THEORETICAL FOUNDATIONS OF NURSING – FINALS

OREM'S SELF-CARE DEFICIT NURSING THEORY

Biography of Dorothea E. Orem

Dorothea E. Orem was born in 1914 in Baltimore, Maryland. In the early 1930s, she earned her nursing
diploma from the Providence Hospital School of Nursing in Washington, D.C. She went on to complete her
Bachelor of Science in Nursing in 1939 and her Master’s of Science in Nursing in 1945, both from the Catholic
University of America in Washington, D.C. Dorothea Orem died on June 22, 2007.

Career of Dorothea E. Orem

Dorothea Orem had a distinguished career in nursing. She earned several Honorary Doctorate degrees. She
was given Honorary Doctorates of Science from both Georgetown University in 1976 and Incarnate Word
College in 1980. She was given an Honorary Doctorate of Humane Letters from Illinois Wesleyan University in
1988, and a Doctorate Honoris Causae from the University of Missouri in Columbia in 1998.

The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of improving
the quality of nursing in general hospitals in her state. The model interrelates concepts in such a way as to
create a different way of looking at a particular phenomenon. The theory is relatively simple, but generalizable
to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be
consistent with other validated theories, laws and principles.

The major assumptions of Orem’s Self-Care Deficit Theory are:

 People should be self-reliant, and responsible for their care, as well as others in their family
who need care.
 People are distinct individuals.
 Nursing is a form of action. It is an interaction between two or more people.
 Successfully meeting universal and development self-care requisites is an important
component of primary care prevention and ill health.
 A person’s knowledge of potential health problems is needed for promoting self-care
behaviors.
 Self-care and dependent care are behaviors learned within a socio-cultural context.

Orem’s theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of
nursing system.

The theory of self-care includes self-care, which is the practice of activities that an individual initiates and
performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human
ability that is “the ability for engaging in self-care,” conditioned by age, developmental state, life experience,
socio-cultural orientation, health, and available resources; therapeutic self-care demand, which is the total
self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods
and related sets of operations and actions; and self-care requisites, which include the categories of universal,
developmental, and health deviation self-care requisites.
Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of
human structure and functioning. Orem identifies these requisites, also called activities of daily living, or ADLs,
as:

1. the maintenance of sufficient intake of air, food, and water

2. provision of care associated with the elimination process
3. a balance between activities and rest, as well as between solitude and social interaction
4. the prevention of hazards to human life and well-being
5. the promotion of human functioning

Developmental self-care requisites are associated with developmental processes. They are generally derived
from a condition or associated with an event.

Health deviation self-care is required in conditions of illness, injury, or disease. These include:
1. Seeking and securing appropriate medical assistance
2. Being aware of and attending to the effects and results of pathologic conditions
3. Effectively carrying out medically prescribed measures
4. Modifying self-concepts to accept onseself as being in a particular state of health and in specific forms
of health care
5. Learning to live with the effects of pathologic conditions.

The second part of the theory, self-care deficit, specifies when nursing is needed. According to Orem, nursing
is required when an adult is incapable or limited in the provision of continuous, effective self-care. The theory
identifies five methods of helping: acting for and doing for others; guiding others; supporting another; providing
an environment promoting personal development in relation to meet future demands; and teaching another.

The theory of nursing systems describes how the patient’s self-care needs will be met by the nurse, the
patient, or by both. Orem identifies three classifications of nursing system to meet the self-care requisites of
the patient: wholly compensatory system, partly compensatory system, and supportive-educative system.

Orem recognized that specialized technologies are usually developed by members of the health care industry.
The theory identifies two categories of technologies.

The first is social or interpersonal. In this category, communication is adjusted to age and health status. The
nurse helps maintain interpersonal, intra-group, or inter-group relations for the coordination of efforts. The
nurse should also maintain a therapeutic relationship in light of psychosocial modes of functioning in health
and disease. In this category, human assistance adapted to human needs, actions, abilities, and limitations is
given by the nurse.

The second is regulatory technologies, which maintain and promote life processes. This category regulates
psycho- and physiological modes of functioning in health and disease. Nurses should promote human growth
and development, as well as regulating position and movement in space.
Orem’s approach to the nursing process provides a method to determine the self-care deficits and then to
define the roles of patient or nurse to meet the self-care demands. The steps in the approach are thought of
uas the technical component of the nursing process. Orem emphasizes that the technological component
“must be coordinated with interpersonal and social pressures within nursing situations.

The nursing process in this model has three parts. First is the assessment, which collects data to determine
the problem or concern that needs to be addressed. The next step is the diagnosis and creation of a nursing
care plan. The third and final step of the nursing process is implementation and evaluation. The nurse sets the
health care plan into motion to meet the goals set by the patient and his or her health care team, and, when
finished, evaluate the nursing care by interpreting the results of the implementation of the plan.
MYRA ESTRIN LEVINE - NURSING THEORIST

Biography and Career of Myra Estrine Levine

Myra Estrine Levine was born in Chicago in 1920. In 1944, she earned a diploma in nursing from the Cook
County School of Nursing, then went on to complete her Bachelor of Science in Nursing from the University of
Chicago in 1949. Her Master’s of Science in Nursing was given to her from Wayne State University in Detroit
in 1962. She earned an honorary doctorate from Loyola University in 1992.

Myra Estrine Levine’s Contribution to Nursing Theory: Four Conservation Principles

Levine developed the Four Conservation Principles. In this model, the goal of nursing is to promote adaptation
and maintain wholeness using the principles of conservation. The model guides nurses to focus on the
influences and responses at the level of the organism. Nurses accomplish the theory’s goal through the
conservation of energy, structure, and personal and social integrity.

According to Levine, every individual has a unique range of adaptive responses. They vary by heredity, age,
gender or the challenges that come with experiencing an illness. The responses are the same, but the timing
and manifestation of the responses are unique to each individual pulse rate.

Adaptation is an ongoing process of change in which the patient is able to maintain his or her integrity while
staying within the realities of the environment. This is achieved through the “frugal, economic, contained and
controlled use of environmental resources by the individual in his or her best interest.”

Wholeness exists when the patient’s interaction with the environment allows integrity to be assured.
Wholeness is promoted by the use of the conservation principle.

