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TFN Handouts
Historical and Societal Influences on Nursing.

 Nursing in Ancient Civilization

o The Primitive Man
 Believed in the spirit world
 Disease or illness was blamed on the spirit world
 Performed pummeling, a form of massage and to expose a person to
strong odors and smoke
o The East (Hindus)
 The early nurses were primarily men
 Nursing was view as a sacred service that only the purist may take part
 Hygiene  Health
 4 Qualifications to be a nurse
1. Knowledge of drug preparation
2. Cleverness of decision
3. Devotion to patients
4. Purity of body and mind
o China
 Yin Yang (Balance of energy)
 Yin  soft, passive, negative
 Yang  hard, active, positive
 Imbalance of energy causes all illness
 Followed guidelines of traditional Chinese medicine
 Defined health as a balance
 Hot soup is a must
 Believed when a child was born, the heat lost due to child leaving
the body needed to be replenished
 Since before 2000 BC performed in order to increase health and cure
illness:
 Dissection
 Acupuncture
 Prescribed herbal remedies
 Bloodletting
o The practice of driving or draining the evil spirits out from
the body.
o Egypt
 Two major branches
 Theurgic magic
o Both white and black magic
 Natural cures
 Better remedies (Ebers of Papyrus)
 Therapies outlined from
o Plants
o Minerals
o Animals
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o Decoration
o Tablets
o Pills
o Injections
o Infusion
 Dying persons were placed on the streets so the passersby could give
advice
 Discovered that the most effective means against the common cold was
mothers breast feeding their young
o Babylonia
 Showed great interest in astrology
 Viewed illness as punishment for displeasing or sinning against the gods
 Hammurabi code – 1900 BC
 Among other things gave instructions to have the hands of a
surgeon amputated in the event of an unsuccessful surgery
o Assyria
 Believed in the good and evil spirit for the human conditions
 Their medieval practices centers in the sacred rites for evil spirits or
punishment for sins
o Persia
 Three types of physicians
 One using only a knife (surgeon)
 Exorcism and incantations
 Using plants
o Palestine
 Resorted to natural cures and rejected magical therapies
 Food inspection
 Tree preservation
 Infectious quarantine
 Fumigation
 Visiting the sick is an act of charity
o Greece
 Devine myth
 Several gods responsible for medical needs
 Xenodochion
 Housed the sick, poor and stranger
 Iotrions
 Surgery and dispensaries
 Abaton
 Temple and housed the sick
 The terminally ill were left on the streets to die
 Hippocrates
 Outlined the role of physicians
 Sets the standards for bathing and bandages
 Viewed nurses as co-workers
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o Rome
 Believed that lost health could only be restored with good will and peace
to the god (Apollo)
 Wounded soldiers were brought into private homes or tents and cared for
by older men or women with an irreproachable reputation (prostitutes)
 Built public health infrastructure
 Sewage
 Cemeteries
 Etc.…
 Slaves played a role in the advancement of knowledge
o Germany
 Highly regarded women
 Possessed great knowledge and skill in medicine and surgery
o Northern Europe
 White magic
 Use medicinal plants with remedial qualities
 Black magic
 Use magic as a healing method

Periods of Nursing

 Historical Evolution of Nursing

I. Period of intuitive nursing  Medieval period (Pre-historic – early
Christian era)
II. Period of apprentice nursing  Middle ages (11th cen – 1836)
III. Period of educated  Nightingale era (19th – 20th cen)
IV. Period of contemporary Nursing (20th cen – current)
o Period of Intuitive Nursing
 Nursing was untaught and instinctive
 Nursing care
 Out of compassion
 Desire to help
 Out of a wish to do well
 Nurse by instinct
 Stages of labor
1. Panting
2. Breaking
3. Drying
4. Nursing
 A function that belonged o women
 Based on experience and observation
 Techniques
 White magic, hypnosis, charms, dances
o Incantation, purgatives, massage, fire, water, herbs
 Trephining – drilling a hole in the skull to drive out spirits
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o The reformation
 Dispersion of religious orders
 Serious deuteriation in nursing care
 Women viewed as subordinates
o The renounce
 A rise in the need to advance nursing profession
 Delayed by poverty

o Period of apprentice nursing

 Care was done by:
 Crusaders
 Prisoners
 Religious orders
 On the job training
 Developed by the religious orders
 Nursing went down the lowest level
 Religious orders
 Knights of St. John o Jerusalem
 The Teutonic Knights
 Knights Templars
 Knights of St. Lazarus
 Wrath of Protestantism (the Dark Period of Nursing)
 Confiscated properties of catholic hospitals and schools
 Women not allowed to get an education
 Nurses fled for their lives creating a nursing shortage
 Nursing became the work of the least desirable women
o Prostitutes
o Alcoholics
o Prisoners
o Period of educated nursing
 The development of nursing was strongly influenced by war
 American civil war
 Crimean war
 Arousal of social consciences
 Increased educational opportunities offered to women
 Florence Nightingale
 Recruited female nurses at the request of Sir Sidney Herbert
 Started the Nightingale Training School
o Served as the model for other training schools
o Period of contemporary nursing
 Licensure of nurses started
 Nursing as a science over nursing as an instinct
 Specialization of hospital diagnosis
 Training of nurses
 Diploma – baccalaureate – advanced degree
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 Scientific and technological development

