HISTORY OF NURSING DEVELOPMENT

Neuman’s
- Began with FLORENCE NIGHTINGALE.
- Nursing as a science provides knowledge to describe, explain,
and predict outcomes.
- Nursing is a process.
-

FIVE HISTORICAL ERAS AND SIGNIFICANT EVENTS

Systems Model
1. CURRICULUM ERA (1900 – 1940s) Summary: This
Major Emphasis Outcomes Emerging
Question
What
curriculum
Courses
included in
Standardized
curricula
Goal
Develop
specialized
theory focuses on
content
should
student
nursing
programs
for diploma
programs
knowledge
and higher
education
the client as a
nurses
study to be
nurses?
system and on the
2. RESEARCH ERA (1950 – 1970s) client’s responses
to stressors
Major Emphasis Outcomes Emerging
Question Goal
What is the Role of Problem Isolated

Betty Neuman
focus for nurses and studies and studies do
nursing what studies of not
research? to research nurses yield unified
knowledge

3. GRADUATE EDUCATION ERA (1950 – 1970s)

Nursing is a
Major
Question
What
Emphasis

Carving out
Outcomes

Nurses have
Emerging
Goal
Focus
unique profession
knowledge is
needed for
the
an advanced
role and
basis for
an important
role in health
care
graduate
education on
knowledge
that is concerned
practice of
nursing?
nursing
practice
development
with all of the
4.

Major
THEORY ERA (1980 – 1990s)

Emphasis Outcomes Emerging

variables affecting
an individual’s
Question Goal
How do There are Nursing Theories
these many ways theoretical guide nursing
frameworks to works shift research and
guide
research
and practice?
think about
nursing
the focus
to the patient
practice
response to stres
5. THEORY UTILIZATION ERA (21st Century)
Neuman’s
Major
Question
Emphasis Outcomes Emerging
Goal Systems Model
What new Nursing Middle-range Nursing
theories
are needed
to produce
theory guides
research,
practice,
theory
may be from
quantitative
frameworks
produce
knowledge
Summary: This
evidence of
quality
care?
education,
and
administratio
or qualitative
approaches
(evidence)
for quality
care
theory focuses on
the client as a
n
system and on the 
client’s responses  Flexible Line of
to stressors Defense is a
Betty Neuman protective
Nursing is a  accordion-like
unique profession mechanism that
that is concerned surrounds and
with all of the  protects the
variables affecting normal line of
an individual’s defense from
response to stres  invasion by
Neuman’s Systems Model - Betty Neuman
Summary: This theory focuses on the client as a system and on the
client’s responses to stressors
stressors
 Nursing is a unique profession that is concerned with all of the
variables affecting an individual’s response to stress.  3 Prevention
 Theoretical Modalities
Foundations of  • Primary
Nursing prevention
 Nursing (before;
Qualifying prevention)
Examination  • Secondary
Reviewer prevention
 Fely Rose S. (during;
Boquida  treatment)
 • Tertiary o Internal
(after; processes
rehabilitation) o • Regulator
Lines of Resistance - is the series of concentric circles that surrounds
the basic structure.
Normal line of defense - is an adaptation level of health developed
overtime and is considered normal for a particular individual client or
(physiological)
system; it becomes a standard for wellness-deviance determination
Flexible Line of Defense - is a protective accordion-like mechanism
o • Cognator
that surrounds and protects the normal line of defense from invasion
by stressors
3 Prevention Modalities
(mental)
o
o
Primary prevention (before; prevention)
Secondary prevention (during; treatment) o 4 Adaptive
o Tertiary (after; rehabilitation)

modes
o Roy’s
o •
Adaptation
Physiological-
Model
Physical Mode
o Summary:
– basic
This theory o need is
sees the
composed of
individual as a
the needs
o set of
o associated
interrelated
with
systems that
oxygenation,
maintain a
nutrition,
o balance
o elimination,
between
activity and
various stimuli.
rest, and
o protection o •
o • Self- Interdependenc
Concept Group e Mode –
Identity Mode – focuses on
o includes o attaining
body image and relational
self-ideals integrity
o • Role through the
Function Mode o giving and
– focuses on the receiving of
o primary, love, respect,
secondary, and o and valu
Adaptation Model – Sister Callista Roy

tertiary roles Summary: This theory sees the individual as a set of interrelated
systems that maintain a balance between various stimuli.

