Dorothea Orem Getting to know the theorist: One of Americas foremost nursing theorists Born in Baltimore, Maryland in 1914

14 Received her Bachelor of Science in Nursing degree from the Catholic University of America (CUA) in 1939 Obtained her Master of Science in Nursing from the same university in 1946 She published her first book in 1971 entitled, Nursing: Concepts of Practice Orem retired in 1984 and resides in Savannah, Georgia and continues working alone and with colleagues on the development of Self-Care Deficit Nursing Theory.

Self-Care Deficit Theory of Nursing Dorothea Orem's theory, first published in 1971, includes three related concepts: self-care, self-care deficit, and nursing systems.

Self-care theory is based on four concepts: self-care, self-care agency, self-care requisites, and therapeutic self-care demand. o Self-care refers to those activities an individual performs independently throughout life to promote and maintain personal well-being. o Self-care agency is the individual's ability to perform self-care activities. It consists of two agents: 1. self-care agent (an individual who performs self-care independently) and 2. a dependent care agent (a person other than the individual who provides the care). Most adults care for themselves, whereas infants and people weakened by illness or disability require assistance with self-care activities. o Self-care requisites, also called self-care needs, are measures or actions taken to provide self-care. There are three categories of self-care requisites: 1. Universal requisites are common to all people. They include maintaining intake and elimination of air, water, and food; balancing rest, solitude, and social interaction; preventing hazards to life and wellbeing; and promoting normal human functioning. 2. Developmental requisites result from maturation or are associated with conditions or events, such as adjusting to a change in body image or to the loss of a spouse. 3. Health deviation requisites result from illness, injury, or disease or its treatment. They include actions such as seeking health care assistance, carrying out prescribed therapies, and learning to live with the effects of illness or treatment.

o Therapeutic self-care demand refers to all self-care activities required to meet existing self-care requisites, or in other words, actions to maintain health and well-being. Self-care deficit results when self-care agency is not adequate to meet the known self-care demand. Orem's self-care deficit theory explains not only when nursing is needed but also how people can be assisted through five methods of helping: acting or doing for, guiding, teaching, supporting, and providing an environment that promotes the individual's abilities to meet current and future demands. Orem identifies three types of nursing systems: 1. Wholly compensatory systems are required for individuals who are unable control and monitor their environment and process information. 2. Partly compensatory systems are designed for individuals who are unable to perform some, but not all, self-care activities. 3. Supportive-educative (developmental) systems are designed for persons who need to learn to perform self-care measures and need assistance to do so. Metaparadigm in Nursing Person o Human functioning is an integrated system comprised of physical, psychological, interpersonal, and social aspects. o Individuals have the potential to be developed and learned. Health o State of physical, mental, and social well-being and not merely the absence of disease or infirmity o Promotion and maintenance of health, treatment of disease or injury, and the prevention of complications Environment o Environment is an external source of influence in the internal interaction of a persons different aspects. Nursing o Helping clients to establish or identify ways to perform self-care activities. o Nursing actions are geared towards the independence of the client. o Nursing is a human service and is based on values.

Sister Callista Roy Getting to know the theorist: Sister Callista Roy is born on October 14, 1939 in Los Angeles, California, member of the Sisters of Saint Joseph of Carondelet In 1963, Roy earned a B.S. in Nursing from Mt. Saint Marys College, Los Angeles and an M.SN. in Pediatric Nursing in 1966, MA and Ph.D. in Sociology in 1973 and 1977, from the University of California, LA While completing her M.A., Roy was challenged by one of her nursing teachers, Dorothy E. Johnson, to create a conceptual model for nursing, and that is when she began to develop her Adaptation Model. The Roy Adaptation Model (RAM) was first published in Nursing Outlook in 1970.

Roy Adaptation Model RAM contains the following key concepts: o The person is adapting in a stable interaction with the environment, either external or internal. o The environment serves as the source of a range of stimuli that will either threaten or promote the persons unique wholeness. o The persons major task is to maintain integrity in face of these environmental stimuli Types of Stimuli Focal those stimuli that are the proximate cause of the situation. Contextual all other stimuli in the internal and external environment, which may or may not affect the situation. Residual stimuli those that also exist and may affect the situation. The three types of stimuli act together and influence the adaptation level. Adaptation Level o Modulated by a persons coping mechanism and control processes; ability to respond positively in a situation; can be described integrated, compensatory, or compromised. The adaptation level is modulated by a persons coping mechanism and control processes. Thus, a person does not respond passively to environmental stimuli. There are two categories of coping mechanism according to Roy namely regulator and the cognator subsystems Regulator subsystem transpires through neutral, chemical and endocrine processes like the increase in vital signs sympathetic response to stress.

Cognator subsystem occurs through cognitive-emotive processes. For instance are the effects of prolonged hospitalization for a four-year old child.

Furthermore, Roy identified two control processes namely the stabilizer subsystem and the innovator subsystem. These two coincides with the regulator and cognator subsystems when a person responds to a stimulus. Innovator control process allows the person to change to higher levels of potential through cognitive and emotional strategies. -the internal subsystem that involves structures and processes for growth Stabilizer control process the structures and processes aimed at system maintenance and involving values and daily activities whereby participants accomplish the primary purpose of the group and contribute to the common purpose of the society.

