THEORETICAL FOUNDATION OF ➢ Nightingale focuses vision of

NURSING nursing. Nightingale system was more

THE EVOLUTION OF NURSING on developing the profession within
hospitals. Nurses should be taught in
I. Period of Intuitive Nursing hospitals associated with medical
• From Prehistoric times among primitive schools and that the curriculum
tribes up to the early Christian Era should include both theory and
• Untaught and Instinctive practice.
• Nursing performed out of compassion ➢ It was the first school of nursing
• Nursing belongs to women. It was viewed as that provided both theory-based
a natural nurturing job for women. She is knowledge and clinical skill building.
expected to take good care of the children, the
sick and the age The development of nursing during this
• Primitive men believed that illness was period was strongly influenced by:
caused by the invasion of the victim's body of ➢ trends resulting from wars -
evil spirits. They believed that the medicine Crimean, civil war
man, Shaman or witch doctor had the power ➢ arousal of social consciousness
to heal by using white magic, hypnosis, ➢ increased educational opportunities
charms, dances, incantation, purgatives, offered to women.
massage, fire, water and herbs as a mean of • Florence Nightingale was asked by Sir
driving illness from the victim. Sidney Herbert of the British War department
• Drilling a hole in the skull with a rock or to recruit female nurses to provide care for the
stone without anesthesia was a last resort to sick and injured in the Crimean War.
drive evil spirits from the body of the • Female nursing education and nursing
afflicted. TREPANNING OR TREPHINING. service begun.

II. Period of Apprentice Nursing IV. Period of Contemporary Nursing/20th

• It extends from the founding of religious Century
nursing orders in the crusades which began in • This covers the period after World War II to
the 11th century and ended in 1836. present.
• Period of "on-the-job training". Nursing care • Licensure of nurses started.
was performed without any formal education • Specialization of Hospitals and diagnosis
and by people who were directed by more • Training of nurses in Diploma program
experienced nurses. • Development of Baccalaureate and advance
• Nursing went down to the lowest level: degree programs
➢ wrath/anger of Protestantism, • Scientific and technological developments as
confiscated properties of hospitals and well as social changes mark this period
schools connected with Roman • Health is perceived as a fundamental right
Catholicism. • Nursing involvement in community health
➢ Nurses fled their lives; soon there • Technological advances - disposable
was shortage of people to care for the supplies and equipment
sick • Expanded roles of nurses was developed
➢ Hundreds of hospitals closed; there • WHO was established by the United Nations
was no provision for the sick • Aerospace nursing was developed
➢ Nursing became the work of the • Use of atomic energies for medical
least desirable women - prostitutes, diagnosis, treatment
alcoholics, prisoners • Computers were utilized - data collection,
• Pastor Theodor Fliedner and his wife, teaching, diagnosis, inventory, payrolls,
FRIEDREIKE established the Kaiserswerth record
Institute for the training of Deaconesses (the keeping and billing.
1st formal training school for nurses) in • Use of sophisticated equipment for diagnosis
Germany. and therapy.
• This was where Florence Nightingale
received her 3 months course of study in NURSING THEORY
nursing  Attempt to describe or explain the
• Dark period of Nursing phenomenon called nursing
 An articulated and communicated
III. Period of Educated conceptualization of invented or
Nursing/Nightingale Era 19th - 20th discovered reality in or
century  pertaining to nursing for the purpose of
• Began on June 15,1860 when Florence describing, explaining, and predicting or
Nightingale School of Nursing opened at St. prescribing
Thomas Hospital in London.  nursing care.
➢ The school served as a model for  It is composed of context, content and
other training schools. Its graduates process
traveled to other countries to manage
hospitals and institute nurse-training Nursing theory
programs. -is a system of concepts and
practices put in place to inform meaningful Rationalism emphasizes the use of reasoning
actions in the nursing field, such as how to for the main purpose of knowing the harm or
treat patients, how to communicate with benefits of an act to an individual.
patient families, and how to organize nursing Empiricism
responsibilities. Though there are many It makes use of objective and
theories, they don’t all serve the same exact tangible data or those that are perceived by
purpose. Some apply to the greater whole of the senses (smell, sight, taste and feeling) to
all nursing, while others function only under observe and collect data. These data are then
certain circumstances or conditions. used to formulate general knowledge which is
the inductive type of reasoning.
Importance of nursing theories
 It provides the foundations of nursing THEORY
practice
 Helps to decide what we know and what What is a THEORY?
we need to know
 Aims to describe, predict, and explain Theory is an organized system or supposition
the phenomenon in nursing of ideas that is proposed to explain a given
 It helps to distinguish what should form phenomenon of accepted knowledge intended
the basis of practice to explain a set of fact, event or phenomena.
 Maintains professional boundaries -explores phenomena, expresses
relationships between facts, generates a
Significance to the Discipline hypotheses, and predicts future events and
 Specific to academia and refers to a relationships.
branch of education, a department of
learning or domain of knowledge Primary Purpose: To generate knowledge in
 Provides framework to structure a field.
curriculum content or to guide the
teaching of nursing practice in nursing Creative underscores the role of human
programs imagination and vision in theory development,
 Focus on knowledge about how nurses but caution that the creative processes are also
function which concentrated on the rigorous, systematic, and disciplined.
nursing process Tentative open to revision as new evidence
emerges.
Significance to Profession
A specialized field of practice Components of a Theory
which is founded by upon the theoretical 1. Concept specifically, is an idea, thought, or
structure of the science or knowledge of the notion formulated or conceived in the mind or
discipline and the accompanying practice an experience perceived and observed.
ability “Building Blocks” of theories.
2. Proposition is a statement that expresses
Nursing Science and Theory in the Early or explains the relationships of different
20th Century: Major Developments: concepts and is
• The use of experimentation to gain new capable of being tested, believed, or denied.
knowledge emerged as nurses strive to base 3. Definition is composed of various
their actions on evidence & scientific data descriptions which convey a general meaning
• Positivism –use of both logical reasoning and reduces the
and empiricism became prevalent during this vagueness in understanding a set of concepts.
era 4. Assumption is a statement that specifies
in the discovery of truth for the development the relationship or connection of factual
of science concepts or
• Empirical and objective data co exist as the phenomena.
focus of interest of study as one of each need
to be tested in order to determine as to what is
true or what is not
• As a result of different point of views, the
growth of scientific knowledge commenced.
This is evident with the emergence of radical
thinking – rationalism and empiricism.