o that a person
Internal processes
o Regulator (physiological)
o Cognator (mental)

occupies in FOUR ADAPTIVE MODES:

o Physiological-Physical Mode – basic need is composed of

society and o
the needs associated with oxygenation, nutrition,
elimination, activity and rest, and protection
Self-Concept Group Identity Mode – includes body image

o knowing
and self-ideals
o Role Function Mode – focuses on the primary, secondary,
and tertiary roles that a person occupies in society and
knowing where they stand as a member of society

where they o Interdependence Mode – focuses on attaining relational

integrity through the giving and receiving of love, respect,
and value.

stand as a
o Johnson’s
member
o of society Behavioral
Systems Model
o Summary: optimum level
This theory under
advocates to o those
foster conditions in
o efficient and which the
effective behavior
behavioral o constitutes a
functioning in threat to the
o the patient to physical or
prevent illness social
o Dorothy o health or in
Johnson which illness is
o Nursing is an found.
Behavioral Systems Model – DOROTHY JOHNSON Summary: This

external theory advocates to foster efficient and effective behavioral

functioning in the patient to prevent illness
 Nursing is an external regulatory force that acts to preserve the

regulatory force organization and integrate the patient’s behaviors at an

optimum level under those conditions in which the behavior
constitutes a threat to the physical or social health or in which

that acts illness is found.

 A person is a behavioral system
Subsystems

o to preserve •
•
Achievement
Attachment-affiliative

the organization
• Aggressive-protective
• Dependency
• Ingestive
• Eliminative

and integrate • Sexual

Theory of Interpersonal Relations – Hildegard Peplau

the
Summary: This theory emphasizes the nurse-client relationship as
the foundation of nursing practice.
 nursing as an interpersonal process of therapeutic interactions

o patient’s between an individual who is sick or in need of health services

and a nurse specially educated to recognize, respond to the
need for help

behaviors at an
 According to her
•
•
A client is an individual with a felt need.
Health implies forward movement of personality and other
ongoing human process in the direction of creative,
Summary: In this
•
constructive, productive, personal, and community living.
Nursing is a significant, therapeutic, interpersonal process theory, the nurse’s
role is to
Phases
• Orientation (problem defining) – involves engaging the
client in treatment, providing explanations and information,
and answering questions
• Identification – the client works interdependently with the
nurse, expresses feelings, and begins to feel stronger
• Exploitation – the client makes full use of the services
find out and meet
offered
• Resolution – the client no longer needs professional
services and gives up dependent behavior
the patient’s
Nursing roles
• Stranger
immediate needs
for help.
• Resource
• Teacher
• Counselor
• Surrogate Theory of Deliberative Nursing Process – Ida Jean Orlando
• Active leadership
• Technical expert Summary: In this theory, the nurse’s role is to find out and meet the
patient’s immediate needs for help.

Nursing roles Automatic Nursing Actions- are nursing actions decided upon for
reasons other than the patient’s immediate need

• Stranger
Deliberative Nursing Actions are actions decided upon after
ascertaining a need and then meeting this need.

• Resource The patient’s

• Teaching participation is
• Counseling critically
• Surrogate important
• Active in the nursing
leadership process.
• Technical Stages
expert • Assessment
Orlando’s Theory • Diagnosis
of Deliberative • Planning
Nursing •
Process Implementation
 • Emerging identities – relationship begins to form

• Evaluation • Empathy – sharing another’s psychological state but standing apart

and not sharing feelings.

Sympathy –
 The patient’s participation is critically important in the nursing
process.
Stages



Assessment
Diagnosis
sharing, feeling
and
 Planning
 Implementation
 Evaluation
Human to Human Relationship – Joyce Travelbee
Summary: This theory focuses on developing rapport or relationship
experiencing what
others are feeling
with the patient. This theory extended the interpersonal relationship
theories of Peplau and Orlando.

