1.

Hildegard Peplau: Interpersonal Relations Theory

Hildegard Elizabeth Peplau (September 1, 1909 – March 17, 1999) was an American nurse who
is the only one to serve the American Nurses Association (ANA) as Executive Director and later
as President. She became the first published nursing theorist since Florence Nightingale.
Peplau was well-known for her Theory of Interpersonal Relations, which helped to revolutionize
the scholarly work of nurses. Her achievements are valued by nurses all over the world and
became known to many as the “Mother of Psychiatric Nursing” and the “Nurse of the Century.”
Hildegard Peplau’s Interpersonal Relations Theory
Hildegard Peplau’s Interpersonal Relations Theory emphasized the nurse-client relationship as
the foundation of nursing practice. It gave emphasis on the give-and-take of nurse-client
relationships that was seen by many as revolutionary. Peplau went on to form an interpersonal
model emphasizing the need for a partnership between nurse and client as opposed to the
client passively receiving treatment and the nurse passively acting out doctor’s orders.
The four components of the theory are: person, which is a developing organism that tries to
reduce anxiety caused by needs; environment, which consists of existing forces outside of the
person, and nursing, which is a significant therapeutic interpersonal process that functions
cooperatively with other human process that make health possible for individuals in
communities.
The nursing model identifies four sequential phases in the interpersonal
relationship: orientation, identification, exploitation, and resolution.
It also includes seven nursing roles: Stranger role, Resource role, Teaching role, Counseling
role, Surrogate

Major Concepts of the Interpersonal Relations Theory

 Man
Peplau defines man as an organism that “strives in its own way to reduce tension generated by
needs.” The client is an individual with a felt need.
 Health
Health is defined as “a word symbol that implies forward movement of personality and other
ongoing human processes in the direction of creative, constructive, productive, personal, and
community living.”

 Society or Environment
Although Peplau does not directly address society/environment, she does encourage the nurse
to consider the patient’s culture and mores when the patient adjusts to hospital routine.
 Nursing
Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal process.” She
defines it as a “human relationship between an individual who is sick, or in need of health
services, and a nurse specially educated to recognize and to respond to the need for help.”
Therapeutic nurse-client relationship
A professional and planned relationship between client and nurse that focuses on the client’s
needs, feelings, problems, and ideas. It involves interaction between two or more individuals
with a common goal. The attainment of this goal, or any goal, is achieved through a series of
steps following a sequential pattern.
Four Phases of the therapeutic nurse-patient relationship:
1. Orientation Phase
The orientation phase is directed by the nurse and involves engaging the client in treatment,
providing explanations and information, and answering questions.
Problem defining phase
Starts when the client meets nurse as a stranger
Defining problem and deciding the type of service needed
Client seeks assistance, conveys needs, asks questions, shares preconceptions and
expectations of past experiences
Nurse responds, explains roles to the client, helps to identify problems and to use
available resources and services
2. Identification Phase
The identification phase begins when the client works interdependently with the nurse,
expresses feelings, and begins to feel stronger.
Selection of appropriate professional assistance
Patient begins to have a feeling of belonging and a capability of dealing with the problem
which decreases the feeling of helplessness and hopelessness
3. Exploitation Phase
In the exploitation phase, the client makes full use of the services offered..
Use of professional assistance for problem-solving alternatives
Advantages of services are used is based on the needs and interests of the patients
The individual feels like an integral part of the helping environment
They may make minor requests or attention-getting techniques
The principles of interview techniques must be used in order to explore, understand and
adequately deal with the underlying problem
Patient may fluctuate on independence
Nurse must be aware of the various phases of communication
Nurse aids the patient in exploiting all avenues of help and progress is made towards the
final step
4. Resolution Phase
In the resolution phase, the client no longer needs professional services and gives up
dependent behavior. The relationship ends.
Termination of professional relationship
The patients needs have already been met by the collaborative effect of patient and
nurse
Now they need to terminate their therapeutic relationship and dissolve the links between
them.
Sometimes may be difficult for both as psychological dependence persists
Patient drifts away and breaks the bond with the nurse and healthier emotional balance
is demonstrated and both becomes mature individuals
Strengths
Peplau’s theory helped later nursing theorists and clinicians develop more therapeutic
interventions regarding the roles that show the dynamic character typical in clinical nursing.
Its phases provide simplicity regarding the natural progression of the nurse-patient relationship,
which leads to adaptability in any nurse-patient interaction, thus providing generalizability.
Weaknesses
Though Peplau stressed the nurse-client relationship as the foundation of nursing
practice, health promotion, and maintenance were less emphasized.
Also, the theory cannot be used in a patient who doesn’t have a felt need such as with
withdrawn patients.

2. Ida Jean Orlando: Deliberative Nursing Process Theory

.
Ida Jean Orlando-Pelletier (August 12, 1926 – November 28, 2007) was an internationally
known psychiatric health nurse, theorist and researcher who developed the “Deliberative
Nursing Process Theory.” Her theory allows nurses to create an effective nursing care plan that
can also be easily adapted when and if any complications arise with the patient.
Orlando’s Deliberative Nursing Process Theory
One important thing that nurses do is converse with the patients and let them know what the
plan of care for the day is going to be. However, regardless of how well thought out a nursing
care plan is for a patient, unexpected problems to the patient’s recovery may arise at any time.
With these, the job of the nurse is to know how to deal with those problems so the patient can
continue to get back and reclaim his or her well-being. Ida Jean Orlando developed
her Deliberative Nursing Process that allows nurses to formulate an effective nursing care plan
that can also be easily adapted when and if any complexity comes up with the patient.
Ida Jean Orlando’s nursing theory stresses the reciprocal relationship between patient and
nurse. It emphasizes the critical importance of the patient’s participation in the nursing process.
Orlando also considered nursing as a distinct profession and separated it from medicine where
nurses as determining nursing action rather than being prompted by physician’s orders,
organizational needs and past personal experiences. She believed that the physician’s orders
are for patients and not for nurses.
She proposed that “patients have their own meanings and interpretations of situations and
therefore nurses must validate their inferences and analyses with patients before drawing
conclusions.”
.
Major Concepts
 Human Being
Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of
the nurse-patient relationship. For her, humans in need are the focus of nursing practice.
 Health
In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity
for nursing. She stated that nursing deals with individuals who are in need of help.
 Environment
Orlando completely disregarded environment in her theory, only focusing on the immediate
need of the patient, chiefly the relationship and actions between the nurse and the patient (only
an individual in her theory; no families or groups were mentioned). The effect that the
environment could have on the patient was never mentioned in Orlando’s theory.
 Nursing
Orlando speaks of nursing as unique and independent in its concerns for an individual’s need
for help in an immediate situation. The efforts to meet the individual’s need for help are carried
out in an interactive situation and in a disciplined manner that requires proper training.
5 Stages of the Deliberative Nursing Process.