Rationalism
It makes use of reason gained Characteristics of a Theory 
thru expert study, tested theory and  Theories should be simple but
established facts to evidently prove  generally broad in nature 
something. Deductive type of reasoning is  Theories must be logical in nature. 
used to generate rationalist view which starts  Theories can correlate concepts in
from the general to specific knowledge.  such a way as to generate a different way
of looking at  a certain fact or
phenomenon 
  Theories contribute in enriching the According to abstraction :
general body of knowledge through the
studies implemented to validate them.  Three major categories
 Theories can be the
source of hypotheses 1. Grand Theories 
that can be tested for -Grand theories are abstract, broad in
it to be elaborated. scope, and complex, therefore requiring
 Theories can be used further research for  clarification.
by practitioners to
direct and enhance 2. Middle-Range Nursing Theories 
their practice.  -More limited in scope (as
 Theories must be compared to grand theories) and
consistent with other present concepts and propositions
validated theories, laws, at  a lower level of abstraction.
and principles but will   They address a specific
leave open unanswered phenomenon in nursing.  
issues that need to be  Most middle-range theories are based
tested.  on the works of a grand theorist but
they can be conceived  from research,
Nursing Theory   nursing practice, or the theories of
• Attempt to describe or explain the other disciplines.
phenomenon called nursing 
• An articulated and communicated 3. Practice-Level Nursing Theories
conceptualization of invented or (Micro-Range Theories) 
discovered reality in or  -Practice nursing theories are
pertaining to nursing for the situation specific theories that
purpose of describing, explaining, are narrow in scope and focuses
and predicting or prescribing  on a specific patient population
nursing care.  at a specific time.
• It is composed of context, content and Classification According to Meleis 
process 

