The four concepts of nursing are human being (the patient as a whole person), environment, health and nursing.

2. OUTLINE OF TOPICS
PROFESSIONAL NURSING CONCEPTS AND PRACTICES
 Conceptual and theoretical models of nursing practice.
 Introduction to models, health belief model,
health promotion model etc.
 Introduction to Theories in Nursing; Peplau’s Henderson’s, Orem’s
Neuman’s, Rogar’s and Roy’s.
•
 Linking theories with nursing process.

4. CONCEPTUALAND THEORETICAL MODELS OF NURSING PRACTICE.
 “The systematic accumulation of knowledge is essential to progress in
any profession . . . however theory and practice must be constantly
interactive. Theory without practice is empty and practice without theory
is blind.”
( Cross, 1981).

5. Introduction
 Nursing theory provides a perspective from which to define the
what of nursing, to describe the who of nursing (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.
The professionalization of nursing has been and is being brought
about through the development and use of nursing theory.
 The basic elements that structure a nursing theory are
concepts and propositions. In a theory, propositions
represent how concepts affect each other. A concept is the
basic building block of a theory.

6. For nursing to define its activities and develop its research, it must have its
own body of knowledge. This knowledge can be expressed as conceptual
MODELS and THEORIES.
Nursing theories and models provide information about:
 1. Definitions of nursing and nursing practice
 2. Principles that form the basis for practice.
 3. Goals and functions of nursing
 4. Clarifies the scope of nursing practice.

7. Nursing theories and models are derived from concepts
 (i) Concept is an idea of an object, property, or event.
 (ii) Concepts are basically vehicles of thought involving mental images.
 (iii) In Nursing, concepts have been borrowed from other discipline (adaption,
culture, homeostasis) as well as developed directly from nursing practice and
research (maternal-infant boding, health-promoting behaviours).
 (iv) Concepts are building blocks of theory.

8. What Is a Theory?
 A theory: is a set of concepts and propositions that provide an orderly way to
view phenomena. In the scientific literature, Nursing theory is developed to
describe the phenomenon (process, occurrence, or event) called nursing.
 Nursing theory differentiates nursing from other disciplines and activities that
in that the purposes of describing, explaining, predicting, and controlling
desired outcome of nursing care practices.

9.  Theory is a belief , policy or procedure followed as the basis of action,{ Webster new
collegiate dictionary }
 DEFENITIONS
 “It is a systemic explanation of an event in which constructs and concept are
identified and relationships are proposed and predictions are made”
STEUBERT ,SPEZIALE, CARPENTER 2003
 “It is a creative and regress structuring of ideas that project a tentative purposeful
and systematic view of the phenomenon ”.
CHINN AND KRAMER 2004
 “It is a set of interpretative assumptions , principles or propositions that help to
explain guide action”.
YOUNG , TAYLOR 2001
 “Theories can interrelate concepts in such a way as to create a different way of
looking at a particular phenomena”
 TORRES
MEANING

10.  Theories are composed of concepts, definitions, models,
propositions & are based on assumptions.
 A theory makes it possible to “organize the relationship
among the concepts to describe, explain, predict, and control
practice”
 (Torres,1986,p.21).Torres (1990,pp.6–9)

11. Defined as a belief, policy, or procedure proposed or followed
as the basis of action. It is an organized framework of
concepts and purposes designed to guide the practice of
nursing.
NURSING THEORY

12. 1. Theories can interrelate concepts in such a way as to create
a different way of looking at a particular phenomenon.
2. Theories must be logical in nature.
3. Theories should be relatively simple yet generalizable.
4. Theories can be the bases for hypotheses that can
be tested.
CHARACTERISTICS OF THEORIES

13. 5. Theories contribute to and assist in increasing the general
body of knowledge within the discipline through the
research implemented to validate them.
6. Theories can be used by the practitioners to guide and
improve their practice.

14. Historical Perspectives and Terminology
INTRODUCTION TO
NURSING THEORY

15. KEY CONCEPTS
Nightingale 1860:
Peplau 1952:
Henderson 1955:
• To facilitate “the body’s reparative
processes” by manipulating client’s
environment
• Nursing is; therapeutic
interpersonal process.
• The needs often called
Henderson’s 14 basic needs

16. Abdellah 1960:
Johnson’s Theory
1968:
• delivering nursing care for the whole
person to meet the physical, emotional,
intellectual, social, and spiritual needs
of the client and family.
• focuses on how the client adapts to
illness and how actual or potential
stress can affect the ability to adapt.
The goal of nursing to reduce stress so
that; the client can move more easily
through recovery.