1. Assessment
In the assessment stage, the nurse completes a holistic assessment of the patient’s needs. This
is done without taking the reason for the encounter into consideration. The nurse uses a nursing
framework to collect both subjective and objective data about the patient.
2. Diagnosis
The diagnosis stage uses the nurse’s clinical judgment about health problems. The diagnosis
can then be confirmed using links to defining characteristics, related factors, and risk factors
found in the patient’s assessment.
3. Planning
The planning stage addresses each of the problems identified in the diagnosis. Each problem is
given a specific goal or outcome, and each goal or outcome is given nursing interventions to
help achieve the goal. By the end of this stage, the nurse will have a nursing care plan.
4. Implementation
In the implementation stage, the nurse begins using the nursing care plan.
5. Evaluation
Finally, in the evaluation stage, the nurse looks at the progress of the patient toward the goals
set in the nursing care plan. Changes can be made to the nursing care plan based on how well
(or poorly) the patient is progressing toward the goals. If any new problems are identified in the
evaluation stage, they can be addressed, and the process starts over again for those specific
problems.

Strengths
The guarantee that patients will be treated as individuals is very much applied in Orlando’s
theory of Deliberative Nursing Process. Each patient will have an active and constant input into
their own care.
Assertion of nursing’s independence as a profession and her belief that this independence must
be based on a sound theoretical framework.
The model also guides the nurse to evaluate her care in terms of objectively observable patient
outcomes.
Weaknesses
The lack of the operational definitions of society or environment was evident which limits the
development of research hypothesis.
Orlando’s work focuses on short term care, particularly aware and conscious individuals and on
the virtual absence of reference group or family members.

3. LYDIA HALL – CORE, CARE, CURE

Lydia Eloise Hall (September 21, 1906 – February 27, 1969) was a nursing theorist who
developed the Care, Cure, Core model of nursing. Her theory defined Nursing as “a participation
in care, core and cure aspects of patient care, where CARE is the sole function of nurses,
whereas the CORE and CURE are shared with other members of the health team.”
She was an innovator, motivator, and mentor to nurses in all phases of their careers and an
advocate for chronically ill patients and worked to involve the community in public health issues
as well.

Major Concepts of Care, Core, Cure

 Individual
The individual human who is 16 years of age or older and past the acute stage of long-term
illness is the focus of nursing care in Hall’s work. The source of energy and motivation for
healing is the individual care recipient, not the health care provider. Hall emphasizes the
importance of the individual as unique, capable of growth and learning, and requiring a total
person approach.
 Health
Health can be inferred to be a state of self-awareness with a conscious selection of behaviors
that are optimal for that individual. Hall stresses the need to help the person explore the
meaning of his or her behavior to identify and overcome problems through developing self-
identity and maturity.
 Society and Environment
The concept of society or environment is dealt with in relation to the individual. Hall is credited
with developing the concept of Loeb Center because she assumed that the hospital
environment during treatment of acute illness creates a difficult psychological experience for the
ill individual. Loeb Center focuses on providing an environment that is conducive to self-
development. In such a setting, the focus of the action of the nurses is the individual, so that any
actions taken in relation to society or environment are for the purpose of assisting the individual
in attaining a personal goal.
 Nursing
Nursing is identified as consisting of participation in the care, core, and cure aspects of patient
care.

Subconcepts
1. The Care Circle
According to the theory, nurses are focused on performing the noble task of nurturing patients.
This circle solely represents the role of nurses, and is focused on performing the task of
nurturing patients. Nurturing involves using the factors that make up the concept of mothering
(care and comfort of the person) and provide for teaching-learning activities.
The care circle defines the primary role of a professional nurse such as providing bodily care for
the patient and helping the patient complete such basic daily biological functions as eating,
bathing, elimination, and dressing. When providing this care, the nurse’s goal is the comfort of
the patient.
Moreover, the role of the nurse also includes educating patients, and helping a patient meet any
needs he or she is unable to meet alone. This presents the nurse and patient with an
opportunity for closeness. As closeness develops, the patient can share and explore feelings
with the nurse.
2. The Core Circle
The core, according to Hall’s theory, is the patient receiving nursing care. The core has goals
set by him or herself rather than by any other person and behaves according to his or her
feelings and values. This involves the therapeutic use of self and is shared with other members
of the health team.
This area emphasizes the social, emotional, spiritual, and intellectual needs of the patient in
relation to family, institution, community and the world. This is able to help the patient verbally
express feelings regarding the disease process and its effects by the use of the reflective
technique. Through such expression, the patient is able to gain self-identity and further develop
maturity.
Reflective technique is used by the professional nurse in a way the he or she acts as a mirror to
the patient to help the latter explore his or her own feelings regarding his or her current health
status and related potential changes in lifestyle.
Motivations are discovered through the process of bringing into awareness the feelings being
experienced. With this awareness, the patient is now able to make conscious decisions based
on understood and accepted feelings and motivation.
3. The Cure Circle
The cure as explained in this theory is the aspect of nursing which involves the administration of
medications and treatments. Hall explains in the model that the cure circle is shared by the
nurse with other health professionals, such as physicians or physical therapists.
In short, these are the interventions or actions geared toward treating the patient for whatever
illness or disease he or she is suffering from. During this aspect of nursing care, the nurse is an
active advocate of the patient.
For example, in the care phase, the nurse gives hands-on bodily care to the patient in relation in
relation to the activities of daily living such as toileting and bathing. In the cure phase, the nurse
applies medical knowledge to treatment of the person, and in the core phase, the nurse
addresses the social and emotional needs of the patient for effective communication and a
comfortable environment.
Strengths
Lydia Hall’s model appears to be completely and simply logical. Her work may be viewed as the
philosophy of nursing.
The three Cs (care, core and cure) in this theory were unique. In all the circles of the model, the
nurse is present, although focus of the nurse’s role is on the care circle.
Weaknesses
Lydia Hall’s model is considered to be plain and simple in its presentation. However, the
receptiveness and resilience necessary for its utilization and function may not be so simple for
nurses whose personality, educational preparation, and experience have not prepared them to
function with minimal structure. This and the self-imposed age and illness requirements limit the
generalizability.
The age requirement for the application of her theory which is 16 years of age and above limits
the theory since it cannot be disregarded that nurses are faced with pediatric clients every now
and then.
The concept of a patient aggregate such as having families and communities as the focus of
nursing practice was not tackled. It is purely on the individual himself. Although, the role of the
family or the community within the patient’s environment was modestly discussed.

