NUR 016: THEORETICAL FOUNDATIONS IN NURSING ✔ Man's reaction to stress is dependent on the integrity of the

MODULE 07: BETTY NEUMAN, DOROTHY JOHNSON, AND lines of resistance and defense.
SISTER CALLISTA ROY
✔ When the line of defense fails, man's reaction will now depend
on the lines of resistance.
BETTY NEUMAN’S
✔ Because of the reaction, man can adapt to a stressor This is
SYSTEM MODEL
called reconstitution.

"Nursing is a unique ✔ Therefore, nursing interventions focus on keeping or

profession that is concerned maintaining the stability of the open system.
with all of the variables
✔ These interventions can be carried out on the three levels of
affecting an individual's
prevention: primary, secondary, and tertiary.
response to stress."

✔ A unique, systems-based perspective that provides a unifying

focus for approaching a wide range of nursing concerns.
Major Concepts & Definitions:
✔ A comprehensive guide for nursing practice, research,
In holistic approach, the client as a whole, whose parts are in
education, and administration that is open to creative
dynamic interaction with itself and the environment. It strongly
implementation.
advises the consideration of all variables that simultaneously
✔ It has the potential for unifying various health-related theories, affect the client system.
clarifying the relationships of variables in nursing care and role
definitions at various levels of nursing practice. Open system
✔ Based on the person's relationship to stress, his reaction to it, → characterized by elements that are in continuous exchange
and reconstitution factors that are dynamic in nature. within a complex organization

✔ Considers the person as an open system which is composed of

→ these exchanges may be in the form of information or energy
a basic structure of energy resources. → basic to this is stress and stress reaction

✔ These resources include physiologic, psychologic,

sociocultural, developmental, and spiritual.
Created environment
→ developed unconsciously by the client in order to express the
✔The basic structure, or central core, is surrounded by two
wholeness of the system by using symbols
concentric boundaries or rings called the lines of resistance.

✔ These lines represent the internal factors that aid the person Client system
defend against a stressor.
→ composed of the five system variables interacting with the
✔ The line of resistance is further surrounded by two lines of environment.
defense.
1. Physiologic variables are body structure and function
• First line of defense is the person's state of 2. Psychological variables include mental processes in
equilibrium or the state of adaptation developed and interaction with the environment
maintained over time and which is considered normal 3. Sociocultural variables are the effects and influences
for the person. of social and cultural conditions
4. Developmental variables are age-related processes
• Second line of defense is flexible, dynamic, and can
and activities throughout life
be readily and rapidly changed over a short period of
time.
5. Spiritual variables are beliefs and influences related to
spirituality
✔ She classified stressors as intrapersonal, interpersonal, and
extrapersonal stressors.
Basic Client Structure resistance to stressors in order to prevent
recurrence or reaction or regression.
→ composed of a central core surrounded by concentric ring
EXAMPLE: Referring the newly diagnosed diabetic client to
→ the core reflects basic survival factors or energy resources of the Diabetic Resource Nurse.
the client

Reconstitution
Lines of Resistance
→ occurs following the treatment of stressor reactions; marks
→ represents resources that help the client defend against a the return of the client system to stability
stressor

→ normal line of defense reflects the client's stability which Level of Sability
serves as the guide to assess deviations from the client's usual
→ after reconstitution, may be higher or lower than the previous
wellness
level before the invasion of the stressor

Flexible Line of Defense

→ a protective layer for preventing stressors from breaking Neuman Three-Step Nursing Process
through the usual wellness state
1. Intrapersonal factors occur within the individual STEP 1: ASSESSMENT
✔ In the initial assessment, the nurse looks at the client's basic
2. Interpersonal factors occur between one or more
make-up and the known, unknown and universal stressors.
individuals
3. Extrapersonal factors occur outside the individual ✔ When examining the client's basic makeup, predispositions are
considered. They are important because they affect how the
Preventive Interventions client will deal with stressors.

