M.M.

COLLEGE OF NURSING
MULLANA, AMBALA.

SUBJECT:- Community Health

Nursing

ASSIGNMENT ON :-
Theories in Community Health
Nursing

SUBMITTED TO: SUBMITTED BY:

Mr.. BANKIM CHANDRA AMBIKA RANA
ASSOCIATE PROFESSOR ROLL NO. 1924718

(COMMUNITY HEALTH NURSING) MSc NURSING 1ST YEAR

SUBMITTED ON:- 07-11-24

Introduction:

Nursing theory provides an overview: who is the client and when nursing is needed, and to identify the
boundaries and goals of nursing’s therapeutic activities. Theory is fundamental to effective nursing practice
and research. Effective nursing practice is facilitated when nurses use a systematic approach to clients, their
health status, and nursing interventions needed to promote, maintain, or restore health

Difference between Theory and Model:

A description used as pattern to enhance :

*Model .our understanding of something that is known

*Purpose:
 to explain a complex reality in a .systematic manner
 A nursing model is a collection of interrelated concepts that provides direction for nursing practice,
research and education.

*Theory:
set of systematically interrelated concepts or hypotheses; explain or predict phenomena ( Barnum,1988 )
In nursing, theory is used to explain a relationship between observed behaviors and their effects of .human’s
health

*Purpose:
to make nursing actions meaningful and maintain nursing practice as unique as a professional discipline

Nightingale Theory
Introduction

 Theory and practice are two sides of a coin in other words are reciprocal ends of nursing profession .

 In fact, clinical Nursing practice derived light from theoretical foundation.

 Practice without integrating nursing theory is blind.

 Temple of theoretical wisdom direct nursing practice and research in right way .

 Clinical nursing practice itself is the single most authentic platform to test the theory

 My selected theory for clinical application is the pioneer theory of modern nursing profession.

 selected theory of Florence nightingale will be applied to clinical scenario along with brief description
of theorist and theory concerned followed by analysis and critique in reference to established criteria
and concluded with practice outcomes
Theorist Background
 Florence Nightingale also known as "Lady with the Lamp" a persuasive and transformative character in
nursing is the founder of modern nursing.

 She born in 1820 in Florence Italy.

 First nurse theorist, scientist, writer and philosopher of its kind who base the discipline of nursing on
caring with wholeness and spirituality

 She explores the basics of nursing in her famous piece of writing "Notes on Nursing: What it is, what it
is not" (1860) which is primitive basis of nursing practice and research.

 Her philosophy of nursing was her belief that nursing to her is "calling from God"

 She emerged during Crimean war with her philosophy of nursing as calling from god.

 She introduced her theoretical philosophical concept of holistic approach in the era when medicine was
greatly involved with biological and physical phenomena of health and disease.

 Holistic nursing focus on healing of whole person rather than caring for a separate sphere of person
health like physiological aspect, and nurses are the healing agent who facilitate mechanism of healing
with honor to person’s individual subjective feelings

 Nightingale emphasis spirituality along with physiological determination of health disease subject,
although her ideology of spirituality was not based on religious grounds rather her focus was nature and
she largely argue the role of environmental alteration in health and disease process.

 Her pioneer theory mainly known by nightingale environmental theory

Description of Theory
In watching disease, both in private homes and public hospitals, the thing which strikes the experienced
observer most forcefully is this, that the symptoms or the sufferings generally considered to be inevitable
and incident to the disease are very often not symptoms of the disease at all, but of something quite different
— of the want of fresh air, or light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in
the administration of diet

Major Assumptions of Nightingale Theory

 Major assumptions in nightingale theory as illustrated by Victoria Fondriest and Joan Osborne in [1994]
are that: health and sickness are governed by natural laws.

 Nursing is a distinct field and is not like medicine.

 It is a science and also an art.

 Disease process is not important for nursing rather nurses concern is with the individual in the
environment. Environment plays important role in patients’ health.
 Nurses should manipulate the surrounding to promote sufferer recovery.

 Furthermore, nurses should be skillful, vigilant and confidential, and their practice should be evidence
base.

