Historical Foundation of Nursing

The Four Great Periods of Nursing

1. Intuitive Nursing

• This untaught nursing was instinctive

• Dated from pre-historic times
• Practice among primitive tribes and lasted through Christian era.
• Performed out of feeling of compassion to others
• Out of wish to do good – HELPING

2. Apprentice Nursing

• Extend from the founding of religious orders in the 6th Century through the crusades
which began in the 11th Century to 1836
• The Deacons School of Nursing at Kaiserswerth, Germany established by Pastor
Fliedner and his wife.
• Period of “on the job training” – desired of person to be trained

3. Educated Nursing

• Began in 1860
• Florence Nightingale School of Nursing opened at St. Thomas’ in London.
 First program of formal education for nurses started

4. Contemporary Nursing

• Began at the end of World War II (1945)

• Scientific and technological developments of many social changes occurs
INTUITIVE NURSING
• Cause of illness was believed to be the invasion of the victims’ body by an evil spirit.
• Uses black magic or voodoo to harm or driven out by using supernatural powers.
• Believed in medicine man (shaman or witch doctor) that had power to heal by using white
magic.
 They made use of hypnosis, charms, dances, incantations, purgatives, massage, fire,
water, herbs or other vegetations and even animals.
• Performing a trephine
 Drilling a hole in the skull with a rock or stone without benefit of anesthesia
 Goal of this therapy is to drive the evil spirit from the victim’s body.
• Nurse’s role was instinctive – directive toward comforting, practicing midwifery and being
wet nurse to a child.
• Acts performed without training and Direction.

Babylonia
• Practice of medicine is far advanced
• Code of Hammurabi
- Legal and civil measures is establish
- Regulate the practice of physicians
- Greater safety of patient provided
• No mention of Nurses or nursing this time

Egypt
• Art of embalming enhance their knowledge of human anatomy
• Developed the ability to make keen clinical observations and left a record of 250 recognized
diseases.
• Control of health was in the hands of Gods. The first acknowledge physician was Imhotep.
• Made great progress in the field of hygiene and sanitation.
• Reference to nurses in Moses’ 5th book is a midwife and wet nurse.

Palestine
• The Hebrews book of Genesis emphasized the teachings of Judaism regarding hospitality to
the stranger and acts of charity
• Implementation of laws like
- controlling the spread of communicable disease
- cleanliness
- preparation of food
- purification of man (bathing) and his food
• The ritual of circumcision of the male child on the 8th day
• The established of the High Priest Aaron as the physician of people
China
• Culture was imbued with the belief in spirits and demons
• Gave the world the knowledge of material medica (pharmacology); method of treating
wounds, infection and muscular afflictions.
• Chan Chun Ching – Chinese Hippocrates
• Emperor Shen Nung – said to be the father of Chinese medicine and the inventor of
acupuncture technique
• No mention of nursing in Chinese writings so it is assumed that care of the sick will fall to
the female members of the household.

India
• First recorded reference to the nurse’s taking care of patients on the writings of shushurutu.
• Functions and qualifications of nurse includes:
- knowledge in drug preparation and administration
- cleverness
- devotedness to the patient
- purity of both mind and body
• King Asoke, a Buddhist, published an edict to established hospitals throughout India where
nurses were employed.

Greece
• Made contribution in the area aesthetic arts and clinical medicine, but nursing was the task of
the untrained slave.
• Aesculapius, the Father of Medicine in Greek mythology to whom we associate the
Caduceus. (known insignia of medical profession today)
• Hippocrates, the “Father of Medicine” insisted that magic and philosophical theories had no
place in medicine
• The work of women was restricted to the household. Where mistress of the mansion gave
nursing care to the sick slaves.

Rome
• Acquired their knowledge of medicine from the Greeks,
• Emperor Vespasian opened schools to teach medicine
• Developed military medicine – First aid, field ambulance service and hospitals for wounded
soldiers.
• Translated Greek medical terminologies into Latin terms which has been used in medicine
ever since.
APPRENTICE NURSING
• Religious orders of Christian Church played a major role in this kind of nursing.

