NURSING THEORIES.pptx

NURSING THEORETICAL WORKS
A. Nursing Philosophies
1. Nightingale’s Environmental Theory
2. Watson’s Theory of Human Caring
3. Benner Benner’s Stages of Nursing Expertise Nursing
Philosophies
4. Eriksson’s Caritative Caring Theory
B. Nursing Conceptual Models
1. Roger’s Science of Unitary Human Beings Nursing Conceptual
Model
2. Orem’s Self – care Deficit Model
3. King’s General Systems Framework Nursing Conceptual Model
4. Neumann’s Systems Model
5. Roy’s Adaptation Model
6. Johnson’s Behavioral System Model

THEORY
2 or more Concepts:
• something conceived
in mind: thought
Florence Nightingale believes
that a healthy environment was
fundamental to healing
Sets of Proposition:
• something offered
for consideration : proposal
Nurses should use their brain, heart to create a healthy
environment to care for patient’s body,mind and spirit
Hypotheses
 an interpretation of a
practical situation or
condition taken as the
ground for action
• the act of utilizing the
environment of the
patient to assist him in
his recovery

• Nursing theories are organized bodies of knowledge to define
= what nursing is
= what nurses do and
= why do they do it.
• Nursing theories provide a way to define nursing as a unique
discipline that is separate from other disciplines (e.g.,
medicine).
= It is a framework of concepts and purposes intended to
guide the practice of nursing at a more concrete and
specific level.
NURSING THEORY
• is an organized framework of two or more concepts and sets
prepositions to arrive at hypothesis to set in place to inform
meaningful actions in the nursing field,

• Nursing, as a Profession:
= is committed to recognizing its own unparalleled body of
knowledge vital to nursing practice—nursing science.
= To distinguish this foundation of knowledge, nurses need to:
= identify
= develop, and
= understand concepts and theories in line with nursing.
• As a science, nursing is based on the theory of
= what nursing is
= what nurses do, and why.

1. History of Nursing Theory
• The history of professional nursing began with Florence
Nightingale.
• She envisioned nurses as a body of educated women at a time
when women were neither educated nor employed in public
service.
• After the Crimean war, she established a School of Nursing at
St. Thomas Hospital in London and marked the birth of
modern nursing.
Evolution of Nursing Theories

History of Nursing Theory
• Nightingale’s pioneering activities in:
= nursing practice and education and her subsequent writings
became a guide for:
= establishing nursing schools and hospitals in the United
States at the beginning of the 20th century.
The CURRICLUM ERA : addressed the question of
= what content nurses should study to learn how to be a nurse.
= emphasis was on what courses nursing students should take,
with the goal of arriving at a standardized curriculum
• By the mid-1930s, a standardized curriculum had been
published and adopted by many diploma programs.

The CURRICLUM ERA
• emphasized course selection and content for nursing programs
and gave way to the research era:
- focused on the research process and the long-range
goal of acquiring substantive knowledge to guide nursing
practice.
The RESEARCH ERA
• nurses increasingly sought degrees in higher education
• research was the path to new nursing knowledge.
• Nurses began to participate in research, and research courses
were included in the nursing curricula of early developing
graduate nursing programs

The RESEARCH ERA
• Research revealed that nursing studies lacked :
- conceptual connections and theoretical frameworks,
• Awareness of the need for concept and theory development
coincided with two other significant milestones in the evolution
of nursing theory.
• The first
- is the standardization of curricula for nursing master’s
education by the National League for Nursing accreditation
criteria for baccalaureate and higher-degree programs, and
• The second
- is the decision that doctoral education for nurses should be in
nursing

Introduction to Nursing Theory:
The Research era and the Graduate Education Era
• Master’s degree programs in nursing emerged across the
country to meet the public need for nurses for specialized
clinical nursing practice
• Many of these graduate programs included a course that
introduced the student to the research process.
• Also during this era, nursing master’s programs began to include
courses in concept development and nursing models,
introducing students to early nursing theorists and knowledge
development processes

A. Introduction to Nursing Theory:
The Research era and the Graduate Education Era
• “theory is not a luxury in the discipline of nursing . . . but an
integral part of the nursing dictionary in education,
administration, and practice”
• An important forerunner to the theory era was the general
acceptance of nursing as a profession and an academic
discipline in its own right.
• As understanding of research and knowledge development
increased, it became obvious that research without conceptual
and theoretical frameworks produced isolated information.

Significance of Nursing Theory
• At the beginning of the twentieth century, nursing was not
recognized as an academic discipline or a profession.
• The accomplishments of the past century led to the recognition of
nursing in both areas.
A profession
= refers to a specialized field of practice, founded on the theoretical
structure of the science or knowledge of that discipline and
accompanying practice abilities.

Significance for the Discipline
A discipline
= is specific to academia and refers to a branch of education, a
department of learning, or a domain of knowledge.
 after Nursing Research had been published for 25 years, studies
were reviewed comprehensively, and strengths and weaknesses
were reported in the journal
• Batey (1977) called attention to the importance of nursing
conceptualization in the research process and the role of a
conceptual framework in the design of research for the
production of science.
= Conceptual framework. A conceptual framework is a group of
related ideas, statements, or concepts

A conceptual framework is a group of related ideas, statements, or
concepts

Soon the nursing theoretical works began to be recognized to
address Batey’s call :
1. Johnson, 1968, 1974 5. Orem, 1971
2. King, 1971 6. Rogers, 1970
3. Levine, 1969 7. Roy, 1970
4. Neuman, 1974
Nursing scholars were recognized for the theoretical nature of their
earlier writings, such as :
= Henderson, Nightingale, Orlando, Peplau, and Wiedenbach
These early works were developed by educators as frameworks to
structure curriculum content in nursing programs.