 Social changes mark this period
 Changes that drive development
1. Health is perceived as a fundamental right
2. Nursing is involved in community health
3. Technological advancement
4. Expanded roles of nurses
5. WHO was established by the UN
6. Aerospace nursing
7. Use of atomic energies for medical diagnosis and treatment
8. Computers were utilized
9. Use of sophisticated equipment for diagnosis and treatment
 Factors that influence contemporary nursing
 Economics
 Change in lifestyle
 Consumer demand
 Changing family structure
 The nursing shortage
 Improvised technologies and treatments
 Communication
 Legislation
 Demography
 Nursing association
 The feminists

 History of Nursing in the Philippines

o Early beliefs and practices and care of the sick
o Early Filipinos subscribed to superstitious beliefs and practices in the relation to
health and sickness
o Cause of disease was either another person or evil spirits
o Persons suffering from diseases without identified causes were bewitched by
mangkukulam
o Difficult childbirths were attributed to nonos
o Evil spirits could be driven away by persons with powers to expel demons
o Belief in special gods of healing
 Priest-physician  albolarios
o Early hospitals during the Spanish regime
 Hospital Real de Manila
 San Juan de Dios Hospital
 San Lazaro Hospital
 Hospital de Aguas Santas
 Hospital de Indios
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o Prominent Persons Involved during the Philippine Revolution

 Josephine Bracken
 Wife of Jose Rizal
 Set up a field hospital on her estate to care for wounded
 Rose Sevilla de Alvaro
 Converted their house as soldiers’ quarters
 Hilaria de Aguinaldo
 Wife of Emilio Aguinaldo
 Organized the Filipino Red Cross
 Melchora Aquino
 Nursed wounded with food and shelter
 Captain Salome
 Revolutionary leader as well as a nurse to her troops
 Agueda Kahabagan
 Revolutionary leader and nurse in time off
 Trinidad Tecson
 Stayed in hospital to care for patients
o Early hospitals and Schools of Nursing
 St. Paul’s hospital of nursing  1900
 Iloilo Mission Hospital training school of nursing  1906
 1909 1st graduated nurses
 April 1946 first board exam
 St. Luke’s Hospital school of nursing  1907
 Mary Johnston hospital school of nursing  1907
 Philippines General hospital school of nursing  1910
 Manila sanitarium and hospital 1930
 The first college of nursing
 UST  1946
 MCU  1947
 UP  1948
 FEU  1955
 UE  1958
 Requirements for admission
 Completion of at least 7th grade
 Sound mental and physical functions
 Good moral character
 Food social and family standing
 Recommendations from three different well known people
o 1909  3 females graduated as qualified surgical nurses
o 1919  1st nurses law enacted to regulate the practice and hold two board exams
o 1920  first board examination
 93 candidates, 68 passed, 93.5% highest score – Anna Dahlgen
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 Theoretical exam at UP
 Practical exam at PGH library
o 1921  PNA established
 Rosario Delgado – 1st President
 Founder – Anastcia Giron-Tupas
o 1953  Republic act 877, nursing practice law approved
o Prominent Nurses in the Philippines
 Cesaria Tan
 first nursing masters
 Sicorro Sirilan
 reformed social service for indigenous patient
 Magdalena Valenzuela
 first industrial nurse
 Annies Sand
 founded the National League of Philippine Government Nurses
 Coronel Elvegia Mendoza
 first female military nurse
 Loreto Tupaz
 Dean of Philippine education – Florence Nightingale of Iloilo
 Socorro Diaz
 first editor of Message
 Conchita
 first editor of the e filipino nurses
 Dr. Julita Sotejo
 Florence Nightengale of the Philippines
 Anastacia Giron Tupaz
 first Filipino with title of nursing superintendent chief nurse at
PGH
 Dr. Diosscorides Salmin
 SDA nurse leader
o AUP CON
 1930  offered 3-year degree
 1930-1942, 1949-1950  operated by Manila Sanitarium and Hospital
 1957  full government recognition to offer BSN
 1963  supplemental program replaced post basic course
 1967  Full transfer of admin of the School of Nursing from MSH to
PUC with 5 and 6 year curriculums
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Learning Theory
 What you need to know
o Nursing is relevant to the present and future.
o Students are not expected to become nurse theorists or experts.
o What do nurses do?
o What makes it unique from other professions?
o What is wholistic nursing care?
o What is it meant by terms as wellness and illness?
o Do certain nursing actions measurably improve client outcomes?
o What differentiates excellent care from marginal nursing care?
o Is a nursing a job, a vocation, a profession or a combination?
o Is the core nursing caring or a technique skill mastery?
o Is nursing meant to be an independent profession or an auxiliary of the medical
profession?
o Should nursing formally encompass the metaphysical or spiritual?
o How should phenomena that cannot be concretely measured through the five
senses be addressed in nursing?
 Importance of Nursing theories
o aims to describe, predict and explain phenomenon of nursing
o provides of nursing practice, help to generated further knowledge and indicated in
which direction nursing should develop in the future
o helps nurses to decide what they know and what they need to know
o helps to distinguish what should form the basis of practice by explicitly describing
nursing