Concepts in Nightingale Theory

Pure air, Pure water, Efficient drainage, Cleanliness, Light, Noise, Nutrition and food, Variety, Personal
cleanliness, Bed and bedding were major concepts in nightingale environmental nursing theory.

1. Meta paradigm of Nightingale Environmental Theory

2. Health
According to nightingale was not only absence of ailment or being well but to be able to use
every power that a person poses

3 . Environment
Regarded by nightingale is that can be manipulated according to needs to keep patient in best
form for nature to act upon. Both physical and psychological aspects of environment are addressed.

4. Patient (Person)
Is the holistic being in nightingale theory and is regarded as someone consisting physical,
spiritual, emotional intellectual and social aspects.

5. Nursing
 According to nightingale was "calling from God".

 Nurses assist nature and utilize in favor to heal sufferer .

 Beside mention description nightingale philosophy advocate legacy for activism in care.

 Some author noted about her favor for feminism and wrote that she was champion of feminist ideology
in care as quoted in reference .

 I have an intellectual nature which requires satisfaction and that would find it in him.

 I have a passionate nature which requires satisfaction and that would find it in him.

 I have a moral, an active nature which requires satisfaction and that would not find it in his life

Analysis Nightingale Nursing Theory

 According to reference theories should be analyzed in systematic structured manner to know either it is
ready enough to shape practice, develop hypothesis or research question as there is no unquestionable
acceptance of theories in nursing.

 Analysis of theory is judge on the base of set criteria including Significance, Internal Consistency,
Parsimony, Testability, Empirical Adequacy, and Pragmatic Adequacy
Significance
 The significance criteria met when theory justify its worthiness to the disciplined concerned by offering
unambiguous paradigmatic and philosophical underpinning along with conceptual clarification of meta
paradigm and appropriate antecedent knowledge citation .

 Nightingale very simply and clearly describe the concept of environment and its role in disease and
health continuum.

 She clearly describes the environment and its essential elements; fresh air, clean water, proper
sanitation, cleanness and light.

 She considers illness as imbalance in these essential elements and believe that manipulation in
environment makes client prone for acting of nature .

 Nightingale was aware of germ theory and the role of hygiene in infection control.

 She emphasis on the proper disposal of excreta.

Internal Consistency
 In the framework of theory evaluation in reference mention that internal consistency attained when
theorist is clear in his/her definitions of concept, construct and composition and congruency should be
there in the define elements of theory.

 Nightingale kept the base of public health nurse and her philosophical underpinning significantly make
foundation of modern nursing as distinct disciplined of health care although her theory main focus was
home care and she focus on house environment at same time

 she device a foundation courses of nursing science at that mainly limited to women being largely
involved in caring at homes thus nightingale work was congruent in reference to context and contents

Parsimony
 Parsimony described by is focus on content and the criteria of parsimony fulfilled when theorist explain
phenomena of interest clearly in concise way.

 Nightingale conceptual contents are free of jargons and utilized simple language, her story is her true
experience, her theme is accompanied by demonstration

Testability
 Testability comes fourth in the framework devised by (Fawcett, 2006) to analyze a theory.

 In a grand nursing theory like nightingale environmental theory for criteria of testability met if the
research carried out in qualitative and inductive way,

 its research methodology is in congruence to the contents and philosophical stance of the theory, and the
data collection methodology satisfied the essence of grand theory by showing researcher personal detail
experience of used data collection mechanism .
 Nightingale define in detailed construct and abstract concepts of her theory.

 Her concept of spirituality and wholeness is well explained in her theory and later on tested by the
theorist and researcher to adopt in approach to patient care

.Empirical Adequacy
 Empirical adequacy refers to the consistency between theoretical statement and empirical evidence
which can be determine from findings of studies conducted under the direction of that theory .

 Main concepts of her theory noise, spirituality and environment are testable hypothesis, moreover her
empirical work and statistical analysis of nineteenth century guide the thinking of 21st century scientist

Pragmatic Adequacy
 According to Reference pragmatic adequacy of nursing theory is concerned with the practical
application and it is determining by the understanding of nurses to use theory in their clinical practice
along with knowledge and psychomotor skills required to operationalize practically.

