As you could recall, on our Module 1, page 9 we discussed the metaparadigm of

nursing which is a nursing theory is a set of concepts and principles that define the scientific
basis of nursing profession. Nursing theories enhance students' understanding of the
principles, values, and meanings of nursing profession. In addition, it helps nurses to
understand their role in the healthcare setting.

Let us have a recall on the metaparadigm of Nursing before we move to the next
page.

In the next page, you will identify the metaparadigm of nursing as presented by
various theorist. You may able to compare and contrast their views on person, health,
environment and nursing. And as you go along with our lesson about theories, you will
understand the metaparadigm of nursing theories.
THEORIST NURSING PERSON HEALTH ENVIRONMENT
NIGHTANGLE The nurse has to put the patient in the are defined in relationship to their She believed nature alone cures. Given her She focused on ventilation, warmth, noise,
best condition for nature to act upon him. environment and the impact of the definition that of the art of nursing is to light, and cleanliness.
environment upon them. unmake what God had made the disease.
BENNER She viewed nursing practice as the care A person has an effortless and non- She defines health as what can be assessed, She used the phenomenological terms of
and study of the lived experience of reflective understanding of the self in while wellbeing is the human experience of being situated and situated meaning, which
health, illness and disease and the the world. health or wholeness. are defined by the person’s engaged
relationships among three elements. interaction, interpretation and understanding
of the situation
Henderson health as a quality of life and is very basic person is an individual who requires Nurses must provide physicians data about the It is important for a healthy individual to
for a person to function fully. As a vital assistance to achieve health and safety needs of the patient. control the environment but ass illness
need, health requires independence and independence or in some cases, a occurs, this ability diminished or affected.
interdependence peaceful death.
NEUMAN This concept provides the nurse to -person as an individual, family, health as dynamic in nature. A person's health The environment can be internal,
consider that a client's physical, community or the society. depends upon which state of the continuum external and created force that interacts
physiological, psychological, mental, -person as an open system that works they are in line with, the person maybe in line with a person's state of health.
with other parts of its body as it with the state of wellness or illnesses.
social, cultural, development and
interacts with the environment.
spiritual well-being is dynamic.

OREM nursing as a human service. It is human beings are very much health should be perceived this way Orem’s view of health as a phenomenon
distinguished human service its focus different from the other living since she believes that these integrated affected by inseparable entities shows
is on persons with inabilities to things in terms of their capacity. aspects of health are inseparable her view of the surrounding environment
maintain continuous provision of Humans can reflect upon events, as an external source of influence in the
health care. She added that Nursing themselves and their internal interaction of a person’s
is based on values environment. different aspects.
Sister Callista Roy Roy's goal is to promote the person as a biophysical being in Health is the process of being and environment as circumstances, conditions
adaptation in four aspects to nursing. constant interaction with the becoming integrated and whole person and influences that affect the
She contributed to the person's environment. The person is open, according to Roy development of a person. There are
health, quality of life and dying with adaptive who uses coping skills to stimuli termed as "residual stimuli" that
dignity. deal with stressors. are stressors that influence the person.
These stimuli are focal, contextual and
residual.

Imogene King Nursing for King is an act wherein the person existing in an open system Health as the ability of a person to Environment as the Process of balance
nurse interacts and communicates as a spiritual being and rational adjust to the stressors that the internal involving internal and external
with the client. The nurse helps the thinker who makes choices, and external environment exposes to the interactions inside the social system.
client identify the existing health selects alternative courses of client. It is the maximal use of the
condition, exploring and agreeing on action, and has the ability to potentials that a person can perform to
activities to promote health. record their history through their achieve balance in one's health.
own language and symbols,
 unique, holistic and have
different needs, wants and goals

Abdellah The concept of nursing in this theory Abdellah classifies the beneficiary health is defined as the center and The idea of Environment is addressed by
is generally grouped into twenty-one of care as individuals. However, purpose of nursing services. Although Abdellah and is included in ''planning for
problem areas for nurses to work out she does not set standard limits Abdellah does not give a definition of optimum health on local, state, national,
their judgment and appropriate care. on the nature and essence of health, she speaks to a ''total health and international levels.
human beings. needs'' and a healthy state of mind and
body'' in her description of nursing as a
comprehensive service.
 Lesson 1
A. FLORENCE NIGHTINGALE

Florence Nightingale, (12 May 1820 - 13 August 1910), who came

to be known as The Lady with the Lamp, was a pioneer of modern
nursing and noted statistician.

