Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

College of Health Sciences

THEORETICAL FOUNDATION IN NURSING
Nursing Theories
FINAL PERIOD

1. HILDEGARD PEPLAU’S
INTERPERSONAL RELATIONSHIP THEORY
The need for a partnership between nurse and of this goal, or any goal, is achieved through a series of
client is very substantial in nursing practice. This helps steps following a sequential pattern.
nurses and healthcare providers develop more
therapeutic interventions in the clinical setting. According Four Phases of the therapeutic nurse-patient
to Peplau (1952/1988), nursing is therapeutic because it relationship:
is a healing art, assisting an individual who is sick or in 1. Orientation Phase: The nurse’s orientation
need of health care. Nursing can be viewed as an phase involves engaging the client in treatment,
interpersonal process because it involves interaction providing explanations and information, and
between two or more individuals with a common goal. In answering questions.
nursing, this common goal provides the incentive for the § Problem defining phase
therapeutic process in which the nurse and patient § It starts when the client meets the nurse
respect each other as individuals, both of them learning as a stranger.
and growing due to the interaction. An individual learns § Defining the problem and deciding the
when she or he selects stimuli in the environment and type of service needed
then reacts to these stimuli. § The client seeks assistance, conveys
needs, asks questions, and shares
Hildegard Peplau’s Interpersonal Relations preconceptions and expectations of past
Theory emphasized the nurse-client relationship as the experiences.
foundation of nursing practice. It emphasized the give- § The nurse responds, explains roles to the
and-take of nurse-client relationships that was seen by client, identifies problems, and uses
many as revolutionary. Peplau went on to form an available resources and services.
interpersonal model emphasizing the need for a 2. Identification Phase: The identification phase
partnership between nurse and client as opposed to the begins when the client works interdependently
client passively receiving treatment and the nurse acting with the nurse, expresses feelings, and begins to
out doctor’s orders. feel stronger.
§ Selection of appropriate professional
The four components of the theory are person, assistance
which is a developing organism that tries to § The patient begins to have a feeling of
reduce anxiety caused by needs; environment, which belonging and the capability of dealing
consists of existing forces outside of the person and put with the problem, which decreases the
in the context of culture; health, which is a word symbol feeling of helplessness
that implies a forward movement of personality and hopelessness.
and nursing, which is a significant therapeutic 3. Exploitation Phase
interpersonal process that functions cooperatively with § In the exploitation phase, the client
another human process that makes health possible for makes full use of the services offered.
individuals in communities. § In the exploitation phase, the client
makes full use of the services offered.
Hildegard E. Peplau’s theory defined Nursing § Use of professional assistance for
as “An interpersonal process of therapeutic interactions problem-solving alternatives
between an individual who is sick or in need of health § The advantages of services are used
services and a nurse especially educated to recognize, based on the needs and interests of the
and respond to the need for help.” It is a “maturing force patients.
and an educative instrument” involving an interaction § The individual feels like an integral part of
between two or more individuals with a common goal. the helping environment.
In nursing, this common goal provides the § They may make minor requests or
incentive for the therapeutic process in which the nurse attention-getting techniques.
and patient respect each other as individuals, both of § The principles of interview techniques
them learning and growing due to the interaction. An must be used to explore, understand and
individual learns when she or he selects stimuli in the adequately deal with the underlying
environment and then reacts to these stimuli. problem.
§ The patient may fluctuate in
Therapeutic nurse-client relationship independence.
A professional and planned relationship between § Nurses must be aware of the various
client and nurse focuses on the client’s needs, feelings, phases of communication.
problems, and ideas. It involves interaction between two
or more individuals with a common goal. The attainment

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Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

College of Health Sciences

§ The nurse aids the patient in exploiting all § Technical Expert: Provides physical care for the
avenues of help, and progress is made patient and operating equipment
towards the final step.
4. Resolution Phase Peplau also believed that the nurse could take on many
In the resolution phase, the client no other roles, but these were not detailed. However, they
longer needs professional services and gives up were “left to the intelligence and imagination of the
dependent behavior. The relationship ends. readers.” (Peplau, 1952)
§ In the resolution phase, the client no Additional roles include:
longer needs professional services and § Technical expert
gives up dependent behavior. The § Consultant
relationship ends. § Health teacher
§ Termination of professional relationship § Tutor
§ The collaborative effect of patient and § Socializing agent
nurse has already met the patient’s § Safety agent
needs. § Manager of the environment
§ Now they need to terminate their § Mediator
therapeutic relationship and dissolve the § Administrator
links between them. § Recorder observer
§ Sometimes, it may be difficult for both as § Researcher
psychological dependence persists.
§ The patient drifts away and breaks the Anxiety was defined as the initial response to a psychic
nurse’s bond, and a healthier emotional threat. There are four levels of anxiety described below.
balance is demonstrated, and both
become mature individuals. Four Levels of Anxiety
§ Mild anxiety is a positive state of heightened
awareness and sharpened senses, allowing the
Subconcepts of the Interpersonal Relations Theory person to learn new behaviors and solve
problems. The person can take in all available
Peplau’s model has proved greatly used by later stimuli (perceptual field).
nurse theorists and clinicians in developing more § Moderate anxiety involves a decreased
sophisticated and therapeutic nursing interventions. perceptual field (focus on the immediate task
The following are the roles of the Nurse in the only); the person can learn a new behavior or
Therapeutic relationship identified by Peplau: solve problems only with assistance. Another
§ Stranger: offering the client the same acceptance person can redirect the person to the task.
and courtesy that the nurse would respond to any § Severe anxiety involves feelings of dread and
stranger terror. The person cannot be redirected to a task;
§ Resource person: providing specific answers to he or she focuses only on scattered details and
questions within a larger context has physiologic symptoms of tachycardia,
§ Teacher: helping the client to learn formally or diaphoresis, and chest pain.
informally § Panic anxiety can involve loss of rational thought,
§ Leader: offering direction to the client or group delusions, hallucinations, and complete
§ Surrogate: serving as a substitute for another physical immobility and muteness. The person
such as a parent or a sibling may bolt and run aimlessly, often exposing
§ Counselor: promoting experiences leading to himself or herself to injury.
health for the client such as the expression of
feelings

2. IDA JEAN ORLANDO’S

DELIBERATIVE NURSING PROCESS THEORY
One important thing that nurses do is converse emphasizes the critical importance of the patient’s
with the patients and let them know what the plan of care participation in the nursing process. Orlando also
will be. However, regardless of how well thought out considered nursing as a distinct profession. She
a nursing care plan is for a patient, unexpected problems separated it from medicine, where nurses determine
to the patient’s recovery may arise at any time. With nursing action rather than being prompted by physician’s
these, the nurse’s job is to know how to deal with those orders, organizational needs, and past personal
problems so the patient can continue to get back and experiences. She believed that the physician’s orders
reclaim his or her well-being. Ida Jean Orlando developed were for patients and not for nurses.
her Deliberative Nursing Process that allows nurses to
formulate an effective nursing care plan that can also be She proposed that “patients have their meanings
easily adapted when and if any complexity comes up with and interpretations of situations and therefore nurses
the patient. must validate their inferences and analyses with patients
Ida Jean Orlando’s nursing theory stresses the before concluding.”
reciprocal relationship between patient and nurse. It

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Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