 Nightingale theory works as basis and is alive in the foundation of nursing education and practice, and
her philosophy of environment is still playing central role in the ecosystem of man.

 Nurses across the world utilized nightingale theory in nursing education and care of patients at different
clinical settings

Application Nightingale Theory to Practice Scenario:

I was on evening duty in surgical unit a patient was brought to surgical unit through causality. Patient was
Mrs. X with post op colostomy. patient was operated for intestinal obstruction due to unknown etiology
companied by her mother in law and three children MRS X was a widow her husband was killed in the war
turn northern province of Afghanistan three years back. Patient was extremely pale with septic wound;
colostomy bag was not covered properly rather it was covered by plastic bag. entire skin of abdomen was
red and lacerated on examination she was febrile with 103f temperature Blood Pressure was 100/70 and
pulse was 96/min weight was 38 kg. lab findings were hemoglobin 8.5 with moderately leukocytosis. during
history taking patient attendant told that they live in a small house patient room was also shared by 5
children mother in law and two Cattles. patient economically poor living on less than 1 dollar per day. on
previous medical history there was intestinal infestation they were used to drink water from nearby well.
According to patient attendant

Application of Nightingale’s Theory to Nursing Care of Mrs. X Person Mrs. X is in need of nursing care
through nature reparative process. my (Nurse) goal is to promote nature in the process with application of
nightingale theory with nursing process model

Assessment:

Physical Environment

Nightingale theory suggest assessment of environment through 13 canons: According to verbal statement
of Mrs. X, and her attendant the house where they live is injurious to Mrs. x health as their room is
overcrowded and shared by domestic castles. They used well water and use nearby field for toileting
purpose which is the worse form of sanitation and most common Couse of contamination of water which
 leads to gastro enteric pathology Currently Mrs. x is lying on bed in surgical unit with a colostomy bag not
appropriately attached rather over tied by a plastic shopping bag. The leakage of feces contents badly
infected the stoma and lacerate the abdominal skin

Nursing Diagnosis

Infection related to the contamination of the wound with feces Impaired Skin Integrity related to skin
contamination with feces

Interventions

 It is planed that Mrs. x and her attendant well be fully educate regarding importance and methods of
cleaning drinking water.

 Proper disposal for house excreta and source of social aid will be searched for financial support to Mrs.
x in this connection. Mrs. X Was provided a side room in the unit.

 Her stoma was cleaned with antiseptics and colostomy bag was appropriately applied.

 The surrounding skin was washed with saline and soothing anti-infective ointment was applied.

 A pad (gauze) putted to absorb the flow of feces Demonstration regarding stoma care and change of bag
provided to patient.

 Room windows were kept open for ventilation.

 Prescribed medication were given

Psychological Environment

Mrs. X was very much anxious regarding her health and kids as she is a widow and have financial Burdon
as well as she is feeling little bit concern due to non-national and therefore have limited approaches to local
resources currently. She has problem to adopt to new life style with stoma and have difficulty in falling
asleep due to fear of opening bag during sleep time.

Nursing Diagnoses

Anxiety related to fear of isolation from native country and culture Disturbed Sleep Pattern related to the
fear of the state of the stoma

Nursing Intervention

 Mrs. X was reassured that she will soon adopt to society.

 Her special deserving case in financial terms was forwarded to hospital administration for free treatment
and a non-government organization was contacted to help her in easing financial burden.

 Environmental factors were evaluated to avoid disturbance in her sleep.

 Her visitors were informed regarding importance of rest and sleep in her recovery they were counselled
to minimize rush in sleeping hours and avoid unnecessary interruption in the room environment of Mrs.
x. Mrs. X was explained that her stoma bag will not open during sleep as it is closed mechanically
Nutritional Status

Mrs. x was underweight she lost weight significantly in the last three weeks. Due to fear of colostomy
problem she was afraid of eating as according to her attendant she avoids eating as after eating she develops
empting problem.

Nursing Diagnosis

Imbalanced Nutrition Less Than Body Requirements related to ignorance against the needs of food.

Interventions

 Nutritionist was consulted regarding food menu appropriate for Mrs. X condition Adequate nutrition
was provided: containing foods rich in nutritious values and less in gastro enteric troubles.