→ purposeful actions to help the client retain, attain, or ✔ The nurse also looks at Neuman's five variables: physiological,
maintain the stability of the client system and carried out when a psychological, sociocultural, developmental and spiritual.
stressor is either suspected or identified
✔ The nurse uses these variables to examine the person's
predispositions and stressors.
PRIMARY LEVEL
DEFINITION: This is carried out when a stressor is suspected or ✔ The client's perception of these stressors is discussed and the
identified. The degree of risk is already known but nurse provides input.
the reaction of the client may not yet be visible.
✔ Stressors are identified as interpersonal, intrapersonal or
EXAMPLE: Teaching a person about weight reduction to
extrapersonal.
decrease the client's chances of developing
diabetes.
STEP 2: DIAGNOSIS, PLANNING, IMPLEMENTATION
✔ The next step addresses the nursing diagnosis, which
SECONDARY LEVEL
describes the context of the whole client as a system.
DEFINITION: This is carried out when symptoms from stress
have already occurred. It involves activities that ✔ Goals are then determined in collaboration with the client.
"treat" the symptoms.
EXAMPLE: Parents that have a disabled child. Initially they ✔ Interventions are determined relative to the goals, and are
may feel they can never accept this situation. carried out at three levels: primary, secondary, and tertiary
However, they are able to draw on resources they prevention.
were unaware of and eventually find themselves
coping well. STEP 3: EVALUATION
✔ The next step involves nursing outcomes which refers to
evaluation of the effectiveness of interventions.
TERTIARY LEVEL
DEFINITION: This occurs after the active treatment. It ✔ This includes assessing changes in intrapersonal,
readjusts the client system toward optimum interpersonal, and extrapersonal factors.
levels of stability. The goal is to strengthen
✔ Any changes in the nature of the stressors are examined, as Health
change in these areas determine the success of the nursing Health is defined as the condition or degree of system stability
interventions. and is viewed as a continuum from wellness to illness. When
system needs are met, optimal wellness exists. When needs are
✔ If change has not occurred, more data collection is required
not satisfied, illness exists. When the energy needed to support
and the nursing process is repeated.
life is not available, death occurs.

Theoretical Assertions
Environment
✔Each client system is unique, a composite of factors and
The environment is a vital arena that is germane to the system
characteristics within a given range of responses.
and its function. The environment may be viewed as all factors
✔ Many known, unknown, and universal stressors exist. Each that affect and are affected by the system. In Neuman Systems
differs in its potential for disturbing a client's usual stability level Model identifies three relevant environments: (1) internal, (2)
or normal line of defense. The particular interrelationships of external, and (3) created.
client variables at any point in time can affect the degree to
which a client is protected by the flexible line of defense against SISTER CALLISTA ROY'S
possible reaction to stressors.
ADAPTATION MODEL OF
✔ Each client/client system has evolved a normal range of
NURSING
responses to the environment referred to as a normal line of
defense. The normal line of defense can be used as a standard A nursing theorist, professor, and
from which to measure health deviation. author. She is known for her
groundbreaking work in creating the
✔ When the flexible line of defense is no longer capable of
Adaptation Model of Nursing.
protecting the client/client system against an environmental
stressor, the stressor breaks through the normal line of defense.

✔ Whether in a state of wellness or illness, the client is a ✔ The model assumes that systems of matter and energy
dynamic composite of the variables' interrelationships. Wellness progress to higher levels of complex self-organization.
is on a continuum of available energy to support the system in an
✔ Consciousness and meaning comprise person and environment
optimal system stability state.
integration while awareness of self and environment is rooted in
✔ Implicit within each client system are internal resistance thinking and feeling.
factors known as lines of resistance, which function to stabilize
✔ System relationships include acceptance, protection and
and realign the client to the usual wellness state.
fostering of independence

✔ Man and his environment have common patterns and integral

relationships and transformations are created in human
Theory in View of Metaparadigms
consciousness.