LIFE of Florence Nightingale

Florence nightingale was born into a middle class, lavish, well connected
British family at the Villa Columbia, Florence, Italy and was named after
the city of her birth. Inspired by what she took as a Christian divine calling,
experienced first in 1837 at Embley Park and later throughout her life,
Nightingale committed herself to nursing

The Crimean War

During the Crimean War, from 1853 to 1856, many British soldiers died from wounds and
disease until Florence Nightingale set up a hospital near the battlefront. This picture shows
soldiers at the siege of a key Russian base.

Florence Nightingale's most famous contribution came during the Crimean War which become
her central focus when reports began to filter back to Britain about the horrific conditions for
the wounded.

❖ THEORETICAL SOURCES OF NIGHTINGALE's THEORY

A lot of factors influenced the improvement of Nightingale's Theory for Nursing.

Individual, societal and professional values were all essentials to the development of her work.
She combined her individual resources with societal and professional.

Nightingale’s approach to health care was systemic and holistic. She consistently
stressed health promotion and disease prevention. The foundations for good health were:

• decent housing (a rarity in her day, even for the wealthy);

• clean water and air (large numbers died from water and air-borne diseases);
• good nutrition (especially a problem for the poor, but lack of standards in the food
industry harmed everyone);
• safe childbirth (mortality rates were much higher than, both for childbirth and post
childbirth from puerperal fever);
• good child care (a major subject in her Notes on Nursing) and no child should ever be in
a workhouse (when many were).

Yet, even with the best of conditions—a long time yet in realization—some people would
become ill. Her strategy for dealing with illness was again holistic and comprehensive,
but notes its conservative strain, for intervention can be dangerous:
 • home visiting by nurse and doctor;
• minimal use of hospitals—concern over mortality rates in general (acute-care) hospitals;
• linking of general (acute care) hospitals in city centers with convalescent hospitals in
the country or seaside.

“NIGHTINGALE’S ENVIRONMENTAL MODEL”

A. HEALTH OF HOUSES
B. VENTILATION AND WARMING
C. LIGHT
D. NOISE
E. VARIETY
F. BED AND BEDDING
G. PERSONAL CLEANLINESS
H. NUTIRTION AND TAKING FOOD
I. CHATTERING HOPES AND ADVICES
J. SOCIAL CONSIDERATIONS

Let’s watch this!

Click this link at YouTube https://www.youtube.com/watch?v=_s05qFON5EA
And watch "Nurses: Their Vital Role in Transforming Healthcare." Hope it will give you
more passion to aim your dream to be a Nurse.

RELEVANCE OF THEORY IN NURSING PRACTICE, EDUCATION AND RESEARCH

EDUCATION
1. Principles of nursing training. Better practice result from better education.
2. Skills measurement through licensing by the use of testing methods, the case studies.
RESEARCH
1. Use of graphical representations like the bar, pie diagrams.
2. Notes on nursing.
NURSING PRACTICE
1. Disease control
2. Sanitation and water treatment
3. Utilized by modern architecture in the prevention of “sick building syndrome” applying
the principles of ventilation and good lightning.
4. Waste disposal
5. Control of room temperature
APPLICATION OF NIGHTANGALE’S THEORY IN NURSING PROCESS
Assessment
The following information should be adequate
• Adequacy of ventilation
• Cleanliness of environment
• Presence of draft
• Sudden noises
• Amount of sunlight and artificial light

ANALYSIS

Nightingale believed that the environment was the major component creating illness in
a patient; she regarded disease as ''the reactions of kindly nature against the conditions in which
we have placed ourselves''. She recognized not only the dangers of the environment, but she
also highlighted the benefit of good environments in preventing illness.

Nightingale's Theory has been used to provide general guidelines for all nurse
practitioners for a number of years. The universality of her concepts still remains relevant
except for some specific activities. The concept of the nurse, patient and environment are still
applicable and relevant in all nursing settings today. Therefore, it meets the criterion of
generality.
 Nightingale's concepts in her theory are often stated completely and are presented as
truths rather than tentative, testable statements. In contrast to her quantitative research on
mortality done in Crimean; she proposed that nurses should base their practice or observations
and experiences rather than systematic, empirical research. Her writings continue to motivate
creative thinking nurses and her works gives food for thought that continues to encourage the
profession. It is only right that Nightingale continues to be honored as the brilliant founder of
modern nursing.

