NCM-131-Unit-IIIA.-The-Needs-Theories PDF

Unit III. The Nursing Theories The “Needs” or Problem Oriented Theories These theories are based around helping individuals to fulfill their physical and mental needs so that progress after hospitalization would not be delayed.  Florence Nightingale’s Environmental T...

Unit III. The Nursing Theories The “Needs” or Problem Oriented Theories These theories are based around helping individuals to fulfill their physical and mental needs so that progress after hospitalization would not be delayed.  Florence Nightingale’s Environmental Theory Grand Theory because it focuses on different areas of nursing care. Known as the “Lady with the Lamp”, providing care to the wounded and ill soldiers during the Crimean War. The Crimean War was a military conflict fought from October 1853 to February 1856 in which Russia lost to an alliance made up of France, the Ottoman Empire, the United Kingdom and Sardinia. The immediate cause of the war involved the rights of Christian minorities in the Holy Land, then a part of the Ottoman Empire. Considered the “Founder of educated and scientific nursing”. Florence Nightingale’s Environmental Theory Wrote the first “Notes on Nursing: What it is, What is not” in 1860 that became the basic of nursing practice and research. Considered the “First Nursing Theorist”. One of her theories was the “Environmental Theory”, which incorporated the restoration of the usual health status of the nurse’s clients into the delivery of health care which is still practiced today. Florence Nightingale’s Environmental Theory She was also considered as an statistician due to her use of empirical evidence through her statistical diagram in her notes, reports, books and letters. She highlighted the use of observation and the performance of task in the nursing education. DOB: May 12, 1820 DOD: August 13, 1910 at the age of 90 in her sleep  Florence Nightingale’s Environmental Theory 1 - Health of Houses Badly constructed and dilapidated houses or hospitals where patient is staying affects his/her recovery. 2 - Ventilation and Warm 2 The patient should not be too warm or too cold. The temperature could be controlled by an appropriate balance between burning fires and ventilation from windows. Noxious odors should be considered. 3 - Light She believed that second to fresh air, the sick patient 1 3 should have a well-light room and if possible direct sunlight must illuminate the room.  4 – Noise The nurse should not disturb patients with long thoughtless conversations and considered these as cruel. She viewed unnecessary noise, including noise from female dress, as cruel and irritating to the patient. 5 – Variety The need for changes in color and form, or bringing the 4 patient outside with brightly colored flowers or plants can helped the patient’s recovery. She also advocated reading, needlework, writing, and cleaning as activities to relieve the sick of boredom. 6 – Bed and Beddings The bed should be placed in the lightest part of the room and placed so the patient could see out of a 5 6 window. Nurses should never lean against, sit upon, or unnecessarily shake the bed of the patient.  7 – Personal Cleanliness The nurse should attend the personal hygiene of the patient, however every nurse ought to wash hands very frequently during the day.” 8 – Nutrition and Taking Food 7 The nurse should consider the diet of the patient and their desire of different foods at different times and urged that distraction must be avoided while patient is 9 8 eating. 9 – Chattering Hopes and Advice It is necessary to cheer the sick by making light of their illness and that bad news from families and relatives must be avoided to assist them in their recovery.  10 – Social Considerations Nightingale supported the importance of looking beyond the individual to the social environment in which he or she lived. In summary, Florence Nightingale’s Environmental Theory believed that the presence of these 5 environmental 10 factors: fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight can lead to total recovery of the patient.  Metaparadigm of Nightingale’s Theory ENVIRONMENT Her concepts of ventilation, warmth, light, diet, cleanliness NURSING and noise. She focused on the Nursing as “the act of utilizing the physical aspects of the environment of the patient to environment. She believed that assist him in his recovery.” “Healthy surroundings were necessary for proper nursing care PATIENT The patient is the focus of the HEALTH theory, where the nurse perform A healthy body can recover and the task for the patient and undergo reparative process control the environment for easy through environmental control recovery. She practices nurse- towards recovery. patient passive relationship.  