College of Health Sciences

Subconcepts The nursing process discipline is the investigation into
The function of professional nursing is the the patient’s needs. Any observation shared and explored
organizing principle. This means finding out and meeting with the patient is immediately useful in ascertaining and
the patient’s immediate needs for help. According to meeting his or her need or finding out they have no needs
Orlando, nursing is responsive to individuals who suffer or at that time. The nurse cannot assume that any aspect of
who anticipate a sense of helplessness. It is focused on his or her reaction to the patient is correct, helpful, or
the process of care in an immediate experience. It is appropriate until he or she checks its validity by exploring
concerned with providing direct assistance to a patient in it with the patient. The nurse initiates this exploration to
whatever setting they are found to avoid, relieve, diminish, determine how the patient is affected by what they say
or cure the patient’s sense of helplessness. The Nursing and do. Automatic reactions are ineffective because the
Process Discipline Theory labels the purpose of nursing nurse’s action is determined for reasons other than the
to supply the help a patient needs for their needs to be meaning of the patient’s behavior or the patient’s
met. If the patient has an immediate need for help, and immediate need for help. When the nurse doesn’t explore
the nurse discovers and meets that need, the purpose of the patient’s reaction with him or her, it is reasonably
nursing has been achieved. certain that effective communication between nurse and
patient stops.
Presenting behavior is the patient’s problematic The nurse decides on the appropriate action to
situation. Through the presenting behavior, the nurse resolve the need in cooperation with the patient. This
finds the patient’s immediate need for help. To do this, the action is evaluated after it is carried out. If the patient’s
nurse must first recognize the situation as problematic. behavior improves, the action is successful, and the
Regardless of how the presenting behavior appears, it process is completed. If there is no change or the
may represent a cry for help from the patient. The behavior gets worse, the process recycles with new
patient’s presenting behavior, which is considered the efforts to clarify the patient’s behavior or the appropriate
stimulus, causes an automatic internal response in the nursing action.
nurse, which in turn causes a response in the patient.
Distress. The patient’s behavior reflects distress 5 Stages of the Deliberative Nursing Process
when the patient experiences a need that he cannot
resolve, a sense of helplessness occurs. The Deliberative Nursing Process has five
stages: assessment, diagnosis, planning,
The immediate reaction is the internal response. implementation, and evaluation.
The patient perceives objects with his or her five senses.
These perceptions stimulate automatic thought, and each 1. In the assessment stage, the nurse completes a
thought stimulates an automatic feeling, causing the holistic assessment of the patient’s needs. This is
patient to act. These three items are the patient’s done without taking the reason for the encounter into
immediate response. The immediate response reflects consideration. The nurse uses a nursing framework
how the nurse experiences his or her participation in the to collect both subjective and objective data about
nurse-patient relationship. the patient.
Nurse Reaction. The patient’s behavior
stimulated a nurse’s reaction, which marks the nursing 2. The diagnosis stage uses the nurse’s clinical
process discipline’s beginning. judgment about health problems. The diagnosis can
Nurse’s Action. When the nurse acts, an action then be confirmed using links to defining
process transpires. This action process by the nurse in a characteristics, related factors, and risk factors found
nurse-patient contact is called the nursing process. The in the patient’s assessment.
nurse’s action may be automatic or deliberative.
Automatic Nursing Actions are nursing actions 3. The planning stage addresses each of the problems
decided upon for reasons other than the patient’s identified in the diagnosis. Each problem is given a
immediate need. specific goal or outcome, and each goal or outcome
is given nursing interventions to help achieve the
Deliberative Nursing Actions are actions decided upon goal. By the end of this stage, the nurse will have a
after ascertaining a need and then meeting this need. nursing care plan.
The following list identifies the criteria for deliberative
actions: 4. In the implementation stage, the nurse begins
§ Deliberative actions result from the correct using the nursing care plan.
identification of patient needs by validating the
nurse’s reaction to patient behavior. 5. Finally, in the evaluation stage, the nurse looks at
§ The nurse explores the meaning of the action with the patient’s progress toward the goals set in the
the patient and its relevance to meeting his nursing care plan. Changes can be made to the
needs. nursing care plan based on how well (or poorly) the
§ The nurse validates the action’s effectiveness patient is progressing toward the goals. If any new
immediately after completing it. problems are identified in the evaluation stage, they
§ The nurse is free of stimuli unrelated to the can be addressed, and the process starts over again
patient’s need when she acts. for those specific problems.

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Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

College of Health Sciences

3. JOYCE TRAVELBEE’S
HUMAN-TO-HUMAN RELATIONSHIP

Joyce Travelbee assumes that nursing is fulfilled due to role envy, lack of interest in others, inability
by utilizing human-to-human relationships. She defined to transcend the self, or refusal to initiate
nursing as “an interpersonal process whereby the emotional investment. This phase is described by
professional nurse practitioner assists an individual, the nurse and patient perceiving each other as
family or community to prevent or cope with the unique individuals. At this time, the link of the
experience of illness and suffering, and if necessary, to relationship begins to form.
find meaning in these experiences”.
3. The phase of Empathy: This phase involves
Inspired by being a psychiatric nurse, she sharing another’s psychological state but
struggles for a “Humanistic Revolution” in nursing, with standing apart and not sharing feelings. It is
devotion to caring and compassion for patients. She characterized “by the ability to predict the
expressed that achieving the goal of nursing necessitates behavior of another”.
a genuine human-to-human relationship, which can only
be established by an interaction process, this process is 4. The phase of Sympathy: Sharing, feeling, and
further divided into five phases. experiencing what others are feeling and
experiencing is accomplished. This phase
The 5 interactional phases of Travelbee’s model demonstrates emotional involvement and
are in consecutive order and developmentally achieved discredits objectivity as dehumanizing. The task
by the nurse and the patient as their relationship with each of the nurse is to translate sympathy into helpful
other goes deeper and more therapeutic. nursing actions. Sympathy happens when the
nurse wants to lessen the cause of the patient’s
1. The phase of the Original Encounter: Emotional suffering. It goes beyond empathy. “When one
knowledge colors impressions and perceptions of sympathizes, one is involved but not
both nurse and patient during initial encounters. incapacitated by the involvement.” The nurse
The task is “to break the bond of categorization to should use a disciplined intellectual approach
perceive the human being in the patient” and vice together with the therapeutic use of self to make
versa. Patients are the same human beings as us helpful nursing actions.
and families; only, they need other human beings
specifically nurses and doctors to maintain 5. The phase of Rapport: Rapport is described as
health. Health, which, Travelbee defines in two nursing interventions that lessen the patient’s
categories: subjective and objective. Subjective suffering. The nurse and the sick person are
health is an individually defined state of well- relating as human being to human being. The sick
being in accord with self-appraisal of physical- person shows trust and confidence in the nurse.
emotional-spiritual status. Objective health is an “A nurse is able to establish rapport because she
absence of discernable disease, disability or possesses the necessary knowledge and skills
defect as measured by physical examination, required to assist ill persons and because she is
laboratory tests, and assessment by the spiritual able to perceive, respond to, and appreciate the
director or psychological counselor. uniqueness of the ill human being.”