POINTS FOR Further Study

• Read on Nightingale’s Notes on Nursing: “What It is, What It is Not”

• Florence is a unique figure in the history of the world. The nursing profession continues
to embrace her as a founder of modern nursing.
• She provided the nursing profession the “Legacy of Caring”

B. PATRICIA BENNER
Patricia Benner- From Novice to Expert

‘’Nursing is concerned with the social sentient body that

dwells in finite human world; that gets sick and recovers; that
is altered during illness, pain and suffering; and that engages
with the world differently upon recovery.’’
Getting to Know the Theorist
Born in Hampton, Virginia and spent her childhood in
California, where she had her eagerly and professional
education. She received her Bachelor’s Degree in Nursing from
Pasadena College in 1964, her Master’s Degree in Medical Surgical Nursing from the University
of California, San Francisco in 1970 and Ph. D. from University of California, Berkeley.
“From Novice to Expert”
 ACCEPTANCE BY THE NURSING COMMUNITY

RELEVANCE OF THEORY TO NURSING PRACTICE, EDUCATION, RESEARCH

The model has been used to aid in the development of clinical ladders of promotion,
new graduate orientation programs and clinical knowledge development seminars. This has
greatly contributed in the competency ladders and promotions in the nursing service.
Nursing educators have realized that learning needs at the early stages of clinical
knowledge development are different from those required at later researches. These
researches have been used in studying the impact of nursing and its seven domains in every
aspect of the profession. Several researches tested these models and validated them. In
application of the theory presented, nurses have clear vision of the competencies required in
order for them to climb up into the leadership ladder.

Analysis
Benner’s model is comparatively simple about the five stages of skill acquisition. It gives
a relative guide for classifying levels of nursing practice, from individual nurse descriptions and
observations to actual nursing practice.
Benner’s model has universal characteristics for the reason that it is no restricted by
age, illness, health or location of nursing practice. The descriptive model of nursing practice
has the potential for universal application as framework; however, the description is limited by
dependence on the actual clinical nursing situations from which they must be used.
Benner’s model was tested using qualitative methodologies. Succeeding researches
suggest that the framework is applicable and useful in providing knowledge of the description
of nursing practice. The strength of Benner’s is that data-based research contributes to the
science of nursing. The implication of Benner’s research finding lies on her conclusion that ‘’a
nurse’s clinical knowledge is relevant to the extent to which its manifestation in nursing skill
makes a difference in patient care and patient outcome.

C. ERNESTINE WEIDENBACH
ERNESTINE WEIDENBACH- The Helping Art of Clinical Nursing

LIFE OF WIEDENBACH

Ernestine Wiedenbach was born in 1900 in Hamburg,

Germany, and her family moved to New York in 1909. She earned
a Bachelor of Arts from Wellesley College in 1922 and her
Registered Nurse’s license from the John Hopkins School of
Nursing in 1925. She got her Masters of Arts from Teachers
College, Columbia University in 1934. In 1946,

Ernestine Wiedenbach’s Contribution to Nursing

“The Helping Art of Clinical Nursing”
It defines nursing as the practice of identifying a patient’s need for help through the
observation of presenting behavior and symptoms, exploration of the meaning of those
symptoms, determination of the cause of discomfort, the determination of the patient’s ability
to resolve the patient’s discomfort, or determining if the patient has a need for help from the
nurse or another health care professional.

Wiedenbach’s model of nursing defines the patient as any person receiving help of some
kind from the health care system. Help can include care, teaching, and advice. In this nursing
theory, a patient does not need to be ill or injured since health education qualifies someone as
a patient. The nurse is a functioning human being who not only acts, but thinks and feels. A
nurse uses his or her knowledge in his or her role. Knowledge encompasses all that has been
perceived and grasped by the human mind. It may be factual, speculative, or practical.

➢ Wiedenbach’s prescriptive theory is based on three factors:

• The central purpose which the practitioner recognizes as essential to the particular
discipline.
• The prescription for the fulfillment of the central purpose.
 • The realities in the immediate situation that influence the central purpose

Nurse’s Notes
The art of nursing includes understanding a patient’s needs and concerns,
developing
goals and actions intended to enhance a patient’s ability, and directing the
activities
related to the medical plan to improve the patient’s condition. The nurse also focuses
on prevention of complications that can come up due to re-occurrence, or the development
of new concerns.

