Interpersonal/Caring Theories

Peplau’s Psychodynamic Nursing Theory

Peplau’s Psychodynamic Nursing Theory
Peplau’s Psychodynamic Nursing Theory

Hildegard Peplau is one of the first theorists since Nightingale to present a theory for nursing. She introduced her interpersonal concepts in 1952 and based them on available theories at the time: psychoanalytic theory, principles of social learning, and concepts of human motivation and personality development. Psychodynamic nursing is defined as understanding one’s own behavior to help others identify  felt difficulties and applying principles of human relations to problems arising during the experience.

Peplau views nursing as a maturing force that is realized as the personality develops through educational, therapeutic, and interpersonal process. Nurses enter into  a personal relationship with an individual when a felt need is present. This nurse-patient relationship evolves in four phases:

1. Orientation. During this phase, the patient seeks help and the nurse assists the patient to understand the problem and the extent of need for help.

2. Identification. During this phase, the patient assumes a posture of dependence, interdependence, or independence e in relation to the nurse (relatedness). The nurse’s focus is to assure the person that the nurse understands the interpersonal meaning of the patient’s situation.

3. Exploitaiton. In this phase, the patient derives full value from what the nurse offers through the relationship. The patient uses available services on the basis of self-interest and needs. Power shifts from the nurse to the patient.

4. Resolution. In this final phase, old needs and goals are put aside and new ones adopted. Once older needs are resolved, newer and more mature ones emerge.

During the nurse-patient relationship, nurses assumes many roles: stranger, teacher, resource person, surrogate, leader,  and counselor. Today Peplau’s model continues to be used by clinicians when working with individuals who have psychologic problems.


Kozier, Barbare et. al Fundamentals of Nursing 5th edition

Addison Wesley Publishing Company Inc p53


Dorothea E. Orem

Dorothea E. Orem
Dorothea E. Orem


A unity who can be viewed as functioning biologically, symbolically, and socially and who initiates  and performs self-care activities on own behalf in maintaining life, health and well-being; self-care activities deal with air, water, food elimination, activity and rest, solitude and social interaction, prevention of hazards to life and well-being, and promotion of human functioning.


The environment is linked to the individual, forming an integrated and interactive system.


Health is a state that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning. It includes physical, psychologic, interpersonal, and social aspects. Well-being is used in the sense of individual’s perceived condition of existence. Well-being is a state characterized by experiences of contentment, pleasure and certain kinds  of happiness; by spiritual experiences; by movement toward fulfillment of one’s ideal; and by continuing personalization. Well-being is associated with health, with success in  personal endeavors, and with sufficiency of resources.


A helping or assisting service to persons who are wholly or partly dependent-infants, children and adults – when they, their parents, guardians, or other adults responsible for their care are no longer able to give  or supervise their care.  A creative effort of one human being to help another human being. Nursing is deliberate action, a function of the practical intelligence of nurses, and action to bring about humanely desirable conditions in persons and their environments. It is distinguished from other human services and other forms of care by its focus on human beings.

Orem’s Self-Care Deficit Theory

Dorothy Orem’s self-care deficit theory, published first in 1971, has been widely accepted by the nursing community. It includes three related theories of self-care, self-care deficit, and nursing system. Self-care theory postulates that self-care and the self-care of dependents are learned behaviors that individuals initiate and perform on theri own behalf to maintian life, health, and well-being. The individual’s ability to perform self care is called self-care agency. Adults care for themselves, whereas infants, the aged, the ill, and the disabled require assistance with self-care activities.

These are three kinds of self-care requisites:

1. Universal requisites, common to all people, include the maintenance of air, water, food, elimination, activity and rest, solitude and social interaction; prevention of hazards to life and well-being; and the promotion of human functioning.

2. Developmental requisites are those associated with conditions that promote known developmental processes throughout the life cycle.

3. Health deviation requisites relates to defects and deviations from normal structure and integrity that impair an individual’s ability to perform self-care.

