LESSON 5.

NURSING THEORIES

O VERVIEW
Introduction
Welcome to Lesson 5.
This section presents the nursing theories, the third type of
nursing frameworks, comprises nursing works derived from
nursing philosophies, conceptual models, abstract nursing
theories, or works in other disciplines (Alligood, 2010a; Wood,
2010). A work classified as a nursing theory is developed from
some conceptual framework and is generally not as specific as a
middle-range theory. Although some use the terms model and
theory interchangeably, theories differ from models in that they
propose a testable action (Alligood, 2010a).
Are you ready? Let’s deep dive now!

Figure 1. Welcome to Theoretical Foundation in Nursing

Module Lesson 5

LEARNING OUTCOMES:
1. Appreciate the value of evidence-based nursing practice in the application of nursing and
related models / theories.

LEARNING OBJECTIVES:
1. Identify the different views of nursing theorists that fosters growth in both the client
and the nurse.
2. Analyze the metaparadigm of the different nursing theories.
3. Value the theoretical works of the nursing theorists as it relates to nursing knowledge
development.

KEY TERMS:

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 Culture: refers to patterned lifeways, values, beliefs, norms, symbols, and practices of
individuals, groups or institutions, that are shared, learned, and usually transmitted from
one generation to another.
Health: is the “pattern of the whole” of a person and includes diseases as a manifestation
of the pattern of the whole, based on the premise that life is an ongoing process of
expanding consciousness.
Personal factors: categorized as biological, psychological, and socio-cultural. These
factors are predictive of a given behavior and are shaped by the nature of the target
behavior being considered.

ACTIVITY:

Before reading the abstraction, do this activity:

1. Have you ever noticed advertisements in malls, grocery stores, or schools that
advocate healthy eating or regular exercise? Have you gone to local centers or
hospitals promoting physical activities and smoking cessation programs such as
“quit” activities and “brief intervention?” or heard about the sensationalized
Covid-19 health protocols and vaccination?” What is this all about? Can we
consider these an example of health promotion? Take a minute to reflect on this
concept and jot down notes relating this to your experience. What specific activity
do you practice to promote health and prevent diseases? Why do you have to do
this? What happens when you fail to follow?

ANALYSIS
Now that you have done this activity, what have you realized? I have
given you this activity to help you learn to appreciate the theoretical works of the
different nursing theorists as you proceed to reading the abstraction.

ABSTRACTION

Lesson 5: Nursing Theories

1. Peplau’s Theory of Interpersonal

Relationship

Hildegard E. Peplau defined nursing as a

a. therapeutic,
b. interpersonal process which strives to develop a nurse- patient relationship in which
the nurse serves as a resource person, counselor and surrogate.

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>Introduced the Interpersonal Model.
Defined nursing as an interpersonal process of therapeutic between an individual who is
sick or in need of health services and a nurse especially educated to recognize and
respond to the need for help.
>Her work is influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow,
and Neal Elgar Miller.
She identified four phases of the nurse client relationship namely:
1. Orientation: the nurse and the client initially do not know each other’s goals and
testing the role each will assume. The client attempts to identify difficulties and the
amount of nursing help that is needed;
2. Identification: the client responds to help professionals or the significant others who
can meet the identified needs. Both the client and the nurse plan together an appropriate
program to foster health;
3. Exploitation: the clients utilize all available resources to move toward a goal of
maximum health functionality;
4. Resolution: refers to the termination phase of the nurse-client relationship. it occurs
when the client’s needs are met and he/she can move toward a new goal.
Peplau further assumed that nurse-client relationship fosters growth in both the
client and the nurse.

2. ORLANDO’S THEORY OF
DELIBERATIVE NURSING PROCESS

>Developed the Nursing Process Theory

> “Patients have their own meanings and interpretations of situations and therefore
nurses must validate their inferences and analysis with patients before drawing
conclusions.”
>Allow nurses to formulate an effective nursing care plan that can also be easily adapted
when and if any complexity comes up with the patient.
>According to her, persons become patients requiring nursing care when they have needs
for help that cannot be met independently because of their physical limitations, negative
reactions to an environment, or have an experience that prevents them from
communicating their needs.
>The role of the nurse is to find out and meet the patient’s immediate needs for help.