Significance for the Discipline
• Frameworks and theories are structures about human beings and
their health;
= these structures provide nurses with a perspective of the
patient for professional practice.
• Professionals provide public service in a practice focused on those
whom they serve.
• The nursing process is useful in practice, but the primary focus is
the patient, or human being.
• Knowledge of persons, health, and environment forms the basis
for recognition of nursing as a discipline, and this knowledge is
taught to those who enter the profession

Significance for the Profession
• Nursing practice settings are:
= complex, and the amount of data (information) confronting
nurses is virtually endless.
• Nurses
= must analyze a vast amount of information about each patient
and decide what to do.
• A theoretical approach helps practicing nurses
= not to be overwhelmed by the mass of information and to
progress through the nursing process in an orderly manner.
• Theory enables them to:
= organize and understand what happens in practice,
= analyze patient situations critically for clinical decision making;
= plan care and propose appropriate nursing interventions;
= predict patient outcomes from the care and evaluate its
effectiveness.

Structure of Nursing Knowledge
1. Metaparadigm
What is the Nursing Metaparadigm?
• The nursing metaparadigm is a set of beliefs that guide the
practice and care of patients.
• The metaparadigm is a conceptual framework or an idea-map
about how something works.
• It can be used for purposes such as:
= teaching (to explain things)
= research (to understand them), and
= decision making (what to do next).

1. Metaparadigm
The nursing Metaparadigm includes 5 guiding principles:
• Caring, concern for life, continuity of personhood
• Wholeness in health/illness
• Relief from suffering
• Reverence for life to death continuum
• Safety principle with priority on patient’s well-being first
• There are four major concepts :
= person, environment, health, and nursing.

Four major concepts :
Person
• Person (also referred to as Client or Human Beings) is
the recipient of nursing care and may include
individuals, patients, groups, families, and communities.
Environment
• Environment (or situation) is defined as the internal and
external surrounds that affect the client.
• It includes all positive or negative conditions that affect
the patient
• the physical environment, such as families, friends, and
significant others, and the setting for where they go for
their healthcare.

Health
• Health is defined as the degree of wellness or well-being that the
client experiences.
• It may have different meanings for each patient, the clinical
setting, and the health care provider.
Nursing
• The attributes, characteristics, and actions of the nurse providing
care on behalf of or in conjunction with, the client.
• There are numerous definitions of nursing, though nursing
scholars may have difficulty agreeing on its exact definition,
= the ultimate goal of nursing theories is to
improve patient care.

1. Metaparadigm
Nursing Metaparadigm of Different Nurse Theorist
• Incorporating four major concepts :
1. Nightingale
2. Orem
3. Henderson
4. Peplau
5. Roger
6. King
7. Watson’s

Florence Nightingale: Environmental Theory

A. Nursing Philosophies
1. Nightingale’s Environmental Theory
• Environmental Theory
Florence Nightingale’s Environmental Theory defined Nursing as
“ the act of utilizing the environment of the patient to assist
him in his recovery.”

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

• It involves the nurse’s initiative to arrange environmental
settings appropriate for
= the gradual restoration of the patient’s health, and that
= external factors associated with the patient’s surroundings
affect life or biologic and physiologic processes, and his
development.
• She identified 5 environmental factors: fresh air, pure water,
efficient drainage, cleanliness or sanitation and light or direct
sunlight.

Nursing
• “ What nursing has to do… is to put the patient in the best
condition for nature to act upon him”
• Nightingale stated that nursing :
“ ought to signify the proper use of:
= fresh air
= light
= warmth
= cleanliness
= quiet, and the
= proper selection and administration of diet – all at the
least expense of vital power to the patient.”
Major Concepts of Florence Nightingales Theory

• Human Beings
= Human beings are not defined by Nightingale specifically. They
are defined in relation to their environment and the impact of
the environment upon them.
• Environment
= The physical environment is stressed by Nightingale in her
writing. In her theory, Nightingale’s writings reflect a community
health model in which all that surrounds human beings is
considered in relation to their state of health.

• Health
= Nightingale (1859/1992) did not define health specifically. She
stated,
= “We know nothing of health, the positive of which
pathology is negative, except for the observation and
experience.
• Given her definition that of the art of nursing is to “unmake what
God had made disease,” then the goal of all nursing activities
should be client health.
• She believed that nursing should provide care to the healthy as
well as the ill and discussed health promotion as an activity in
which nurses should engage.

• Health of Houses
= “Badly constructed houses do for the healthy what badly
constructed hospitals do for the sick.
= Once ensure that the air is stagnant and sickness is certain to
follow.”
• Ventilation and Warming
= “Keep the air he breathes as pure as the external air, without
chilling him.”
• Nightingale believed that the person who repeatedly breathed
his or her own air would become sick or remain sick.
• She was very concerned about “noxious air” or “effluvia (a by
product from waste)” and foul odors that came from excrement

• She also criticized “fumigations,” for she believed that the
offensive source, not the smell, must be removed.
• The importance of room temperature was also stressed by
Nightingale.
= The patient should not be too warm or too cold.
= The temperature could be controlled by an appropriate
balance between burning fires and ventilation from windows.

Light
= Nightingale believed that second to fresh air, the sick needed
light.
= She noted that direct sunlight was what patients wanted.
Noise
= She stated that patients should never be “waked intentionally”
or accidentally during the first part of sleep.
= She asserted that whispered or long conversations about
patients are thoughtless and cruel.
= She viewed unnecessary noise, including noise from female
dress, as cruel and irritating to the patient.

• Variety
= She discussed the need for changes in color and form, including
bringing the patient brightly colored flowers or plants.
= She also advocated rotating 10 or 12 paintings and engravings
each day, week, or month to provide variety for the patient.
= Nightingale also advocated reading, needlework, writing, and
cleaning as activities to relieve the sick of boredom

• Bed and Bedding
= Nightingale noted that an adult in health exhales about
three pints of moisture through the lungs and skin in a 24-
hour period.
= This organic matter enters the sheets and stays there unless
the bedding is changed and aired frequently.
= She believed that the bed should be placed in the lightest
part of the room and placed so the patient could see out of
a window.
= She also reminded the caregiver never to lean against, sit
upon, or unnecessarily shake the bed of the patient.