2. The phase of Emerging Identities: Tasks in the Comparison of the theories

second phase (visibility of personal or emerging
identities) include separating oneself and one’s Joyce Travelbee’s Human-to-human Relationship
experiences from others AND recognizing the Theory was influenced by Hildegard Peplau’s Work,
different qualities that each possesses, Interpersonal Relations Theory. Both theories show how
transcending roles by separating self and a nurse-to-patient relationship is established. Travelbee’s
experiences from one another – not using oneself theory focused on having the presence of hope
to judge others. Neither the nurse nor the patient (emotional part) in the patient’s recovery while Peplau’s
is not to stereotype the other as having a theory focused on the totality of how a nurse should act
particular vexatious characteristic as this is not upon meeting the patient until he/she is discharged.
facilitative to building a relationship. Tasks include
avoiding “using oneself as a yardstick” by which
to evaluate others. Barriers to such tasks may be

4. LYDIA HALL’S
CARE, CURE, CORE NURSING THEORY

Nursing theory, in line with Lydia Hall, is nothing own simple words, her thoughts about nursing. She did
short of revolutionary. In the 1960s, she put down, in her not consider herself a nurse theorist but instead talked

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CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

College of Health Sciences

about her transparent thoughts and remarkable nursing § The core, according to Hall’s theory, is the
care ideas as she learned them over the years. These led patient receiving nursing care. The core
to the development of her “Care, Cure, Core Theory,” also has goals set by him or herself rather than
known as the “Three Cs of Lydia Hall.” by any other person and behaves
according to their feelings and values. This
Lydia Hall’s theory defines Nursing as involves the therapeutic use of self and is
the “participation in care, core and cures aspects of shared with other members of the health
patient care, where CARE is the sole function of nurses, team.
whereas the CORE and CURE are shared with other § This area emphasizes the patient’s social,
members of the health team.” The major purpose of care emotional, spiritual, and intellectual needs
is to achieve an interpersonal relationship with the concerning family, institution, community,
individual to facilitate the development of the core. and the world. This can help the patient
verbally express feelings regarding the
As Hall says, “To look at and listen to self is often disease process and its effects by using the
too difficult without the help of a significant figure reflective technique. Through such
(nurturer) who has learned how to hold up a mirror and expression, the patient can gain self-
sounding board to invite the behaver to look and listen to identity and further develop maturity.
himself. If he accepts the invitation, he will explore the § The professional nurse uses the reflective
concerns in his acts. As he listens to his exploration technique to act as a mirror to the patient
through the reflection of the nurse, he may uncover in to help the latter explore his or her feelings
sequence his difficulties, the problem area, his problem, regarding his or her current health status
and eventually the threat which is dictating his out-of- and related potential changes in lifestyle.
control behavior.” § Motivations are discovered through the
process of bringing into awareness the
Lydia Hall’s theory has three components which feelings being experienced. With this
are represented by three independent but interconnected awareness, the patient can now make
circles. The three circles are the core, the care, and the conscious decisions based on understood
cure. The size of each circle constantly varies and and accepted feelings and motivation.
depends on the state of the patient.
3. The Cure Circle
1. The Care Circle. § As explained in this theory, the cure is
§ According to the theory, nurses are nursing, which involves the administration
focused on performing the noble task of of medications and treatments. Hall
nurturing patients. This circle solely explains in the model that the nurse shares
represents the role of nurses and is the cure circle with other health
focused on performing the task of nurturing professionals, such as physicians or
patients. Nurturing involves using the physical therapists.
factors that make up the concept of § In short, these are the interventions or
mothering (care and comfort of the person) actions geared toward treating the patient
and providing teaching-learning activities. for whatever illness or disease he or she is
§ The care circle defines a professional suffering from. During this aspect of
nurse’s primary role, such as providing nursing care, the nurse is an active
bodily care for the patient and helping the advocate of the patient.
patient complete such basic daily biological
functions as eating, bathing, elimination, The three interlocking circles may change in size
and dressing. When providing this care, the and overlap concerning the patient’s phase in the disease
nurse’s goal is the comfort of the patient. process. A nurse functions in all three circles but to
§ Moreover, the nurse’s role also different degrees.
includes educating patients and helping a
patient meet any needs he or she is unable For example, in the care phase, the nurse gives
to meet alone. This presents the nurse and hands-on bodily care to the patient about daily living
patient with an opportunity for closeness. activities such as toileting and bathing. In the curing
As closeness develops, the patient can phase, the nurse applies medical knowledge to the
share and explore feelings with the nurse. treatment of the person. In the core phase, the nurse
addresses the patient’s social and emotional needs for
2. The Core Circle. effective communication and a comfortable environment.

5. FAYE GLENN ABDELLAH’S

21 NURSING PROBLEMS THEORY

According to Faye Glenn Abdellah’s skills of the individual nurse into the desire and ability to
theory, “Nursing is based on an art and science that molds help people, sick or well, cope with their health needs.”
the attitudes, intellectual competencies, and technical

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CAMARINES SUR POLYTECHNIC COLLEGES
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College of Health Sciences

The patient-centered approach to nursing was 19. To accept the optimum possible goals in the light
developed from Abdellah’s practice, and the theory is of limitations, physical and emotional.
considered a human needs theory. It was formulated to be 20. To use community resources as an aid in
an instrument for nursing education, so it is most suitable resolving problems that arise from an illness.
and useful in that field. The nursing model is intended to 21. To understand the role of social problems as
guide care in hospital institutions but can also be applied influencing factors in the cause of illness.
to community health nursing, as well.
Major Concepts of 21 Nursing Problems Theory Moreover, patients’ needs are further divided into four
categories: basic to all patients, sustenance care needs,
The model has interrelated concepts of health remedial care needs, and restorative care needs.
and nursing problems and problem-solving, which is
inherently logical. I. Basic Needs. The basic needs of an individual patient
are to maintain good hygiene and physical comfort;
Nursing Problems. The client’s health needs can promote optimal health through healthy activities, such
be viewed as problems, overt as an apparent condition, as exercise, rest, and sleep; promote safety through
or covert as a hidden or concealed one. the prevention of health hazards like accidents, injury,
Because covert problems can be emotional, sociological, or other trauma and the prevention of the spread of
and interpersonal, they are often missed or infection; and maintain good body mechanics and
misunderstood. Yet, in many instances, solving the covert prevent or correct deformity.
problems may solve the overt problems as well.
II. Sustenal care needs to facilitate the maintenance of
Abdellah’s Typology of 21 Nursing Problems a supply of oxygen to all body cells; facilitate the
maintenance of nutrition of all body cells; facilitate the
The 21 nursing problems fall into three maintenance of elimination; facilitate the maintenance
categories: physical, sociological, and emotional of fluid and electrolyte balance; recognize the
needs of patients; types of interpersonal relationships physiological responses of the body to disease
between the patient and nurse; and common elements of conditions; facilitate the maintenance of regulatory
patient care. She used Henderson’s 14 basic human mechanisms and functions, and facilitate the
needs and nursing research to establish the classification maintenance of sensory function.
of nursing problems. Abdellah’s 21 Nursing Problems are
the following: III. Remedial care needs to identify and accept positive
and negative expressions, feelings, and reactions;
1. To maintain good hygiene and physical comfort. identify and accept the interrelatedness of emotions
2. To promote optimal activity: exercise, rest, sleep and organic illness; facilitate the maintenance of
3. To promote safety by preventing accidents, effective verbal and non-verbal communication;
injuries, or other trauma and preventing the promote the development of productive interpersonal
spread of infection. relationships; facilitate progress toward achievement
4. To maintain good body mechanics and prevent of personal spiritual goals; create and maintain a
and correct deformity. therapeutic environment; and facilitate awareness of
5. To facilitate the maintenance of a supply of the self as an individual with varying physical,
oxygen to all body cells. emotional, and developmental needs.
6. To facilitate the maintenance of nutrition for all
body cells. IV. Restorative care needs include the acceptance of the
7. To facilitate the maintenance of elimination. optimum possible goals in light of limitations, both
8. To facilitate the maintenance of fluid and physical and emotional; the use of community
electrolyte balance. resources as an aid to resolving problems that arise
9. To recognize the physiologic responses of the from an illness; and the understanding of the role of
body to disease conditions—pathologic, social problems as influential factors in the case of
physiologic, and compensatory. illness.
10. To facilitate the maintenance of regulatory
mechanisms and functions. Abdellah’s work, based on the problem-solving
11. To facilitate the maintenance of sensory function. method, serves as a vehicle for delineating nursing
12. To identify and accept positive and negative (patient) problems as the patient moves toward a healthy
expressions, feelings, and reactions. outcome. The theory identifies ten steps to identify the
13. To identify and accept the interrelatedness of patient’s problem and 11 nursing skills to develop a
emotions and organic illness. treatment typology.
14. To facilitate the maintenance of effective verbal
and nonverbal communication. The ten steps are:
15. To promote the development of productive 1. Learn to know the patient.
interpersonal relationships. 2. Sort out relevant and significant data.
16. To facilitate progress toward achievement and 3. Make generalizations about available data
personal spiritual goals. concerning similar nursing problems presented
17. To create or maintain a therapeutic environment. by other patients.
18. To facilitate awareness of self as an individual 4. Identify the therapeutic plan.
with varying physical, emotional, and 5. Test generalizations with the patient and make
developmental needs. additional generalizations.