The Crusades (11th Century)

• Series of holy wars were conducted by Christians in an attempt to recapture the Holy land
from the Turks.
• Military religious orders founded during the crusades established hospitals and staffed them
with men who served as nurses. Among these were:
- The Knights of St. John of Jerusalem served both as warriors in battle and nurses in
the hospital and was called Knight Hospitallers.
- The Teutonic Knights built hospitals cared for sick and defended the faith.
- The Knights of St. Lazarus established primarily for the nursing of lepers,
forerunners of our now known communicable diseases hospital (also called
lazarettos).

The Rise of Religious Nursing Orders

• The Regular Orders – established monasteries to house travelers, paupers and patient under
one roof. Later as society became better organized hospitals tended to become separate
institutions apart from monasteries.
• The Secular Orders – developed for the primary purpose of nursing; were similar to the
regular orders by their temporary vows, uniformity in dress and religious observation.
• The Nursing Orders – definitely organized. The sisters advanced the stage of probationer
to wearing the white robe to receiving the hood; “they were all under the superintendent of
nurses” or director of nursing; later adopted a uniform dress that eventually became entirely
standardized.

Nursing Saints

• St. Hildegarde – a Benedictine abbess in Germany, actually prescribed cures in her 2 books
on medicine and natural history.
• Sts. Francis and Clara – took vows of poverty, obedience, service and chastity and took
care of the sick and the afflicted; founders of the Franciscan Order and the Order of the Poor
Clares respectively.
• St. Elizabeth of Hungary – the patroness of nurses; built a hospital for the sick and the
needy.
 • St. Catherine of Siena – the 1st “lady with a lamp”; became a tertiary of St. Dominic and
engaged in works of mercy among the sick and of the Church.

The Reformation

• St. Vincent de Paul – set up the first program of social service in France and organized the
“Community of the Sisters of Charity”. His 1st superior and co-founder was Louise de Gras
(nee de Marillac).

The Intellectual Revolution (17th Century)

 Characterized by the development of natural science, medicine, arts and as well as interest in
human beings and their welfare. Among the leaders for reform were:
• St. John of God – founder of the Brother Hospitallers & and declared the “patron of all
hospitals and sick folk” by Pope Leo XIII in 1930.
• George Fox – founder of the sect known as the Society of Friends (Quakers) who advocated
equality of men and women, thus making it easier for women to become active in Nursing.
• John Howard – introduced prison reforms (fresh air and plenty of water).
• Philippe Pinel – introduced his modern open-door treatment of the mentally ill.
• Elizabeth Fry – greatly improved prison conditions by developing work for the prisoners
and the segregations of sexes, later established the Institute of Nursing sisters, the first
organization of women to be trained as private duty nurse.
• Mother Mary Catherine McAuley – founder of the “Order of the Sisters of Mercy”, 2nd
largest of the Roman Catholic Orders.
• Theodor Fliedner and his wife Friederike Munster - established the Institute of
Kaisserswerth on the Rhine for the for the practical Training of Deaconesses (1836), which
is considered as the 1st organized training school for nurses. It was here where Florence
Nightingale received some of her training and the inspiration for the establishment of her
school of nursing. Some of its features includes:
1. A rotating 3 year experience in cooking and housekeeping, laundry and linen
and nursing care in the women’s and men’s wards; and
2. A preliminary and probationary 3 month period of trial and error for both
school and student.

The “Dark Period of Nursing” (17th – 19th Century)

• Many hospitals were closed; the wealth took care of their sick at home; the
indigent sick were taken care of by uneducated, illiterate women who had no background for
nursing.
• Charles Dickens in his book entitled Martin Chuzzleswit published the
selfish and cruel conduct of 2 private duty nurses namely Sairey Gamp and Betsy Prig.
THE PERIOD OF EDUCATED NURSING

