Theoretical Background

The proponents had three theories that anchored the foundation of the family case

study. These theories include the works of Salmon White’s Public Health Nursing

expanded in Florence Nightingale’s Environmental Theory and Dorothea Orem’s Self

Care Deficit Theory.

The Environmental Theory of Florence Nightingale viewed the manipulation of the

physical environment as a major component of nursing care. This theory is also based

on the 13 canons namely ventilation and warmth, light, cleanliness of rooms and wall,

health of houses, noise, taking food, petty management and observation of the sick

and these canons are the possible factors that affect the health of a person.

In the case of Family their environment greatly affect the health of every member

of the family. Their trash can be found in any place of the house, wherein the theory

of Florence’s Nightingale manipulated that improving the surroundings cleanliness,

the health of individuals living in the house, and there is continuity of care by putting

on garbage sacks to segregate the family’s trash by encouraging and helping the

family about the importance of having a clean and sanitary environment.

In like manner, the theory of Mark Salmon White (1982) describes a public

health as an organized societal effort to protect, promote and restore the health of

people and public health nursing as focused on achieving and maintaining public

health. With White’s 3 practice priorities (1) prevention of disease and poor health (2)
protection against disease and external agents (3) promotion of health. For the 3

general categories of nursing intervention have also been put forward, they are:

 Education directed toward voluntary change in the attitude and behavior of the

subjects

 Engineering directed at managing risk-related variables

 Enforcement directed at mandatory regulation to achieve better health

The proponents applied White’s theory as a guide in conducting actions

community health nursing which aims to prevent disease and poor health, protect the

family against disease and external agents and promote health for the family.

Orem's theory is comprised of three related parts: theory of self-care; theory of

self-care deficit; and theory of nursing system.

In like manner, the theory of Roper-Logan-Tierney Model is a theory of nursing

care based on activities of daily living, which are often abbreviated ADLs or ALs.

The purpose of the theory is as an assessment used throughout the patient's care. It is

often used to assess how the life of a patient has changed due to illness, injury, or

admission to a hospital rather than as a way of planning for increasing independence

and quality of life.

The theory attempts to define what living means. It categorizes the discoveries

into activities of living through complete assessment, which leads to interventions that

support independence in areas that may be difficult for the patient to address alone.
The goal of the assessment and interventions is to promote maximum independence

for the patient.

The activities of living listed in the Roper-Logan-Tierney Model of Nursing are:

 maintaining a safe environment

 communication

 breathing

 eating and drinking

 elimination

 washing and dressing

 controlling temperature

 mobilization

 working and playing

 sleeping

The theory of self-care includes self-care, which is the practice of activities that

an individual initiates and performs on his or her own behalf to maintain life, health,

and well-being; self-care agency, which is a human ability that is "the ability for

engaging in self-care," conditioned by age, developmental state, life experience,

socio-cultural orientation, health, and available resources; therapeutic self-care

demand, which is the total self-care actions to be performed over a specific duration
to meet self-care requisites by using valid methods and related sets of operations and

actions; and self-care requisites, which include the categories of universal,

developmental, and health deviation self-care requisites.

According to the model, there are five factors that influence the activities of living.
The incorporation of these factors into the theory of nursing makes it a holistic model.
If they aren't considered, the resulting assessment is incomplete and flawed. The
factors are used to determine the individual patient's relative independence in regards
to the activities of daily living.

They are: biological, psychological, sociocultural, environmental, and politico

economic. The biological factor addresses the impact of the overall health, of current
injury and illness, and the scope of the patient's anatomy and physiology. The
psychological factor addresses the impact of emotion, cognition, spiritual beliefs, and
the ability to understand. According to Roper, this is about "knowing, thinking,
hoping, feeling and believing."

The sociocultural factor is the impact of society and culture as experienced by the
individual patient. This includes expectations and values based on class and status,
and culture within the sociocultural factor relates to the beliefs, expectations, and
values held by the individual patient for him or herself, as well as by others pertaining
to independence in and ability to carry out the activities of daily living.

The environmental factor in Roper's theory of nursing makes it a "green" model.

The theory takes into consideration the impact of the environment on the activities of
daily living, but also examines the impact of the activities of daily living on the
environment. The politicoeconomic factor is the impact of the government, politics,
and economy on the activities of daily living. This factor addresses issues such as
funding, government policies and programs, war or conflict, availability to benefits,
political reforms, interest rates, and availability of public and private funding, among
others.

Her assertion leads to the conclusion that rather than deleting or disregarding
activities of daily living, it can benefit the individual being assessed if the nurse uses
the model more thoroughly and assesses the patient using the five factors in
conjunction with the activities of daily living, regardless of the area in which the care
is being received. Roper stated, "The patient is the patient, they are not a different
patient because they are in a different clinical area. Their needs are the same- it's who
will meet those needs that changes."

Orem's theory is comprised of three related parts: theory of self-care; theory of

self-care deficit; and theory of nursing system.

The theory of self-care includes self-care, which is the practice of activities that
an individual initiates and performs on his or her own behalf to maintain life, health,
and well-being; self-care agency, which is a human ability that is "the ability for
engaging in self-care," conditioned by age, developmental state, life experience,
socio-cultural orientation, health, and available resources; therapeutic self-care
demand, which is the total self-care actions to be performed over a specific duration
to meet self-care requisites by using valid methods and related sets of operations and
actions; and self-care requisites, which include the categories of universal,
developmental, and health deviation self-care requisites.

Universal self-care requisites are associated with life processes, as well as the
maintenance of the integrity of human structure and functioning. Orem identifies
these requisites, also called activities of daily living, or ADLs, as:

 the maintenance of sufficient intake of air, food, and water

 provision of care associated with the elimination process
 a balance between activities and rest, as well as between solitude and
social interaction
 the prevention of hazards to human life and well-being
  the promotion of human functioning

Developmental self-care requisites are associated with developmental processes.

They are generally derived from a condition or associated with an event.

Health deviation self-care is required in conditions of illness, injury, or disease.

These include:

 Seeking and securing appropriate medical assistance

 Being aware of and attending to the effects and results of pathologic
conditions
 Effectively carrying out medically prescribed measures
 Modifying self-concepts to accept onseself as being in a particular state of
health and in specific forms of health care
 Learning to live with the effects of pathologic conditions.

According to Dorothea Orem Other problems that the proponents found out were

the family’s hygiene and family resources. The family, especially the children has less

knowledge on proper hygiene and children have incomplete immunization. With this,

the proponents applied Dorothea Orem’s Self Care Deficit Theory. This theory

addresses specific events and related conditions that have relevance to health and

well-being. The theory includes practice of activities that individuals initiate and

perform independently on their behalf in maintaining life, health, and well-being. The

theory is associated with life processes and the maintenance of the integrity of human

structure and functioning.

The proponents used Dorothea Orem’s Self Care Deficit Theory because of the

need to improve hygiene and immunization of the family. In connection with this, the

proponents helped to improve the family’s hygiene by educating the family about the
steps in proper handwashing, the steps in brushing teeth and by emphasizing to the

family the importance of daily bath.