE
EDUCATIVE SYSTEM
 Describes how thepatient’s self
careneedswill bemet by the
nurse,thepatient orbyboth.
C
L
A
S
S
I
F
I
C
A
T
I
O
N

48.  When the individual is unable to engage in those
self care action required, self directed and
controlled. Ex: Ambulation and manipulative
movement or medical prescription to restrict from
such activity
 Both nurse and patient performs care measures or
other actions involving manipulative task or
ambulation. e.g. Patient who had abdominal
surgery.
 In this patient is able to perform or can and can
learn to perform required measure of externally or
internally oriented therapeutic self care, but cannot
do so without assistance.
 Ex: Self administration of insulin injection.
 One or more of the 3 types of systems may be
used with a single patient.

49. Simple but yet complex.
The use of self care in
multitude of terms
Orem’s definition of
health was confined in
three static conditions
which she refers to a
“concrete nursing
system”, which
connotes rigidity
Throughout her work,
there is limited
acknowledgement of the
individual’s emotional
needs.
LIMITATIONS
OREM’S
THEORY

50. STRENTHS OF OREM’S THEORY
Specifically defines when nursing is
needed. Nursing is needed when
the individual cannot maintain
continuously that amount and
quality of self care necessary to
sustain life and health, recover from
disease or injury, or cope with their
effects.
02
Applicable for nursing by the
beginning practitioners as well as
the advance clinicians
01
Three identifiable nursing
systems were clearly
delineated and are easily
understood
03

51. • REFERENCES :-
https://www.slideshare.net/h
ariomgangwar35/nursing-
theoriesppt-72689208
https://www.slidesha
re.net/MaeAguilar/n
ursing-theories-
24734303
Taylor, et.al., Fundamentals of
nursing – the art and science of
nursing care, 7th ed. Wolters
Kluwer
https://www.slideshar
e.net/roviechjohn26/n
ursing-theory-power-
point
George B. Julia , Nursing
Theories- The base for
professional nursing Practice, 3rd
ed. Norwalk, Appleton & Lange.
Smith C. Marlaine and Parker E. Marilyn,
Nursing theories and Nursing practices, 4th
ed., F.A. Davis company, Philadelphia.

52. Thank You
THANKS FOR LISTENING ME PATIENTLY

54. ⦿ nurse theorist, writer, lecturer,
researcher and teacher
⦿ Professor and Nurse Theorist at the
Boston College of Nursing in Chestnut
Hill
⦿ Born at Los Angeles on October 14,
1939.
⦿ Bachelor of Arts with a major in
nursing - Mount St. Mary's College,
Los Angeles in 1963.
⦿ Master's degree program in pediatric
nursing - University of California, Los
Angeles in 1966.

55. ⦿ Master’s and PhD in Sociology in
1973 and 1977.
⦿ Worked with Dorothy E. Johnson
⦿ Worked as f faculty of Mount St.
Mary's College in 1966.
⦿ Organized course content
according to a view of person
and family as adaptive systems.
⦿ RAM as a basis of curriculum at
Mount St. Mary’s College
⦿ 1970 - The model was
implemented in Mount St.
Mary’s school
⦿ 1971- she was made chair of the
nursing department at the
college.

57. ⦿Roy’s Adaptation Model for Nursing was derived
in 1964 from Harry Helson’s Adaptation
Theory – adaptive responses are a function of
the incoming stimulus and the adaptive level
⦿Roy combines Helson’s work with Rapport’s
definition of system and views the
person as an adaptive system.

58. ⦿ After the development of her theory, Roy developed
the model as a framework for nursing practice,
research, and education.
⦿ According to Roy, more than 1500 faculty and
students have contributed to the theoretical
development of the adaptation model.
⦿ The model uses concepts from AH Maslow to
explore beliefs and values of persons. Roy’s holistic
approach to nursing is based in humanism.

59. ⦿A pilot research study and a survey research
study from 1976 to 1977 led to some tentative
confirmations of the model.
⦿From this beginning, the adaptation model has
been supported through research in practice and
in education.

61. ⦿A set of units so related or connected as to form
a unity or whole and characterized by inputs,
outputs, and control and feedback processes.

62. ⦿A constantly changing point, made up of focal,
contextual and residual stimuli, which represent
the person’s own standard of the range of stimuli
to which one can respond with ordinary adaptive
responses.

63. ⦿The occurrences of situations of inadequate
response to need deficits or excesses.
⦿Seen not as nursing diagnosis, but areas of
concern for the nurse related to adapting person
or group (Within each adaptive mode)

64. ⦿Focal Stimulus – the degree of change or stimulus most
immediately confronting the person and the one to which
the person must make an adaptive response, that is, the
factor that precipitates behavior
⦿Contextual Stimuli – all other stimuli present that
contribute to the behavior caused or precipitated by the focal
stimuli
⦿Residual Stimuli – factors that may be affecting
behavior but whose efforts are not validated

65. ⦿Regulator – subsystem coping mechanism
which responds automatically through neural-
chemical-endocrine processes.
⦿Cognator - subsystem coping mechanism
which responds to complex processes of
perception and information processing,
judgment, and emotion.

