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The Environmental Theory

By Florence Nightingale

The goal of nursing is to put the patient in the best condition
for nature to act upon him. - Nightingale
Introduction
Born - 12 May 1820
Founder of modern nursing.
The first nursing theorist.
Also known as "The Lady with the Lamp"
She explained her environmental theory in her famous book Notes on Nursing: What it is, What it is
not.
She was the first to propose nursing required specific education and training.
Her contribution during Crimean war is well-known.
She was a statistician, using bar and pie charts, highlighting key points.
International Nurses Day, May 12 is observed in respect to her contribution to Nursing.
Died - 13 August 1910

Assumptions of Nightingale's Theory
Natural laws
Mankind can achieve perfection
Nursing is a calling
Nursing is an art and a science
Nursing is achieved through environmental alteration
Nursing requires a specific educational base
Nursing is distinct and separate from medicine

Nightingales Canons: Major Concepts
1. Ventilation and warming
2. Light, Noise
3. Cleanliness of rooms/walls
4. Health of houses
5. Bed and bedding
6. Personal cleanliness
7. Variety
8. Chattering hopes and advices
9. Taking food. What food?
10. Petty management/observation

Nursing Paradigms
Nightingale's documents contain her philosophical assumptions and beliefs regarding all elements
found in the metaparadigm of nursing. These can be formed into a conceptual model that has
great utility in the practice setting and offers a framework for research conceptualization.
(Selanders LC, 2010)

Nursing
Nursing is different from medicine and the goal of nursing is to place the patient in the best
possible condition for nature to act.
Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving
situation. They can be done by anyone."
Person
People are multidimensional, composed of biological, psychological, social and spiritual
components.
Health
Health is not only to be well, but to be able to use well every power we have.
Disease is considered as dys-ease or the absence of comfort.
Environment
"Poor or difficult environments led to poor health and disease".
"Environment could be altered to improve conditions so that the natural laws would allow healing to
occur."
Nightingale's Theory and Nursing Practice
Application of Nightingale's theory in practice:
"Patients are to be put in the best condition for nature to act on them, it is the responsibility of
nurses to reduce noise, to relieve patients anxieties, and to help them sleep."
As per most of the nursing theories, environmental adaptation remains the basis of holistic nursing
care.


Helping Arts of Nursing or Perspective Theory
By Ernestine Weidenbach


Introduction
Ernestine Wiedenbach was born in August 18, 1900, in Hamburg, Germany.
Wiedenbach's conceptual model of nursing is called ' The Helping Art of
Clinical Nursing".
Education:
o B.A. from Wellesley College in 1922
o R.N. from Johns Hopkins School of Nursing in 1925
o M.A. from Teachers College, Columbia University in 1934
o Certificate in nurse-midwifery from the Maternity Center Association School for Nurse-
Midwives in New York in 1946..
Career:
o Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity nursing.
o Assistant professor of obstetric nursing in 1954 and an associate professor in 1956.
o She wrote Family-Centered Maternity Nursing in 1958.
o She was influenced by Ida Orlando in her works on the framework.
She died on March 8, 1998.

Concept and definitions
Wiedenbach defined key terms commonly used in nursing practice.
The patient
"Any individual who is receiving help of some kind, be it care, instruction or advice from a member
of the health profession or from a worker in the field of health."
The patient is any person who has entered the healthcare system and is receiving help of some
kind, such as care, teaching, or advice.
The patient need not be ill since someone receiving health-related education would qualify as a
patient.
A need-for-help
A need-for-help is defined as "any measure desired by the patient that has the potential to restore
or extend the ability to cope with various life situations that affect health and wellness.
It is crucial to nursing profession that a need-for-help be based on the individual perception of his
own situation.
Nurse
The nurse is functioning human being.
The nurse no only acts, but thinks and feels as well.
Knowledge
Knowledge encompasses all that has been perceived and grasped by the human mind.
Knowledge may be :
o factual
o speculative or
o practical
Judgment
Clinical Judgment represents the nurses likeliness to make sound decisions.
Sound decisions are based on differentiating fact from assumption and relating them to cause and
effect.
Sound Judgment is the result of disciplined functioning of mind and emotions, and improves with
expanded knowledge and increased clarity of professional purpose.
Nursing Skills
Nursing Skills are carried out to achieve a specific patient-centered purpose rather than completion
of the skill itself being the end goal.
Skills are made up of a variety of actions, and characterized by harmony of movement, precision,
and effective use of self.
Person
Each Person (whether nurse or patient), is endowed with a unique potential to develop self-
sustaining resources.
People generally tend towards independence and fulfillment of responsibilities.
Self-awareness and self-acceptance are essential to personal integrity and self-worth.
Whatever an individual does at any given moment represents the best available judgment for that
person at the time.
Key Elements
Wiedenbach proposes 4 main elements to clinical nursing.
o a philosophy
o a purpose
o a practice and
o the art.

The Philosophy
The nurses' philosophy is their attitude and belief about life and how that effected reality for them.
Wiedenbach believed that there were 3 essential components associated with a nursing
philosophy:
o Reverence for life
o Respect for the dignity, worth, autonomy and individuality of each human being and
o resolution to act on personally and professionally held beliefs.