4. Faye Abdellah: 21 Nursing Problems Theory

Faye Glenn Abdellah (March 13, 1919 – present) is a pioneer in nursing research who
developed the “Twenty-One Nursing Problems.” Her model of nursing was progressive for the
time in that it refers to a nursing diagnosis during a time in which nurses were taught that
diagnoses were not part of their role in health care.
She was the first nurse officer to earn the ranking of a two-star rear admiral and the first nurse
and the first woman to serve as a Deputy Surgeon General.
21 Nursing Problems Theory
According to Faye Glenn Abdellah’s theory, “Nursing is based on an art and science that
moulds the attitudes, intellectual competencies, and technical skills of the individual nurse into
the desire and ability to help people, sick or well, cope with their health needs.”
The patient-centered approach to nursing was developed from Abdellah’s practice, and the
theory is considered a human needs theory. It was formulated to be an instrument for nursing
education, so it most suitable and useful in that field. The nursing model is intended to guide
care in hospital institutions, but can also be applied to community health nursing, as well.
Major Concepts of 21 Nursing Problems Theory
The model has interrelated concepts of health and nursing problems, as well as problem-
solving, which is an activity inherently logical in nature.
 Individual
She describes the recipients of nursing as individuals (and families), although she does not
delineate her beliefs or assumptions about the nature of human beings.
 Health
Health, or the achieving of it, is the purpose of nursing services. Although Abdellah does not
give a definition of health, she speaks to “total health needs” and “a healthy state of mind and
body.”
Health may be defined as the dynamic pattern of functioning whereby there is a continued
interaction with internal and external forces that results in the optimal use of necessary
resources to minimize vulnerabilities.
 Society
Society is included in “planning for optimum health on local, state, and international levels.”
However, as Abdellah further delineates her ideas, the focus of nursing service is clearly the
individual.
 Nursing Problems
The client’s health needs can be viewed as problems, which may be overt as an apparent
condition, or covert as a hidden or concealed one.
Because covert problems can be emotional, sociological, and interpersonal in nature, they are
often missed or perceived incorrectly. Yet, in many instances, solving the covert problems may
solve the overt problems as well.
Problem Solving
Quality professional nursing care requires that nurses be able to identify and solve overt and
covert nursing problems. These requirements can be met by the problem-solving process
involves identifying the problem, selecting pertinent data, formulating hypotheses, testing
hypotheses through the collection of data, and revising hypotheses when necessary on the
basis of conclusions obtained from the data.
Subconcepts
The following are the subconcepts of Faye Abdellah’s “21 Nursing Problems” theory and their
definitions.
Abdellah’s Typology of 21 Nursing Problems

The 21 nursing problems fall into three categories: physical, sociological, and emotional needs
of patients; types of interpersonal relationships between the patient and nurse; and common
elements of patient care. She used Henderson’s 14 basic human needs and nursing research to
establish the classification of nursing problems. Abdellah’s 21 Nursing Problems are the
following:
1. To maintain good hygiene and physical comfort
2. To promote optimal activity: exercise, rest, sleep
3. To promote safety through prevention of accident, injury, or other trauma and through
prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformity
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition for all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease conditions—pathologic,
physiologic, and compensatory
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
 15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement and personal spiritual goals
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs
19. To accept the optimum possible goals in the light of limitations, physical and emotional
20. To use community resources as an aid in resolving problems that arise from illness
21. To understand the role of social problems as influencing factors in the cause of illness
Moreover, the needs of patients are further divided into four categories: basic to all
patients, sustenal care needs, remedial care needs, and restorative care needs.

 Basic Needs
The basic needs of an individual patient are to maintain good hygiene and physical comfort;
promote optimal health through healthy activities, such as exercise, rest and sleep; promote
safety through the prevention of health hazards like accidents, injury or other trauma and
through the prevention of the spread of infection; and maintain good body mechanics and
prevent or correct deformity.

 Sustenal Care Needs

Sustenal care needs facilitate the maintenance of a supply of oxygen to all body cells; facilitate
the maintenance of nutrition of all body cells; facilitate the maintenance of elimination; facilitate
the maintenance of fluid and electrolyte balance; recognize the physiological responses of the
body to disease conditions; facilitate the maintenance of regulatory mechanisms and functions;
and facilitate the maintenance of sensory function.