Self-care deficit theory asserts that people benefit from nursing because they have health-related limitations in providing self-care. Limitations may result from illness, injury, of form the effects of medical tests or treatments.Two variables affect these deficits: self-care agency (ability) and therapeutic self-care demands (the measures of care required to meet existing requisites). Self-care deficit results when self-care agency is not adequate to meet he known self-care demand.

Nursing system theory postulates that nursing systems form when nurses prescribe, design, and provide nursing that regulates the individual’s self-care capabilities and meets therapeutic self-care requirements. Three types of nursing systems are identified:

1. Wholly compensatory systems are required for individuals unable to control and monitor their environment and process information.

2. Partially compensatory systems are designed for individuals who are unable to perform some (but not all) self-care activities.

3. Supportive-educative (developmental) systems are designed for persons who need to learn to perform self-care measures ans need assistance to do so.



Kozier, Barbara Fundamentals of Nursing 5th edition

Addison-Wesley Publishing Company, Inc 1998 p.51


Dorothy E. Johnson

Dorothy E. Johnson
Dorothy E. Johnson

Behavioral System Model (1959,1968,1974,1980)


A behavioral system composed of seven subsystems: affiliative, achievement, dependence, aggressive, eliminative, ingestive, and sexual.


Consists of all factors that are not part of the individual’s behavioral system but that influence the system and some of which can be manipulated by the nurse to achieve the health goal of the client. The individual links to and interacts with the environment.


Health is an elusive, dynamic state of influenced by biologic, psychologic, and social factors. Health is reflected by the organization, interdependence, and integration of the subsystem. Human attempt to achieve a balance in this system; this balance leads to functional behavior. A lack of balance in the structural or functional requirements of the subsystem leads to a poor health.


An external regulatory force that acts to preserve the organization and integration of the client’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found.


Johnson’s Behavioral System Model

Dorothy Johnson used her observations of behavior over many years to formulate a general theory of man as a behavioral system. The theory was originally presented orally in 1968 but was not published until 1980. Johnson defines a system as a whole that functions as a whole by virtue of the interdependence of its parts. Individuals strive to maintian stability and balance in these parts through adjustments and adaptations to the forces that impinge on them. A behavioral system is patterned, repetitive, and purposeful.

Johnson’s key concepts describe the individual  as a behavioral system composed of seven subsystems:

1. The attachment-affiliative subsystem provides survival and security. Its consequences are social inclusion, intimacy, and the formation and  maintenance of a strong social bond.

2. The dependency subsystem promotes helping behavior that calls for a nurturing response. Its consequences are approval, attention or recognition, and p[physical assistance.

3. The ingestive subsystem satisfies appetite. It is governed by social and psychologic considerations as well as biologic.

4. The eliminative subsystem excrete body wastes.

5. The sexual subsystem functions dually for procreation and gratification.

6. The achievement subsystem attempts to manipulate the environment. It controls or masters an aspect of the self or environment to some standard of excellence.

7. The aggressive subsystem protects and preserves the self and society within the limits imposed by society.

Each of the above subsystem has the same functional requirements: protection, nurturance, and stimulation. The subsystems’ responses are developed through motivation, experience, and learning and are influenced by biopsychosocial factors.

Other concepts associated with Johnson’s model are equilibrium, a stabilized more or less transitory resting state in which the individual is in harmony with the self and the environment; tension, a state of being stretched or strained; and stressors, internal or external stimuli that produce tension ans result in a degree of instability.



Kozier, Barbara Fundamental of Nursing 5th edition

Addison-Wesley Publishing Company, Inc 1998 p.49


Betty Neuman

Betty Neuman
Betty Neuman

Health Care System Model




Open system consisting of a basic structure or central core of survival factors surrounded by concentric rings that are bounded by lines of resistance , a normal line of defense, and a flexible line of defense. The total person is a composite of physiologic, psychologic, sociocultural, and developmental variables.