>Conceptualized The Dynamic Nurse – Patient Relationship Model.

>She believed that the nurse
-helps patients meet a perceived need that the patient cannot meet for themselves.
>Orlando observed that the nurse provides direct assistance to meet an immediate need
for help in order to avoid or to alleviate distress or helplessness.

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 She emphasized the importance of
i. validating the need and
ii. evaluating care based on observable outcomes

3. Travelbee’s Human To Human

Relationship

>Joyce Travelbee Postulated the Interpersonal Aspects of Nursing Model

>Advocated that the goal of nursing individual or family is
• preventing or coping with illness,
• regaining health
• finding meaning in illness, or
• maintaining maximal degree of health.

>Further viewed that interpersonal process is

• a human-to-human relationship formed during illness and
“experience of suffering

 States in her Human-to-Human Relationship Model that the purpose of nursing

was to help and support and individual, family or community to prevent or cope
with the struggles of illness and suffering and, if necessary, to find significance
in these occurrences, with the ultimate goal being the presence of hope.
 Nursing was accomplished through human-to-human relationships.
 Extended the interpersonal relationship theories of Peplau and Orlando.
 Believed that a person is a
• unique,
• irreplaceable individual who is in a continuous process of becoming,
evolving and changing.

Note: Please see also Travelbee’s Theory of Spiritual Well-Being in Illness

4. Hall’s CORE, CARE, CURE

>Lydia E. Hall developed the Care, Cure, Core Theory also known as the
“Three Cs of Lydia Hall.”

>Hall defined nursing as the “participation in care, core, and cure aspects of
patient care, where CARE is the sole function of the nurse, whereas the CORE
and CURE are shared with the other members of the health.”

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 >The major purpose of care is to achieve an interpersonal relationship with the
individual that will facilitate the development of the core.

>The client is composed of the following overlapping parts:

1. person (core),
2. pathologic state and treatment (cure) and
3. body (care)

>Introduced the model of Nursing: What Is It?

>Focusing on the notion that centers around three components of
• CARE,
• CORE and
• CURE.

1. Care
• represents nurturance and is exclusive to nursing.
• Defines the primary role of a professional nurse such as
providing bodily care
2. Core
• involves the therapeutic use of self and emphasizes the
use of reflection.
• Is the patient receiving nursing care
3. Cure
• focuses on nursing related to the physician’s orders.
• Core and cure are shared with the other health care
providers.
• The aspect of nursing which involves the administration
of medications and treatments

5. Faye Abdellah’s 21 Nursing

Problems

>Developed the 21 Nursing Problem Theory

> “Nursing is based on an art and science that molds 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.”
>Defined nursing as having a problem-solving approach with key nursing
problems related to
1. health needs of people
2. developed list of 21 nursing-problem areas

>Introduced Patient – Centered Approaches to Nursing Model

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 -Changed the focus of nursing from disease-centered to patient-centered,
and began to include the care of the families and the elderly in nursing
care.
>The nursing model is intended to guide care in hospital institutions, but can
also be applied to community health nursing, as well.
>She defined nursing as service to individual and families; therefore the
society. Furthermore, she conceptualized nursing as an art and a science that
molds the:
a. Attitudes
b. intellectual competencies and
c. technical skills of the individual nurse into the desire and ability to help
people, sick or well, and cope with their health needs.

6.
Henderson’s Nursing Need Theory

>Virginia Henderson introduced/developed The Nursing Need Theory / Nature of

Nursing Model.
>Focuses on the importance of increasing the patient’s independence to hasten their
progress in the hospitals.
>Emphasized the basic human needs and how nurses can assist in meeting those
needs.
> “The nurse is expected to carry out a physician’s therapeutic plan, but
individualized care is a result of the nurse’s creativity in planning of care.”
>Identified fourteen basic needs.
>Postulated that the unique function of the nurse is
• to assist the clients, sick or well, in the performance of those activities
contributing to health or its recovery,
• the clients would perform unaided if they had the necessary strength, will
or knowledge.
>Further believed that nursing involves
• assisting the client in gaining independence as rapidly as possible, or
• assisting him achieves peaceful death if recovery is no longer
possible.

