Dorothea Orem- Self-Care Theory

 

 DOROTHEA OREM - SELF CARE THEORY

Dorothea Elizabeth Orem (1914 – June 22, 2007), born in Baltimore, Maryland, was a nursing theorist and creator of the self-care deficit nursing theory, also known as the Orem model of nursing.

Through these, the Self-Care Nursing Theory or the Orem Model of Nursing was developed by Dorothea Orem between 1959 and 2001. It is considered a grand nursing theory, which means the theory covers a broad scope with general concepts that can be applied to all instances of nursing.

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partial compensatory and supportive-educative.

Theory of Self-care

This theory focuses on the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being.
Self-care Requisites

Self-care Requisites or requirements can be defined as actions directed toward the provision of self-care. It is presented in three categories:

Universal self-care requisites

Universal self-care requisites are associated with life processes and the maintenance of the integrity of human structure and functioning.

    The maintenance of a sufficient intake of air
    The maintenance of a sufficient intake of water
    The maintenance of a sufficient intake of food
    The provision of care associated with elimination process and excrements
    The maintenance of a balance between activity and rest
    The maintenance of a balance between solitude and social interaction
    The prevention of hazards to human life, human functioning, and human well-being
    The promotion of human functioning and development within social groups in accord with human potential, known human limitations, and the human desire to be normal

Theory of Self-care Deficit

This theory delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self-care. Orem identified 5 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
    Teaching another

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Virginia Henderson - Nursing Need Theory

 

VIRGINIA HENDERSON - NURSING NEED THEORY

Virginia Avenel Henderson, (November 30, 1897 – March 19, 1996) was an influential nurse, researcher, theorist and author.[1]

Henderson is famous for a definition of nursing: "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge" (first published in Henderson & Nite 1978, p. 5, 1955 ed.).She is known as "the first lady of nursing" and has been called, "arguably the most famous nurse of the 20th century"and "the quintessential nurse of the twentieth century". In a 1996 article in the Journal of Advanced Nursing Edward Halloran wrote, "Virginia Henderson's written works will be viewed as the 20th century equivalent of those of the founder of modern nursing, Florence Nightingale."

The Nursing Need Theory was developed by Virginia A. Henderson to define the unique focus of nursing practice. The theory focuses on the importance of increasing the patient’s independence to hasten their progress in the hospital. Henderson’s theory emphasizes on the basic human needs and how nurses can assist in meeting those needs.

The 14 components of the Need Theory show a holistic approach to nursing that covers the physiological, psychological, spiritual and social needs.

Physiological Components

    1. Breathe normally
    2. Eat and drink adequately
    3. Eliminate body wastes
    4. Move and maintain desirable postures
    5. Sleep and rest
    6. Select suitable clothes – dress and undress
    7. Maintain body temperature within normal range by adjusting clothing and modifying environment
    8. Keep the body clean and well groomed and protect the integument
    9. Avoid dangers in the environment and avoid injuring others
Psychological Aspects of Communicating and Learning

    10. Communicate with others in expressing emotions, needs, fears, or opinions.
    14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.
Spiritual and Moral

    11. Worship according to one’s faith

Sociologically Oriented to Occupation and Recreation

    12. Work in such a way that there is sense of accomplishment
    13. Play or participate in various forms of recreation

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Sister Callista L. Roy - Adaptation Model of Nursing

 

SISTER CALLISTA L. ROY -  ADAPTATION MODEL OF NURSING

Sister Callista Roy, CSJ (born October 14, 1939) is an American nursing theorist, professor and author. She is known for creating the adaptation model of nursing. Roy was designated as a 2007 Living Legend by the American Academy of Nursing.

Roy’s Adaptation Model of Nursing was developed by Sister Callista Roy in 1976. The prominent nursing theory aims to explain or define the provision of nursing. In her theory, Roy’s model sees the individual as a set of interrelated systems who strives to maintain balance between these various stimuli.

The Adaptation Model of Nursing is a prominent nursing theory aiming to explain or define the provision of nursing science. In her theory, Sister Callista Roy’s model sees the individual as a set of interrelated systems who strives to maintain balance between various stimuli.

The Roy Adaptation Model was first presented in the literature in an article published in Nursing Outlook in 1970 entitled “Adaptation: A Conceptual Framework for Nursing.” In the same year, Roy’s Adaptation Model of Nursing was adapted in Mount St. Mary’s School in Los Angeles, California.

Roy’s model was conceived when nursing theorist Dorothy Johnson challenged her students during a seminar to develop conceptual models of nursing. Johnson’s nursing model was the impetus for the development of Roy’s Adaptation Model.

