1. Nursing Theories and
Frameworks
GENALYN B. CIRINEO, RN, MSN

2. NURSING THEORIES
1. Florence Nightingale
 Developed and described the first theory of
nursing. She focused on changing and
manipulating the environment in order to put
the patient in the best possible conditions for
nature to act.
 She believed that in the nurturing
environment, the body could repair itself.

3. 2. Faye Abdellah
Identified 21 nursing problems. She
defined nursing as service to individuals and
families; therefore to society. Furthermore,
she conceptualized nursing as 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.

4. 21 NURSING PROBLEMS
 1. To promote good hygiene and physical comfort
 2. To promote optimal activity, exercise, rest, and
sleep
 3. To promote safety through prevention of accidents,
injury, or other trauma and through the prevention
of the spread of infection
 4. To maintain good body mechanics and prevent
and correct deformities
 5. To facilitate the maintenance of a supply of oxygen
to all body cells
 6. To facilitate the maintenance of nutrition of all body
cells
 7. To facilitate the maintenance of elimination

5.  8. To facilitate the maintenance of fluid and
electrolyte balance
 9. To recognize the physiologic responses of the
body to disease conditions
 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 the interrelatedness of
emotions and organic illness
 14. To facilitate the maintenance of effective
verbal and nonverbal communication

6.  15. To promote the development of
productive interpersonal relationships
 16. To facilitate progress toward achievement
of personal spiritual goals
 17. To create and 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
light of physical and emotional limitations
 20. To use community resources as an aid in
resolving problems arising from illness
 21. To understand the role of social problems
as influencing factors in the cause of illness

7. NURSING THEORIES
3. Virginia Henderson (1960)
Identified 14 basic needs. She
postulated that the unique function of the
nurse is to assist clients, sick or well in the
performance of those activities contributing
to health, its recovery, or peaceful death
that clients would perform unaided if they
had the necessary strength, will or
knowledge.

8. 14 BASIC NEEDS
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 the environment.

9. 8. keep the body clean and well groomed and
protect the integument.
9. avoid dangers in the environment and avoid
injuring others.
10. communicate with others in expressing
emotions, needs, fears or opinions.
11. worship according to one's faith.
12. work in such a way that there is a sense of
accomplishment.
13. play or participate in various forms of recreation.
14. learn, discover, or satisfy the curiosity that leads
to normal development and health and use the
available health facilities.

10. 4. Dorothy E. Johnson
Conceptualized the Behavioral System
Model for nursing w/c has 7 subsystems:
1. attachment/affiliation
2. dependence
3. ingestive
4. eliminative
5. sexual
6. aggressive
7. achievement

11. 5. Imogene king
Postulated the Goal Attainment Theory. She
descried nursing as a helping profession that assist
individual and group in society to attain, maintain,
and restore health. If this is not possible, nurse help
individual to die with dignity.
In addition, King viewed nursing as an
interaction process between client and nurse
whereby during perceiving, setting goals, and
acting on them, transactions occur and goal are
achieved.

12. 6. Madeleine Leininger
Developed the Transcultural Nursing Model.
She advocate that nursing is a humanistic and
scientific mode of helping a client through
specific cultural caring process (cultural values,
beliefs and practices) to improve or maintain a
health condition.

13. 7. Myra Levine
described the Four Conservation Principles. She
advocated that nursing is a human interaction and
proposed four conservation principles of nursing which
are concerned with unity and integrity of the individual.
The four conservation principles are as follows:
(1)conservation of energy. The human body functions
by using energy. The human body needs energy
producing input. (food, oxygen, fluids) to allow energy
utilization as an output. (2) conservation of Structural
integrity. The human body has physical boundaries (skin
and mucous membrane)that must be maintained to
facilitate health and prevent harmful agents from
entering the body.