Importance of nursing theories  Afaf Ibrahim Meleis (2011), in her

book Theoretical Nursing: Development
• It provides the foundations of nursing and Progress, organizes the  major nurse
practice  theories and models using the following
• Helps to decide what we know and headings: needs theories, interaction
what we need to know  theories, and  outcome theories. These
• Aims to describe, predict, and explain categories indicate the basic
the phenomenon in nursing  philosophical underpinnings of the
• It helps to distinguish what should theories. 
form the basis of practice 
• Maintains professional boundaries  1. Needs theory – based around
helping individuals to fulfill their
Basic processes in the development of physical and mental needs.
nursing theories  2. Interaction theory – revolves
3. around the relationship of nurses
1. General system theory - it describes how
with the patients.
to break whole things into parts and then
4. Outcome theory – nurse as
learn how the parts  works together in
changing force, who enables
systems 
individual to adapt or to cope with
2. Adaptation theory - the adjustment of
ill  health. 
living matter to other living things
5. Humanistic theory – in response
and to environmental conditions
to the psychoanalytic thought that a
3. Developmental theory - it outlines the person’s destiny was  determined in
process of growth and development early life. 
of humans as orderly and  
predictable, beginning with According to Alligood 
conception and ending with death
In her book, Nursing Theorists and Their
Classification of Nursing Theories  Work, Raile Alligood (2017) categorized
nursing theories into four  headings: nursing
According to function 
philosophy, nursing conceptual models,
1. Descriptive or Factor-isolating theories 
nursing theories and grand theories, and
2. Explanatory or Factor-relating theories 
middle-range nursing theories. 
3. Predictive or Situation-relating theories 
4. Prescriptive or Situation-producing 1. Nursing Philosophy.
theories
--Is the most abstract type and sets forth  Advocated for care of those afflicted
the meaning of nursing phenomena with diseases caused by lack of
through analysis, reasoning, and logical hygienic practices
presentation. Works of Nightingale,  At age 31, she entered the
Watson, Ray, and  Benner are Deaconesses School at Kaiserswerth
categorized under this group.  in spite of her family’s resistance to
her ambitions. She became a nurse
2. Nursing Conceptual Models. over the objections of society and
her
--Are comprehensive nursing theories  family.
that are regarded by some as  pioneers in  ▪ Worked as a superintendent for
nursing. These theories address the Gentlewomen Hospital, a charity
nursing metaparadigm and explain the hospital for ill governesses.
relationship between them. Conceptual  Disapproved the restrictions on
models of Levine, Rogers, Roy, King, admission of patients and considered
and Orem are under  this group.  this unchristian and incompatible
with health care
3. GraFLOEnd Nursing Theories.  Upgraded the practice of nursing
and made nursing an honorable
--Are works derived from nursing profession for women.
philosophies, conceptual models, and  Led nurses that took care of the
other grand theories that are generally wounded during the Crimean war
not as specific as middle-range theories.  Put down her ideas in 2 published
books: Notes on Nursing, What It Is
4. Middle-Range Theories. and What It Is Not and Notes on
Hospitals.
--Are precise and answer specific nursing
 She revolutionized the public’s
practice questions. They  address the perception of nursing (not the image
specifics of nursing situations within the
of a doctor’s handmaiden) and the
perspective of the model or theory from method for educating nurses.
which  they are derived. Examples of
Middle-Range theories are that of The seeds of nursing was planted in
Mercer, Reed, Mishel, and  Barker.  Germany (place of first nursing school).
In 1936, Pastor Theodor Fliedner
opened a hospital and designed a school
of nursing. Florence applied with a 12
page handwritten “curriculum”
showing her interest of becoming a
nurse. She graduated after 3 months
and went back to London. With her
lamp, Nightingale traversed the night
during the Crimean war (battle of
FLORENCE NIGHTINGALE English versus Turkish) to look for
(LADY WITH A LAMP) wounded soldiers and to heal them with
her consoling hands. She went to the
FACTS ABOUT FLORENCE front of the Crimean war at the request
NIGHTINGALE of her friend, Sir Sidney Herbert,
Secretary at war at Great Britain. She
 Born on May 12, 1820 in Florence, arrived in Scutari (barrack hospital)
Italy accompanied by 38 nurses. They stayed
 Victorian woman there for 19 months. The barracks was
 Raised in England in an atmosphere filled with fleas, rats and sewage (water
of culture and affluence carrying waste w/c needed to be
 Linguist, knowledgeable in math, removed) flowed under the ward.
science, literature and arts, well read Mortality rate was 42.7% from disease
in philosophy, history and economic. than from war injuries, After 6 months
 Not contended with the social it decreased to 2.2 %
custom imposed upon her as a
Victorian Lady, she developed her Recognition and Adulation
self-appointed goal: To change the
profile of Nursing Florence was showered with awards and
 She compiled notes of her visits to decorations in recognition of her work.
hospitals and her observations of the She became a national icon. Her
sanitary facilities,social problems of contemporary fame was reflected in the
the places she visited. production of merchandise
 Noted the need for preventive commemorating her achievements.
medicine and good nursing Florence herself was publicity-shy and
was appalled at the adulation she
 received. But this did not prevent the temperature could be controlled by
development of a whole industry based appropriate balance between burning
on her celebrity. fires and ventilation from windows.