 Remedial Care Needs

Remedial care needs to identify and accept positive and negative expressions, feelings, and
reactions; identify and accept the interrelatedness of emotions and organic illness; facilitate the
maintenance of effective verbal and non-verbal communication; promote the development of
productive interpersonal relationships; facilitate progress toward achievement of personal
spiritual goals; create and maintain a therapeutic environment; and facilitate awareness of the
self as an individual with varying physical, emotional, and developmental needs.

 Restorative Care Needs

Restorative care needs include the acceptance of the optimum possible goals in light of
limitations, both physical and emotional; the use of community resources as an aid to resolving
problems that arise from illness; and the understanding of the role of social problems as
influential factors in the case of illness.
Abdellah’s work, which is based on the problem-solving method, serves as a vehicle for
delineating nursing (patient) problems as the patient moves toward a healthy outcome. The
theory identifies ten steps to identify the patient’s problem and 11 nursing skills used to develop
a treatment typology.

The ten steps are:

 1. Learn to know the patient.
2. Sort out relevant and significant data.
3. Make generalizations about available data in relation to similar nursing problems
presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient’s conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting his or her behavior.
8. Explore the patient and his or her family’s reactions to the therapeutic plan and involve
them in the plan.
9. Identify how the nurses feel about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.

The 11 nursing skills are:

 observation of health status

 skills of communication
 application of knowledge
 teaching of patients and families
 planning and organization of work
 use of resource materials
 use of personnel resources
 problem-solving
 direction of work of others
 therapeutic uses of the self
 nursing procedure

Abdellah also explained nursing as a comprehensive service, which includes:

Recognizing the nursing problems of the patient
Deciding the appropriate course of action to take in terms of relevant nursing principles
Providing continuous care of the individual’s total needs
Providing continuous care to relieve pain and discomfort and provide immediate security
for the individual
Adjusting the total nursing care plan to meet the patient’s individual needs
Helping the individual to become more self-directing in attaining or maintaining a healthy
state of body and mind
Instructing nursing personnel and family to help the individual do for himself that which
he can within his limitations
Helping the individual to adjust to his limitations and emotional problems
Working with allied health professions in planning for optimum health on local, state,
national, and international levels
Carrying out continuous evaluation and research to improve nursing techniques and to
develop new techniques to meet people’s health needs
Strengths
  The problem-solving approach is readily generalizable to the client with specific health
needs and specific nursing problems.
 With the model’s nature, healthcare providers and practitioners can use
Abdellah’s problem-solving approach to guide various activities within the clinical setting.
This is true when considering nursing practice that deals with clients who have specific
needs and specific nursing problems.
 The language of Faye Abdellah’s framework is simple and easy to comprehend.
 The theoretical statement greatly focuses on problem-solving, an activity that is
inherently logical in nature.
Weaknesses
 The major limitation to Abdellah’s theory and the 21 nursing problems is their very strong
nurse-centered orientation. She rather conceptualized nurses’ actions in nursing care
which is contrary to her aim.
 Another point is the lack of emphasis on what the client is to achieve was given in terms
of client care.
 Framework seems to focus quite heavily on nursing practice and individuals. This
somewhat limits the ability to generalize although the problem-solving approach is
readily generalizable to clients with specific health needs and specific nursing.
 Also, Abdellah’s framework is inconsistent with the concept of holism. The nature of the
21 nursing problems attests to this. As a result, the client may be diagnosed as having
numerous problems that would lead to fractionalized care efforts, and potential problems
might be overlooked because the client is not deemed to be in a particular stage of
illness.

5. Virginia Henderson: Nursing Need Theory

Virginia Avenel Henderson (November 30, 1897 – March 19, 1996) was a nurse, theorist, and
author known for her Need Theory and defining nursing as: “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 peaceful death) that he would perform unaided if he had the necessary
strength, will or knowledge.” Henderson is also known as “The First Lady of Nursing,” “The
Nightingale of Modern Nursing,” “Modern-Day Mother of Nursing,” and “The 20th
Century Florence Nightingale.”
Major Concepts of the Nursing Need Theory
 Individual
Henderson states that individuals have basic needs that are component of health and require
assistance to achieve health and independence or a peaceful death. According to her, an
individual achieves wholeness by maintaining physiological and emotional balance.
She defined the patient as someone who needs nursing care but did not limit nursing to illness
care. Her theory presented the patient as a sum of parts with biopsychosocial needs and the
mind and body are inseparable and interrelated.
 Environment
Although the Need Theory did not explicitly define the environment, Henderson stated that
maintaining a supportive environment conducive for health is one of the elements of her 14
activities for client assistance.
Henderson’s theory supports the tasks of the private and the public health sector or agencies in
keeping the people healthy. She believes that society wants and expects the nurse’s service of
acting for individuals who are unable to function independently.
 Health
Although not explicitly defined in Henderson’s theory, health was taken to mean balance in all
realms of human life. It is equated with the independence or ability to perform activities without
any aid in the 14 components or basic human needs.
Nurses, on the other hand, are key persons in promoting health, prevention of illness and being
able to cure. According to Henderson, good health is a challenge because it is affected by
numerous factors such as age, cultural background, emotional balance, and others.
 Nursing
Virginia Henderson wrote her definition of nursing before the development of theoretical nursing.
She defined nursing as “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. And to do this in such a way as to
help him gain independence as rapidly as possible.” The nurse’s goal is to make the patient
complete, whole, or independent. In turn, the nurse collaborates with the physician’s therapeutic
plan.
Nurses temporarily assist an individual who lacks the necessary strength, will, and knowledge to
satisfy one or more of the 14 basic needs. She states: “The nurse is temporarily the
consciousness of the unconscious, the love life for the suicidal, the leg of the amputee, the eyes
of the newly blind, a means of locomotion for the infant, knowledge, and confidence of the
young mother, the mouthpiece for those too weak or withdrawn to speak”
Additionally, she stated that “…the nurse does for others what they would do for themselves if
they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the
patient independent of him or her as soon as possible.”
Her definition of nursing distinguished the role of a nurse in health care: The nurse is expected
to carry out a physician’s therapeutic plan, but individualized care is the result of the nurse’s
creativity in planning for care.
The nurse should be an independent practitioner able to make an independent judgment. In her
work Nature of Nursing, she states the nurse’s role is “to get inside the patient’s skin and
supplement his strength, will or knowledge according to his needs.” The nurse has the
responsibility to assess the needs of the patient, help him or her meet health needs, and provide
an environment in which the patient can perform activity unaided.
14 Components of the Need Theory
The 14 components of Virginia Hendersons Need Theory show a holistic approach to nursing
that covers the physiological, psychological, spiritual and social needs.
Physiological Components
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and undress
7. Maintain body temperature within normal range by adjusting clothing and modifying
environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others
Psychological Aspects of Communicating and Learning
10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Learn, discover, or satisfy the curiosity that leads to normal development and health and use
the available health facilities.
Spiritual and Moral
12. Worship according to one’s faithSociologically Oriented to Occupation and Recreation
13. Work in such a way that there is sense of accomplishment
14. Play or participate in various forms of recreation
Strengths
 Virginia Henderson’s concept of nursing is widely accepted in nursing practice today.
Her theory and 14 components are relatively simple, logical, and can be applied to
individuals of all ages.
Weaknesses
 There is an absence of a conceptual diagram that interconnects the 14 concepts and
subconcepts of Henderson’s theory. On assisting the individual in the dying process,
there is a little explanation of what the nurse does to provide “peaceful death.