Application of Nightingale’s Theory in Nursing Process Adequacy of Ventilation Cleanliness of environment Presence of draft Sudden noises Amount of sunlight and artificial light Variety of Dietary offerings Odors present in the ward/room Methods of disposal of human waste and sputum  Insufficient warmth Company from family and other patient Insufficient knowledge regarding disease Non-stimulating environment Non-stimulating diets: vegetables, grains, fruits Non-stimulating drinks: water Non-stimulating activity: staying at home or staying idle  Strengths Limitations Nightingale’s Environmental Theory has In Nightingale’s Environmental Theory, broad applicability to the practitioner. there is scant information on the Her model can be applied in most psychosocial environment when complex hospital intensive care compared to the physical environment. environment, the home, a work site, or The application of her concepts in the the community at large. Reading twentieth century is in question. Nightingale’s Environmental Theory raises consciousness in the nurse about how the environment influences client outcomes.  Faye Glenn Abdellah’s 21 Nursing Problems A Human Need Theory “Nursing researcher and theorist” as well as the first woman to become a surgeon general as a nurse. She was appointed Chief Nurse Officer of the US Public Health Service in 1970 and serve that position in 17 years. Inducted into the US National Women’s Hall of Fame in 2000 due to her contributions in the field of Education and Research.  Faye Glenn Abdellah’s 21 Nursing Problems She gave the theory of 21 nursing problems in 1960 on those who are hospitalized and also who are in the community. Developed the “Patient Assessment of Care Evaluation (PACE), a system of standards used to measure the relative quality of individual Health-Care Facilities that was still used in the health care industry into the 21st century  Faye Glenn Abdellah’s 21 Nursing Problems The first in health care industry to develop a “Classification System” for patient care and patient – oriented records. As educator and researcher, she went on to become a nursing instructor and researcher and helped transform the focus of profession from disease centered to patient. Faye Glenn Abdellah’s 21 Nursing Problems She expanded the role of nurses to include care of families and the elderly. DOB: March 13, 1919 DOD: February 24, 2017 at the age of 97  http://fayeabdellah.blogspot.com/p/applicat ion-to-nursing-practice.html Faye Glenn Abdellah’s 21 Nursing Problems Basic to All Patients 1. To maintain good hygiene and physical comfort After any invasive procedure like colonoscopy or endoscopy, clients are usually soiled from the procedure. It is therefore important to clean them properly. Physical comfort through proper positioning in bed.  Faye Glenn Abdellah’s 21 Nursing Problems 2. To promote optimal activity: exercise, rest and sleep. Nurses should stay with the patients who were sedated during the procedure until the effect of the sedation decreases. Make sure the patients are able to rest and sleep by providing conducive environment for rest like decreasing noise and light dimming.  Faye Glenn Abdellah’s 21 Nursing Problems 3. To promote safety through prevention of accident, injury or other trauma and through the prevention of the spread of infection. Making sure the side rails are always up when leaving the patient. One way to prevent spread of infection is through proper disinfection of the equipments.  Faye Glenn Abdellah’s 21 Nursing Problems 4. To maintain good body mechanics and prevent and correct deformity. Positioning the patient properly, allowing for the normal anatomical position of body parts.  Faye Glenn Abdellah’s 21 Nursing Problems Sustenal Care Needs 5. To facilitate the maintenance of a supply of oxygen to all body cells. When patients manifest breathing problems, oxygen is attached. Sedated patients are attached with cardiac monitor or pulse oximetry.  Faye Glenn Abdellah’s 21 Nursing Problems 6. To facilitate the maintenance of nutrition to all body cells. Patients who are place on NPO for special procedures, should be monitored for blood glucose level.  Faye Glenn Abdellah’s 21 Nursing Problems 7. To facilitate the maintenance of elimination. Providing bedpans or urinals to patients and at times, insertion of FBC when the patient is not able to void.  Faye Glenn Abdellah’s 21 Nursing Problems 8. To facilitate the maintenance of fluid and electrolyte balance. Proper regulation of the IVF as well as proper incorporations it may have.  