1. Chapter 7 Grand Nursing Theories Based on Human Needs

2. Florence Nightingale
“For us who nurse, our nursing is a thing which, unless we are making progress every year, every month, every week, take my word for it, we are going back.”

3. Florence Nightingale—(cont.)
Born: Florence, Italy, 1820
Wealthy English parents
Well educated
Parents desired her to pursue social graces.
Attended nursing school in Kaiserswerth, Germany in (program was 3 months)
Believed that nursing was her “calling”

4. Florence Nightingale—(cont.)
Spent most of her later life (54 years) confined to her home
Died in 1910—age 90 years

5. Florence Nightingale—Work
Crimean War (1854–1855)
Served at Scutari Army Hospital in Turkey
Conditions deplorable
Advocated cleanliness, pure water, good food
Cut casualties from 48% to 2%
Kept excellent statistics demonstrating changes

6. Florence Nightingale—Work—(cont.)
Nightingale School for Nurses
St. Thomas’ Hospital, London
In 1872, the New York Training School (Bellevue Hospital) was the first nursing school in the United States using Nightingale’s model.

7. Florence Nightingale—Work—(cont.)
Writings
Notes on Nursing
Notes on Hospitals
Many essays and letters

8. Question
Which of the following is NOT among the many accomplishments credited to Florence Nightingale?
She wrote extensively on nursing and nursing care.
She served during World War I, actively improving the care of British soldiers.
She instituted a program of record keeping for government health statistics.
She started a program for formal education for nurses in England.

9. Answer
B. She served during World War I, actively improving the care of British soldiers. Rationale: Nightingale’s work predated WWI by about 60 years. She was active during the Crimean War in the 1850s.

10. Florence Nightingale—Theory
Notes on Nursing: What It Is and What It Is Not
Based on providing a healthful environment
Improve cleanliness, ventilation, warming, light, noise, bedding, etc.
Believed that nursing is an art, medicine is a science
Nurses were to do what they could to provide “the best possible conditions for nature to restore or preserve health.”

11. Florence Nightingale—Theory—(cont.)
A nurse may be any woman who had “charge of the personal health of somebody.”
Believed that nursing is a calling or “God’s work”
Nursing is based on compassion, observation, experience, statistical data, sanitation, nutrition, and administrative skills.

12. Florence Nightingale—Theory—(cont.)
Basic tenets/issues of Nightingale’s work
Ventilation and warming
Avoidance of “petty management”
Avoidance of noise
Variety of sights, activities, foods
Taking food/selection of food
Clean and dry bedding
Light
Cleanliness of rooms and walls
Personal cleanliness
Observation of the sick
Avoidance of “chattering homes and advices”

13. Florence Nightingale—Theory—(cont.)
Nurses performed tasks to and for the patient.
Interestingly, she rejected the “germ theory” but was a very strong advocate of cleanliness.

14. Florence Nightingale—Metaparadigm Concepts
Nursing—Nursing is an art that serves to “put the constitution in such a state that it will have no disease, or that it can recover from disease.”
Health—“to be well and to be able to use well every power we have”
Environment—central concept
Person—not explicitly addressed

15. Florence Nightingale—Resources

16. Virginia Henderson Well-known nursing educator Prolific author
Created basic nursing curriculum for the NLN
Nursing is “patient centered and organized around nursing problems rather than medical diagnoses.”

17. Virginia Henderson—(cont.)
Born 1897 in Kansas City
Large family
Education
Graduated from the Army School of Nursing in Washington, DC in 1921
Received her BS in Nursing Education (1932) and MA in nursing education (1934) from Columbia University

18. Virginia Henderson—(cont.)
Career
Taught nursing at Columbia between 1934 and 1948
With Bertha Harmer, revised the fifth edition of The Principles and Practice of Nursing (1953); sixth edition (1966); Nature of Nursing (1966)
Yale University School of Nursing faculty 1953– 1959

19. Virginia Henderson—(cont.)
Remained very active in nursing well into her 90s
Died in 1996—99 years old

20. Virginia Henderson—Theory
“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 that he would perform unaided if he had the necessary strength, will or knowledge.”