The Purpose
Nurses purpose is that which the nurse wants to accomplish through what she does.
It is all of the activities directed towards the overall good of the patient.
The Practice
Practice are those observable nursing actions that are affected by beliefs and feelings about
meeting the patients need for help.
The Art
The Art of nursing includes
o understanding patients needs and concerns
o developing goals and actions intended to enhance patients ability and
o directing the activities related to the medical plan to improve the patients condition.
The nurses also focuses on prevention of complications related to reoccurrence or development of
new concerns.
Perspective Theory
Wiedenbach's prescriptive theory is based on three factors:
The central purpose which the practitioner recognizes as essential to the particular discipline.
The prescription for the fullfillment of central purpose.
The realities in the immediate situation that influence the central purpose.

Diagram














Fourteen Activities of Daily Living
By Virginia Henderson
Nursing theories mirror different realities, throughout their development; they
reflected the interests of nurses of that time.
Introduction
The Nightingale of Modern Nursing
Modern-Day Mother of Nursing.
"The 20th century Florence Nightingale."
Born in Kansas City, Missouri, in 1897.
Received a Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital,
Washington, D.C. in 1921.
Worked at the Henry Street Visiting Nurse Service for 2 years after graduation.
In 1923, started teaching nursing at the Norfolk Protestant Hospital in Virginia
In 1929, entered Teachers College at Columbia University for Bachelors Degree in 1932, Masters
Degree in 1934.
Joined Columbia as a member of the faculty, remained until 1948.
Since 1953, a research associate at Yale University School of Nursing.
recipient of numerous recognitions.
Her work influenced the nursing profession throughout the world.
a well known nursing educator and a prolific author.
honorary doctoral degrees from the Catholic University of America, Pace University, University of
Rochester, University of Western Ontario, Yale University
In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical
Library Association.
Died: March 19, 1996.
In 1939, she revised: Harmers classic textbook of nursing for its 4th edition, and later wrote the
5th; edition, incorporating her personal definition of nursing (Henderson,1991)
Hendersons Theory Background
Hendersons concept of nursing was derived form her practice and education therefore, her work is
inductive..
She called her definition of nursing her concept (Henderson1991)
She emphasized the importance of increasing the patients independence so that progress after
hospitalization would not be delayed (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).
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 definition of nursing was one of the first statements clearly delineating nursing from medicine:
"The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to 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, 1966).

The 14 components
Breathe normally. Eat and drink adequately.
Eliminate body wastes.
Move and maintain desirable postures.
Sleep and rest.
Select suitable clothes-dress and undress.
Maintain body temperature within normal range by adjusting clothing and modifying environment
Keep the body clean and well groomed and protect the integument
Avoid dangers in the environment and avoid injuring others.
Communicate with others in expressing emotions, needs, fears, or opinions.
Worship according to ones faith.
Work in such a way that there is a sense of accomplishment.
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.
The first 9 components are physiological. The tenth and fourteenth are psychological aspects of
communicating and learning The eleventh component is spiritual and moral The twelfth and thirteenth
components are sociologically oriented to occupation and recreation

Assumption
The major assumptions of the theory are:
"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.
Hendersons theory and the four major concepts
1. 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.
2. 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
3. Health
Definition based on individuals 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 individuals ability to meet these needs independently?
4. 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."
Henderson's classic definition of nursing:
"I say that the nurse does for others what they would do for themselves if they had the strength, the
will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or
her as soon as possible."
The nurse is expected to carry out physicians therapeutic plan Individualized care is the result of
the nurses creativity in planning for care.
Use nursing research
o Categorized Nursing : nursing care
o Non nursing: ordering supplies, cleanliness and serving food.
In the Nature of Nursing that the nurse is and should be legally, an independent practitioner and
able to make independent judgments as long as s/he is not diagnosing, prescribing treatment for
disease, or making a prognosis, for these are the physicians function.
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 patients skin and supplement his strength
will or knowledge according to his needs.
And nurse has responsibility to assess the needs of the individual patient, help individual meet their
health need, and or provide an environment in which the individual can perform activity unaided
Henderson's classic definition of nursing "I say that the nurse does for others what they would do
for themselves if they had the strength, the will, and the knowledge.
But I go on to say that the nurse makes the patient independent of him or her as soon as possible."


Twenty-One Nursing Problems
Faye Glenn Abdellah


Introduction
Faye Glenn Abdellah, pioneer nursing researcher, helped transform
nursing theory, nursing care and nursing education
Birth:1919
Dr Abdellah worked as Deputy Surgeon General in US and Chief Nurse Officer for the US Public
Health Service , Department of Health and human services, Washington, D.C.
She was a leader in nursing research and has over one hundred publications related to nursing
care, education for advanced practice in nursing and nursing research.
According to her, nursing is based on an art and science that mould the attitudes, intellectual
competencies, and technical skills of the individual nurse into the desire and ability to help people ,
sick or well, cope with their health needs.
As per Abdellah, nursing as a comprehensive service includes:
1. Recognizing the nursing problems of the patient
2. Deciding the appropriate course of action to take in terms of relevant nursing principles
3. Providing continuous care of the individuals total needs
4. Providing continuous care to relieve pain and discomfort and provide immediate security for the
individual
5. Adjusting the total nursing care plan to meet the patients individual needs
6. Helping the individual to become more self directing in attaining or maintaining a healthy state of
mind & body
7. Instructing nursing personnel and family to help the individual do for himself that which he can
within his limitations
8. Helping the individual to adjust to his limitations and emotional problems
9. Working with allied health professions in planning for optimum health on local, state, national and
international levels
10. Carrying out continuous evaluation and research to improve nursing techniques and to develop
new techniques to meet the health needs of people
(In 1973, the item 3, - providing continuous care of the individuals total health needs was eliminated.)