7. Nola Pender’s Health Promotion

Model; Nursing Theories
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o The Health Promotion Model notes that each person has unique personal
characteristics and experiences that affect subsequent actions.
o The set of variables for behavioral specific knowledge and affect have
important motivational significance. These variables can be modified
through nursing actions.
o Health promoting behavior is the desired behavioral outcome and is the
endpoint in the Health Promotion Model. Health promoting behaviors
should result in:
o improved health, enhanced functional ability and
o better quality of life at all stages of development.

o The final behavioral demand is also influenced by the immediate

competing demand and preferences, which can derail intended health-
promoting actions.

o 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.
o 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.
o Pender’s health promotion model defines health as “a positive dynamic
state not merely the absence of disease.”
o Health promotion is directed at increasing a client’s level of well-
being.
o It describes the multi-dimensional nature of persons as they
interact within the environment to pursue health.
o The model focuses on the following three areas: 1) individual
characteristics and experiences; 2) behavior-specific cognitions and affect,
and; 3) behavioral outcomes.

8. Leinenger’s Theory of Culture

Care Diversity and Universality

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>Developed the Transcultural Nursing Model / Culture Care Theory of
Diversity & Universality
>She advocated that nursing is a
-humanistic and scientific mode of helping a client through specific cultural caring
processes (cultural values, beliefs and practices) to improve or maintain

>Leininger’s Culture Care Theory attempts to provide culturally congruent

nursing care through “cognitively based assistive, supportive, facilitative, or
enabling acts or decisions that are mostly tailor-made to fit with individual,
group’s, or institution’s cultural values, beliefs, and lifeways.” The intent of the
care is to fit with or have beneficial meaning and health outcomes for people of
different or similar culture backgrounds
> The Culture Care Theory defines nursing as a “learned scientific and
humanistic profession that focuses on human care phenomena and caring
activities in order to help, support, facilitate, or enable patients to maintain or
regain health in culturally meaningful ways, or to help them face handicaps or
death.”

> Leininger’s model has developed into a movement in nursing care called
transcultural nursing.

>In 1995, Leininger defined transcultural nursing as “a substantive area of

study and practice focused on comparative cultural care (caring) values, beliefs,
and practices of individuals or groups of similar or different cultures with the goal
of providing culture-specific and universal nursing care practices in promoting
health or well-being or to help people to face unfavorable human conditions,
illness, or death in culturally meaningful ways.”

> Leininger developed new terms for the basic concepts of her theory. The
concepts addressed in the model are:

Care, which assists others with real or anticipated needs in an effort to

improve a human condition of concern, or to face death.
Caring is an action or activity directed towards providing care.
Culture refers to learned, shared, and transmitted values, beliefs, norms,
and lifeways to a specific individual or group that guide their thinking,
decisions, actions, and patterned ways of living.
Culture Care is the multiple aspects of culture that influence and help a
person or group to improve their human condition or deal with illness or
death.
Culture Care Diversity refers to the differences in meanings, values, or
acceptable forms of care in or between groups of people.
Culture Care Universality refers to common care or similar meanings
that are evident among many cultures.
Nursing is a learned profession with a disciplined focus on care
phenomena.

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 Worldview is the way people tend to look at the world or
universe in creating a personal view of what life is about.
Cultural and Social Structure Dimensions include factors
related to spirituality, social structure, political concerns,
economics, educational patterns, technology, cultural values, and
ethnohistory that influence cultural responses of people within a
cultural context.
Health refers to a state of well-being that is culturally defined
and valued by a designated culture.
Cultural Care Preservation or Maintenance refers to nursing
care activities that help people from particular cultures to retain
and use core cultural care values related to healthcare concerns
or conditions.
Cultural Care Accommodation or Negotiation refers to
creative nursing actions that help people of a particular culture
adapt or negotiate with others in the healthcare community in an
effort to attain the shared goal of an optimal health outcome for
patients of a designated culture.
Cultural Care Re-Patterning or Restructuring refers to therapeutic
actions taken by culturally competent nurses. These actions help a patient
to modify personal health behaviors towards beneficial outcomes while
respecting the patient’s cultural values.