Adaptive Modes Physiological The way a person responds as a physical being to stimuli from the environment. it involves the body's basic physiologic needs and ways of adapting with regard to Five physiologic needs: fluid and electrolytes; activity and rest; circulation and oxygen; nutrition and elimination; and protection; and Four complex processes: senses; fluid, electrolyte and acid-base balance; neurologic function; and endocrine function. Goal: Physiological integrity Needs: o Individual - degree of wholeness achieved through adaptation to changes in needs o Group adaptation in relation to basic operating resources (participants, capacities, physical facilities, and fiscal sources) Self Concept Psychological and spiritual characteristics of the person consist of all beliefs and feelings that one has performed about oneself. It includes two components: the physical self and the personal self o Physical self - which involves sensation and body image o Personal self - which involves self-ideal, self-consistency, and the moralethical-spiritual self. Goal: Psychological integrity Needs: o Individual Psychic and spiritual integrity o Group group identity integrity

Role Function Primary, secondary, or tertiary roles that a person performs in the society. Determined by the need for social integrity and refers to the performance of duties based on given positions within society. Goal: Social Integrity Needs: o Individual Social integrity o Group Role clarity Interdependence Involves one's relations with significant others and support systems that provide help, affection, and attention. The close relationships of people and their purpose , structure and development individually and in groups and the adaptation potential of these relationships. Goal: Affectional Adequacy Needs: o Individual achieve relational integrity using process of affectional adequacy o Group achieve relational integrity using processes of developmental and resource adequacy Metaparadigm in Nursing Person o A unified biopsychosocial system in constant interaction with a changing environment. o An adaptive system, functions as a whole through interdependence of its parts. Health o A state and process of being and becoming integrated and whole person. Environment o Conditions, circumstances and influences that surround and affect the development and behaviour of the person. Nursing o A theoretical system of knowledge that prescribes a process of analysis and action related to the care of the ill person. o The science and practice that expands adaptive abilities and enhances person and environment transformation.

Martha Rogers Getting to know the theorist: Born on May 12, 1914 in Dallas, Texas Earned her BSN Degree at Knoxville General Hospital School of Nursing (1936); Graduate in Public Health Nursing at George Peabody College (1937); MA at Teachers college, Columbia University, New York (1945); Masters in Public Health at Johns Hopkins University, Baltimore (1952); and Doctorate in Nursing at Johns Hopkins University, Baltimore (1954) She died on March 13, 1994

Science of Unitary Human being Concepts of Rogerss model: Energy field The energy field is the fundamental unit of both the living and nonliving. This energy field "provide a way to perceive people and environment as irreducible wholes". The energy fields continuously vary in intensity, density, and extent. Openness The human field and the environmental field are constantly exchanging their energy. There are no boundaries or barrier that inhibit energy flow between fields. Pattern Pattern is defined as the distinguishing characteristic of an energy field perceived as a single wave "pattern is an abstraction and it gives identity to the field". Pan dimensionality Pan dimensionality is defined as "non linear domain without spatial or temporal attributes". The parameters that human use in language to describe events are arbitrary. The present is relative, there is no temporal ordering of lives. Homeodynamic principles The principles of homeodynamic postulates the way of perceiving unitary human beings. The fundamental unit of the living system is an energy field. Three principle of homeodynamics: Resonancy, Helicy, Integrality Resonance Resonance is an ordered arrangement of rhythm characterizing both human field and environmental field that undergoes continuous dynamic metamorphosis in the human environmental process.

Helicy Helicy describes the unpredictable, but continuous, nonlinear evolution of energy fields as evidenced by non repeating rhythmicties. The principle of Helicy postulates an ordering of the humans evolutionary emergence. Integrality The mutual, continuous relationship of the human energy field and the environmental field. Changes occur by by the continuous repatterning of the human and environmental fields by resonance waves. The fields are one and integrated but unique to each other. Nursing Paradigms Unitary Human Being (Person) A unitary human being is an "irreducible, indivisible, pan dimensional (four-dimensional) energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts" and "a unified whole having its own distinctive characteristics which cannot be perceived by looking at, describing, or summarizing the parts" Environment The environment is an "irreducible, pan dimensional energy field identified by pattern and integral with the human field". The field coexist and are integral. Manifestation emerge from this field and are perceived. Health "an expression of the life process; they are the "characteristics and behavior emerging out of the mutual, simultaneous interaction of the human and environmental fields". Health and illness are the part of the sane continuum. The multiple events taking place along life's axis denote the extent to which man is achieving his maximum health potential and very in their expressions from greatest health to those conditions which are incompatible with the maintaining life process Nursing Two dimensions Independent science of nursing. 1. 2. An organized body of knowledge which is specific to nursing is arrived at by scientific research and logical analysis Art of nursing practice: The creative use of science for the betterment of the human. The creative use of its knowledge is the art of its practice Nursing exists to serve people. It is the direct and overriding responsibility to the society The safe practice of nursing depends on the nature and amount of scientific nursing knowledge the individual brings to practice.the imaginative, intellectual judgment with which such knowledge is made in service to the man kind.

Rogerian theories-Grand theories The theory of paranormal phenomena The theory of rhythmicities The theory of accelerating evolution

Theory of paranormal phenomena This theory explains precognition, djvu, clairvoyance, telepathy, and therapeutic touch Clairvoyance is rational in a four dimensional human field in continuous mutual, simultaneous interaction with a four dimensional world; there is no linear time nor any separation of human and the environmental fields The theory of accelerating evolution Theory postulates that evolutionary change is speeding up and that the range of diversity of life process is widening. Higher wave frequencies are associated with accelerating human development

Theory of Rhythmicity Focus on the human field rhythms (these rhythms are different from the biological, psychological rhythm) Theory deals with the manifestations of the whole unitary man as changes in human sleep wake patterns, indices of human field motion, perception of time passing, and other rhythmic development