Conservation is the product of adaptation. It is the achievement of a balance of energy supply and demand
that is within the unique biological realities of the individual patient. The conservation principle has four
aspects: conservation of energy, conservation of structural integrity, conservation of personal integrity, and
conservation of social integrity.

Conservation of energy refers to balancing how energy goes in and out of the body to avoid fatigue. It includes
adequate rest, nutrition, and exercise. Conservation of structural integrity refers to maintaining or restoring the
physical body and promoting physical healing. The conservation of personal integrity recognizes the patient’s
need for recognition, respect, self-awareness, and self-determination. In this area, for example, a nurse will
honor a patient’s need for personal space. The conservation of social integrity addresses the patient’s
interactions and relationships with other people, such as in a family, community, or religious group.

In this theory, nursing is a profession and an academic discipline, and should be studied and practiced in
harmony with all disciplines that make up the health sciences. Nursing involves engaging in human
interactions. Levine states that the goal of nursing is to promote wholeness, while realizing that every
individual requires a unique cluster of activities to achieve wholeness.

The patient’s individual integrity is his or her concern, and it is the nurse’s responsibility to assist him or her to
defend and seek the realization of that individual integrity.
Levine offers nine models of guided assessment in the Four Conservation Principles theory of nursing. They
are:

1. vital signs
2. body movement and positioning
3. meeting personal hygiene needs
4. pressure gradient system in nursing interventions
5. nursing determination in provision of nutritional needs
6. pressure gradient system in nursing
7. local application of hot and cold
8. administration of medicine
9. establishing an aseptic environment
The nursing process used in this model is:

1. Assessment
2. Trophicognosis
3. Hypothesis
4. Interventions
5. Evaluation

BETTY NEUMAN - NURSING THEORIST

It’s important to look at a patient from a holistic perspective. A patient is not simply the illness or injury being
treated, but an entire person. In fact, every aspect of a patient can contribute to how that patient deals with
treatment and recovery, and it should all be considered when caring for the patient. In Betty Neuman’s nursing
theory, patients are cared for from a holistic perspective in order to ensure they are cared for as people and
not simply ailments.

Biography of Betty Neuman

Born in Lowel, Ohio in 1924, Betty Neuman earned her diploma as a Registered Nurse in 1947 from the
Peoples Hospital School of Nursing in Akron, Ohio. She went on to complete her Bachelor of Science in
Nursing in 1957 and her Master of Science in Mental Health, both from the University of California-Los
Angeles in 1966. She also earned a Ph.D. in clinical psychology from Pacific Western University in 1985.
In 1992, Neuman was given an Honorary Doctorate of Letters at the Neumann College in Aston,
Pennsylvania. Finally, in 1998, the Grand Valley State University in Michigan gave her an Honorary
Doctorate of Science.

Career of Betty Neuman

After earning her Masters degree, Neuman began working as a nurse. Specifically, she was a pioneer in
nursing involvement in community mental health.

While she was developing her systems model, she was working as a lecturer at the University of California-
Los Angeles in community health nursing. Due to her work in nursing, Neuman was named as an Honorary
Member of the Fellowship of the American Academy of Nursing.
Betty Neuman’s first book, The Neuman Systems Model , was published in 1982. The book included nursing
process format and care plans, and was a total approach to client care. Newer editions were published in
1989, 1995, 2002, and 2010.
After the publication of her model, Neuman spent her time educating nurses and professors about it through
her work as an author and speaker.

NEUMAN'S SYSTEMS MODEL

Betty Neuman’s Systems Model provides a comprehensive holistic and system-based approach to nursing

that contains an element of flexibility. The theory focuses on the response of the patient system to actual or
potential environmental stressors and the use of primary, secondary, and tertiary nursing prevention
intervention for retention, attainment, and maintenance of patient system wellness.
The basic assumptions of the model are:

 Each patient system is a unique composite of factors and characteristics within a range of
responses contained in a basic structure.
 Many known, unknown, and universal stressors exist. Each differ in their potential for
upsetting a client’s usual stability level.
 Each patient has evolved a normal range of responses to the environment referred to as the
normal line of defense. It can be used as a standard by which to measure health deviation.
 The particular inter-relationships of patient variables can, at any point in time, affect the
degree to which a client is protected by the flexible line of defense against possible reaction
to stressors.
 When the flexible line of defense is incapable of protecting the patient against an
environmental stressor, that stressor breaks through the line of defense.
 The client is a dynamic composite of the inter-relationships of the variables, whether in a state
of illness or wellness. Wellness is on a continuum of available energy to support the system in
a state of stability.
 Each patient has implicit internal resistance factors known as LOR, which function to stabilize
and realign the patient to the usual state of wellness.
 Primary prevention is applied in patient assessment and intervention, in identification and
reduction of possible or actual risk factors.
 Secondary prevention relates to symptomatology following a reaction to stressors,
appropriate ranking of intervention priorities, and treatment to reduce their noxious effects.
 Tertiary prevention relates to adjustive processes taking place as reconstitution begins, and
maintenance factors move them back in a cycle toward primary prevention.
 The patient is in dynamic, constant energy exchange with the environment.

The major concepts of Neuman’s theory are content, which is the variables of the person in interaction with
the environment; basic structure or central core; degree to reaction; entropy, which is a process of energy
depletion and disorganization moving the client toward illness; flexible line of defense; normal line of defense;
line of resistance; input-output; negentropy, which is a process of energy conservation that increases
organization and complexity, moving the system toward stability or a higher degree of wellness; open system;
prevention as intervention; reconstitution; stability; stressors; wellness/illness; and prevention.

In the Systems Model, prevention is the primary intervention. It focuses on keeping stressors and the stress
response from having a detrimental effect on the body. Primary prevention occurs before the patient reacts to
a stressor. It includes health promotion and maintaining wellness. Secondary prevention occurs after the
patient reacts to a stressor and is provided in terms of the existing system. It focuses on preventing damage to
the central core by strengthening the internal lines of resistance and removing the stressor. Tertiary prevention
occurs after the patient has been treated through secondary prevention strategies. It offers support to the
patient and tries to add energy to the patient or reduce energy needed to facilitate reconstitution.

In the Neuman’s theory, a human being is a total person as a client system and the person is a layered,
multidimensional being. Each layer consists of a five-person variable or subsystem. The subsystems are
physiological, which refers to the physiochemical structure and function of the body; psychological, which
refers to mental processes and emotions; socio-cultural, which refers to relationships, and social/cultural
expectations and activities; spiritual, which refers to the influence of spiritual beliefs; and developmental, which
refers to those processes related to development over the lifespan.