The theory’s culturalogical assessment provides a holistic, comprehensive

overview of the client’s background. The assessment addresses the following:

communication and language

gender considerations
sexual orientation
ability and disability
occupation
age
socioeconomic status
interpersonal relationships
appearance dress
use of space
foods and meal preparation and related lifeways
>Leininger proposes that there are three modes for guiding nurse’s judgments,
decisions, or actions in order to provide appropriate, beneficial, and meaningful
care:

preservation and/or maintenance;

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 accommodation and/or negotiation; and
re-patterning and/or restructuring.

The modes have greatly influenced the nurse’s ability to provide

culturally congruent nursing care, as well as fostering culturally-
competent nurses.

> The Sunshine Model is Leininger’s visual aid to the Culture Care
Theory.

a health condition.
9. Newman’s Theory of Health as
Expanding Consciousness

• Margaret Newman focused on Health as Expanding Consciousness.

• She believed that human are unitary in whom disease is a manifestation of the
pattern of health.
• She defined consciousness as the information capability of the system
which is influenced by
• Time
• space movement and is
• ever – expanding.
 According to Newman, “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. 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.”

 How a disease manifests in an individual patient depends on the pattern of that

patient, so the pathology of the disease exists before the symptoms appear. By this
logic, the removal of the symptoms of the disease will not change the patient’s
individual structure or pattern.

 The model also addresses the interrelatedness of time, space, and movement. Time
and space are the temporal pattern of the patient, and have a complementary
relationship. People are constantly changing through time and space, which is
movement, which shows a unique pattern of reality.

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  According to Newman, nursing is the “process of recognizing the patient in
relation to the environment, and it is the process of the understanding of
consciousness.”

 The nurse helps patients understand how to use the power they have within in
order to develop a higher level of consciousness. Therefore, it helps to realize the
process of disease, its recovery, and its prevention.

 Nursing is seen as a partnership between the nurse and patient, and both grow in
the sense of higher levels of consciousness.

10. PARSE’S Theory of HUMAN

Becoming

Rosemarie Rizzo Parse's Human Becoming Theory guides the practice of nurses to
focus on quality of life as it is described and lived.

The human becoming theory of nursing presents an alternative to both the conventional
bio-medical approach as well as the bio-psycho-social-spiritual approach of most other
theories and models of nursing.

Parse’s model rates quality of life from each person’s own perspective as the goal of the
practice of nursing. Rosemarie Rizzo Parse first published the theory in 1981 as the
“Man-living-health” theory, and the name was changed to the “human becoming theory”
in 1992.

The assumptions underpinning the theory were synthesized from works by European
philosophers. The theory is structured around three abiding themes: meaning,
rhythmicity, and transcendence.

The model makes assumptions about man and becoming, as well as three major assumptions
about human becoming.

The Human Becoming Theory makes the following assumptions about man:

The human is coexistent while co-constituting rhythmical patterns with the

universe.
The human is open, freely choosing meaning in a situation, as well as bearing
responsibility for decisions made.
The human is unitary, continuously co-constituting patterns of relating.

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 The human is transcending multidimensionally with the possibles.

The Human Becoming Theory makes the following assumptions about becoming:

Becoming is unitary with human-living-health.

Becoming is a rhythmically co-constituting the 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 the unitary human’s emerging.

The three major assumptions about human becoming are: meaning, rhythmicity, and
transcendence

1. 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. In addition, man and environment co-create.
2. Rhythmicity states that human becoming is co-creating rhythmical patterns of relating in
mutual process with the universe. Man and environment co-create (imaging, valuing,
languaging) in rhythmical patterns.
3. Transcendence explains that human becoming is co-transcending multidimensionally
with emerging possibilities. It refers to reaching out and beyond the limits a person sets,
and that one constantly transforms.

These three themes are permeated by four postulates: illimitability, paradox, freedom, and
mystery.

1. Illimitability is “the indivisible unbounded knowing extended to infinity, the all-at-once

remembering and prospecting with the moment.”
2. Paradox is “an intricate rhythm expressed as a pattern preference.” Paradoxes are not
“opposites to be reconciled or dilemmas to be overcome but, rather, lived rhythms.”
3. Freedom is “contextually construed liberation.” People are free to continuously choose
ways of being with their situations.
4. Mystery is “the unexplainable, that which cannot be completely known.”