 the benefits of having a defined body of

theory in nursing include:
o better patient care
o enhanced professional status for
nurses
o improved communication between
nurses
o guidance for research and education

o the main exponent of nursing – caring – cannot be measured, it is vital to have the
theory to analyze and explain what nurse do
 Importance of nursing theories
o as medicine tries to make a move forwards adopting a more multidisciplinary
approach to healthcare, nursing continues to strive to establish a unique body of
knowledge
o this can be seen as an attempt by the nursing profession to maintain its
professional boundaries
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 Purposes of theory
o Provide direction and guidance for:
 Structuring professional nursing practice, education and research
 Differentiating the focus of nursing from other professions
o Education
 Provide the general focus for curriculum design
 Guide curricular decision making
o Research
 Offer framework for generating knowledge and new ideas
 Assist in discovering knowledge gaps in the specific field of study
 Offer a systematic approach to identify questions for study, select
carriables, interpret findings and validate nursing interventions.
o Nursing practice
 Assist nurses to describe, explain, and predict everyday experiences
 Serve as a guide assessment, intervention, and evaluation of nursing care
 Provide rationale for collecting reliable and valid data about the health
status of clients, which are essential for effective decision making and
implementation
 Purpose of a theory
o Help establish criteria to measure the quality of nursing care
o Help build a common nursing terminology to use in communicating with other
health professionals. Ideas are developed and words defined.
o Enhance autonomy (independence and self-governance) of nursing through
defanging its own independent functions.
 Characteristics of a theory
o And interrelate concepts in such a way as to create a different way of looking at a
particular phenomenon
o Logical in nature
o Simple yet generalized
o Bases for hypotheses that can be tested for a theory to be expanded
o Contribute to or assist in increasing the general body of knowledge within the
discipline through the research implemented to validate them
o Can be used by their practitioners to guide and improve their practice
o Consistent with other validated theories. Laws and principles but will leave open
unanswered questions that need to be investigated.
 Classification of Nursing theories
o Nursing theory
 Explains
 Describes
 Predicts
 Prescribes
 Nursing Care
A. Based on function
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a. Descriptive
i. Describe phenomena, speculate why phenomena occur, and
describe the consequences of phenomena.
b. Explanatory
i. To examine how properties relate and thus affect the discipline
c. Predictive
i. To calculated relationships between properties and how they
occur
d. Prescriptive
i. Address nursing interventions and predict the consequence of a
specific nursing intervention. Action oriented.
B. Based on the generalizability of their principles
a. Meta-theory
i. Is a theory about a theory. Most are abstract and not easily
tested.
b. Grand theory
i. Are broad in scope and complex and require further
specification though research before they can be fully tested.
1. A theory which attempts an overall explanation of
social life, history or human experience.
C. Based on the principles of the discipline
a. Middle range
i. Theory is more precise and only analyze a particular situation
b. Practice theory
i. Explores one particular situation found in nursing. it identifies
explicit goals and details how these goals will be achieved
D. Based on the philosophical underpinnings of the theories.
a. Needs theories
i. Based around helping individuals to fulfill their physical and
mental needs
1. Nightingale
2. Henderson
3. Abdallah
4. Orem
5. Hall
b. Interaction theories
i. Theories revolve the relationship a nurse forms with patients
1. Peplau
2. King
3. Travelbee
4. Orlando
c. Outcome theories
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i. Portray the nurse as the changing force, who enable individuals

to adapt to cope with ill health. Identified as abstract and
difficult to implement in practice.
1. Johnson
2. Roy
3. Nueman
4. Levine – adaptation theory
ii. Humanistic theories
1. Emphasizes a persons capacity for self-actualization
a. Watson
b. Benner