Nursing ✔ Integration of man and environment meanings result in

Nursing's primary concern is to define the appropriate action in adaptation.
situations that are stress-related or concerning possible
✔ Roy's model of nursing is best exemplified in the nursing
reactions of the client or client system to stressors. Nursing
process.
interventions aim to help the system adapt or adjust and retain,
restore, or maintain some degree of stability between the client
system variables and environmental stressors, focusing on
conserving energy. Nursing Process
- the nursing process is a problem solving approach for gathering
data, identifying the capacities and needs of the human adaptive
Person
system, selecting and implementing approaches for nursing care,
Humans are defined as "men, women, and children cared for
and evaluating the outcome of care provided. It includes the
either singly or as social units" and are the "material object" of
following steps:
nurses and others who provide direct care.
1. ASSESSMENT OF BEHAVIOR 1. Physiological-Physical Mode
✔ the first step of the nursing process
✔ which involves gathering data about the behavior of the • Physical and chemical processes are involved in the
person as an adaptive system in each of the adaptive modes function and activities of living organisms. These are the
actual processes put in motion by the regulator
2. ASSESSMENT OF STIMULI subsystem.
✔ the second step of the nursing process
• This mode's basic need is composed of the needs
✔ which involves the identification of internal and external
associated with oxygenation, nutrition, elimination,
stimuli that are influencing the person's adaptive behavior
activity and rest, and protection.
✔ Stimuli are classified as:
• This model's complex processes are associated with the
✔ Focal - those most immediately confronting the senses, fluid and electrolytes, neurologic function, and
person endocrine function.
✔ Contextual - all other stimuli present that are
affecting the situation 2. Self-Concept Group Identity Mode
✔ Residual - those stimuli whose effect on the
• The goal of coping is to have a sense of unity, meaning
situation is unclear
the purposefulness in the universe, and a sense of
identity integrity. This includes body image and self-
3. NURSING DIAGNOSIS
ideals.
✔ The step three of the nursing process
✔ which involves the formulation of statements that interpret
data about the adaptation status of the person, including the 3. Role Function Mode
behavior and most relevant stimuli • This focuses on the primary, secondary, and tertiary
roles that a person occupies in society and knowing
4. GOAL SETTING where they stand as a member of society.
✔ The fourth step of the nursing process
✔ which involves the establishment of clear statements of the 4. Interdependence Mode
behavioral outcomes for nursing care
• This mode focuses on attaining relational integrity
through the giving and receiving of love, respect and
5. INTERVENTION
value. This is achieved with effective communication
✔ The fifth step of the nursing process
and relations.
✔ which involves the determination of how best to assist the
person in attaining the established goals

6. EVALUATION
Major Concepts & Definitions:
✔ The sixth and final step of the nursing process
✔ which involves judging the effectiveness of the nursing Health
intervention in relation to the behavior after the nursing → a state and process of being and becoming integrated and
intervention in comparison with the goal established whole that reflects person and environmental mutuality

Adaptation
Four Adaptive Modes:
→ the process and outcome whereby thinking and feeling
These are how the regulator and cognator mechanisms are persons, as individuals and in groups, use conscious awareness
manifested; in other words, they are the external expressions of and choice to create human and environmental integration
the above and internal processes.
Adaptive responses
→ responses that promote integrity in terms of the goals of the
human system, that is, survival, growth, reproduction, mastery,
and personal and environmental transformation
Ineffective responses adaptation, both innate and acquired, to respond to the
environmental stimuli they experience. Human systems can be
→ responses that do not contribute to integrity in terms of the
individuals or groups, such as families, organizations, and the
goals of the human system
whole global community.

Adaptation levels
Health
→ represent the condition of the life processes described on Health is defined as the state where humans can continually
three different levels: integrated, compensatory, and adapt to stimuli. Because illness is a part of life, health results
compromised. from a process where health and illness can coexist. If a human
can continue to adapt holistically, they will maintain health to
Theory Assertions: reach completeness and unity within themselves. If they cannot
adapt accordingly, the integrity of the person can be affected
✔ Roy's model views the person as an adaptive system with
negatively.
coping processes.