Faye Glenn Abdellah’s 21 Nursing Problems 9. To recognize the physiological responses of the body to disease conditions – pathological, physiological, and compensatory. Fever is an indication that client has infection that needs further assessment and intervention.  Faye Glenn Abdellah’s 21 Nursing Problems 10. To facilitate the maintenance of regulatory mechanisms and functions. When a patient has dyspnea, elevating the head part of the bed is done to facilitate the respiratory function.  Faye Glenn Abdellah’s 21 Nursing Problems 11. To facilitate the maintenance of sensory function. Sometimes there are semi- conscious patients, in these cases, it is still necessary to talk to them while performing nursing care to maintain their auditory sense.  Faye Glenn Abdellah’s 21 Nursing Problems Remedial Care Needs 12. To identify and accept positive and negative expressions, feelings, and reactions. Most patients feel anxious before undergoing procedures. Nurses should listen / observe patient’s expressions / behaviors and to allow questions.  Faye Glenn Abdellah’s 21 Nursing Problems 13. To identify and accept interrelatedness of emotions and organic illness. Encourage patients to verbalize their feeling and allow them to cry when they have the need to do so. Some patients are diagnosed with malignancy and during this time emotional needs of the patient is a priority.  Faye Glenn Abdellah’s 21 Nursing Problems 14. To facilitate the maintenance of effective verbal and nonverbal communication When patients are not able to express themselves verbally, it is important to assess for nonverbal cues like pain or for facial grimacing.  Faye Glenn Abdellah’s 21 Nursing Problems 15. To promote the development of productive interpersonal relationships. Allow the patient’s SO to stay with the patient before and after the procedure. This allows for bonding and support.  Faye Glenn Abdellah’s 21 Nursing Problems 16. To facilitate progress toward achievement of personal spiritual goals. Allowing them time time for patients to practice their faith.  Faye Glenn Abdellah’s 21 Nursing Problems 17. Providing proper lighting, proper room temperature, a quiet environment are done to patients staying in the unit.  Faye Glenn Abdellah’s 21 Nursing Problems 18. To facilitate awareness of self as individual with varying physical, emotional, and developmental needs. Care to patients vary according to their developmental needs. Allowing the parents to stay during a procedure to help the pediatric patients in their emotional and developmental needs.  Faye Glenn Abdellah’s 21 Nursing Problems Restorative Care Needs 19. To accept the optimum possible goals in the light of limitations, physical, and emotional. The goals for each patient vary depending on the capacity of the patient.  Faye Glenn Abdellah’s 21 Nursing Problems 20. To use community resources as an aid in resolving problems arising from illness. Some patients live far from the city and thus referral to health centers is sometimes done.  Faye Glenn Abdellah’s 21 Nursing Problems 21. To understand the role of social problems as influencing factors in the cause of illness. Some patients who are diagnosed with amoebic colitis for instance are advised to avoid buying street foods to which the preparation they are not sure of, and also avoid drinking water that are not safe.  Metaparadigm of Abdellah’s Theory NURSING ENVIRONMENT Nursing is based on an art and She defines environment as the science that molds the attitudes, home or community from which intellectual competencies, and the patient comes. Society is part technical skills of the individual in “planning for optimum health”. nurse into the desire and ability to However, the focus of nursing help people, sick or well, cope service is the individual. with their health needs.” PATIENT The patient is the focus of the HEALTH theory. The individuals and Emphasis should be placed upon families are the recipients of prevention and rehabilitation. nursing.  Application of Abdellah’s Theory in Nursing Process 10 Steps to Identify Client’s Problems Learn to know the patient Sort out relevant and significant data Make generalizations about available data in relation to similar nursing problems presented by other patients Identify the therapeutic plan Test generalizations with the patient and make additional generalizations  Validate the patient’s conclusions about his nursing problems Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan Identify how the nurses feels about the patient’s nursing problems Discuss and develop a comprehensive nursing care plan The results of data collection wound determine the client’s specific overt or covert problems. The statements of nursing problems most closely resemble goal statements. Once the problem has beendiagnosed, the goals have been established. The four categories of Abdellah’s 21 nursing problems will serve as guide for care The most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals. EXAMPLE: A case of Pedro who experienced severe chest pain associated with shortness of breath, tachycardia and profuse diaphoresis Assessment reveals possible cardiac dysfunction with the following history of similar episodes the past two years. Problems include chest pain, impaired cardiac functioning, work related stress and failure to seek medical attention.  