 Common concepts in nursing theories

o Person
 The person is the recipient of care and includes:
 Physical
 Spiritual
 Psychological
 Socio-cultural
 Individual
 Family
 Community and group components
o Environment
 All internal and external conditions, circumstances, and influence
affecting the person
 All possible conditions affecting the client and the setting in which health
care needs to occur
o Health
 The degree of wellness or well-being that the client experiences
o Nursing
 The attributes, characteristics and action of the nurse providing care on
the behalf of or on conjunction with the client
 Why the theorists created theories?
o 2 primary reasons
 To further nursing as a scholarly profession
 To organize and improve the delivery of nursing care
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 Florence Nightingale
o Environmental Theory
o Meta-Paradigm
 Environment
 Is the physical surroundings about a person that can be altered to
either promotes or alter conditions to allow healing?
 Person
 The individual having physical, intellectual, emotional and
spiritual components and has the ability and the responsibility to
alter current condition.
 Nursing
 An art and science in care for the wholistic needs of a person
through control of the environment
 Health
 A combined result environmental, physical, and psychological
factors
o Environmental concepts
 Florence nightingale’s original theory for nursing practice holistic
 Her concepts included human/individual, society/environment,
health/disease and nursing
 She focused more on physical factors than on psychological needs of
patients because of the nature of nursing practice during her time
 Nightingale believed that the environment could be altered to improve
conditions so that the natural laws would allow healing to occur
 This grew from empirical observation that poor or difficult
 Poor health and diseases
o Concepts
 Health nursing
 Or general nursing are those activities that promote health which
occur in any care giving situation.
 They can be done by anybody
 Nursing proper
 Or sick nursing is reserved for those individuals who are:
o Educated in the art and science of nursing
 Nurses
 Help patients retain their own vitality by meeting their basic needs
through control of the environment
 Factors of mortality in Crimean War
 Filth
 Inadequate nutrition
 Dirty water
 Inappropriate sewage disposal
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 Nursing
 The goal of nursing is to place the patient in the best possible
condition for nature to act
 Health is not only to be well but to be able to use well every power
we have
o Nightingales assumptions
 Nursing is both an empirical science and an art
 Nursing
 Nursing activities were based not only compassion, but on
observation and experience, statistical data, knowledge of
sanitation and nutrition and administrative skills
o The cannons
 Ventilation and warming
 Light/noise
 Cleanliness of rooms and walls
 Health of houses
 Bed and bedding
 Personal cleanliness
 Variety
 Chattering hopes
 Taking food/selecting food
 Pretty management
 Observation
o Nursing concepts
 Activities must include
 Maintenance of health
 Prevention of infection and injury
 Recovery from illness
 Health teaching
 Environmental control
o Person concepts
 Having physical, intellectual, emotional and spiritual components
 Has the ability and the responsibility to alter rather than conform to the
existing condition
 Are innately good or at least capable of progressing toward perfection
through hard work and knowledge of Gods law
 Helping person to become physically heathy was tantamount to bringing
them closer to God.
o Health concepts
 An innate process and combined result environmental, physical, and
psychological factors
 Is experienced as part of the persons path toward spiritual fulfillment
 Being able to use well every power we have to use
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 Could be augmented through education and improvement of unsanitary

conditions
 Disease is more accurately portrayed as disease or the absence of comfort
 A reparative process – the body’s attempt to correct some problems
 An opportunity to gain spiritual perspective
 Her concern for health extended beyond the hospital to setting goals for
high level wellness in the community and for the spiritual achievement of
the nurse
o Environment
 In her model this refers to those physical elements eternal to the patient
that affect the healing process and health
 Nursing’s concern is with the person in the environmental
 The nurse is responsible for altering the environment to improve it for the
benefit of the client
o The theory
 Keep the air as pure as external air without chilling the patient
 Check the patient body temp as well as room temp and ventilation and
foul odors
 Create a plan to keep the room well ventilated and free of odor while
maintaining the patients body temperature.
 Health and house
 Check for fresh air, pure water, drainage, and cleanliness and light.
 Remove garbage, stagnant water and ensure clean water and air
 Light
 Check for adequate light, sunlight is beneficial to the patient
 Create and implement light in the room without placing the patient
in the direct sunlight
 Cleanliness
 Check the room for dust, dampness and dirt
 Keep room free of dust, dirt and dampness
 Noise
 Check for noise level in the room and the surroundings
 Attempt to keep the noise level optimal and minimal
 Bed and bedding
 Check bed and bedding for dampness, wrinkles and soiling
 Hygiene
 Attempt to keep the patient dry and clean at all times
 Frequent assessment of the patient’s skin is essential to maintain
good skin integrity
 Variety
 Attempt to accomplish variety in the room and with the client
 This is done with cards, flowers, and books.
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 Psychosocial
 These needs are addressed by an emphasis on the importance of
variety and their view that recovery is enhanced by the effect of
colorful objects.
 Also engage in stimulating activities
 The patients room needs to be clean and organized
 Chattering hopes and advice
o Avoid talking that gives advice that is without fact
o Respect patient and avoid personal talk
 Taking food
o Check the diet of the patient
o Note the amount of food and fluid ingested at every meal
 Petty management
o This ensures continuity of care
o Document a plan of care and evaluate outcomes to ensure
continuity
 Observation of the sick
o Observe and record anything about the patient
o Continue observation in the patients environment and make
changes in the care plan if needed

 HILDEGARD E. PEPLAU
o Interpersonal relations theory
o Meta-Paradigm
 Person:
 a developing organism that “strives in its own way to reduce
tension generated by needs”
The client = an individual with a felt need
 Environment
 encourages nurses to consider patient’s culture and more when
patient adjusts to hospital routine
 Health
 implies forward movement of personality and other ongoing human
processes in direction of creative, constructive, productive,
personal and community living
 Nursing
 a significant therapeutic interpersonal process – “human
relationship b/n an individual who is sick or in need of health
services; specifically educated to recognize and to response the
need for help”
o Who is she
 Promoted professional standards & regulations through credentialing
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 Her scope of influence includes contributions as a:

