BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

light, as she believed that a

Florence Nightingale healthy environment was
fundamental for healing


DEFINED NURSING AS “the act of
utilizing the environment of the
• Often people who went into
patient to assist him in his
hospital died
recovery”, that involves the
• They were Dirty
nurse's initiative to configure
• Badly run
environmental settings
• Nurses didn’t know what to do
appropriate for the gradual
restoration of the patient's health,
and that external factors o Broke out when Florence was
associated with the patient's 34 years old
surroundings affect life or biologic o War Russia vs Turkey (Britain and
and physiologic processes, and his France)
development. o Reports were coming through
about terrible conditions in
KNOWN AS “THE LADY WITH THE hospitals
LAMP” o Florence left London with 38
 Born in May 12, 1820 in nurses
Florence, Italy
 Nursing Education: SCUTARI BARRACK
trained in Kaiserwerth, HOSPITAL
Germany at a Protestant 2. Mortality rate at the hospital was
religious community with 42.7% of those treated
a hospital and after 3 3. Mortality rate dropped to 2.2%
months she was declared 4. She got to work
trained as a nurse (1851).  Scrubbed the floors
 One day she visited a  Cleaned the wards
hospital and that CHANGED  Washed the bedclothes
HER LIFE. Made the men comfortable
 She also rejected proposals  In the night she carried a
from Harry Nicholson, lamp, so she was called “The
Richard Monckton Milnes, Lady with the Lamp”
and Harry Verney to focus  Soldiers kissed her shadow
on her nursing career.  They began to get better
Sitting up, cheerful and
happier.
 Letter from Queen Victoria
Florence Nightingale's
Thanking “Miss Nightingale and
environmental theory is based on
her ladies” for all their hard work
five points, which she believed to
be essential to obtain a healthy
home, such as clean water and air,
basic sanitation, cleanliness and  a book first published by
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

Florence Nightingale in universal natural laws

1859. that govern the ways
o On the purpose of in which the world
nursing.” …the proper works.
use of fresh air, light, 3. Mankind can achieve
warmth, cleanliness, perfection
quiet, and the proper o Mankind can achieve
selection and perfection relates to
administration of her strongly held
diet- all at the least beliefs in self-
expense of vital determination, in self-
power to the realization, and that
ultimately, mankind
patient”
does seek self-
o On the
empowering perfection, which
partnership with means perfect health.
clients in the The route to perfection
community.” “We is through strict
must not talk to adherence to the
them or at them natural laws.
but with them” o The role of the nurse
 was to alter the
environment in such a
way as to obey the
 Prolific writer. natural laws, and thus
 Her ideas, values, and provide the
beliefs on a wide range environment in which
of topics can be perfection might be
identified in her achieved.
documents. 4. Nursing is a calling
 In 1859, she was the first to o She defined a calling
conceptualize nursing work as doing work in such a
into a theoretical framework. way as to do what is
right and best.
o Nursing work is to be
1. Law – “thoughts of God” done with enthusiasm
o This is reflective of and is so important it
Nightingale’s profound should be thought of
belief in God. She AS A RELIGIOUS
defined a law as “the VOW.
thought of God” and 5. Nursing is an art and a
discussed the science
predictability of o By identifying nursing
nature. as having components
2. Natural laws of art and science, she
o Natural Laws are provides the
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