66. ⦿Adaptive Responses – responses that
promote integrity of the person in terms of goals
of survival, growth, reproduction, and mastery
⦿Ineffective Responses – responses that do
not contribute to adaptive goals, that is, survival,
growth, reproduction, and mastery

67. 1. Physiological Mode – involve the body’s basic
needs and ways of dealing with adaptation in
regard to fluid and electrolytes; exercise and rest;
elimination; nutrition; circulation and oxygen; and
regulation, which includes the senses, temperature
and endocrine regulation
2. Self-Concept Mode – the composite of beliefs
and feelings that one holds about oneself at a given
time. It is formed from perceptions, particularly of
other’s reactions, and directs one’s behavior.
(physical self and personal self)

68. 3. Role Performance Mode – role function is the
performance of duties based on given positions
in society.
4. Interdependence Mode – involves one’s
relations with significant others and support
systems. In this mode one maintains psychic
integrity by meeting needs for nurturance and
affection.

70. ⦿The person is a bio-psycho-social being.
⦿The person is in constant interaction with a
changing environment.
⦿Tocope with a changing world, person uses both
innate and acquired mechanisms which are
biological, psychological and social in origin.
⦿Health and illness are inevitable dimensions of
the person’s life.

71. ⦿ To respond positively to environmental changes, the person
must adapt.
⦿ The person’s adaptation is a function of the stimulus he is
exposed to and his adaptation level
⦿ The person’s adaptation level is such that it comprises a zone
indicating the range of stimulation that will lead to a positive
response.
⦿ The person has 4 modes of adaptation: physiologic needs,
self-concept, role function, and interdependence.

72. Nursing
• A “theoretical system of
knowledge which prescribes a
process of analysis and action
related to the care of the ill or
potentially ill person.”
• Roy differentiates nursing as a
science from nursing as a
practice discipline.

73. Person
• A “biopsychosocial being in constant
interaction with a changing environment.”
• The recipient of nursing care, is a living, complex,
adaptive system with internal processes (cognate and
regulator) acting to maintain adaptation in the four
adaptive modes (physiological needs, self-concept,
role function, and interdependence.)
• The person as a living system is “a whole made up of
parts of subsystems that function as a unity for
some purpose.”

74. Health
• A “state and a process of
being and becoming an
integrated and whole person.
Lack of integration
represents lack of health.”

75. Environment
• “All the conditions, circumstances, and
influences surrounding and affecting the
development and behavior of persons or
groups. ”
• The input into the person as an adaptive system
involving both internal and external factors (may
be slight or large, positive or negative)
• Any environmental change demands increasing
energy to adapt to the situation. Factors in the
environment that affect the person are
categorized as focal, contextual, and residual
stimuli.

79. Outcome Theory - well articulated
conception of man as a nursing client and of
nursing as an external regulatory mechanism.

80. ⦿ Both deductive and inductive
⦿ Deductive – derived from Helson’s Theory. Helson developed the concepts
of focal, contextual, and residual stimuli, which Roy defined within nursing
to form a typology of factors related to adaptation levels of persons. Roy
also uses other concepts and theories outside the discipline of nursing and
relates these to her adaptation theory.
⦿Inductive – she developed the four adaptive modes from research and
practice experiences of herself, her colleagues, and her students. Roy built
on the conceptual framework of adaptation and as a result, developed a
step-by-step model by which nurses use the nursing process to administer
nursing care to promote adaptation in situations of health and illness.

82. ⦿ Useful for it outlines the features of the discipline and
provides direction for practice
⦿ The model considers goals, values, the client, and
practitioner interventions
⦿ Using Roy’s six-step nursing process, the nurse:
1. Asesses behaviors
2. Asseses stimuli
3. Diagnosis
4. Sets goals to promote adaptation
5. Nursing interventions
6. Evaluation

83. ⦿The model is a valuable tool to analyze overlap
and distinctions between the professions of
nursing and medicine.
⦿Throughout the 1970’s and 1980’s, Roy’s model
has been implemented as a basis for curriculum
development in associate degree diploma,
baccalaureate, and higher degree programs in
many countries.

84. ⦿The model does generate many testable
hypothesis related to practice and theory.

85. Middle range theories have been derived from RAM
› Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes,
P., Kowitski, C., and Ziegler, E. (1998). Women's perception of group
support and adaptation to breast cancer. Journal of Advanced Nursing.
28(6), 1259-1268.
› Yeh, C. H. (2001). Adaptation in children with cancer: research with Roy's
model. Nursing Science Quarterly. 14, 141-148.
› Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing-
impaired older persons: testing Roy's adaptation model. Nursing Science
Quarterly. 13(2), 158-165.

86. ⦿ Clarity - logical; claims to follow a holistic view
but leaves out “spiritual, humanistic, and
existential aspects of being a person”
⦿Simplicity – has several major concepts and
subconcepts and numerous relational
statements; complex

87. ⦿ Generality – generalizable to all settings in nursing
practice, but is limited in scope because it primarily
addresses the concept of person-environment
adaptation and focuses primarily on the client
⦿ Empirical Precision – Testable hypothesis have been
derived from the model
⦿ Derivable Consequences – has a clearly defined
nursing process and can be useful in guiding clinical
practice; capable of generating new information
through hypothesis-testing

88. ⦿ www.currentnursing.com
⦿Tomey, A.M., (1994). Nursing Theorists and Their
Work. 3rd ed. Missouri: Mosby