• Personal Cleanliness
= “Just as it is necessary to renew the air round a sick person
frequently to carry off morbid effluvia from the lungs and
skin, by maintaining free ventilation, so it is necessary to
keep pores of the skin free from all obstructing excretions.”
= “Every nurse ought to wash her hands very frequently
during the day.”
• Nutrition and Taking Food
= Nightingale noted in her Environmental Theory :
= that individuals desire different foods at different times of
the day and that frequent small servings may be more
beneficial to the patient than a large breakfast or dinner.
= She urged that no business be done with patients while they
are eating because this was a distraction

• Chattering Hopes and Advice
= Florence Nightingale wrote in her Environmental Theory
= that to falsely cheer the sick by making light of their illness
and its danger is not helpful.
= She encouraged the nurse to heed :
= what is being said by visitors
= believing that sick persons should hear the good
news that would assist them in becoming healthier.
• Social Considerations
= Nightingale supported the importance of looking beyond the
individual to the social environment in which he or she lived.

What is the application of theory to practice in nursing?
• Nursing theory comes alive when it is integrated into clinical
practice, and plays a vital role in all stages of the nursing
process.
• During the assessment phase, nurses draw upon theoretical
frameworks to collect relevant data and identify patients'
needs, incorporating both objective and subjective findings
Assumptions of Florence Nightingale's Theory
• A healthy environment is essential for healing.
• She stated that “nature alone cures.”
• Nurses must make accurate observations of their patients and
report the state of the patient to the physician in an orderly
manner.
• Nursing is an art, whereas medicine is a science.

How can application of nursing theory benefit the nursing
profession?
• Nursing theories offer frameworks that give shape to the scope
of nursing care and practice.
• These consist of concepts, such as collaboration or respect,
descriptions of relationships, and definitions.
• Nursing theories guide nurses in their practice and give them a
foundation to make clinical decisions.

Jean Watson: Theory of Human Caring
Definition of caring
• feeling or showing concern for or kindness to others

Philosophy and Theory of Transpersonal 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.
• The nursing model states that
= “nursing is concerned with promoting health, preventing
illness, caring for the sick, and restoring health.”
• It focuses on health promotion, as well as the treatment of
diseases. According to Watson, Caring ;
= is central to nursing practice, and promotes health better
than a simple medical cure.
• She believes that a holistic approach to health care is central to
the practice of caring in nursing.

• Watson also defined three of the four metaparadigm concepts in
nursing including person or human being, health, and nursing.
• She referred human being :
= a valued person in and of him or herself to be cared for,
respected, nurtured, understood and assisted;
= in general a philosophical view of a person
= as a fully functional integrated self.
= Human is viewed as greater than and different from the
sum of his or her parts.
• Health, meanwhile, is defined:
= as a high level of overall physical, mental, and social
functioning;
= a general adaptive-maintenance level of daily functioning; and
= absence of illness, or the presence of efforts leading to the
absence of illness.

• And nursing as a science of persons and health-illness
experience = that are intervened by :
professional
personal INTERACTION
scientific
ethical care
Ethics: discipline dealing with what is good or bad with moral duty
& obligation
• She does not define the fourth metaparadigm concept of
environment but instead devised:
= 10 caring needs specific Carative factors critical to the caring
human experience that need to be addressed by nurses with
their patients when in a caring role.
Carative:
= Dr. J Watson uses the term “ carative” instead of “curative” to
distinguish between nursing and medicines

Theory of Human Caring of Jean Watson
• There are many reasons to consider in becoming a
professional nurse, but compassion is often a trait required of
nurses.
• Jean Watson’s “Philosophy and Theory of Transpersonal
Caring” mainly concerns on how nurses :
= care for their patients, and how that caring
= progresses into better plans to :
= promote health and wellness, prevent illness and
restore health.

Theory of Human Caring of Jean Watson
• In today’s world, :
= nursing seems to be responding to the various demands of
the machinery with less consideration of the needs of the
person attached to the machine.
• In Watson’s view:
= the disease might be cured, but illness would remain because,
without caring, health is not attained.
• Caring is the essence of nursing and connotes responsiveness
= between the nurse and the person;
= the nurse co-participates with the person.
• Watson contends that caring can assist the person to:
= gain control, become knowledgeable, and promote health
changes.

10 Carative Factors
1. Forming humanistic-altruistic value systems,
2. Instilling faith-hope, having unselfish concern for the welfare of others
3. Cultivating a sensitivity to self and others,
4. Developing a helping-trust relationship,
5. Promoting an expression of feelings,
6. Using problem-solving for decision-making,
7. Promoting teaching-learning,
8. Promoting a supportive environment,
9. Assisting with gratification of human needs, and
10. Allowing for existential-phenomenological forces.
The first three factors form the “philosophical foundation” for the
science of caring, and the remaining seven come from that
foundation.

Patricia Benner: Model of Skill Acquisition in Nursing

• In her model, students passes:
= through five levels of skill acquisition:
• Novice: advanced beginner – competent – proficient – expert
• First: they move from relying on abstract principles to using
concrete experiences.
• Second: they move from analytic, rule based thinking to insight.
• Third: their perception changes from a situation composed of
equally relevant parts to a complex whole in which certain
parts are more relevant than others
• Finally: they move from a detached observer to an actively
involved performer
Foundation – Wellness – Curative – Leadership/management

• Person
= “A person is a self-interpreting being, that is, the person
does not come into the world predefined but gets defined
in the course of living a life.
• Health :
= is defined as what can be assessed, whereas well-being is the
human experience of health or wholeness.
• Health is described as not just the absence of disease and
illness. a person may have a disease and not experience illness,
= illness :
= human experience of loss or dysfunction
= disease
= assessed at the physical level

Nursing
• Nursing is described as a caring relationship, an “enabling
condition of connection and concern”
• “Caring is primary because:
= caring sets up the possibility of giving help and
receiving help”
• “Nursing is viewed as a caring practice whose science is
guided by the moral art and ethics of care and
responsibility”
= understand nursing practice as the care and study of the
lived experience of:
= health, illness, and disease and the relationships
among these three elements.