profession with the o She focused on the physical

expectation that aspects of the environment.
nursing will be o She believed that "Healthy
practiced by educated surroundings were necessary
individuals using for proper nursing care."
current research and o She stated that “Nursing is
methods as well as an act of utilizing the
compassion and environment of the patient
common logic. to assist him in his
6. Nursing is achieved through recovery”
environmental alteration
o Environmental alteration-
see canons (which are
laws or rules). 1. Pure fresh air - "to keep the air
he breathes as pure as the
7. Nursing requires a specific external air without chilling
educational base him. “
o Nursing cannot be 2. Pure water - "well water of a
taught by books alone. very impure kind is used for
Nurses need a domestic purposes. And
combination of clinical when epidemic disease
and theoretical training. shows itself, persons using
such water are almost sure to
8. Nursing is distinct and separate
suffer. “
from medicine
3. Effective drainage - "all the
o Although the physician
while the sewer maybe
and nurse my deal with
nothing but a laboratory from
the same population,
which epidemic disease and ill
nursing is not to be
health is being installed into
viewed as subservient
the house."
to medicine, as the
4. Cleanliness - "the greater part of
purposes of the two are
nursing consists in preserving
distinctly different.
cleanliness. “
o Nursing’s focus is on caring
5. Light (especially direct
through environmental
sunlight) - "the usefulness of
alteration, whereas
light in treating disease is very
medicine’s focus is cure of
important. “
the disease.
o Nursing and medicine are
o Any deficiency in one or
most effective when working
more of these factors could
in a collaborative manner.
lead to impaired functioning
o ENVIRONMENTAL THEORY:
of life processes or
Major Concepts and Definitions
diminished health status.
o Environment - concepts of
o The factors posed great
ventilation, warmth, light, diet,
significance during
cleanliness and noise.
Nightingale's time, when
 BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

health institutions had poor patient's health or disease

sanitation, and health condition is still applied today, in
workers had little education such cases as patients infected
and training and were with Clostridium tetani
frequently incompetent and (suffering from tetanus), who
unreliable in attending to need minimal noise to calm them
the needs of the patients and a quiet environment to
prevent seizure-causing
 Pure Water? stimulus.
 Pure fresh air?
 Effective drainage o Proper ventilation focuses on
 Light? the architectural aspect of the
 Control of noise? hospital.
o Light has quite as real and
tangible effects to the body.
Her nursing intervention
1. Ventilation includes direct exposure to
2. Light sunlight.
3. Warmth o Cleanliness and sanitation.
4. Control noise She assumes that dirty
5. Control odor environment was the source
of infection and rejected the
"germ theory". Her nursing
o Also emphasized in her
interventions focus on proper
environmental theory is the
handling and disposal of
provision of a quiet or noise-free
bodily secretions and
and warm environment,
sewage, frequent bathing
attending to patient's dietary
for patients and nurses,
needs by assessment,
clean clothing and
documentation of time of food
handwashing.
intake, and evaluating its effects
o Warmth, diet and quiet
on the patient.
environment. She
o Nightingale's theory was shown introduced the manipulation
to be applicable during the of the environment for
Crimean War when she, along patient's adaptation such as
with other nurses she had fire, opening the windows
trained, took care of injured and repositioning the room
soldiers by attending to their seasonally, etc.
immediate needs, when o Unnecessary noise is not
communicable diseases and healthy for recuperating
rapid spread of infections were patients.
rampant in this early period in o Dietary intake.
the development of disease- o Petty management
capable medicines. proposed the avoidance of
o The practice of environment psychological harm, no
configuration according to upsetting news. Strictly war
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

issues and concerns should should perform the task

not be discussed inside the for the patient and
hospital. She includes the control the
use of small pets of environment for easy
psychological therapy. recovery. She
practices nurse-
patient passive
relationship.
o Nursing o Health
 Nursing is different from  Health is “not only to
medicine and the goal be well, but to be
of nursing is to place able to use well every
the patient in the bes power we have”.
possible condition for  A healthy body can
nature to act. recuperate and
 Nursing is the "activities undergo
that promote health (as reparative process.
outlined in canons) Environmental control
which occur in any uplifts maintenance of
caregiving situation. health.
They can be done by  Disease is considered as
anyone." dysease or the absence
 Major component of of comfort.
nursing: manipulation of  Six D’s of Dys-ease:
physical environment - Dirt
 Nursing “ought to signify - Drink
the proper use of fresh air, - Diet
light, warmth, cleanliness, - Damp
quiet, and the proper - Draughts
selection and - Drains
administration of diet –  balance between human
all at the least expense and his/her environment
of vital power to the  being well and using every
patient.” power (resource) to the
o Person fullest extent in living life
 People are  disease and illness –
multidimensional, reparative process that
composed of nature instituted when a
biological, person did not attend to
psychological, social health concerns
and spiritual  health maintenance
components. through prevention of
 The patient is the focus disease via
of the environmental environmental control
theory. The nurse and social responsibility
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