✔ She described the person as a whole comprising parts and Environment

which functions as a unity for some purpose. The environment is defined as conditions, circumstances, and
influences that affect humans' development and behavior as an
✔ It includes people as individuals or in groups (families,
adaptive system. The environment is a stimulus or input that
organizations, communities, nations, and society as whole).
requires a person to adapt. These stimuli can be positive or
✔ The person is an adaptive system with cognator and regulator negative.
subsystems acting to maintain adaptation in the four adaptive
modes.

✔The environment is viewed as all conditions, circumstances,

Application of the Theory:
✔ Nursing process is cyclical in nature - beginning with
and influences surrounding and affecting the development and
assessment, diagnosis, planning, implementation, and evaluation
behavior of persons and groups with particular consideration of
- the evaluation may also serve as the assessment findings for
mutuality of person and earth resources.
another set of nursing problems.
✔ Nursing is the science and practice that expands adaptive
✔ It means that the assessment component of the nursing
abilities and enhances person and environment transformation.
process is the stimuli or the input and the planning and
✔ The goals of nursing are to promote adaptation for individuals implementation are the throughput processes.
and groups in the four adaptive modes, thus contributing to
✔ The output is the evaluation which then provides the
health, quality of life, and dying with dignity.
necessary feedback to the goal of care.
✔ This is done by assessing behavior and factors that influence
✔The nurse then decides what necessary actions should be
adaptive abilities and by intervening to expand those abilities
taken next, in the light of the patient's response to the nursing
and to enhance environmental interactions.
interventions. This action by the nurse is adaptation in its
simplest terms.
Theory in View of Metaparadigms:
✔Patients adapt, too. The nursing interventions we perform
Nursing
ultimately elicits a response from our patients, our patients may
In the Adaptation Model, nurses are facilitators of adaptation.
or may not actually adapt according to our expectations.
They assess the patient's behaviors for adaptation, promote
positive adaptation by enhancing environment interactions and
helping patients react positively to stimuli. Nurses eliminate
ineffective coping mechanisms and eventually lead to better
outcomes.

Person
Based on Roy, humans are holistic beings that are in constant
interaction with their environment. Humans use a system of
DOROTHY JOHNSON'S
✔ The "science and art" of nursing should focus on the patient as
BEHAVIORAL SYSTEMS an individual and not on the specific disease entity. The model is
MODEL patterned after a systems model; a system is defined as
consisting of interrelated parts functioning together to form a
"Nursing is an external force that
whole.
acts to preserve the organization of
the patient's behavior by means of ✔ She stated that a nurse should use the behavioral system as
imposing regulatory mechanisms or their knowledge base. The reason Johnson chose the behavioral
by providing resources while the system model is the idea that "all the patterned, repetitive,
patient is under stress." purposeful ways of behaving that characterize each person's life
make up an organized and integrated whole, or a system".

Credentials and Background of Johnson

✔ Born August 21, 1919 in Savannah, Georgia. 7 Subsystems of Human Behavior
The ultimate goal for each subsystem is expected to be the
✔Graduated BSN from Vanderbilt University in Nashville,
same for all individuals.
Tennessee and her M.P.H. from Harvard University in Boston.

✔ She was a staff nurse at the Chatham-Savannah Health 1. Attachment

Council (1943-1944).
- probably the most critical, because it forms the basis for all
✔ She is proud to receive the 1975 Faculty Award from graduate social organization
students.
- provides survival & security; its consequences are social
✔ She was an early proponent of nursing as a science as well as inclusion, intimacy, & formation and maintenance of a strong
an art; also believed nursing had a body of knowledge reflecting social bond
both the science and the art.