11. Watson’s Theory of Human

Caring

(Please see Nursing Philosophies)

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 #2. Orlando’s Nursing Process

>Conceptualized the Dynamic Nurse – Patient Relationship Model.

>She believed that the nurse
-helps patients meet a perceived need that the patient cannot meet for themselves.

>Orlando observed that the

-nurse provides direct assistance to meet an immediate need for help in order to
avoid or to alleviate distress or helplessness.

>She emphasized the importance of

a. validating the need and
b. evaluating care based on observable outcomes.

Developed the Deliberative Nursing Process Theory

 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.”
 Orlando’s nursing theory stresses the reciprocal relationship between patient and
nurse. What the nurse and the patient say and do affects them both.
 She views the professional function of nursing as finding out and meeting the
patient’s immediate need for help.
 Described her model as revolving around the following five major interrelated concepts:
function of professional nursing, presenting behavior, immediate reaction, nursing
process discipline, and improvement.
o The function of professional nursing is the organizing principle.
o Presenting behavior is the patient’s problematic situation.
o The immediate reaction is the internal response. The nursing process discipline
is the investigation into the patient’s needs.
o And lastly, improvement is the resolution to the patient’s situation.

The Deliberative Nursing Process has five stages: assessment, diagnosis, planning,
implementation, and evaluation.

o Nurses use the standard nursing process in Orlando’s Nursing Process

Discipline Theory to produce positive outcomes or patient improvement
o Orlando’s key focus was the definition of the function of nursing.
o The model provides a framework for nursing, but the use of her theory does not
exclude nurses from using other nursing theories while caring for patients.

Orlando’s Deliberative Nursing Process Theory

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 o 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.
o 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.
o 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.

Goal

o To develop a theory of effective nursing practice. The theory explains that the
role of the nurse is to find out and meet the patient’s immediate needs for help.
All patient behavior can be a cry for help. Through these, the nurse’s job is to find
out the nature of the patient’s distress and provide the help he or she needs.

12. Locsin’s Technological

Competency as Caring

Rozzano Locsin
Assumptions:
o Technological Competency as Caring in Nursing is a middle range
theory grounded in Nursing as Caring (Boykin & Schoenhofer),
2001). It is illustrated in the practice of nursing grounded in the
harmonious coexistence between technology and caring in nursing.
The assumptions of the theory are: • Persons are caring by virtue of
their humanness (Boykin & Schoenhofer, 2001).
o Persons are whole or complete in the moment (Boykin &
Schoenhofer, 2001). • Knowing persons is a process of nursing that
allows for continuous appreciation of persons moment to moment
(Locsin, 2005).
o Technology is used to know wholeness of persons moment to
moment (Locsin, 2004).
o Nursing is a discipline and a professional practice (Boykin &
Schoenhofer, 2001).
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 Dimensions of Technological Value in the Theory
o Technology as completing human beings to re-formulate the
ideal human being such as in replacement parts, both mechanical
(prostheses) or organic (transplantation of organs.)
o Technology as machine technologies, e.g. computers and
gadgets enhancing nursing activities to provide quality patient care
such as Penelope or Da Vinci in the Operating Theatres;
o Technologies that mimic human beings and human activities to
meet the demands of nursing care practices, e.g. cyborgs
(cybernetic organisms) or anthropomorphic machines and robots
such as ‘nursebots’ (Locsin & Barnard, 2007).

 Technological Competency as Caring in Nursing

o Technological competency as caring in nursing is the harmonious
coexistence between technologies and caring in nursing.
o The harmonization of these concepts places the practice of nursing
within the context of modern healthcare and acknowledges that
these concepts can co-exist.
o Technology brings the patient closer to the nurse. Conversely,
technology can also increase the gap between the nurse and nursed.
o When technology is used to know persons continuously in the
moment, the process of nursing is lived.