POINTS FOR Further Study

Refer to page 272 of Theoretical Foundations of Nursing by Josie Quiambao-Udan First Edition
 Lesson 2

A. Virginia Henderson (14 NURSING

BASIC NEEDS)

GETTING TO KNOW THE THEORIST

Virginia Henderson -‘’First Lady of Nursing’’ and the

‘’First Truly International Nurse’’
▪ Began her career in public health nursing in the Henry
Street Settlement, Washington, D.C.
▪ First fulltime instructor in nursing in Virginia.
▪ Early advocate for the introduction of psychiatric nursing in 1929

THEORETICAL ASSERTIONS

THE NURSE – PATIENT RELATIONSHIP

Three levels comprising the nurse-patient relationship can be identified, ranging from a
very dependent to a quite independent relationship: (1) the nurse as a substitute for the
patient, (2) the nurse as a helper to the patient, and (3) the nurse as a partner with the patient.
In times of grave illness, the nurse is seen as a ‘’substitute for what the patient lacks to make
him ‘complete, “whole, ’or ‘ independent,’ by the lack of physical strength, will, or
knowledge.’’

THE NURSE-PHYSICIANS RELATIONSHIP

Henderson insisted that the nurse have a unique function that is distinct from the
physician’s function. The care plan, formulated by both the nurse and the patient, must be
implemented in such a way as to promote the physician’s prescribed therapeutic plan.
Henderson stressed that nurses do not follow doctor’s orders because a nurse ‘’questions a
philosophy that allows the physician to give order to patients or other health workers. ‘’She
extended this to emphasize that nurses help patients with health management when physicians
are unavailable. She also indicated that many nurse and physician functions overlap.

THE NURSE AS A MEMBER OF THE HEALTH CARE TEAM

Henderson compared the entire medical team, including the patient and family, to
wedges on a pie graph. The size of each members section depends on the patient’s current
needs; therefore, it changes as the patient progress toward independence. In some situations,
certain team members are not included in the pie. The goal is for the patient to have the largest
wedge possible or to take the whole pie.
 ACCEPTANCE BY THE NURSING COMMUNITY PRACTICE
RELEVANCE OF THEORY TO:

NURSING
In gathering data, the nurse uses observation, smell, feeling and hearing. In the
assessment phase, the nurse would assess the patient in all 14 components of basic nursing
care. To complete the assessment phase, the nurse must analyze the collected data. This
requires knowledge of what is normal in the health and disease.

EDUCATION
Henderson stated, ‘’in order for a nurse to practice as expect in her own right and to
use the scientific approach to the improvement of practice, the nurse needs the kind of
education available only in colleges and universities. The nurse education demands universal
understanding of diverse human beings. The student becomes involved in the complete study
of the patient and the patient’s needs.

RESEARCH
Research questions arise from each of the 14 components of basic nursing care. It is the
nurse’s function to assume responsibility for identifying problems, continually validating his or
her function, improving the methods he or she uses and reassuring the effectiveness of nursing
care.
 B. BETTY NEUMAN
“System Model in Nursing Practice”

Getting to know the Theorist

System Model in Nursing Practice

“Health is a condition in which all parts and subparts
are in harmony with the whole of the client”

Betty Neuman was born on 1924 on a farm near Lowell,

Ohio. Worked as head nurse, school nurse, industrial nurse and
was also involved in clinical teaching at University of Southern
California Medical Center, Los Angeles.

Betty Neuman's theory incorporated the concept of a whole

person as an open system approach. The concept is aimed towards the development of a person
in a state of wellness having the capacity to function optimally. The main role of the nurse in
her theory is to help a person to adapt with environmental stimuli causing illness back to a
state of wellness.

“SYSTEM MODEL IN NURSING PRACTICE”

The picture above illustrates that Nursing is a unique profession in 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. The concern of the nursing is to prevent
stress invasion, to protect the client’s basic structure and to obtain or maintain a maximum
wellness. The nurse helps the client, through primary, secondary and tertiary prevention
modes, to adjust to environmental stressors and maintain client stability.

THEORETICAL ASSERTIONS
Theoretical assertions are the relationships among the essential concepts of a model.

• The Neuman model depicts the nurse as an active participant with the client and as
“concerned with all the variables affecting an individual’s response to stressors”.
• The client is in a reciprocal relationship with the environment in that “he interacts
with this environment by adjusting himself to it or adjusting it to himself”.
• Neuman links the four essential concepts of person, environment, health, and nursing
in her statements regarding primary, secondary, and tertiary prevention.
• Earlier publications by Neuman stated basic assumptions that linked essential concepts
of the model. These statements have also been identified as propositions and serve to
define, describe, and link the concepts of the model.
C. Dorothea Orem
‘’Self-Care Theory of Nursing’’
Getting to know the Theorist
“’Individuals, families, groups and communities need
to be taught selfcare’’
Dorothea Elizabeth Orem, one of America’s foremost nursing
theorist, was born in Baltimore, Maryland in 1914. Orem began her
nursing career at Providence Hospital School of Nursing in
Washington, D.C., where she received a diploma of nursing in the early 1930’s.
Orem’s theory addresses client’s self-care needs. It is defined as goal-oriented activities
that are set towards generating interest in the part of the client to maintain life and health
development. The theory is aimed towards making the clients perform self-care activities in
order to live independently.

