Concepts & Models

Environmental
Theory

12 May 1820 – 13 August 1910

  A social Reformer
 A Statistician
 The Mother of Modern Nursing
 The Lady with the Lamp in
Crimean War
 Versatile Writer = tracts on
medicine
 Belong to an upper class family
 Refused the life of traditional
women of her time
Religious inspiration led her to
devote her life to serving others,
both directly and as a reformer.
 To place the an individual
in best condition for
nature to act.

 is capable of reparative
process; responsive to the
environment.
 PHYSICAL ENVIRONMENT

Cleanliness
Ventilation
Air, Light
Noise, Water
Bedding
Drainage
Warmth, Diet

PATIENT

Communication
Advice Mortality data
Variety Prevention of disease

PSYCHOLOGICAL ENVIRONMENT SOCIAL ENVIRONMENT

 external condition that effect
the life & development of the
individual

 focus on the reparartive process

of getting well; very limited an
absence of disease
1. Gives different way of looking at a
phenomena= interrelatedness of the
concepts leads to prediction.
2. logical: the description of environment
affects human is congruent with the
explanation of the purpose and goal of
nursing and meaning of health.
3. Applicable to different settings &
outcome measurable.
4. Bases for hypothesis.
5. Simple & easy to understand.
6. Limited concept on disease.
 Definition of
Nursing

(November 30, 1897-March 19, 1996)

Foremost Nurse of the 20th
century.
holds twelve honorary
doctoral degrees
received the International
Council of Nursing's
Christianne Reimann Prize-
nursing's most prestigious
award.
 Born in Kansas City,
Missouri,
 Educator & researcher
 Advocated humane and
holistic care for patients
 Authored one of the most
accurate definitions of
nursing
 Promoted nursing research
as the basis for nursing
knowledge
Represented nursing with
dignity, honor, and grace.
 “ The unique function of the nurse is to
assist the individual, sick or well, in the
performance of those activities contributing
to health or its recovery ( or to a peaceful
death) that he would perform unaided if he
had necessary strength, will or knowledge.
And to do this in such a way as to help him
gain independence as rapidly as possible.”
1. Breath Normally
2. Eat & drink adequately
3. Eliminate Body wastes
4. Move & maintain desirable position Items 1-9
5. Sleep & Rest PHYSIOLOGIC
6. Select suitable clothes
7. Maintain body temperature within normal
range by adjusting clothing and modifying
the environment
8. Keep the body clean & well groomed &
protect the integument.
9. Avoid dangers in the environment & avoid
injuring others.
10. Communicate othersSPIRITUAL
in expressing
emotions, needs, fears & opinions. PSYCHO-
11. Worship according to one’s faith LOGICAL
12. Work in such a way that there is a sense of
accomplishments.
SOCIOLOGICAL
13. Play & participate in various forms of
recreation.
14. Learn, discover or satisfy the curiosity that
leads to normal development & health & use
the available health facilitities.
  Focus on rendering INDIVIDUAL
care
 Highlighted the 14 concepts of
Basic
 Nursing Care
 CLIENT CENTERED: doing for
patients what they can not do for
themselves.
 include the concept of spirituality
  consider as biological,
psychological, sociological,
spiritual components
 have basic needs reflected
on 14 components
 mind & body are
inseperable
pertains to family but rarely
to community
 society wants nurses to do
service for patient to act
independently, thus they
should contribute to nursing
education
 ability of the individual to function
independently

 definition of nursing
 nurses needs liberal education
 practice of individualized & human
care
STRENGTHS
She utilized concept of human needs,
biophysiology, culture & interaction
and is correlated & applied to
delineate nursing practice.
 Fits well with Maslow’ Hierarchy of
needs.
 It emphasize that nurses cannot fully
interpret & supply all the needs of a
person but instead her role is to HELP.
STRENGTHS
It emphasize that nurses cannot
fully interpret & supply all the needs
of a person but instead her role is to
HELP.
 Inclusion of the concept of health
recovery & peaceful death
 Simple, generalizable
 Applicable to all patients in all
ages.
LIMITATIONS
 No seen linkages in the 14 basic needs
 No concept of prioritization in the 14
basic needs.
 No clear discussion on what the nurse
“does” in peaceful death
 Client centered as strength & also the
main weakness.
 The definition cannot be fully viewed
as a theory.
 14 basic needs are for assessment
21 Nursing
Problems
  Born on March 13, 1919, in New
York City.
 May 6, 1937, the German hydrogen-
fueled airship Hindenburg exploded
over Lakehurst, New Jersey.
 1942, nursing diploma, magna cum
laude from Fitkin Memorial Hospital's
School of Nursing New Jersey.
 Bachelor of Science Degree in 1945,
Master of Arts degree in 1947 and
Doctor of Education in Teacher’s
College, Columbia University. 1947
she also took Master of Arts Degree in
Physiology.
  Educator
 Researcher
 Military Nurse
1. HEALTH = the interaction of
internal & external forces to
optimally use resources.
2. NURSING PROBLEMS = overt &
covert that nurses can assess.
3. PROBLEM SOLVING APPROACH =
step by step; systematic way of
dealing with nursing problems.
is the use of problem
solving approach with
key nursing problems
related to the health
needs of the people
 Conditions faced by the patient
and/or family which the nurse can
assist him or them to meet through the
performance of her professional
function.

