Theoretical Foundations of Nursing

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“I think one’s feelings waste
themselves in words; they ought all to
be distilled into actions which bring
Florence Nightingale (1860)
Florence Nightingale defined Nursing as “the act of
utilizing the environment of the patient to assist him in
his recovery” (1860/1969), that it involves the nurse's
initiative to configure environmental settings appropriate
for the gradual restoration of the patient's health, and
that external factors associated with the patient's
surroundings affect life or biologic and physiologic
processes, and his development.
Environmental Factors Affecting Health
Defined in her environmental theory are the following
factors present in the patient’s environment:
• pure or fresh air
• pure water
• sufficient food supplies
• efficient drainage
• cleanliness
• light (especially direct sunlight)
Adequate ventilation has also been regarded as a
factor contributing to changes of the patient’s process of illness recovery. Any deficiency in one or more of these
factors could lead to impaired functioning of life
processes or diminished health status.
She also emphasized in her environmental theory is the
provision of a quiet or noise-free and warm environment,
attending to patient’s dietary needs by assessment,
documentation of time of food intake, and evaluating it’s
effects on the patient.
Nightingale believed that the environment was the
major component creating illness in a patient; she regarded
disease as “the reactions of kindly nature against the
conditions in which we have placed ourselves.” Her theory
Contains three major relationships:
• environment to patient
• nurse to environment
• nurse to patient


“The kind of person that the nurse
becomes makes a substantial difference in
what each patient will learn as he or she
receives nursing care.”
Hildegard Peplau (1952)
She defined Nursing as “an interpersonal process of
therapeutic interactions between an individual who is sick
or in need of health services and a nurse especially
educated to recognize, respond to the need for help.”
Dr. Peplau emphasized the nurse-client relationship as
the foundation of nursing practice. At the time, her
research and emphasis on the give-and-take of nurse-client
relationships was seen by many as revolutionary. She
described the nurse-patient relationship as a four-phase
phenomenon. Each phase is unique and has distinguished
contributions on the outcome of the nurse-patient
Phases Of Nurse-Patient Relationship
1. Orientation
Individual/family has a “felt need”
and seeks professional assistance from a
nurse (who is a stranger). This is the
problem identification phase.
2. Identification
Where the patient begins to have
feelings of belongingness and a capacity
for dealing with the problem, creating an
optimistic attitude from which inner
strength ensues. Here happens the
selection of appropriate professional
3. Exploitation
The nurse uses communication tools
to offer services to the patient, who is
expected to take advantage of all
4. Resolution
Where patient’s needs have already
been met by the collaborative efforts
between the patient and the nurse.
Therapeutic relationship is terminated
and the links are dissolved, as patient
drifts away from identifying with the
nurse as the helping person.
Nursing Roles
In the course of the nurse-patient relationship, the
nurse assumes several roles which empower and equip her in
meeting the needs of the patient.
1. Stranger Role: Receives the client the same way one
meets a stranger in other life situations; provides
an accepting climate that builds trust.
2. Resource Role: Answers questions. Interprets
clinical treatment data, gives information.
3. Teaching Role: Gives instructions and provides
training; involves analysis and...
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