 Psychiatric nurse expert
 Educator
 Author
 Nursing leader
 Theorist

o History
 Born in Reading, Pennsylvania, USA (1909)
 Immigrant parents of German descent;
2nd daughter out of six children
 Go beyond gender role
 As a child, watcher of people’s behaviors
 Witnessed devastating flu epidemic of 1918  influenced understanding
of impact of illness and death on families
 1931 – Diploma program in Pottstown Hospital School of Nursing
 1943 – BA in Interpersonal Psychology from Bennington College
 1947 – MA in Psychiatric nursing from Colombia University New York
 1953—EdD (Education doctorate) in curriculum development
 Professor emeritus from Rutgers University
 Started first post-baccalaureate program in nursing
 1952—Published
“Interpersonal Relations in Nursing”
 1968—Interpersonal Techniques
= crux of psychiatric nursing
 Worked as an executive director and president of ANA
 Helped pioneer the Development of the Clinical Specialist in Psychiatric
Nursing
 Worked with W.H.O, NIMH, and Nurse Corps
 Died in 1999
 AWARDS|ESTABLISHMENTS UNDER NAME
 The Hildegard Peplau Award – ANA
o 1990—to honor nurses who made significant contributions
to nursing practices via:
 Scholarly activities
 Clinical practice
 Policy development
o Theory
 Nurse
 Values
 Culture race
 Beliefs
 Past experiences
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 Expectations
 Preconceived ideas
 Patients
 Values
 Culture race
 Beliefs
 Past experiences
 Expectations
 Nurse  Patient
 Nurse patient relationship
o Characteristics of the theory
 Influenced by: Freud, Maslow, and Sullivan – interpersonal relations
theories
 Contemporaneous psychoanalytical model
 Specific to nurse-patient relationship and is a theory for practice of
nursing
o 4 PSYCHOBIOLOGICAL EXPERIENCES
 compel destructive/constructive patient responses:
 Needs
 Frustrations
 Conflicts
 Anxieties
o Identified 4 PHASES OF NURSE-PATIENT RELATIONSHIP
 Orientation
 Identification
 Exploitation
 Resolution
o Described 6 NURSING ROLES
 Stranger
 Resource person
 Teacher
 Leader
 Surrogate
 Counselor
o Assumptions
 Nurse and patient can interact
 Both nurse and patient mature as result of therapeutic interaction
 Communication and interviewing skills remain fundamental nursing tools
 Nurses must clearly understand themselves to promote client growth and
to avoid client’s choices to those that nurses value
o Uses of the theory
 Used in hospitals and medical settings to gain trust b/n patients
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 Defined the roles of a nurse–researcher, teacher, leader, etc…

o Contributions
 Conceptually: borrowed ideas from other scientific fields
 Clinically: nurse and patient involved in relationship  common goal of
meeting patient’s needs
 Empirically: based on assumption that is accessible via senses (e.g. touch,
hearing, and seeing)

 Virginia Henderson
o Needs theory
o Meta-Paradigm

o Henderson
 11/30/1897 – 4/19/1996
 Known as the first lady of nursing
 The nightingale of modern nursing (the Florence Nightingale of the 20th
Century)
 The mother of modern-day nursing
 She stressed a nurse’s duty is to the patient rather than the doctor
 Her efforts provided a basis to the science of nursing including a system to
record observations of the patient and helped make nurses more valuable
to doctors
o The theory
 Assumptions
 Nurses care for patients until they are able to care for themselves
 Patients desire to return to health
 Nurses are willing to serve and that nurses will devote themselves
to the patient’s day and night
 Mind and body are inseparable and interrelated
 Consisted of 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 temperatures within a normal range by adjusting
clothing and 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
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 Worship according to ones faith

 Work in such a way that there is some 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
 Major concepts in the theory
 Individual
 Environmental
 Health
 Nursing
 Strengths
 Is simple, logical and widely acceptable in modern day nursing
 It can be applied to all ages
 Weaknesses
 No conceptual diagram interconnecting the components
 There little direction in proving a peaceful death

 Joyce Travelbee
o Human-to-Human Relationship theory
o Meta-Paradigm
 Environment
 Is not clearly defined
 She defined human conditions and life experiences encountered by
all men as sufferings, hope, pain, and illness.
 Nursing
 Interpersonal process whereby the professional nurse 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
 Person
 defined as human being, both patient and nurse are human being.
 a unique, irreplaceable individual who is in the continuous process
of becoming, evolving and changing.
 Health
 Subjective health is an individually defined state of well being
 Objective Health is the absence of discernible disease, disability,
or defect as measured.
o History
 1925-1973
 Psychiatric nurse, educator and writer
 Born in 1926
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 1946, completed her nursing preparation at Charity Hospital School of