 OVERT & COVERT NURSING

PROBLEMS
 The process of identifying
nursing problems and interpreting,
analyzing, and electing appropriate
courses of action to solve these
problems
1. To promote good hygiene & physical Preventive care
comfort. Needs
2. To promote optimal activity: exercise, rest
& sleep.
3. To promote safety through preventions of
accident, injury, or other trauma & through
the prevention of the spread of infection.
4. To maintain good body mechanics &
prevent & correct deformity.
5. To facilitate the maintenance of a supply
of oxygen to all body cells.
6. To facilitate the maintenance of nutrition of
all body cells.
PHYSIOLOGICAL
7. To facilitate maintenance of elimination.
8. To facilitate maintenance of fluid &
electrolyte balance.
9. To recognize the physiological responses of
the body to disease conditions- pathological,
physiological & compensatory.
10. To facilitate the maintenance of regulatory
mechanism & functions.
11. To facilitate maintenance of sensory
function.
12. To identify & accept positive & negative
expressions, feelings & reactions.
13. To identify & accepted interrelatedness of
emotions & organic illness. EMOTIONAL &
INTERPERSONAL
14. To facilitate maintenance of verbal & non-
verbal communications.
15. To promote the development of productive
interpersonal relationships.
16. To facilitate progress toward achievement &
personal spiritual goals.
17. To create & maintain therapeutic environment.
18. To facilitate awareness of self as an
individual with varying physical, emotional &
developmental needs.
19. To accept the optimum possible goals in
the light of limitations, physical &
emotional.
20. To use community resources as anSOCIOLOGICAL
aid in
resolving problems arising from illness.
21. To understand the role of social problems
as influencing factors in the cause of illness.
1.Physical, socio, emotional need
of patient
2. Types of interpersonal
relationship between nurse and
patient
3. Common elements of patient
care
PERSON
 recipient of nursing care
HEALTH
 the mind & body
interaction
 purpose of nursing
service
SOCIETY
 mentioned as served by
nursing but not mentioned
as patient.
NURSING
 Grouped into 21 nursing
problems area to guide
care & promote use of
nursing judgement
1. The 21 nursing Problems are based on
the work of research.
2. It allow getting away from the
medical diagnosis.
3. The concept of overt & covert.
4. ideal for training new nurses and
students.
5. Problem solving is logical.
6. Generalizability of problem solving
approach to all patients.
1. Very strong nursing centered
orientation.
2. inconsistency with holism
( interaction & prioritization)
3. Limited to individual with health
needs.
4. Role of patients in the 21 nursing
problems
5. Manifest fragmented care.
 WELLNESS
CENTERED
DISEASE
CENTERED

NURSE CENTERED

PATIENT
CENTERED
Core, Care
and Cure
Model
 INTERDEPENDENT
ROLE

DEPENDENT
ROLE
INDEPENDENT ROLE
Self-Care
Deficit Theory
of Nursing
 UNIVERSAL
DEVELOPMENTAL
HEALTH
DEVIATION
 WHOLLY COMPENSATORY
SYSTEM
JUDGEMENT & ACTIVITY
 PARTLY COMPENSATORY
SYSTEM
 SUPPORTIVE-EDUCATIVE
Conceptual
Model of
Nursing
Helping Relationship

Conceptual Model

Systematic Process
 Goal of profession
 Beneficiary
 Role
 Sources of Difficulty
 Interventions
 Consequences
1. Nurses have unique functions
although she shares certain functions
with other profession.
2. When nurses takes physician’s role,
she delegate her primary function to
inadequately prepared person.

