Nursing Theories and History

Foundations of Nursing

Nursing Theories and History

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Foundations of Nursing Abejo

FOUNDATIONS OF NURSING


Lecturer: Mark Fredderick R. Abejo R.N, M.A.N

NURSING THEORIES and CONCEPTUAL

FRAMEWORK

Florence Nightingale

Developed and described the first theory of nursing

Focused on changing and manipulating environment

in order to put the patient in the best possible

conditions for nature to act.

Identified 5 environmental factors: fresh air, pure

water, efficient drainage, cleanliness/sanitation and

light/direct sunlight.

Client’s environment is manipulated to include

appropriate nose, nutrition, hygiene, light, comfort,

socialization and hope.

Virginia Henderson

Introduced The Nature of Nursing Model

Identified 14 basic needs :

o Breathing normally

o Eating and drinking adequately

o Eliminating body wastes

o Moving and maintaining desirable position

o Sleeping and resting

o Selecting suitable clothes

o Maintaining body temperature within

normal range

o Keeping the body clean and well-groomed

o Avoiding dangers in the environment

o Communicating with others

o Worshipping according to one’s faith

o Working in such a way that one feels a sense

of accomplishment

o Playing/participating in various forms of

recreation

o Learning, discovering or satisfying the

curiosity that leads to normal development

and health and using available health

facilities.

She postulated that the unique function of the nurse is

to assists the clients, sick or well in the performance of

those activities contributing to health or its recovery,

that clients would perform unaided if they had the

necessary strength, will or knowledge.

Believed that nursing involves in assisting the client in

gaining independence as rapidly as possible or

assisting him achieved peaceful death if recovery is no

longer possible.

Faye Abdellah

Patient – Centered

Approaches to Nursing

Model

21 Nursing Problems

To maintain good hygiene.

To promote optimal activity; exercise, rest and sleep.

To promote safety.

To maintain good body mechanics

To facilitate the maintenance of a supply of oxygen

To facilitate maintenance of nutrition

To facilitate maintenance of elimination

To facilitate the maintenance of fluid and electrolyte

balance

To recognize the physiologic response of the body to

disease conditions

To facilitate the maintenance of regulatory

mechanisms and functions

To facilitate the maintenance of sensory functions

To identify and accept positive and negative

expressions, feelings and reactions

To identify and accept the interrelatedness of emotions

and illness.

To facilitate the maintenance of effective verbal and

non-verbal communication

To promote the development of productive

interpersonal relationship

To facilitate progress toward achievement of personal

spiritual goals

To create and maintain a therapeutic environment

To facilitate awareness of self as an individual with

varying needs.

To accept the optimum possible goals

To use community resources as an aid in resolving

problems arising from illness.

To understand the role of social problems as influencing factors

Defined nursing as service to individuals and families.

Conceptualized nursing as an art and a science that

molds the attitudes, intellectual competencies and

technical skills of the individual nurse into the desire

and ability to help people, sick or well and cope with

their health needs.

Dorothy Johnson

Behavioral System Model

According to her, each

person as a behavioral

system is composed of

seven subsystem namely:

Ingestive

Eliminative

Affiliative

Aggressive

Dependence

Achievement

Sexual and Role Identity Behavior

Imogene King

Goal Attainment Theory

Described nursing as a helping

profession that assists

individuals and groups in

society to attain, maintain and

restore health





Madeleine Leininger

Transcultural Nursing Model

Nursing is a learned

humanistic and scientific

profession and discipline

which is focused on

human care phenomena

and activities in order to

assist, support, facilitate,

or enable individuals or

groups to maintain or

regain their well being

(or health) in culturally meaningful and beneficial

ways, or to help people face handicaps or death.

Transcultural nursing as a learned subfield or branch

of nursing which focuses upon the comparative study

and analysis of cultures with respect to nursing and

health-illness caring practices, beliefs and values with

the goal to provide meaningful and efficacious nursing

care services to people according to their cultural

values and health-illness context.

Focuses on the fact that different cultures have

different caring behaviors and different health and

illness values, beliefs, and patterns of behaviors.