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6. Validate the patient’s conclusions about his The 11 nursing skills are:
nursing problems.
7. Continue to observe and evaluate the patient 1. observation of health status
over a period to identify any attitudes and clues 2. skills of communication
affecting his or her behavior. 3. application of knowledge
8. Explore the patient and their family’s reactions to 4. the teaching of patients and families
the therapeutic plan and involve them in the plan. 5. planning and organization of work
9. Identify how the nurses feel about the patient’s 6. use of resource materials
nursing problems. 7. use of personnel resources
10. Discuss and develop a comprehensive nursing 8. problem-solving
care plan. 9. the direction of the work of others
10. therapeutic uses of the self
11. nursing procedure

6. VIRGINIA HENDERSON’S
NURSING NEED THEORY

Virginia Henderson developed the Nursing Need 4. Move and maintain desirable postures
Theory to define the unique focus of nursing practice. The 5. Sleep and rest
theory focuses on the importance of increasing the 6. Select suitable clothes – dress and undress
patient’s independence to hasten their progress in the 7. Maintain body temperature within normal range
hospital. Henderson’s theory emphasizes the basic by adjusting clothing and modifying environment
human needs and how nurses can meet those needs. 8. Keep the body clean and well-groomed and
protect the integument
“I believe that the function the nurse performs is 9. Avoid dangers in the environment and avoid
primarily an independent one – that of acting for the injuring others
patient when he lacks knowledge, physical strength, or
the will to act for himself as he would ordinarily act in Psychological Aspects of Communicating and
health or in carrying out prescribed therapy. This function Learning
is seen as complex and creative, as offering unlimited 10. Communicate with others in expressing
opportunity to apply the physical, biological, and social emotions, needs, fears, or opinions.
sciences and the development of skills based on them.” 14. Learn, discover, or satisfy the curiosity that leads
(Henderson, 1960) to normal development and health and use the
available health facilities.
Additionally, she stated that “…the nurse does for
others what they would do for themselves if they had the Spiritual and Moral
strength, the will, and the knowledge. But I go on to say 11. Worship according to one’s faith
that the nurse makes the patient independent of them as
soon as possible.” Sociologically Oriented to Occupation and
Recreation
Her definition of nursing distinguished a nurse’s 12. Work in such a way that there is a sense of
role in health care: The nurse is expected to carry out a accomplishment
physician’s therapeutic plan, but individualized care 13. Play or participate in various forms of recreation
results from the nurse’s creativity in planning for care.
The nurse should be an independent practitioner able to Since there is much similarity, Henderson’s 14
make an independent judgment. In her work Nature of components can be applied or compared to Abraham
Nursing, she states the nurse’s role is “to get inside the Maslow‘s Hierarchy of Needs. Components 1 to 9 are
patient’s skin and supplement his strength, will or under Maslow’s Physiological Needs, whereas the 9th
knowledge according to his needs.” The nurse is component is under the Safety Needs. The 10th and 11th
responsible for assessing the patient’s needs, helping components are under the Love and Belongingness
them meet health needs, and providing an environment in category, and the 12th, 13th, and 14th components are
which the patient can perform activities unaided. under the Self-Esteem Needs.

14 Components of the Need Theory Henderson’s Needs Theory can be applied to nursing
The 14 components of Virginia Henderson’s practice as a way for nurses to set goals based on
Need Theory show a holistic nursing approach covering Henderson’s 14 components. Meeting the goal of
physiological, psychological, spiritual, and social needs. achieving the 14 needs of the client can be a great basis
to further improve one’s performance towards nursing
Physiological Components care. In nursing research, each of her 14 fundamental
1. Breathe normally concepts can serve as a basis for research, although the
2. Eat and drink adequately statements were not written in testable terms.
3. Eliminate body wastes

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7. NOLA PENDER’S
HEALTH PROMOTION MODEL

Have you ever noticed advertisements in malls, actualize human health potential. It is an approach to
grocery stores, or schools that advocate healthy eating or wellness.
regular exercise? Have you gone to your local centers or On the other hand, health protection or illness
hospitals promoting physical activities and smoking prevention is described as behavior motivated desire to
cessation programs such as “quit” activities and “brief actively avoid illness, detect it early, or maintain
interventions?” These are all examples of health functioning within illness constraints.
promotion. The Health Promotion Model, developed by
nursing theorist Nola Pender, has provided healthcare a Individual characteristics and
new path. According to Nola J. Pender, Health Promotion experiences (prior related behavior and personal
and Disease Prevention should focus on health care. factors).
When health promotion and prevention fail to anticipate Behavior-specific
predicaments and problems, care for illness becomes the cognitions and affect (perceived benefits of action,
subsequent priority. perceived barriers to action, perceived self-efficacy,
activity-related affect, interpersonal influences, and
The Health Promotion Model notes that each situational influences).
person has unique personal characteristics and
experiences that affect subsequent actions. The set of Behavioral outcomes (commitment to a plan of
variables for behavioral-specific knowledge and effect action, immediate competing demands and preferences,
have important motivational significance. These variables and health-promoting behavior).
can be modified through nursing actions. Health-
promoting behavior is the desired behavioral outcome Subconcepts of the Health Promotion Model
and is the endpoint in the Health Promotion Model.
Health-promoting behaviors should result in improved 1. PERSONAL FACTORS are categorized as biological,
health, enhanced functional ability, and better quality of psychological, and socio-cultural. These factors are
life at all development stages. The final behavioral predictive of a given behavior and shaped by the target
demand is also influenced by the immediate competing behavior’s nature being considered.
demands and preferences, which can derail intended a. Personal biological factors. Include variables
health-promoting actions. such as age, gender, body mass index, pubertal
status, aerobic capacity, strength, agility, or
Nola Pender’s Health Promotion Model theory balance.
was originally published in 1982 and later improved in b. Personal psychological factors. Include
1996 and 2002. It has been used for nursing research, variables such as self-esteem, self-motivation,
education, and practice. Applying this nursing theory and personal competence, perceived health status,
the body of knowledge that has been collected through and definition of health.
observation and research, nurses are in the top c. Personal socio-cultural factors. Include
profession to enable people to improve their well-being variables such as race, ethnicity, acculturation,
with self-care and positive health behaviors. education, and socioeconomic status.