3. Society wants & expects this nursing

service from the nurse and no other
worker is as able or willing to give it.
Cultural Care
Theory
 DIVERSITY
VS.
UNIVERSALITY
CULTURAL CARE PRESERVATION
- Maintenance

CULTURAL CARE ACCOMODATION

- Negotiation

CULTURAL CARE REPATTERNING

- Restructuring
 Philosophy
and Science of
CARING

Theory of Transpersonal
Caring

Human to human connectedness
occurring in a nurse- patient
encounter, each touched by the
human center of the other

The nurse enters the life space of
the patient, able to detect the
patient condition of being, feels this
condition within self & respond to
the patient by allowing him to
release thought, feelings & tension


it shows uniqueness of the nurse &
patient but the relationship is
reciprocal & mutual
 PHILOSOPHICAL FOUNDATION

1.Formation of a Humanistic-
altruistic system of values.
2.Instillation of Faith & Hope
3.Cultivation of sensitivity to
self & others
4. Development of Helping-Trust Relationship
5. Promotion & acceptance of the expression
of Positive & Negative feelings.
6. Systematic use of the Scientific problem-
solving method in decision making.
7. Promotion of Interpersonal-teaching
learning.
8. Provision for supportive, protective and
corrective mental, physical, socio-cultural,
and spiritual environment.
9. Assistance with gratification of Human
Needs
10. Allowance for existential &
phenomenological forces.

Whenever a nurse or others come
together with their unique life
histories in human to human
transaction, becoming a part of the
life of the other
 Human
Becoming
Theory

MAN-LIVING-HEALTH
Interpersonal
Relations in
Nursing
  Born in Reading,
Pennsylvania
 1931: graduated from Diploma
Nursing Program in Pottstown,
Pennsylvania
 1943 : B.A. Degree in
Interpersonal Psychology from
Bennington College
1947: MA in Psychiatric
Nursing
 1953 : EdD in Curriculum Dev’t
from Columbia University, N.Y.
  She became a
private & general
duty nurse, US
Army nurse,
Nursing
Researcher,
Private Practice in
Psychiatric Nursing & Nursing
Educator.
1952 : publish the book “
Interpersonal Relations in Nursing” –
many consider this as a radical book
during that time.
 She long held national &
international recognition as a nurse
& a leader in health care.
 Growth & Development

ORIENTATION
Teacher

Resource IDENTIFICATION

Counselor

Leader COMMUNICATION

Technical Expert
EXPLOITATION
Surrogate

RESOLUTION

Growth & Development

1. ORIENTATION
Meeting as
stranger – FELT
NEED
NURSE as COUNSELOR, AS A
RESOURCE
Values, culture, experiences of
nurse & client affect each other
2. IDENTIFICATION
 Selection of

appropriate
professional
assistance
Patient responded by:
1. Autonomous &
independent with the
Nurse
2. Passive & dependent
with the nurse
3. Participative with &
interdependent with Nurse
 Examples:

- Post MRM patient

- Diabetic Diet
Planning
3. EXPLOITATION PHASE
 Use of professional assistance to
solve problem
 Advantage of all available services
taken
 Two client reaction
 1. Demanding & attention getting
2. Active interest &
independence leading to
self-care
( Fluctuation between
dependence &
independence)
( Communication important)
4. RESOLUTION
TERMINAL PHASE
Needs met

Maybe hard both

for client & Nurse

ASSESSMENT ORIENTATION

PLANNING IDENTIFICATION
IMPLEMENTATION EXPLOITATION

EVALUATION RESOLUTION
PERSON OR MAN
 Strives in its own
way to reduce tension
generated by needs
 HEALTH
 a word symbol that
implies forward movement
or personality & other
ongoing human process in
the direction of creative,
constructive, productive,
personal & community
living.
 ENVIRONMENT/SOCIETY
 not directly
addressed
 encourage the
nurse to consider
patient’s culture &
mores.
 NURSING
 significant, therapeutic,
interpersonal process
 human relationship between
a, individual who is sick, or in
need of health services, and
of a nurse especially educated
to recognize and to respond to
the need for help.
Great contribution to
Nursing body of knowledge
not only on psychiatric-
mental health
 Generated research
questions & testable
hypotheses

Provides a framework
for nurse self-
assessment
 thrust of improving
nurse-patient

focus is on assisting
patients in identifying
psychological & growth
needs, thus is limited in
patient in many physiologic
needs.

limitation in caring for
unconscious patients
 limitation in the
concept of environment.