Philosophical Underpinnings of the theory
Abdellahs patient-centred approach to nursing was developed inductively from her practice and is
considered a human needs theory.
The theory was created to assist with nursing education and is most applicable to the education of
nurses.
Although it was intended to guide care of those in the hospital, it also has relevance for nursing
care in community settings.

MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS
The language of Abdellahs framework is readable and clear.
She uses the term she for nurses, he for doctors and patients, and refers to the object of nursing
as patient rather than client or consumer.
She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a
nurses prerogative.
Assumptions were related to
change and anticipated changes that affect nursing;
the need to appreciate the interconnectedness of social enterprises and social problems;
the impact of problems such as poverty, racism, pollution, education, and so forth on health care
delivery;
changing nursing education
continuing education for professional nurses
development of nursing leaders from under reserved groups
Abdellah and colleagues developed a list of 21 nursing problems.They also identified 10 steps to identify the
clients problems. 11 nursing skills to be used in developing a treatment typology

10 steps to identify the clients problems
Learn to know the patient
Sort out relevant and significant data
Make generalizations about available data in relation to similar nursing problems presented by
other patients
Identify the therapeutic plan
Test generalizations with the patient and make additional generalizations
Validate the patients conclusions about his nursing problems
Continue to observe and evaluate the patient over a period of time to identify any attitudes and
clues affecting his behavior
Explore the patients and familys reaction to the therapeutic plan and involve them in the plan
Identify how the nurses feels about the patients nursing problems
Discuss and develop a comprehensive nursing care plan
11 nursing skills
Observation of health status
Skills of communication
Application of knowledge
Teaching of patients and families
Planning and organization of work
Use of resource materials
Use of personnel resources
Problem-solving
Direction of work of others
Therapeutic use of the self
Nursing procedure

21 NURSING PROBLEMS
Three major categories
Physical, sociological, and emotional needs of clients
Types of interpersonal relationships between the nurse and patient
Common elements of client care
Basic to all patients
To maintain good hygiene and physical comfort
To promote optimal activity: exercise, rest and sleep
To promote safety through the prevention of accidents, injury, or other trauma and through the
prevention of the spread of infection
To maintain good body mechanics and prevent and correct deformity
Sustenal Care Needs
To facilitate the maintenance of a supply of oxygen to all body cells
To facilitate the maintenance of nutrition of all body cells
To facilitate the maintenance of elimination
To facilitate the maintenance of fluid and electrolyte balance
To recognize the physiological responses of the body to disease conditions
To facilitate the maintenance of regulatory mechanisms and functions
To facilitate the maintenance of sensory function.
Remedial Care Needs
To identify and accept positive and negative expressions, feelings, and reactions
To identify and accept the interrelatedness of emotions and organic illness
To facilitate the maintenance of effective verbal and non verbal communication
To promote the development of productive interpersonal relationships
To facilitate progress toward achievement of personal spiritual goals
To create and / or maintain a therapeutic environment
To facilitate awareness of self as an individual with varying physical , emotional, and
developmental needs
Restorative Care Needs
To accept the optimum possible goals in the light of limitations, physical and emotional
To use community resources as an aid in resolving problems arising from illness
To understand the role of social problems as influencing factors in the case of illness

ABDELLAHS THEORY AND THE FOUR MAJOR CONCEPTS
1. Nursing
Nursing is a helping profession.
In Abdellahs model, nursing care is doing something to or for the person or providing information
to the person with the goals of meeting needs, increasing or restoring self-help ability, or alleviating
impairment.
Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing
judgment.
She considers nursing to be comprehensive service that is based on art and science and aims to
help people, sick or well, cope with their health needs.
2. Person
Abdellah describes people as having physical, emotional, and sociological needs. These needs
may overt, consisting of largely physical needs, or covert, such as emotional and social needs.
Patient is described as the only justification for the existence of nursing.
Individuals (and families) are the recipients of nursing
Health, or achieving of it, is the purpose of nursing services.
3. Health
In PatientCentered Approaches to Nursing, Abdellah describes health as a state mutually
exclusive of illness.
Although Abdellah does not give a definition of health, she speaks to total health needs and a
healthy state of mind and body in her description of nursing as a comprehensive service.
4. Society and Environment
Society is included in planning for optimum health on local, state, national, and international
levels. However, as she further delineated her ideas, the focus of nursing service is clearly the
individual.
The environment is the home or community from which patient comes.


Carative Nursing
By Jean Watson


Introduction
Theorist was born in West Virginia, US
Educated: BSN, University of Colorado, 1964, MS, University of Colorado,
1966, PhD, University of Colorado, 1973
Distinguished Professor of Nursing and endowed Chair in Caring Science at the University of
Colorado Health Sciences Center.
Fellow of the American Academy of Nursing.
Previously, Dean of Nursing at the University Health Sciences Center and President of the National
League for Nursing
Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in
educational psychology and counseling. She has six (6) Honorary Doctoral Degrees.
Her research has been in the area of human caring and loss.
In 1988, her theory was published in nursing: human science and human care.
The seven assumptions
Caring can be effectively demonstrated and practiced only interpersonally.
Caring consists of carative factors that result in the satisfaction of certain human needs.
Effective caring promotes health and individual or family growth.
Caring responses accept person not only as he or she is now but as what he or she may become.
A caring environment is one that offers the development of potential while allowing the person to
choose the best action for himself or herself at a given point in time.
Caring is more healthogenic than is curing. A science of caring is complementary to the science
of curing.
The practice of caring is central to nursing.
The ten primary carative factors
1. The formation of a humanistic- altruistic system of values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to ones self and to others.
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive and negative feelings.
6. The systematic use of the scientific problem-solving method for decision making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and
spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces.