England

• June 15, 1860 marked the day when 15 probationers entered St. Thomas’ Hospital in
London to establish the Nightingale system of Nursing, founded by Florence Nightingale
(May 12, 1820). Among the highlights in her life are the following:
- At age of 31, obtained parental consent to enter the Deaconess School at
Kaisserswerth.
- Had 3 months training at Kaisserswerth; later superintendent of the “Establishment
for Gentlewomen During Illness” (1853) during which time she initiated the policy of
admitting and visiting the patients of all faiths
- In 1854 a volunteered for Crimean war service together with 38 women at Scutari
in the Crimea upon the request of Sir Sidney Herbert, Minister of War in England. At
first their work is not accepted because it consisted of cleaning the area, thus reducing
the infections, clothing for the men; establishing a laundry system; providing
recreations for the men, writing letters to their families; their work served as
inspiration for the Red Cross later on.
- In 1860 started the Nightingale System of Nursing at the St. Thomas Hospital in
London believed that schools should be self-supporting; that schools of nursing
should have decent living quarters for their students; that they should have paid nurse
instructors; that the school should correlate theory to practice and these students
should be taught the “why” not just the “how” in nursing.
- 2 books written – Notes on Nursing and Notes on Hospital, contain many timely
portions applicable in the 1970’s as they were in 1859.

United States

• At the time that Florence Nightingale was opening her school in London; the U.S. was on the
brink of the civil war. However though the country was in a condition of chaos, nursing had
many supporters and the needs to train nurses were recognized.
- Linda Richards is the first graduate nurse in the U.S. completed her training at the
New England Hospital for Women and Children in Boston, Massachusetts, patterned
after the Deaconess School of Kaisserswerth.
- In 1873 3 schools of nursing opened, patterned after the Nightingale plan – the
Bellevue Training School for Nurse in the New York City, the Connecticut training.
School in New Haven and the Massachusetts General Hospital in Boston.
- In 1881 – founding of American Red Cross by Clara Barton
 - In 1889 John Hopkins hospital opened a school of Nursing with Isabel Hamptom
Robb as its 1st principal and the person most influential in directing the development
of nursing in the U.S.
- In 1893 the groundwork for the estimate of the 2 new nursing organization was laid:
1. The Associated Alumnae, later known as the American Nurses Association was
begun at the Chicago Worlds fair and
2. The American Society of Superintendent of Training Schools for Nurses, later known
as the National League for Nursing Education, also began.
- During the Spanish American War (1898-1899) nurse were concerned with the care
of the wounded as well as care of those inflicted with malaria and yellow fever.
Nurse Clara Louise Maas gave her life for the advancement of medical science in
the search for control yellow fever.

The 20th Century

• In 1900-1912
- advancement in hospital nursing, private duty nursing, public health nursing, school
nursing, government service and pre-maternal nursing;
- there was a growing awareness for the for preventive measures that could be uses to
maintain the health of the nation;
- There was beginning specializations in medicine

• 1913-1937
- a standard curriculum for schools of nursing was prepared by the National League for
Nursing Education
- the practice of nursing was gradually infiltrated with educational objectives

• World War I (1917-1918)

- Private duty nurses were now nursing in the hospitals rather than in homes
- Opening of more nursing school as a result of the construction of more hospitals
- Increase demand for public health nurse for preventive aspects of care
- Awareness of the need for military ranking among nurses for which a bill was later
introduced and passed.
 Julia Stimson was the first woman to hold rank of major

• World War II (1942-1945)

- the start of aero-medical nursing (flight nursing)
- creation of the U.S. Cadet Nurses Corps with Mrs. Lucille Petry Leone as director
and later the 1st woman to serve as assistant surgeon of the U.S. public Health Service
- granting of permanent commissioned rank for both army and navy nurses
- the concept of family centered care as methods to help patients help themselves
- concept of psychosomatic medicine and early ambulation
- Concept of creative nursing, which has necessitated the need for laundering
definitive studies of all aspects of nursing thus helping to raise the standards to a
professional level.
CONTEMPORARY NURSING
• Creation of United Nations in San Francisco California in 1945
2 folds purpose are:
- International peace and international security with provisions for equal justice,
machinery for peaceful disputes and provisions.
- Provisions for assuring human rights, social justice and economic progress.