 Client was motivated for eating and reassured not spare food due to fear of causing trouble.

 Beside systematic care given through nursing process under the influence of nightingale theoretical
stance her remaining canon are related to observation of patient condition and petty management which
focus on continuity of care.

 In case of Mrs. I observe her condition critically and after keen observation of case her attendant was
demonstrated and trained regarding colostomy dressing, cleanness of stoma with antiseptic moisturizing
medication, patient diet need and variety along with observation of skin color near stoma was explained
in detail

Contradictions of Nightingale Theory to Current Day Health Care System

 Some beliefs of nightingale are interesting and though I fell would be contradicted in today's healthcare:
In her concept noise in the theory suggest that patient sleep should not be disturb at night on any cost,
she emphasis oppose standardization through licensure examination rather focus on moral
characteristics and spirit of working for nurses, she preferred the ideal nurse as self-sacrificing,
distinguished, and an "angel of mercy," as compared to an educated, skillful professional nurse

 Her philosophy of variety suggests changes in walls color and setting changes Contradiction: in today
health care settings nurses needs to awake patients for medications, procedures and vital sign
recordings. Without passing license exam practice is not possible

.Conclusion

Colostomy is a major surgical condition in which the colon is surgically incised for removal of ill or damage
part the remaining end is brought to abdominal surface with an orifice for drainage of gut. The condition
required effective nursing care and Florence nightingale theory is very appropriate for application to the care
of such patients, beside the fact that theory is more than a century old it is still alive, easy to applicate in the
fundamental undertaking of nursing interventions. Although nursing science is progressively advancing with
higher degree of learning, research and invention of suitable technology, nightingale caring model is
functional in the era globally because her philosophy fits to the basics of nursing and basics remains same.
 OREM’S self care
 INTRODUCTION Theorist : Dorothea Orem (1914-2007) Born 1914 in Baltimore, US Earned

 her diploma at Providence Hospital – Washington, DC 1939 – BSN Ed., Catholic University of America
1945 – MSN Ed., Catholic University of America

 She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant.
Received honorary Doctor of Science degree in 1976.

 Theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995, and 2001

MAJOR ASSUMPTIONS 

 People should be self-reliant and responsible for their own care and others in their family needing care


 People are distinct individuals 

 Nursing is a form of action – interaction between two or more persons 

 Successfully meeting universal and development selfcare requisites is an important component of

primary care prevention and ill health

  A person’s knowledge of potential health problems is necessary for promoting self-care behaviors 

 Self care and dependent care are behaviors learned within a socio-cultural context

Health

 – health and healthy are terms used to describe living things …

 It is when they are structurally and functionally whole or sound …

 wholeness or integrity. .

 includes that which makes a person human,…

 operating in conjunction with physiological and psychophysiological mechanisms and a material

structure and in relation to and interacting with other human beings

Environment

environment components are enthronement factors, enthronement elements, conditions, and

developed environment
Human being –

has the capacity to reflect, symbolize and use symbols Conceptualized as a total being with
universal, developmental needs and capable of continuous self care A unity that can function biologically,
symbolically and socially

Nursing client

A human being who has "health related /health derived limitations that render him incapable of
continuous self care or dependent care or limitations that result in ineffective / incomplete care. A human
being is the focus of nursing only when a self –care requisites exceeds self care capabilities

OREM’S GENERAL THEORY OF NURSING

 Orem’s general theory of nursing in three related parts:- 

i. Theory of self care 

ii. Theory of self care deficit 

iii. Theory of nursing system

A. Theory of Self Care

This theory Includes:
Self care –

practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and
well being

Self care agency –

is a human ability which is "the ability for engaging in self care" -conditioned by age developmental state,
life experience sociocultural orientation health and available resources

Therapeutic self care demand –

"totality of self care actions to be performed for some duration in order to meet self care requisites by using
valid methods and related sets of operations and actions"

Self care requisites -

action directed towards provision of self care. 3 categories of self care requisites are

 Universal self care requisites

 Developmental self care requisites

 Health deviation self care requisites

1. Universal self care requisites
 Associated with life processes and the maintenance of the integrity of human structure and functioning 
Common to all , ADL 