The first three carative factors form the philosophical foundation for the science of caring. The remaining
seven carative factors spring from the foundation laid by these first three.
1. The formation of a humanistic- altruistic system of values
Begins developmentally at an early age with values shared with the parents.
Mediated through ones own life experiences, the learning one gains and exposure to the
humanities.
Is perceived as necessary to the nurses own maturation which then promotes altruistic behavior
towards others.
2. Faith-hope
Is essential to both the carative and the curative processes.
When modern science has nothing further to offer the person, the nurse can continue to use faith-
hope to provide a sense of well-being through beliefs which are meaningful to the individual.
3. Cultivation of sensitivity to ones self and to others
Explores the need of the nurse to begin to feel an emotion as it presents itself.
Development of ones own feeling is needed to interact genuinely and sensitively with others.
Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and
self-actualization, in both the nurse and those with whom the nurse interacts.
The nurses promote health and higher level functioning only when they form person to person
relationship.
4. Establishing a helping-trust relationship
Strongest tool is the mode of communication, which establishes rapport and caring.
Characteristics needed to in the helping-trust relationship are:
o Congruence
o Empathy
o Warmth
Communication includes verbal, nonverbal and listening in a manner which connotes empathetic
understanding.
5. The expression of feelings, both positive and negative
Feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring
relationship.
Awareness of the feelings helps to understand the behavior it engenders.
6. The systematic use of the scientific problem-solving method for decision making
The scientific problem- solving method is the only method that allows for control and prediction,
and that permits self-correction.
The science of caring should not be always neutral and objective.
7. Promotion of interpersonal teaching-learning
The caring nurse must focus on the learning process as much as the teaching process.
Understanding the persons perception of the situation assist the nurse to prepare a cognitive plan.
8. Provision for a supportive, protective and /or corrective mental, physical, socio-cultural and
spiritual environment
Watson divides these into eternal and internal variables, which the nurse manipulates in order to
provide support and protection for the persons mental and physical well-being.
The external and internal environments are interdependent.
Nurse must provide comfort, privacy and safety as a part of this carative factor.
9. Assistance with the gratification of human needs
It is based on a hierarchy of need similar to that of the Maslows.
Each need is equally important for quality nursing care and the promotion of optimal health.
All the needs deserve to be attended to and valued.
Watsons ordering of needs
Lower order needs (biophysical needs)
o The need for food and fluid
o The need for elimination
o The need for ventilation
Lower order needs (psychophysical needs)
o The need for activity-inactivity
o The need for sexuality
Higher order needs (psychosocial needs)
o The need for achievement
o The need for affiliation
o Higher order need (intrapersonal-interpersonal need)
o The need for self-actualization
10. Allowance for existential-phenomenological forces
Phenomenology is a way of understanding people from the way things appear to them, from their
frame of reference.
Existential psychology is the study of human existence using phenomenological analysis.
This factor helps the nurse to reconcile and mediate the incongruity of viewing the person
holistically while at the same time attending to the hierarchical ordering of needs.
Thus the nurse assists the person to find the strength or courage to confront life or death.
Watsons theory and the four major concepts
1. Human being
Human being refers to .. 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. He, human is viewed as greater than and different from, the sum of his or her
parts.
2. Health
Watson adds the following three elements to WHO definition of health:
o A high level of overall physical, mental and social functioning
o A general adaptive-maintenance level of daily functioning
o The absence of illness (or the presence of efforts that leads its absence)
3. Environment/society
According to Watson, caring (and nursing) has existed in every society.
A caring attitude is not transmitted from generation to generation.
It is transmitted by the culture of the profession as a unique way of coping with its environment.
4. Nursing
Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring
health.
It focuses on health promotion and treatment of disease. She believes that holistic health care is
central to the practice of caring in nursing.
She defines nursing as..
a human science of persons and human health-illness experiences that are mediated by
professional, personal, scientific, esthetic and ethical human transactions.






Self-Care Theory
Dorothea Orem (1914-2007)


Introduction
One of foremost nursing theorists.
Born 1914 in Baltimore.
Earned her diploma at Providence Hospital Washington, DC
1939 BSN Ed., Catholic University of America
1945 MSN Ed., Catholic University of America
Involved in nursing practice, nursing service, and nursing education
During her professional career, she worked as a staff nurse, private duty nurse, nurse educator
and administrator and nurse consultant
Received honorary Doctor of Science degree in 1976
Published first formal articulation of her ideas in Nursing: Concepts of Practice in 197, second in
1980, and in 1995.
Development of Theory
1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State
Board of Health.
Her goal was to upgrade the quality of nursing in general hospitals throughout the state. During this
time she developed her definition of nursing practice.
1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant
professor of nursing education at CUA. She continued to develop her concept of nursing and self
care during this time.
Orems Nursing: Concept of Practice was first published in 1971 and subsequently in 1980, 1985,
1991, 1995, and 2001.