The Health Promotion Model was designed to be 2. BEHAVIOR-SPECIFIC COGNITION AFFECT

a “complementary counterpart to models of health a. Perceived Benefits of Action. Anticipated
protection.” It develops to incorporate behaviors for positive outcomes that will occur from health
improving health and applies across the lifespan. Its behavior.
purpose is to help nurses know and understand the major b. Perceived Barriers to Action. Anticipated,
determinants of health behaviors as a foundation for imagined, or real blocks and personal costs of
behavioral counseling to promote well-being and healthy understanding a given behavior.
lifestyles. c. Perceived Self-Efficacy. The judgment of
personal capability to organize and execute a
Pender’s health promotion model defines health health-promoting behavior. Perceived self-
as “a positive dynamic state not merely the absence of efficacy influences perceived barriers to action,
disease.” Health promotion is directed at increasing a so higher efficacy results in lowered perceptions
client’s level of well-being. It describes the multi- of barriers to the behavior’s performance.
dimensional nature of persons as they interact within the d. Activity-Related Affect. Subjective positive or
environment to pursue health. negative feeling occurs before, during, and
following behavior based on the stimulus
The model focuses on the following three areas: properties of the behavior itself. Activity-related
individual characteristics and experiences, behavior- effect influences perceived self-efficacy, which
specific cognitions and affect, and behavioral outcomes. means the more positive the subjective feeling,
the greater its efficacy. In turn, increased feelings
Major Concepts of the Health Promotion Model of efficacy can generate a further positive affect.
e. Interpersonal Influences. Cognition concerning
Health promotion is defined as behavior behaviors, beliefs, or attitudes of others.
motivated by the desire to increase well-being and Interpersonal influences include norms

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(expectations of significant others), social support h. Immediate Competing Demands and
(instrumental and emotional encouragement), Preferences. Competing demands are those
and modeling. Primary sources of interpersonal alternative behaviors over which individuals have
influences are families, peers, and healthcare low control because of environmental
providers. contingencies such as work or family care
f. Situational Influences. Personal perceptions responsibilities. Competing preferences are
and cognitions of any given situation or context alternative behaviors over which individuals exert
can facilitate or impede behavior. Include relatively high control, such as the choice of ice
perceptions of options available, demand cream or apple for a snack.
characteristics, and aesthetic features of the
environment in which given health-promoting is 3. BEHAVIORAL OUTCOME-HEALTH PROMOTING
proposed to take place. Situational influences BEHAVIOR
may have direct or indirect influences on health a. Health-Promoting Behavior. A health-promoting
behavior. behavior is an endpoint or action-outcome
g. Commitment to Plan of Action. The concept of directed toward attaining positive health outcomes
intention and identification of a planned strategy such as optimal well-being, personal fulfillment,
leads to the implementation of health behavior. and productive living.

8. MADELEINE LEININGER’S
TRANSCULTURAL NURSING THEORY
The Transcultural Nursing Theory or Culture Ethnonursing. This is the study of nursing care
Care Theory by Madeleine Leininger involves knowing beliefs, values, and practices as cognitively perceived and
and understanding different cultures concerning nursing known by a designated culture through their direct
and health-illness caring practices, beliefs, and values to experience, beliefs, and value system (Leininger, 1979).
provide meaningful and efficacious nursing care services
to people’s cultural values health-illness context. Nursing is defined as a learned humanistic and
scientific profession and discipline which is focused on
It focuses on the fact that different cultures have human care phenomena and activities to assist, support,
different caring behaviors and different health and illness facilitate, or enable individuals or groups to maintain or
values, beliefs, and patterns of behavior. regain their well-being (or health) in culturally meaningful
and beneficial ways, or to help people face handicaps or
The cultural care worldview flows into knowledge death.
about individuals, families, groups, communities, and
institutions in diverse healthcare systems. This Professional Nursing Care (Caring).
knowledge provides culturally specific meanings and Professional nursing care (caring) is defined as formal
expressions about care and health. The next focus is on and cognitively learned professional care knowledge and
the generic or folk system, professional care system(s), practice skills obtained through educational institutions
and nursing care. Information about these systems that are used to provide assistive, supportive, enabling, or
includes the characteristics and the specific care features facilitative acts to or for another individual or group to
of each. This information allows for the identification of improve a human health condition (or well-being),
similarities and differences or cultural care universality disability, lifeway, or to work with dying clients.
and cultural care diversity.
Cultural Congruent (Nursing) Care. is defined
Next are nursing care decisions and actions that as those cognitively based assistive, supportive,
involve cultural care preservation/maintenance, cultural facilitative, or enabling acts or decisions that are tailor-
care accommodation/negotiation, and cultural care re- made to fit with the individual, group, or institutional,
patterning or restructuring. It is here that nursing care is cultural values, beliefs, and lifeways to provide or support
delivered. meaningful, beneficial, and satisfying health care, or well-
being services.
Major Concepts of the Transcultural Nursing Theory
Health. It is a state of well-being that is culturally
The following are the major concepts and their defined, valued, and practiced. It reflects individuals’ (or
definitions in Madeleine Leininger’s Transcultural Nursing groups) ‘ ability to perform their daily role activities in
Theory. culturally expressed, beneficial, and patterned lifeways.
Transcultural nursing is defined as a learned
subfield or branch of nursing that focuses upon the Human Beings. Such are believed to be caring
comparative study and analysis of cultures concerning and capable of being concerned about others’ needs,
nursing and health-illness caring practices, beliefs, and well-being, and survival. Leininger also indicates that
values to provide meaningful and efficacious nursing care nursing as a caring science should focus beyond
services to their cultural values and health-illness context. traditional nurse-patient interactions and dyads to include
families, groups, communities, total cultures, and
institutions.

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Professional Care Systems are defined as
Society and Environment. Leininger did not formally taught, learned, and transmitted professional
define these terms; she speaks instead of worldview, care, health, illness, wellness, and related knowledge and
social structure, and environmental context. practice skills that prevail in professional institutions,
usually with multidisciplinary personnel to serve
Worldview. how people look at the world, or the consumers.
universe, and form a “picture or value stance” about the
world and their lives. Etic. The knowledge that describes the
professional perspective. It is professional care
Cultural and social structure dimensions are knowledge.
defined as involving the dynamic patterns and features of
interrelated structural and organizational factors of a Ethnohistory includes those past facts, events,
particular culture (subculture or society) which includes instances, experiences of individuals, groups, cultures,
religious, kinship (social), political (and legal), economic, and instructions that are primarily people-centered
educational, technological, and cultural values, (ethno) and describe, explain, and interpret human
ethnohistorical factors, and how these factors may be lifeways within particular cultural contexts over short or
interrelated and function to influence human behavior in long periods.
different environmental contexts.
Environmental context is the totality of an Care as a noun is defined as those abstract and
event, situation, or particular experience that gives concrete phenomena related to assisting, supporting, or
meaning to human expressions, interpretations, and enabling experiences or behaviors toward or for others
social interactions in particular physical, ecological, with evident or anticipated needs to ameliorate or improve
sociopolitical, and/or cultural settings. a human condition or lifeway.