• World Health Organization (WHO)

- special agency of U.N. established in Geneva, Switzerland in 1948
- providing health information in fighting diseases and improving the nutrition, living
standards and environmental conditions of all people
- Scientific and Technical Research used in disease prevention and health care
- Social Force affecting Nursing – Legislation, prepaid health care, technology
efficiency and nursing involvement with minority groups.

Nursing in the Philippines

Early Care of the Sick

• Early life of Filipinos had been more or less mixed with superstitious belief
- believed in the powers of witch
- belief in the powers of “herbolarios” (albularyo)
• Hospitals existed as early as 15th Century, which were established by the religious and also
by Spanish administration.
• Franciscan Order is more than any other religious group. Among their early hospitals are:
- Hospital Real de Manila (1577) – established primarily for king’s soldiers and
Spanish civilians
- San Lazaro Hospital (1578) – Exclusively for the service of leprous patients. Named
after San Lazaro, patron saint of lepers
- Hospital de Indios (1586) – offered general services; supported purely by alms and
contributions from charitable persons.
- Hospital de Aguas Santas (1590) – convalescent hospital in Pansol, Laguna; this
was near medicinal spring, which cured several patients.
- San Juan de Dios Hospital (1596) – founded by brotherhood of misericordia;
administered by the Hospitallers of San Juan de Dios
- Hospital de Dulac (1602-1603) – located in Paco and existed only for 1 year.
- Hospital de Nueva Caceres (1655) – general hospital located in Bicol
 - Hospital de Convalenscecia (1656) – estimated by the Brotherhood of San Juan de
Dios on the little island on the Pasig River, where the Hospicio de San Jose now
stands; patients of San de Dios Hospital who were in the convalescent stage were sent
there for their complete recovery.
- Hospital de Zamboanga (1842) – this is a government military hospital run and
finance by Spanish government.
- Hospital de Cavite (1842) – a general hospital estimated and managed by
Brotherhood of San Juan de Dios
- Hospital de San Gabriel (1866) – exclusively for Chinese patients
• Fray Juan Clemente was one of the 1st member’s of the Mission of the Order of St. Francis
in the Philippines in 1578.
- Collected native herbs for medicine later set a little pharmacy which he filled with
various medical remedies.
- Performed both the function of a physician and those of a nurse
• Persons who really did nursing care of the sick were religious group (called hospitallers)
but they were assisted by Filipino attendants
• In the early development of nursing, the work of the nurse and those of the physician were
not clearly defined.

Nursing service during the Philippine Revolution

• The women during Philippine revolutions took active part in nursing the wounded soldier.
They dressed wounds, alleviate pains, prepared food and gave comfort even without previous
trainings.
• These were the prominent women who volunteered and gave nursing service.
- Josephine Bracken – she requested a field hospital to set in Tejeros.
- Mrs. Rosa Sevilla de Alvaro – volunteered here service for the wounded soldier at
age of 18; she work hand in hand with Doña Hilaria de Aguinaldo and they led other
Filipino women to form the Filipino Red Cross in 1899.
- Doña Hilaria de Aguinaldo – organized Filipino Red Cross and was inspired by the
idea of Apolinario Mabini
- Melchora Aquino “Tandang Sora” –gave tender nursing care to wounded soldiers,
giving them shelter and food.
• The Filipino Red Cross had its own constitution approved by the revolutionary government.
This was founded on February 17, 1899 with Doña Hilaria Aguinaldo as president and Doña
Sabina Herrera as secretary.