Nursing
 1956, completed her BS degree in Nursing Education from Louisiana
State University
 1959, completed her MS degree in Nursing from Yale University
 1973, Doctoral program in Florida. She was not able to finish it because
later that year she died at the age of 47 (1973).
 1952, Psychiatric Nursing Instructor at DePaul Hospital Affiliate School,
New Orleans
 She taught at Charity Hospital School of Nursing in Louisiana State
University, New York University and University of Mississippi.
 1970, Project Director of Graduate Education at Louisiana State
University School of Nursing until her death.
 1963, started to publish articles and journals in nursing.
 1966 and 1971, publication of her first book Interpersonal Aspects of
Nursing.
 1969, publication of her second book Intervention in Psychiatric Nursing:
Process in the One-in-One Relationship.
o Theory development
 Catholic Charity Institutions
 Ida Jean Orlando, her instructor–The nurse and the patient interrelate with
each other.
 Viktor Frankl, a survivor of Auschwitz and other Nazi concentration
camps-proposed the theory of logotheraphy
o The theory
 Interactional Phases of Human-to-Human Model:
 Original Encounter
o First impression
o Stereotyped or traditional roles
 Emerging Identities
o the time when the relationship begins
o perceiving each other as unique individuals
 Empathy
o Ability to share in the person’s experience
o predict the behavior of the individual (result)
 Sympathy
o when the nurse wants to lessen the cause of patient’s
suffering.
o it goes beyond empathy
o therapeutic use of self
 Rapport
o describes as nursing interventions that lessens the patient’s
suffering.
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o relation as human being to human being

o “A nurse is able to establish rapport because she possesses
the necessary knowledge and skills required to assist ill
persons and because she is able to perceive, respond to and
appreciate the uniqueness of the ill human being.”

 Faye Glenn Abdallah

o 21-Nursing Problems Theory
o Meta-Paradigm
 Environment
 the home or community from which patient comes.
 Person
 has physical, emotional, and sociological needs
 Health
 A state mutually exclusive of illness
 Nursing
 Is a helping profession with the goals of meeting needs, increasing
or restoring self-help ability, or alleviating impairment
o History
 Born in March 13, 1919 in New York City
 She earned her Nursing Diploma from Fitkin Memorial Hospital, now
known as Ann May School of Nursing.
 Graduated from Columbia University where she earned her
 Bachelor’s Degree in nursing 1945
 Master’s degree in Physiology 1947
 Doctorate Degree in Education 1955
 She received twelve honorary university degrees
 She died February 24, 2017
 Dr. Faye Glenn Abdallah was an American pioneer in nursing research.
 She created the 21 Nursing Problems, or twenty-one areas of focus for a
Nurse.
 Her research also helped to change the focus of nursing from a disease-
oriented practice to a patient-centered practice
 Joined the United States Public Health Services in 1949
 She served as Deputy Surgeon General, the first nurse and first woman to
do so
 She is a Veteran of the Korean War and earned 5 distinguished service
medals
 When she retired in 1989, she became the first dean of the Uniformed
Services University of the Health Sciences Graduate School of Nursing in
Bethesda
 2012: Inductee, American Nurses Association Hall of Fame
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 2000: Inductee, National Women's Hall of Fame

 1994: Living Legend, American Academy of Nursing
 1982-1989: First woman and nurse Deputy Surgeon General
 1970-1987: First Nurse to achieve the rank of two-star flag officer
 Allied Signal Achievement Award for pioneering research in aging
 Sigma Theta Tau’s Lifetime Achievement Award
o The Theory

 Abdallah’s 21 Nursing Problems theory interrelates the concepts of health,

nursing problems, and problem-solving.
 She views nursing as an art and a science that mold the attitude,
intellectual competencies, and technical skills of the individual nurse into
the desire and ability to help individuals cope with their health needs,
whether they are ill or well.
 Three major categories:
 Physical, sociological, and emotional needs of clients
 Types of interpersonal relationships between the nurse and patient
 Common elements of client care
 The 21 nursing problems fall into three categories: physical, sociological,
and emotional needs of patients; types of interpersonal relationships
between the patient and nurse; and common elements of patient care. She
used Henderson’s 14 basic human needs and nursing research to establish
the classification of nursing problems.
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 Abdallah’s 21 problems are actually a model describing the "arenas" or

concerns of nursing, rather than a theory describing relationships among
phenomena. In this way, the theory distinguished the practice of nursing,
with a focus on the 21 nursing problems, from the practice of medicine,
with a focus on disease and cure.