Awareness of the differences allows the nurse to

design culture-specific nursing interventions

Myra Levin

Four Conservation Principles

She advocated that nursing is a

human interaction and

proposed 4 conservation

principles of nursing which are

concerned with the unity

and integrity of the individual.

Conservation of Energy

Conservation of Structural Integrity

Conservation of Personal Integrity

Conservation of Social Integrity

Betty Neuman

Health care System Model

Nursing is a unique profession

that is concerned with all the

variables affecting an individual’s

response to stresses, which are:

- intra ( within the individual )

- inter ( between one or more

other people )

- extrapersonal ( outside the

individual )

The nurse helps the client, through primary, secondary

and tertiary prevention to adjust to environment

stressors and maintain client stability.

Dorotheo Orem

Self-Care and Self-Care Deficit Theory

Defined Nursing: “The act of

assisting others in the provision

and management of self-care

to maintain/improve human

functioning at home level of

effectiveness.”

Focuses on activities that adult

individuals perform on their

own behalf to maintain life, health

and well-being.

Has a strong health promotion and maintenance focus.

Identified 3 related concepts:

1. Self-care – activities an Individual performs

independently throughout life to promote and

maintain personal well-being.

2. Self-care deficit – results when self-care agency

(Individual’s ability) is not adequate to meet the

known self-care needs.

3. Nursing System – nursing interventions needed

when Individual is unable to perform the

necessary self-care activities:

A. Wholly compensatory – nurse provides entire

self-care for the client.

Example: care of a new born, care of client recovering

from surgery in a post-anesthesia care unit

B. Partial compensatory – nurse and client perform

care, client can perform selected self-care

activities, but also accepts care done by the nurse

for needs the client cannot meet independently.

Example: Nurse can assist post operative client to

ambulate, Nurse can bring a meal tray for client who

can feed himself

C. Supportive-educative – nurse’s actions are to

help the client develop/learn their own self-care

abilities through knowledge, support and

encouragement.

Example: Nurse guides a mother how to breastfeed her

baby, Counseling a psychiatric client on more adaptive

coping strategies.

Hildegard Paplau

Interpersonal Model

Defined nursing as an

interpersonal process of

therapeutic interactions between

an individual who is sick or in

need of health services and

a nurse especially educated to

recognize and respond to the

need for help.

Identified 4 phases of the Nurse – Patient relationship:

Orientation – individual/family has a “felt need” and

seeks professional assistance from a nurse (who is a

stranger). This is the problem identification phase.

Identification – where the patient begins to

have feelings of belongingness and a

capacity for dealing with the problem,

creating an optimistic attitude from which

inner strength ensues. Here happens the

selection of appropriate professional

assistance.

Exploitation – the nurse uses

communication tools to offer services to the

patient, who is expected to take advantage of

all services.

Resolution – where patient’s needs have

already been met by the collaborative efforts

between the patient and the nurse.

Therapeutic relationship is terminated and

the links are dissolved, as patient drifts away

from identifying with the nurse as the helping person

Martha Rogers

Science of Unitary Human Beings

Unitary Man, is an energy field in

constant interaction with the

environment.

Human beings are more than

and different from the

sum of their parts; the

distinctive properties of the

whole are significantly different

from those of its parts.

5 basic assumptions:

The human being is a unified whole, possessing

individual integrity and manifesting

characteristics that are more than and different

from the sum of parts.





The individual and the environment are

continuously exchanging matter and energy with

each other

The life processes of human beings evolve

irreversibly and unidirectionally along a space-

time continuum

Patterns identify human being and reflect their

innovative wholeness

The individual is characterized by the capacity

for abstraction and imagery, language and

thought, sensation and emotion

Sister Callista Roy

Adaptation Model

Viewed each person as a

unified biopsychosocial system

in constant interaction with a

changing environment.

Person as an adaptive

system consists of input, control,

processes, output and feedback.

All people have certain needs

which is divided into

four different modes: physiological, self concept, role

function and interdependence.