17. Rogers 1970:
Orem1971:
King 1971:
• maintain and promote health,
prevent illness, and care for and
rehabilitate ill and disabled client
through “humanistic science of
nursing”
• self-care deficit theory. Nursing
care becomes necessary when
client is unable to fulfill biological,
psychological, developmental, or
social needs.
• use communication to help client
reestablish positive adaptation to
environment.

18. Neuman 1972:
Roy 1979:
• Stress reduction is goal of system
model of nursing practice
• This adaptation model is based on
the physiological, psychological,
sociological and dependence-
independence adaptive modes.

19. TERMINOLOGY

20. CONCEPTS
 vehicles of thought that involve images. Are words that
describe objects, properties, or events & are basic
components of theory.
 Types:
 Empirical concepts
 Inferential concepts
 Abstract concepts

21. Types of concepts:
 1. Empirical or concrete concepts: These are directly observable objects, events, or
properties, which can be seen, felt or heard e.g. colour of the skin, communication
skill, presence of lesion, wound status etc., These are limited by time and space (it
can be viewed/measured only specific period & specific setting and variable).
 2. Inferential concepts: These are indirectly observable concepts, e.g. pain,
Dyspnoea and temperature.
 3. Abstract Concepts: These concepts are not clearly observable directly or
indirectly (known as “Non -observable concepts directly”).E.g. social support,
Personal Role, Self-esteem etc.
 Most of the theories use abstract concepts and it should be defined as observable
(concrete) concepts when applied in research, education and practice. In simple
terms, we transform the abstract concepts to concrete concepts based on local need.
 Abstract concepts not affected by time and space. It can be applied and used wider
settings and populations.

22.  Specifies the main concepts that encompass the subject
matter and the scope of discipline.
 “There is a general agreement that nursing’s metaparadigm
consists of the central concepts of person, environment,
health and nursing.” (Powers and Knapp)
METAPARADIGM

23. METAPARADIGM CONCEPTS
THE PERSON
THE ENVIRONMENT
HEALTH
NURSING (GOALS, ROLES & FUNCTIONS)

24. Common concept in nursing Theories:
 Four concepts common in nursing theory that influence and determine nursing
practice are:
 1-The person (patient)
 2- Environment
 3- Health and
 4- Nursing
 Each of these concepts is usually defined and described by a nursing theorist,
and although these concepts are common to all nursing theories, both the
definition and the relations among them may differ from one theory to
another. Of the four concepts, the most important is that of the person .The
focus of nursing, regardless of definition or Theory, is the person .

25. Importance of nursing theories ;in clinical practice:
 Nursing theories provide a framework for thought in which to examine situations.
As framework provides a structure for organization, analysis, and decision making.
 In addition, nursing theories provide a structure for communicating with other
nurses and with other members of the health care team.
 Nursing theories assist the discipline of nursing in clarifying beliefs, values, and
goals, and they help to define the unique contribution of nursing in the care of
clients.
 control of certain aspects of practice are achieved.
 In the broadest sense, nursing theory is necessary for the continued development
and evolution of the discipline of nursing.
 Knowledge for nursing practice is developed through nursing research that, in turn,
is used to either test existing theories or generate new theories

26.  representations of the interaction among and between the
concepts showing patterns.
 In nursing, models are often designed by theory authors to
depict the beliefs in their theory
 (Lancaster and Lancaster 1981).
MODELS

27. II. MODELS
 Conceptual Model is a set of interrelated concepts that symbolically represents of mental
image or phenomenon. Model deals with highly abstract concepts than theory.
 A. General information
 1. Describe a set of ideas that are connected to illustrate a larger, more general concept
 2. Are a symbolic depiction of reality
 3. Provide a schematic representation of some relationships among PHENOMENA
 4. Use symbols or diagrams to represent an idea
 B. Characteristics
 1. Attempt to describe, explain, and sometimes predict the relationships among phenomena.
 2. Are composed of empirical, inferential, and abstract concepts.
 3. Provide an organized framework for nursing assessment, planning, intervention, and
evaluation.
 4. Facilitate communication among nurses and encourage a unified approach to practice,
teaching, administration, and research.
 Conceptual models and theories in nursing are based on the nursing metaparadigm

28.  VERBAL MODELS – worded
statements, a form of
closely related knowledge
development.
 SCHEMATIC MODELS –
diagrams, drawings, graphs
and pictures that facilitate
understanding.