 Environment lean against, sit upon, or

o Poor or difficult unnecessarily shake the
environments led to bed of a patient
poor health and
 clean, neat, and dry
disease.
 positioning the patient for
o Environment could
maximum comfort
be altered to
Variety
improve conditions
 need for changing color
so that the natural
and form
laws would allow
 reading, needlework,
healing to occur.
writing and cleaning as
o F. N. synthesized
activities to relieve boredom
immediate
Cleanliness
knowledge of
 personal (patient, nurse)
disease with the
 physical environment
existing sanitary
o dirty environment as
conditions in the
source of infection
environment.
nutrition
 dietary intake
 variety of food
Health of houses  no distraction while eating
 presence of pure air  right food brought at the
 pure water right time
 efficient drainage chattering hopes and advices
Light  False hope can be
 light depressing.
 direct sunlight  Heed what is being said;
 purifying effect of direct sick persons should hear
sunlight upon room air good news.
Ventilation and warming Logical Form
 breathe air that is as pure as o She used inductive
external air; without chilling reasoning from her
 source of the air in the experiences and
patient’s room observation which is
 proper room temperature addressed with
 patient’s body temperature logical thinking and
Noise philosophy.
 can harm the patient Importance of Environmental
Bed and bedding Theory
 Bed should be placed in  Practice
the lightest part of the o Disease control
room and placed so the o Sanitation and water
patient could see out a treatment
window. o Utilized modern
 Care giver should never architecture in the
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

prevention of "sick education.

building syndrome"
applying the principles Patricia Benner
of ventilation and good
lighting. 
o Waste disposal
o Control of room   Patricia Benner was born
temperature. in Hampton, Virginia, and
o Noise management. spent her childhood in
 Education California.
o Principles of nursing   She obtained a
training. Better practice baccalaureate of arts degree
result from better in nursing from Pasadena
education. College in 1964.
o Skills measurement   She earned her master’s
through licensing by the degree in 1970 with major
use of testing methods, emphasis in medical-
the case studies. surgical nursing, from
 Research University of California, San
o Use of graphical Francisco.
representations like the   Her PhD in stress, coping,
polar diagrams. and health was conferred in
o Notes on nursing. 1982 at the University of
California, Berkeley, and her
 critique dissertation was published
 Simplicity – simple and in 1984.  In 1985, Benner
logical; tends toward was inducted into the
description and American Academy of
explanation rather than Nursing.
prediction   She received the National
 Generality – provides general League for Nursing's Linda
guidelines for all nurses Richards Award for
 Empirical Precision – Little leadership in education in
or no provision is made for 1989.
empirical examination;  She received both the
individual observation National League for
rather than systematic Nursing (NLN) Excellence
research in Leadership Award for
 Derivable Consequences – Nursing Education and the
to extraordinary degree, NIN President's Award for
direct the nurse to action Creativity and Innovation
on behalf of patient and in Nursing Education in
2010.
herself; These directives
 In 1990 she received the
encompass the areas of
Excellence in Nursing
practice, research and
Research and Excellence in
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