14.  (3) conservation of Personal Integrity. The
nursing intervention are base on the
conservation of an individual clients
personality. Every individual has sense of
identity, self-worth and self-esteem, which
must be preserved and enhanced by
nurses. (4) Conservation of Social Integrity.
The social integrity of the client reflects
the family and the community in which
the client functions. Health care
institutions may separate individuals from
their family. It is important for nurses to
consider the individual in the context of
the family.

15. NURSING THEORIES
8. Betty Neuman
proposed the Health Care System Model.
She asserted that nursing is a unique profession
in that ii is concerned with all the variables
affecting an individual’s response to stresses,
which are intra- (within the individual), inter-
(between one or more other people), and extra
personal (outside the individual) in nature The
concern of nursing is to prevent stress invasion,
to protect the client’s basic structure and
obtain or maintain a maximum level of wellness.
The nurse helps the client through primary,
secondary and tertiary prevention modes, to
adjust to environmental stressors and maintain
client system stability.

16. NURSING THEORIES
9. Dorothea Orem
developed the Self-Care and Self-
Care Deficit Theory. She define self-care as
“the practice of activities that individual
initiate and perform on their own behalf in
maintaining life, health and well-being.” she
conceptualized three nursing system as
follows: (1) wholly Compensatory: when the
nurse in expected to accomplish all the
patient’s therapeutic self-care or to
compensate for the patient’s inability to
engage in self-care or when the patient
need continuous guidance in self-care;

17. (2) Partially Compensatory: when both
nurse and patient engage in meeting self-
care needs; (3)Supportive-Educative: the
system that requires assistance in decision
making, behavior control and acquisition of
knowledge and skills.

18. NURSING THEORIES
10. Hildegard Peplau
Introduced that Interpersonal Model.
She defined nursing as interpersonal process
of therapeutic interactions between an
individual who is sick or need of health
services and a nurse especially educated
to recognize and respond to the need for
help. She identified four phases of the
nurse-client relationship namely:( 1)
orientation: the nurse and the client initially
do not now each other goals and testing
the role each will assume. The client
attempts to identify difficulties and the
amount of nursing help that is needed;

19. Identification: the client respond to the
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 client utilized all available
resources to move toward the goal of
maximal health or functionality; (4)
resolution: refers to the termination phase of
the nurse client relationship. It occurs when
the clients needs are met and he/she can
move toward a new goal. Peplau further
assume that nurse client relationship fosters
growth in both the client and the nurse.

20. NURSING THEORIES
11. Martha Rogers
conceptualized the Science of Unitary
Human Beings. To Rogers unitary man is an
energy field constant interaction with the
environment. She asserted that human
being are more than and different from the
sum of their parts. Further more she believed
that human being is characterized by the
capacity for abstraction and imagery,
language and thought, sensation and
emotion.

21. 12. Sister Callista Roy
 presented the Adaptation model.
 She views each person as a unified
biopsychosocial system in constant
interaction with a changing environment.
 She contended that the person as an
adaptive system, functions as a whole
through interdependence of its parts. The
system consist input control process,
output and feedback. In addition, she
advocated that all people have certain
needs which they endeavor to meet in
order to maintain integrity.

22. These need are divided into four different
model, the physiological, self-concept, role
function, and interdependence.
Accordingly, Roy believed adaptive human
behaviors is directed toward an attempt to
maintain homeostasis or integrity of
individual by conserving energy and
promoting survival, growth , reproduction
and mastery of the human system.

23. 13. Lydia Hall
 Introduce the notion that nursing centers
around three components of CARE, CORE,
CURE.
 Care represents nurturance and is exclusive to
nursing.
 Core involves the therapeutic use of self and
emphasizes the use of reflection.
 Cure focuses on nursing related to the
physician’s orders.
 Core and cure are shared with other health care
providers.

