Major Concepts
Nursing
“What nursing has to do… is to put the
patient in the best condition for nature to act
upon him” (Nightingale, 1859/1992)
Nightingale stated that nursing “ought to
signify the proper use of fresh air, light,
warmth, cleanliness, quiet, and the proper
selection and administration of diet – all at
the least expense of vital power to the
patient.”
She reflected the art of nursing in her
statement that, “the art of nursing, as now
practised , seems to be expressly constituted
to unmake what God had made disease to be,
viz., a reparative process.”
Human Beings
Human beings are not defined by Nightingale
specifically. They are defined in relationship
to their environment and the impact of the
environment upon them.
Environment
The physical environment is stressed by
Nightingale in her writing. Nightingale’s
writings reflect a community health model in
which all that surrounds human beings is
considered in relation to their state of health.
Health
Nightingale (1859/1992) did not define
health specifically. She stated, “We know
nothing of health, the positive of which
pathology is the negative, except from the
observation and experience. Given her
definition that of the art of nursing is to
“unmake what God had made disease,” then
the goal of all nursing activities should be
client health.
Subconcepts
Nightingale’s (1859/1992) statements:
Health of Houses
“Badly constructed houses do for the healthy
what badly constructed hospitals do for the
sick. Once insure that the air is stagnant and
sickness is certain to follow.”
Ventilation and Warming
“Keep the air he breathes as pure as the
external air, without chilling him.”
Nightingale believed that the person who
repeatedly breathed his or her own air would
become sick or remain sick.
Nightingale was very concerned about
“noxious air” or “effluvia” or foul odors that
came from excrement
She also criticized “fumigations,” for she
believed that the offensive source, not the
smell, must be removed.
The importance of room temperature was
stressed by Nightingale. The patient should
not be too warm or too cold. The temperature
could be controlled by appropriate balance
between burning fires and ventilation from
windows.
Light
Nightingale believed that second to fresh air
the sick needed light. She noted that direct
sunlight was what patients wanted.
Noise
She stated that patients should never be
waked intentionally or accidentally during
the first part of sleep. She asserted that
whispered or long conversations about

She believed that nursing should provide care
to the healthy as well as the ill and discussed
health promotion as an activity in which
nurses should engage.
patients are thoughtless and cruel. She
viewed unnecessary noise, including noise
from female dress, as cruel and irritating to
the patient.
Variety
She discussed the need for changes in color
and form, including bringing the patient
brightly colored flowers or plants. She also
advocated rotating 10 or 12 paintings and
engravings each day, week, or month to
provide variety for the patient. Nightingale
also advocated reading, needlework, writing,
and cleaning as activities to relieve the sick
of boredom.
Bed and Bedding
She noted that an adult in health exhales
about three pints of moisture through the
lungs and skin in a 24-hour period. This
organic matter enters the sheets and stays
there unless the bedding is changed and aired
frequently.
She believed that the bed should be placed in
the lightest part of the room and placed so the
patient could see out of a window. She
reminded the caregiver never to lean against,
sit upon, or unnecessarily shake the bed of
the patient.
Personal Cleanliness
“Just as it is necessary to renew the air round
a sick person frequently to carry off morbid
effluvia from the lungs and skin, by
maintaining free ventilation, so it is necessary
to keep pores of the skin free from all
obstructing excretions.”
“Every nurse ought to wash her hands very
frequently during the day.”
Nutrition and Taking Food
 She noted that individuals desire different
foods at different times of the day and that
frequent small servings may be more
beneficial to the patient than a large breakfast
or dinner.

She urged that no business be done with

patients while they are eating because this
was distraction.

Chattering Hopes and Advices

She wrote that to falsely cheer the sick by

making light of their illness and its danger is
not helpful.

Nightingale encouraged the nurse to heed

what is being said by visitors, believing that
sick persons should hear good news that
would assist them in becoming healthier.

Social Considerations

Nightingale supported the importance of

looking beyond the individual to the social
environment in which he or she lived.
Assumptions
Nightingale (1860/1957/1969) believed that five points were essential in achieving a healthful
house: “pure air, pure water, efficient drainage, cleanliness and light.”

A healthy environment is essential for healing. She stated that “nature alone cures.”

Nurses must make accurate observations of their patients and be able to report the state of the
patient to the physician in an orderly manner.

Nursing is an art, whereas medicine is a science. Nurses are to be loyal to the medical plan, but
not servile.
Strengths/Weaknesses
Strengths:

The language she used to write her books was cultured and flowing, logical in format, and
elegant in style.

Nightingale’s theory has broad applicability to the practitioner. Her model can be applied in most
complex hospital intensive care environment, the home, a work site, or the community at large.
Reading her work raises a consciousness in the nurse about how the environment influences
client outcomes.