SELF-CARE THEORY OF NURSING

Orem defined self-care as the practice of activities that individuals initiate and perform on
their own behalf in maintaining life, health and well-being.

ACCEPTANCE OF THE NURSING COMMUNITY

RELEVANCE OF THEORY TO:
PRACTICE
Orem’s Self-Care Deficit Theory has been used in studies in patients having heart
problems, cancer, and mental illness. Orem’s theory had been widely used in dealing with
geriatric cases, especially those having chronic illnesses. The use of her theory gave way for
further studies in health promotion, self-care, and family caregiver stress.
EDUCATION
The use of Orem’s theory in curriculum development was reported in the late 1970’s.
the theory is used at all levels of curriculum and in continuing education. Some American
universities continuously use her theory as a strong and effective framework for curricular
design, gradually, focus on preventive health care is being introduced also in nursing schools.
RESEARCH
A number of researches derived from Orem’s theory can be classified relating to the
development of research instruments for scientific measurements of the components of her
theory and studies that test these components.

ANALYSIS
Orem’s theory is stated in limited number of terms. These terms are defining and
used consistently in her theories. The Self-Care Deficit Theory of Nursing is a systematic
synthesis of knowledge about the theoretical entities such as self-care, self-care agency,
therapeutic self-care demand, the relational entity self-care deficit and nursing agency.
GENERALITY
As Orem described her theory, Self-Care Deficit Theory assists nurses in different areas
in any clinical setting. This is true as the theory operates upon the combinations of several
conceptualized properties or features common to all instances of nursing. Moreover, the theory
she proposed helps nurses develop and validate nursing knowledge, and in teaching and learning
the nursing profession.\
EMPIRICAL PRECISION
Orem’s theory is used in both qualitative and quantitative methodologies. Although
widely used by researchers, several components of the theory still need instrument
development in order for them to be measured accurately. The significant value of Orem’s
theory is in its scope, complexity, and clinical usefulness. It could be effectively used in
generating hypotheses and adding to the body of knowledge of nursing.
DERIVABLE CONSEQUENCES
Orem’s theory distinguishes nursing from other disciplines in terms of focus. Although
other disciplines use the instruments developed from Orem’s theory, the theory of nursing
systems in terms of focus and emphasis sets the nursing profession apart. Orem’s theory gives
direction to nursing specific outcomes related to identifying and meeting the therapeutic self-
care demands and self-management systems.
 Lesson 3:
A. Sister Callista Roy (Adaptation Model)
"The model provides a way of thinking about
people and their environment that is useful in any
setting. It helps one prioritize care and challenges the nurse to
move the patient from survival to transformation."

Getting to Know the Theorist

Sister Callista L. Roy was born on October 14,

1939 in Los Angeles, California. She graduated in
nursing in 1963 at the Mount Saint Mary College, Los Angeles.
Her Master's Degree in Pediatric Nursing was finished in 1966 and
Doctorate in Sociology in 1977 from the University of California.

Roy Adaptation Model

The Adaptation Model contains the following concepts:

➢ The person is adapting in stable interaction with the environment, either internal or
external
➢ The environment serves as the source of a range of stimuli that will either threaten
or promote the person's unique wholeness
➢ The person's major task is to maintain integrity in face of these environment stimuli:
• Focal - Most immediately confronting the person and attracts the most
attention.
• Contextual -all other stimuli that strengthens the effect of focal stimulus
• Residual - Those stimuli that affect focal stimulus but the effects are not
clear.

Nursing Process
Steps in the nursing Process
Step 1: Assessment of Behavior
Data gathering about the behavior of the person as an adaptive system in each of the
adaptive modes.
Step2: Assessment of Stimuli
 There are stressors that are termed as "stimuli" that influence the person. These stimuli
are focal, contextual and residual.
Step3: Nursing Diagnosis
Formulation of statements that interpret data about the status of a person.
step4: Goal Setting
Creation of clear statements of the outcomes for nursing care that is specific, measurable,
attainable, realistic and time bound.
Step5: Intervention
Determination of how best to assists the person in attaining the established goals
Step6: Evaluation
Judging the outcome of the nursing care in relation to the behavior after the
intervention in comparison with goal.