21. Question
Which theorist related her theory to the metaparadigm of nursing with a belief that the function of the nurse is to assist the individual client?
Betty Neuman
Virginia Henderson
Dorothea E. Orem
Dorothy Johnson

22. Answer B. Virginia Henderson
Rationale: Henderson believed that nurses should care for patients until they can care for themselves. The nurse was the focus and the theory related to the nursing metaparadigm.

23. Virginia Henderson—Theory—(cont.)
14 Basic Needs of Patients
Breathe normally.
Eat and drink adequately.
Eliminate body wastes.
Move and maintain desirable postures.
Sleep and rest.
Select suitable clothes—dress and undress.
Maintain body temperature within normal range.

24. Virginia Henderson—Theory—(cont.)
14 Basic Needs of Patients—(cont.)
Keep the body clean and well groomed.
Avoid dangers in the environment.
Communicate with others in expressing emotions, needs, fears, or opinions.
Worship according to one’s faith.
Work to provide a sense of accomplishment.
Play or participate in recreation.
Learn, discover, or satisfy the curiosity that leads to normal development and uses health facilities.

25. Virginia Henderson—Theory—(cont.)
The person must maintain physiological and emotional balance.
The mind and body of the person are inseparable.
Patients require help toward independence.

26. Virginia Henderson—Metaparadigm Concepts
Nursing—“to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will or knowledge . . .”
Person—“patient” as someone who needs nursing care (not limited to illness care)

27. Virginia Henderson—Metaparadigm Concepts—(cont.)
Environment—not explicitly defined; maintaining a supportive environment is implicit in her 14 activities
Health—not explicitly defined; inferred to be a balance in all realms of human life

28. Virginia Henderson—on Education
Strong advocate for university-based education for nurses
Also strong advocate for liberal education courses for nurses
Pushed library research and increasing knowledge for all nurses
Promoted research and research-based practice

29. Virginia Henderson—Resources ml

30. Dorothea Orem
Self-Care Deficit Theory “Nursing is an art . . .”

31. Dorothea Orem—(cont.) Born in Baltimore—1914
Diploma in nursing—1930s from Providence Hospital School of Nursing, Washington, DC
BSN in 1939 and master’s degree in 1945 from Catholic University

32. Dorothea Orem—(cont.)
Director of the School of Nursing at Detroit’s Providence Hospital in the late 1940s
Indiana Board of Health 1949–1957
Joined Catholic University Faculty in 1959

33. Orem: Self-Care Deficit Nursing Theory
First book on Self-Care Deficit Nursing Theory (SCDNT) in 1971; latest edition in 2001
Three nested theories
Theory of self-care
Theory of self-care deficit
Theory of nursing system

34. Question
Which of the following is NOT one of the three nested theories that comprise the SCDNT?
Theory of self-care
Theory of self-care deficit
Theory of self-care interventions
Theory of nursing system

35. Answer
C. Theory of self-care interventions Rationale: Orem’s SCDNT is composed of the theory of nursing system as the outer/encompassing component with the theory of self-care deficit and theory of self-care being subsumed within it.

36. Self-care deficit nursing theory.
(Source: Orem, D. [2001]. Nursing: Concepts of practice [6th ed.]. St. Louis: Mosby.)

37. Orem: Self-Care Deficit Nursing Theory—(cont.)
Theory of Self- Care
Theory of Self- Care Deficit
Theory of Nursing Systems
Self-care
When therapeutic self-care demand exceeds self-care agency, a self-care deficit exists and nursing is needed.
Nursing agency
Self-care agency
Nursing systems
Wholly compensatory
Partially compensatory
Supportive/educative
Self-care requisites
Therapeutic self-care demand

38. Orem: Self-Care Deficit Nursing Theory—(cont.)
“Condition that validates the existence of a requirement for nursing is an adult The absence of the ability to maintain continuously the amount and quality of self-care that is therapeutic in sustaining life and health, removing from disease or injury in on coping with their effects”

39. Orem: Self-Care Deficit Nursing Theory—(cont.)
Nursing—”an art through which the practitioner gives specialized assistance to persons with disabilities to meet needs for self-care also intelligently participates in the medical care the individual receives from the physician”