 Moreover, the needs of patients are further divided into four categories:
 basic to all patients
 sustenal care needs
 remedial care needs
 restorative care needs
o 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 deformities
o 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
o 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.
o 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.
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 To understand the role of social problems as influencing factors in the case

of illness.
o The 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 uses of the self
 Nursing procedure
o Steps to Identify Patient Problems
 The ten steps are:
 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 or her behavior.
 Explore the patient and his or her family’s reactions to the
therapeutic plan and involve them in the plan.
 Identify how the nurses feel about the patient’s nursing problems.
 Discuss and develop a comprehensive nursing care plan.
o A Comprehensive Service
 Recognizing the nursing problems of the patient
 Deciding the appropriate course of action to take in terms of relevant
nursing principles
 Providing continuous care of the individual’s total needs
 Providing continuous care to relieve pain and discomfort and provide
immediate security for the individual
 Adjusting the total nursing care plan to meet the patient’s individual needs
 Helping the individual to become more self-directing in attaining or
maintaining a healthy state of body and mind
 Instructing nursing personnel and family to help the individual do for
himself that which he can within his limitations
 Helping the individual to adjust to his limitations and emotional problems
 Davis

 Working with allied health professions in planning for optimum health on

local, state, national, and international levels
 Carrying out continuous evaluation and research to improve nursing
techniques and to develop new techniques to meet people’s health needs

o The nursing process in Abdallah’s theory includes:

 assessment
 nursing diagnosis
 planning
 implementation
 evaluation
o 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.
o 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.
o PLANNING PHASE
 The statements of nursing problems most closely resemble goal
statements. Therefore, once the problem has been diagnosed, the goals
have been established.
 Given that these problems are called nursing problems, then it becomes
reasonable to conclude that these goals are basically nursing goals.
o IMPLEMENTATION
 Using the goals as the framework, a plan is developed, and appropriate
nursing interventions are determined.
o EVALUATION
 According to the American Nurses’ Association Standards of Nursing
Practice, the plan is evaluated in terms of the client’s progress or lack of
progress toward the achievement of the stated goals.
 This would be extremely difficult if not impossible to do for Abdallah’s
nursing problem approach since it has been determined that the goals are
nursing goals, not the client goals.
 Thus, the most appropriate evaluation would be the nurse progress or lack
of progress toward the achievement of the stated goals.
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 Dorothea Orem
o Self-care deficit theory
o Meta-paradigm
 Environment
 Has physical, chemical and biological features. It includes the
family, culture and community.
 Person
 Defined as “men, women, and children cared for either singly or as
social units,” and are the “material object” of nurses and other who
provide direct care
 Nursing
 Is an art through which the practitioner of nursing gives specialized
assistance to persons with disabilities which makes more than
ordinary assistance necessary to meet needs for self care. The
nurse also intelligently participates in the medical care the
individual receives from the physician.
 Health
 “being structurally and functionally whole or sound.” Also, health
is a state that encompasses both the health of individuals and of
groups, and human health is the ability to reflect on one’s self, to
symbolize experience, to communicate with others.
o History
 1914-2007
 One of foremost nursing theorists
 Born 1914 in Baltimore
 Earned her diploma at Providence Hospital – Washington, DC
 1939 – BSN Ed., Catholic University of America
 1945 – MSN Ed., Catholic University of America
 Involved in nursing practice, nursing services, and nursing education
 During her professional career, she worked as a staff nurse, private duty
nurse, nurse educator, administrator and nurse consultant
 Received honorary Doctor of Science degree in 1976
 Published first formal articulation of her ideas in Nursing: Concepts of
Practice in 1971, second in 1980, and in 1995
o Theory
 Dorothea Orem’s theory is composed of three related parts which are:
 Self-Care
o Activities that an individual completes or assist with to
maintain life and/or a higher level of well-being.
o Components of Self-Care
 Self-Care
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 Is the performance or practice of activities

that individuals initiate and perform on their
own behalf to maintain life, health and well-
being.
 Self-Care Requisites
 Can be defined as actions directed toward
the provision of self-care. It is presented in
three categories:
o Universal
 Air, water food
 Elimination
 Activity and rest
 Solitude/social interaction
 Safety
 Normalcy
o Developmental self-care requisites
 Supporting human growth
and development
 Preventing or overcoming
conditions that adversely
effect human growth and
development
o Health deviation self-care requisites
 Seeking medical assistance
O – Often for injury/illness
 Carrying out diagnostic,
R – Reminds therapeutic and rehabilitative
measures
E – Everyday  Attending to effects of injury
or illness and of prescribed
M – Maintenance
treatment
 Modifying self-concept
 Integrating condition and
treatment into lifestyle
 Self-Care Agency
 Is the human’s ability or power to engage in
self-care and is affected by basic
conditioning factors.
 Agents within
o Self-care agent
 Person who provides the self-
care
o Dependent care agent
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 Person other than the

individual who provides the
care (such as a parent)

 Therapeutic Self-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?”
 Self-Care Deficit
o Occurs when the demand of self-care is greater than the
individual’s ability to satisfactorily attain it.
 Nursing Systems
o Identifies actions that the nurse and client can take to
reduce or eliminate the identified self-care deficit.