Major Assumptions
People should be self-reliant and responsible for their own care and others in their family needing
care
People are distinct individuals
Nursing is a form of action interaction between two or more persons
Successfully meeting universal and development self-care requisites is an important component of
primary care prevention and ill health
A persons knowledge of potential health problems is necessary for promoting self-care behaviors
Self care and dependent care are behaviors learned within a socio-cultural context
Definition of Domain Concept
1. Nursing is art, a helping service, and a technology
Actions deliberately selected and performed by nurses to help individuals or groups under their
care to maintain or change conditions in themselves or their environments
Encompasses the patients perspective of health condition ,the physicians perspective , and the
nursing perspective
Goal of nursing to render the patient or members of his family capable of meeting the patients
self care needs
To maintain a state of health
To regain normal or near normal state of health in the event of disease or injury
To stabilize ,control ,or minimize the effects of chronic poor health or disability
2. Health health and healthy are terms used to describe living things
It is when they are structurally and functionally whole or sound wholeness or integrity. .includes
that which makes a person human,operating in conjunction with physiological and
psychophysiological mechanisms and a material structure and in relation to and interacting with
other human beings.
3. Environment
environment components are enthronement factors, enthronement elements, conditions, and
developed environment
4. Nursing client - A human being who has "health related /health derived limitations that render him
incapable of continuous self care or dependent care or limitations that result in ineffective /
incomplete care.
A human being is the focus of nursing only when a self care requisites exceeds self care
capabilities

OREMS GENERAL THEORY OF NURSING
Orems general theory of nursing in three related parts:
Theory of self care
Theory of self care deficit
Theory of nursing system

A. Theory of Self Care
This theory Includes:
Self care practice of activities that individual initiates and perform on their own behalf in
maintaining life ,health and well being
Self care agency is a human ability which is "the ability for engaging in self care" -conditioned by
age developmental state, life experience sociocultural orientation health and available resources
Therapeutic self care demand "totality of self care actions to be performed for some duration in
order to meet self care requisites by using valid methods and related sets of operations and
actions"
Self care requisites-action directed towards provision of self care. 3 categories of self care
requisites are-
1. Universal
Developmental
Health deviation
2. Universal self care requisites
Associated with life processes and the maintenance of the integrity of human structure and
functioning
Common to all , ADL
Identifies these requisites as:
Maintenance of sufficient intake of air ,water, food
Provision of care assoc with elimination process
Balance between activity and rest, between solitude and social interaction
Prevention of hazards to human life well being and
Promotion of human functioning
3. Developmental self care requisites
Associated with developmental processes/ derived from a condition. Or associated with an event
o E.g. adjusting to a new job
o adjusting to body changes
Health deviation self care
o Required in conditions of illness, injury, or disease .these include:--
o Seeking and securing appropriate medical assistance
o Being aware of and attending to the effects and results of pathologic conditions
o Effectively carrying out medically prescribed measures
o Modifying self concepts in accepting oneself as being in a particular state of health and in
specific forms of health care
o Learning to live with effects of pathologic conditions
B. Theory of self care deficit
Specifies when nursing is needed
Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited
in the provision of continuous effective self care. Orem identifies 5 methods of helping:
o Acting for and doing for others
o Guiding others
o Supporting another
o Providing an environment promoting personal development in relation to meet future
demands
o Teaching another
C. Theory of Nursing Systems
Describes how the patients self care needs will be met by the nurse , the patient, or both
Identifies 3 classifications of nursing system to meet the self care requisites of the patient:-
Wholly compensatory system
Partly compensatory system
Supportive educative system
Design and elements of nursing system define
Scope of nursing responsibility in health care situations
General and specific roles of nurses and patients
Reasons for nurses relationship with patients and
The kinds of actions to be performed and the performance patterns and nurses and patients
actions in regulating patients self care agency and in meeting their self care demand
Orem recognized that specialized technologies are usually developed by members of the health
profession
A technology is systematized information about a process or a method for affecting some desired
result through deliberate practical endeavor ,with or without use of materials or instruments

Diagram
Self care deficit
Nursing system



Self care









Four Conservation Principles
Myra Estrine Levine


Introduction
Born in Chicago
Very fond of her father who was often ill and frequently hospitalized with GI
problem. This was the reason of choosing nursing as a career
Also called as renaissance women-highly principled, remarkable and committed to patients quality
of care
Died in 1996
Educational Achievement
Diploma in nursing:-Cook county SON, Chicago, 1944
BSN:-University of Chicago,1949
MSN:-Wayne state University, Detroit, 1962
Publication:-An Introduction to Clinical Nursing, 1969,1973 & 1989
Received honorary doctorate from Loyola University in 1992
Achievements
Clinical experience in OT technique and oncology nursing
Civilian nurse at the Gardiner general hospital
Director of nursing at Drexel home in Chicago
Clinical instructor at Bryan memorial hospital in Lincoln, Nebraska
Administrative supervisor at university of Chicago
Chairperson of clinical nursing at cook country SON
Visiting professor at Tel Aviv university in Israel
Conservational model
Goal: To promote adaptation and maintain wholeness using the principles of conservation
Model guides the nurse to focus on the influences and responses at the organismic level
Nurse accomplishes the goal of model through the conservation of energy, structure and personal
and social integrity
Adaptation
Every individual has a unique range of adaptive responses
The responses will vary by heredity, age, gender or challenges of illness experiences
Example: The response to weakness of cardiac muscle is an increased heart rate, dilation of
ventricle and thickening of myocardial muscle
While the responses are same, the timing and manifestation of organismic responses will be
unique for each individual pulse rate)
An ongoing process of change in which patient maintains his integrity within the realities of
environment
Achieved through the "frugal, economic, contained and controlled use of environmental resources
by individual in his or her best interest"
Wholeness
Exist when the interaction or constant adaptations to the environment permits the assurance of
integrity
Promoted by use of conservation principle
Conservation
The product of adaptation
"Keeping together "of the life systems or the wholeness of the individual
Achieving a balance of energy supply and demand that is with in the unique biological realities of
the individual