Weaknesses:

There is scant information on the psychosocial environment when compared to the physical
environment.

The application of her concepts in the twentieth century is in question.

Analysis
In the era that we are in today, we are faced with environmental conditions beyond what was
ought to be natural and nurturing. Some of the global environmental issues that we have now are
the global warming, nuclear radiation threats, man-made environmental calamities and pollution.
From these occurrences, Nightingale’s model seemed to be very ideal. Her concept of providing
fresh air to patients is in question with today’s industrialization effects.

In addition to the analysis of the concept of ventilation, it is not always beneficial for all clients
to have fresh air. Natural air has its impurities which in turn may infect open wounds and
drainages such as in burns.

With the idea of providing light, the light emitted by the sun today is proven to be harmful
already because of the destruction of the ozone layer of the Earth. Exposing the patient
constantly to direct sunlight may then be more destructive to patient’s betterment than being
beneficial.

It is true that a health environment heals as what Nightingale stated but the question now is how
our environment would remain health amidst the negative effects of the progress of technology
and industrialization.

Since the applicability of some of the concepts to specific situations today are non-feasible,
development of this theory is utterly needed to accommodate the changes of the environment that
we currently have. Still, above all this, it is very much clear the Nightingale’s theory is superb as
a starting point of the progression of our profession and served as a catalyst for nursing’s
improvement.
http://nursingtheories.weebly.com/florence-nightingale.html
Theoretical Foundations of Nursing

 Home
 Virginia Henderson
 Dorothea E. Orem
 Nola Pender
 Myra Estrin Levine
 Sister Callista Roy
 Lydia E. Hall
 Hildegard E. Peplau
 Ida Jean Orlando
 Imogene M. King
 Jean Watson
 Madeleine M. Leininger
 Betty Neuman
 Florence Nightingale
 Faye G. Abdellah
 Martha Rogers
 Dorothy Johnson
 References
 TFNWeebly Blogspot
 Course Application

Dorothea E. Orem
The Self-Care Deficit Nursing Theory.

Orem developed the Self-Care Deficit Theory of Nursing, which is composed of three interrelated
theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing
systems.

“The condition that validates the existence of a requirement for nursing in an adult is the absence of the
ability to maintain continuously that amount and quality of self-care which is therapeutic in sustaining
life and health, in recovering from disease or injury, or in coping with their effects. With children, the
condition is the inability of the parent (or guardian) to maintain continuously for the child the amount
and quality of care that is therapeutic.” (Orem, 1991)

Major Concepts Subconcepts

Nursing is as art through which the practitioner
of nursing gives specialized assistance to persons
with disabilities which makes more than ordinary
assistance necessary to meet needs for self-care.
The nurse also intelligently participates in the
Self-care Requisites or requirements can be
defined as actions directed toward the provision
of self-care. It is presented in three categories:
A. Universal self-care requisites are associated
medical care the individual receives from the
physician.
Humans are defined as “men, women, and
children cared for either singly or as social units,”
and are the “material object” of nurses and
others who provide direct care.
Environment has physical, chemical and
biological features. It includes the family, culture
and community.
Health is “being structurally and functionally
whole or sound.” Also, health is a state that
encompasses both the health of individuals and
of groups, and human health is the ability to
reflect on one’s self, to symbolize experience,
and to communicate with others.
Self-care is the performance or practice of
activities that individuals initiate and perform on
their own behalf to maintain life, health and
well-being.
Self-care agency is the human’s ability or power
to engage in self-care and is affected by basic
conditioning factors.
Basic conditioning factors are age, gender,
developmental state, health state, sociocultural
orientation, health care system factors, family
system factors, patterns of living, environmental
factors, and resource adequacy and availability.
Therapeutic Self-care Demand is the totality of
“self-care actions to be performed for some
duration in order to meet known self-care
requisites by using valid methods and related
sets of actions and operations.”
Self-care Deficit delineates when nursing is
with life processes and the maintenance of the
integrity of human structure and functioning.
1. The maintenance of a sufficient intake of air
2. The maintenance of a sufficient intake of
water
3. The maintenance of a sufficient intake of food
4. The provision of care associated with
elimination process and excrements
5. The maintenance of a balance between
activity and rest
6. The maintenance of a balance between
solitude and social interaction
7. The prevention of hazards to human life,
human functioning, and human well-being
8. The promotion of human functioning and
development within social groups in accord with
human potential, known human limitations, and
the human desire to be normal
Normalcy is used in the sense of that which is
essentially human and that which is in accord
with the genetic and constitutional
characteristics and the talents of individuals.
B. Developmental self-care requisites are
“either specialized expressions of universal self-
care requisites that have been particularized for
developmental processes or they are new
requisites derived from a condition or associated
with an event.”
C. Health deviation self-care requisites are
required in conditions of illness, injury, or
needed. Nursing is required when an adult (or in
the case of a dependent, the parent or guardian)
is incapable of or limited in the provision of
continuous effective self-care.
Nursing Agency is a complex property or
attribute of people educated and trained as
nurses that enables them to act, to know, and to
help others meet their therapeutic self-care
demands by exercising or developing their own
self-care agency.
Nursing System is the product of a series of
relations between the persons: legitimate nurse
and legitimate client. This system is activated
when the client’s therapeutic self-care demand
exceeds available self-care agency, leading to the
need for nursing.
disease or may result from medical measures
required to diagnose and correct the condition.
1. Seeking and securing appropriate medical
assistance
2. Being aware of and attending to the effects
and results of pathologic conditions and states
3. Effectively carrying out medically prescribed
diagnostic, therapeutic, and rehabilitative
measures
4. Being aware of and attending to or regulating
the discomforting or deleterious effects of
prescribed medical measures
5. Modifying the self-concept (and self-image) in
accepting oneself as being in a particular state of
health and in need of specific forms of health
care
6. Learning to live with the effects of pathologic
conditions and states and the effects of medical
diagnostic and treatment measures in a life-style
that promotes continued personal development
The Three Basic Nursing Systems:
(1) The wholly compensatory nursing system is
represented by a situation in which the
individual is unable “to engage in those self-care
actions requiring self-directed and controlled
ambulation and manipulative movement or the
medical prescription to refrain from such
activity… Persons with these limitations are
socially dependent on others for their continued
existence and well-being.”
(2) The partly compensatory nursing system is
represented by a situation in which “both nurse
 and perform care measures or other actions
involving manipulative tasks or ambulation…
[Either] the patient or the nurse may have the
major role in the performance of care
measures.”