Phases: and
• Original experiencing is
encounter – nurse accomplished
and patients • Rapport – the
are strangers sick person shows
• Emerging trust
identities – and confidence in
relationship the nurse
begins to form
• Sympathy – sharing, feeling and experiencing what others are
feeling and experiencing is accomplished
• Rapport – the sick person shows trust and confidence in the nurse

• Empathy – Care, Cure, Core – Lydia Hall

Summary: This theory emphasizes the importance of the total patient

sharing another’s
rather than looking at one part or aspect.
The Three Interlocking Circle: Care, Cure, Core

psychological
 Care – represents the patient’s body
o The nurse gives hands-on bodily care to the
patient in relation to activities in daily living such
as toileting and bathing.

state but standing  Cure – represents the disease, affecting the patient’s
physical system
o The nurse applies medical knowledge to

apart 
treatment of the person
Core – represents as the inner feelings and management
of the person

and not sharing o The nurse addresses the social and emotional
needs of the patient for effective communication
and a comfortable environment.

feelings 21 Nursing Typology – Faye Glenn Abdellah

Summary: This theory focuses on what the nurse should give and
Phases: what the patient should receive.
• Original encounter – nurse and patients are strangers
 Faye Glenn Abdellah changed the focus of nursing from
disease-centered to patient-centered.
 Nursing is based on an art and science that molds the attitudes,
intellectual competencies, and technical skills of the individual
hospital.
nurse into the desire and ability to help people, sick or well,
cope with their health needs. Virginia
21 Nursing Typology
• To facilitate the maintenance of fluid and electrolyte balance
• To recognize the physiologic responses of the body to disease
Henderson
Nursing Need Theory – Virginia Henderson
conditions
• To facilitate the maintenance of regulatory mechanisms and Summary: This theory focuses on the importance of increasing the
functions patient’s independence to hasten their progress in the hospital.
• To facilitate the maintenance of sensory function Virginia Henderson
• To identify and accept positive and negative expressions, feelings,
and reactions 14 Components
• To identify and accept interrelatedness of emotions and organic
illness • To facilitate the maintenance of effective verbal and • Breathe normally
nonverbal communication • Eat and drink adequately
• To promote the development of productive interpersonal • Eliminate body wastes
relationships • Move and maintain desirable postures
• To facilitate progress toward achievement and personal spiritual • Sleep and rest
goals • Select suitable clothes – dress and undress
• To create or maintain a therapeutic environment • Maintain body temperature within normal range by adjusting
• To facilitate awareness of self as an individual with varying physical, clothing and modifying environment
emotional, and developmental needs • Keep the body clean and well-groomed and protect the integument
• To accept the optimum possible goals in the light of limitations, • Avoid dangers in the environment and avoid injuring others
physical and emotional • Communicate with others in expressing emotions, needs, fears, or
• To use community resources as an aid in resolving problems that opinions
arise from an illness • Worship according to one’s faith
• To understand the role of social problems as influencing factors in • Work in such a way that there is a sense of accomplishment
the cause of illness • Play or participate in various forms of recreation
• Learn, discover, or satisfy the curiosity that leads to normal
development and health and use the available health facilities

Henderson’s
Nursing Need
Pender’s Health
Theory
Promotion Model
Summary: This
Summary: This
theory focuses on
model is a basis
the
for behavioral
importance of
counseling to
increasing the
promote a healthy
patient’s
lifestyle
independence to
hasten their
progress in the
 • Cultural care accommodation or negotiation – adapt to or negotiate

Nola Pender is the with others for a beneficial or satisfying health outcome
• Cultural care repatterning or restructuring – reorder, change, or

living legend of
greatly modify their lifeways

the American
Technological Nursing as Caring Model – Rozzano Locsin

Summary: Technology and caring in nursing are concepts that

harmoniously coexist

Academy of  Modern healthcare is greatly dependent on technology.

 The nurse can know the person fully only in the moment.