Identifies these requisites as: 

 Maintenance of sufficient intake of air ,water, food

 Provision of care assoc with elimination process 

 Balance between activity and rest, between solitude and social interaction

 Prevention of hazards to human life well being and 

 Promotion of human functioning

2. Developmental self care requisites

Associated with developmental processes/ derived from a condition…. Or associated with an event E.g.
adjusting to a new job adjusting to body changes

3. Health deviation self care

 Required in conditions of illness, injury, or disease .these include:--

 Seeking and securing appropriate medical assistance

 Being aware of and attending to the effects and results of pathologic conditions

 Effectively carrying out medically prescribed measures

 Modifying self concepts in accepting oneself as being in a particular state of health and in specific forms
of health care

 Learning to live with effects of pathologic conditions

B. Theory of self care deficit

  Specifies when nursing is needed

  Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in
the provision of continuous effective self care.

Orem identifies 5 methods of helping:

1. Acting for and doing for others

2. Guiding others 

3. Supporting another
4. Providing an environment promoting personal development in relation to meet future demands 

5. Teaching another

C. Theory of Nursing Systems

Describes how the patient’s self care needs will be met by the nurse , the patient, or both

Identifies 3 classifications of nursing system to meet the self care requisites of the patient:-

1) Wholly compensatory system Partly compensatory system Supportive – educative system Design and
elements of nursing system

2) define Scope of nursing responsibility in health care situations General and specific roles of nurses and
patients Reasons for nurses’ relationship with patients and Orem recognized that specialized
technologies are usually developed by members of the health profession

3) A technology is systematized information about a process or a method for affecting some desired result
through deliberate practical endeavor, with or without use of materials or instrument

Categories of technologies

1. Social or interpersonal

Communication adjusted to age, health status Maintaining interpersonal, intra group or inter group relations
for coordination of efforts Maintaining therapeutic relationship in light of psychosocial modes of
functioning in health and disease Giving human assistance adapted to human needs ,action abilities and
limitations

2. Regulatory technologies

Maintaining and promoting life processes Regulating psycho physiological modes of functioning in health
and disease Promoting human growth and development Regulating position and movement in space

OREM’S THEORY AND NURSING PROCESS

 Nursing process presents a method to determine the self care deficits and then to define the roles of
person or nurse to meet the self care demands.

 The steps within the approach are considered to be the technical component of the nursing process.

 Orem emphasizes that the technological component "must be coordinated with interpersonal and social
processes within nursing situations.
OREM’S WORK AND THE CHARACTERISTICS OF A
THEORY
 Orem's theory interrelate concepts in such a way as to create a different way of looking at a particular
phenomenon is logical in nature.

 is relatively simple yet generalizable is basis for hypothesis that can be tested contribute to and assist in
increasing the general body of knowledge within the discipline through the research implemented

 to validate them can be used by the practitioners to guide and improve their practice must be consistent
with other validated theories ,laws and principles

Strengths

 Provides a comprehensive base to nursing practice

 It has utility for professional nursing in the areas of nursing practice nursing curricula ,nursing
education administration ,and nursing research

 Specifies when nursing is needed Her self-care approach is contemporary with the concepts of health
promotion and health maintenance

Limitations

 In general system theory a system is viewed as a single whole thing while Orem defines a system as a
single whole, thing.

 Health is often viewed as dynamic and ever changing.

 The theory is illness oriented

RESEARCH ON OREM'S THEORY

 Self-care requirements for activity and rest: an Orem nursing focus Nursing diagnoses in patients after
heart catheterization--

 contribution of Orem Self-care--the contribution of nursing sciences to health care Self-care:

 a foundational science Orem's self-care deficit nursing theory:

 its philosophic foundation and the state of the science Dorothea E. Orem:

 thoughts on her theory Orem's theory in practice.

 Hospice nursing care Solving the Orem mystery: an educational strategy Orem's family evaluation
 Bibliography
 Park K, Textbook of preventive and social medicine, nineteenth edition,
Banarisdas Bhannot Publication:2002;12, Pp-400-405.
 • community theories introduction Available from : http://www.legal theories
in community. com/ introduction of theoriesin community html.