Both internal and external environments exists and a person maintains varying degrees of harmony and balance between them. It is all factors affecting and affected by the system.


Wellness is the condition in which all parts and sub-parts of an individual are in harmony with the whole system. Wholeness is based on interrelationships of variables that determine the resistance of an individual to any stressor. Illness indicates lack of harmony among the parts and sub-parts of the system of the individual. Health is viewed as a point along a continuum from wellness to illness; health is dynamic. Optimal wellness or stability indicates that all a person’s needs are being met. A reduced state of wellness is the result of unmet systemic needs. The individual is in a dynamic state of wellness-illness, in varying degrees, at any given time.


Neuman’s Health Care Systems Model

Betty Neuman’s systems model, first published in 1972, is based on the individuals relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. Reconstitution is the state of adaptation to stressors.

Neuman views the client as an open system consisting of a basic structure or central core of energy sources surrounded by two concentric boundaries or rings referred to as lines of resistance. The two lines of resistance represent internal factors that help the client defend against a stressor. The inner or normal line of defense represents the person’s state of equilibrium of the state of adaptation developed and maintained over time  and considered normal for that person. The flexible line of defense is dynamic and can be rapidly altered over a short period of time. It is a protective buffer that prevents stressors from penetrating  the normal line of defense.

The nurse’s focus is all the variables affecting an individual’s response to stressors. Nursing interventions are carried out on three preventive levels:

1. Primary prevention identifies risk factors, attempts to eliminate the stressor, and focuses on protecting the normal line of defense and strengthening the flexible line of defense. A reaction has not yet occurred, but the degree of risk is known.

2. Secondary prevention relates to interventions or active treatment initiated after symptoms have occurred. The focus is to strengthen internal lines of resistance, reduce the reaction, and increase resistance factors.

3. Tertiary prevention refers to intervention following that in the secondary stage. It focuses on readaptation and stability and protects reconstitution or return to wellness follwing treatment. The nurse emphasizes educating the client in strengthening resistance to stressors and ways to help prevent recurrence of reaction or regression.

Betty Neuman’s model of nursing has been widely accepted by the nursing community, nationally and internationally. it is applicable to a variety of nursing practice settings involving individuals, families, groups, and communities.


Kozier, Barbara Fundamentals of Nursing 5th edition

Addison-Wesley Publishing Company, Inc.1998 p.49


Imogene King

Imogene King
Imogene King

Goal Attainment Theory (1971,1981,1986,1987,1989)


Three interacting systems; individuals (personal system), groups (interpersonal system), and society (social system); the personal system is a unified, complex, whole self who perceives, thinks, desires, imagines, decides, identifies goals, and selects means to achieve them.


Adjustments to life and health are influenced by an individual;s interactions with environment. The environment is constantly changing.


A dynamic state in the life cycle; illness is an interference in the life cycle. Health implies continuous adaptation to stress in the internal and external environment through the use of one’s resources to achieve a maximum potential for daily living.


A helping profession that assists individuals and groups in society to attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity. Nursing is perceiving, thinking, relating, judging and acting a vis-avis the behavior of individuals who come to a nursing situation.  A nursing situation is the immediate environment, spatial and temporal reality, in which nurse and client establish a relationship to cope with health state and adjust to changes in activities of daily living if the situation demands adjustment. It is an interpersonal process of action, reaction, interaction, and transaction whereby nurse and client share information about their perceptions in the nursing situation.

King’s Goal Attainment Theory

Imogene King’s theory of goal attainment, first published in 1971, was derived from conceptual framework of three dynamic interacting systems; (a) personal systems (individuals), (b) interpersonal systems (groups), and social systems (society). Key concepts are identified for each system as follows:

1. Personal system concepts: perception, self, body image, growth and development, space and time

2. Interpersonal system concepts: interaction, communication, transaction, role and stress

3. Social system concepts: organization, authority, power, status, and decision making.

The client ans nurse are personal systems subsystems within interpersonal and social systems. To identify problems and to establish goals, the nurse and client perceive one another, act and react, interact, and transact. Transactions are defined as purposeful interactions that lead to goal attainment. Transactions have the following characteristics:

1. They are basic to goal attainment and include social exchange, bargaining and negotiating, and sharing a frame of reference toward mutual goal setting.