Neuman explains environment as the totality of the internal and external forces which surround a person, and
with which they interact at any given time. These forces include the intrapersonal, interpersonal, and extra-
personal stressors, which can affect the person’s normal line of defense and so can affect the stability of the
system. The environment has three components: the internal, which exists within the client system; the
external, which exists outside the client system; and the created, which is an environment that is created and
developed unconsciously by the client, and is symbolic of system wholeness.

The Systems Model of health is equated with wellness, and defined as “the condition in which all parts and
subparts, or variables, are in harmony with the whole of the client.” The client system moves toward illness
and death when more energy is needed than what’s available. The client system moves toward wellness when
more energy is available than is needed.

Neuman views nursing as a unique profession concerned with the variables that influence the response the
patient might have to a stressor. Nursing also addresses the whole person, giving the theory a holistic
perspective. The model defines nursing as “actions which assists individuals, families and groups to maintain
a maximum level of wellness, and the primary aim is stability of the patient-client system, through nursing
interventions to reduce stressors.” Neuman also says the nurse’s perception must be assessed in addition to
the patient’s, since the nurse’s perception will influence the care plan he or she sets up for the patient. The
Systems Model views the role of nursing in terms of the degree of reaction to stressors, as well as the use of
primary, secondary, and tertiary interventions.
In Neuman’s Systems Model nursing process, there are six steps, each with specific categories of data about
the patient.

First is the assessment of the patient, which looks at: actual and potential stressors; condition and strength of
basic factors and energy sources; characteristics of flexible and normal lines of defense, lines of resistance,
degree of reaction and potential for reconstitution; interaction between the patient and his or her environment;
life process and coping factors for optimal wellness; and the perceptual difference between the care giver and
the patient.

Second, the nurse makes a diagnosis by interpreting the data collected. The data includes health-seeking
behaviors, activity intolerance, ineffective coping, and ineffective thermoregulation. The third step in the
nursing process is to set goals. The ultimate goal is to keep the client system stable. From the goals, a plan is
created, which focuses on strengthening lines of defense and resistance. That plan is implemented using
primary, secondary, and tertiary preventions. Finally, the nursing process is evaluated to determine whether or
not balance was restored, and a stable state maintained.
FLORENCE NIGHTINGALE - NURSING THEORIST

Florence Nightingale is the most recognized name in the field of nursing. Her work was instrumental
for developing modern nursing practice, and from her first shift, she worked to ensure patients in her
care had what they needed to get healthy. Her Environmental Theory changed the face of nursing to
create sanitary conditions for patients to get care.

Biography of Florence Nightingale

Florence Nightingale was born in 1820 in Italy to a wealthy British family. She was raised in the Anglican faith,
and believed the God called her to be a nurse. This call came to her in February 1837 while at Embley Park.

She announced her intention to become a nurse in 1844. Her mother and sister were angry at her decision,
but Nightingale stood strong. She worked hard to learn about nursing, despite society’s expectation that she
become a wife and mother. In fact, she rejected a suitor because she thought it would interfere with her
nursing career. In 1853, she accepted the position of superintendent at the Institute for the Care of Sick
Gentlewomen in Upper Harley Street, London. She held this position until October 1854. The income given to
her by her father during this time allowed her to pursue her career and still live comfortably.

Though Nightingale had several important friendships with women, including a correspondence with an Irish
nun named Sister Mary Clare Moore, she had little respect for women in general, and preferred friendships
with powerful men.

She died in 1910.

Career of Florence Nightingale

Nightingale is best known for her pioneering work in the field of nursing. She tended to wounded soldiers
during the Crimean War. She became known as the “Lady with the Lamp” because of her night rounds. While
nursing soldiers during the war, Nightingale worked to improve nutrition and conditions in the wards. Many
injured soldiers were dying from illnesses separate from their injuries, such as typhoid, cholera, and dysentery.
Nightingale made changes on the wards or started the process by calling the Sanitary Commission. Her work
led to a reduction in the death rates of injured soldiers from 42% to 2%. Nightingale believed the deaths were
the result of poor nutrition, inadequate supplies, and the soldiers being dramatically overworked. After
collecting evidence that pointed to unsanitary conditions as a major cause of death, Nightingale worked to
improve sanitation in army and civilian hospitals during peacetime.

After the Crimean War, she established a nursing school at St. Thomas’ Hospital in London in 1860. The first
nurses trained at this school began working in 1865 at the Liverpool Workhouse Infirmary. It was the first
secular nursing school in the world, and is now part of King’s College London. Her work laid the foundation for
modern nursing, and the pledge all new nurses take was named after her.

Nightingale wrote Notes on Nursing (1859), which was the foundation of the curriculum for her nursing school
and other nursing schools. This short text was considered the foundation of nursing education, and even sold
well to the public. She also wroteNotes on Hospitals, Notes on Matters Affecting the Health, and Efficiency
and Hospital Administration of the British Army. Nightingale spent the rest of her career working toward the
establishment and development of nursing as a profession, paving the way for nursing in its current form.
In 1883, Nightingale was given the Royal Red Cross by Queen Victoria. In 1907, she was the first woman to
receive the Order of Merit. In 1908, she was given the Honorary Freedom of the City of London. International
Nurses Day is celebrated on her birthday.

NIGHTINGALE'S ENVIRONMENT THEORY

As the founder of modern nursing, Florence Nightingale’s Environment Theory changed the face of

nursing practice. She served as a nurse during the Crimean War, at which time she observed a
correlation between the patients who died and their environmental conditions. As a result of her
observations, the Environment Theory of nursing was born. Nightingale explained this theory in her
book, Notes on Nursing: What it is, What it is Not. The model of nursing that developed from
Nightingale, who is considered the first nursing theorist, contains elements that have not changed
since the establishment of the modern nursing profession. Though this theory was pioneering at the
time it was created, the principles it applies are timeless.