Nursings paradigm
1. Person
A holistic being who constantly strives to preserve wholeness and integrity
A unique individual in unity and integrity, feeling, believing, thinking and whole system of system
2. Environment
Competes the wholeness of person
Internal
Homeostasis
Homeorrhesis
External
Preconceptual
Operational
Conceptual

Internal Environment
Homeostasis: A state of energy sparing that also provide the necessary baselines for a multitude
of synchronized physiological and psychological factors
A state of conservation
Homeorrhesis: A stabilized flow rather than a static state
Emphasis the fluidity of change within a space-time continuum
Describe the pattern of adaptation, which permit the individuals body to sustain its well being with
the vast changes which encroach upon it from the environment
External Environment
Preconceptual: Aspect of the world that individual are able to intercept
Operational: Elements that may physically affects individuals but not perceived by hem: radiation,
micro-organism and pollution
Conceptual: Part of person's environment including cultural patterns characterized by spiritual
existence, ideas, values, beliefs and tradition
Person and environment
Adaptation
Organismic response
Conservation
Adaptation
Characteristics
Historicity: Adaptations are grounded in history and await the challenges to which they respond
Specificity: Individual responses and their adaptive pattern varies on the base of specific genetic
structure
Redundancy: Safe and fail options available to the individual to ensure continued adaptation
Organismic response
A change in behavior of an individual during an attempt to adapt to the environment
Help individual to protect and maintain their integrity
They co-exist
They are four types:
1. Flight or fight: An instantaneous response to real or imagined threat, most primitive response
2. Inflammatory: response intended to provide for structural integrity and the promotion of healing
3. Stress: Response developed over time and influenced by each stressful experience
encountered by person
4. Perceptual: Involves gathering information from the environment and converting it in to a
meaning experience
Nine models of guided assessment
Vitals signs
Body movement and positioning
Ministration of personal hygiene needs
Pressure gradient system in nursing interventions
Nursing determination in provision of nutritional needs
Pressure gradient system in nursing
Local application of heat and cold
Administration of medicine
Establishing an aseptic environment
Assumption
The nurse creates an environment in which healing could occur
A human being is more than the sum of the part
Human being respond in a predictable way
Human being are unique in their responses
Human being know and appraise objects ,condition and situation
Human being sense ,reflects, reason and understand
human being action are self determined even when emotional
Human being are capable of prolonging reflection through such strategists raising questions
Levines work & Characteristics of theory
Theories can interrelate concepts in such a way as to create a different way of looking at a
particular phenomenon
The concept of illness adaptation, using interventions, and the evaluation of nursing interventions
are interrelated .they are combined to look at nursing care in a different way (more comprehensive
view incorporating total patient care) form previous time.
Theories must be logical in nature.
Levines idea about nursing care are organized in such a way as to b sequential and logical. they
can be used to explain the consequences of nursing action
Theories should be relatively simple yet generalizable.
Levines theory is easy to use .
Its major elements are easily comprehensible and the relation ship have the potential for being
complex but are easily manageable
Certain isolated aspect of the theory are the generalizable i.e. those related to the conservational
principles
Theories can be the bases for hypotheses that can be tested.
Levines idea can be tested
Hypothesis can be derived from them .
The principle of conservation are specific enough to be testable
Levines work & Characteristics of theory
Theories contribute to and assist in increasing the general body of knowledge within the discipline
through the research implemented to validate them.
Since Levines idea have not yet been widely researched ,it is hard o determine the contribution to
the general body of knowledge with in the discipline
Theories can be utilized by the practitioner to guide and improve their practice.
Paula E.Crawford-gamble :-successfully applied Levines theory to the female patient undergoing
surgery for the traumatic amputation of the fingers
These ideas lend themselves to use in practice particularly in acute care setting
Theories must be consistent with other validated theories, laws and principles but will leave open
unanswered questions that need to be investigated .
Levines ideas seem to be consistent with other theories, laws and principles particularly those
from the humanities and sciences
Conservational Principle
Conservation of energy
Conservation of structural integrity
Conservation of personal integrity
Conservation of social integrity
1. Conservation of energy
Refers to balancing energy input and output to avoid excessive fatigue
includes adequate rest, nutrition and exercise
Example:
Availability of adequate rest
Maintenance of adequate nutrition
2. Conservation of structural integrity
Refers to maintaining or restoring the structure of body preventing physical breakdown And
promoting healing
Example:
Assist patient in ROM exercise
Maintenance of patients personal hygiene
3. Conservation of personal integrity
Recognizes the individual as one who strives for recognition, respect, self awareness, selfhood and
self determination
Example:
Recognize and protect patients space needs
4. Conservation of social integrity
An individual is recognized as some one who resides with in a family, a community ,a religious
group, an ethnic group, a political system and a nation
Example:
Position patient in bed to foster social interaction with other patients
Avoid sensory deprivation
Promote patients use of news paper, magazines, radio. TV
Provide support and assistance to family

