Chapter 07

Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 7
Grand Nursing Theories Based on
Human Needs

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

Florence Nightingale—(cont.)
• Born: Florence, Italy, 1820
• Wealthy English parents
– Well educated
– Parents desired her to pursue social graces.
• Attended nursing school in Kaiserswerth, Germany in
1851 (program was 3 months)
– Believed that nursing was her “calling”

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

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

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

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

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

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

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

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

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

• Nurses performed tasks to and for the patient.
• Interestingly, she rejected the “germ theory” but was a
very strong advocate of cleanliness.

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

Florence Nightingale—Resources
• http://www.florence-nightingale.co.uk/
• http://clendening.kumc.edu/dc/fn/

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

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

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

• Remained very active in nursing well into
her 90s
• Died in 1996—99 years old

Virginia Henderson—Theory
• “The unique function of the nurse is to assist the
individual, sick or well, in the performance of those
activities contributing to health or its recovery . . . that
he would perform unaided if he had the necessary
strength, will or knowledge.”

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

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

Virginia Henderson—Theory—(cont.)
14 Basic Needs of Patients
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.

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

• The person must maintain physiological and
emotional balance.
• The mind and body of the person are
inseparable.
• Patients require help toward independence.

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

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

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

Virginia Henderson—Resources
• http://www.unc.edu/~ehallora/henderson.htm
• http://www.nursinglibrary.org/vhl/
• http://www.angelfire.com/ut/virginiahenderson/index.ht
ml

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

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

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

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

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

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

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

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

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

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

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

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

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

(cont.)
• Self-care requirements
– Maintenance of sufficient intake of air, water, and
food
– Provision of care associated with elimination and
excrement
– Maintenance of balance between activity and rest
– Maintenance of balance between solitude and social
interaction
– Prevention of hazards to human life, functioning, and
well-being
– Promotion of human functioning and development

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

Dorothea Orem—Resources
• http://www.nurses.info/nursing_theory_person_orem_do
rothea.htm
• http://www.orem-society.com/

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

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

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

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

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

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

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

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

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

Betty Neuman—Resources
• http://currentnursing.com/nursing_theory/Neuman.html/
• http://www.neumansystemsmodel.org/

Chapter 07

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Chapter 07