Situation
• Benner use the term situation rather than environment,
because situation conveys a social environment with social
definition and meaningfulness.
• being situated and situated meaning, which are defined by the
person’s engaged interaction, interpretation, and
understanding of the situation.
• “Personal interpretation of the situation is bounded by the
way the individual is in it”
= This means that each person’s past, present, and future,
which include her or his own personal meanings, habits,
and perspectives, influence the current situation.

Katie Eriksson: Theory of Caritative Caring

Theoretical Sources
• Eriksson’s leading thoughts have been not only to :
develop the substance of caring, but also to develop caring
science as an independent discipline
• The basic motive in caring science and caring for Eriksson is
caritas:
= which constitutes the leading idea and keeps the various
elements together.
= it gives both the substance and the discipline of caring
science a distinctive character.

MAJOR CONCEPTS & DEFINITIONS
• Caritas
= Caritas means love and charity.
= In caritas, eros and agapé are united, and caritas is by nature
unconditional love.
eros : the sum of life-preserving instincts that are manifested
as impulses to gratify basic needs to protect and preserve
the body and mind
• Eros is a primal love that comes as a natural instinct for most
people.
• It's a passionate love displayed through physical affection.
• These romantic behaviors include, but are not limited
to, kissing, hugging and holding hands.
• This love is a desire for another person's physical body

agape : being in a state of wonder
• It means that caring is an attempt thru effort to facilitate:
= faith, hope, and love through tending, playing, and learning.
• Agape love is about giving to others, sacrificing our time,
energy and resources for someone else without expecting
anything in return.
• Agape love is about responding calmly when faced with
difficulties, sacrificing without complaining, and waiting
patiently.
• It can be found in the people who dedicate their lives to
helping others for the good of humanity, like teachers, nurses,
or people who dedicate themselves to others.
• Another example of this love is in the Bible, where God's love
for all of humanity is expressed throughout the literature.

• Caring communion is characterized by
= intensity and vitality, and by
= warmth, closeness, rest, respect, honesty, and tolerance
Caring Communion
The Act of Caring
• The act of caring contains the caring elements
(faith, hope, love, tending, playing, and learning),
involves the categories of infinity and eternity, and invites
to deep communion.
• The act of caring is the art of making something very special out
of something less special.

• Nursing
= Eriksson emphasizes that caritative caring relates to the
innermost core of nursing.
She distinguishes between caring nursing and nursing care.
= nursing care is :
= based on the nursing care process, and it represents good
care only when it is based on the innermost core of caring.
= caring nursing:
= represents a kind of caring without prejudice that
emphasizes the patient and his or her suffering and desires

B. Nursing Conceptual Models
1. Roger’s Science of Unitary Human Beings
Nursing Conceptual Model
2. Orem’s Self – care Deficit Model
3. King’s General Systems Framework Nursing Conceptual Model
4. Neumann’s Systems Model
5. Roy’s Adaptation Model
6. Johnson’s Behavioral System Model

Martha Rogers’ theory is known as the
Science of Unitary Human Beings (SUHB).
• The theory views nursing as both a science and an art as it
provides a way to view the unitary (undivided) human being, who is
integral (essential to completeness) with the universe.
• Her model addresses the importance of the environment as an
integral part of the patient, and uses that knowledge to:
= help nurses blend:
= the science and art of nursing to ensure
= patients have a smooth recovery and can get back to the
best health possible.

• Rogers’ theory defined Nursing as:
“an art and science that is humanistic and humanitarian.
• It is directed toward the unitary human and is concerned with
the nature and direction of human development.
• The goal of nurses is to participate in the process of change.”

Assumptions
(1) Man is a unified whole possessing his own integrity and
manifesting characteristics that are more than and different
from the sum of his parts.
(2) Man and environment are continuously exchanging matter and
energy with one another.
(3) The life process evolves irreversibly and unidirectionally along
the space-time continuum.
(4) Pattern and organization identify the man and reflect his
innovative wholeness and lastly,
(5) Man is characterized by the capacity for abstraction and
imagery, language and thought sensation and emotion.

Health
• Rogers defines health as an expression of the life process.
• The characteristics and behavior coming from the :
= mutual ,simultaneous interaction of the human and
environmental fields and
= health and illness are part of the same continuum.
• The multiple events occurring during the life process show how
a person is achieving his or her maximum health potential.
mutual (directed by each towards the others)

Nursing
• It is the study of unitary, irreducible, indivisible human and
environmental fields: people and their world.
• Rogers claims that nursing exists:
= to serve people, and
= the safe practice of nursing depends on the nature and
amount of scientific nursing knowledge the nurse brings to
his or her practice.
unitary (whole), irreducible (impossible to transform)

Scope of Nursing
• Nursing aims to assist people in achieving their maximum
health potential.
• Maintenance and promotion of health, prevention of
disease, nursing diagnosis, intervention, and rehabilitation
encompass the scope of nursing’s goals.
• Nursing is concerned with people-all people-well and sick, rich
and poor, young and old.
• The arenas of nursing’s services extend into all areas where
there are people:
= at home, at school, at work, at play, in hospital, nursing
home, and clinic; on this planet and now moving into outer
space.

Environmental Field
• “An irreducible, indivisible, pan-dimensional energy field
identified by pattern and integral with the human field.”

MAJOR CONCEPTS & DEFINITIONS
The self-care deficit nursing theory is a general theory composed of
the following four related theories:
1. The theory of self-care, which describes why and how people
care for themselves.
2. The theory of dependent-care, which explains how family
members and/or friends provide dependent-care for a person
who is socially dependent.
3. The theory of self-care deficit, which describes and explains
why people can be helped through nursing
4. The theory of nursing systems, which describes and explains
relationships that must be brought about and maintained for
nursing to be produced.