 The Process of Nursing

o A. Knowing: The process of knowing person is guided by
technological knowing in which persons are appreciated as
participants in their care rather than as objects of care. The nurse
enters the world of the other. In this process, technology is used to
magnify the aspect of the person that requires revealing - a
representation of the real person. The person’s state change
moment to moment - person is dynamic, living, and cannot be
predicted.

o B. Designing: Both the nurse and the one nursed (patient) plan a
mutual care process from which the nurse can organize a
rewarding nursing practice that is responsive to the patient’s desire
for care. C. Participation in appreciation: The simultaneous
practice of conjoined activities which are crucial to knowing
persons. In this stage of the process is the alternating rhythm of
implementation and evaluation. The evidence of continuous
knowing, implementation and participation is reflective of the
cyclical process of knowing persons.
o D. Verifying knowledge: The continuous, circular process
demonstrates the ever-changing, dynamic nature of knowing in

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 nursing. Knowledge about the person that is derived from
knowing, designing, and implementing further informs the nurse
and the one nursed.

OTHER NURSING THEORIES NOT INCLUDED IN THE

SYLLABUS BUT NEEDS TO BE STUDIED

13. LEVINE’S The

CONSERVATIONAL MODEL

 According to Myra Estrin Levine’s Conservational Model, “Nursing is

human interaction.”
 Provides a framework within which to teach beginning nursing students.
 Logically congruent, is extremely and internally consistent, has breadth as well
as depth, and is understood, with few exceptions, by professionals and
consumers of health care.

 According to Levine’s theory, every patient has a unique range of adaptive

responses, which vary based on the individual circumstances of the patient
including age, gender, and illness. The responses are the same, but the timing
and manifestation of organismic responses will be unique for each patient’s
pulse rate. An ongoing process of change in which the patient maintains his or
her integrity within the realities of the environment. Adaptation is achieved
through the “frugal, economic, contained and controlled use of environmental
resources by individual in his or her best interest.”

The goal of the Four Conservation Principles of Nursing, created by Myra

Estrine Levine, is to promote adaptation and maintain wholeness by using the
principles of conservation. The model guides the nurse in focusing on the
influences and responses at the organismic level.

There are assumptions made by the theory.

 The nurse creates an environment in which healing can occur.

 A human being is more than the sum of his or her parts.
 Human beings respond in a predictable way.
 Human beings are unique in their responses.
 Human beings know and appraise objects, conditions, and situations.

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  Human beings sense, reflect, reason, and understand.
 Human beings actions are self-determined, even when emotional.
 Human beings are capable of prolonging reflection through strategies
such as asking questions.

 Wholeness exists when the interaction or constant adaptations to the environment

permits the assurance of integrity, and is promoted by the use of conservation
principle.
 Conservation is the product of adaptation. It is the achievement of balance of energy
supply and demand that is within the biological realities of the individual patient.
 The Four Conservation Principles in Levine’s model of nursing are:
conservation of energy, conservation of structural integrity, conservation of
personal integrity, and conservation of social integrity. They help the nurse
accomplish the goals of the model.

1. Conservation of energy refers to balancing the input and output of energy in

order to protect from over-fatigue. It includes adequate rest, nutrition, and
exercise.
2. The conservation of structural integrity means maintaining or restoring the
physical body by preventing physical breakdown or promoting healing.
3. Personal integrity conservation recognizes the patient as someone who seeks
recognition, respect, self-awareness, self-hood, and self-determination.
4. The conservation of social integrity exists when a patient is recognized as
someone who lives with a family, a community, a religious or ethnic group, a
political system, and a nation.

14. Wiedenbach’s The Helping Art

of Clinical Nursing

 Ernestine Wiedenbach developed The Helping Art of Clinical Nursing

conceptual model
 It defines nursing as the “practice of identifying a patient’s need for help through
the observation of presenting behavior and symptoms, exploration of the meaning
of those symptoms, determination of the cause of discomfort, the determination
of the patient’s ability to resolve the patient’s discomfort, or determining if the
patient has a need for help from the nurse or another health care professional.
 Definition of nursing reflects on nurse-midwife experiences as “People may
differ in their concept of nursing, but few would disagree that nursing is
nurturing or caring for someone in a motherly fashion.”

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 Wiedenbach’s model of nursing defines the patient as any person receiving
help of some kind from the health care system.
 Help can include care, teaching, and advice.
 In this nursing theory, a patient does not need to be ill or injured since health
education qualifies someone as a patient.