There are seven assumptions made in the Environment Theory, which focuses on taking care of the patient’s
environment in order to reach health goals and cure illness. These assumptions are:

 natural laws
 mankind can achieve perfection
 nursing is a calling
 nursing is an art and a science
 nursing is achieved through environmental alteration
 nursing requires a specific educational base
 nursing is distinct and separate from medicine
The focus of nursing in this model is to alter the patient’s environment in order to affect change in his or her
health. The environmental factors that affect health, as identified in the theory, are: fresh air, pure water,
sufficient food supplies, efficient drainage, cleanliness of the patient and environment, and light (particularly
direct sunlight). If any of these areas is lacking, the patient may experience diminished health. A nurse’s role
in a patient’s recovery is to alter the environment in order to gradually create the optimal conditions for the
patient’s body to heal itself. In some cases, this would mean minimal noise and in other cases could mean a
specific diet. All of these areas can be manipulated to help the patient meet his or her health goals and get
healthy.

The Environment Theory of nursing is a patient-care theory. That is, it focuses on the care of the patient rather
than the nursing process, the relationship between patient and nurse, or the individual nurse. In this way, the
model must be adapted to fit the needs of individual patients. The environmental factors affect different
patients unique to their situations and illnesses, and the nurse must address these factors on a case-by-case
basis in order to make sure the factors are altered in a way that best cares for an individual patient and his or
her needs.

The ten major concepts of the Environment Theory, also identified as Nightingale’s Canons, are:

1. Ventilation and warming

2. Light and noise
3. Cleanliness of the area
4. Health of houses
 5. Bed and bedding
6. Personal cleanliness
7. Variety
8. Offering hope and advice
9. Food
10. Observation

According to Nightingale, nursing is separate from medicine. The goal of nursing is to put the patient in the
best possible condition in order for nature to act. Nursing is “the activities that promote health which occur in
any caregiving situation.” Health is “not only to be well, but to be able to use well every power we have.”
Nightingale’s theory addresses disease on a literal level, explaining it as the absence of comfort.
The environment paradigm in Nightingale’s model is understandably the most important aspect. Her
observations taught her that unsanitary environments contribute greatly to ill health, and that the environment
can be altered in order to improve conditions for a patient and allow healing to occur.

Nightingale’s Modern Nursing Theory also impacted nursing education. She was the first to suggest that
nurses be specifically educated and trained for their positions in healthcare. This allowed there to be
standards of care in the field of nursing, which helped improve overall care of patients.

Sister Callista Roy - Nursing Theorist

Though there are hard and fast answers in the healthcare field, it is also adaptive and nurses need to
be flexible in order to provide the best care for their patients. After all, each patient is different and
should be cared for based on the individual needs of that particular patient. To better understand the
adaptive nature of nursing, it would help to study Sister Callista Roy’s Adaptive Model of Nursing.

Biography of Sister Callista Roy

Sister Callista Roy was born in 1939 in Los Angeles. In 1963, she earned a Bachelor of Arts Degree in
Nursing from Mount St. Mary’s College in Los Angeles. In 1966, she earned a Master’s Degree in Pediatric
Nursing from the University of California-Los Angeles. She also earned a Master’s Degree in Sociology in
1973, and went on to complete a Doctoratal degree in Sociology in 1977. She is a sister of St. Joseph of
Carondelet.

Career of Sister Callista Roy

After working as a staff nurse and in administrative positions at St. Mary’s Hospital in Tucson, Arizona, and St.
Joseph’s Hospital in Lewiston, Idaho, Roy joined the faculty of Mount St. Mary’s College in 1996. She also
served as Department Chair between 1971 and 1982.

While working at the University of Portland, Roy helped create a Master’s program in Nursing. And at the
Connell School of Nursing, she was involved in developing a Ph.D. program in Nursing. She also served as a
visiting professor to colleges around the world, including La Sabana University in Colombia, the University of
Lund in Sweden, and the University of Conception in Chile.
ROY'S ADAPTATION MODEL OF NURSING

The Adaptation Model of Nursing was developed by Sister Callista Roy in 1976. After working with Dorothy E.
Johnson, Roy became convinced of the importance of describing the nature of nursing as a service to society.
This prompted her to begin developing her model with the goal of nursing being to promote adaptation. She
first began organizing her theory of nursing as she developed course curriculum for nursing students at Mount
St. Mary’s College. She introduced her ideas as a basis for an integrated nursing curriculum.

The factors that influenced the development of the model included: family, education, religious background,
mentors, and clinical experience. Roy’s model asks the questions:

Who is the focus of nursing care?

What is the target of nursing care?
When is nursing care indicated?
Roy explained that adaptation occurs when people respond positively to environmental changes, and it is the
process and outcome of individuals and groups who use conscious awareness, self-reflection, and choice to
create human and environmental integration.

The key concepts of Roy’s Adaptation Model are made up of four components: person, health, environment,
and nursing.

According to Roy’s model, a person is a bio-psycho-social being in constant interaction with a changing
environment. He or she uses innate and acquired mechanisms to adapt. The model includes people as
individuals, as well as in groups such as families, organizations, and communities. This also includes society
as a whole.

The Adaptation Model states that health is an inevitable dimension of a person’s life, and is represented by a
health-illness continuum. Health is also described as a state and process of being and becoming integrated
and whole.

The environment has three components: focal, which is internal or external and immediately confronts the
person; contextual, which is all stimuli present in the situation that all contribute to the effect of the focal
stimulus; and residual, whose effects in the current situation are unclear. All conditions, circumstances, and
influences surrounding and affecting the development and behavior of people and groups with particular
consideration of mutuality of person and earth resources, including focal, contextual, and residual stimuli.

The model includes two subsystems, as well. The cognator subsystem is a major coping process involving
four cognitive-emotive channels: perceptual and information processing, learning, judgment, and emotion. The
regulator subsystem is a basic type of adaptive process that responds automatically through neural, chemical,
and endocrine coping channels.

The Adaptive Model makes ten explicit assumptions:

1. The person is a bio-psycho-social being.

2. The person is in constant interaction with a changing environment.
 3. To cope with a changing world, a person uses coping mechanisms, both innate and acquired, which
are biological, psychological, and social in origin.
4. Health and illness are inevitable dimensions of a person’s life.
5. In order to respond positively to environmental changes, a person must adapt.
6. A person’s adaptation is a function of the stimulus he is exposed to and his adaptation level.
7. The person’s adaptation level is such that it comprises a zone indicating the range of stimulation that
will lead to a positive response.
8. The person has four modes of adaptation: physiologic needs, self-concept, role function, and
interdependence.
9. Nursing accepts the humanistic approach of valuing others’ opinions and perspectives. Interpersonal
relations are an integral part of nursing.
10. There is a dynamic objective for existence with the ultimate goal of achieving dignity and integrity.
There are also four implicit assumptions which state:

1. A person can be reduced to parts for study and care.

2. Nursing is based on causality.
3. A patient’s values and opinions should be considered and respected.
4. A state of adaptation frees a person’s energy to respond to other stimuli.
The goal of nursing is to promote adaptation in the four adaptive modes. Nurses also promote adaptation for
individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with
dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance
environmental interactions. The Four Adaptive Modes of Roy’s Adaptation Model are physiologic needs, self-
concept, role function, and interdependence.