Acceptance by the Nursing Community

RELEVANCE OF THEORY TO:

Practice
Bower and baker (1976) consider Roy's Model useful for nursing practice because it
outlines the features of the discipline and provides direction for practice, education and
research. It is valuable theory for nursing practice because it includes a goal that specified as
the aim for activity and prescription of activities to attain the goal.
The nursing process is well suited for use in practice setting. The two-level assessment
in unique to this model and leads to identification of adaptation problems of nursing diagnosis.

Education
Roy's Adaptation model can help as basis for student nurses who render care for clients
to promote adaptation with regard to their science. According to Roy, the goal of a nurse is to
help a patient put his energy to achieve recovery.
Research
Roy's model was used extensively to guide knowledge development through nursing
research. Roy together with her colleagues outlined a typology of adaptation problems or
nursing diagnosis in which research and testing is considered necessary.

Analysis

Roy's model is considered complex in terms of structure because it is composed

of several major concepts (nursing, person, health-illness, environment, adaptation and nursing
interventions) sub-concepts (regulator and cognator) and four effector modes (physiological,
self-concept, role function and interdependence).

The Roy's Adaptation Model is described as broad in scope which is considered an

advantage because it can be used for theory building and testing. It can also be applied in all
settings of nursing practice. However, it is limited because it only focuses on the patient and
has adaptation in the environment.

The empirical data indicates that this theory has substance. It also offers a guide to
researchers who wants to integrate physiological phenomena in their study. In order for its
empirical precision to increase researchers should continue to utilize the model as the basis for
their study. The holistic approach of the model makes it helpful for researchers who are
interested to study adaptive process.

Let’s Watch this

Visit this link https://www.youtube.com/watch?v=Ug4fDIJNQhw to have an idea on the steps of nursing
process. Practice making an assessment as early as now.
Nursing Process Steps, May 3,2018
 A. Imogene King (Goal Attainment Theory)

Getting to Know the Theorist

Imogene King received a diploma in nursing from St.
John's Hospital of Nursing in St. Louis, Missouri, in 1945. While
working in a variety of staff nurse roles, she began a course work
toward a Bachelor of Science in Nursing Education, which she
received from St. Louis University in 1948.
King model is composed of three interacting systems: these
are personal Interpersonal and Social Communication. These are
used to establish a nurse-client relationship and utilize by the nurse to form a strong foundation
for a dynamic and interactive environment. King discussed the three health needs of human
beings:
o Need for information
o Need for care for illness prevention and
o Need for total care when a person doesn't have the capacity to help themselves.

Nurse’s Notes

The theory focuses on creating a positive behavior that can be adapted both by the
nurse and client to achieve goals established by the client with the help of a nurse.

“GOAL ATTAINMENT THEORY”

Action
In King's theory, reaction is not specified but somehow relates reaction as part of action.
According to her reaction is a form of reacting or a response to a certain stimulus.
Interaction
Interaction, as defined by King, is any situation wherein the nurse relates and deals with
a clientele or patient.
Open System
Open system is the absence of boundary existence, where a dynamic interaction
between the internal and external environment can exchange information without barriers or
hindrances.

PROPOSITION OF KING's GOAL ATTAINMENT THEORY

King gave a proposal wherein goal attainment is possible if the nurse will fulfill
several conditions:

• If a continuous accuracy is currently is a nurse-patient interaction, a transaction will

happen.
• If nurse and patient will build a transaction, goals will be achieved
• If goals are achieved, satisfaction will happen.
• If goals are met, efficient nursing care will happen.
• If transactions are done in a nurse-client interaction, growth and development will be
increase.
• If role anticipation and performance in the nurse and patient are the same transaction
will happen.
• If role disagreement happens in both nurse and patient, stress would be the result.
• If nurse with exceptional skill and knowledge correspond adequate information to
patient, the same goals and accomplishment will happen.

ACCEPTANCE BY THE NURSING COMMUNITY

Practice
Professional have used Kings theory in different specialized are with the use of dynamic
interactive communications between the nurse and the client as proof, Professionals need
communication to successfully and correctly make decisions for their plan of care.
King also developed the Goal Oriented Nursing Record (GONR) from her theory GONR
have been useful in documenting the outcomes of care that was performed by nurses. It helps
nurses to easily facilitate the present problem from careful assessment of the client gathered
through the interactive communication process between the nurse and the client. Her record
management facilitates proper and correct range for the use of evaluation system.
Education
King's theory has been used to design the nursing curriculum in different schools and
universities and framework for nursing education. It provides a systematic means of viewing
the nursing profession, organizing nursing knowledge and clarifying the nursing discipline.
Research
King's theory has been one of theoretical basis of some researches that helped in
formulating a system view of the application of the nursing practice. Some researchers have
formulated a middle range theory out of King's theory such as patient's satisfaction from nursing
care, clients with chronic illness and family health. The theory can also help set a framework
for nursing studies which can further prove the use and advantages of the nursing practice.