24. 14.Ida Jean Orlando
 Believe that the nurse helps patients meet a
perceived need that the patients cannot meet for
themselves.
 Orlando observed that nurse provide direct
assistance to meet an immediate need for help in
order to avoid or to alleviate distress or
helplessness.
 She emphasized the importance of validating the
need and evaluating care based on observable
outcomes. She also indicated that nursing actions
can be automatic (those chosen for reasons other
than the immediate need for help) or deliberative
(those resulting from validating the need for help,
exploring the meaning of the need, and validating
the effectiveness of the actions taken to meet the
need.)
 Nursing Process Discipline

25. 15. Ernestine Weidenbach
 The theory of clinical nursing that she is known for has four
elements:
1. A nursing philosophy - a nurse's attitude and belief about life
is what motivates a nurse to act in a certain way. Three
important components of a nurse's philosophy are reverence
for life, respect for the dignity and individuality of each human
being, and resolving to act on personal and professional
beliefs.
2. A nursing purpose - that which a nurse wants to accomplish
through what s/he does.
3. A nursing practice - those (observable) nursing actions that
are affected by beliefs and feelings about meeting the
patient's needs.
4. The art of nursing - this includes understanding a patient's
needs and concerns, developing goals and actions intended
to enhance patient's well-being, and directing the activities
related to the medical plan to improve the patient's condition.

26. 16. Jean Watson
 Conceptualized the Human Caring Model.
 She emphasized that nursing is the application of
the art and human science through transpersonal
caring transactions to help persons achieve mind-
body soul harmony, which generates self-
knowledge, self-control, self-care, and self-healing.
 She included health promotion and treatment of
illness in nursing.

27. 17. Rosemarie Rizzo Parse
 Introduce the theory of Human Becoming.
 She emphasized free choice of personal
meaning in relating value priorities, co-creating
of rhythmical patterns, in exchange with the
environment and contranscending in many
dimensions as possibilities unfold.
 She also believed that each choice opens
certain opportunities while closing others. Thus,
she referred to revealing-concealing, enabling-
limiting, and connecting-separating.
 Since each individual makes his or her own
personal choices, the role of the nurse is that of
guide, not decision maker.

28. 18. Josephine Paterson and
Loretta Zderad
 Provided a Humanistic Nursing Practice Theory.
 This is based on their belief that nursing is an existential
experience.
 Nursing is viewed as a lived dialogue that involves the
coming together of the nurse and the person to be
nursed.
 The essential characteristics of nursing is nurturance.
 Humanistic care cannot take place without the
authentic commitment of the nurse being with and
doing with the client.
 Humanistic nursing also presupposes responsible
choices.

29. 19. Helen Erickson, Evelyn
Tomlin and Mary Ann Swain
 Developed the Modeling and Role - Modeling Theory.
 The focus of this theory is on the person.
 The nurse model (assesses), role models (plans), and
intervenes in this interpersonal and interactive theory.
 They asserted that each individual is unique has some
self-care knowledge, needs simultaneous to be
attached to and separate from others, and has
adaptive potential, nurses in this theory, facilitate,
nurture and accept the person unconditionally.
 They view nursing as a self-care model based on the
client's perception of the world and adaptations to
stressors.

30. 20. Margaret Newman
 Focused on health as expanding consciousness.
 She believed that human are unitary beings 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, and movement and is ever-
expanding.
 Change occurs through transformation.
 Nursing is involved with human beings who have
reached choice points and found that their old
ways are no longer effective.
 Caring is a moral imperative for nursing.
 The nurse is a partner with the client rather than
the goal setter and outcome predictor.

31. 21. Anne Boykin and Savina
Schoenhofer
 Presented the grand theory of Nursing as Caring.
 They believed that all persons are caring, and nursing
is a response to a unique social call.
 The focus of nursing is on nurturing persons living and
growing in caring in a manner that is specific to each
nurse-nursed relationship or nursing situation.
 Each nursing situation is original. They support that
caring is a moral imperative.
 Nursing as Caring is or based on need or deficit but is
an egalitarian model of helping.