Roy’s model incorporated concepts from Adaptation-level Theory of Perception from renown American physiological psychologist Harry Helson, Ludwig von Bertalanffy’s System Model, and Anatol Rapoport’s system definition.

Adaptation is the “process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create human and environmental integration.”

Levels of Adaptation
Integrated Process

The various modes and subsystems meet the needs of the environment. These are usually stable processes (e.g., breathing, spiritual realization, successful relationship).
Compensatory Process

The cognator and regulator are challenged by the needs of the environment, but are working to meet the needs (e.g., grief, starting with a new job, compensatory breathing).
Compromised Process

The modes and subsystems are not adequately meeting the environmental challenge (e.g., hypoxia, unresolved loss, abusive relationships).

Six-Step Nursing Process

A nurse’s role in the Adaptation Model is to manipulate stimuli by removing, decreasing, increasing or altering stimuli so that the patient

1. Assess the behaviors manifested from the four adaptive modes.
2. Assess the stimuli, categorize them as focal, contextual, or residual.
3. Make a statement or nursing diagnosis of the person’s adaptive state.
4. Set a goal to promote adaptation.
5. Implement interventions aimed at managing the stimuli.
6. Evaluate whether the adaptive goal has been met.

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Madeleine M. Leininger – Transcultural Nursing Theory

 

MADELEINE M. LEININGER - TRANSCULTURAL NURSING THEORY

Madeleine Leininger (13 July 1925 – 10 August 2012) was a nursing theorist, nursing professor and developer of the concept of transcultural nursing. First published in 1961,[1] her contributions to nursing theory involve the discussion of what it is to care.

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 which led her to develop the theory of Transcultural Nursing also known as Culture Care Theory.

This 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 main focus of Leininger’s theory is for the nursing care to fit with or have beneficial meaning and health outcomes for people of different or similar cultural backgrounds. With these, she has developed the Sunrise Model in a logical order to demonstrate the interrelationships of the concepts in her theory of Culture Care Diversity and Universality.

In 1960, Leininger was awarded a National League of Nursing Fellowship for fieldwork in the Eastern Highlands of New Guinea, where she studied the convergence and divergence of human behavior in two Gadsup villages.

While at Wayne State, Leininger won numerous awards, including the prestigious President’s Award for Excellence in Teaching, the Board of Governors Distinguished Faculty Award, and the Gershenson’s Research Fellowship Award.
Qualitative Research Methods in Nursing

Qualitative Research Methods in Nursing

In 1998, she was honored as a Living Legend by the American Academy of Nursing and Distinguished Fellow, Royal College of Nursing in Australia.

The Leininger Transcultural Nursing Award was established in 1983 to recognize outstanding and creative leaders in transcultural nursing. This prestigious award will continue as the Leininger Transcultural Nursing Award under the auspices of the Transcultural Nursing Society in Madeleine Leininger’s honor.

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Imogene M. King - Theory of Goal Attainment

 

IMOGENE M. KING - THEORY OF GOAL ATTAINMENT

Imogene King (January 30, 1923 – December 24, 2007) was a pioneer of nursing theory development. Her interacting systems theory of nursing and her theory of goal attainment have been included in every major nursing theory text. These theories are taught to thousands of nursing students, form the basis of nursing education programs, and are implemented in a variety of service settings.

The Theory of Goal Attainment states that “Nursing is a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation” and “a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals.”

In this definition, action is a sequence of behaviors involving mental and physical action, and reaction is included in the sequence of behaviors described in action. King states that the goal of a nurse is to help individuals to maintain their health so they can function in their roles. The domain of the nurse “includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying.” The function of a professional nurse is “to interpret information in the nursing process to plan, implement, and evaluate nursing care.”

3 Interacting Systems

According to King, there are three interacting systems in the Theory of Goal Attainment. These are the personal system, the interpersonal system, and the social system. Each system is given different concepts. The concepts for the personal system are: perception, self, growth and development, body image, space, and time. The concepts for the interpersonal system are: interaction, communication, transaction, role, and stress. The concepts for the social system are: organization, authority, power, status, and decision making.
Personal Systems

Each individual is a personal system. King designated an example of a personal system as a patient or a nurse. King specified the concepts of body image, growth and development, perception, self, space, and time in order to comprehend human beings as persons.

