Florence Nightingale

(1860)
Florence Nightingale defined Nursing as the act of utilizing the
environment of the patient to assist him in his recovery
(1860/1969), that it involves the nurse's
initiative to configure environmental settings appropriate for the
gradual restoration of the patient's health, and that external factors
associated with the patient's
surroundings affect life or biologic and physiologic processes, and his
development.
Environmental Factors Affecting Health
Defined in her environmental theory are the followingfactors present
in the patients environment:
pure or fresh air
efficient drainage
pure water
cleanliness
sufficient food supplies
light (especially direct sunlight)

Virginia Henderson(1955)

Henderson defined Nursing as assisting the individual, sick or well, in the

performance of those
activities contributing to health or its recovery (or to peaceful death) that an
individual would perform unaided if he had the necessary strength, will or
knowledge. She conceptualized the 14 Fundamental Needs of humans.

These needs are:

Breathing normally

Communicating with others

Eating and drinking

Worshipping according to ones faith

adequately

Working in such a way that one feels a

Eliminating body
sense of
wastes

accomplishment

Moving and

Playing/participating in various forms of

maintaining desirable position
recreation
Sleeping and resting

Learning, discovering or satisfying the

Selecting suitable clothes
curiosity that
Maintaining body temperature within

leads to normal development and health

normal range
and using
Keeping the body clean and well-groomed

available health facilities.

Avoiding dangers in the environment
The Nurse-Patient Relationship
1. The nurse as a substitute for the patient
2. The nurse as a helper to the patient.
3. The nurse as a partner with the patient

Betty Neuman

Her theory incorporated the concept of a

whole person
and 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 illnesses
back to a state of
wellness.

(1972)

Terms Related to Neumans System

Theory
Client Variables
The clients variables can be one or
combination of
the following: physiological,
sociocultural, developmental
and spiritual. These variables function to
achieve
stability in relation to the environmental
stressors
experienced by the client.
Lines of Resistance

Lines of Resistance act when the Normal

Line of
Defense is invaded by too much stressor,
producing
alterations in the clients health.
Normal Line of Defense
To achieve the stability of the system,
the Normal
Line of Defense must act in coordination
with the normal
wellness state. It must reflect the actual
range of
responses that is normally acted by
clients in response to
any stressors. It is the baseline in
determining the level
of client within the continuum of health.
Flexible Line of Disease
It serves as a boundary for the Normal
Line of Defense
to adjust to situations that threaten the
imbalance within
the clients stability.

Faye
Glen

Stressors
These are forces that produce tensions,
alterations or
potential problems causing instability
within the clients
system.
Reaction
These are the outcomes or produced
results of certain
stressors and actions of the lines
resistance of a client.
It can be positive or negative depending
on the degree of
reaction the client produces to adjust
and adapt with the
situation. Neuman specified these
reactions as negentropy
or entropy. Negentropy is set towards
stability or wellness
while Egentropy is set towards
disorganization of the
system producing illness.

Twenty-One Nursing Problems

Abdellah (1960)
The concept of
Nursing in this theory
is generally
grouped into twentyone problem areas for
nurses to work
out their judgment
and appropriate care.
Abdellah considers
nursing to be an allinclusive service that
is based on the
disciplines of art and
science that serves
individuals,
sick or well with their
health needs.
Typology of
Twenty-one
Nursing Problems
1. To maintain good
hygiene.

2. To promote optimal
activity; exercise, rest
and sleep.
3. To promote safety.
4. To maintain good
body mechanics.
5. To facilitate the
maintenance of a
supply of oxygen
6. To facilitate
maintenance of
nutrition
7. To facilitate
maintenance of
elimination
8. To facilitate the
maintenance of fluid
and electrolyte
balance
9. To recognize the
physiologic response
of the body to
disease conditions
10.To facilitate the
maintenance of
regulatory
mechanisms
and functions.
11.To facilitate the
maintenance of
sensory functions

12.To identify and

accept positive and
negative
expressions, feelings
and reactions
13.To identify and
accept the
interrelatedness of
emotions and illness.
14.To facilitate the
maintenance of
effective verbal and
non-verbal
communication
15.To promote the
development of
productive
interpersonal
relationship
16.To facilitate
progress toward
achievement of
personal
spiritual goals
17.To create and
maintain a
therapeutic
environment
18.To facilitate
awareness of self as
an individual with
varying needs.

19.To accept the

optimum possible
goals

20.To use community

resources as an aid in
resolving
problems arising from
illness.

21.To understand the

role of social
problems as
influencing factors

Imogene King (1971)

King stated that Nursing is a

process
of action, reaction, and interaction
whereby nurse and client share
information
about their
perception in the
nursing situation.
Action
Action is a means
of behavior or
activities that are
towards the
accomplishment of
certain act. It is both
physical and mental.
Reaction
In Kings theory, reaction is not
specified but
somehow relates reaction as part of
action. According to
her, reaction is a response to a
stimuli.
Interaction
Interaction, as defined by King, is
any situation
wherein the nurse relates and deals
with a clientele or

patient.
Open System
It is the absence of boundary
existence, where a
dynamic interaction between the
internal and external
environment can exchange
information without barriers or
hindrances.
King proposed that the nurse
interacts in the system
simultaneously at three different
levels. These levels are
independent and at the same time
co-exist to influence
over-all nursing practice.
Personal- how the nurse views and
integrates self
based from personal goals and
beliefs
Interpersonal- how the nurse
interrelates with a coworker
or patient, particularly in a nursepatient
relationship
Social- how the nurse interacts
with co-workers,
superiors, subordinates and the
client environment in
general

Hildegard
Peplau (1952)
She 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, respond to
the need for help.
Dr. Peplau emphasized the nurseclient relationship as

the foundation of nursing

practice. At the time, her
research and emphasis on the giveand-take of nurse-client
relationships was seen by many as
revolutionary. She
described the nurse-patient
relationship as a four-phase
phenomenon. Each phase is unique
and has distinguished
contributions on the outcome of the
nurse-patient
interaction.
Phases Of Nurse-Patient
Relationship
1. Orientation
Individual/family has a felt need
and seeks professional assistance
from a
nurse (who is a stranger). This is the
problem identification phase.
2. 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.
3. Exploitation
The nurse uses communication tools
to offer services to the patient, who
is
expected to take advantage of all
services.
4. Resolution
Where patients 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.

Nursing Roles
In the course of the nurse-patient
relationship, the
nurse assumes several roles which
empower and equip her in
meeting the needs of the patient.
1. Stranger Role: Receives the
client the same way one
meets a stranger in other life
situations; provides
an accepting climate that builds
trust.
2. Resource Role: Answers
questions. Interprets
clinical treatment data, gives
information.
3. Teaching Role: Gives
instructions and provides
training; involves analysis and
synthesis of the
learners experience.
4. Counseling Role: Helps client
understand and
integrate the meaning of current life
circumstances;
provides quidance and
encouragement to make changes.
5. Surrogate Role: Helps clients
clarify domains of
dependence, interdependence, and
independence and
acts on clients behalf as advocate.
6. Leadership Role: Helps client
assume maximum
responsibility for meeting treatment
goals in a
mutually satisfying way.
Additional Roles include:
1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator

10.Recorder observer

11.Researcher