29.  statements that explain the relationship between the
concepts.
PROPOSITION
PROCESS
 a series of actions, changes or functions intended to bring
about a desired result.

30.  The delivery of nursing care within the nursing process is
directed by the way specific conceptual frameworks &
theories define the person (patient), the environment,
health & nursing.
 outlines possible courses of action or to present a preferred
approach to an idea or thought.
CONCEPTUAL FRAMEWORK

31. TYPES OF NURSING THEORIES
According to Scope, Functions

32.  GRAND THEORY - It is the broadest in scope, represents the most abstract level of
development, and addresses the broad phenomena of concern within the discipline.
Typically, a grand theory is not intended to provide guidance for the formation of
specific nursing interventions, but rather provides an overall framework for
structuring broad, abstract ideas.
 An example of a grand theory is Orem’s Self-Care Deficit Theory of Nursing.
 MIDDLE-RANGE THEORY -: A theory that addresses more concrete and more
narrowly defined phenomena than a grand theory is known as a middle-range theory.
Descriptions, explanations, and predictions put forth in a middle-range theory are
intended to answer questions about nursing phenomena, yet they do not cover the full
range of phenomena of concern to the discipline.
A middle range theory provides a perspective from which to view complex situations and a
direction for interventions .
An example of a middle-range theory is Peplau’s Theory of Interpersonal Relations.
 MICRO-RANGE THEORY -A micro-range theory is the most concrete and narrow in
scope. A micro-range theory explains a specific phenomenon of concern to the
discipline.
 such as the effect of social supports on grieving and would establish nursing care
guidelines to address the problem.

TYPES ACCORDING TO SCOPE

33.  Descriptive-to identify the properties and workings of a
discipline
 Explanatory-to examine how properties relate and thus
affect the discipline
 Predictive-to calculate relationships between properties and
how they occur
 Prescriptive -to identify under which conditions relationships
occur
TYPES ACCORDING TO FUNCTION (Polit et. al 2001)

34.  Nursing theory is a useful tool for reasoning, critical thinking,
and decision making in the nursing practice.
NURSING THEORY AND THE PRACTICE OF NURSING
Theory assists the practicing nurse to:
•Organize patient data
•Understand patient data
•Analyze patient data
•Make decisions about nursing interventions
•Plan patient care
•Predict outcomes of care
•Evaluate patient outcomes

35.  Professional practice requires a systematic approach that is
focused on the patient. Nursing theoretical works provide a
perspective of the patient.

36.  Aims to describe, predict and explain the phenomenon of
nursing (Chinn and Jacobs1978).
 Provides the foundations of nursing practice, help to
generate further knowledge and indicate in which direction
nursing should develop in the future (Brown 1964).
 Helps us to decide what we know and what we need to
know (Parsons1949).
 Helps to distinguish what should form the basis of practice
by explicitly describing nursing.
IMPORTANCE OF NURSING THEORIES

37.  The benefits of having a defined body of theory in nursing
include better patient care, enhanced professional status for
nurses, improved communication between nurses, and
guidance for research and education (Nolan 1996).
 The main exponent of nursing – caring – cannot be
measured, it is vital to have the theory to analyze and
explain what nurses do.

38. NURSING THEORISTS AND
THEIR WORKS

39. THE PRINCIPLES AND
PRACTICE OF NURSING
“I believe that the function the nurse performs
is primarily an independent one – that of
acting for the patient when he lacks
knowledge , physical strength, or the will to
act for himself as he would ordinarily act in
health, or in carrying out prescribed therapy.
This function is seen as complex and creative,
as offering unlimited opportunity for the
application of the physical, biological, and
social sciences and the development of skills
based on them.” (Henderson, 1960)
VIRGINIA
HENDERSON

40.  Name: Virginia Avenel Henderson
 “First Lady of Nursing” & “First International Nurse”
 Born: November 30, 1897, in Kansas City, Missouri
 Died: March 16, 1996 at age 98 at the Connecticut Hospice, Branford. CT