Florence later suffered from what is now Light

known as Chronic Fatigue Syndrome.
Despite being bedridden for many Nightingale believed that second to fresh air
years, she still campaigned tirelessly to the sick needed light. She noted that
improve health standards. She died on direct sunlight was what patients
13 August 1910 aged 90. wanted.

Legacy Cleanliness

Before Florence Nightingale, nursing was Check room for dust, dampness and dirt.
not considered a respectable profession.
With the exception of nuns, the women Health of Houses
who worked as nurses were often ill-
trained and poorly disciplined. Most “Badly constructed houses do for the
were working-class. Florence was healthy what badly constructed
determined to encourage educated, hospitals do for the sick.Once ensure
'respectable' women into nursing. that the air is stagnant and sickness is
certain to follow.”
ENVIRONMENTAL THEORY
Noise
Metaparadigm in nursing
She stated that patients should never be
Nursing: Very essential for checking waked intentionally or accidentally
surrounding environment for fresh air, during the first part of sleep. She
pure water everybody’s well being asserted that whispered or long
conversations about patients are
Person: she viewed the essence of a person thoughtless and cruel. She viewed
as a patient. She believed that nurses unnecessary noise, including noise from
should female dress, as cruel and irritating to
the patient.
perform tasks to and for the patient as well
as control the patient’s environment to Bed and Bedding
facilitate easy recovery.
She noted that an adult in health exhales
Health: being well and using every power about three pints of moisture through
that the patient has to the fullest extent. the lungs and skin in a 24-hour period.
This organic matter enters the sheets
Environment: The physical environment is and stays there unless the bedding is
stressed by Nightingale in her writing. changed and aired frequently. She
Nightingale’s writings reflect a believed that the bed should be placed
community health model in which all in the lightest part of the room and
that surrounds human beings is placed so the patient could see out of a
considered in relation to their state of window. She reminded the caregiver
health. never to lean against, sit upon, or
unnecessarily shake the bed of the
Nightingale’s Canons: patient.

Ventilation and Warming Personal Cleanliness

“Keep the air he breathes as pure as the “Just as it is necessary to renew the air
external air, without chilling him.” round a sick person frequently to carry
off morbid effluvia from the lungs and
Nightingale believed that the person who skin, by maintaining free ventilation, so
repeatedly breathed his or her own air it is necessary to keep pores of the skin
would become sick or remain sick. free from all obstructing excretions.”

Nightingale was very concerned about “Every nurse ought to wash her hands very
“noxious air” or “effluvia” or foul odors frequently during the day.”
that came from excrement She also
criticized “fumigations,” for she Variety
believed that the offensive source, not
the smell, must be removed. The She discussed the need for changes in color
importance of room temperature was and form, including bringing the patient
stressed by Nightingale. The patient brightly colored flowers or plants. She
should not be too warm or too cold. The also advocated rotating 10 or 12
 paintings and engravings each day,
week, or month to provide variety for
the patient. Nightingale also advocated
reading, needlework, writing, and
cleaning as activities to relieve the sick
of boredom..

Chattering Hopes and Advices

She wrote that to falsely cheer the sick by

making light of their illness and its
danger is not helpful .Nightingale
encouraged the nurse to heed what is
being said by visitors, believing that
sick persons should hear good news that
would assist them in becoming
healthier.

Nutrition and Taking Food

She noted that individuals desire different

foods at different times of the day and
that frequent small servings may be
more beneficial to the patient than a
large breakfast or dinner. She urged that
no business be done with patients while
they are eating because this was
distraction.

Petty Management

This ensure continuity of care. Document

the plan of care and evaluate the
outcomes to ensure continuity.

Observation of the sick

Observe and record about the patient and

his environment and make changes in
the plan of care.