The Adaptation Model includes a six-step nursing process.

1. The first level of assessment, which addresses the patient’s behavior

2. The second level of assessment, which addresses the patient’s stimuli
3. Diagnosis of the patient
4. Setting goals for the patient’s health
5. Intervention to take actions in order to meet those goals
6. Evaluation of the result to determine if goals were met
Throughout the nursing process, the nurse and other health care professionals should make adaptations to
the nursing care plan based on the patient’s progress toward health.

JEAN WATSON - NURSING THEORIST

Many men and women enter the nursing field because they see it as a career that cares about
people. Compassion is often a trait required of nurses, since taking care of patients’ needs is their
primary purpose. Jean Watson’s Philosophy and Science of Caring addresses how nurses care for
their patients, and how that caring translates into better health plans to help patients get healthy.

Biography and Career of Jean Watson

Jean Watson was born in a small town in the Appalachian Mountains of West Virginia in the 1940s.

Watson graduated from the Lewis Gale School of Nursing in 1961, and then continued her nursing studies at
the University of Colorado at Boulder. She earned her bachelor’s degree in 1964, a Master’s degree
in psychiatric and mental health nursing in 1966, and a Ph.D. in educational psychology and counseling in
1973.
She served as Dean of Nursing at the University Health Sciences Center and was the President of the
National League for Nursing. She is a fellow of the American Academy of Nursing.

WATSON'S PHILOSOPHY AND SCIENCE OF CARING

The Philosophy and Science of Caring has four major concepts: human being, health, environment/society,
and nursing.

Jean Watson refers to the human being as “a valued person in and of him or herself to be cared for,
respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional
integrated self. Human is viewed as greater than and different from the sum of his or her parts.”
Health is defined as a high level of overall physical, mental, and social functioning; a general adaptive-
maintenance level of daily functioning; and the absence of illness, or the presence of efforts leading to the
absence of illness.

Watson’s definition of environment/society addresses the idea that nurses have existed in every society, and
that a caring attitude is transmitted from generation to generation by the culture of the nursing profession as a
unique way of coping with its environment.

The nursing model states that nursing is concerned with promoting health, preventing illness, caring for the
sick, and restoring health. It focuses on health promotion, as well as the treatment of diseases. Watson
believed that holistic health care is central to the practice of caring in nursing. She defines nursing as “a
human science of persons and human health-illness experiences that are mediated by professional, personal,
scientific, esthetic and ethical human transactions.”
The nursing process outlined in the model contains the same steps as the scientific research process:
assessment, plan, intervention, and evaluation. The assessment includes observation, identification, and
review of the problem, as well as the formation of a hypothesis. Creating a care plan helps the nurse
determine how variables would be examined or measured, and what data would be collected. Intervention is
the implementation of the care plan and data collection. Finally, the evaluation analyzes the data, interprets
the results, and may lead to an additional hypothesis.
Watson’s model makes seven assumptions:

1. Caring can be effectively demonstrated and practiced only interpersonally.

2. Caring consists of carative factors that result in the satisfaction of certain human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept the patient as he or she is now, as well as what he or she may become.
5. A caring environment is one that offers the development of potential while allowing the patient to
choose the best action for him or herself at a given point in time.
6. A science of caring is complementary to the science of curing.
7. The practice of caring is central to nursing.

The first three carative factors are the “philosophical foundation” for the science of caring, while the remaining
seven derive from that foundation. The ten primary carative factors are:
 1. The formation of a humanistic-altruistic system of values, which begins at an early age with the values
shared by parents. The system of values is mediated by the nurse’s life experiences, learning gained,
and exposure to the humanities. It is perceived as necessary to the nurse’s maturation which in turn
promotes altruistic behavior toward others.
2. The installation of faith-hope, which is essential to the carative and curative processes. When modern
science has nothing else to offer a patient, a nurse can continue to use faith-hope to provide a sense of
well-being through a belief system meaningful to the individual.
3. The cultivation of sensitivity to one’s self and to others, which explores the need of nurses to feel an
emotion as it presents itself. The development of a nurse’s own feeling is needed to interact genuinely
and sensitively with patients. By striving to become more sensitive, the nurse is more authentic. This
encourages self-growth and self-actualization in both the nurse and the patients who interact with the
nurse. The nurses promote health and higher-level functioning only when they form person-to-person
relationships.
4. The development of a helping-trust relationship, which includes congruence, empathy, and warmth.
The strongest tool a nurse has is his or her mode of communication, which establishes a rapport with
the patient, as well as caring by the nurse. Communication includes verbal and nonverbal
communication, as well as listening that connotes empathetic understanding.
5. The promotion and acceptance of the expression of both positive and negative feelings, which need to
be considered and allowed for in a caring relationship because of how feelings alter thoughts and
behavior. The awareness of the feelings helps the nurse and patient understand the behavior it causes.
6. The systematic use of the scientific method for problem-solving and decision-making, which allows for
control and prediction, and permits self-correction. The science of caring should not always be neutral
and objective.
7. The promotion of interpersonal teaching-learning, since the nurse should focus on the learning process
as much as the teaching process. Understanding the person’s perception of the situation assists the
nurse to prepare a cognitive plan.
8. The provision for a supportive, protective and/or corrective mental, physical, socio-cultural, and spiritual
environment, which Watson divides into interdependent internal and external variables, manipulated by
the nurse in order to provide support and protection for the patient’s mental and physical health. The
nurse must provide comfort, privacy, and safety as part of the carative factor.
9. Assistance with satisfying human needs based on a hierarchy of needs similar to Maslow’s. Each need
is equally important for quality nursing care and the promotion of the patient’s health. In addition, all
needs deserve to be valued and attended to by the nurse and patient.
10. The allowance for existential-phenomenological forces, which helps the nurse to reconcile and mediate
the incongruity of viewing the patient holistically while at the same time attending to the hierarchical
ordering of needs. This helps the nurse assist the patient to find strength and courage to confront life or
death. Phenomology is a way of understanding the patient from his or her frame of reference.
Existential psychology is the study of human existence.
Watson’s hierarchy of needs begins with lower-order biophysical needs, which include the need for food and
fluid, elimination, and ventilation. Next are the lower-order psychophysical needs, which include the need for
activity, inactivity, and sexuality. Finally, are the higher order needs, which are psychosocial. These include
the need for achievement, affiliation, and self-actualization.