Category Abdellah’s Nursing Problems Nursing Interventions Sustenal care needs 5. To facilitate the maintenance of a Position to fowler’s supply of oxygen to all body cells. Promote rest Monitor vital signs Administer oxygen therapy Remedial care needs 13. To identify and accept the Find the nature of the job with interrelatedness of emotional and health-related instructions. organic illness. Explore work related goals with family and support system. * Decrease job-related stress.  Category Abdellah’s Nursing Problems Nursing Interventions Restorative care 20. To use community resources as an aid Teach early signs and needs in resolving problems arising from symptoms of cardiac distress. illness. Encourage use of community resources.  Virginia Henderson’s Nursing Need Theory Known as “The Florence Nightingale of the 20th century” Attended the US Army School of Nursing during World War 1 where she graduated in 1921. The theory was developed to define the unique focus of nursing practice, that is - the importance of increasing the patient’s independence to hasten their progress in the hospital.  Virginia Henderson’s Nursing Need Theory She later received a Bachelor of Science degree in 1932 and a Masters degree in 1934 from Teachers College, Columbia University. Afterwards, she became part of the faculty. She revised Bertha Harmer’s “Textbook on the Principles and Practice of Nursing”. It became widely used by nurses throughout the world.  Virginia Henderson’s Nursing Need Theory In 1953, she joined the Yale School of Nursing as faculty and remained there for 40 years. The theory was developed to define the unique focus of nursing practice, that is - the importance of increasing the patient’s independence to hasten their progress in the hospital. DOB: 30 November 1897 DOD: 19 March 1996 at the age of 97  Virginia Henderson’s Nursing Need Theory NURSING ENVIRONMENT “The unique function of the nurse Henderson stated that is to assist the individual, sick or maintaining a supportive well, in the performance of those environment conducive for health activities contributing to health or is one of the elements of her 14 its recovery that he would activities for client assistance. perform unaided if he had the necessary strength, will or knowledge. HEALTH Health means balance in all PATIENT realms of human life. It is equated An individual achieves wholeness with the independence or ability by maintaining physiological and to perform activities without any emotional balance. aid in the 14 components or basic human needs. Application of Henderson’s Theory in Nursing Process  Dorothea Orem’s Self-Care Deficit Theory Grand Theory In 1930, received her diploma in nursing, in 1939, her BS nursing education and in 1946, her MS in nursing education. During her professional career, Orem worked as a staff nurse, private duty nurse, nurse educator, asministrator and nurse consultant. Developed the Self-Care Deficit Theory as a result of working toward “improving the quality of nursing in general hospitals”.  Dorothea Orem’s Self-Care Deficit Theory First published Self-Care Theory in 1959. However, Orem “continued to develop her conceptual model over several decades”. DOB: June 15, 1914 in Baltimore, Maryland DOD: June 22, 2007 age 92.  Orem’s general theory of nursing’s has 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– are activities that an individual initiates and performs on his/her behalf in maintaining life, health and well-being.  SELF-CARE AGENCY– is a human ability which is “the ability for engaging in self-care”. This is conditioned by age, developmental state, life experience, sociocultural orientation, health, and available resources.  THERAPEUTIC SELF-CARE DEMAND. This is the totality of self-care actions performed for some duration inorder to meet self-care requisites by using valid methods and related sets of operations and actions. Some of these actions include massage, diversion, self-medications, consultation and any independent remedies (cold/hot compress, positioning).  