2. They require perceptual accuracy in nurse-client interactions and congruence between role performance and role expectation for nurse and client.

3. They lead to goal attainment, satisfaction, effective care, and enhanced growth and development.

King postulates seven hypothesis in goal attainment theory:

1. Perceptual congruence in nurse-client interactions increases mutual goal setting.

2. Communication increases mutual goal setting between nurses and clients and leads to satisfactions.

3. Satisfaction in nurses and clients increase goal attainment.

4. goal attainment decreases stress and anxiety in nursing situations.

5. Goal attainment increases client learning and coping ability in nursing situations.

6. Role conflict experienced by clients, nurses, or both decreases transactions in nurse-client interactions.

7. Congruence in role expectations and role performance in creases transactions in nurse-client interactions.

King’s theory highlights the importance of the participation of all individuals in decision making and deals with the choices, alternatives, and outcomes of nursing care. The theory offers insight into nurses’ interactions with individuals and groups within the environment t.



Kozier, Barbara Fundamentals of Nursing  5th edition

Addison-Wesley Publishing Company, Inc pp.48-49

Fundamentals Nursing

The Development of Nursing in America

In North America, nursing and health services were slow to be established before the American Revolution (1775 – 1783). One notable organization was the Nurse Society of Philadelphia, which gave women minimal instruction in obstetrics to enable them to provide maternity nursing services in home settings.

During the American Civil War, several nurses emerged who were notable for their contributions to a country torn by internal strife. Harriet Tubman and Sojourner Truth provided care and safety to slaves fleeing to the North on the “Underground Railroad.” Mother Biekerdyke and Clara Barton (who is credited with founding the American Red Cross) searched the battlefields and gave care to injured and dying soldiers. Noted authors Walt Whitman and Louisa May Alcott volunteered as nurses to give care to injured soldiers in military hospitals. They chronicled their experiences in their writing as a permanent record of nursing’s contribution during this time.

The late 1800s was a time of rapid reform of nursing services in the United States and Canada. Schools of nursing with planned educational programs were founded. A number of their graduates became the early leasers in the profession. Isabel Hampton Robb is one example a young school-teacher in Canada. Robb decided to change her profession and entered the Bellevue Hospital Training School in New York. After graduation, she nursed in Rome for 2 years, and then she became superintendent of the Illinois Training School at 26 years of age. Three years later she went to Baltimore to organize a new school in connection with Johns Hopkins Hospital. Among her many accomplishment was to author nursing textbook, which became the standard text for nursing schools in America.

Mary Adelaide Nutting, also from Canada, was in the first class at Johns Hopkins. After graduation, she established a course of training for students prior to ward experience at Johns Hopkins. Later, she reduced the nursing training to 3 years.

Mary Agnes Snively graduated from Bellevue Hospital Training School and returned to Canada to take charge of the nurses’ training at Toronto General Hospital. She is credited largely with direction of Canadian nursing education and was the first president of the Canadian Nurses Association.

Two American graduates of the New York Hospital, Lillian D. Wald and Mary Brewster, were the first to offer trained nursing services to the poor in the New York slums. Their home among the poor on the upper floor of a tenement is now famous as a center of public health nursing: the Henry Street Settlement, school nursing was established as an adjunct to visiting nursing. Again, Wald was involved, along with Lina L. Rogers.

Linda Rochards, who graduated in 1873 from the New England Hospital for Women and Children Training School for Nurses in Boston, is cited by many historians as America’s first trained nurse. She is credited with reforming nursing in 12 major hospitals, some of which were specialized mental hospitals. She also founded the first training school for nurses in Japan.