The Rise of Hospital Schools in Nursing

• The need for hospitals, dispensaries and laboratories led to the establishment of the Board of
Health in July 1901;
• A small dispensary in Manila opened for civil officers and employees, called Civil Hospital.
• The need for doctors and nurses to help eradicate the epidemics of cholera and smallpox led
to the employment of U.S. physicians and graduate nurses.
 • In 1906 the idea of training Filipino girls to become nurses initiated the growth of nursing
schools.
- Iloilo Mission Hospital School of Nursing (1906)
 First trained nursing student graduated after 3 years
 No standard requirements for admission except willingness to work
- Philippine General Hospital School of Nursing (1907)
 Mrs. Anastacia Guiron-Tupaz was the first Filipino nurse to occupy the position
of chief nurse and superintendent of the Philippines.
- St. Luke’s Hospital School of Nursing (1907)
- Mary Johnston Hospital and School of Nursing (1907)
- San Juan de Dios Hospital School of Nursing (1913, Intramuros)
 Was destroyed during the war with a new hospital built along Dewey Boulevard
- Emmanuel Hospital School of Nursing (1913, Capiz)
- Southern Islands Hospital (1913, Cebu)
- Zamboanga General Hospital School of Nursing (1921)
- Chinese General Hospital School of Nursing (1921)
- Baguio General Hospital School of Nursing (1923)
- Manila Sanitarium and Hospital School of Nursing (1930)
- Quezon Memorial Hospital School of Nursing ((1957)
- St. Paul’s Hospital School of Nursing (1446, Iloilo)
- North General Hospital School of Nursing (1946)
- Siliman University School of Nursing (1947, Dumaguete)
- Occidental Negros Provincial Hospital School of Nursing (1946)
- Cebu (Velez) General Hospital School of Nursing (1951)
- Brokenshire School of Nursing (1960, Nueva Ecija)
- De Ocampo Memorial School of Nursing (1954)
- Marian School of Nursing (1960)
- St. Rita Hospital and Schools of Midwifery (1956) and Nursing (1960)

Advantages of university hospitals over hospital schools of nursing:

1. students are treated as students and not as employees

2. adequate financial support
3. the head of the school is responsible only for the education of students in nursing and
4. the environment for the university school of nursing school education

Among the Colleges were:

- UST College of Nursing
 The first basic collegiate school for Nursing in the Philippines
- U.P. College of Nursing (1946)
- Southwestern Colleges College School of Nursing (1947, Cebu)
- Manila Central University College of Nursing (1947)
- Philippine Union College of Nursing (1947)
- Central Philippine College of Nursing(1947)
- Siliman University College of Nursing (1947)
- Philippines Women’s University College of Nursing (1951)
 - FEU Institute of Nursing (1955)
- UE College of Nursing (1958)
- Saint Paul College of Nursing (1958, Manila)

Some Highlights in the History of Nursing in the Philippines

• 1906 – at the Union Mission Hospital (now Iloilo Mission Hospital) in Iloilo City, 4 women
started training in nursing; 3 graduated in 1909 as “Qualified Surgical & Medical Nurses”.
• 1907 – 19 students admitted to a preliminary course in nursing as the Philippine Normal
College
• 1909 – A nursing school was established under the Bureau of Education by Authority of Act
No. 1931.
• 1910 – Act No. 1975 recognized the school under the Bureau of Health. The school
continued as one of the activities of the newly opened Philippine General Hospital and
became known as the Philippine General Hospital School of Nursing.
• 1915 – Act No. 2468 authorized the granting of the titles of graduate in nursing and graduate
in midwifery to nursing midwifery students of the PGHSN.
- Public Health Nursing in the Bureau of Health began in accordance with Act No.
2468
• 1919 – Act No. 2808 (Nurses Law) was passed. This act was later amended in 1922, 1933
and 1950.
• 1920 – 1st Board examination for nurse was conducted.
• 1922 – Filipino Nurses Association was established.
• 1924 – A standard curriculum for school of nursing was published by the PNA.
• 1948 – UP college of Nursing was established.
- First attempt to offer a 4 year basic nursing course leading to a B.S Nursing degree
- The 1st attempt to elevate nursing as profession by enriching & broadening the
preparation of nurses & by educating them in a university setting.
- The idea was conceived by Julita V. Sotejo, a nurse & lawyer, who later became the
1st Dean of the school.
- A program was opened for graduates of the 3 year hospital nursing course to obtain a
B.S. Nursing degree at the U.P College of Nursing. This program ended in 1975.
• 1951 – Republic Act 649 provided for the standardization of nurses’ salaries both in
institutions & in public health.
• 1953 – Republic Act No. 877 (Nursing Practice Law) was approved. Minor revisions were
incorporated in 1957, 1966, 1970 & 1972.
• 1955 – The UPCN offered a Master of Arts (Nursing) degree program to prepare BSN
holders of demonstrated competence & scholarship for senior positions in nursing and to
encourage nursing research.
- A one-year course leading to a certificate of public health nursing was opened at the
UPCN. This program ended in 1969.
• 1965 – The Academy of Nursing of the Philippines (ANPHI) approved its constitution.
- Among its objectives are initiate, promote, sponsor, encourage, and/or conduct
nursing studies & research, & to serve as a medium of exchange through conference,
seminar, institutes & workshops.
 • 1966 – R.A. 4704, amending R.A 877 was approved.
• 1968 – A movement towards accreditation of nursing schools in the Philippines was started.
• 1970 – WHO started an ongoing project in nursing education on family planning to prepare
faculty members to introduce family planning in basic nursing curricula.
- R.A. 6136 amending R.A. 877 & 4704 was approved.
• 1972 – A national seminar on public health nursing education was held with WHO technical
assistance.
• 1975 – A National Health Plan was formulated.
- It redefined the functions and responsibilities of nurses & other health workers with
implication for nursing education and community health nursing.
- The Psychiatric-nursing Specialists, Inc. (PNSI), the 1st independent nurse
practitioners groups, was established.
• 1976 – A National Workshop on the Proposed Nurse-Midwife Curriculum of Schools of
Nursing in the Ministry of health was sponsored by the ministry. The workshop drafted an
experimental 4-year nurse-midwifery curriculum.
• 1977 – ILO convention 149 & recommendations 157, concerning the employment of nursing
personnel & the conditions of their life & work, were adopted in Geneva.
• 1978 – The Declaration of the Economic & School Welfare of Filipino Nurses was passed by
the PNA.
• 1979 – The 1st national Nurses Congress was held, its theme “Nursing Issues in the 80’s”.
- The 1st National Tripartite Conference on employment & Conditions of Life & work
of Nursing & other Health Personnel was held.
- Labor, management & government were involved.