Nursing Education Award  The Dreyfus brothers

from the California developed the skill
Organization of Nurse acquisition model by
Executives. studying the performance
of chess masters and
airline pilots.
 Benner acknowledges that  Benner’s model is situational
her thinking in nursing was and describes five levels of
influenced greatly by skill acquisition and
Virginia Henderson. development:
 Articulation research, 1. Novice
defined as: “describing, 2. Advanced
illustrating, and giving beginner
language to taken-for- 3. Competent
granted areas of practical 4. Proficient
wisdom, skilled know-how, 5. Expert
and notions of good  The model posits that
practice." changes in four aspects of
 One of the first philosophical performance occur in
distinctions that Benner movement through the
made was to differentiate levels of skill acquisition:
between practical and 1. Movement from a reliance
theoretical knowledge. on abstract principles and
 Benner emphasizes the rules to the use-of past,
difference between concrete experience.
“knowing how,” a practical 2. Shift from reliance on
knowledge that may elude analytical, rule-based
precise abstract thinking to intuition.
formulations, and “knowing  3. Change in the
that,” which lends itself to learner's perception of
theoretical explanations. the situation from
 Nurses must develop the viewing it as a
knowledge base practice  compilation of equally
(Know-how), and through relevant bits to viewing it as
investigation and an increasingly complex
observation, begin to whole, in which certain parts
record and develop the stand out as more or less
knowhow of clinical relevant.
expertise.  4. Passage from a detached
 Stuart Dreyfus and Hubert observer, standing outside
Dreyfus developed the the situation, to one of a
Dreyfus Model of Skills position of involvement,
Acquisition which Benner fully engaged in the
applied in her work, Novice situation.
to Expert.   Because the model is
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

situation-based and not Advanced Beginner

traitbased, the level of  Advanced beginner stage in
performance is not an the Dreyfus model
individual characteristic of develops when the person
an individual performer, but can demonstrate
a function of a given nurse's marginally acceptable
familiarity with a particular performance, having coped
situation in combination with enough real situations
with her or his educational to note, or to have pointed
background. out by a mentor, the
  The performance level can recurring meaningful
be determined only by components of the
consensual validation of situation.
expert judges and by  The advanced beginner has
assessment of outcomes of enough experience to
the situation. grasp aspects of the
 situation.
  Nurses functioning at this
level are guided by rules
 Novice and are oriented by task
 Stage of skill acquisition in completion.
the Dreyfus model, the  They have difficulty grasping
person has no background the current patient
experience of the situation situation in terms of the
in which he or she is larger perspective.
involved.  Advanced beginners feel
 Context-free rules and highly responsible for
objective attributes must managing patient care, yet
be given to guide still rely on the help of
performance. those who are more
 There is difficulty discerning experienced.
between relevant and  Benner places most newly
irrelevant aspects of a graduated nurses at this
situation. level.
 Generally, this level applies
to students of nursing, but Competent
Benner has suggested that  Through learning from actual
nurses at higher levels of practice situations and by
skill in one area of practice following the actions of
could be classified at the others, the advanced
novice level if placed in an beginner moves to the
area or situation competent level.
completely foreign to  The competent stage of the
them, such as moving from Dreyfus model is typified
general med by conscious and
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

deliberate planning that guide them.  Nurses at

determines which aspects this stage feel exhilarated
of current and future when they perform well
situations are important and feel remorse when
and which can be ignored. they recognize that their
 Consistency, predictability, performance could have
and time management are been more effective or
important in competent more prescient because
performance. they had paid attention to
 A sense of mastery is the wrong things or had
acquired through planning missed relevant subtle sign
and predictability. of symptoms.
 The level of efficiency is Proficient
increased, but “the focus is  At the proficient stage of the
on time management and Dreyfus model, the
the nurse's organization of performer perceives the
the task world rather than situation as a whole (the
on timing in relation to the total
patient's needs.  Picture) rather than in terms
 The competent nurse may of aspects, and the
display hyper responsibility performance is guided by
for the patient, often more maxims.
than is realistic, and may  The proficient level is a
exhibit an ever present and qualitative leap beyond the
critical view of self. competent.
 The competent nurse devises  Now the performer
new rules and reasoning recognizes the most silent
procedures for a plan, aspects and has an
while applying learned intuitive grasp of the
rules for action on the basis situation based on
of relevant facts of that background
situation. understanding.
 The competent stage of  Nurses at this level
learning is pivotal in the demonstrate a new ability
formation of the everyday to see changing relevance
ethical comportment of the in a situation, including
nurse. recognition and
 Coaching at this point implementation of skilled
should encourage responses to the situation
competent level nurses to as it evolves.
follow through on a sense  They no longer rely on preset
that things are not us goals for organization and
usual, because they have demonstrate increased
to learn to decide what is confidence in their
relevant with no rules to knowledge and abilities.
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