Some, however, despite that Richards was the first trained nurse. Evidence in a seriese of reports if Women’s Hospital of Philadelphia suggest that Harriet Newton Phillips was the first trained nurse to receive a certificate from that hospital in 1864 (Large 1976, p. 50). Philips is also considered the first trained nurse in America to do community nursing, to do missionary service, and to take postgraduate training.

America’s first trained black nurse was Mary Mahoney. She trained at the same hospital as Linda Richards and graduated in 1879.

The need for concerted action by nurses was first felt in England during the late 1800s. In 1894, the Matron’s Council of Great Britain and Ireland was organized, followed by the American Society of Superintendents of Training Schools for Nurses of the United States and Canada. Alumnae associations joined to form the Nurses Associated Alumnae of the United States and Canada in 1897. These North American organizations were the predecessors of current national groups. The Society if Superintendents divided nationally and ultimately became the Canadian National Association of Trained Nurses in 1908 – now the Canadian Nurses Association (CNA) – and the National League of Nursing Education in 1912. The Nurses Associated Alumnae became the American Nurses Association (ANA) in 1911. In 1908, the National Association of Colored Graduate Nurses was founded by a group of nurses who felt such an association could further not only the nursing cause but also their own interests.

In 1893, the Nightingale Pledge was written and administered to the graduating class of the Farrand (Nurse) Training School in Detroit, Michigan. At the time, the pledge reflected the nurse’s commitment to moral and ethical values and principles in the practice of nursing. Despite modern criticism of the pledge as portraying the nurse as subservient to the physician, it continues to provide “a framework for clarifying moral and ethical values and principles needed for delivering health care and promoting the standards of nursing” (Calhoun 1993m p. 130).

After World War I, the Frontier Nursing Service (FNS) was established by notable pioneer nurse, Mary Breckinridge. In 1918, she worked with the American Committee for Devastated France, distributing food, clothing, and supplies to rural villages in France and taking care of sick children. In 1921, Breckinridge returned to the United States with plans to provide health care to the people of rural America. She had initially prepared herself by taking courses at Teacher’s College in New York (where she met Mary Adelaide Nutting and gained her approval) and midwifery training in London and by developing prominent social contacts for fund-raising. In 1925, Breckinridge and two other nurses began the FNS in Leslie Country, Kentucky. Within this organizations, Breckinridge started one of the first midwifery training schools in the United States.

From the beginning of formal organization of nursing if the late 1800s to the end of World War I, the general trend was rapid expansion in the establishment of hospitals, with nursing schools dependent on them for support, Hospitals in turn depended on the schools to carry the chief nursing load. During the war, greater numbers of young women were accepted for entrance, and less consideration was given to selection requirements. Most schools by this time had adopted 3-year program, but the 8-hour day originally proposed with those programs was less quickly adopted.

By 1920, the hospital system of educating nurses was coming under increasing criticism. In addition, the effectiveness of having nurses teach other nurses was being questioned. This, a special post-basic course was offered at Teachers College, Columbia University, New York, to nursing program was also developed, in response to the postwar influenza epidemic and the medical profession’s new emphasis on teaching the principles of healthful living to individuals, families, and community groups.

During the early 1920s, the Rockefeller Survey (Committee for the Study of Nursing Education) recommended that nursing schools be independent of hospitals and on a college level. As a result, two university schools of nursing were set up, on at Yale University, New Haven, Connecticut, the other at Western Reserve University, Cleveland, Ohio. The Purpose of these experimental schools was to prove the feasibility of planning both classroom instruction and ward practice in accordance with the educational need of the students. These schools emphasized the social welfare and health aspects of nursing and demonstrated the value of university standards in the nursing field.

Another far-reaching result of the Rockefeller Survey was the National League of Nursing Education’s comprehensive study of nursing education (1926 – 1934), which led to the grading of nursing schools. It was believed that grading would establish standards for education in these schools. This was the beginning of the accreditation function now carried out by the National League for Nursing (NLN).