✔ Johnson (1959) proposed that the science of nursing necessary 2. Achievement

for effective nursing care included a synthesis of key concepts - attempts to manipulate the environment with its function is
drawn from basic and applied sciences. control or mastery of an aspect of self or environment to some
standard of excellence
✔ In 1961, she proposed that nursing care facilitated the client's
maintenance of a state of equilibrium.
- areas of achievement behavior include intellectual, physical,
✔ She also proposed that clients were "stressed" by a stimulus of creative, mechanical, & social skills
either an internal or external nature.
3. Aggressive
• These stressful stimuli created such disturbance, or
- function is protection & preservation which holds that
"tensions", in the patient that a state of disequilibrium
aggressive behavior is not only learned, but has a primary intent
occurred.
to harm others
✔ She identified 2 areas that nursing care should be based in
order to return the client to a state of equilibrium: - however, society has placed limits when dealing with self-
protection and that people & their properly be respected and
• Reduce stressful stimuli
protected
• Support natural and adaptive processes

4. Dependence
- promotes helping behavior that calls for a nurturing response
Theoretical Sources
- its consequences are approval, attention, or recognition, and
✔ Johnson's behavioral system theory springs from Nightingale's physical assistance
belief that nursing's goal is to help individuals prevent or recover
from disease or injury.
- dependency behavior develops from the complete reliance on Behavioral system
others for certain resources essential for survival
→ encompasses the patterned, repetitive, & purposeful ways of
behaving
- an imbalance produces tension, which results in disequilibrium
→ the system is flexible enough to allow influence that affect it

5. Sexual
- has dual functions of procreation & gratification that begins Subsystems
with the development of gender role identity & includes the → mini-systems with its own particular goal & function that can
broad range of sex role behaviors be maintained as long as its relationship to the other subsystems
or the environment is not changed or disturbed
6. Ingestive
- have to do with when, how, what, how much, and under what Equilibrium
conditions we eat
→ a stabilized but more or less transitory, resting state where
the person is in harmony with himself & with his environment
7. Eliminative
- have to do with when, how, what, how much, and under what
Tension
conditions we eliminate
→the state of being stretched or strained can be viewed as an
end-product of a disturbance in equilibrium
NOTE:
✔ These responses are a set of behavioral responses or
tendencies that share a common goal developed through
Stressor
experience and learning and are determined by numerous → a stimulus, either internal or external, that produce tension
physical, biological, psychological, and social factors. and result in a degree of instability

✔ Each subsystem has three functional requirements:

• Each subsystem must be "protected from noxious

Theory Assumptions
influences with which the system cannot cope".
These are in three categories: assumptions about system,
• Each subsystem must be "nurtured through the input of
assumptions about structure, and assumptions about functions.
appropriate supplies from the environment".
• Each subsystem must be "stimulated for use to
Assumptions About System
enhance growth and prevent stagnation".
1. There is "organization, interaction, interdependency and
✔ As long as the subsystems are meeting these functional integration of the parts and elements of behaviors that
requirements, the system and the subsystems are viewed as go to make up the system."
self-maintaining and self-perpetuating.
2. A system "tends to achieve a balance among the
various forces operating within and upon it, and that
man strives continually to maintain a behavioral system
Major Concepts & Definitions balance and steady-state by more or less automatic
adjustments and adaptations to the natural forces
Behavior occurring on him."