6. Nola Pender: Health Promotion Model

Nola Pender was born on August 16, 1941, in Lansing, Michigan to parents who advocated
education for women. Her first encounter with the nursing profession was when she was 7 years
old and witnessed the care given to her hospitalized aunt by nurses. This situation led her to the
desire to care for other people and her goal was to help people care for themselves.
What is Health Promotion Model?
The Health Promotion Model notes that each person has unique personal characteristics and
experiences that affect subsequent actions. The set of variables for behavioral specific
knowledge and affect have important motivational significance. These variables can be modified
through nursing actions. Health promoting behavior is the desired behavioral outcome and is the
endpoint in the Health Promotion Model. Health promoting behaviors should result in improved
health, enhanced functional ability and better quality of life at all stages of development. The
final behavioral demand is also influenced by the immediate competing demand and
preferences, which can derail intended health-promoting actions.
Nola Pender’s Health Promotion Model theory was originally published in 1982 and later
improved in 1996 and 2002. It has been used for nursing research, education, and practice.
Applying this nursing theory and the body of knowledge that has been collected through
observation and research, nurses are in the top profession to enable people to improve their
well-being with self-care and positive health behaviors.
The Health Promotion Model was designed to be a “complementary counterpart to models of
health protection.” It develops to incorporate behaviors for improving health and applies across
the life span. Its purpose is to assist nurses in knowing and understanding the major
determinants of health behaviors as a foundation for behavioral counseling to promote well-
being and healthy lifestyles.
Pender’s health promotion model defines health as “a positive dynamic state not merely the
absence of disease.” Health promotion is directed at increasing a client’s level of well-being. It
describes the multi-dimensional nature of persons as they interact within the environment to
pursue health.
The model focuses on the following three areas: individual characteristics and experiences,
behavior-specific cognitions and affect, and behavioral outcomes.
Major Concepts of the Health Promotion Model
 Health promotion is defined as behavior motivated by the desire to increase well-being
and actualize human health potential. It is an approach to wellness.
On the other hand, health protection or illness prevention is described as behavior motivated
desire to actively avoid illness, detect it early, or maintain functioning within the constraints
of illness.

 Individual characteristics and experiences (prior related behavior and personal factors).
 Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers
to action, perceived self-efficacy, activity-related affect, interpersonal influences, and
situational influences).
 Behavioral outcomes (commitment to a plan of action, immediate competing demands
and preferences, and health-promoting behavior).
Subconcepts of the Health Promotion Model
 Personal Factors
Personal factors categorized as biological, psychological and socio-cultural. These
factors are predictive of a given behavior and shaped by the nature of the target
behavior being considered.
Personal biological factors. Include variables such as age gender body mass index
pubertal status, aerobic capacity, strength, agility, or balance.
Personal psychological factors. Include variables such as self-esteem, self-motivation,
personal competence, perceived health status, and definition of health.
Personal socio-cultural factors. Include variables such as race, ethnicity, acculturation,
education, and socioeconomic status.

 Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.
Perceived Barriers to Action
Anticipated, imagined or real blocks and personal costs of understanding a given
behavior.

 Perceived Self-Efficacy
Judgment of personal capability to organize and execute a health-promoting behavior.
Perceived self-efficacy influences perceived barriers to action so higher efficacy results
in lowered perceptions of barriers to the performance of the behavior.

 Activity-Related Affect
Subjective positive or negative feeling that occurs before, during and following behavior
based on the stimulus properties of the behavior itself.
Activity-related affect influences perceived self-efficacy, which means the more positive
the subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of
efficacy can generate a further positive affect.

 Interpersonal Influences
Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal
influences include norms (expectations of significant others), social support (instrumental
and emotional encouragement) and modeling (vicarious learning through observing
others engaged in a particular behavior). Primary sources of interpersonal influences are
families, peers, and healthcare providers.

 Situational Influences
Personal perceptions and cognitions of any given situation or context that can facilitate
or impede behavior. Include perceptions of options available, demand characteristics
and aesthetic features of the environment in which given health promoting is proposed to
take place. Situational influences may have direct or indirect influences on health
behavior.

 Commitment to Plan of Action

The concept of intention and identification of a planned strategy leads to the
implementation of health behaviour

 Immediate Competing Demands and Preferences

 Competing demands are those alternative behaviors over which individuals have low
control because there are environmental contingencies such as work or family care
responsibilities. Competing preferences are alternative behaviors over which individuals
exert relatively high control, such as choice of ice cream or apple for a snack

 Health-Promoting Behavior
A health-promoting behavior is an endpoint or action outcome that is directed toward
attaining positive health outcomes such as optimal wellbeing, personal fulfillment, and
productive living.
Major Assumptions in Health Promotion Model

 Individuals seek to actively regulate their own behavior.