“The self is a composite of thoughts and feelings which constitute a person’s awareness of his individual existence, his conception of who and what he is. A person’s self is the sum total of all he can call his. The self includes, among other things, a system of ideas, attitudes, values, and commitments. The self is a person’s total subjective environment. It is a distinctive center of experience and significance. The self constitutes a person’s inner world as distinguished from the outer world consisting of all other people and things. The self is the individual as known to the individual. It is that to which we refer when we say “I.”

Growth and development can be defined as the processes in people’s lives through which they move from a potential for achievement to actualization of self.

King defines body image as the way one perceives both one’s body and others’ reactions to one’s appearance.

Space includes that space exists in all directions, is the same everywhere, and is defined by the physical area known as “territory” and by the behaviors of those occupy it.

Time is defined as “a duration between one event and another as uniquely experienced by each human being; it is the relation of one event to another event.”

King (1986) added learning as a subconcept in the personal system but did not further define it.
Interpersonal Systems

These are formed by human beings interacting. Two interacting individuals form a dyad; three form a triad, and four or more form small or large groups. As the number of interacting individuals increases, so does the complexity of the interactions. Understanding the interpersonal system requires the concepts of communication, interaction, role, stress, and transaction.

Interactions are defined as the observable behaviors of two or more individuals in mutual presence.

King (1990) defines communication as “a process whereby information is given from one person to another either directly in face-to-face meeting or indirectly through telephone, television, or the written word.”

King defines transactions as “a process of interactions in which human beings communicate with the environment to achieve goals that are valued… goal-directed human behaviors.

The characteristics of role include reciprocity in that a person may be a giver at one time and a taker at another time, with a relationship between two or more individuals who are functioning in two or more roles that learned, social, complex, and situational.

Stress is “a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance, which involves an exchange of energy and information between the person and the environment for regulation and control of stressors.”
Social Systems

A more comprehensive interacting system consists of groups that make up society, referred to as the social system. Religious, educational, and health care systems are examples of social systems. The influential behavior of an extended family on an individual’s growth and development is another social system example. Within a social system, the concepts of authority, decision making, organization, power, and status guide system understanding.

Power is the capacity to use resources in organizations to achieve goals… is the process whereby one or more persons influence other persons in a situation… is the capacity or ability of a person or a group to achieve goals… occurs in all aspects of life and each person has potential power determined by individual resources and the environmental forces encountered. Power is social force that organizes and maintains society. Power is the ability to use and to mobilize resources to achieve goals.

Status is “the position of an individual in a group or a group in relation to other groups in an organization” and is identified that status is accompanied by “privileges, duties and obligation.”

Decision making is “a dynamic and systematic process b y which goal-directed choice of perceived alternatives is made and acted upon by individuals or groups to answer a question and attain a goal” (King, 1990).

King (1986) added control as a subconcept in the social system but did not further define the concept.

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Faye G. Abdellah – Pioneer of 21 Nursing Problems

 

FAYE G. ABDELLAH - 21 NURSING PROBLEMS

Faye Glenn Abdellah (born March 13, 1919) is a pioneer in nursing research. In 1974 she became the first nurse officer in the U.S. to receive the rank of a two-star rear admiral.[ Her research has helped to change the focus of nursing theory from a disease-centered to a patient-centered approach.

Abdellah is well known for her development of the “Twenty-One Nursing Problems Theory” that has interrelated the concepts of health, nursing problems, and problem-solving.

She views nursing as an art and a science that mold the attitude, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help individuals cope with their health needs, whether they are ill or well.

She used Henderson’s 14 basic human needs and nursing research to establish the classification of nursing problems. Abdellah’s 21 Nursing Problems are the following:

    To maintain good hygiene and physical comfort
    To promote optimal activity: exercise, rest, sleep
    To promote safety through prevention of accident, injury, or other trauma and through prevention Cof the spread of infection
    To maintain good body mechanics and prevent and correct deformity
    To facilitate the maintenance of a supply of oxygen to all body cells
    To facilitate the maintenance of nutrition for all body cells
    To facilitate the maintenance of elimination
    To facilitate the maintenance of fluid and electrolyte balance
    To recognize the physiologic responses of the body to disease conditions—pathologic, physiologic, and compensatory
    To facilitate the maintenance of regulatory mechanisms and functions
    To facilitate the maintenance of sensory function
    To identify and accept positive and negative expressions, feelings, and reactions
    To identify and accept interrelatedness of emotions and organic illness
    To facilitate the maintenance of effective verbal and nonverbal communication
    To promote the development of productive interpersonal relationships
    To facilitate progress toward achievement and personal spiritual goals
    To create or maintain a therapeutic environment
   To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs
    To accept the optimum possible goals in the light of limitations, physical and emotional
    To use community resources as an aid in resolving problems that arise from illness
    To understand the role of social problems as influencing factors in the cause of illness.