→ the output of intra-organismic structures and processes as 3. A behavioral system, which requires and results in
they are coordinated and articulated by & responsive to changes regularity and constancy in behavior, is essential to man.
in sensory stimulation It is functionally significant because it serves a useful
purpose in social life and the individual.
System 4. "System balance reflects adjustments and adaptations
→ a whole that functions as a whole by virtue of the that are successful in some way and to some degree.'
interdependence of its parts characterized by organization,
interaction, interdependency, & integration of the parts &
elements
Assumptions About Structure The environment consists of all the factors that are not part of
1. "From the form the behavior takes and the the individual's behavioral system, but that influence the system.
consequences it achieves can be inferred what 'drive' The nurse may manipulate some aspects of the environment so
has been stimulated or what 'goal' is being sought." the goal of health or behavioral system balance can be achieved
for the patient.
2. Each person has a "predisposition to act concerning the
goal, in certain ways rather than the other ways." This
predisposition is called a "set."
Application of the Theory
3. Each subsystem has a repertoire of choices called a
✔ The subsystems are interactive and interdependent,
"scope of action."
restoration in one subsystem could bring about restoration of
4. The individual patient's behavior produces an outcome behavior in another or others. This means that healthcare
that can be observed. practitioners must direct all efforts, interventions, or actions to
all the subsystems.
Assumpti ✔ As nurses, we should provide the highest level of quality care
ons About Functions to our patients by taking into consideration the whole person and
1. The system must be protected from toxic influences trying to understand the interrelatedness of its individual
with which the system cannot cope component parts.
2. Each system has to be nurtured through the input of
appropriate supplies from the environment.

3. The system must be stimulated for use to enhance

growth and prevent stagnation.

Theory in View of Metaparadigms:

Nursing
This is viewed as an external force that acts to preserve the
organization of the patient's behavior by means of imposing
regulatory mechanisms or by providing resources while the
patient is under stress. Nursing activities are not dependent on
medical authority, rather, nursing is complementary to the
practice of medicine.

Person
This is a behavioral system with patterned, repetitive, and
purposeful ways of behaving that link the person to his
environment. The person is a system of interdependent parts
that requires some regularity and adjustment to maintain
balance or equilibrium. A person' attempt to regain balance may
require an unnecessary use of energy.

Health
Health as an elusive, dynamic state influenced by biological,
psychological, and social factors. A lack of balance in the
structural or functional requirements of the subsystems leads to
poor health.

Environment
 - the phase in the nurse-patient interaction where the client
seeks help and the nurse assists the client to understand the
NUR 016: THEORETICAL FOUNDATIONS IN NURSING problem and the extent of the help.
MODULE 08: HILDEGARD PEPLAU AND IDA JEAN ORLANDO 2. Identification
HILDEGARD PEPLAU’S THEORY OF - characterized by the client who assumes a posture of
INTERPERSONAL RELATIONSHIP dependence, interdependence, or independence in relation to the
nurse
“Nursing is the interpersonal therapeutic process
of functioning cooperatively with other human - the nurse's focus is to assure the person that the nurse
processes that make health possible for individuals understands the interpersonal meaning of the client's situation
in communities through education that aims to
promote forward movement of personality.” 3. Exploitation
- the client derives full value from what the nurse offers through
the relationship
Credentials and Background of Hildegard Peplau
- client uses available services based on self-interest and needs
✔ She is considered as the “Mother of Psychiatric Mental Health
- power shifts from the nurse to the client
Nursing” and “Nurse of the Century”.

✔ She served as a Executive Director and President of the 4. Resolution

American Nurse Association (ANA) - old needs and goals are set aside and new ones are adopted

- once older needs are resolved, newer and more mature one
✔ Peplau taught the first classes for graduate psychiatric nursing become evident.
students at Teachers College, Columbia University.

✔ Contributed to the advancement of the nursing profession was

more than what she gave for this special area of clinical nursing. 6 Proposed Nursing Roles
1. Stranger Role
✔ Her seminal book is recognized as the first nursing theory
textbook since Nightingale's work in the 1850s. Peplau is → is exemplified by the nurse receiving the client in the same
credited for the following in nursing profession: way one meets a stranger in other life situations.