41. Henderson’s Theory Background
 Henderson’s concept of nursing was derived form her practice and
education therefore, her work is inductive.
 She called her definition of nursing her “concept” (Henderson1991)
 her major clinical experiences were in medical-surgical hospitals, she
worked as a visiting nurse in New York City. (Henderson,1991)
 Virginia Henderson defined nursing as "assisting individuals to gain
independence in relation to the performance of activities contributing to
health or its recovery" (Henderson, 1966, p. 15).
 She was one of the first nurses to point out that nursing does not consist
of merely following physician's orders.
 She categorized nursing activities into 14 components, based on human
needs.
 She described the nurse's role as substitutive (doing for the
person),supplementary (helping the person), complementary (working
with the person), with the goal of helping the person become as
independent as possible.
 Her famous definition of nursing was one of the first statements clearly
delineating nursing from medicine:

42.  In 1918, she entered the Army School of Nursing in
Washington, DC.
 1921, she was a staff nurse Henry Street Visiting Nurse
Service in New York
 She began her career as a nurse educator in 1924 at the
Norfolk Protestant Hospital in Virginia where she was the
first and only teacher in the school of nursing

43.  Five years later she entered Teacher’s College at Columbia
University where she earned her B.S. and M.A. degrees in
Nursing Education.
 1939 – rewrote the 4th edition of Bertha Hammer’s Textbook
of the Principles and Practice of Nursing.
 Henderson's career in research began when she joined the
Yale School of Nursing as Research Associate in 1953 to work
on a critical review of nursing research.

44.  In 1955 she published the 5th edition with her own definition
of nursing.
 1960 – Coauthored Basic of Principles in Nursing care for the
International Council of Nurses which was translated into
more than 20 languages.
 1966-The Nature of Nursing. A definition and its implication
for practice, Research and Education

45.  In 1985, Henderson was presented with the first Christianne Reimann
Prize from the International Council of Nurses.
 She was also an honorary fellow of the United Kingdom's Royal College
of Nursing.
 The same year, she was also honored at the Annual Meeting of the
Nursing and Allied Health Section of the Medical Library Association.
 Awarded in 1988 by the American Nurses Association for her lifelong
contributions to nursing research, education and professionalism.
 Henderson died on March of 1996 at the age of 98

46. Achievements
 Is the recipient of numerous recognitions for her outstanding
contributions to nursing?
 was a well known nursing educator and a prolific author.
 She has received honorary doctoral degrees from the
 Catholic University of America
 Pace University,
 University of Rochester,
 University of Western Ontario,
 Yale University
 Her stature as a nurse, teacher, author, researcher, and consumer health
advocate warranted an obituary in the New York Times, Friday March 22.
1996.
 In 1985, Miss Henderson was honored at the Annual Meeting of the
Nursing and Allied Health Section of the Medical Library Association.

47. Publications
 1956 (with B. Harmer)-Textbook for the principles and practices of
Nursing.
 1966-The Nature of Nursing. A definition and its implication for practice,
Research and Education
 1991- The Nature of Nursing Reflections after 20 years

48.  !

49.  “ The unique function of the nurse is to
assist the individual, sick or well, in the
performance of those activities
contributing to health or it’s recovery (or to
a peaceful death) that he would perform
unaided if he had the necessary strength,
will, or knowledge, and to do this in such a
way as to help him gain independence as
rapidly as possible” (Henderson, 1991).

50.  The needs theory is based
on the idea that the nurse
cares for the patient until
they are able to take care of
themselves again. We
educate and provide care as
needed until the patient
becomes stronger enough to
independently care for
themselves again.

51. NURSING NEED THEORY

52. 14
FUNDAMENTAL
NEEDS OF
HUMAN
ACCORDING TO
VIRGINIA
HENDERSON
52

53. 14 Activities for Client Assistance
 first 9 components
Physiological
 tenth and fourteenth
Psychological Aspects of
Communicating and
Learning
 eleventh component
Spiritual and Moral
 twelfth and thirteenth
components Sociologically
Oriented to Occupation and
Recreation

54. FUNDAMENTAL NEEDS OF HUMAN
54

55. 55

56. 56
Play or participate in various forms of recreation.
Learn, discover, or satisfy the
curiosity that leads to normal
development and health and
use the available health
facilities.