 At the proficient stage, there

is much more involvement  Aspects are the recurring
with the patient and family meaningful situational
Expert components recognized
 The fifth stage of the and understood in context
Dreyfus model is achieved because the nurse has
when "the expert previous knowledge.
performer no longer relies
on analytical principle (i.e.,  Attributes are measurable
rule, guideline, maxim) to properties of a situation
connect an understanding that can be explained
of the situation to an without previous
appropriate action". experience in the situation.
 The expert nurse as having
an intuitive grasp of the  Competency is “an
situation and as being able interpretatively defines
to identify the region of the area of skilled performance
problem without losing identified and described by
time considering a range of its intent, functions, and
alternative diagnoses and meanings.”
solutions.
 There is a qualitative change  Domain is an area of
as the expert performer practice having a number
"knows the patient," of competencies with
meaning knowing typical similar intents, functions,
patterns of responses and and meanings.
knowing the patient as a
person.  Exemplar is an example of a
 Key aspects of expert clinical situation that
practice include the conveys one or more
following: intents, meanings,
• Demonstrating a clinical functions, or outcomes
grasp and resource- easily translated to other
based practice clinical situations.
• Possessing embodied
know-how  Experience is not a mere
• Seeing the big picture passage of time, but an
• Seeing the unexpected active process of refining
• For the expert nurse, and changing preconceived
meeting the patient’s theories, notions, and
actual concerns and ideas when confronted with
needs is of utmost actual situations; it implies
importance, even if it there is a dialogue between
means planning and what is found in practice
negotiating for a change and what is expected.
in the plan of care.
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

development of senses,
 Maxim is a cryptic description esthetics, perceptual
of skilled performance that acuities, relational skills,
requires a certain level of knowledge and dispositions
experience to recognize the that take place as student
implications of the nurses form professional
instructions. identity.

 Paradigm cases create new  Situated Coaching occurs in

clinical understanding and particular clinical situations
open new clinical in which the teacher
perspectives and describes his or her
alternatives. understanding of the
situation for students,
 Salience describes a including what is perceived
perceptual stance or as most relevant and
embodied knowledge silent.
whereby aspects of a
situation stand out as more
or less important.
Nursing
 Ethical comportment is good  Nursing is described as a
conduct born out of an caring relationship, an
individualized relationship “enabling condition of
with the patient. connection and concern.”
 It involves engagement in a  “Caring is primary because
particular situation and caring sets up the
entails a sense of possibility of giving help
membership in the relevant and receiving help.”
professional group  “Nursing is viewed as a
caring practice whose
 Hermeneutics means science is guided by the
“interpretive.” moral art and ethics of care
 Refers to describing and and responsibility.”
studying “meaningful  Understand nursing practice
human phenomena in a as the care and study of the
careful and detailed lived experience of health,
manner as free as possible illness, and disease and the
from prior theoretical relationships among these
assumptions, based three elements.
instead on practical Person
understanding.  Person is a self-interpreting
being, that is, the person
 Transformation and does not come into the
formation address the world predefined but gets
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