Lydia Hall

Three Components of Nursing : Care, Core and

Cure Care: represent nurturance

and is exclusive to nursing

Core: involves therapeutic

use of self and emphasizes

the use of reflection

Cure: focuses on

nursing related to the

physician’s orders

Ida Jean Orlando

The Dynamic Nurse – Patient Relationship Model

Believed that the nurse helps patients meet a perceived

need that the patients cannot meet for themselves.

Observed that the nurse provides direct assistance to

meet an immediate need for help in order to avoid or

to alleviate distress or helplessness.

She also indicated that nursing actions

can be:

Automatic

Deliberative

Advocated the three elements

composing nursing situation:

Client behavior

Nurse reaction

Nurse action

Jean Watson

Human Caring Model ( Nursing: Human Science

and Human Care )

Nursing is the application of the

art and human science through

transpersonal caring transactions

to help persons achieve

mind-body-soul harmony, which

generates self-knowledge,

self-control, self-care and

self-healing

She defined caring as a nurturant way or responding

to a valued client towards whom the nurse feels a

personal sense of commitment and responsibility. It is

only demonstrated interpersonally that results in the

satisfaction of certain human needs. Caring accepts the

person as what he/she may become in a caring

environment

Carative Factors:

1. The promotion of a humanistic-altruistic system of

values

2. Instillation of faith-hope

3. The cultivation of sensitivity to one’s self and others

4. The development and acceptance of the expression of

positive and negative feelings.

5. The systemic use of the scientific problem-solving

method for decision making

6. The promotion of interpersonal teaching-learning

7. The provision for supportive, protective and corrective

mental, physical, socio-cultural and spiritual

environment

8. Assistance with the gratification of human needs

9. The allowance for existential phenomenological forces

Rosemarie Rizzo Parse

Theory of Human Becoming

Emphasized free choice of

personal meaning in relating

value priorities, co-creating of

rhythmical patterns, in

exchange with the environment,

and co transcending in

many dimensions as possibilities

unfold.

Human becoming is freely choosing personal

meaning in situation in the intersubjective

process of relating value priorities

Human becoming is co-creating rhythmic

patterns or relating in mutual process in the

universe

Human becoming is co-transcending multidimensionally with emerging possibilities.

Ernestine Weidenbach

Developed the Clinical Nursing – A Helping Art

Model

She believed that nurses meet

the individual’s need for

help through the

identification of the needs,

administration of help and

validation that actions were

helpful.

Components of clinical practice: Philosophy, purpose,

practice and an art.

Joyce Travelbee

Interpersonal Aspects of Nursing Model

The goal of nursing is to

assist individual or

family in preventing

or coping with

illness regaining health,

finding meaning in

illness or maintaining

maximal degree of health.





HISTORY OF NURSING

PERIOD OF INTUITIVE NURSING

Beliefs and Practices of Prehistoric Man

He was nomad. His philosophy of life was “the best

for the most” and he was ruled by the law of self-

preservation.

Nursing was a function that belonged to women

Believed that illness was caused by invasion of evil

spirit

Believed that medicine man called “shaman” or witch

doctor had the power to heal by using white magic.

Practices “trephining” (drilling a hole in the skull with

a stone or rock without anesthesia as a last resort to

drive evil spirit from the body.

Nursing in the Near East

Man’s mode of living changed from nomadic style to

an agrarian society to an urban community life.

Developed a means of communication and the

beginnings of a body of scientific knowledge

Nursing remained the duty of slaves, wives, sister or

mother

The care of the sick was still closely related to

religion, superstition and magic.

Contribution to Medicine and Nursing:

Babylonia

Code of Hammurabi : Provided laws that covered

every facet of Babylonian life including medical

practice.

Egypt

Egyptians introduced the art of embalming which

enhance their knowledge of human anatomy.

Israel

Moses – “Father of Sanitation”

He wrote the five book of the Old Testament which:

Emphasized the practice of hospitality to

strangers and acts of charity.

Promulgated laws of control on the spread

of communicable disease and the ritual of

male circumcision.

Nursing in the Far East

China

Strongly believed in spirits and demons.

Prohibition of dissecting the dead human body.