SELF-CARE REQUISITES – are actions directed towards provision of self-care. There are three categories of self-care requisites: 1. Universal self-care requisites (associate with life processes and maintenance of human structure and functioning: air, water, food, elimination, activity, rest, social interaction hazard prevention and promotion of human functioning). 2. Developmental self-care requisites (associated with developmental processes derived from a condition or associated with an event. Like for example: adjusting to new job... To new role... To body changes. 3. Health deviation self-care requisites. Requires in conditions of illness, injury or disease. * seeking medical assistance * Being aware to the effects and results of pathologic conditions. * Compliance of medications. * Modifying lifestyle The Theory of Self-Care deficit Specifies when nursing is needed Nursing is required when the patient is incapable or there is limited in the provision of continuous effective self- care. Once nursing is required or needed, Orem identifies five methods of helping the patient: Acting for and doing for others. Guiding others. Supporting another. Providing an environment promoting personal development in relation to meet future demands. Teaching another. The Theory of Nursing System Describes how the patient’s self-care needs will be met by the nurse, the patient, or both. Idenifies three classifications of nursing system to meet the self-care requisites of the patient: o Wholly compensatory system o Partly compensatory system o Supportive-educative system Application of Orem’s Theory in Nursing Process  Dorothea Orem’s Self – Care Deicit Theory NURSING ENVIRONMENT Nursing is an art through which The environment has physical, the practitioner of nursing gives chemical and biological features. specialized assistance to persons It includes the family, culture, and with disabilities which makes community. more than ordinary assistance necessary to meet needs for self- care. HEALTH PATIENT Health is “structurally and Patients or Humans are defined functionally sound.” Health is a as “men, women, and children state that encompasses both the cared for either singly or as social health of individuals and of units,” and are the “material groups, and human health is the object” of nurses and others who ability to reflect on one’s self, to provide direct care. symbolize experience, and to communicate with others. Lydia Eloise Hall’s Core, Care, & Cure Model She began her nursing career as a graduate of York Hospital School of Nursing in Pennsylvannia. Earned her BS and MA degrees from Teachers College, Columbia University, in New York. Had faculty position at York Hospital School of Nursing and Fordham Hospital School of Nursing Lydia Eloise Hall’s Core, Care, & Cure Model Became consultant in Nursing Education to the Nursing Faculty at the State University of New York, Upstate Medical Center. She was an Instructor of Nursing education at Teacher’s College. Career interests: Public Health Nursing, Cardiovascular nursing, pediatric cardiology and nursing of long term illness. Lydia Eloise Hall’s Core, Care, & Cure Model Greatest Achievements: Design and develop Loeb Center for Nursing at Montefiore Hospital in New York City and apply her theory to nursing practice. An 80-bed capacity for persons aged 16 or older who were no longer having acute biological disturbances. Lydia Eloise Hall’s Core, Care, & Cure Model The Core, Care, Cure Theory is referred to as the three interlocking circles.  Core involves the therapeutic use of self in communicating with the patient and vice versa. The nurse through the use of reflective technique helps the patient clarify motives “CORE” The Person and goals, facilitating the process of Social Sciences and increasing the patient’s self-awareness. Therapeutic Use of Self Aspect of Patient care is based on social science Nursing and the use of thepeutic use of self, the relationship should be symbiotic in nature.  Lydia Eloise Hall’s Core, Care, & Cure Model Patient care is based on social science and the use of therapeutic use of self, the relationship should be symbiotic in nature. Helps patient learn their role in the “CORE” The Person healing process. Social Sciences and Patient is able to maintain who they Therapeutic Use of are. Self Aspect of Nursing Patients are able to develop a maturity level when nurse listen to them and act as sounding board.  Lydia Eloise Hall’s Core, Care, & Cure Model Patient is able to make informed decisions. “CORE” The Person Emphasis on social, emotional, Social Sciences and spiritual and intellectual needs. Therapeutic Use of Self Aspect of Nursing Patient makes more rapid progress towards recovery and rehabilitation.  