57. MATAPARADIGM OF HENDERSON’S THEORY
Henderson’s theory and the four major concepts
Individual
 Have basic needs that are component of health.
 Requiring assistance to achieve health and independence or a peaceful
death.
 Mind and body are inseparable and interrelated.
 Considers the biological, psychological, sociological, and spiritual
components.
 The theory presents the patient as a sum of parts with biopsychosocial
needs, and the patient is neither client nor consumer.
57

58. Environment:
 Settings in which an individual learns unique pattern for living.
 All external conditions and influences that affect life and
development.
 Individuals in relation to families.
 Minimally discusses the impact of the community on the individual
and family.
 Supports tasks of private and public agencies
 Society wants and expects nurses to act for individuals who are unable
to function independently.
 In return she expects society to contribute to nursing education.
 Basic nursing care involves providing conditions under which the
patient can perform the 14 activities unaided
58

59. Health:
 Definition based on individual’s ability to function
independently as outlined in the 14 components.
 Nurses need to stress promotion of health and prevention and
cure of disease.
 Good health is a challenge -affected by age, cultural
background, physical, and intellectual capacities,
and emotional balance
 Is the individual’s ability to meet these needs independently?
59

60. Nursing:
 Temporarily assisting an individual who lacks the necessary strength, will and
knowledge to satisfy 1 or more of 14 basic needs.
 Assists and supports the individual in life activities and the attainment of
independence.
 Nurse serves to make patient “complete” “whole", or "independent."
 The nurse is expected to carry out physician’s therapeutic plan. Individualized
care is the result of the nurse’s creativity in planning for care.
 “Nurse should have knowledge to practice individualized and human care and
should be a scientific problem solver.”
 In the Nature of Nursing Nurse role is,” to get inside the patient’s skin and
supplement his strength will or knowledge according to his needs.”
60

61. The major assumption of the theory is that:
 Nurses care for patients until patient can care for themselves
once again.
 Patients desire to return to health, but this assumption is not
explicitly stated.
 Nurses are willing to serve and that “nurses will devote
themselves to the patient day and night”
 A final assumption is that nurses should be educated at the
university level in both arts and sciences.
ASSUMPTIONS

62. Weaknesses
 Limited in a way that it can generally be applied to fully
functional individuals.
 A major shortcoming in her work is the lack of a
conceptual linkage between physiological and other
human characteristics.

63. STRENGTHS
 The concept of nursing formulated by Henderson in her
definition of nursing and the 14 components of basic
nursing is uncomplicated and self-explanatory. Therefore,
it can be used without difficulty as a guide for nursing
practice by most nurses.
 Henderson’s work is relatively simple yet generalizable
with some limitations.
 Her work can be applied to the health of individuals of all
ages.
 Each of the 14 activities can be the basis for research.
63

64. HENDERSON’S THEORY AND NURSING PROCESS
 Nursing assessment: Assess needs of human being based
in the 14 components of basic nursing care.
Nursing Diagnosis: Identify individual’s ability to meet own
needs with or without assistance, taking into consideration
strength, will or knowledge.
Nursing Plan: Document how the nurse can assist the
individual, sick or well.
64

65.  Nursing Implementation
Assist the sick or well individual in to performance of
activities in meeting human needs to maintain health,
recover from illness, or to aid in peaceful death.
Implementation based on the physiological principles, age,
cultural background, emotional balance, and physical and
intellectual capacities.Carry out treatment prescribed by the
physician.
65

66. Nursing Evaluation
Use the acceptable definition of nursing and appropriate
laws related to the practice of nursing. The quality of care is
drastically affected by the preparation and native ability of
the nursing personnel rather that the amount of hours of
care.Successful outcomes of nursing care are based on the
speed with which or degree to which the patient performs
independently the activities of daily living.
66

67. “Nursing must not exist in a vacuum. Nursing must
grow and learn to meet the new health needs of the
public as we encounter them.”
–Virginia Henderson

68. KEEP
CALM
And
More Slides to GO!!!

69.  BETTY NEUMANN’S SYSTEM MODEL
 INTRODUCTION
 Betty Neumann’s system model provides a comprehensive flexible
holistic and system based perspective for nursing.
 It focuses attention on the response of the client system to actual or
potential environmental stressors.
 And the use of primary, secondary and tertiary nursing prevention
intervention for retention, attainment, and maintenance of optimal
client system wellness