Give the world knowledge of material medica which

prescribed methods of treating wounds, infection and

muscular afflictions.

India

Men of medicine built hospitals, practiced an intuitive

form of asepsis and were proficient in the practice of

medicine and surgery.

Sushurutu made a list of function and qualifications

of nurses.

Greece

Nursing was the task of untrained slave

Introduced the caduceus

Hippocrates, Father of Scientific Medicine

Rome

Attempted to maintain vigorous health, because illness

was a sign of weakness.

Care of the ill was left to the slaves or Greek

physician.

Fabiola, made her home the first hospital in the

Christian world.

PERIOD OF APPRENTICE NURSING

Periods extends from the founding of religious nursing

orders in The Crusades and establishment of

Kaiserwerth Institute for the Training of Deaconesses.

It is called the period of “on the job” training. Nursing

care was performed without any formal education and

by people who were directed by more experienced

nurses.

Military Religious Orders:

Knights of St. John of Jerusalem

Teutonic Knights, tent hospital for wounded

Knights of St. Lazarus, nursing care for

lepers

Rise of Secular Orders,

Order of St. Francis of Assisi

The Bequines

The Oblates

Benedictines

Ursulines

Augustinians

Hospitals were poorly ventilated and the

beds were filthy.

Overcrowding of patients

Practice of environmental sanitation and

asepsis were non-existent.

Older nuns prayed with and took good

care of the sick; while the younger nuns

washed soiled linens.

Important Nursing Personage During The Period of

Apprentice

St. Claire

St. Elizabeth of Hungary “Patroness of

Nurses”

St. Catherine of Siena “First Lady with a

Lamp”

DARK PERIOD OF NURSING

The religious upheaval led by Martin Luther destroyed

the unity of the Christian faith.

The wrath of Protestantism swept away everything

connected with Roman Catholicism.

Hundreds of hospitals were closed

There were no provision for the sick, no one

to care for the sick.

Nursing become the work of the least

desirable women.

Several Leaders Sought to Bring Reforms:

John Howard

Mother Mary Aikenhand

Pastor Theodor Fliedner and Frederika

Munster Fliedner, established the Institute

for Training of Deaconesses at Kaiserwerth,

Germany. The first organized training

school for nurses.

Nursing in America

Jeanne Mance, the first laywoman who worked as a

nurse in North America. She founded the Hotel Dieu

of Montreal, a log cabin hospitals

Mrs. Elizabeth Seton, founded the Sister of Charity

of Emmitsberg, Maryland

American Reforms in Nursing

The Nurse’s Society of Philadelphia,

organized a school of nursing under the

direction of Dr. Joseph Warrington. Nurses

were trained on the job and attended some

preparatory courses.

Women’s Hospital in Philadelphia,

established a six month course in nursing.

Nursing During the Civil War

The American Medical Associa during the

Civil War created the Committee on

Training of Nurses.

Dorothea Dix, established the Nurse Corps

of the United States Army.

Clara Barton, founded the American Red

Cross

PERIOD OF EDUCATED NURSING

This period began on June 15, 1860 when the Florence

Nightingale School of Nursing opened at St. Thomas

Hospital in London (St.Thomas Hospital School of

Nursing)





Facts About Florence Nightingale

Recognized as the “Mother of Modern Nursing”

Also known as the “ Lady with a Lamp”

Born on May 12, 1820 in Florence Italy

Not contented with the social custom imposed

upon her as a Victorian Lady, she developed her

self-appointed goal: “To change the profile of

nursing”

Compiled notes of her visits to hospitals, her

observation of the sanitary facilities and social

problems of the places she visited.

Advocated for care of those afflicted with disease

caused by lack of hygienic practices.

At the age of 31, she overcome her family’s

resistance to her ambitions. She entered the

Deaconess School at Kaiserworth.

Worked as a superintendent for Gentlewomen

during illness.

Upgraded the practice of nursing and made

nursing an honorable profession for

gentlewomen.

Led the nurses that took care of the wounded

during the Crimean War.