 Individuals in all their biopsychosocial complexity interact with the environment,
progressively transforming the environment and being transformed over time.
 Health professionals constitute a part of the interpersonal environment, which exerts
influence on persons throughout their life span.
 Self-initiated reconfiguration of person-environment interactive patterns is essential to
behavior change.
Propositions

 Prior behavior and inherited and acquired characteristics influence beliefs, affect, and
enactment of health-promoting behavior.
 Persons commit to engaging in behaviors from which they anticipate deriving personally
valued benefits.
 Perceived barriers can constrain commitment to action, a mediator of behavior as well
as actual behavior.
 Perceived competence or self-efficacy to execute a given behavior increases the
likelihood of commitment to action and actual performance of the behavior.
 Greater perceived self-efficacy results in fewer perceived barriers to a specific health
behavior.
 Positive affect toward a behavior results in greater perceived self-efficacy, which can, in
turn, result in increased positive affect.
 When positive emotions or affect are associated with a behavior, the probability of
commitment and action is increased.
 Persons are more likely to commit to and engage in health-promoting behaviors when
significant others model the behavior, expect the behavior to occur, and provide
assistance and support to enable the behavior.
 Families, peers, and health care providers are important sources of interpersonal
influence that can increase or decrease commitment to and engagement in health-
promoting behavior.
 Situational influences in the external environment can increase or decrease commitment
to or participation in health-promoting behavior.
 The greater the commitments to a specific plan of action, the more likely health-
promoting behaviors are to be maintained over time.
 Commitment to a plan of action is less likely to result in the desired behavior when
competing demands over which persons have little control require immediate attention.
  Commitment to a plan of action is less likely to result in the desired behavior when other
actions are more attractive and thus preferred over the target behavior.
 Persons can modify cognitions, affect, and the interpersonal and physical environment to
create incentives for health actions.

Strengths
 The Health Promotion Model is simple to understand yet it is complex in structure.
 Nola Pender’s nursing theory gave much focus on health promotion and disease
prevention making it stand out from other nursing theories.
 It is highly applicable in the community health setting.
 It promotes the independent practice of the nursing profession being the primary source
of health promoting interventions and education.
Weaknesses
 The Health Promotion Model of Pender was not able to define the nursing metapradigm
or the concepts that a nursing theory should have, man, nursing, environment, and
health.
 The conceptual framework contains multiple concepts which may invite confusion to the
reader.
 Its applicability to an individual currently experiencing a disease state was not given
emphasis.

7. Madeleine Leininger: Transcultural Nursing Theory

Madeleine Leininger (July 13, 1925 – August 10, 2012) was an internationally known educator,
author, theorist, administrator, researcher, consultant, public speaker and the developer of the
concept of transcultural nursing that has a great impact on how to deal with patients of different
culture and cultural background.
She is a Certified Transcultural Nurse, a Fellow of the Royal College of Nursing in Australia, and
a Fellow of the American Academy of Nursing. Her theory is now a nursing discipline that is an
integral part of how nurses practice in the healthcare field today.
Leininger’s Transcultural Nursing Theory
The Transcultural Nursing Theory or Culture Care Theory by Madeleine Leininger involves
knowing and understanding different cultures with respect to nursing and health-illness caring
practices, beliefs and values with the goal to provide meaningful and efficacious nursing care
services to people according to their cultural values and health-illness context.
It focuses on the fact that different cultures have different caring behaviors and different health
and illness values, beliefs, and patterns of behaviors.
The cultural care worldview flows into knowledge about individuals, families, groups,
communities, and institutions in diverse health care systems. This knowledge provides culturally
specific meanings and expressions in relation to care and health. The next focus is on the
generic or folk system, professional care system(s), and nursing care. Information about these
systems includes the characteristics and the specific care features of each. This information
allows for the identification of similarities and differences or cultural care universality and cultural
care diversity.
Next are nursing care decisions and actions which involve cultural care
preservation/maintenance, cultural care accommodation/negotiation and cultural care re-
patterning or restructuring. It is here that nursing care is delivered.