70.  HISTORY AND BACKGROUND OF THE THEORIST
 Betty Neumann was born in 1924, in Lowel, Ohio.
 She completed BS in nursing in 1957 and MS in Mental Health Public health
consultation, from UCLA in 1966. She holds a Ph.D. in clinical psychology
 She was a pioneer in the community mental health movement in the late 1960s.
 Betty Neumann began developing her health system model while a lecturer in
community health nursing at University of California, Los Angeles.
 The models was initially developed in response to graduate nursing students
expression of a need for course content that would expose them to breadth of nursing
problems prior to focusing on specific nursing problem areas.
 The model was published in 1972 as “A Model for Teaching Total Person Approach to
Patient Problems” in Nursing Research.
 It was refined and subsequently published in the first edition of Conceptual Models
for Nursing Practice, 1974, and in the second edition in 1980.

71.  DEVELOPMENT OF THE MODEL
 Neumann’s model was influenced by a variety of sources.
 The philosophy writers deChardin and cornu (on wholeness in system).
 Von Bertalanfy, and Lazlo on general system theory.
 Selye on stress theory.
 Lararus on stress and coping.
 BASIC ASSUMPTIONS
 Each client system is unique, a composite of factors and characteristics within a given range of responses
contained within a basic structure.
 Many known, unknown, and universal stressors exist. Each differ in it’s potential for disturbing a client’s usual
stability level or normal LOD
 The particular inter-relationships of client variables at any point in time can affect the degree to which a client is
protected by the flexible LOD against possible reaction to stressors.
 Each client/ client system has evolved a normal range of responses to the environment that is referred to as a
normal LOD. The normal LOD can be used as a standard from which to measure health deviation.
 When the flexible LOD is no longer capable of protecting the client/ client system against an environmental
stressor, the stressor breaks through the normal LOD
 The client whether in a state of wellness or illness, is a dynamic composite of the inter-relationships of the
variables. Wellness is on a continuum of available energy to support the system in an optimal state of system
stability.
 Implicit within each client system are internal resistance factors known as LOR, which function to stabilize and
realign the client to the usual wellness state.
 Primary prevention relates to G.K. that is applied in client assessment and intervention, in identification and
reduction of possible or actual risk factors.
 Secondary prevention relates to symptomatology following a reaction to stressor, appropriate ranking of
intervention priorities and treatment to reduce their noxious effects.
 Tertiary prevention relates to adjustive processes taking place as reconstitution begins and maintenance factors
move the back in circular manner toward primary prevention.
 The client as a system is in dynamic, constant energy exchange with the environment.


72.  CONCEPTS
 Content: - the variables of the person in interaction with the internal and external
environment comprise the whole client system
 Basic structure/Central core: - common client survival factors in unique individual
characteristics representing basic system energy resources.
 The basis structure, or central core, is made up of the basic survival factors that are
common to the species (Neumann,2002).
 These factors include:- - Normal temp. range, Genetic structure.- Response pattern. Organ
strength or weakness, Ego structure
 Stability, or homeostasis, occurs when the amount of energy that is available exceeds that
being used by the system.
 A homeostatic body system is constantly in a dynamic process of input, output, feedback,
and compensation, which leads to a state of balance.
 Degree to reaction: - the amount of system instability resulting from stressor invasion of
the normal LOD.
 Entropy: - a process of energy depletion and disorganization moving the system toward
illness or possible death.