40. Orem: Self-Care Deficit Nursing Theory—(cont.)
Metaparadigm concepts
Nursing—an art through which the practitioner gives specialized assistance to persons with disabilities to meet needs for self-care also intelligently participates in the medical care the individual receives from the physician”
Humans—“men, women, and children cared for either singly or as social units” objects of nursing care

41. Orem: Self-Care Deficit Nursing Theory—(cont.)
Metaparadigm concepts—(cont.)
Environment—has physical, chemical, and biological features (includes the family, culture, and community)
Health—“being structurally and functionally whole or sound”; also a state that encompasses both the health of individuals and groups

42. Orem: Self-Care Deficit Nursing Theory—(cont.)
Self-care—“human regulatory function that is a deliberate action to supply or ensure the supply of necessary materials needed for continued life, growth, and development and maintenance of human integrity”

43. Orem: Self-Care Deficit Nursing Theory—(cont.)
Self-care requirements
Maintenance of sufficient intake of air, water, and food
Provision of care associated with elimination and excrement
Maintenance of balance between activity and rest
Maintenance of balance between solitude and social interaction
Prevention of hazards to human life, functioning, and well-being
Promotion of human functioning and development

44. Orem: Self-Care Deficit Nursing Theory—(cont.)
Ms. Orem died in 2007.
Her work is readily applied in nursing practice, education, and research.
Many research articles testing relationships within the theory
One of the most frequently used theories for nursing education curricular frameworks

45. Dorothea Orem—Resources
rothea.htm

46. Betty Neuman Born in 1924 in Ohio Mother was a midwife.
Graduated from Peoples’ Hospital (Akron, OH) diploma program in 1947
BS in Public Health Nursing (1957) and an MS in Public/Mental Health Nursing (1966) from UCLA
PhD in Clinical Psychology—Pacific Western University (1985)

47. Neuman Systems Model
Developed the model in 1970—UCLA graduate students introductory course that considers holistic view of humans
Model initially published in Nursing Research in 1972

48. The Neuman systems model.
(Source: Neuman, B., & Fawcett, J. [2002]. The Neuman systems model [4th ed.]. Upper Saddle River, NJ: Pearson Education, Inc. Used with permission of Betty Neuman, RN, PhD, FAAN.)

49. Neuman Systems Model—(cont.)
Two major components
Stress
Reaction to stress
Client is an open system (may be individual, family, group or community).
Exchanges between the client/system and environment are reciprocal.

50. Neuman Systems Model—(cont.)
Nursing is provided to achieve optimal stability.
Concept of “prevention as intervention”
Combines elements of primary, secondary, and tertiary prevention
Multiple lines of resistance
Lines of defense
Client variables (physiological, psychological, sociocultural, developmental, and spiritual) are considered in care.

51. Neuman Systems Model—(cont.)
Stressors are stimuli that produce tensions and might cause system instability.
Intrapersonal
Interpersonal
Extrapersonal
Goal of nursing is to help the client attain, maintain, or retain system stability.
Assessment of actual and potential effect of stressors
Assisting the client make adjustments needed for wellness

52. Neuman Systems Model—(cont.)
Metaparadigm concepts
Person—“human beings” as “client/client system as a composite of variables (physiological, psychological, sociocultural, developmental and spiritual), each of which is a subpart of all parts . . .”
Nursing—Major concern is to maintain client system stability through assessing environmental and other stressors and assisting the client to adjust to maintain wellness.

53. Neuman Systems Model—(cont.)
Metaparadigm concepts—(cont.)
Environment—“both internal and external forces surrounding the client, influencing and being influenced by the client at any point in time”
Health—“a continuum; wellness and illness are at opposite ends”

54. Neuman Systems Model—(cont.)
One of most widely used of the grand nursing theories in nursing research
Many studies test relationships between variables.
Most commonly used as a framework for a study
Widely used as a curriculum framework in nursing programs throughout the world
Continual development—latest edition (5th) (with J. Fawcett) published in 2010

55. Betty Neuman—Resources