Lydia Eloise Hall’s Core, Care, & Cure Model Care alludes the “hands on”, intimate bodily care aspect of nursing of the patient and implies a comforting, “CARE” nurturing relationship. The Body The Ultimate Body While intimate physical is given, the Care patient and the nurse develop a close relationship.  Lydia Eloise Hall’s Core, Care, & Cure Model The natural and biological sciences (the body) involve: Nurturing component of care, its “CARE” The Body mothering role and ultimate comforter. The Ultimate Body Care Provides teaching and learning activities as well as applies knowledge of biological and natual sciences.  Lydia Eloise Hall’s Core, Care, & Cure Model Cure is the aspect of nursing involved with the administration of medications and treatments. “CURE” The Body The nurse functions as investigator and carer to relieve discomforts like injections The Ultimate Bodily Care and dressing changes. Seeing the patient and family through the medical care aspect of nursing.  Lydia Eloise Hall’s Core, Care, & Cure Model The pathological and therapeutic sciences (the disease) involve: “CURE” Care is based on pathological and The Disease therapeutic sciences. Seeing the patient and family through Application of medical knowledge by medical care nurses Nurse assisting the doctor in performing tasks  Lydia Eloise Hall’s Core, Care, & Cure Model Nurse is patient advocate in this area. “CURE” Nurses role changes from positive The Body quality to negative quality Seeing the patient and family through medical care Lydia Eloise Hall’s Core, Care, & Cure Model ENVIRONMENT NURSING She assumed that the hospital environment during the treatment Nursing is identified as consisting of acute illness creates a difficult of participation in the care, core, psychological experience. cure aspects. HEALTH PATIENT Hall viewed becoming ill is a Viewed a patient as composed of behavior. Illness is directed by three aspects: body, pathology feelings-out-of-awareness, which and person. are the root of adjustment difficulties.  Application of Hall’s Theory in Nursing Process Assessment Planning Implementation Core Care and Cure So, the patient whoever The nurse who is providing care should meet all his bodily comes to the hospital will be care like bathing, eating, elimination and dressing thereby considered as a body, meeting his comfort with integration of interpersonal person and disease. relation and advocacy role. Jean Watson’s Science of Caring Watson has earned undergraduate and graduate degrees in nursing and psychiatric- mental health nursing and PH.D in educational psychology and counseling. A distinguished professor of Nursing at the University of Colorado Health Sciences Center. Jean Watson’s Science of Caring She was also the Dean of Nursing at the University of Health Sciences Center and President of the National League for Nursing Now retired and still living in Boulder, Colorado at 81, Watson has written many well-known nursing texts, including “Nursing: The Philosophy and Science of Caring” (2008) and Nursing: Human Science and Human Care: A Theory of Nursing.” Jean Watson’s Science of Caring Watson’s Philosophy and Science of Caring is concerned on how nurses express care to their patients. Her theory stresses humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice. Jean Watson’s Science of Caring Watson’s Philosophy and Science of Caring is built upon the ten carative factors and there are: 1. The formation of a humanistic-altruistic system of values. As a nurse, treat all the patients as he or she is and respect their values, even if they are different from your own and treat each patient and their family as if they were a member of your own family. 1.1 This begins at an early age with values shared with the parents. 1.2 Mediated through ones own life experiences, the learning one gains and exposure to the humanities. 1.3 Is perceived as necessary to the nurses own maturation which then promotes altruistic behavior towards others.  1.Inspire: Faith and Hope and Honor Others 2. Instillation of Faith and Hope The nurse honor and inspire others. Respecting the person’s Positive acceptance of cultures, faith, traditions patient’s current health status Facilitate the promotion of positive health between the nurse and the patient. 2.1 When modern science has nothing further to offer the person, the nurse can continue to use faith – hope to provide a sense of well-being through belief which are meaningful to the individual. 