Culture. Culture is learned, shared, and Care as a verb is defined as actions and activities
transmitted values, beliefs, norms, and lifeways of a directed toward assisting, supporting, or enabling another
particular group that guides their thinking, decisions, and individual or group with evident or anticipated needs to
actions in patterned ways. ameliorate or improve a human condition or lifeway or
face death.
Culture Care. is defined as the subjectively and
objectively learned and transmitted values, beliefs, and Culture Shock may result when an outsider
patterned lifeways that assist, support, facilitate, or enable attempts to comprehend or adapt effectively to a different
another individual or group to maintain their well-being, cultural group. The outsider is likely to experience feelings
and health, improve their human condition lifeway, or deal of discomfort helplessness and some degree
with illness, handicaps or death. of disorientation because of the differences in cultural
values, beliefs, and practices. Culture shock may lead to
Culture Care Diversity. Indicates the variabilities and/or anger and can be reduced by seeking knowledge of the
differences in meanings, patterns, values, lifeways, or culture before encountering that culture.
symbols of care within or between collectives related to
assistive, supportive, or enabling human care Cultural imposition refers to the outsider’s
expressions. efforts, both subtle and not so subtle, to impose their
cultural values, beliefs, and behaviors upon an individual,
Culture Care Universality. Indicates the common, family, or group from another culture. (Leininger, 1978)
similar, or dominant uniform care meanings, patterns,
values, lifeways, or symbols manifest among many Sunrise Model of Madeleine Leininger’s Theory
cultures and reflect assistive, supportive, facilitative, or
enabling ways to help people. (Leininger, 1991) The Sunrise Model is relevant because it enables
nurses to develop critical and complex thoughts about
Subconcepts nursing practice. These thoughts should consider and
The following are the subconcepts of the integrate cultural and social structure dimensions in each
Transcultural Nursing Theory of Madeleine Leininger and specific context, besides nursing care’s biological and
their definitions: psychological aspects.

Generic (Folk or Lay) Care Systems are Three modes of nursing care decisions and actions
culturally learned and transmitted, indigenous (or
traditional), folk (home-based) knowledge and skills used 1. Cultural care preservation or Maintenance.
to provide assistive, supportive, enabling, or facilitative Cultural care preservation is also known as maintenance.
acts toward or for another individual, group, or institution It includes those assistive, supporting, facilitative, or
with evident or anticipated needs to ameliorate or improve enabling professional actions and decisions that help
a human life way, health condition (or well-being), or to people of a particular culture to retain and/or preserve
deal with handicaps and death situations. relevant care values so that they can maintain their well-
being, recover from illness, or face handicaps and/or
Emic. Knowledge gained from direct experience death.
or directly from those who have experienced it. It is
generic or folk knowledge. 2. Cultural care accommodation or Negotiation
Cultural care accommodation, also known as negotiation,

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includes those assistive, supportive, facilitative, or assistive, supporting, facilitative, or enabling professional
enabling creative professional actions and decisions that actions and decisions that help clients reorder, change, or
help people of a designated culture to adapt to or greatly modify their lifeways for new, different, and
negotiate with others for a beneficial or satisfying health beneficial health care pattern while respecting the clients’
outcome with professional care providers. cultural values and beliefs and still providing a beneficial
or healthier lifeway than before the changes were
3. Culture care repatterning or Restructuring. established with the clients. (Leininger, 1991)
Culture care repatterning or restructuring includes those

9. MARGARET NEWMAN’S
THEORY OF HEALTH AS EXPANDING CONSCIOUSNESS

“The theory of health as expanding Newman’s Health as Expanding Consciousness

consciousness was stimulated by concern for those for Theory is beneficial because it can be applied in any
whom health as the absence of disease or disability is not setting and “generates caring interventions.” However, its
possible. Nurses often relate to such people: people drawbacks are that it is abstract, multidimensional, and
facing the uncertainty, debilitation, loss, and eventual qualitative, and there is little discussion
death associated with chronic illness. The theory has on the environment within the model.
progressed to include the health of all persons regardless
of the presence or absence of disease. The theory asserts Health is the “pattern of the whole” of a person
that every person in every situation, no matter how and includes disease as a manifestation of the pattern of
disordered and hopeless it may seem, is part of the the whole, based on the premise that life is an ongoing
universal process of expanding consciousness – a process of expanding consciousness (Newman, 1986). It
process of becoming more of oneself, of finding greater is regarded as the evolving pattern of the person and
meaning in life, and of reaching new dimensions of environment and is viewed as an increasing ability to
connectedness with other people and the world.” perceive alternatives and respond in a variety of ways
(Newman, 1986). Health is “a transformative process to
The theory explains that health and illness are more inclusive consciousness” (Newman, 2008, p. 16).
synthesized as health. That is the fusion of one state of Using Hegel’s dialectical fusion of opposites, Newman
being (disease) with its opposite (non-disease) results in explained conceptually how disease fuses with its
what can be considered health. In this model, the human opposite, nondisease or absence of disease, to create a
is unitary. He or she cannot be divided into parts and is new concept of health that is relational and is “patterned,
inseparable from the larger unitary field. People are emergent, unpredictable, unitary, intuitive, and
individuals, and human beings are, as a species, innovative,” rather than a traditional linear view that is
identified by their patterns of consciousness. The person “causal, predictive, dichotomous, rational, and controlling”
does not possess consciousness. Instead, the person is (Newman, 1994, p. 13). Health and the evolving pattern
conscious. People are centers of consciousness with an of consciousness are the same. The essence of the
overall pattern of expanding consciousness. The emerging paradigm of health is the recognition of
environment is described as a “universe of open patterns. Newman sees the life process as a progression
systems.” toward higher levels of consciousness.
“Nursing is the process of recognizing the patient
about the environment, and it is the process of the Pattern is information that depicts the whole and
understanding of consciousness.” understanding of the meaning of all of the relationships at
“The theory of health as expanding once (M. Newman, personal communication, 2004). It is
consciousness was stimulated by concern for those for conceptualized as a fundamental attribute of all there is,
whom health as the absence of disease or disability is not and it gives unity in diversity (Newman, 1986). The pattern
possible . . . “ is what identifies an individual as a particular person.
Nursing is regarded as a connection between the Examples of explicit manifestations of the pattern of a
nurse and patient, and both grow in the sense of higher person are the genetic pattern that contains information
levels of consciousness. that directs becoming, the voice pattern, and the
In this model, nursing is “caring in the human movement pattern. Characteristics of patterns include
health experience.” It is seen as a partnership between movement, diversity, and rhythm. Pattern is
the nurse and patient, with both growing in the “sense of conceptualized as being somehow intimately involved in
higher levels of consciousness.” energy exchange and transformation (Newman, 1994).
Newman’s theory is considered a grand nursing According to Newman (1987b), “Whatever manifests itself
theory. She states that people cannot be divided into in a person’s life is the explication of the underlying
parts. Health is central to the theory and is seen as a implicate pattern …. the phenomenon we call health is the
process of developing awareness of the individual self manifestation of that evolving pattern” (p. 37).
and the person’s environment. She also states that
“consciousness is a manifestation of an evolving pattern In Health as Expanding
of person-environment interaction.” Consciousness, Newman (1986, 1994) developed a
pattern as a major concept that is used to understand the