• promotion of professional standards and regulation → the nurse provides an accepting climate that builds trust.
through credentialing
• introduced the concept of advanced nursing practice 2. Resource Role
• stressed the importance of psychodynamics in nursing
→ the nurse answers questions, interprets clinical treatment
practice
data, and gives information.
• proponent of the nurse's unique ability to understand
his or her own behavior in order to help others identify 3. Teaching Role
their perceived difficulties
→ the nurse gives instructions and provides training. She also
✔ She discussed four psychobiological experiences that compel involves analysis and synthesis of the learner's experience.
destructive or constructive patient responses, as follows:
• needs 4. Counseling Role
• frustrations → the nurse helps clients understand and integrate the meaning
• conflicts of current life circumstances and provides guidance and
• anxieties. encouragement to make changes.

5. Surrogate Role
4 Phases of the Nurse-Patient Relationship → the nurse helps clients clarify domains of dependence,
(which Peplau identified) interdependence, and independence and acts on client's behalf
as advocate.
1. Orientation
6. Active Leadership Role
→ the nurse helps the client assume maximum responsibility
for meeting treatment goals in a mutually satisfying way.

Theoretical Assertions
✔ Nurse and the patient can interact.
IDA JEAN ORLANDO'S
THEORY OF DELIBERATIVE
✔ Peplau emphasized that both the patient and nurse mature as
the result of the therapeutic interaction. NURSING PROCESS
✔ Communication and interviewing skills remain fundamental
"Nursing is a profession that seeks to
nursing tools.
find out and meet the patient's
✔ Peplau believed that nurses must clearly understand immediate need for help."
themselves to promote their client's growth and avoid limiting
their choices to those that nurses value.

Credentials & Background of the Theorist:

Theory in View of Metaparadigms ✔ Developed her theory from a study conducted at the Yale
University School of Nursing, integrating mental health concepts
into basic nursing curriculum.
Nursing
Hildegard Peplau considers nursing to be a "significant, ✔ She was one of the first nursing leaders to identify and
therapeutic, interpersonal process." She defines it as a "human emphasize the elements of the nursing process and the critical
relationship between an individual who is sick, or in need of importance of the patient's participation in the nursing process.
health services, and a nurse specially educated to recognize and
✔ Orlando's theory focuses on how to produce improvement in
to respond to the need for help."
the patient's behavior. Evidence of relieving the patient's distress
is seen as positive changes in the patient's observable behavior.
Person
Peplau defines man as an organism that "strives in its own way ✔ Orlando analyzed the content of 2000 nurse-patient contacts
to reduce tension generated by needs." The client is an and created her theory based on analysis of these data.
individual with a felt need.
✔ She was one of the early thinkers in nursing who proposed that
patients have their own meanings and interpretations of
Health
situations and therefore nurses must validate their inferences
Health is defined as "a word symbol that implies forward
and analyses with patients before drawing conclusions.
movement of personality and other ongoing human processes in
the direction of creative, constructive, productive, personal, and
community living." Theory Description
✔ Ida Jean Orlando's theory developed observations she recorded
Environment between a nurse and patient. Orlando's nursing theory stresses
Although Peplau does not directly address society/environment, the reciprocal relationship between patient and nurse. What the
she does encourage the nurse to consider the patient's culture nurse and the patient say and do affects them both.
and mores when the patient adjusts to the hospital routine.
✔According to Orlando (1961), persons become patients who
require nursing care when they have needs for help that cannot
be met independently because they have physical limitations,
have negative reactions to an environment, or have an
experience that prevents them from communicating their needs.

✔ Patients experience distress or feelings of helplessness as the

result of unmet needs for help (Orlando, 1961).
✔ Orlando proposed a positive correlation between the length of
time the patient experiences unmet needs and the degree of
distress. Therefore, immediacy is emphasized throughout her → the nurse's and patient's individual perceptions, thoughts,
theory.
and feelings
✔ In Orlando's view, when individuals are able to meet their own
needs, they do not feel distress and do not require care from a Nursing process discipline
professional nurse. → includes the nurse communicating to the patient his or her
✔ Orlando emp hasizes that it is crucial for nurses to share their
own immediate reaction
perceptions, thoughts, and feelings so they can determine
whether their inferences are congruent with the patient's need
→ made in order to ask for validation, clarification, or correction
from the patient
(Schmieding, 2006).