Self-Care Theory
Her theory defined Nursing as
“ The act of assisting others in the provision and management
of self-care to maintain or improve human functioning at
home level of effectiveness.”
• It focuses on each individual’s ability to:
perform self-care, defined as
= “ the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and
well-being.”

1. Theory of Self-Care
= Self-care comprises the practice of activities that :
= maturing and mature persons initiate and perform,
within time frames, on their own behalf in the interest of :
= maintaining life, healthful functioning,
= continuing personal development, and
= well-being by meeting known requisites for functional
and developmental regulations
Self-care is
• the practice of individuals looking after their own health
using the knowledge and information available to them.
• It is a decision-making process that empowers
= individuals to look after their own health efficiently and
conveniently, in collaboration with health and social care
professionals as needed.

• Self-Care Requisites (needed for a particular purpose)
= A self-care requisite is a
= formulated and expressed understanding about actions to be
performed that are known or hypothesized to be necessary in :
= the regulation of an aspect(s) of human functioning and
development
= continuously or under specified conditions and
circumstances.

• Universal Self-Care Requisites (needed for a particular
purpose)
= Universally required goals are to be met through:
= self-care or dependent care
= they have their origins in :
= what is known (diagnosis)
= what is validated ( s& sx) or
= what is in the process of being validated(dx pro.)
= about human structural and functional integrity at
various stages of the life cycle

• Universal Self-Care Requisites
The following eight self-care requisites common to men, women,
and children are suggested:
1. Maintenance of a sufficient intake of air
2. Maintenance of a sufficient intake of food
3. Maintenance of a sufficient intake of water
4. Provision of care associated with elimination processes and
excrements

5. Maintenance of balance between activity and rest
6. Maintenance of balance between lonely place and social
interaction
7. Prevention of hazards to human life, human functioning, and
human well-being
8. Promotion of human functioning and development within :
= social groups in accordance with human potential
= known human limitations, and
= the human desire to be normal.

Health Deviation Self-Care Requisites
• These self-care requisites exist for:
= persons who are ill or injured
= who have specific forms of pathological conditions or
disorders, including defects and disabilities, and
= who are under medical diagnosis and treatment.
• The characteristics of health deviation as conditions extending
over time determine the types of:
= care demands that individuals experience as they live with
the effects of pathological conditions and live through their
durations.

Therapeutic Self-Care Demand
• Therapeutic self-care demand consists of the:
= summary of care measures necessary at specific times or
over a duration of time to meet all of an individual’s known
self-care requisites
= particularized for existent conditions and circumstances by
methods appropriate for the following:
= controlling or managing factors identified in the requisites,
= the values of which are regulatory of human functioning
(sufficiency of air, water, and food)
• Fulfilling the activity element of the requisites (maintenance,
promotion, prevention, and provision)

Dependent-Care Demand
• The summation of care measures at a specific point in time or
over a duration of time for
= meeting the dependent’s therapeutic self-care demand when
his or her self-care agency is not adequate or operational.
2. The theory of dependent-care,
= which explains how family members and/or friends provide
dependent-care for a person who is socially dependent

Self-care agency is
• the human's ability or power to engage in self-care and is
affected by basic conditioning factors.
Self-Care Agency
• The self-care agency is a complex acquired ability of mature
and maturing persons:
= to know and meet their continuing requirements for
deliberate, purposive action to regulate their own human
functioning and development

Dependent-Care Agency
• Dependent-care agency refers to the acquired ability of a
person
= to know and meet the therapeutic self-care demand of the
dependent person and/or regulate the development and
exercise of the dependent’s self-care agency.

3. Theory of Self-Care Deficit
An individual’s therapeutic
self-care demands
His or her powers of self-care
agency in which the
constituent developed self-care
capabilities within self-care agency
-
Inoperable (inoeperative)
or Inadequate
for knowing and meeting
some or all components of
the existent or projected
therapeutic self-care
demand.
= which describes and explains why people can be helped
through nursing

Assumptions of the Self-Care Deficit Theory
The assumptions of Dorothea Orem’s Self-Care Theory are:
(1) In order to stay alive and remain functional:
= humans engage in constant communication and connect
among themselves and their environment.
(2) The power to act deliberately is exercised to identify needs and
to make needed judgments.
(3) Mature human beings experience privations in the form of
= action in care of self
= others involving making life-sustaining and
= function-regulating actions.

Assumptions of the Self-Care Deficit Theory
The assumptions of Dorothea Orem’s Self-Care Theory are:
(4) Human agency is exercised in:
= discovering, developing, and
= transmitting to others ways and means to
= identify needs for, and
= make inputs into, self and others.
(5) Groups of human beings with :
= structured relationships cluster tasks and
= allocate responsibilities for providing care to group
members.

Wholly Compensatory Nursing System
• This is represented by a situation in which the individual is
unable
“ to engage in those self-care actions requiring self-directed
and controlled ambulation and manipulative movement or
the medical prescription to refrain from such activity…
Persons with these limitations are socially dependent on others
for their continued existence and well-being.”
Example: care of a newborn, care of client recovering
from surgery in a post-anesthesia care unit
4. Theory of Nursing Systems
= which describes and explains relationships that must be brought
about and maintained for nursing to be produced.

Partial Compensatory Nursing System
• This is represented by a situation in which
= “both nurse and perform care measures or other actions
involving manipulative tasks or ambulation the
patient or the nurse may have a major role in the
performance of care measures.”
Example: Nurse can assist the postoperative client in ambulating,
Nurse can bring a meal tray for a client who can feed
himself

Supportive-Educative System
• This is also known as a supportive-developmental system.
The person :
= “can perform or can and should learn to perform required
measures of externally or internally oriented therapeutic
self-care but cannot do so without assistance.”
Example:
• Nurse guides a mother on how to breastfeed her baby,
• Counseling a psychiatric client on more adaptive coping
strategies.

Theory of Goal Attainment
• The Theory of Goal Attainment states that
= “ Nursing is a process of action, reaction, and interaction
whereby nurse and client share information about their
perception in the nursing situation.”
• It explains that the nurse and patient go hand-in-hand in
= communicating information
= set goals together, and then
= take actions to achieve those goals.