ANALYSIS
Simplicity
King's theory was a result of a careful research study. Her research literature was based
on the existing evidences during her study. She maintains the simplicity of her theory even if
she presented different complex concepts.
Generality
King's theory has been said to have limited application for the nursing practice. It was
stated that the interaction between the nurse and the client also comprises non-verbal
communication that cannot be clearly defined and evaluated. This has been the issues of the
communication barriers that exist between the nurse-patient relationships. King addresses this
critique through concepts of another theorist that cannot also be tested completely.
Empirical Precision
King's formulated theory was based on empirical data that are observed within the
boundaries of the nurse-patient relationship. Her observation consists of the different
characteristics of transactions among different patients. As her theory has been used by
different nursing students and other allied nursing practitioner. It is noted that her theory can
be used to measure the effectiveness of nursing care provided to clients.
Derivable Consequences
King’s theory can be applied to nursing process: Assessment, Planning, Implementation,
and Evaluation. She believes that nurses must carefully assess clients to set mutual goals and
achieve those goals appropriately and effectively. Her theory provided clients to think choices
and be able to participate in the desired outcome of the care plan.
 Lesson 4

A. Faye Glenn Abdellah (21) Twenty-One Nursing Problems

GETTING TO KNOW THE THEORIST

In March 13, 1919, Faye Glenn Abdellah was born in

New York City. She completes her basic nursing education, Magna
cum laude in 1942 from Fitkin Memorial Hospital School of Nursing, in Neptune m, New Jersey.
According to Abdellah, the practice of competent nursing care in the future is for the
nursing student to realize that identifying and answering overt and covert nursing problems is
the core of Nursing.

Typology of Twenty-one Nursing Problems

1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, sleep.
3. To promote safety through prevention of accident, injury, or other trauma and
through the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body disease conditions-pathological,
physiological and compensatory.
10. To facilitate the maintenance of the regulatory mechanism and functions.
11. To facilitate the maintenance of sensory function.
12. To identify and accept positive and negative expressions, feelings and reactions.
13. To identify and accept interrelatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and non-verbal communications.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement and personal spiritual goals.
17. To create or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical emotional and
developmental needs.
19. To accept the optimum possible goals in the light of limitations, physical and
emotional.
20. To use community resources as an aid in resolving problems arising from illness.
21. To understanding the role of social problems as influencing factors in the cause of
illness.

It is anticipated that the Twenty-one Nursing Problems as an extensive collection, would

give confidence to the simplification of principles and as a result, would guide care and promote
the development of the nurse's judgmental ability. From this, it can be said that Abdellah's
Twenty-One Typology of Nursing Problems is one of the forerunners of the Nursing Diagnoses as
complied by the North American Nursing Diagnosis Association (NANDA).
 Theoretical Assertions

Abdellah repeatedly stated several assertions, although they were not labeled
assertions:
1. ''The nursing problem and nursing treatment typologies are the principles of nursing
practice and constitute the unique body of knowledge that is running.'
2. ''Correct identification of the nursing problem influences the nurse's judgment in
selecting steps in solving the patient's problem.''
3. The core of nursing is the patient/client problems that focus on the patient and his/her
problems.

ACCEPTANCE BY THE NURSING COMMUNITY

Practice
Using the Twenty-one Nursing problems Technique, the clinical practitioner could assess
the patient, make a nursing diagnosis and plan interventions. With the Problem-Solving process,
the nurse and nursing student will now attempt to make the welfare of the patient as the
essential goal or objective rather than his or her medical condition. Using the typology in the
clinical setting, nurses will now give their work an empirical basis.
Education
Abdellah's Typology of Twenty-one Nursing Problems had the most potent effect on the
educational system. Educators came to the realization that revisions are of prime importance
if nurses were to become self-governing. They saw that the biggest flaw in the profession was
the absence or limited base of a scientific body of knowledge unique to nursing. The typology
satisfied this void and gave the most crucial and timely opportunity to move away from the
medical replica of cultivating nurses.
Research
The Typology of Twenty-one Nursing Problems was shaped through research; therefore,
it is expected that more research followed after its introduction to the academic world.
Intensive research, like the Function Studies (a type of research) scrutinized the quantity of
time the nurse spent with the patient. The typology utilized by Abdellah and Strachan became
the root for cultivating the nursing care model and was then employed for setting up the staffing
outline in clinical settings. The staffing pattern were found on the patient's identified needs
and, as Abdellah foresaw, they comprise of: Intensive care, Intermediate care, Long-term
care, Self-care, Home-care units.
Arranging patients by similar needs than by diagnoses, the nursing service could give the
optimum staffing patterns to acknowledge patient's needs. Abdellah and Levine released in
1965 the first major text book in nursing research entitled Better Patient Care through Nursing
Research.
 ANALYSIS