Awards and Honors
The National Women's Hall of Fame

The National Women’s Hall of Fame

Abdellah is recognized as a leader in the development of nursing research and nursing as a profession within the Public Health Service (PHS) and as an international expert on health problems. She was named a “living legend” by the American Academy of Nursing in 1994 and was inducted into the National Women’s Hall of Fame in 2000 for a lifetime spent establishing and leading essential health care programs for the United States. In 2012, Abdellah was inducted into the American Nurses Association Hall of Fame for a lifetime of contributions to nursing.

Her contributions to nursing and public health have been recognized with almost 90 professional and academic honors, such as the Allied Signal Achievement Award for pioneering research in aging and Sigma Theta Tau’s Lifetime Achievement Award.

Abdellah’s leadership, her publications, and her lifelong contributions have set a new standard for nursing and for health care. Her legacy of more than 60 years of extraordinary accomplishments lives on nationally and globally.

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Hildegard Peplau - Interpersonal Relations Theory

HILDEGUARD PEPLAU -  INTERPERSONAL RELATIONS THEORY

Hildegard E. Peplau (September 1, 1909 - March 17, 1999)[1] was an American nurse and the first published nursing theorist since Florence Nightingale and created the middle-range nursing theory of interpersonal relations, which helped to revolutionize the scholarly work of nurses. As a primary contributor to mental health law reform, she led the way towards humane treatment of patients with behavior and personality disorders.

The need for a partnership between nurse and client is very substantial in nursing practice. This definitely helps nurses and healthcare providers develop more therapeutic interventions in the clinical setting. Through these, Hildegard E. Peplau developed her “Interpersonal Relations Theory” in 1952, mainly influence by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.

Description

Peplau’s theory 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.” It is a “maturing force and an educative instrument” involving an interaction between two or more individuals with a common goal.

In nursing, this common goal provides the incentive for the therapeutic process in which the nurse and patient respect each other as individuals, both of them learning and growing as a result of the interaction. An individual learns when she or he selects stimuli in the environment and then reacts to these stimuli.

Contents [show]
Assumptions

The assumptions of Peplau’s Interpersonal Relations Theory are: (1) Nurse and patient can interact. (2) Peplau emphasized that both the patient and nurse mature as the result of the therapeutic interaction. (3) Communication and interviewing skills remain fundamental nursing tools. And lastly, (4) Peplau believed that nurses must clearly understand themselves to promote their client’s growth and to avoid limiting client’s choices to those that nurses value.
Major Concepts

The theory explains the purpose of nursing is to help others identify their felt difficulties and that nurses should apply principles of human relations to the problems that arise at all levels of experience.
Man

Peplau defines man as an organism that “strives in its own way to reduce tension generated by needs.” The client is an individual with a felt need.
Health

Health is defined as “a word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.”
Society or Environment

Although Peplau does not directly address society/environment, she does encourage the nurse to consider the patient’s culture and mores when the patient adjusts to hospital routine.
Nursing

Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal process.” She defines it as a “human relationship between an individual who is sick, or in need of health services, and a nurse specially educated to recognize and to respond to the need for help.”
Therapeutic nurse-client relationship

A professional and planned relationship between client and nurse that focuses on the client’s needs, feelings, problems, and ideas. It involves interaction between two or more individuals with a common goal. The attainment of this goal, or any goal, is achieved through a series of steps following a sequential pattern.

Four Phases of the therapeutic nurse-patient relationship:
Orientation Phase

*The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions.

    Problem defining phase
    Starts when client meets nurse as stranger
    Defining problem and deciding type of service needed
    Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences
    Nurse responds, explains roles to client, helps to identify problems and to use available resources and services

Identification Phase

*The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger.

    Selection of appropriate professional assistance
    Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness

*Exploitation Phase

In the exploitation phase, the client makes full use of the services offered.

    In the exploitation phase, the client makes full use of the services offered.
    Use of professional assistance for problem solving alternatives
    Advantages of services are used is based on the needs and interests of the patients
    Individual feels as an integral part of the helping environment
    They may make minor requests or attention getting techniques
    The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem
    Patient may fluctuates on independence
    Nurse must be aware about the various phases of communication
    Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step

*Resolution Phase

In the resolution phase, the client no longer needs professional services and gives up dependent behavior. The relationship ends.