MADELEINE LEININGER - NURSING THEORIST

While it is important to look at a patient as a whole person from a physiological, psychological,

spiritual, and social perspective, it is also important to take a patient’s culture and cultural
background into consideration when deciding how to care for that patient. After all, the values and
beliefs passed down to that patient from generation to generation can have as much of an effect on
that patient’s health and reaction to treatment as the patient’s environment and social life. The
Transcultural Nursing theory developed by Madeleine Leininger is now a nursing discipline that is an
integral part of how nurses practice in the healthcare field today.

Biography and Career of Madeleine Leininger

Madeleine Leininger was born on July 13, 1925 in Sutton, Nebraska. She earned several degrees, including a
Doctor of Philosophy, a Doctor of Human Sciences, a Doctor of Science, and is a Registered Nurse. She is a
Certified Transcultural Nurse, a Fellow of the Royal College of Nursing in Australia, and a Fellow of the
American Academy of Nursing.

CULTURE CARE THEORY

Early in her career, Madeleine Leininger recognized the importance of the element of caring in the
profession of nursing. Through her observations while working as a nurse, she identified a lack of
cultural and care knowledge as the missing component to a nurse’s understanding of the many
variations required in patient care to support compliance, healing, and wellness.

Leininger’s Culture Care Theory attempts to provide culturally congruent nursing care through
“cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are mostly
tailor-made to fit with individual, group’s, or institution’s cultural values, beliefs, and lifeways.” The
intent of the care is to fit with or have beneficial meaning and health outcomes for people of different
or similar culture backgrounds.

Culturally congruent care is possible when the following occurs in the nurse-patient relationship:
“Together the nurse and the client creatively design a new or different care lifestyle for the health or
well-being of the client. This mode requires the use of both generic and professional knowledge and
ways to fit such diverse ideas into nursing care actions and goals. Care knowledge and skill are often
repatterned for the best interest of the clients. Thus all care modalities require coparticipation of the
nurse and clients (consumers) working together to identify, plan, implement, and evaluate each
caring mode for culturally congruent nursing care. These modes can stimulate nurses to design
nursing actions and decisions using new knowledge and culturally based ways to provide meaningful
and satisfying wholistic care to individuals, groups or institutions.”

Leininger’s model has developed into a movement in nursing care called transcultural nursing. In
1995, Leininger defined transcultural nursing as “a substantive area of study and practice focused on
comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or
different cultures with the goal of providing culture-specific and universal nursing care practices in
promoting health or well-being or to help people to face unfavorable human conditions, illness, or
death in culturally meaningful ways.”

Leininger developed new terms for the basic concepts of her theory. The concepts addressed in the
model are:
 Care, which assists others with real or anticipated needs in an effort to improve a human
condition of concern, or to face death.
 Caring is an action or activity directed towards providing care.
 Culture refers to learned, shared, and transmitted values, beliefs, norms, and lifeways to a
specific individual or group that guide their thinking, decisions, actions, and patterned ways of
living.
 Culture Care is the multiple aspects of culture that influence and help a person or group to
improve their human condition or deal with illness or death.
  Culture Care Diversity refers to the differences in meanings, values, or acceptable forms of
care in or between groups of people.
 Culture Care Universality refers to common care or similar meanings that are evident among
many cultures.
Nursing is a learned profession with a disciplined focus on care phenomena.

Worldview is the way people tend to look at the world or universe in creating a personal view
of what life is about.

Cultural and Social Structure Dimensions include factors related to spirituality, social
structure, political concerns, economics, educational patterns, technology, cultural values, and
ethnohistory that influence cultural responses of people within a cultural context.

Health refers to a state of well-being that is culturally defined and valued by a designated
culture.

Cultural Care Preservation or Maintenance refers to nursing care activities that help people
from particular cultures to retain and use core cultural care values related to healthcare concerns or
conditions.

Cultural Care Accommodation or Negotiation refers to creative nursing actions that help
people of a particular culture adapt or negotiate with others in the healthcare community in an effort
to attain the shared goal of an optimal health outcome for patients of a designated culture.

Cultural Care Re-Patterning or Restructuring refers to therapeutic actions taken by culturally

competent nurses. These actions help a patient to modify personal health behaviors towards
beneficial outcomes while respecting the patient’s cultural values.

The theory’s culturalogical assessment provides a holistic, comprehensive overview of the client’s
background. The assessment addresses the following:

 communication and language

 gender considerations
 sexual orientation
 ability and disability
 occupation
 age
 socioeconomic status
 interpersonal relationships
 appearance
 dress
 use of space
 foods and meal preparation and related lifeways

Leininger proposes that there are three modes for guiding nurses judgments, decisions, or actions in order to
provide appropriate, beneficial, and meaningful care: preservation and/or maintenance; accommodation
and/or negotiation; and re-patterning and/or restructuring. The modes have greatly influenced the nurse’s
ability to provide culturally congruent nursing care, as well as fostering culturally-competent nurses.