Major Concepts of the Transcultural Nursing Theory

 Transcultural Nursing
Transcultural nursing is defined as a learned subfield or branch of nursing which focuses upon
the comparative study and analysis of cultures with respect to nursing and health-illness caring
practices, beliefs, and values with the goal to provide meaningful and efficacious nursing care
services to people according to their cultural values and health-illness context.
 Ethnonursing
This is the study of nursing care beliefs, values, and practices as cognitively perceived and
known by a designated culture through their direct experience, beliefs, and value system
(Leininger, 1979).
 Nursing
Nursing is defined as a learned humanistic and scientific profession and discipline which is
focused on human care phenomena and activities in order to assist, support, facilitate, or enable
individuals or groups to maintain or regain their well-being (or health) in culturally meaningful
and beneficial ways, or to help people face handicaps or death.
 Professional Nursing Care (Caring)
Professional nursing care (caring) is defined as formal and cognitively learned professional care
knowledge and practice skills obtained through educational institutions that are used to provide
assistive, supportive, enabling, or facilitative acts to or for another individual or group in order to
improve a human health condition (or well-being), disability, lifeway, or to work with dying
clients.
 Cultural Congruent (Nursing) Care
Cultural congruent (nursing) care is defined as those cognitively based assistive, supportive,
facilitative, or enabling acts or decisions that are tailor-made to fit with individual, group, or
institutional cultural values, beliefs, and lifeways in order to provide or support meaningful,
beneficial, and satisfying health care, or well-being services.
 Health
It is a state of well-being that is culturally defined, valued, and practiced, and which reflects the
ability of individuals (or groups) to perform their daily role activities in culturally expressed,
beneficial, and patterned lifeways.
  Human Beings
Such are believed to be caring and to be capable of being concerned about the needs, well-
being, and survival of others. Leininger also indicates that nursing as a caring science should
focus beyond traditional nurse-patient interactions and dyads to include families, groups,
communities, total cultures, and institutions.
 Society and Environment
These terms are not defined by Leininger; she speaks instead of worldview, social structure,
and environmental context.
Worldview
Worldview is the way in which people look at the world, or at the universe, and form a “picture or
value stance” about the world and their lives.
Cultural and Social Structure Dimensions
Cultural and social structure dimensions are defined as involving the dynamic patterns and
features of interrelated structural and organizational factors of a particular culture (subculture or
society) which includes religious, kinship (social), political (and legal), economic, educational,
technological and cultural values, ethnohistorical factors, and how these factors may be
interrelated and function to influence human behavior in different environmental contexts.
Environmental Context
Environmental context is the totality of an event, situation, or particular experience that gives
meaning to human expressions, interpretations, and social interactions in particular physical,
ecological, sociopolitical and/or cultural settings.
Culture
Culture is the learned, shared and transmitted values, beliefs, norms, and lifeways of a
particular group that guides their thinking, decisions, and actions in patterned ways.
Culture Care
Culture care is defined as the subjectively and objectively learned and transmitted values,
beliefs, and patterned lifeways that assist, support, facilitate, or enable another individual or
group to maintain their well-being, health, improve their human condition and lifeway, or to deal
with illness, handicaps or death.
Culture Care Diversity
Culture care diversity indicates the variabilities and/or differences in meanings, patterns, values,
lifeways, or symbols of care within or between collectives that are related to assistive,
supportive, or enabling human care expressions.
Culture Care Universality
Culture care universality indicates the common, similar, or dominant uniform care meanings,
pattern, values, lifeways or symbols that are manifest among many cultures and reflect
assistive, supportive, facilitative, or enabling ways to help people. (Leininger, 1991)
Subconcepts
The following are the subconcepts of the Transcultural Nursing Theory of Madeleine Leininger
and their definitions:
Generic (Folk or Lay) Care Systems
Generic (folk or lay) care systems are culturally learned and transmitted, indigenous (or
traditional), folk (home-based) knowledge and skills used to provide assistive, supportive,
enabling, or facilitative acts toward or for another individual, group, or institution with evident or
anticipated needs to ameliorate or improve a human life way, health condition (or well-being), or
to deal with handicaps and death situations.
Emic
Knowledge gained from direct experience or directly from those who have experienced. It is
generic or folk knowledge.
Professional Care Systems
Professional care systems are defined as formally taught, learned, and transmitted professional
care, health, illness, wellness, and related knowledge and practice skills that prevail in
professional institutions usually with multidisciplinary personnel to serve consumers.
Etic
Knowledge which describes the professional perspective. It is professional care knowledge.
Ethnohistory
Ethnohistory includes those past facts, events, instances, experiences of individuals, groups,
cultures, and instructions that are primarily people-centered (ethno) and which describe,
explain, and interpret human lifeways within particular cultural contexts and over short or long
periods of time.
Care
Care as a noun is defined as those abstract and concrete phenomena related to assisting,
supporting, or enabling experiences or behaviors toward or for others with evident or anticipated
needs to ameliorate or improve a human condition or lifeway.
Care
Care as a verb is defined as actions and activities directed toward assisting, supporting, or
enabling another individual or group with evident or anticipated needs to ameliorate or improve
a human condition or lifeway or to face death.
Culture Shock
Culture shock may result when an outsider attempts to comprehend or adapt effectively to a
different cultural group. The outsider is likely to experience feelings of discomfort and
helplessness and some degree of disorientation because of the differences in cultural values,
beliefs, and practices. Culture shock may lead to anger and can be reduced by seeking
knowledge of the culture before encountering that culture.
 Cultural Imposition
Cultural imposition refers to efforts of the outsider, both subtle and not so subtle, to impose his
or her own cultural values, beliefs, behaviors upon an individual, family, or group from another
culture. (Leininger, 1978)
Sunrise Model of Madeleine Leininger’s Theory
The Sunrise Model is relevant because it enables nurses to develop critical and complex
thoughts towards nursing practice. These thoughts should consider, and integrate, cultural and
social structure dimensions in each specific context, besides the biological and psychological
aspects involved in nursing care.
Strengths
 Leininger has developed the Sunrise Model in a logical order to demonstrate the
interrelationships of the concepts in her theory of Culture Care Diversity and
Universality.
 Leininger’s theory is essentially parsimonious in that the necessary concepts are
incorporated in such a manner that the theory and its model can be applied in many
different settings.
 It is highly generalizable. The concepts and relationships that are presented are at a
level of abstraction which allows them to be applied in many different situations.
 Though not simple in terms, it can be easily understood upon the first contact.
Weakness
 The theory and model are not simple in terms.

9. Health As Expanding Consciousness: Margaret Newman

BACKGROUND OF THE THEORIST
Born on October 10, 1933.
Bachelor’s degree - University of Tennessee in 1962
Master’s degree - University of California in 1964
Doctorate - New York University in 1971
She has worked in - University of Tennessee, New York University, Pennsylvania State University,
University of Minnesotat, University of Minnesota

THEORY DEVELOPMENT
She was influenced by following theorists:

 Martha Roger’s theory of Unitary Human Beings was the main basis of the development of her
theory, Health as Expanding Consciousness
 Itzhak Bentov – The concept of evolution of consciousness
 Arthur Young – The Theory of Process
 David Bohm – The Theory of Implicate.
DESCRIPTION OF THE THEORY
  “The theory of health as expanding consciousness (HEC) was stimulated by concern for those for
whom health as the absence of disease or disability is not possible. Nurses often relate to such
people: people facing the uncertainty, debilitation, loss and eventual death associated with
chronic illness. The theory has progressed to include the health of all persons regardless of the
presence or absence of disease. The theory asserts that every person in every situation, no
matter how disordered and hopeless it may seem, is part of the universal process of expanding
consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of
reaching new dimensions of connectedness with other people and the world” (Newman, 2010).
 Humans are open to the whole energy system of the universe and constantly interacting with the
energy. With this process of interaction humans are evolving their individual pattern of whole.
 According to Newman understanding the pattern is essential. The expanding consciousness is
the pattern recognition.
 The manifestation of disease depends on the pattern of individual so the pathology of the
diseases exists before the symptoms appear so removal of disease symptoms does not change
the individual structure.
 Newman also redefines nursing according to her nursing is the process of recognizing the
individual in relation to environment and it is the process of understanding of consciousness.
 The nurse helps to understand people to use the power within to develop the higher level of
consciousness.
 Thus it helps to realize the disease process, its recovery and prevention.
 Newman also explains the interrelatedness of time, space and movement.
 Time and space are the temporal pattern of the individual, both have complementary relationship.
 Humans are constantly changing through time and space and it shows unique pattern of reality.
NURSING PARADIGMS
 Health
“Health and illness are synthesized as health - the fusion on one state of being (disease) with its
opposite (non-disease) results in what can be regarded as health”.
 Nursing
Nursing is “caring in the human health experience”.
Nursing is seen as a partnership between the nurse and client, with both grow in the “sense of higher
levels of consciousness”
 Human
“The human is unitary, that is cannot be divided into parts, and is inseparable from the larger unitary
field”
“Persons as individuals, and human beings as a species are identified by their patterns of
consciousness”…
“The person does not possess consciousness-the person is consciousness”.
Persons are “centers of consciousness” within an overall pattern of expanding consciousness”
 Environment
Environment is described as a “universe of open systems”
Strengths
 Can be applied in any setting
 “Generates caring interventions”
W eaknesses
 Abstract
 Multi-dimensional
 Qualitative
 Little discussion on environment

10. Human Becoming Theory : Rosemarie Rizzo Parse

ABOUT THE THEORIST
Educated at Duquesne University, Pittsburgh
MSN and Ph.D. from University of Pittsburgh
Published her theory of nursing, Man-Living-Health in 1981
Name changed to Theory of Human Becoming in 1992
Editor and Founder, Nursing Science Quarterly
Has published eight books and hundreds of articles about Human Becoming Theory
Professor and Niehoff Chair at Loyola University, Chicago
THEORY DEVELOPMENT
The human becoming theory was developed as a human science nursing theory in the tradition
of Dilthey, Heidegger, Sartre, Merleau-Ponty, and Gadamer and Science of Unitary Human
Beings by Martha Rogers .
The assumptions underpinning the theory were synthesized from works by the European
philosophers, Heidegger, Sartre, and Merleau-Ponty, along with works by the pioneer American
nurse theorist, Martha Rogers.
The theory is structured around three abiding themes: meaning, rhythmicity, and
transcendence.
ASSUMPTIONS

 About man
 The human is coexisting while coconstituting rhythmical patterns with the universe.
 The human is open, freely choosing meaning in situation, bearing responsibility for
decisions.
 The human is unitary, continuously coconstituting patterns of relating.
 The human is transcending multidimensionally with the possibles

 About Becoming
  Becoming is unitary human-living-health.
 Becoming is a rhythmically coconstituting human-universe process.
 Becoming is the human’s patterns of relating value priorities.
 Becoming is an intersubjective process of transcending with the possibles.
 Becoming is unitary human’s emerging

Three Major Assumptions of Human Becoming

Meaning
 Human Becoming is freely choosing personal meaning in situations in the intersubjective
process of living value priorities.
 Man’s reality is given meaning through lived experiences
 Man and environment cocreate

Rhythmicity
 Human Becoming is cocreating rhythmical patterns of relating in mutual process with the
universe.
 Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns

Transcendence
 Human Becoming is cotranscending multidimensionally with emerging possibles.
 Refers to reaching out and beyond the limits that a person sets
 One constantly transforms

SUMMARY OF THE THEORY

 Human Becoming Theory includes Totality Paradigm
 Man is a combination of biological, psychological, sociological and spiritual factors
 Simultaneity Paradigm
 Man is a unitary being in continuous, mutual interaction with environment
 Originally Man-Living-Health Theory

NURSING PARADIGMS AND PARSE'S THEORY

 Person
Open being who is more than and different from the sum of the parts
 Environment
Everything in the person and his experiences
Inseparable, complimentary to and evolving with
 Health
Open process of being and becoming. Involves synthesis of values
 Nursing
A human science and art that uses an abstract body of knowledge to serve people

SYMBOL OF HUMAN BECOMING THEORY

 Black and white = opposite paradox significant to ontology of human becoming and
green is hope
 Center joined =co created mutual human universe process at the ontological level &
nurse-person process
 Green and black swirls intertwining = human-universe co creation as an ongoing process
of becoming
Strengths
 Differentiates nursing from other disciplines
 Practice - Provides guidelines of care and useful administration
 Useful in Education
 Provides research methodologies
 Provides framework to guide inquiry of other theories (grief, hope, laughter, etc.)

Weaknesses
 Research considered to be in a “closed circle”
 Rarely quantifiable results - Difficult to compare to other research studies, no control
group, standardized questions, etc.
 Does not utilized the nursing process/diagnoses
 Negates the idea that each person engages in a unique lived experience
 Not accessible to the novice nurse
 Not applicable to acute, emergent care

APPLICATION OF THE THEORY

Nursing Practice
 A transformative approach to all levels of nursing
 Differs from the traditional nursing process, particularly in that it does not seek to “fix”
problems
 Ability to see patients perspective allows nurse to “be with” patient and guide them
toward desired health outcomes
 Nurse-person relationship cocreates changing health patterns

Research
 Enhances understanding of human lived experience, health, quality of life and quality of
nursing practice
 Expands the theory of human becoming
 Builds new nursing knowledge about universal lived experiences which may ultimately
contribute to health and quality of life