The typology is straightforward and it is practical to use among patients. The notion of
nursing, nursing problems and problem-solving-process are distinctly explicit. The
Metaparadigm of Nursing are understood and implied. Nursing and nursing problems were
connotatively given meaning, whereas the problem-solving process in given denotatively, these
styles of definitions do not seem to move away from the simplicity of the definitions.
Generality
The aim this model differs in generalization. The more general is to affect nursing
education optimistically, whereas sub-goals are to present scientific basis for practice and to
present a method of qualitative appraisal of educational familiarity of the students. Therefore,
it’s a goal are suitable for nursing.
Empirical Precision
The concepts are very exact empirical referents that are easily recognizable. The
concepts are inclusive of the field of nursing. The faculty of 40 collegiate schools of nursing
performed a rigorous analysis and study then confirmed and validated the typology.
Derivable Consequences
The importance on problem solving is not restricted by time or space and gives a way
for continual growth and change in the service of nursing care. The problem-solving process
and the typology of twenty-one nursing problems can then be deemed the forerunner of the
nursing care process, classification of nursing diagnoses, and outcome calculation in evidence
in the present time.

B. Lydia Hall

Care, Core, Cure Theory

GETTING TO KNOW THE THEORIST

Lydia Eloise Hall (September 21, 1906 –

February 27, 1969) was a nursing theorist who developed
the Care, Cure, Core model of nursing.

Her theory defined Nursing as “a participation in care,

core and cure aspects of patient care, where CARE is the sole
function of nurses, whereas the CORE and CURE are shared with
other members of the health team.”

“Care, Core, Cure Theory “

Lydia Hall used her knowledge of psychiatry and nursing experiences in the Loeb Center
as a framework for formulating her theory. Also known as “the Three Cs of Lydia Hall,” it
contains three independent but interconnected circles: the core, the care, and the cure.

The core is the patient receiving nursing care. The core has goals set by him or herself
rather than by any other person, and behaves according to his or her feelings and values. The
cure is the attention given to patients by medical professionals. Hall explains in the model that
the cure circle is shared by the nurse with other health professionals, such as physicians or
physical therapists. These are the interventions or actions geared toward treating the patient
for whatever illness or disease he or she is suffering from. The care circle addresses the role of
nurses, and is focused on performing the task of nurturing patients. This means the “motherly”
care provided by nurses, which may include comfort measures, patient instruction, and helping
the patient meet his or her needs when help is needed.

Assumptions

The assumptions of Hall’s Care, Cure, Core Theory are as follows:(1) The
motivation and energy necessary for healing exist within the patient, rather than in the
healthcare team. (2) The three aspects of nursing should not be viewed as functioning
independently but as interrelated. And lastly, (3) The three aspects interact, and the circles
representing them change size, depending on the patient’s total course of progress.

Care
• Nurturing component of care
• It is exclusive to nursing
• “Mothering”
• Provides teaching and learning activities
• Nurses goal is to “comfort” the patient
• Patient may explore and share feelings with nurse
• Nurse is concerned with intimate bodily care
• Nurse applies knowledge of natural and biological sciences
• Nurse act as potential comforter
Core

• Patient care is based on social sciences

• Therapeutic use of self
• Helps patient learn their role is in the healing process
• Patient is able to maintain who they are
• Patient able to develop a maturity level when nurse listens to them and acts as
sounding board
• Patient able to make informed decisions
• Emphasis on social, emotional, spiritual and intellectual needs
• Patient makes more rapid progress towards recovery and rehabilitation
Cure

• Care based on pathological and therapeutic sciences

• Application of medical knowledge by nurses
• Nurse assisting the doctor in performing tasks
• Nurse is patient advocate in this area
• Nurse is a patient advocate
• Nurses role changes from positive quality to negative quality
• Medical surgical and rehabilitative care
• COPERATE WITH FAMILIES OR CARE GIVERS