Leininger’s model makes the following assumptions:

1. Care is the essence of nursing and a distinct, dominant, and unifying focus.
2. Caring is essential for well-being, health, healing, growth, and to face death.
3. Culture care is the broadest holistic means by which a nurse can know, explain, interpret, and predict
nursing care phenomena to guide nursing care practices.
4. Nursing is a transcultural, humanistic, and scientific care discipline and profession with the central
purpose to serve human beings worldwide.
5. Caring is essential to curing and healing. There can be no curing without caring.
6. Culture care concepts, meanings, expressions, patterns, processes, and structural forms of care are
different and similar among all cultures of the world.
7. Every human culture has lay care knowledge and practices and usually some professional care
knowledge and practices which vary transculturally.
8. Culture care values, beliefs, and practices are influenced in the context of a particular culture. They
tend to be embedded in such things as worldview, language, spirituality, kinship, politics and
economics, education, technology, and environment.
9. Beneficial, healthy, and satisfying culturally-based nursing care contributes to the well-being of
individuals, families, and communities within their environmental context.
10. Culturally congruent nursing care can only happen when the patient, family, or community values,
expressions, or patterns are known and used appropriately, and in meaningful ways by the nurse with
the people.
11. Culture care differences and similarities between the nurse and patient exist in any human culture
worldwide.
12. Clients who experience nursing care that fails to be reasonably congruent with their beliefs, values, and
caring lifeways will show signs of cultural conflicts, noncompliance, stresses and ethical or moral
concerns.
13. The qualitative paradigm provides new ways of knowing and different ways to discover the epistemic
and ontological dimensions of human care.
The Culture Care Theory defines nursing as a learned scientific and humanistic profession that focuses on
human care phenomena and caring activities in order to help, support, facilitate, or enable patients to maintain
or regain health in culturally meaningful ways, or to help them face handicaps or death.

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

IDA JEAN ORLANDO - NURSING THEORIST

Regardless of how well thought out a nursing care plan is for a patient, obstacles to the patient’s
recovery may come up at any time. This may cause problems for the original nursing care plan, and
it’s the nurse’s job to know how to deal with those obstacles so the patient can continue to recover
and stay on the path to health. Ida Jean Orlando’s Deliberative Nursing Process is a nursing theory
that allows nurses to create an effective nursing care plan that can also be easily adapted when and
if any complications arise with the patient.

Biography of Ida Jean Orlando

Ida Jean Orlando was a first generation Irish American born in 1926. She received her nursing diploma from
New York Medical College at the Lower Fifth Avenue Hospital School of Nursing. She earned her Bachelor of
Science in Public Health from St. John’s University in Brooklyn, and her Master of Arts Degree in Mental
Health Nursing from Teachers College, Columbia University. She is married to Robert Pelletier and lives in the
Boston area.

Career of Ida Jean Orlando

Orlando was an associate professor at Yale School of Nursing, and while there, served as the Director of the
Graduate Program in Mental Health Psychiatric Nursing. It was also at Yale that she was project investigator
of a National Institute of Mental Health grant. The research from this grant led to Orlando’s development of the
Deliberative Nursing Process published in The Dynamic Nurse-Patient Relationship: Function, Process, and
Principles (NLN Classics in Nursing Theory)  in 1961.
She also worked as the director of a research project at McLean Hospital in Belmont, Massachusetts. This
research led to the publication of The Discipline and Teaching of Nursing Process (an evaluative study)  in
1972. Orlando has served as a board member of Harvard Community Health Plan.

ORLANDO'S NURSING PROCESS DISCIPLINE THEORY

The Dynamic Nurse-Patient Relationship  , published in 1961 and written by Ida Jean Orlando, described
Orlando’s Nursing Process Discipline Theory. The major dimensions of the model explain that the role of the
nurse is to find out and meet the patient’s immediate needs for help. The patient’s presenting behavior might
be a cry for help.

However, the help the patient needs may not be what it appears to be. Because of this, nurses have to use
their own perception, thoughts about perception, or the feeling engendered from their thoughts to explore the
meaning of the patient’s behavior. This process helps nurses find out the nature of the patient’s distress and
provide the help he or she needs.

The concepts of the theory are: function of professional nursing, presenting behavior, immediate reaction,
nursing process discipline, and improvement.
The function of professional nursing is the organizing principle. This means finding out and meeting the
patient’s immediate needs for help.

According to Orlando, nursing is responsive to individuals who suffer, or who anticipate a sense of
helplessness. It is focused on the process of care in an immediate experience, and is concerned with
providing direct assistance to a patient in whatever setting they are found in for the purpose of avoiding,
relieving, diminishing, or curing the sense of helplessness in the patient. The Nursing Process Discipline
Theory labels the purpose of nursing to supply the help a patient needs for his or her needs to be met. That is,
if the patient has an immediate need for help, and the nurse discovers and meets that need, the purpose of
nursing has been achieved.

Presenting behavior is the patient’s problematic situation. Through the presenting behavior, the nurse finds the
patient’s immediate need for help. To do this, the nurse must first recognize the situation as problematic.
Regardless of how the presenting behavior appears, it may represent a cry for help from the patient. The
presenting behavior of the patient, which is considered the stimulus, causes an automatic internal response in
the nurse, which in turn causes a response in the patient.

The immediate reaction is the internal response. The patient perceives objects with his or her five senses.
These perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the
patient to act. These three items are the patient’s immediate response. The immediate response reflects how
the nurse experiences his or her participation in the nurse-patient relationship.

The nursing process discipline is the investigation into the patient’s needs. Any observation shared and
explored with the patient is immediately useful in ascertaining and meeting his or her need, or finding out he or
she has no needs at that time. The nurse cannot assume that any aspect of his or her reaction to the patient is
correct, helpful, or appropriate until he or she checks the validity of it by exploring it with the patient. The nurse
initiates this exploration to determine how the patient is affected by what he or she says and does. Automatic
reactions are ineffective because the nurse’s action is determined for reasons other than the meaning of the
patient’s behavior or the patient’s immediate need for help. When the nurse doesn’t explore the patient’s
reaction with him or her, it is reasonably certain that effective communication between nurse and patient
stops.

Improvement is the resolution to the patient’s situation. In the resolution, the nurse’s actions are not evaluated.
Instead, the result of his or her actions are evaluated to determine whether his or her actions served to help
the patient communicate his or her need for help and how it was met. In each contact, the nurse repeats a
process of learning how he or she can help the patient. The nurse’s own individuality, as well as that of the
patient, requires going through this each time the nurse is called upon to render service to those who need
him or her.

Orlando’s model of nursing makes the following assumptions:

 When patients are unable to cope with their needs on their own, they become distressed by
feelings of helplessness.
 In its professional character, nursing adds to the distress of the patient.
 Patients are unique and individual in how they respond.
 Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a
child.
 The practice of nursing deals with people, environment, and health.
 Patients need help communicating their needs; they are uncomfortable and ambivalent about
their dependency needs.
 People are able to be secretive or explicit about their needs, perceptions, thoughts, and
feelings.
 The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse
and the patient.
 People attach meanings to situations and actions that aren’t apparent to others.
 Patients enter into nursing care through medicine.