defined in the course of interpretation and

living a life. A person also understanding of the
has an effortless and non- situation.
reflective understanding of
the self in the world"  Nursing Theorists and their
 Person is embodied. Benner Work 9
and Wrubel conceptualized th Edition (Unit II, Chapter 9)
the following four major
aspects of understanding
that the person must deal Jean Watson
with:
 The role of the
situation
 The role of the • Watson’s work has been called
body a philosophy, blueprint, ethic,
 The role of paradigm, worldview, treatise,
personal concerns conceptual model, and theory
 The role of • Defines theory as “an
temporality imaginative grouping of
Health knowledge, ideas, and experience
 Health is defined as what can that are represented symbolically
be assessed, whereas well- and seek to illuminate a given
being is the human phenomenon”
experience of health or • Watson acknowledges
wholeness. phenomenological, existensial,
 A person may have a disease and spiritual orientation from the
and not experience illness, sciences and humanities as well
because illness is the as philosophical and intellectual
human experience of loss guidance
or dysfunction, whereas
disease is what can be
assessed at the physical  The formation of a
level. humanistic-altruistic system
Situation of values
 Benner uses the term  The instillation of faith-hope
situation rather than  The cultivation of sensitivity
environment, because to one’s self and to others
situation conveys a social  Development of a help-
environment with social trusting, human caring
definition and relation
meaningfulness.  The promotion and
 They use phenomenological acceptance of the expression
terms being situated and of positive and negative
situated meaning, which feelings
are defined by the person’s  Systematic use of a creative
engaged interaction, problem solving caring
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

process  Describes nurse’s role in

 The promotion of developing effective
transpersonal teaching- nurse patient
learning interrelationships and in
 The provision of supportive, promoting wellness
protective, and (or) 3. Cultivation of One’s Own
corrective mental, physical, Spiritual Practices and
societal, and spiritual Transpersonal Self, Going
environment Beyond Ego-Self
 The assistance with  As nurses acknowledge
gratification of human needs their sensitivity and
 The allowance for existential- feelings, they become
phenomenological forces more genuine, authentic,
became “allowance for and sensitive to others
existential-  The nurse also goes
phenomenological spiritual beyond feelings in a
forces” (in 2004 Watson lifelong exploration of
website) personal values and
belief systems with the
1. Cultivating the Practice of goal of increased
Loving-Kindness and mindfulness in caring
Equanimity toward Self and actions
Others as Foundational to 4. Development and Sustaining
Caritas Consciousness a Helping-Trust Caring
 Humanistic and altruistic Relationship
values are learned early in  A trusting relationship
life but can be influenced promotes and accepts the
greatly by nurse educators expression of both
and clinical experience. positive and negative
 Defined as satisfaction feelings
through giving and  It involves congruence,
extension of the sense of empathy, non-possessive
self and an increased warmth, and effective
understanding of the impact communication
of love and caring on self  Congruence: involves
and others being real, honest,
2. Being Authentically Present: genuine, and authentic
Enabling, Sustaining, and  Empathy: Ability to
Honoring the Faith, Hope, experience and thereby
and Deep Belief System and understand the other
the Inner-Subjective World person’s perceptions and
of Self/Other. feelings and to
 Facilitates the promotion communicate those
of holistic nursing care understandings
and positive health within  Non-possessive Warmth:
the patient population demonstrated by a
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

moderate speaking the Other’s Frame of

volume, a relaxed open Reference
posture, and facial  The nurse facilitates this
expressions that are process with teaching
congruent with other learning techniques that
communications are designed to enable
 Effective Communication: patients to provide self-
has cognitive, affective, care, determine personal
and behavior response needs, and provide
components opportunities for their
5. Being Present to, and personal growth
Supportive of, the Expression 8. Creating a Healing
of Positive and Negative Environment at All Levels
Feelings  Concepts relevant to the
 The sharing of feelings is internal environment
a risk-taking experience include the mental and
for both nurse and spiritual well-being and
patient sociocultural beliefs of an
 The nurse must be individual
prepared for either  In addition to
positive or negative epidemiological
feelings variables, other external
 The nurse must variables include
recognize that comfort, privacy, safety,
intellectual and and clean, aesthetic
emotional surroundings
understandings of a 9. Administering Sacred Nursing
situation differ Acts of Caring-Healing by
6. Creative Use of Self and All Tending to Basic Human
Ways of Knowing as Part of Needs
the Caring Process; Engage
in the Artistry of Caritas  Patients must satisfy
Nursing lower-order needs
before attempting to