3. Health
Health is a wholeness and successful adaptation
It is not merely healing of an afflicted part ,it is return to daily activities, selfhood and the ability of
the individual to pursue once more his or her own interest without constraints
Disease: It is unregulated and undisciplined change and must be stopped or death will ensue

4. Nursing
"Nursing is a profession as well as an academic discipline, always practiced and studied in concert
with all of the disciplines that together from the health sciences"
The human interaction relying on communication ,rooted in the organic dependency of the
individual human being in his relationships with other human beings
Nursing involves engaging in "human interactions"
Diagram




















Science of Unitary Human Beings
Martha Roger


Introduction
Born :May 12, 1914, Dallas, Texas
Diploma : Knoxville General Hospital School of Nursing(1936)
Graduation in Public Health Nursing : George Peabody College, TN, 1937
MA :Teachers college, Columbia university, New York, 1945
MPH :Johns Hopkins University, Baltimore, MD, 1952
Doctorate in nursing :Johns Hopkins University, Baltimore, 1954
Fellowship: American academy of nursing
Position: Professor Emerita, Division of Nursing, New York University, Consultant, Speaker
Died : March 13 , 1994
Publications of Martha Rogers
Theoretical basis of nursing (Rogers 1970)
Nursing science and art :a prospective (Rogers 1988)
Nursing :science of unitary, irreducible, human beings update (Rogers 1990)
Vision of space based nursing (Rogers 1990)
Rogers nursing theory
Nursing is both a science and art. the uniqueness of nursing, like that of any other science, lies in
the phenomenon central to its focus.
Nurses long established concern with the people and the world they live is in a natural forerunner
of an organized abstract system encompassing people and the environments.
The irreducible nature of individuals is different from the sum of the parts.
The integral ness of people and the environment that coordinate with a multidimensional universe
of open systems points to a new paradigm the identity of nursing as a science.
The purpose of nurses is to promote health and well-being for all persons wherever they are.
Evolution of abstract system
The development of the abstract system was strongly influenced by an early grounding in arts and
background of science and her keen interest in space
The science of unitary human beings originated as a synthesis of facts and ideas from multiple
sources of knowledge
The uniqueness is in the central phenomena : people and environment
The Rogerian view of a causality emerges from an infinite universe of open system.
Overview of Rogerian model
Rogers model provides the way of viewing the unitary human being
Humans are viewed as integral with the universe
The unitary human being and the environment are one ,not dichotomous
Nursing focus on people and the manifestations that emerge from the mutual human
/environmental field process
Change of pattern and organization of the human field and the environmental field is propagated by
waves
The manifestations of the field patterning that emerge are observable events
The identification of the pattern provide knowledge and understanding of human experience
Basic characteristics which describes the life process of human: energy field, openness, pattern,
and pan dimensionality
Basic concepts include unitary human being, environment, and homeodynamic principles
Concepts of Rogers 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 varies 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
waves
"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
o Resonancy
o Helicy
o 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
Integrality cover 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
1. 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"
The people has the capacity to participate knowingly and probabilistically in the process of change
2. 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.
3. Health
Rogers defined health as 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
4. Nursing
The concept Nursing encompasses two dimensions Independent science of nursing
An organized body of knowledge which is specific to nursing is arrived at by scientific research and
logical analysis
Art of nursing practice:
o The creative use of science for the betterment of the human
o 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
People needs knowledgeable nursing








Behaviour System Model
Dorothy E. Johnson

Introduction
Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia.
B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her
M.P.H. from Harvard University in Boston in 1948.
From 1949 till retirement in 1978 she was an assistant professor of pediatric
nursing, an associate professor of nursing, and a professor of nursing at the
University of California in Los Angeles.
Johnson stressed the importance of research-based knowledge about the effect of nursing care on
clients.
Behavior system model
Dorothy first proposed her model of nursing care in 1968 as fostering of the efficient and effective
behavioral functioning in the patient to prevent illness".
She also stated that nursing was concerned with man as an integrated whole and this is the
specific knowledge of order we require.
In 1980 Johnson published her conceptualization of behavioral system of model for nursingwhere
she explains her definitions of the behavioral system model.
Definition of nursing
She defined nursing as an external regulatory force which acts to preserve the organization and integration
of the patients behaviors at an optimum level under those conditions in which the behaviors constitutes a
threat to the physical or social health, or in which illness is found