During this period, the concept of the clinical nurse specialist arose. In the early decades of the 20th century, hospitals started to segregate patients according to their disease process. Nurses were called upon to acquire expert knowledge in the care of specific patient types. These nursing roles were called extended or expanded roles. In the early 1940s, it was thought that more emphasis needed to be placed on the clinical specialties in the advanced professional curricula of colleges and universities. Most advanced nursing curricula were preparing specialists in nursing school administration, teaching, and supervision in public health and in hospitals administration but were not emphasizing clinical specialties. These specialties gained prominence in the post – World War II society. Nurses returning from overseas were required to work in clinical areas not familiar to them. One such area was psychiatric nursing, which helped individuals readjust to civilian life. By 1946, many nursing programs in the United States were providing more clinical content. Today the clinical nurse specialist is a graduate of a master’s or doctoral program in nursing with a major in a clinical specialty. These nurses are responsible for increasing their own clinical knowledge and competence and for enhancing the quality of nursing care and the quality of the organizational climate of learning and research.

From its early days to the present, nursing has undergone change in very area. Rapid strides have been made in nursing education programs and in a wide variety of hospital and community nursing services. Throughout these changes, nursing has continued to provide a stable service to help people. Nurses have also been part of the larger societal changes that have influenced nursing. Twentieth-century nursing leaders in the United States have been active in women’s suffrage, civil rights, and health care reform movements. Nurses have been elected to office at local and state levels. In 1992, Eddie Bernice Johnson from Texas became the first nurse elected to the United States House of Representatives. The time line running throughout this article highlights selected people and events in nursing’s history, demonstrating that nursing is a profession for and influenced by women and men of all cultural backgrounds and all socioeconomic levels.

Kozier, Barbara Fundamentals of Nursing 5th edition (Addison –  Wesley Publishing Company, Inc. p.7-11)
Fundamentals Nursing

The Development of Modern Nursing

The intellectual revolution of the 18th and 19th centuries led to a scientific revolution. With the discovery and exploration of new continents, an economic revolution evolved, after which nations became more interdependent through trade. The Industrial Revolution displaced workers from cottage craftsmen to factory laborers. With these changes came stressors to health. New illnesses, transmitted in the holds of ships by seamen and stowaway rodents, jumped national boundaries and continents. The closeness of factory work, the long hours, and the unhealthy working conditions led to the rapid transmission of communicable disease such as cholera and plague. Lack of prenatal care, inadequate nutrition, and poor delivery techniques resulted in a high rate of material and infant mortality. Many orphaned children died in workhouses of neglect or cruelty.

During this time, a “proper” woman’s role in life was to maintain a gracious and elegant home for her family. The common women worked as servants in private homes or were dependent on their husbands’ wages. The provision if care for the sick in hospitals or private homes fell to the uncommon women – often prisoners or prostitutes who had little or no training in nursing. Because of this nursing had little acceptance and no prestige. The only acceptable nursing role was within a religious order where services were provided as part of Christian charity.

The creation of the institute of Protestant Deaconesses at Kaiserswerth, Germany, changed the Order of Deaconesses ignited recognition of the need for the services of women in the care of the sick, the poor, children, and female prisoners. The training school for nurses at Kaiserswerth included care of the sick in hospitals, instruction in visiting nursing, instruction in religious doctrine and ethics, and pharmacy. The deaconess movement eventually spread to four continents, including North America, North Africa, Asia, and Australia.