2.2 Is essential to both the carative and the curative processes 3. Cultivation of sensitivity to one’s self and to others. The development of a nurse's own feeling through experiences is needed to interact genuinely and sensitively with patients. By striving to become more sensitive, the nurse is more authentic. By striving to become more sensitive, the nurse is more authentic. 3.1 Development of one’s own feeling is needed to interact genuinely and be sensitive with others. 3.2 Striving to become sensitive, makes the nurse more real or authentic, which encourages self-growth and self – actualization. 3.3 The nurse promote health only when they form person to person relationship. 4. Establishing a helping – trust relationship. 4.1 Strongest tool is the mode of communication, which establishes rapport and caring. 4.2 Are congruence to empathy and warmth. 4.3 Communication includes verbal, non-verbal and listening in a manner which express empathy and understanding. 5. The expression of feeling, both positive and negative. 5.1 According to Watson, “feelings alter thoughts and behavior, and need to be considered and allowed in a caring relationship” 5.2 Such expression improves one’s level of awareness. 5.3 Awareness helps to understand the behavior. 6. The systematic use of the scientific problem-solving methods for decision making. 6.1 According to Watson, the scientific problem solving method is the only method that allows for control and prediction, and that permits self correction. 6.2 She also values the nature of nursing and supports the need to develop the holistic perspective of care. 7. Promotion of interpersonal teaching - learning 7.1 The caring nurse must focus on the learning process as much as the teaching process. 7.2 Understanding the person’s perception of the situation in assisting the nurse to prepare cognitive plan. 8. Provision for a supportive, protective and / or corrective mental, physical, socio-cultural and spiritual environment. 8.1 Watson divides these into external and internal variable which the nurse manipulates in order to provide support and protection for the persons mental and physical well being. 9. Assistance with the gratification of human needs. 9.1 Watson’s theory is grounded in a hierarchy of need to that of Maslow’s and created her own hierarchy, which she believes is relevant to the science of caring in nursing. 10. Allowance for existential-phenomenological forces. 10.1 Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference. 10.2 Existential psychology ia the study of human existence using phenomenological analysis. 10.3 This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attenting to the hierarchical ordering of needs. 10.4 Thus the nurse assists the person to find the strength or courage to confront life or death. Nurse’s commitment on protecting and enhancing human dignity. The nurses caring and connection have potential to heal since experience, intention and perception are taking place. Nursing goals should beyond and objective assessment and shows concern for the patients own health care. A caring occasion is the moment when the nurse and another person come together in such a way that an occasion for human caring is created Both persons come together in a human transaction. The one caring for and the one being for are influenced by the choices and actions decided within the relationship.  Jean Watson’s Science of Caring ENVIRONMENT She did not define the NURSING ”environment” but instead Nursing is a science of persons devised 10 carative factors to the and health-illness experience that caring human experience that are mediated by professional, need to be addressed by nurses personal, scientific, and ethical with their patients when in a care interactions. caring role. PATIENT HEALTH The human being as a valued, Health is defined as overall respected, cared, nurtured, physical, mental, and social understood, assisted person or in functioning; a general adaptive- general viewed as a fully maintenance level of daily functional integrated self. Human functioning; and the absence of is viewed as greater than and illness, or the presence of efforts different from the sum of his or leading to the absence of illness. her parts.  Application of Watson’s Theory in Nursing Process Watson points out that nursing process contains the same steps as the scientific research process. Assessment Plan Intervention Evaluation Involves observation, It helps to determine It is the direct action The interpretation of identification and how variables would be and implementation of the results, the review of the problem; examined or measured the plan. degree to which use of applicable includes a conceptual positive outcome has knowledge in approach or design for occurred. literature. problem solving.