Foundations of Nursing

Nursing Theories and History

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

Faye Abdellah

Patient – Centered
Approaches to Nursing
Model
FOUNDATIONS OF NURSING

Nursing Theories and History 21 Nursing Problems

Lecturer: Mark Fredderick R. Abejo R.N, M.A.N  To maintain good hygiene.

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.
 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.

Virginia Henderson Conceptualized nursing as an art and a science that
Introduced The Nature of Nursing Model molds the attitudes, intellectual competencies and
Identified 14 basic needs : technical skills of the individual nurse into the desire
o Breathing normally and ability to help people, sick or well and cope with
o Eating and drinking adequately their health needs.
o Eliminating body wastes
o Moving and maintaining desirable position Dorothy Johnson
o Sleeping and resting Behavioral System Model
o Selecting suitable clothes According to her, each
o Maintaining body temperature within person as a behavioral
normal range system is composed of
o Keeping the body clean and well-groomed seven subsystem namely:
o Avoiding dangers in the environment  Ingestive
o Communicating with others  Eliminative
o Worshipping according to one’s faith  Affiliative
o Working in such a way that one feels a sense  Aggressive
of accomplishment  Dependence
o Playing/participating in various forms of  Achievement
recreation  Sexual and Role Identity Behavior
o Learning, discovering or satisfying the
curiosity that leads to normal development Imogene King
and health and using available health Goal Attainment Theory
facilities. Described nursing as a helping
She postulated that the unique function of the nurse is profession that assists
to assists the clients, sick or well in the performance of individuals and groups in
those activities contributing to health or its recovery, society to attain, maintain and
that clients would perform unaided if they had the restore health
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.
Foundations of Nursing Abejo
Foundations of Nursing
Nursing Theories and History
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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.
Foundations of Nursing
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.
Abejo
Foundations of Nursing
Nursing Theories and History
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

 The individual and the environment are Carative Factors:

continuously exchanging matter and energy with 1. The promotion of a humanistic-altruistic system of
each other values
 The life processes of human beings evolve 2. Instillation of faith-hope
irreversibly and unidirectionally along a space- 3. The cultivation of sensitivity to one’s self and others
time continuum 4. The development and acceptance of the expression of
 Patterns identify human being and reflect their positive and negative feelings.
innovative wholeness 5. The systemic use of the scientific problem-solving
 The individual is characterized by the capacity method for decision making
for abstraction and imagery, language and 6. The promotion of interpersonal teaching-learning
thought, sensation and emotion 7. The provision for supportive, protective and corrective
mental, physical, socio-cultural and spiritual
Sister Callista Roy environment
Adaptation Model 8. Assistance with the gratification of human needs
Viewed each person as a 9. The allowance for existential phenomenological forces
unified biopsychosocial system
in constant interaction with a
changing environment. Rosemarie Rizzo Parse
Person as an adaptive Theory of Human Becoming
system consists of input, control, Emphasized free choice of
processes, output and feedback. personal meaning in relating
All people have certain needs value priorities, co-creating of
which is divided into rhythmical patterns, in
four different modes: physiological, self concept, role exchange with the environment,
function and interdependence. and co transcending in
many dimensions as possibilities
unfold.
Lydia Hall  Human becoming is freely choosing personal
Three Components of Nursing : Care, Core and meaning in situation in the intersubjective
Cure process of relating value priorities
 Care: represent nurturance  Human becoming is co-creating rhythmic
and is exclusive to nursing patterns or relating in mutual process in the
 Core: involves therapeutic universe
use of self and emphasizes  Human becoming is co-transcending
the use of reflection multidimensionally with emerging possibilities.
 Cure: focuses on
nursing related to the
physician’s orders Ernestine Weidenbach
Developed the Clinical Nursing – A Helping Art
Model
She believed that nurses meet
Ida Jean Orlando the individual’s need for
The Dynamic Nurse – Patient Relationship Model help through the
Believed that the nurse helps patients meet a perceived identification of the needs,
need that the patients cannot meet for themselves. administration of help and
Observed that the nurse provides direct assistance to validation that actions were
meet an immediate need for help in order to avoid or helpful.
to alleviate distress or helplessness. Components of clinical practice: Philosophy, purpose,
She also indicated that nursing actions practice and an art.
can be:
 Automatic
 Deliberative Joyce Travelbee
Advocated the three elements Interpersonal Aspects of Nursing Model
composing nursing situation: The goal of nursing is to
 Client behavior assist individual or
 Nurse reaction family in preventing
 Nurse action or coping with
illness regaining health,
finding meaning in
Jean Watson illness or maintaining
Human Caring Model ( Nursing: Human Science maximal degree of health.
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
Foundations of Nursing Abejo
Foundations of Nursing
Nursing Theories and History
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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.
Foundations of Nursing
 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)
Abejo
Foundations of Nursing
Nursing Theories and History
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
 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 )
Foundations of Nursing
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”
Abejo