Nursing *Dimensions of Technological Value

*The process of nursing
*Risk with technology in nursing Relationship between structure

The goal of and function

nursing is to help A person is

people care for defined as the
themselves nurse or the
Pender’s Health Promotion Model – Nola Pender
Summary: This model is a basis for behavioral counseling to promote
a healthy lifestyle
patient.
 Nola Pender is the living legend of the American Academy of
Nursing
 The goal of nursing is to help people care for themselves
The nurses use
Targets: well patients (instead of ill patients)
Health promoting behaviors are the desired behavioral outcome.
technology in
 Health promotion is defined as behavior motivated by the
desire to increase well-being and actualize human healthy
potential. It is an approach to wellness
order to know the
 Health protection or illness prevention is described as
behavior motivated desire to actively avoid illness, detect it
early, or maintain functioning within illness constraints.
patient better and
through deeper
 Individual characteristics and experiences – prior related
behavior and personal factors
 Behavior-specific cognitions and affect – perceived benefits

knowledge in
of action, perceived barriers of 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) technology there
will be a deeper
Culture Care, Diversity & Universality – Madeleine Leininger
Summary: Knowing and understanding different cultures to provide
optimal nursing care.
 Ethno nursing is the study of nursing care beliefs, values, and
practices as cognitively perceived and known by a designated
connection
between the nurse
culture through their direct experience, beliefs, and value
system
 Transcultural nursing focuses upon the comparative study and
analysis of cultures concerning nursing and health-illness caring
practices, beliefs, and values to provide meaningful and
efficacious nursing care services to their cultural values and
health-illness context
and patient.
3 modes of nursing care decisions and actions
• Cultural care preservation or maintenance – retain or preserve
Patients are
relevant care values
viewed as and the patient’s
participants in pursuit of health
their care rather desires. The
than nurse acts as the
objects. interface between
A person is defined as the nurse or the patient. The nurses use
technology in order to know the patient better and through deeper
knowledge in technology there will be a deeper connection between
the nurse and patient. Patients are viewed as participants in their
technology
care rather than objects.
and the patient
Technology is
Technology is used to know a person’s health from moment to
moment.
The environment centers mainly on the technological world.
The function of a nurse is to be with the patient and the patient’s

used to know a pursuit of health desires.

The nurse acts as the interface between technology and the patient.

person’s health 

from moment to
moment.
The environment
centers mainly on
the
technological
world.
The function of a
nurse is to be with
the patient
  NURSING DIAGNOSIS
 OUTCOMES AND PLANNING
 IMPLEMENTATION
 EVALUATION

CRITIQUE
DISCIPLINE
 CLARITY
- A branch of education or domain of knowledge.  SIMILARITY
 GENERALITY
PROFESSION
 ACCESSIBILITY
- Specialized field of practice founded upon theoretical structure  IMPORTANCE
of knowledge of a discipline with practice abilities.
- Practice of professional nursing

TWO COMPETING PHILOSOPHICAL PERSPECTIVE

USED IN SCIENCE
RATIONALISM DR. MARGARET JEAN HARMAN WATSON’S THEORY

- Reason is the source of all knowledge - Theory of transpersonal nursing

- THEORY-THEN-RESEARCH STRATEGY METAPARADIGM
EMPIRICISM  PERSONHOOD (HUMAN BEING) - mind/body/spirit/nature
- SENSORY EXPERIENCE.
 ENVIRONMENT - Caring science is not only for sustaining
- The senses are the source of all knowledge. humanity but also sustaining the planet
FLORENCE NIGHTINGALE
 HEALTH - Unity and harmony within the mind, body, mind and
- Modern Nursing soul
- May 12, 1820, Florence Italy
- 1837 wrote about her “calling” in her dairy “God spoke to me  NURSING - “Knowledge, thoughts, values, philosophy,
commitment and action with some degree of passion.”
and called me to His service”
- 1854 Crimean war, Scutari Turkey PATRICIA BENNER
- Lady with the Lamp / of the lamp
-Curing to healing
HOSPITALS
7 DOMAINS OF NURSING PRACTICE
 St. Thomas Hospital and King’s College Hospital
1. HELPING ROLE
NIGHTINGALE’S ENVIRONMENTAL MODEL
-Establishing a healing relationship, providing comfort measure and inviting
 MAJOR CONCEPTS AND DEFINITION (Alligood, 2018) patient participation and control in care
1. Pure Air
2. TEACHING/COACHING FUNCTION DOMAIN
2. Light
3. Cleanliness -Readying patient learning, motivating, change, assisting with the lifestyle
4. Efficient drainage alterations and negotiating agreement on goals
5. Pure Water
6. Quiet 3. DIAGNOSTIC AND PATIENT-MONITORING
7. Diet -Refers to competencies in on going assessment and anticipation of
8. Petty management - “what you do when you are not there outcomes
shall be done when you are not there”
4. EFFECTIVENESS MANAGEMENT OF RAPIDLY CHANGING
NIGHTINGALE’S ENVIRONMENTAL MODEL SITUATION