Theory of Goal Attainment
The goal of the nurse is to
= help patients maintain health so they can function in their
individual roles.
• The nurse’s function is to interpret information in the
= nursing process
= to plan, implement, and evaluate nursing care.
• The factors that affect the attainment of goals are
= roles, stress, space, and time.

• King’s conceptual system and Theory of Goal Attainment were
= “ based on an overall assumption that the focus of nursing is:
= human beings interacting with their environment = leading to
a state of health for individuals = which is an ability to
function in social roles.”
The assumptions are:
(1) The focus of nursing is the care of the human being (patient).
(2) The goal of nursing is the health care of both individuals and
groups.
(3) Human beings are open systems interacting with their
environments constantly.

The assumptions are:
(4) The nurse and patient:
= communicate information
= set goals mutually, and then
= act to achieve those goals.
This is also the basic assumption of the nursing process.
(5) Patients perceive the world as a complete person making
transactions with individuals and things in the environment.
(6) Transaction represents a life situation in which the perceiver
and the thing being perceived are encountered.
= It also represents a life situation in which a person enters
the situation as an active participant.
= Each is changed in the process of these experiences.

Nursing
• “Nursing is an observable behavior found in the health care
systems in society”
= The goal of nursing “is to help individuals maintain their
health so they can function in their roles” .
• Nursing is an interpersonal process of action, reaction,
interaction, and transaction.
• Perceptions of a nurse and a patient influence the
interpersonal process.

Person
• Individuals are spiritual beings
• Individuals have the ability through their language and other
symbols to record their history and preserve their culture
• Individuals are unique and holistic, of intrinsic worth, and
capable of rational thinking and decision making in most
situations
• Individuals differ in their needs, wants, and goals

Health
• Health:
= is a dynamic state in the life cycle,
= Illness interferes with that process.
• Health:
“ implies continuous adjustment to stress in the internal and
external environment through the optimum use of one’s
resources to achieve the maximum potential for daily living”

Environment
• King (1981) believed that :
“ an understanding of the ways that human beings interact
with their environment to maintain health was essential
for nurses”
• Open systems imply that interactions :
= occur constantly between the system and the system’s
environment.
Furthermore,
“adjustments to life and health are influenced by [an]
individual’s interaction with environment . . .
• Each human being perceives the world as :
= a total person in making transactions with individuals and
things in the environment”

Betty Neuman’s Nursing Theory
• Neuman system model is a grand theory, (with a broader
scope) which consists of global conceptual framework.
= It defines broad perspectives for nursing practice and
includes diverse ways of viewing nursing phenomena
• A nursing theory developed by Betty Neuman is based on:
= person’s relationship to stress, the response to it, and
reconstruction factors that are progressive in nature.
Reconstruction : repairing, rebuilding, restoring

The Neuman Systems Model views the client as an
“open system that responds to stressors in the environment. “
• The client variables (sets of values) are:
The physiological variable
• refers to the structure and functions of the body.
The psychological variable
• refers to mental processes and relationships.
The sociocultural variable
• refers to system functions that relate to social and cultural
expectations and activities.
The developmental variable
• refers to those processes related to development over the
lifespan.
The spiritual variable
• refers to the influence of spiritual beliefs.

• The client system consists of a basic or core structure that is
protected by lines of resistance.
• The usual level of health is identified as the :
= normal line of defense that is protected by a flexible line of
defense.
• Stressors are :
= intra (within)-, inter (between) -, and extra (outside)personal in
nature, and
= arise from the internal, external, and created environments.

When stressors break through the flexible line of defense,
System is invaded
The lines of resistance are activated
System is described as moving into illness on a
wellness-illness continuum
• If adequate energy is available, the system :
= will be reconstituted with the normal line of defense
restored at, below, or above its previous level.

Nursing interventions occur through three prevention modalities.
• Primary prevention
= occurs before the stressor invades the system;
• Secondary prevention
= occurs after the system has reacted to an invading stressor;
• Tertiary prevention
= occurs after secondary prevention as reconstitution is being
established.
• It focuses on the response of the patient system to
= actual or potential environmental stressors and the
maintenance of the client system’s stability through primary,
secondary, and tertiary nursing prevention intervention to
reduce stressors.

Primary prevention
• Occurs before the system reacts to a stressor; it includes health
promotion and wellness maintenance.
• Primary prevention focuses on strengthening the flexible line of
defense through preventing stress and reducing risk factors.
• This intervention occurs when the risk or hazard is identified but
before a reaction occurs.
• Strategies that might be used include immunization, health
education, exercise, and lifestyle changes.

Secondary prevention
• Occurs after the system reacts to a stressor and is provided in
terms of existing symptoms.
• Secondary prevention focuses on strengthening the internal
lines of resistance and, thus, protects the basic structure
through appropriate treatment of symptoms.
• The intent is to regain optimal system stability and conserve
energy in doing so
• If secondary prevention is unsuccessful and reconstitution does
not occur, the basic structure will be unable to support the
system and its interventions, and death will occur.

Tertiary prevention
• Occurs after the system has been treated through secondary
prevention strategies.
• Its purpose is to maintain wellness or protect the client system
reconstitution by supporting existing strengths and preserving
energy.
• Tertiary prevention may begin at any point after system stability
has begun reestablished (reconstitution has begun).
• Tertiary prevention tends to lead back to primary prevention.

Major Assumptions
Nursing
• Neuman believes that nursing is concerned with the whole
person.
• She views nursing as a
= “unique profession in that it is concerned with all of the
variables affecting an individual’s response to stress”.
The nurse’s perception influences the care given; therefore,
= Neuman states that the perceptual field of the caregiver and the
client must be assessed.

Major Assumptions
Person
• Neuman presents the concept of person as an open client
system * in reciprocal (shared) interaction with the environment.
• The client may be an individual, family, group, community, or
social issue.
• The client system is a dynamic composite of interrelationships
among:
= physiological / psychological/ sociocultural
= developmental, and spiritual factors
* A system in which there is a continuous flow of input and process,
output and feedback.
• It is a system of organized complexity, where all elements are in
interaction.