Florence Nightingale, the most famous Kaiserswerth pupil, was born to a wealthy and intellectual family. Her education included the mastery of several ancient and modern languages, literature, philosophy, history, science, mathematics, religion, art and music. It was expected that she would follow the usual path of a wealthy and intelligent woman of the day: marry, bear children, and maintain an elegant home. Nightingale believed she was “called by God to help others … [and] to improve the well-being of mankind” (Schuyler 1992, p.4). She was determined to become a nurse, in spite of opposition from her family and the restrictive societal code for affluent young English women. As a well-traveled young woman of the day, she visited Kaiserswerth in 1847, where she received three months’ training in nursing. In 1853, she studied in Paris with the Sisters of Charity, after which she returned to England to assume the position of superintendent of a charity hospital for ill governesses.

During the Crimean War, the inadequacy of care for the soldiers led to public outcry. Florence Nightingale was asked by Sir Sidney Herbert of the British War Department to recruit a contingent of female nurses to provide care to the sick and injured in the Crimea. Nightingale and her nurses transformed the military hospital by setting up diet kitchens, a laundry, recreation centers, and reading rooms, and organizing classes for orderlies. Mary Grant Seacole, a Jamaican born and trained nurse also went to the Crimean to assist Nightingale’s nurses in their care of the injured.

When she returned to England, Nightingale was given an honorarium of ₤4500 by a grateful English public. She later used this to develop the Nightingale Training School for Nurses, which opened in 1860. The school served as a model for other training schools. Its graduates traveled to other countries to manage hospitals and institute nurse training programs. The efforts of Florence Nightingale and her nurses changed the status of nursing to a respectable occupation for women.

Kozier, Barbara Fundamentals of Nursing 5th edition (Addison –  Wesley Publishing Company, Inc. p.6-7)
Fundamentals Nursing

The Role of Religion in the Development of Nursing

Many of the world’s religions encourage benevolence, but it was the Christians value of “love thy neighbor as thyself” that had a significant impact on the development if Western nursing. The principle of caring was established with Christ’s parable of the Good Samaritan providing care for a tired and injured stranger. Converts to Christianity during the third and fourth centuries included several wealthy matrons of the Roman Empire, including Marcella, Fabiola, and Paula, who used their wealth to provide houses of care and healing (the forerunner of hospitals) for the poor, the sick, and the homeless.

Women were not the sole providers of nursing services in the third century in Rome there was an organization of men called the Parabolani Brotherhood. This group of men provided care to the sick and dying during the great plague in Alexandria. During the Crusades, several knighthood orders – such as the Knights of Saint John of Jerusalem (also known as the Knights of Lazarus  – formed, composed of brothers in arms who provided nursing care to their sick and injured comrades. These orders where responsible for building great hospitals, the organization and management of which set a standard for the administration of hospitals throughout Europe at that time. As the Christian church grew, more hospitals were built, as were specialized institutions providing care for orphans, widows, the elderly, the poor, and the sick. During the Middle Ages (AD 500-1500), male and female religious, military, and secular orders with the primary purpose of caring for the sick were formed. Conspicuous among them were the aforementioned Knights of Saint John (Knights Hospitalers); the Alexian Brotherhood (organized in 1431); and the Augustinian sisters, which was the first purely nursing order.

In the late 16th century, Camillus DeLellis, later sainted for his work of Christian charity, founded a nursing order to provide are for the poor, the sick, the dying, and those in prisons, In 1633, the Sisters of Charity were founded by Saint Vincent de Paul in France. It was the first of many such orders organized under various Roman Catholic church auspices and largely devoted to caring for the sick. The Order of the Sisters of Charity sent nursing sisters to provide care in the New World, establishing hospitals in Canada, the United States, and Australia.

The deaconess groups, composed of women who provided care, had their origins in the Roman Empire of the third and fourth centuries but were suppressed during the Middle Ages by the Western churches. However, these groups of nursing providers resurfaced occasionally throughout the centuries, most notably in 1836, when Theodor Fliedner reinstituted the Order of the Deaconesses and opened a small hospital and training school in Kaiserswerth, Germany. Florence Nightingale received her “training” in nursing at the Kaiserswerth School.