Nursing Theories and Philosophies

I. Philosophical Nursing Theorist

Florence Nightingale – Environmental Adaptation Theory

• One of the developers of the nursing profession

• She was born into a wealthy family and as such was socially not expected to enter into the
field of nursing.
• She strove for cleanliness in the medical camps, pushed for proper training for nurses and
eventually opened the first school of nursing in England.
• Her approach is deceptively simple - what nursing is and what it is not
• At the literal level, we can say that Nightingale believed nursing is about Environmental
Manipulation, Nutrition and Conservation of Patient Energy.
• Identified 5 environmental factors: fresh air, pure water, efficient drainage,
cleanliness/sanitation and light/direct sunlight.
• Florence Nightingale, who is universally recognized as the founder of modern nursing, died
in 1910 at the age of 90 years.
Faye Glenn Abdellah – Typology of 21 Nursing Problems

• Dedicated her life to nursing and, as a researcher and educator, helped change the
profession's focus from a disease-centered approach to a patient-centered approach.
• She served as a public health nurse for 40 years, helping to educate Americans about the
needs of the elderly and the dangers posed by AIDS, addiction, smoking, and violence.
• She developed teaching methods based on scientific research and continued to work as a
leader in the nursing profession into her eighties.
• She developed a list of 21 unique nursing problems related to human needs in the 1960s.
• Divided into three areas: (1) the physical, sociological, and emotional needs of the patient;
(2) the types of interpersonal relationships between the nurse and the patient; and (3) the
common elements of patient care.

Patricia Benner – Novice to Expert Theory

• A professor Emerita at the University of California, San Francisco

• She introduced the concept that expert nurses develop skills and understanding of patient
care over time through a sound educational base as well as a multitude of experiences.
• She proposed that one could gain knowledge and skills ("knowing how") without ever
learning the theory ("knowing that").
• She conceptualizes in her writing about nursing skills as experience is a prerequisite for
becoming an expert.
• She described 5 levels of nursing experience as;
- Novice
- Advanced beginner
- Competent
- Proficient
- Expert