Environment
• Neuman defines environment as all the internal and external
factors that surround and influence the client system.
• Neuman identifies three relevant environments:
(1) internal (2) external (3) created.
• The internal environment is intrapersonal, with all interaction
contained within the client. e.g., an infection
• The external environment is interpersonal or extrapersonal, with
all factors arising from outside the client. e.g., financial concerns
• The created environment is unconsciously developed and is used
by the client to support protective coping.
= It is primarily intrapersonal. e.g., unrealistic role expectation

• Health is defined as the condition or degree of system stability
and is viewed as a continuum from wellness to illness.
• When system needs are met, optimal wellness exists.
• When needs are not satisfied, illness exists.
• When the energy needed to support life is not available, death
occurs.
Health

The Adaptation Model of Nursing
• In her theory, Sister Callista Roy’s model sees the:
= individual as a set of interrelated systems who strives to
maintain a balance between various stimuli.
• Additionally, as living systems, persons are in constant
interaction with their environments.
= Between the system and the environment occurs :
= an exchange of information, matter, and energy.
= Characteristics of a system include :
= inputs, outputs, controls, and feedback.

Major Assumptions
Nursing
• Roy defines nursing broadly as a
= “ health care profession that focuses on :
= human life processes and patterns and
= emphasizes promotion of health for
= individuals, families, groups, and society as a whole”
• Specifically, Roy defines nursing according to her model as the
science and practice that:
= expands adaptive abilities and
= enhances person and environmental transformation.
• She identifies nursing activities as the assessment of behavior
and the stimuli that influence adaptation.
• Nursing judgments are based on this assessment, and
interventions are planned to manage the stimuli”.

Major Assumptions
Nursing
• Roy’s goal of nursing is
= “the promotion of adaptation for individuals and groups in
each of the four adaptive modes, thus contributing to :
health, quality of life, and dying with dignity”
• Nursing fills a unique role as a facilitator of adaptation by
1. assessing behavior in each of these four adaptive modes and
factors influencing adaptation and by
2. intervening to promote adaptive abilities and to enhance
environment interactions
Four modes of adaptation defined in Roy Adaptation Model are :
physiologic self-concept
role function interdependence

1. Physiological mode:
• Behavior in this mode is a manifestation of the physiological
activity of all the cells, tissues, organs, & systems of the
body.
• 5 needs serve to promote physiological integrity,
= oxygenation, nutrition, elimination, activity and rest, and
protection
• 4 processes which help maintain physiological integrity
= senses, fluid and electrolytes, neuro, and endocrine
function

2. Self-concept mode: deals with the person’s beliefs & feelings
about himself/herself.
Basic underlying need:
Psychic integrity:
• physical perceptions, ideals, goals, moral/ethical beliefs
Physical self:
• body sensation: ability to express sensations/feel symptoms
• body image: how one sees himself as a physical being
Personal self:
• how one views his qualities, values, worth self-consistency:
= one’s self-description of qualities; also includes self-
organization behavior
= self-ideal/self-expectancy: what one would like to do or be
= moral-ethical-spiritual self: values, beliefs, religion self-
esteem: the value one places on himself/herself

3. Role function mode:
• Involves the position one occupies in society; behaviors
associated with one’s position (role) in society.
• Social integrity Primary role:
= role based on age, sex, developmental state
• Secondary role:
= role(s) a person assumes to complete tasks associated
with a primary role or developmental stage
• Tertiary role: a role freely chosen:
= temporary; associated with accomplishments of tasks or
goals

4. Interdependence mode:
• associated with one’s relationships and interactions with
others and the giving and receiving of love, respect, and value.
• Nurturance and affection significant others:
= intimate relationships (spouse, parent, God)
• Support systems:
= less intimate relationships (coworkers, friends)
• Giving behaviors:
= giving love, nurturance, affection
• Receiving behaviors:
= receiving/taking in love, nurturance, affection

Levels of Adaptation
Integrated Process
• The various modes and subsystems meet the needs of the
environment.
= These are usually stable processes
breathing, spiritual realization, successful relationship).
Compensatory Process
• The cognator and regulator are challenged by the
environment’s needs but are working to meet the needs
= grief, starting with a new job, compensatory breathing
Compromised Process
• The modes and subsystems are not adequately meeting the
environmental challenge
= hypoxia, unresolved loss, abusive relationships

Person
According to Roy, humans are holistic, adaptive systems.
• “As an adaptive system, the human system is described as a
whole with parts that function as unity for some purpose.
• Human systems include people as : individuals or in groups,
including families, organizations, communities, and society as a
whole”
• “Human systems have thinking and feeling capacities, rooted in
consciousness and meaning, by which they :
= adjust effectively to changes in the environment and, in
turn, affect the environment”

Person
• Roy defined the person as the
= main focus of nursing, the recipient of nursing care:
The Internal Processes: Regulator and Cognator.
The regulator subsystem is our physiological coping mechanism.
= It is our bodies' attempt to adapt via regulation of our bodily
processes, including neural, chemical and endocrine systems.
The cognator subsystem is our mental coping mechanism.
A living, complex, adaptive system with
internal processes ( cognator and regulator)
Acting to maintain adaptation in the
four adaptive modes

Health
“Health is a state and a process of being and becoming integrated
and a whole person.
= It is a reflection of adaptation, that is, the interaction of the
person and the environment”

Environment
According to Roy, environment is
• “all the conditions, circumstances, and influences surrounding
and affecting the development and behavior of persons or
groups,
= with particular consideration of the mutuality of person and
earth resources that includes :
focal contextual and residual stimuli”
• “ It is the changing environment [that] stimulates the person
to make adaptive responses”

Focal stimuli
• are those that immediately confront the individual in a particular
situation.
• Focal stimuli for a family include individual needs; the level of
family adaptation; and changes within the family members,
among the members and in the family environment
Contextual stimuli
• are those other stimuli that influence the situation.
Residual stimuli
• include the individual's beliefs or attitudes that may influence
the situation.
 Contextual and residual stimuli for a family system include :
= nurturance
= socialization, and
= support
.