Important Person/Groups/Events During Period of Educated

Nursing

Linda Richards, First graduate nurse in the US

Dr. William Halstead, Designed the first rubber

gloves

Caroline Hampton Robb, The first to nurse to wear

gloves while working as an operating room nurse.

Clara Louise Maas, Engaged in medical research on

yellow fever, She died of yellow fever

Establishment of nursing organization; the American

Nurses Association and the National League for

Nursing Education.

Development of private duty nursing, settlement house

nursing, school nursing, government service of nurses

and maternal and prenatal health nursing.

PERION OF CONTEMPORAY NURSING

Period after World War II

Establishment of the World Health Organization by

the UN

Use of atomic / nuclear energy for medical diagnosis

and treatment

Utilization of computers and use of sophisticated

equipment for diagnosis and therapy

Health is perceived as a fundamental human right.

HISTORY OF NURSING IN THE

PHILIPPINES

EARLY BELIEFS AND PRACTICES

Beliefs about causation of disease: Enemy or a witch

and evil spirit

People believed that evil spirits could be driven away

by persons with power to expel demons.

People believed I special gods of healing, with the

priest-physician (called “word doctors”). If they used

leaves or roots, they were called herb doctors

(“Herbolarios”)

Herbicheros one who practiced witchcraft.

Persons suffering from disease without any identified

cause were believed to be bewitched by the

“mangkukulam or mangagaway.

Difficult childbirth were attributed to “nono”

Earliest Hospitals

Hospital Real de Manila ( 1577)

San Lazaro Hospital ( 1578 )

Hospital de Indio ( 1586 )

Hospital de Aguas Santas ( 1590 )

San Juan de Dios Hospital ( 1596 )

Prominent Person Involved in Nursing Works (Philippine

Revolution)

Josephine Bracken, installed a field hospital in

Tejeros for wounded.

Rosa Sevilla de Alvero

Dona Hilaria de Aguinaldo, organized Filipino Red

Cross.

Dona Maria Agoncillo de Aguinaldo, 2nd wife of

Emilio Aguinaldo, Pres. Of Filipino Red Cross in

Batangas

Melchora Aquino ( Tandang Sora )

Capital Salome

Agueda Kahabagan

Trinidad Tecson, “ Ina ng Biac na Bato “

Hospitals and School of Nursing

Iloilo Mission Hospital School of Nursing ( Iloilo

City, 1906 )

- In April 1944, 22 nurses graduated took the first

Nurses Board Examination at the Iloilo Mission

Hospital.

St. Paul’s Hospital School of Nursing (Manila,

1907)

Philippine General Hospital School of Nursing ( 1907 )

- Anastacia Giron-Tupas, the first Filipino nurse to

occupy the position of chief nurse and superintendent

in the Philippines.

St. Luke’s Hospital School of Nursing ( Quezon

City, 1907 )

Requirements for Admission:

At least completion of seventh grade

Sound physical and mental health

Good moral character

Good family and social standing

Recommendations from three different

persons well known in the community

Mary Johnston Hospital and School of Nursing ( Manila, 1907 )

Philippine Christian Mission Institute School of

Nursing

San Juan de Dios Hospital School of Nursing

(1946)

Emmanuel Hospital School of Nursing ( Capiz, 1913 )

Southern Islands Hospital School of Nursing ( Cebu, 1918 )

First Colleges of Nursing in the Philippines

University of Sto.Tomas College of Nursing (1946)

Manila Central University College of Nursing

(1947)

University of the Philippines College of Nursing

(1948)

Nursing Leaders in the Philippines

Anastacia Giron – Tupas, First Filipino nurse to

hold the position of Chief Nurse Superintendent;

founder of the Philippine Nurses Association.

Cesaria Tan, First Filipino to receive a Masters

degree in Nursing abroad.

Socorro Sirilan, Pioneered in Hospital Social Service

in San Lazaro Hospital where she was the chief nurse

Rosa Militar, pioneer in school health education

Sor Ricarda Mendoza, pioneer in nursing education.

Socorro Diaz, first editor of the PNA magazine called

“ The Message “

Conchita Ruiz, First full time editor of the newly

named PNA magazine “The Filipino Nurse”

Nursing Theories and History

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