    In the resolution phase, the client no longer needs professional services and gives up dependent behavior. The relationship ends.
    Termination of professional relationship
    The patients needs have already been met by the collaborative effect of patient and nurse
    Now they need to terminate their therapeutic relationship and dissolve the links between them.
    Sometimes may be difficult for both as psychological dependence persists
    Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals

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Florence Nightingale - Environmental Theory

FLORENCE NIGHTINGALE 

Florence Nightingale, a nurse, spent her night rounds giving personal care to the wounded, establishing her image as the 'Lady with the Lamp.'

The Environmental Theory by Florence Nightingale defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery.” 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.

Major Concepts
Nursing

“What nursing has to do… is to put the patient in the best condition for nature to act upon him” (Nightingale, 1859/1992)

Nightingale stated that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.” She reflected the art of nursing in her statement that, “the art of nursing, as now practised , seems to be expressly constituted to unmake what God had made disease to be, viz., a reparative process.”
Human Beings

Human beings are not defined by Nightingale specifically. They are defined in relationship to their environment and the impact of the environment upon them.
Environment

The physical environment is stressed by Nightingale in her writing. Nightingale’s writings reflect a community health model in which all that surrounds human beings is considered in relation to their state of health.
Health

Nightingale (1859/1992) did not define health specifically. She stated, “We know nothing of health, the positive of which pathology is the negative, except from the observation and experience. Given her definition that of the art of nursing is to “unmake what God had made disease,” then the goal of all nursing activities should be client health.

She believed that nursing should provide care to the healthy as well as the ill and discussed health promotion as an activity in which nurses should engage.

Health of Houses

“Badly constructed houses do for the healthy what badly constructed hospitals do for the sick. Once insure that the air is stagnant and sickness is certain to follow.”
Ventilation and Warming

“Keep the air he breathes as pure as the external air, without chilling him.”

Nightingale believed that the person who repeatedly breathed his or her own air would become sick or remain sick. She was very concerned about “noxious air” or “effluvia” and foul odors that came from excrement. She also criticized “fumigations,” for she believed that the offensive source, not the smell, must be removed.

The importance of room temperature was also stressed by Nightingale. The patient should not be too warm or too cold. The temperature could be controlled by appropriate balance between burning fires and ventilation from windows.
Light

Nightingale believed that second to fresh air, the sick needed light. She noted that direct sunlight was what patients wanted.
Noise

She stated that patients should never be waked intentionally or accidentally during the first part of sleep. She asserted that whispered or long conversations about patients are thoughtless and cruel. She viewed unnecessary noise, including noise from female dress, as cruel and irritating to the patient.
Variety

She discussed the need for changes in color and form, including bringing the patient brightly colored flowers or plants. She 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.
Bed and Bedding

Nightingale noted that an adult in health exhales about three pints of moisture through the lungs and skin in a 24-hour period. This organic matter enters the sheets and stays there unless the bedding is changed and aired frequently.

She believed that the bed should be placed in the lightest part of the room and placed so the patient could see out of a window. She also reminded the caregiver never to lean against, sit upon, or unnecessarily shake the bed of the patient.
Personal Cleanliness

“Just as it is necessary to renew the air round a sick person frequently to carry off morbid effluvia from the lungs and skin, by maintaining free ventilation, so it is necessary to keep pores of the skin free from all obstructing excretions.”

“Every nurse ought to wash her hands very frequently during the day.”
Nutrition and Taking Food

Nightingale 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.
Chattering Hopes and Advices

Nightingale wrote that to falsely cheer the sick by making light of their illness and its danger is not helpful. She 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.
Social Considerations

Nightingale supported the importance of looking beyond the individual to the social environment in which he or she lived.
Environmental Factors

She identified five (5) environmental factors: fresh air, pure water, efficient drainage, cleanliness or sanitation and light or direct sunlight.

    Pure fresh air – “to keep the air he breathes as pure as the external air without chilling him.”
    Pure water – “well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer.”
    Effective drainage – “all the while the sewer maybe nothing but a laboratory from which epidemic disease and ill health is being installed into the house.”
    Cleanliness – “the greater part of nursing consists in preserving cleanliness.”
    Light (especially direct sunlight) – “the usefulness of light in treating disease is very important.”

The factors posed great significance during Nightingale’s time when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients.

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 its effects on the patient.

Deficiencies in these five factors produce illness or lack of health, but with a nurturing environment, the body could repair itself.
Conclusion

The Environmental Theory of Nursing is a patient-care theory. It focuses in the alteration of the patient’s environment in order to affect change in his or her health. Caring for the patient is of more importance 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.

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