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individual as a whole being. Newman described a essential to understanding the theory. Consciousness
paradigm shift in the field of health care: the shift from the includes not only cognitive and affective awareness, but
treatment of disease symptoms to a search for patterns also the “interconnectedness of the entire living system
and the meaning of those patterns. Newman (1994) which includes physicochemical maintenance and growth
stated that the patterns of interaction with the environment processes as well as the immune system”.
constitute health. Individual life patterns according to In 1978, Newman identified three correlates of
Newman (2008) move “through peaks and troughs, consciousness (time, movement, and space) as
variations in order-disorder that are meaningful for the manifestations of the pattern of the whole. The life
person” (p. 6). An event such as a disease occurrence is process is seen as a progression toward higher levels of
part of a larger process. By interacting with the event, no consciousness. Newman (1979) views the expansion of
matter how destructive the force might be, its energy consciousness as what life and health are all about, and
augments the person’s energy and enhances his or her the sense of time is an indicator of the changing level of
power. One must grasp the pattern of the whole to see consciousness.
this.
Movement-space-time. Newman emphasizes the
Consciousness is both the informational importance of examining movement-space-time together
capacity of the system and the ability of the system to as dimensions of emerging patterns of consciousness
interact with its environment. Newman asserts that rather than as separate concepts of the theory (M.
understanding of her definition of consciousness is Newman, personal communication, 2004).

10. ROSEMARIE PARSE’S

THEORY OF HUMAN BECOMING

Rosemarie Rizzo Parse created the Human “Man-Living-Health”

Becoming Theory of Nursing, which guides nurses to – unique theory of nursing presented by Parse
focus on the quality of life from each person’s perspective (1981)
as the goal of nursing. It presents an alternative to most – synthesized principles and concepts from
of the other theories of nursing, which take a bio-medical Rogers, and concepts and tenets from existential
or bio-psycho-social-spiritual approach. phenomenology

It was first published in 1981 as the “Man-living- Roger’s three major principle
health” theory, and in 1992 the name was changed to “the § helicy
Human Becoming Theory.” It was developed as a human § complimentarity (now called integrality)
science nursing theory, and the assumptions § resonancy
underpinning the theory come from the works of
Heidegger, Sartre, and Merleau-Ponty, as well as Martha Roger’s four major concepts:
Rogers, who was a pioneer American nursing theorist. § energy field
§ openness
The Human Becoming Theory is a combination of § pattern
biological, psychological, sociological, and spiritual § organization
factors, and states that a person is a unitary being in
continuous interaction with his or her environment. It is Tenets and concepts of exixtential-phenomenological
centered around three themes: meaning, rhythmicity, and thought:
transcendence. § intentionality
§ human subjectivity
The theme of meaning says that Human § coconstitution
Becoming is choosing personal meaning in situations and § coexistence
that a person’s reality is given meaning through § situated freedom
experiences he or she lives in the environment.
Rhythmicity explains that Human Becoming is co-creating ASSUMPTIONS
rhythmical patterns of relating with the universe and that 1. The human is co-existing while co-constituting
a person and the environment cocreate in rhythmical rhythmical patterns with the universe.
patterns. Transcendence says that Human Becoming Basis: Pattern and organization; Co-constitution;
refers to reaching beyond the limits a person sets and that Coexistence
a person is constantly transforming him or herself. 2. The human is open, freely choosing meaning in a
situation, and bearing responsibility for decisions.
The Human Becoming Theory of Nursing is a Basis: Energy field; Openness; Situated freedom
model that focuses on the quality of life of the patient and 3. The human is unitary and continuously co-
sees the patient not as different aspects of a whole, but constituting patterns of relating.
as a person. This is different than many other nursing Basis: Energy field; Pattern and organization; Co-
theories and allows nurses to do what so many of them constitution
go into the nursing field to help people. 4. The human is transcending multidimensionality
with the possible.

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Basis: Openness; Four dimensionality; Situated Three main themes:
freedom § Meaning - refers to the linguistic and imagined
5. Becoming is unitary human-living-health content of something and the interpretation that
Basis: Openness; Co-constitution; Situated one gives to something.
freedom § Rhythmicity - refers to the fast-paced, paradoxical
6. Becoming is a rhythmically co-constituting patterning of the human-universe mutual
process of the human- universe process. process.
Basis: Pattern and organization; Four § Transcendence - described as reaching beyond
dimensionality; Co-constitution with possible-the hopes and dreams seen in
7. Becoming is the human’s pattern of relating value multidimensional experience
priorities.
Basis: Openness; Pattern and organization; 1. Principle I - Structuring meaning
Situated freedom multidimensionally is cocreating reality through
8. Becoming is an intersubjective process of languaging valuing and imaging.
transcending with the possible. 2. Principle II - Cocreating rhythmical patterns of
Basis: Openness; Coexistence; Situated freedom relating is living the paradoxical unity of revealing-
9. 9. Becoming is unitary human’s emerging. concealing, and enabling-limiting while
Basis: Energy field; Four dimensionality; connecting-separating.
Coexistence 3. Principle III – Co-transcending with the
possible is powering unique ways of originating in
PRINCIPLES the process of transforming.

11. ERNESTINE WEIDENBACH’S

HELPING ART OF CLINICAL NURSING THEORY

Wiedenbach conceptualizes nursing as the

practice of identifying a patient's need for help through 2. Purpose. That which the nurse wants to
observation of presenting behaviors and symptoms, accomplish through what she does - is the overall
exploration of the meaning of those symptoms with the goal toward which she is striving and so is constant.
patient, determining the cause(s) of discomfort, and It is her reasons for being and doing; it is the why
determining the patient's ability to resolve the discomfort of clinical nursing and transcends the immediate
or if the patient needs help from the nurse or other intent of her assignment or task by specifically
healthcare professionals. Nursing primarily consists of directing her activities towards the ‘good’ of her
identifying a patient's need for help. If the need for help patient. The fulfillment of purpose involves
requires intervention, the nurse facilitates the medical essentially three Major units of Nursing Practice:
plan of care and also creates and implements a nursing I. Identification of the individual’s need for
plan of care based on the needs and desires of the help
patient. In providing care, a nurse exercises sound II. The ministration of help needed
judgment through deliberative, practiced, and educated III. Validation that the help given was indeed
recognition of symptoms. The patient's perception of the the help needed.
situation is an important consideration for the nurse when
providing competent care. 3. Practice. Overt action, directed by disciplines,
thoughts and feelings toward meeting the pa-
Wiedenbach asserted that there are four elements to patient’s need for help, constitutes the practice of
clinical nursing: clinical nursing… goal-directed, deliberately
carried out and patient-centered. Wiedenbach
1. Philosophy. Is an attitude toward life and reality considered that there are three elements
that evolves from each nurse’s beliefs and code of necessary for effective practice, knowledge,
conduct, motivates the nurse to act, guides her judgment and skills, with three additional
thinking about what to do, and influences decisions. components of practice directly related to patient
It stems from both her culture and subculture and care - identification, ministration and
is an integral part of her. It is personal, unique to validation with coordination indirectly related to
each nurse, and expressed in her way of nursing. it.
Philosophy underlines purpose and her purpose
reflects philosophy. According to Wiedenbach, a Knowledge encompasses all that has been
nursing philosophy has three essential perceived and grasped by the human mind. Knowledge
components: has infinite scope and range. Knowledge may be required
I. Reverence for the gift of life by the nurse in the academic arena and be useful for
II. Respect for the dignity, worth, autonomy, directing, teaching, planning and coordinating the care of
and individuality of each human being. the patient but is not sufficient to meet his need for help.
III. A resolution to act on personally and This knowledge comes through interaction with patients
professionally held beliefs