Kozier, Barbara Fundamentals of Nursing 5th edition (Addison –  Wesley Publishing Company, Inc. p.50)
Fundamentals Theorists

Virginia Henderson (1955, 1966, 1969, 1978)

Person/Client: A whole, complete, and independent being who has 14  fundamental needs to breathe, eat and drink, eliminate, move and maintain posture, sleep and rest, dress and undress, maintain body temperature, keep clean, avoid danger, communicate, worship, work, play and learn.

Environment: The aggregate of the external conditions and influences affecting the life and development of an organism

Health: Viewed in terms of the individuals ability to perform 14 components of nursing care unaided (eg, breathe normally, eat and drink adequately). Health is quality of life basic to human functioning and requires independence and interdependence.  It is the quality of health rather life itself that allows people to work most effectively and to teach their highest potential level of satisfaction in life. Individuals will achieve or maintain health if they have necessary strength, will, or knowledge.

Nursing: The unique function of the nurse is to assist clients, sick or well, in performing those activities contributing to health, its recovery, or peaceful death – activities that client would perform unaided if they had the necessary strength, will, or knowledge. Al;so, to do so in such a way as to help clients gain independence as rapidly as possible.

Henderson’s Definition of Nursing:

In 1955, Virginia Henderson formulated a definition of the unique function of nursing. This definition was a major stepping-stone in the emergence of nursing as a discipline separate from medicine. Basic to her definition are various assumptions about the individual: namely, that the individual (a) needs to maintain physiologic and emotional balance, (b) requires assistance to achieve health and independence or a peaceful; death, and (c) needs the necessary strength, will, or knowledge to achieve or maintain health. These needs give direction to the  nurse’s role.

Henderson cenceptualized the nurse’s role as assisting sick or well individuals in a supplementary or complementary way. The nurse needs to be a partner with the patient, a helper to the paitent, and, when necessary, a substitute for the patient. The nurse’s focus is to thelp individuals and families (which she viewed as a unit) to gain independence in meeting 14 fundamental needs (Henderson 1966):

1. Breathing normally.

2. Eating and drinking adequately.

3. Eliminaitng body wastes.

4. Moving and maintining a desirable position.

5. Sleeping and resting.

6. Selecting suitbale clothes.

7. maintianing body temperature within normal range by adjusting clothing and modifying the environamnet.

8. Keeping the body clean and well-groomed to protect the integument.

9. Avoiding dangers in the environment and avoiding inhuring others.

10. Coomunicating with others in expressing emotions, needs, fears, or oipinions.

11. worshiping according to one’s faith.

12. working in such a way that one feels a sense of accomplishment.

13. Playing or participating in various forms of recreations.

14. Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities.

Kozier, Barbara  Fundamentals of Nursing. 5th edition

Addison-Wesley Publishing company, Inc. 1998. p. 47

Fundamentals Theorists

Florence Nightingale (1860)

Nightingale’s Environmental Theory

Florence Nightingale, the “mother of modern nursing,” considered nursing to be a religious calling to be fulfilled only by women. Her theory focused on the environment, although this term never appeared in her writings. She linked health with five environmental factors: (1) pure or fresh air (2) pure water (3) efficient drainage (4) cleanliness, and (5)light, especially direct sunlight. Deficiencies in these five factors produced lack of health or illness.

The above factors attain significance when one considers that sanitation conditions in hospitals of the mid 1800s were extremely poor, and the women working in the hospital were unreliable, uneducated, and incompetent to care for the ill.

In addition to the factors above, Nightingale also stressed the importance of keeping the patient warm, maintaining a noise-free environment, and attending to the patient’s diet in term,s of assessing intake, timeliness of the food, and its effect to the person.

Nightingale set the stage for further work in the development of nursing theories. Her general concepts about ventilation, cleanliness, quiet, warm, and diet remain integral parts of nursing and health care today.

Kozier, Barbara Fundamentals of Nursing 5th edition

Addison-Wesley Publishing  Company, Inc.  pp. 46 & 50