 The nurse is a functioning human being who not only acts, but thinks and
feels. A nurse uses his or her knowledge in his or her role. Knowledge
encompasses all that has been perceived and grasped by the human mind. It may
be factual, speculative, or practical.
 The Helping Art of Clinical Nursing addresses the definition of a person, as
well. The theory states that each person, whether a nurse or patient, has a unique
potential to develop self-sustaining resources. People tend to be independent
and fulfill their own responsibilities.
 In Wiedenbach’s theory, self-awareness and self-acceptance are essential to
personal integrity and self-worth; whatever an individual does at any given
moment is representative of the best judgment available for that person in that
moment.
 Guides the nurse action in the art of nursing and specified four elements of
clinical nursing: philosophy, purpose, practice, and art.
 Clinical nursing is focused on meeting the patient’s perceived need for help in a
vision of nursing that indicates considerable importance on the art of nursing.

 Wiedenbach identifies four main elements of clinical nursing. They are a

philosophy, a purpose, a practice, and the art.

 1. The nurse’s philosophy is his or her attitude and belief about life and how that
attitude affected his or her reality.

o The three essential components associated with nursing philosophy are a

1. reverence for life;
2. respect for the dignity, worth, autonomy, and individuality of each
human being; and a
3. resolution to act on personally and professionally held beliefs.

 2. A nurse’s purpose is that which the nurse wants to accomplish through what he
or she does
o It is all the activities directed toward the overall good of the patient. The
practice of nursing is the observable actions that are affected by the nurse’s
beliefs and feeling about meeting the patient’s need for help.

 3. The art of nursing includes understanding a patient’s needs and concerns,

developing goals and actions intended to enhance a patient’s ability, and directing
the activities related to the medical plan to improve the patient’s condition. The
nurse also focuses on prevention of complications that can come up due to re-
occurrence, or the development of new concerns.

15. Peterson & Zderad’s 18

The Humanistis Model

Josephine Peterson and Loretta Zderad (1976) created the Humanistic
Model
Humanistic nursing theories have a foundation in the belief that patients can grow in
a healthy and creative way.
They believed that nursing education should be founded in experience,
and that a nurse’s training should focus as much on the nurse’s ability to relate to
and interact with patients as a scientific and medical background.
Emphasis on the nurse-patient relationship, in which both people influence the
outcome of the nursing interventions.
The function of the nursing approach shows that the relationship between the nurse
and patient has as much to do with the patient’s healing as medical interventions.
Humanistic nursing focuses closely on how the relationship between the patient and
nurse develops in addition the patient’s physical and mental health.
The humanistic model of nursing looks at the patient as an individual, and each
situation as unique.
In this nursing approach, there is no formulaic method or process in order to care for
patients. Each patient is assessed and treated on a case-by-case basis

The Humanistic Model of Nursing is an approach to nursing that encompasses a

number of individual theories, including Patricia Benner’s From Novice to Expert
Model of Nursing and Jean Watson’s Theory of Caring.

16. Erickson, Tomlin, and Swain (1983)

Theory of Modeling and Role-Modeling

Modeling and Role Modeling theory was developed by Helen C. Erickson,

Evelyn M. Tomlin, and Mary Ann P. Swain
The theory was published in their book Modeling and Role Modeling: A Theory
and Paradigm for Nursing, in 1983.
This theory is considered as a philosophy of nursing.
The Theory of Modeling and Role-Modeling (Erickson, Tomlin,
& Swain, 1983) enables nurses to care for and nurture each client with an
awareness of and respect for the individual's uniqueness. This type of care

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 giving exemplifies theory-based clinical practice that focuses on the clients'
needs (Sappington, 1996).
The Theory draws concepts from
o Maslow's theory of hierarchy of needs
o Erikson's theory of psychosocial stages
o Piaget's theory of cognitive development
o General Adaptation Syndrome (GAS) by Selye and Lazarus

COMMONALITIES AND DIFFERENCES (BARBARA L. IRVIN, 1997)

The theory explains about some commonalities and differences among people.