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in the real-world environment. Knowledge may be factual, Wiedenbach organized four elements to the
speculative, or practical. identification of the patient’s need for help.
§ Observing behaviors consistent or
inconsistent with comfort
§ Factual - accepted knowledge that is known § Exploring the meaning of individual
to be true patients’ behavior with them
§ Speculative - theories and concepts that are § Determining the cause of the discomfort or
put forward to explain phenomena incapability
particularly relevant to the subject areas of § Determining if patients can resolve their
the natural sciences, the social sciences and problems or need help
the humanities
§ Practical - knowing how to apply factual or 2. Ministration is providing the needed help, It
speculative knowledge to the situation at requires the identification of the need for help, the
hand. selection of an appropriate skill and acceptance of
that skill by the patient. Validation is evidence that
The judgment represents the nurse’s potential the patient’s need for help has been met as a result
for making sound decisions after weighing the facts. of the help given.
Judgment is derived from a cognitive process of present
knowledge against the personal values achieved through Wiedenbach identified one other element in practice that
ideals, principles and convictions. The judgment also indirectly affects the nurse’s role. This coordination, in
differentiates facts from assumptions, relating them to which the nurse coordinates all the services to the patient
cause and effect. Wiedenbach, suggested that judgment to prevent fragmentation of care by consulting and
is very personal and the nurse will exercise this according conferring with others to plan future care and reporting
to the purpose to be served, the available knowledge and this information both orally and in writing to ensure
her reaction to the prevailing environment at the time, in teamwork.
terms of the time, setting and individuals involved.
Decisions that are made this way may not be sound Art - the application of knowledge and skill to bring about
depending on the degree to which the nurse’s emotions desired results… Art is individualized action. Nursing art,
and thoughts have been disciplined. Uncontrollable then, is carried out by the nurse in a one-to-one
emotions can blot out both knowledge and purpose. relationship with the patient and constitutes the nurse’s
Unfounded assumptions can distort facts. Hence, the conscious responses to specifics in the patient’s
nurse requires as broad a knowledge and experience immediate situation.
base as possible and as great a clarity of purpose as
practical, to make a sound judgment. the art of clinical nursing consists of:
1. The nurse’s understanding of the patient’s
Skills present the nurse’s potential for achieving condition, situation and need.
the required results. Skill covers various and numerous 2. The nurse’s internal goals and external actions
acts which are characterized by ‘harmony and movement, are meant to enhance patient capability through
expression and intent, by precision and by adroit use of appropriate nursing care.
self’. 3. The nurse’s activities are directed toward the
improvement of the patient’s condition through
1. Identification includes individualized care of artful utilization of the medical plan of care
patients taking into account their experiences and 4. The nurse’s interventions aimed at prevention of
their perception of their condition and needs. the recurrence of the current concern or the
development of a new concern.

Three operational processes influence nursing art - expectation of what the patient may be like and
stimulus, preconception and interpretation. Nurse act interpretation is a comparison of perception with
based on these operations and their actions may be expectation or hope, However, preconception is based on
rational, reactionary, or deliberative. Stimulus is the the interpretation of the stimulus and may be
patient’s presenting behavior, preconception is an misinterpreted by the nurse.

PRESCRIPTIVE THEORY § The prescription for the fulfillment of central

purpose.
Wiedenbach's prescriptive theory is based on three § The realities in the immediate situation that
factors: influence the central purpose
§ The central purpose which the practitioner
recognizes as essential to the particular discipline

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12. KATHARINE KOLCABA’S
COMFORT THEORY

“The state of having addressed basic needs for

ease, relief, and transcendence met in contexts of § Physical: about bodily sensations,
experience (physical, psychospiritual, sociocultural, and homeostatic mechanisms, immune
environmental)” function, etc., that may or may not be
related to medical diagnoses
Nursing’s Metaparadigm § Psycho-spiritual: Having meaning in life,
a. Nursing: Intentional assessment of comfort involves self-awareness, esteem,
needs, design of comfort measures, sexuality, belief in and relationship with
implementation and evaluation of comfort someone higher or a supreme being
measures. The nurse assesses and reassesses § Sociocultural: Interpersonal
the patient by asking questions (e.g., Are you Relationships, in the family, or the society
comfortable? How do you feel?) or observing § Environmental: On external
(lab results, wound after a dressing change, or surroundings, conditions and influences,
behavioral changes). including color, noise, light, temperature,
b. Person: all individuals. Patients are care access to nature and texture.
recipients, individuals, families, institutions,
communities in need of health care Type of comfort:
c. Environment: any aspect of patient, family or 1. Relief – the state of having a specific comfort
institution surroundings that the nurse can need met; free of discomfort
manipulate to aide and improve the patient’s 2. Ease – the state of calm or contentment.
comfort. 3. Transcendence – the state in which one can rise
d. Health: optimum functioning, as defined by above problems or pain; risig above their level of
patient, family or community. discomfort, troubled or pain, strengthened,
motivated, determined
Major concepts
1. Health care needs. Needs related to well-being By having these comforts met, the patient is made
that cannot be relieved or bettered by the stronger immediately or holistically.
patient’s family/support system. Healthcare
needs include physical, psychological, spiritual, 5. Health-seeking behaviors: Actions related to
social and environmental needs. The needs are the goal of striving for health. These behaviors
made known by verbal/non-verbal can be internal, external or dying in peace. They
communication or by signs that the nurse may be defined by the patient or developed in
monitors. consultation with a nurse.

2. Comfort measures: There are interventions by 6. Institutional integrity: These are: corporations,
the nurse that are meant to address the specific communities, schools, hospitals, churches,
comfort needs of the one receiving the care. reformatories and others that possess qualities or
There are three types of comfort measures: states of being complete, whole, sound, upright,
appealing, honest, and sincere.
§ Technical care: reduce pain and
maintain homeostasis
§ Coaching: relieves anxiety, instills hope,
gives reassurance, listens, assists in
planning culturally sensitive measures
§ Comfort food for the soul strengthens
patients in intangible, memorable that
patients do not expect. They fortify
patients through such actions as
massage, guided imagery, music
therapy, reminiscence and hand-holding.

3. Intervening variables: Some variables are

connected and communicate with each other to
change or influence how the person sees total
comfort. These variables are identified as past
experiences, age, attitudes, state of emotion,
system of support, prognosis, finances, and the
totality of elements in the person’s experience.

4. Comfort: It is the state that is experienced and

perceived by the recipients of comfort measures.
The comfort experience can be in four contexts:

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