✔ Abraham (2011) used Orlando's theory to help nurses achieve → once referred to as the "deliberative nursing process"
more successful patient outcomes such as fall reduction.
Automatic nursing actions
✔ Orlando's theory remains a most effective practice theory that
is especially helpful to new nurses as they begin their practice. → nursing activities that are decided upon for reasons other
than the patient's immediate need

Nursing Process Theory: the nursing process is an

interaction of three basic elements.
Deliberative nursing actions
1. The behavior of the patient → those decided upon after ascertaining a need and then
2. The reaction of the nurse meeting this need
3. The nursing actions which are designed for the patient's
benefit.

✔ The role of the nurse is to find out and meet the Theory Assumptions
patient's immediate need for help. ✔ When patients cannot cope with their needs on their own, they
become distressed by feelings of helplessness.
✔ Nursing process helps the nurse find out the nature of
the distress and what helps the patient. ✔ In its professional character, nursing adds to the distress of
the patient.
✔ The use of this theory keeps the nurse's focus on the
patient. ✔ Patients are unique and individual in how they respond.

✔ The strength of the theory is that it is clear, concise ✔ Nursing offers mothering and nursing analogous to an adult
and easy to use. who mothers and nurtures a child.

✔ The practice of nursing deals with people, the environment,

Major Concepts & Definitions and health.

Nurse's responsibility is composed of whatever help the patient ✔ Patients need help communicating their needs; they are
may require for his needs to be met. The nurse may either give uncomfortable and ambivalent about their dependency needs.
this need for help directly herself or indirectly employing the aid
✔ People can be secretive or explicit about their needs,
of other members of the healthcare team.
perceptions, thoughts, and feelings.

Need ✔ The nurse-patient situation is dynamic; actions and reactions

are influenced by both the nurse and the patient.
→ is a situationally defined requirement of the patient which
relieves or diminishes his immediate distress if this is supplied ✔ People attach meanings to situations and actions that aren't
apparent to others.

Presenting behavior of patient ✔ Patients enter into nursing care through medicine.

→ any observable verbal and nonverbal behavior of the patient ✔ The patient cannot state the nature and meaning of his or her
distress without the nurse's help or him or her first having
Immediate reactions established a helpful relationship with the patient.
✔ Any observation shared and observed with the patient is
immediately helpful in ascertaining and meeting his or her need
or finding out that he or she is not in need at that time.

✔ Nurses are concerned with the needs the patient is unable to

meet on his or her own.

Theory in View of Metaparadigms

Nursing
Orlando speaks of nursing as unique and independent in its
concerns for an individual's need for help in an immediate
situation. The efforts to meet the individual's need for help are
carried out in an interactive situation and in a disciplined manner
that requires proper training.

Person
Orlando uses the concept of human as she emphasizes
individuality and the dynamic nature of the nurse-patient
relationship. For her, humans in need are the focus of nursing
practice.

Health
In Orlando's theory, health is replaced by a sense of helplessness
as the initiator of a necessity for nursing. She stated that nursing
deals with individuals who require help.

Environment
Orlando completely disregarded the environment in her theory,
only focusing on the patient's immediate need, chiefly the
relationship and actions between the nurse and the patient (only
an individual in her theory; no families or groups were
mentioned). The effect that the environment could have on the
patient was never mentioned in Orlando's theory.

Application of the Theory

✔ Since the premise of Orlando's theory is in the immediacy of
help needed by patients, this framework will be important for
nurses who are assigned in special clinical areas that require
quick decision making and critical thinking skills. Such areas are
the OR, ER, and ICU/Critical Care Unit.

✔ Orlando's theory stresses the reciprocal relationship between

patient and nurse remains a most effective practice theory that
is especially helpful to new nurses as they begin their practice.