Jean Watson – Theory of Human Caring

• A distinguished professor of nursing whom the recipient pf the highest faculty award for
scholarly work.
• Her theory attempts to :
- define nursing as a distinct health profession
- make explicit nursing values , knowledge and practices
• Her theory has 3 conceptual elements
- Carative factors
- Transpersonal Caring Moment
- Caring Occasion/Caring Moment
Virginia Henderson – Henderson’s 14 basic needs

• She graduated from the Army School of Nursing in Washington, D.C. and she was part of the
"Columbia school" of nursing theory.
• She defined nursing as "assisting individuals to gain independence in relation to the
performance of activities contributing to health or its recovery"
• She categorized nursing activities into 14 components, based on human needs.
• She described the nurse's role as substitutive (doing for the person), supplementary (helping
the person), or complementary (working with the person), with the goal of helping the person
become as independent as possible.
• She was one of the first nurses to point out that nursing does not consist of merely following
physician's orders
• Her famous definition of nursing was one of the first statements clearly delineating nursing
from medicine:
"The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to peaceful death) that he would perform unaided
if he had the necessary strength, will or knowledge, and to do this in such a way as to help him gain
independence as rapidly as possible".

Ernestine Weidenbach – The helping art of clinical nursing

• Helping process meets needs through the art of individualizing care.
• Nurses should identify patients ‘need-for –help’ by:
 Observation
 Understanding client behavior
 Identifying cause of discomfort
 Determining if clients can resolve problems or have a need for help

II. Middle Range Nursing Theories

Ida Jean Orlando – Nursing Process Theory

• Theory was developed in the late 1950s from observations she recorded between a nurse and
patient and was only able to categorize the records as "good" or "bad" nursing.
• The role of the nurse is to find out and meet the patient's immediate need for help
• Nurses need to use their perception, thoughts about the perception, or the feeling engendered
from their thoughts to explore with patients the meaning of their behavior.
• This process helps the nurse find out the nature of the distress and what help the patient
needs.

Joyce Travelbee - Human To Human Relationship Model

• Therapeutic human relationships.
 • Nursing is accomplished through human to human relationships that began with: The
original encounter and then progressed through stages of
• Emerging identities
• Developing feelings of empathy and sympathy, until the nurse and patient attained rapport in
the final stage

Hildegard Peplau – Psychodynamic Nursing Theory

• Define 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, respond to the need for help
• Interpersonal process is maturing force for personality
• Identified 4 phases of the Nurse – Patient relationship:
 Orientation – this is the problem identification phase.
 Identification – selection of appropriate professional assistance.
 Exploitation – the nurse uses communication tools.
 Resolution –goal met and therapeutic relationship is terminated.
• The six nursing roles are:
 Stranger
 Resource person
 Teacher
 Leader
 Surrogate
 Counselor

Helen Erickson – Modeling and Role Modeling

• The theory developed by the nursing theorists Helen C. Erickson, Evelyn M. Tomlin, and
Mary Ann P. Swain.
• From a synthesis of multiple concepts related to basic needs, developmental tasks, object
attachment, and adaptive coping potential, they developed their highly abstract role-modeling
theory.
• The term modeling refers to the development of an understanding of the client's world.
• Role modeling is the nursing intervention, or nurturance, that requires unconditional
acceptance.
• Role modeling provides a framework for understanding the way clients structure their world.
• Erickson, Tomlin, and Swain view nursing as a self-care model based on the client's
perception of the world and adaptations to stressors

Ramona Mercer – Maternal Role Attainment

• Interpersonal process alleviates distress.
 • Nurses must stay connected to patients and assure that patients get what they need, focused
on patient’s verbal and non verbal expressions of need and nurse’s reactions to patient’s
behavior to alleviate distress.
• Elements of nursing situation:
 Patient
 Nurse reactions
 Nursing actions

Kathryn Bernard - Parent Child Interaction Model

• Growth and development of children and mother–infant relationships

• Individual characteristics of each member influence the parent–infant system and adaptive
behavior modifies those characteristics to meet the needs of the system

Madeleine Leininger - Transcultural Care Theory and Ethnonursing

• 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.