Commonalities among people are:

1. Holism
2. Basic Needs
3. Affiliated-Individuation
4. Attachment and Loss
5. Psychosocial Stages
6. Cognitive Stages

Differences among people are:

1. Inherent Endowment
2. Model of the World
3. Adaptation
4. Adaptation Potential
5. Stress
6. Self-Care
7. Self-Care Knowledge
8. Self-Care Resources
9. Self-Care Action
MODELING
Modeling is the process by which the nurse seeks to know and understand the
client’s personal model of his or her world and learns to appreciate its value and
significance.
Modeling recognizes that each person has a unique perspective (model) of his or
her world.

The nurse uses this process to develop an image and understanding of the
client’s world from the client’s perspective.

ROLE MODELING
Role modeling is the process by which the nurse facilitates and nurtures the
individual in attaining, maintaining, and promoting health.

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Role modeling accepts the client unconditionally and allows planning of unique
interventions.
According to this concept, the client is the expert in his or her own care and knows
best how he or she needs to be helped.

According to the theory the roles of nursing are:

1. Facilitation
2. Nurturance
3. Unconditional Acceptance
4. The theory states five goals of nursing interventions as:
5. Build trust
6. Promote client’s positive orientation
7. Promote client’s control
8. Affirm and promote client’s strengths
9. Set mutual, health-directed goals

>Modeling refers to the development of an understanding of the client's world.

>Role modeling is the nursing intervention, or nurturance, that requires
unconditional acceptance.
>This model considers nursing as a self-care model based on the client's
perception of the world and adaptations to stressors.

17. Kolcaba’s Comfort Theory

 Katharine Kolcaba’s Theory of Comfort was first developed in the 1990s. It is a

middle-range theory for health practice, education, and research. This theory has the
potential to place comfort in the forefront of healthcare.
 According to the model, comfort is an immediate desirable outcome of nursing
care.
 Kolcaba's theory of comfort explains comfort as a fundamental need of all
human beings for relief, ease, or transcendence arising from health care situations
that are stressful. Comfort can enhance health-seeking behaviors for patients,
family members, and nurse

 Kolcaba described comfort existing in three forms: relief, ease, and transcendence.

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 o 1. If specific comfort needs of a patient are met, the patient experiences
comfort in the sense of relief. For example, a patient who receives pain
medication in post-operative care is receiving relief comfort.
o 2. Ease addresses comfort in a state of contentment. For example, the
patient’s anxieties are calmed.
o 3. Transcendence is described as a state of comfort in which patients are able
to rise above their challenges.

o The four contexts in which patient comfort can occur are: physical,
psychospiritual, environmental, and sociocultural.

 The Theory of Comfort considers patients to be individuals, families, institutions, or

communities in need of health care. The environment is any aspect of the patient,
family, or institutional surroundings that can be manipulated by a nurse or loved one
in order to enhance comfort. Health is considered to be optimal functioning in the
patient, as defined by the patient, group, family, or community.

APPLICATION AND EXERCISE:

Post-test

Part I. Mastery`

1. How do you consider your own philosophy of health and your description of
wellness before and now being a nursing student? Compare and contrast.
Identify one health-promoting behavior in which you personally could but
don’t engage? Identify factors which could contribute to your decision not to
participate. Why?

2. How do you understand this quote: “Care is the essence of nursing and a
distinct, dominant, central and unifying focus?” Explain in 2 paragraphs.

SUMMARY

This module presented in detail the nursing theories, the third type of nursing frameworks
comprised of nursing works derived from nursing philosophies, conceptual models, abstract
nursing theories, or works in other disciplines developed from some conceptual framework and
is generally not as specific as a middle-range theory.

REFERENCES

1. Alligood, M. R. (2014). Nursing theorist and their work. 8th edition. Elsevier.

2. George, J. (2012). Nursing Theories: The base for Professional Nursing Practice. 6th
edition.
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 3. Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work. 6th
Edition. St. Louis: Mosby

Recommended Follow-Up/Readings:
In order to reinforce your understanding of the material, you are encouraged to read the
following:
1. Nursing Theories from the references listed above and identify the different
models/diagrams used by the nursing theorist to present their theory and use them as
guide in making the Metaparadigm of the various theories.

Thank you!

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