 MAJOR CONCEPTS AND DEFINITION (Udan,2020) -Ability to contingently match demands resources and to assess manage
1. Health of Houses – related to pure air, pure water care during crisis situation
2. Ventilation and warming
3. Light 5. ADMINISTERING AND MONITORING THERAPEUTIC INTERVENTIONS
4. Noise AND REGIMES
5. Variety -Preventing complications during therapy, wound management and
6. Bed and bedding hospitalizations.
7. Cleanliness of rooms and walls
8. Personal cleanliness 6. MONITORING AND ENSURING THE QUALITY OF HEALTHCARE
9. Nutrition and taking food PRACTICE
10. Chattering hopes and advices
11. Observation of the sick -Maintain safety, continuous quality improvement, collaborative and
12. Petty management consultation with physicians, self-evaluation and management of technology.

7. ORGANIZATIONAL AND WORK ROLE COMPETENCIES

METAPARADIGM / MAJOR ASSUMPTIONS
-Competencies in priority settings, team building, coordinating and providing
 PERSON - passive patient for continuity
 ENVIRONMENT - comfort and recovery of the patient. LEVELS OF NURSING
 HEALTH - using every power to the fullest extent in living life.
 NOVICE
 NURSING - responsible of someone else’s health
-beginner
NURSING PROCESS -No experience or background

 ASSESSMENT
  ADVANCE BEGINNER
-Demonstrate acceptable performance
-based on experience begin go be formulated to guide action

 COMPETENT
-Nurse with 2-3 years’ experience
-more aware on long term goals
-Planning own actions based on conscious, abstract and
analytical thinking

 PROFICIENT
-Perceives and understand situations as a whole
-Expect how to modify plans

 EXPERT
-No longer relies in principles, rules or guidelines to connect
situations and determine
-More background
-Flexible and more proficient

KATIE ERIKSSON
Theory – Caritative Caring

MAJOR CONCEPTS

● CARITAS

-Fundamental motive of caring science also motive all caring.

● CARING COMMUNION

-Intensity and vitality and by wrath, closeness, rest, respect, honesty, and
tolerance
● ACT OF CARING

-Faith, hope, love, tending, playing and learning

- Making very special out of something less special

CARITATIVE CARING ETHICS

-Ethics of caring
-Determine by the caritas motive.

CARING ETHICS

-Way in which the nurse meets the patient in an ethical sense.

NURSING ETHICS

-Deals with the ethical principles and rules that guide my work or my decision

● HUMAN DIGNITY

-Absolute dignity partly relative dignity

● ABSOLUTE DIGNITY

-Human being creation

● RELATIVE DIGNITY

-Influenced and formed through culture and external context

● INVITATION

-Act that occur when the career welcomes a patient to the caring communion

● SUFFERING

-Human struggles between good and evil in a state of becoming.

● SUFFERING RELATED TO ILLNESS, TO CARE AND TO LIFE

-Illness is experienced in connection with illness and treatment

● SUFFERING HUMAN BEING

-The patient is suffering human being.

● RECONCILIATION

-Drama suffering
-implies a change through which a new wholeness is formed of the life the
human being has lost in suffering.

● CARING CULTURE

-caring reality and it based on cultural elements such as traditions