Rosemarie Parse – Theory of human becoming

• Indivisible beings and environment co-create health

• A theory of nursing derived from Roger’s conceptual model.
• Clients are open, mutual and in constant interaction with environment.
• The nurse assists the client in interaction with the environment and co creating health

Nola Pender - – The Health promotion; model

• Promoting optimum health supersedes disease prevention.

• Identifies cognitive, perceptual factors in clients which are modified by demographical and
biological characteristics, interpersonal influences, situational and behavioral factors that
help predict in health promoting behavior.
 III. Grand Nursing Theory

Sister Calista Roy - Adaptation Theory

• Viewed humans as Bio-psychosocial beings constantly interacting with a changing

environment and who cope with their environment through Bio-psychosocial adaptation
mechanisms.
• Focuses on the ability of individuals, families, groups, communities, or societies to adapt to
change.
• The degree of internal or external environmental change and the person’s ability to cope
with that change is likely to determine the person’s health status.
• Nursing interventions are aimed at promoting physiologic, psychological, and social
functioning or adaptation

Dorothy Johnson – Behavioral System Model

• Each individual has patterned, purposeful, repetitive ways of acting that comprises a
behavioral system specific to that individual.
• Individuals maintain stability and balance through adjustments and adaptation to the forces
that impinges them.
• Individual as a behavioral system is composed of seven subsystems.
• Attachment, or the affiliate subsystems – is the corner stone of social
organizations.
• Behavioral system also includes the subsystems of dependency, achievement, aggressive,
ingestive-eliminative and sexual.
• Disturbances in these causes nursing problems

Betty Neuman – Health Care System Model

• Reconstitution is a status of adaptation to stressors

• A conceptual model with two theories “Optimal patient stability and prevention as
intervention”
• Neuman’s model includes intrapersonal, interpersonal and extrapersonal stressors.
• Nursing is concerned with the whole person.
• Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the
variables affecting the client’s response to stressors.

Dorothea Orem – 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.
• Identified 3 related concepts:
 Self-care – activities an Individual performs independently throughout life to
promote and maintain personal well-being.
 Self-care deficit – results when self-care agency (Individual’s ability) is not
adequate to meet the known self-care needs.
 Nursing System – nursing interventions needed when Individual is unable to
perform the necessary self-care activities:
• Wholly compensatory – nurse provides entire self-care for the client.
• 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.
• Supportive-educative – nurse’s actions are to help the client develop/learn
their own self-care abilities through knowledge, support and encouragement.

Nancy Roper - A model for nursing based on a model of living

• Individuality in living.
• A conceptual model of nursing from which theory of goal attainment is derived.
• Living is an amalgam of activities of living (ALs).
• Most individuals experience significant life events which can affect ALs causing actual and
potential problems.
• This affects dependence – independence continuum which is bi-directional.
• Nursing helps to maintain the individuality of person by preventing potential problems,
solving actual problems and helping to cope

Martha Rogers - Concept of Science of Unitary Human Beings, and Principles of

Hemodynamics

• Nursing is an art and science that is humanistic and humanitarian. It is directed toward the
unitary human and is concerned with the nature and direction of human development. The
goal of nurses is to participate in the process of change.
• Nursing interventions seek to promote harmonious interaction between persons and their
environment, strengthen the wholeness of the Individual and redirect human and
environmental patterns or organization to achieve maximum health.
• 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 unidirectional 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

Myra Estrin Levine – Conservation Theory

• Defined nursing as supportive & therapeutic interventions based on scientific or therapeutic

knowledge.
• Focuses on conserving an individual's wholeness
• Nursing actions based on four principles: conservation of energy, structural integrity,
personal integrity, & social integrity.
• She describes three environments that present challenges to the individual: Perceptual,
operational, and conceptual.
• She coined a word, "trophicognosis" to describe the nurse's judgments about the patient's
condition

Imogene King – Goal Attainment Theory

• Nursing is a process of action, reaction, and interaction whereby nurse and client share
information about their perception in the nursing situation
• Three interacting systems: personal, interpersonal, and social.
• The nurse and the person interact toward a goal.
• The end-point of this interaction, which occurs over time, is transaction, at which the person's
goal is met