• Adaptation occurs when the total stimuli fall within the
= individual's/family's adaptive capacity, or zone of adaptation.
• The inputs for a family include all of the stimuli that affect the
family as a group.
• The outputs of the family system are three basic goals:
= survival
= continuity
= growth

• Since adaptation level results from the pooled effect of all
other relevant stimuli, the nurse examines the:
Contextual stimuli - stimuli that influence the situation.
Residual stimuli - individual's beliefs or attitudes that may
influence the situation.
Focal stimuli - immediately confront the individual in
a particular situation
will ascertain:
= zone within which positive family coping can take place
= predict when the given stimulus is outside that zone and
will require nursing intervention.

• It advocates the fostering of efficient and effective behavioral
functioning in the patient to prevent illness
Johnson’s Behavioral System Model
• The patient is identified as a behavioral system composed of
seven behavioral subsystems:
= affiliative dependency ingestive eliminative
= sexual aggressive achievement.

• Behavioral system composed of seven behavioral subsystems:
Attachment or affiliative subsystem
• Attachment or affiliative subsystem is the “social inclusion
intimacy and the formation and attachment of a strong social
bond.”
• It is probably the most critical because it forms the basis for all
social organizations.
• On a general level, it provides survival and security.
• Its consequences are social inclusion, intimacy, and the
formation and maintenance of a strong social bond.

Dependency subsystem
• The dependency subsystem is the “approval, attention or
recognition and physical assistance.”
• Broadest sense, it promotes helping behavior that calls for a
nurturing response.
• Its consequences are : approval, attention or recognition, and
physical assistance.
• Developmentally, dependency behavior evolves from almost
total dependence on others to a greater degree of dependence
on self.
• A certain amount of interdependence is essential for the
survival of social groups.

Ingestive subsystem
• An ingestive subsystem is the “emphasis on the meaning and
structures of the social events surrounding the occasion when the
food is eaten.”
• It should not be seen as the input and outputmechanisms of the
system.
• All subsystems are distinct subsystems with their own input and
output mechanisms.
• The ingestive subsystem “has to do with when, how, what, how
much, and under what conditions we eat.”

Eliminative subsystem
• Eliminative subsystem states that “human cultures have
defined different socially acceptable behaviors for excretion of
waste, but the existence of such a pattern remains different
from culture to culture.” (siege)
• It addresses “when, how, and under what conditions we
eliminate.”
• As with the ingestive subsystem, the social and psychological
factors influence the biological aspects of this subsystem and
may conflict with the eliminative subsystem.

Sexual subsystem
• A sexual subsystem is both a biological and social factor that
affects behavior.
• It has the dual functions of procreation and gratification.
• Including, but not limited to, courting and mating, this response
system begins with the development of gender role identity and
includes a broad range of sex-role behaviors.

Aggressive subsystem
• The aggressive subsystem relates to protection and self-
preservation, generating a defense response when there is a
threat to life or territory.
• Its function is protection and preservation.
• Society demands that limits be placed on self-protection modes
and that people and their property be respected and protected.

• The patient is identified as a behavioral system composed of
seven behavioral subsystems:
Achievement subsystem
• The achievement subsystem provokes behavior that tries to
control the environment.
• It attempts to manipulate the environment. Its function is to
control or mastery an aspect of self or environment to some
standard of excellence.
• Areas of achievement behavior include intellectual, physical,
creative, mechanical, and social skills.

• The three functional requirements for each subsystem include
= protection from noxious influences
= provision for a nurturing environment, and
= stimulation for growth.
• An imbalance in any of the behavioral subsystems results in
disequilibrium.
= It is nursing’s role to assist the client to return to a state of
equilibrium.

Major Assumptions
Nursing
• Nursing’s goal is to
= maintain and restore the person’s behavioral system balance
and stability
= to help the person achieve a more optimum level of balance
and functioning.
• An art and a science, nursing supplies :
= external assistance both before and during system balance
disturbance and therefore :
= requires knowledge of order, disorder, and control.
• Nursing activities do not depend on medical authority, but
they are complementary to medicine.

Person
• Johnson viewed the person as a behavioral system with :
= patterned, repetitive, and purposeful ways of behaving
that link the person with the environment.
• The conception of the person is basically a motivational one.
= that innate, biological factors influence the patterning
and motivation of behavior.
= prior experience, learning, and physical and social
stimuli also influence behavior
= be knowledgeable about the physiologic, psychological,
and sociocultural factors operating outside them
( Imogene King: Theory of Goal Attainment :
Nursing is a process of action, reaction, and interaction whereby nurse and
client share information about their perception in the nursing situation.” )

Health
• Johnson perceived health as an elusive ( evade), dynamic ( continuous
productive activity) state influenced by biological, psychological, and
social factors.
• An individual attempts to achieve a balance in this system,
which will lead to functional behavior.
= lack of balance in the structural or functional requirements
of the subsystems leads to poor health.

Health
• Thus, when evaluating “health,” one focuses on the
= behavioral system and system balance and stability
= effective and efficient functioning, and
= behavioral system imbalance and instability.
• The outcomes of behavior system balance are:
(1) a minimum expenditure of energy is required
= implying more energy is available to maintain health, or,
= in the case of illness, energy is available for the biological
processes needed for recovery
(2) continued biologic and social survival are ensured; and
(3) some degree of personal satisfaction accrues

Environment
• In Johnson’s theory, the environment consists of all the
factors that are not part of the individual’s behavioral
system, but that influence the system.
• The nurse may manipulate some aspects of the environment
so the goal of health or behavioral system balance can be
achieved for the patient
• The behavioral system :
= “determines and limits the interaction between the person
and their environment and
= establishes the relationship of the person to the objects,
events and situations in the environment”

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