The process of nursing attain higher-order
requires application of needs
various ways of knowing,  Lower-order biophysical
including “creative, needs: Food,
intuitive, aesthetic, Elimination, and
ethical, personal, and Ventilation
even spiritual”  Lower-order
7. Engage in Genuine Teaching- psychophysical needs:
Learning Experience that Activity, Inactivity, and
Attends to Unity of Being and Sexuality
Subjective Meaning-  We have to be open to
Attempting to Stay Within unknowns we cannot
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

control, even allowing • Watson uses interchangeably the

for what we may terms human being, person
consider a miracle to life, personhood, and self
enter our life and work • She views the person as “a unity
 This process of mind/body/spirit/nature”
acknowledges that the • She says that “personhood is tied
subjective world of the to notions that one’s soul
inner-life experiences of possess a body that is not
self and other is confined by objective time and
ultimately a space”
phenomenon
HEALTH

• Watson’s (1979) definition of

health was derived from WHO as,
NURSING “The positive state of physical,
mental, and social well-being with
 According to Watson, the word the inclusion of three elements:
nurse is both a noun and verb o (1) A high level of overall
 To her, nursing consists of physical, mental, and social
“knowledge, thought, functioning
 values, philosophy, o (2) A general adaptive-
commitment, and action, with maintenance level of daily
 some degree of passion” functioning
 Nurses are interested in  (3) The absence of illness
understanding health, (or the presence of efforts
 illness, and the human that lead to its absence)
experience; promoting • Later, she defined health as
 and restoring health; and “unity and harmony within the
preventing illness mind, body, and soul”; associated
 Watson’s theory calls nurses to with the “degree of congruence
go beyond between the self as perceived and
 procedures, tasks, and the self as experience”
techniques used in practice • Watson (1998) started further,
 settings, coined as the trim of “illness is not necessarily disease;
nursing, in contrast to [instead it is a] subjective turmoil
 the core of nursing or disharmony within a person’s
 Watson described curing as a inner self or soul at some level of
medical term that disharmony within the spheres of
 refers to the elimination of the person”
disease
ENVIRONMENT
PERSONHOOD (HUMAN
BEING) • Watson speaks to the nurse’s
role in the environment as
“attending to supportive,
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

protective, and/or corrective both the nursing school and

mental, physical societal, and the Department of Nursing at
spiritual environments” Providence Hospital, Detroit,
• In later work, she has a much from 1940 to 1949. After
broader view of environment: “the leaving Detroit, she spent
caring science is not only for eight years (1949-1957) in
sustaining humanity, but also for Indiana working at the
sustaining the planet” Division of Hospital and
Institutional Services of the
Indiana State Board of Health.
• Watson’s definition of caring • Her goal was to upgrade the
as opposed to curing is to quality of nursing in general
delineate nursing from hospitals throughout the
medicine and classify the body state. During this time, Orem
of nursing knowledge as a developed her definition of
separate science nursing practice (Orem,
• Another emphasis has been on 1956).
existential, phenomenological,
and spiritual factors  In 1970, Orem left CUA and
• Her works (2005) remind us of began her consulting firm.
the spirit filled dimension of Orem’s first published book
caring work and caring was Nursing: Concepts of
knowledge Practice (Orem, 1971)
 Subsequent editions of
Dorothea Orem Nursing: Concepts of Practice
were published in 1980, 1985,
1991, 1995, and 2001.

 Orem retired in 1984 and

• Dorothea Elizabeth Orem was continued developing the self-
born in Baltimore, Maryland, care deficit nursing theory
in 1914. (SCDNT).
 She began her nursing career  At the age of 92, Dorothea
at Providence Hospital School Orem’s life ended after a
of Nursing in Washington, DC, period of being bedridden.
where she received a diploma She died Friday, June 22,
of nursing in the early 1930s. 2007, at her residence on
• Orem received a bachelor of Skidaway Island, Georgia.
science degree in nursing
education from Catholic
University of America (CUA) in • The primary source for Orem’s
1939, and she received a ideas about nursing was her
master’s of science degree in experiences in nursing.
nursing education from the Through reflection on nursing
same university in 1946. practice situations, she was
• Orem held the directorship of able to identify the proper
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