73.  Flexible LOD: - a protective, accordion like mechanism that surrounds and protects the normal LOD from invasion by stressors.
 Normal LOD: - It represents what the client has become over time, or the usual state of wellness. It is considered dynamic because it can expand
or contract over time.
 LOR: - The series of concentric circles that surrounds the basic structure.
 Protection factors activated when stressors have penetrated the normal LOD, causing a reaction symptomatology. E.g. mobilization of WBC and
activation of immune system mechanism
 Input- output: - The matter, energy, and information exchanged between client and environment that is entering or leaving the system at any
point in time.
 Negentropy: - A process of energy conservation that increase organization and complexity, moving the system toward stability or a higher degree
of wellness.
 Open system:- A system in which there is continuous flow of input and process, output and feedback. It is a system of organized complexity where
all elements are in interaction.
 Prevention as intervention: - Interventions modes for nursing action and determinants for entry of both client and nurse in to health care system.
 Reconstitution: - The return and maintenance of system stability, following treatment for stressor reaction, which may result in a higher or lower
level of wellness.
 Stability: - A state of balance of harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an
optimal level of health thus preserving system integrity.
 Stressors: - environmental factors, intra (emotion, feeling), inter (role expectation), and extra personal (job or finance pressure) in nature, that
have potential for disrupting system stability.
 A stressor is any phenomenon that might penetrate both the F and N LOD, resulting either a positive or negative outcome.
 Wellness/Illness: - Wellness is the condition in which all system parts and subparts are in harmony with the whole system of the client.
 Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002).
 Illness is an excessive expenditure of energy… when more energy is used by the system in its state of disorganization than is built and stored; the
outcome may be death (Neuman, 2002).

74.  PREVENTION
 According to Neumann’s model, prevention is the primary nursing intervention. Prevention focuses on
keeping stressors and the stress response from having a detrimental effect on the body.
 PRIMARY PREVENTION
 Primary prevention occurs before the system reacts to a stressor. On the one hand, it strengthens the
person (primary the flexible LOD) to enable him to better deal with stressors
 On the other hand manipulates the environment to reduce or weaken stressors.
 Primary prevention includes health promotion and maintenance of wellness.
 SECONDARY PREVENTION
 Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing
system.
 Secondary prevention focuses on preventing damage to the central core by strengthening the internal
lines of resistance and/or removing the stressor.
 TERTIARY PREVENTION
 Tertiary prevention occurs after the system has been treated through secondary prevention strategies.
 Tertiary prevention offers support to the client and attempts to add energy to the system or reduce
energy needed in order to facilitate reconstitution.

75.  FOUR MAJOR CONCEPTS
 PERSON
 The focus of the Neumann model is based on the philosophy that each human being is a total person as a client system and the person is a layered multidimensional being.
 Each layer consists of five person variable or subsystems:
 Physiological- Refer of the physicochemical structure and function of the body.
 Psychological- Refers to mental processes and emotions.
 Socio-cultural- Refers to relationships; and social/cultural expectations and activities.
 Spiritual- Refers to the influence of spiritual beliefs.
 Developmental- Refers to those processes related to development over the lifespan.
 ENVIRONMENT
 The environment is seen to be the totality of the internal and external forces which surround a person and with which they interact at any given time.
 These forces include the intrapersonal, interpersonal and extra-personal stressors which can affect the person’s normal line of defense and so can affect the stability of the system.
 The internal environment exists within the client system.
 The external environment exists outside the client system.
 Neumann also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.
 HEALTH
 Neumann sees health as being equated with wellness. She defines health/wellness as “the condition in which all parts and subparts (variables) are in harmony with the whole of the
client (Neumann, 1995)”.
 The client system moves toward illness and death when more energy is needed than is available. The client system moved toward wellness when more energy is available than is
needed
 NURSING
 Neumann sees nursing as a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor.
 The person is seen as a whole, and it is the task of nursing to address the whole person.
 Neuman defines nursing as “action which assist individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient/client system,
through nursing interventions to reduce stressors.’’
 Neuman states that, because the nurse’s perception will influence the care given, then not only must the patient/client’s perception be assessed, but so must those of the caregiver
(nurse).
 The role of the nurse is seen in terms of degree of reaction to stressors, and the use of primary, secondary and tertiary interventions

76.  STAGES OF NURSING PROCESS (BY NEUMAN)
 NURSING DIAGNOSIS
 It depends on acquisition of appropriate database; the diagnosis identifies, assesses,
classifies, and evaluates the dynamic interaction of the five variables.
 Variances from wellness (needs and problems) are determined by correlations and
constraints through synthesis of theory and data base.
 Broad hypothetical interventions are determined, i.e. maintain flexible line of defense.
 NURSING GOALS
 These must be negotiated with the patient, and take account of patient’s and nurse’s
perceptions of variance from wellness.
 NURSING OUTCOMES
 Nursing intervention using one or more preventive modes.
 Confirmation of prescriptive change or reformulation of nursing goals.
 Short term goal outcomes influence determination of intermediate and long – term goals.
 A client outcome validates nursing process.