The patient is unable to state the nature and meaning of his or her distress without the help of
the nurse, or without him or her first having 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.

The nurse uses the standard nursing process in Orlando’s Nursing Process Discipline Theory, which follows:
assessment, diagnosis, planning, implementation, and evaluation. The theory focuses on the interaction
between the nurse and patient, perception validation, and the use of the nursing process to produce positive
outcomes or patient improvement. Orlando’s key focus was the definition of the function of nursing. The model
provides a framework for nursing, but the use of her theory does not exclude nurses from using other nursing
theories while caring for patients.
HILDEGARD PEPLAU - NURSING THEORIST
Many people enter the healthcare field because they want to work with people. For these nurses, it is
the nurse-patient relationship that is one of the most important things. By understanding the nurse-
patient relationship, nurses can be better quipped to work with their patients and, ultimately, provide
better care for them. Hildegard Peplau’s model of nursing focuses on that nurse-patient relationship
and identifies the different roles nurses take on when working with patients.

Biography of Hildegard Peplau

Hildegard Peplau was born in 1909 in Pennsylvania. As a child, she saw the devastating effects of the flu
epidemic in 1918, which greatly influenced how she understood how illness and death impacted families.

She graduated from the Pottstown, Pennsylvania School of Nursing in 1931 and worked as a staff nurse in
Pennsylvania and New York City. After a summer position led to Peplau being recommended to work as a
school nurse at Bennington College in Vermont, she earned her Bachelor’s Degree in Interpersonal
Psychology in 1943. She earned her Master’s and Doctoral degrees from Teacher’s College, Columbia
University, and was certified in psychoanalysis at the William Alanson White Institution of New York City.

Peplau died on March 17, 1999.

PEPLAU'S THEORY OF INTERPERSONAL RELATIONS

Peplau published her Theory of Interpersonal Relations in 1952, and in 1968, interpersonal techniques
became the crux of psychiatric nursing. The Theory of Interpersonal Relations is a middle-range descriptive
classification theory. It was influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and
Neal Elger Miller.
The four components of the theory are: person, which is a developing organism that tries to reduce anxiety
caused by needs; environment, which consists of existing forces outside of the person, and put in the context
of culture; health, which is a word symbol that implies forward movement of personality and other other human
processes toward creative, constructive, productive, personal, and community living.

The nursing model identifies four sequential phases in the interpersonal relationship: orientation, identification,
exploitation, and resolution.

The orientation phase defines the problem. It starts when the nurse meets the patient, and the two are
strangers. After defining the problem, the orientation phase identifies the type of service needed by the
patient. The patient seeks assistance, tells the nurse what he or she needs, asks questions, and shares
preconceptions and expectations based on past experiences. Essentially, the orientation phase is the nurse’s
assessment of the patient’s health and situation.

The identification phase includes the selection of the appropriate assistance by a professional. In this phase,
the patient begins to feel as if he or she belongs, and feels capable of dealing with the problem which
decreases the feeling of helplessness and hopelessness. The identification phase is the development of
a nursing care plan based on the patient’s situation and goals.
The exploitation phase uses professional assistance for problem-solving alternatives. The advantages of the
professional services used are based on the needs and interests of the patients. In the exploitation phase, the
patient feels like an integral part of the helping environment, and may make minor requests or use attention-
getting techniques. When communicating with the patient, the nurse should use interview techniques to
explore, understand, and adequately deal with the underlying problem. The nurse must also be aware of the
various phases of communication since the patient’s independence is likely to fluctuate. The nurse should help
the patient exploit all avenues of help as progress is made toward the final phase. This phase is the
implementation of the nursing plan, taking actions toward meeting the goals set in the identification phase.

The final phase is the resolution phase. It is the termination of the professional relationship since the patient’s
needs have been met through the collaboration of patient and nurse. They must sever their relationship and
dissolve any ties between them. This can be difficult for both if psychological dependence still exists. The
patient drifts away from the nurse and breaks the bond between them. A healthier emotional balance is
achieved and both become mature individuals. This is the evaluation of the nursing process. The nurse and
patient evaluate the situation based on the goals set and whether or not they were met.
The goal of psychodynamic nursing is to help understand one’s own behavior, help others identify felt
difficulties, and apply principles of human relations to the problems that come up at all experience levels.
Peplau explains that nursing is therapeutic because it is a healing art, assisting a patient who is sick or in need
of health care. It is also an interpersonal process because of the interaction between two or more individuals
who have a common goal. The nurse and patient work together so both become mature and knowledgeable in
the care process.

The nurse has a variety of roles in Hildegard Peplau’s nursing theory. The six main roles are: stranger,
teacher, resource person, counselor, surrogate, and leader.
As a stranger, the nurse receives the patient in the same way the patient meets a stranger in other life
situations. The nurse should create an environment that builds trust. As a teacher, the nurse imparts
knowledge in reference to the needs or interests of the patient. In this way, the nurse is also a resource
person, providing specific information needed by the patient that helps the patient understand a problem or
situation. The nurse’s role as a counselor helps the patient understand and integrate the meaning of current
life situations, as well as provide guidance and encouragement in order to make changes. As a surrogate, the
nurse helps the patient clarify the domains of dependence, interdependence, and independence, and acts as
an advocate for the patient. As a leader, the nurse helps the patient take on maximum responsibility for
meeting his or her treatment goals. Additional roles of a nurse include technical expert, consultant, tutor,
socializing and safety agent, environment manager, mediator, administrator, record observer, and researcher.

Some limitations of Peplau’s theory include the lack of emphasis on health promotion and maintenance; that
intra-family dynamics, personal space considerations, and community social service resources are less
considered; it can’t be used on a patient who is unable to express a need; and some areas are not specific
enough to generate a hypothesis.

PATRICIA BENNER NOVICE TO EXPERT - NURSING THEORIST

Biography and Career of Patricia Benner

Benner earned her Bachelor of Arts degree in nursing from Pasadena College in 1964. She was
given a Master of Science in Medical-Surgical Nursing from the University of California at San
Francisco in 1970, and a Ph.D. from the University of California at Berkeley in 1982.

FROM NOVICE TO EXPERT