object, or focus, of nursing. being

• The condition that indicates • Orem identified “five broad
the need for nursing views of human beings that
assistance is the “inability of are necessary for developing
persons to provide an understanding of the
continuously for themselves conceptual constructs of the
the amount and quality of SCDNT and for understanding
required self-care because of the interpersonal and societal
situations of personal health. aspects of nursing systems.”
It is the proper object or focus These are:
that determines the domain o The view of person
and boundaries of nursing, o Agent
both as a field of knowledge o User of symbol
and as a field of practice. o Organism; and
• Originally, three specific o Object
theories were articulated: The  Orem identified two sets of
theory of nursing systems, speculatively practical
the theory of self-care nursing science: nursing
deficits, and the theory of practice sciences and
self-care. An additional foundational nursing
theory, the theory of sciences.
dependent-care has been
 The set of nursing science
articulated. This theory is
includes:
regarded as being parallel
o Wholly compensatory
with the theory of self-care
nursing science
and serves to illustrate the
o Partly compensatory
ongoing development of the
nursing science; and
SCDNT.
o Supportive
• Orem did not specifically
developmental
address the nature of reality;
nursing science
however, the statements and
phrases that she uses reflect  The foundational nursing
a moderate realist position. sciences are:
Four categories of postulated o The science of self-
entities are identified as care
establishing the ontology of o The science of the
SCDNT. These four categories development and
are: exercise of the self-
o Persons in space- care agency in the
time localizations absence or presence
o Attributes or of limitations for
properties of deliberate action; and
these persons o The science of human
o Motion or change; assistance for
and persons with health
o Products brought into
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

associated self- care

deficits. Hildegard Peplau
 Orem stated that “nursing is a
practical endeavor, but it is a  Diploma program in Pottstown,
practical endeavor engaged in PA, 1931
by persons who have  BA in Interpersonal
specialized theoretic nursing Psychology, Bennington
knowledge with developed
College, 1943
capabilities to put this
 MA in Psychiatric Nursing,
knowledge to work in concrete
situations of nursing practice.” Columbia University, 1947
 In addition to developing the  EdD in Curriculum
theory of dependent care, Development, Columbia
there have been other University, 1953
theoretical advances. Hartweg  Professor emeritus from Rutgers
and Pickens used a conceptual University
analysis approach to explicate  Started first post-
the meaning of normalcy. Six
baccalaureate program in
defining attributes of normalcy
nursing
were identified:
o Having adequate  Worked as Executive Director and
resources to provide for President of ANA Worked with
the necessities of life WHO, NIMH and Nurse Corps
o Being able to perform  Mother of psychiatric nursing
activities of daily living (ANA, 2012)
and those activities
consistent with personal
interests  Person
o Accepting and adjusting o Defined as the patient or
to a new normal someone who needs the
o Maintaining one’s help from the nurse.
health through making  IDENTIFICATION
decisions about and o Client begins to identify
implementing care for problems that needs/helps
oneself the patient to recognize
o Engaging in fulfilling his/her
interpersonal  EXPLOITATION
relationships; and o Clients trust to the nurse
o Being safe- not harming begins its full potential
or being harmed by  RESOLUTION
others o Sense of security is found;
Final Phase
BSN 1A – First City Providential College

THEORISTS & THEIR WORKS

THEORETICAL FOUNDATION IN NURSING

on when working with

patients
1. Stranger
2. Resource person
3. Teacher
4. Leader
5. Surrogate
6. Counselor

 Cannot be used with non-

participative patient
o Unconscious
o Catatonic
 Unwilling to participate
o No perceived need
o Defiant

 Interactive care
 Relationships enhance
healing
 Personal fulfillment

 Psychiatric nursing
 Mother of
psychiatric nursing
 Therapeutic
relationship
 All nursing and
practitioners
 Interactive care
 Increased
compliance
 Better outcomes

 Focus on nurse-patient
relationship

 Identify different roles take