 Imogene King
o Middle-Range goal attainment theory
o Meta-Paradigm
 Environment
 Is the background for human interactions
o Internal - transforms energy to enable person to adjust to
continuous external environmental changes.
o External - involves formal and informal organizations.
 Person
 Refers to human being or person refers to social being who are
rational and sentiment.
 Nursing
 defined as the nurse and client using action, reaction, and
interaction in a health care situation to share information about
their perception of each other and the situation.
 Health
 involves dynamic life experiences of a human being, which implies
continuous adjustment to stressors in the internal and external
environment.
o History
 Born in 1923
 BSN from St. louis university in 1948
 1957 – Master of Nursing in same univ.
 doctorate from teacher’s college (1961)
 King had experience in nursing as an administrator, educator and a
practitioner
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o Theory
 Nurse-Patient Relationship
 Nursing
o is an interpersonal process of action, reaction, interaction
and transaction
 Goals of nurse
o to help individuals to maintain their health so they can
function in their roles.
 System Framework
 Individual/Personal
 Group/Interpersonal
 Society/Social
 Personal System
 Perception
o The concept that influences all behaviors
 Self
o made up of those thoughts and feelings related to one’s
awareness of being a person separate from others.
 Growth and Development
o Changes in behavior.
 Body image
o Perception of his or her body.
 Space
o The physical area called territory that exists in all
directions.
 Time
o Interval between the two events that is experienced.
 Interpersonal System
 Interaction
o mechanisms for establishing human relationships.
 Communication
o verbal and nonverbal communication
 Transaction
o a process of interaction in which human beings
communicate with the environment to achieve goals that
are valued.
 Role
o a set of behaviors expected of a person occupying position
in a social system.
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 Stress
o human being interacts with the environment to maintain
balance for growth, development, and performance,
involving an exchange of energy and information between
the person and the environment for regulation and control
of stressors.
 Three Major Elements
o Consist of a set of expected behaviors of those who occupy
an identified position.
o Is a Set of procedures or rules that define the obligations
and rights associated with a position.
o Is A relationship of two or more persons who are
interacting for a purpose in a particular situation
 Social System
 Organization
o made up of individuals who have prescribed roles and
positions.
 Authority
o authority of an individuals to an organization.
 Power
o the process where one or more persons influence.
 Status
o the position of an individual in a group or a group in
relation to other groups in an organization.
 Decision making
o a changing and orderly process through which choices are
related to goals.
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 Dorothy Johnson
o Behavioral System model
o Meta-paradigm
 Environment
 not directly defined, but it is implied to include all elements of the
surroundings of human systems and include interior stressors.
 emphasize that an individual’s behavior is influenced by all the
events in the environment.
 Person
 defined as a behavioral system that strives to make continual
adjustments to achieve, maintain, or regain balance to the steady-
state which is adaptation.
 having 2 major systems:
o 1) the biological system- role of medicine to focus on it
o 2) behavioral system- nursing’s focus
 Nursing
 seen as an external regulatory force which acts to preserve the
organization and integration of patient’s behavior at an optimal
level in which the behavior constitutes a threat to physical or social
health or in which illness is found.
 primary goal is to cultivate equilibrium within the individual
 Health
 elusive state that is affected by social, psychological, sociological
and physiological factors.
 efficient and effective functioning of the systems and as behavioral
system balance and stability.
o History
 is well known for her “Behavioral System Model” which was first propose
in 1968.
 her model was greatly influenced by Florence Nightingale’s book.
 it advocates the fostering of efficient and effective behavioral functioning
in the patient to prevent illness and stresses the importance of research-
based knowledge about the effect of nursing care on patients.
 Born in Savanah, Georgia in 1919
 Youngest in a family of seven
 Obtained her Bachelor of Science in Nursing degree from Vanderbilt
University Nashville, Tennessee and her master’s in Public Health from
Harvard University in Boston, Massachusetts.
 Most of her education career was in Pediatric Nursing
 Early advocate of nursing as a science as well as an art
 Assumed that nursing had a body of knowledge reflecting both science
and art
 Davis

o Theory
 3 Functional requirements of humans
 to be protected from noxious influences which the person cannot
cope
 to be nurtured through the input of supplies from the environment
 to be stimulated to enhance growth and prevent stagnation
 7 Subsystems
 Attachment or affiliative subsystem
o serves the need for security through social inclusion or
intimacy.
 Dependency subsystem
o behavior’s design to get attention, recognition and physical
assistance.
 Injective subsystem
o fulfills the need to supply the biologic requirements for
food and fluids.
 Eliminative subsystem
o functions to excrete wastes.
 Sexual subsystem
o serves biologic requirements of procreation and
reproduction
 Aggressive subsystem
o functions in self and social protection and preservation
 Achievement subsystem
o functions to master and control the self or the environment
 Assumptions
 There is organization, interaction, interdependency and integration
of the parts and elements of the behavior.
 Tends to achieve a balance among various
 forces operating within and upon it.
 Results in some degree of regularity and constancy in behavior.
 System balance reflects adjustments and
 adaptations.
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PLEASE NOTE THAT TFN 1 AND TFN 5 ARE NOT INCLUDED AT THIS TIME.

 MIDTERM