(3) In the supportive-educative system also

known as supportive-developmental system, the
person “is able to perform or can and should
learn to perform required measures of externally
or internally oriented therapeutic self-care but
cannot do so without assistance.”

Relationship of the major components of Orem’s self-care deficit theory

R indicates a relationship between components; < indicates a current or potential deficit where nursing
would be required

Assumptions

Humans engage in continuous communication and interchange among themselves and their
environments to remain alive and to function.

In humans, the power to act deliberately is exercised to identify needs and to make needed judgments.
Mature human beings experience privations in the form of action in care of self and others involving
making life-sustaining and function-regulating actions.

Human agency is exercised in discovering, developing, and transmitting to others ways and means to
identify needs for, and make inputs into, self and others.

Finally, groups of human beings with structured relationships cluster tasks and allocate responsibilities
for providing care to group members who experience privations for making required deliberate
decisions about self and others (Orem, 1995).

Strengths/Weaknesses

Strengths:

A major strength of Orem’s theory is that it is applicable for nursing by the beginning practitioner as well
as the advanced clinicians.

The terms self-care, nursing systems, and self-care deficit are easily understood by the beginning student
nurse and can be explored in greater depth as the nurse gains more knowledge and experience.

She specifically defines when nursing is needed: Nursing is needed when the individual cannot maintain
continuously that amount and quality of self-care necessary to sustain life and health, recover from
disease or injury, or cope with their effects.

Three identifiable nursing systems were clearly delineated and are easily understood.

Weaknesses:

Orem’s theory is simple yet complex. The use of self-care in multitude of terms, such as self-care agency,
self-care demand, self-care deficit, self-care requisites, and universal self-care, can be very confusing to
the reader.

Orem’s definition of health was confined in three static conditions which she refers to a “concrete
nursing system,” which connotes rigidity.

Throughout her work, there is limited acknowledgement of the individual’s emotional needs.

Analysis

There is a superb focus of Orem’s work which is self-care. Even though there is a wide range of scope
seen in the encompassing theory of nursing systems, Orem’s goal of letting the readers view nursing
care as a way to provide assistance to people was apparent in every concept presented.
From the definition of health which is sought to be rigid, it can now be refined by making it suitable to
the general view of health as a dynamic and ever changing state.

The role of the environment to the nurse-patient relationship, although defined by Orem was not
discussed.

The role of nurses in maintaining health for the patient was set by Orem with great coherence in
accordance with the life-sustaining needs of every individual.

Although Orem viewed the importance of the parents or guardian in providing for their dependents, the
definition of self-care cannot be directly applied to those who needs complete care or assistance with
self-care activities such as the infants and the aged.

(c) 2011 Gonzalo, A. All rights reserved

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