32. MORAL THEORIES
1. Freud
Believed that the mechanism for right and wrong
within the individual is the superego, or conscience. He
hypothesized that a child internalizes and adopts the
moral standards and character or character trait of the
model parent through the process on identification.
The strength of the superego depends on the intensity
of the child’s feelings of aggression or attachment
toward the model parent rather than on the actual
standards of the parent.

33. 2. Erickson
Erickson’s theory on the development of virtues or
unifying strengths of the “good man” suggests that
moral development continues throughout life. He
believed that if the conflicts of each psychosocial
developmental stage are favorably resolved then
an “ego- strength” or virtue emerges.

34. 3. Kohlberg
Suggested 3 levels of moral development that
encompasses 6 stages. He focused on the reasons for the
making of a decision, not on the morality of the decision
itself. At first level called the pre-moral or pre-conventional
level, children are responsive to cultural rules and labels of
good and bad, right and wrong. However, children
interpret these in terms of the physical consequences of
their actions, e.i. punishment or reward. At the second
level, the conventional level, the individual is concerned
about maintaining the expectation of the family, groups,
or nation and sees this as right. Level three is called the
post conventional, autonomous, or principled level. At this
level, people make an effort to define valid values and
principles without regard to outside authority or to the
expectations of others. This involves respect for other
humans and belief that relationships are based on mutual
trust.

35. 4. Peters
Proposed a concept of rational morality
based on principles. Moral development is usually
considered to involve three separate components:
moral emotion (what one feels), moral judgment
(how one reasons), and moral behavior (how one
acts). In addition, Peters believed that the
development of character traits or virtues is an
essential aspect of moral development. And that
virtues or character traits can be learned from others
and encourage by the example of others. Also
Peters believed that some virtues can be described
as habits because they are in some sense automatic
and therefore are performed habitually, such as
politeness, chastity, tidiness, thrift, and honestly.

36. 5. Schulman and Mekler
Believed that morality is measure of how
people treat fellow humans and that a moral child is
one who strives to be kind and just. They believed
that morality has two components, namely:
1. The intention of the person acting must be good
in the sense that the goal of the act is the well
being of one or more people.
2. The person acting must be fair or just in the sense
that the person considers the rights of others
without prejudice or favoritism. Furthermore, the
aforementioned authors asserted that the theory
of moral development is based on three
foundations, which they believed can be taught,
as follows:

37. a. Internalizing parental
standards of right and wrong.
b. developing emphatic
reactions
c. acquiring personal
standards

38. 6. Gilligan
Include the concepts of caring and
responsibility. She described three stages in the
process of developing an “ethic of care” which
are as follows:
1. Caring for oneself
2. Caring for others
3. Caring for self and others
She believed that women see morality in the
integrity of relationships and caring. Fro women,
what is right is taking responsibility for others as a
self-chosen decision. On the other hand, men
consider what is right to be what is just.

39. C. Spiritual Theories
1. FOWLER
Described the development of faith.
He believed that faith, or the spiritual
dimensions is a force that gives meaning to
a person’s life. He used the term “faith” as
form of knowing, a way of being in relation
to “an ultimate environment”. To Fowler,
faith is a relational phenomenon: it is “an
active made of being in relation to another
or others in which we invest commitment,
belief, love, risk and hope.”

40. 2. Westerhoff
Proposed that faith is a way of behaving.
He developed a four stage theory of faith
development based largely on his life
experiences and the interpretation of those
experiences. These stages are as follows:
a) Experience faith (infancy/early
adolescence): experiences faith through
interaction with others who are living a
particular faith.
b) Affiliative faith (late adolescence) actively
participates in activities that characterize a
particular faith tradition.
c) Searching faith (young adulthood) through
a process of questioning and doubting own
faith, acquires a cognitive as well as
affective faith.

41. d) Owned faith (middle
adulthood/ old age) puts faith
into personal and social
action and is willing to stand
up for what the individual
believes even against the
nurturing community.