Four goals of nursing are to assist the patient:
1. Whose behavior commensurate with social demands.
2. Who is able to modify his behavior in ways that it supports biological imperatives
3. Who is able to benefit to the fullest extent during illness from the physicians knowledge and skill.
4. Whose behavior does not give evidence of unnecessary trauma as a consequence of illness
Assumptions
There are several layers of assumptions that Johnson makes in the development of conceptualization of the
behavioral system model viz.
Assumptions about system
Assumptions about structure
Assumptions about functions
Assumptions about system
There are 4 assumptions of system:
1. First, there is organization, interaction, interdependency and integration of the parts and elements
of behaviors that go to make up the system
2. A system tends to achieve a balance among the various forces operating within and upon it', and
that man strive continually to maintain a behavioral system balance and steady state by more or
less automatic adjustments and adaptations to the natural forces impinging upon him.
3. A behavioral system, which both requires and results in some degree of regularity and constancy in
behavior, is essential to man that is to say, it is functionally significant in that it serves a useful
purpose, both in social life and for the individual.
4. Last, system balance reflects adjustments and adaptations that are successful in some way and to
some degree..
Assumptions about structure and function of each subsystem
from the form the behavior takes and the consequences it achieves can be inferred what drive
has been stimulated or what goal is being sought
Each individual has a predisposition to act with reference to the goal, in certain ways rather than
the other ways. This predisposition is called as set.
Each subsystem has a repertoire of choices or scope of action
The fourth assumption is that it produce observable outcome that is the individuals behavior.
Each subsystem has three functional requirements
1. System must be protected" from noxious influences with which system cannot cope.
2. Each subsystem must be nurtured through the input of appropriate supplies from the
environment.
3. Each subsystem must be stimulated for use to enhance growth and prevent stagnation.
These behaviors are orderly, purposeful and predictable and sufficiently stable and recurrent to be
amenable to description and explanation
Johnsons Behavioral Subsystem
Attachment or affiliative subsystem: social inclusion intimacy and the formation and attachment
of a strong social bond.
Dependency subsystem: approval, attention or recognition and physical assistance
Ingestive subsystem: the emphasis is on the meaning and structures of the social
events surrounding the occasion when the food is eaten
Eliminative subsystem: 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.
Sexual subsystem:" both biological and social factor affect the behavior in the sexual subsystem
Aggressive subsystem: " it relates to the behaviors concerned with protection and self
preservation Johnson views aggressive subsystem as one that generates defensive response from
the individual when life or territory is being threatened
Achievement subsystem: " provokes behavior that attempt to control the environment
intellectual, physical, creative, mechanical and social skills achievement are some of the areas that
Johnson recognizes".

Representation of Johnson's Model





Affiliation
Dependency
Sexuality
Aggression
Elimination
Ingestion
Achievement



Adaptation Model
By Sister Callista Roy

Introduction
Sr.Callista Roy, a prominent nurse theorist, writer, lecturer, researcher and
teacher
Goal ----- Set --- Choice of Behavior --- Behavior

Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill
Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy
she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los Angeles
in 1963.
a master's degree program in pediatric nursing at the University of California ,Los Angeles in 1966.
She also earned a masters and PhD in Sociology in 1973 and 1977 ,respectively.
Sr. Callista had the significant opportunity of working with Dorothy E. Johnson
Johnson's work with focusing knowledge for the discipline of nursing convinced Sr. Callista of the
importance of describing the nature of nursing as a service to society and prompted her to begin
developing her model with the goal of nursing being to promote adaptation.
She joined the faculty of Mount St. Mary's College in 1966, teaching both pediatric and maternity
nursing.
She organized course content according to a view of person and family as adaptive systems.
She introduced her ideas about Adaptation Nursing as the basis for an integrated nursing
curriculum.
Goal of nursing to direct nursing education, practice and research
Model as a basis of curriculum impetus for growth--Mount St. Marys College
1970-The model was implemented in Mount St. Marys school
1971- she was made chair of the nursing department at the college.
Influencing Factors
Family
Education
Religious Background
Mentors
Clinical Experience
THEORY DESCRIPTION
The central questions of Roys theory are:
o Who is the focus of nursing care?
o What is the target of nursing care?
o When is nursing care indicated?
Roys first ideas appeared in a graduate paper written at UCLA in 1964.
Published these ideas in "Nursing outlook" in 1970
Subsequently different components of her framework crystallized during 1970s, 80s, and 90s
Over the years she identified assumptions on which her theory is based.
Explicit assumptions (Roy 1989; Roy and Andrews 1991)
The person is a bio-psycho-social being.
The person is in constant interaction with a changing environment.
To cope with a changing world, person uses both innate and acquired mechanisms which are
biological, psychological and social in origin.
Health and illness are inevitable dimensions of the persons life.
To respond positively to environmental changes, the person must adapt.
The persons adaptation is a function of the stimulus he is exposed to and his adaptation level
The persons adaptation level is such that it comprises a zone indicating the range of stimulation
that will lead to a positive response.
The person has 4 modes of adaptation: physiologic needs, self- concept, role function and inter-
dependence.
"Nursing accepts the humanistic approach of valuing other persons opinions, and view points"
Interpersonal relations are an integral part of nursing
There is a dynamic objective for existence with ultimate goal of achieving dignity and integrity.
Implicit assumptions
A person can be reduced to parts for study and care.
Nursing is based on causality.
Patients values and opinions are to be considered and respected.
A state of adaptation frees an individuals energy to respond to other stimuli.
ROY ADAPTATION MODEL CONCEPTS: EARLY AND REVISED
Adaptation -- goal of nursing
Person -- adaptive system
Environment -- stimuli
Health -- outcome of adaptation
Nursing -- promoting adaptation and health
Concepts-Adaptation
Responding positively to environmental changes.
The process and outcome of individuals and groups who use conscious awareness, self reflection
and choice to create human and environmental integration
Concepts-Person
Bio-psycho-social being in constant interaction with a changing environment
Uses innate and acquired mechanisms to adapt
An adaptive system described as a whole comprised of parts
Functions as a unity for some purpose
Includes people as individuals or in groups-families, organizations, communities, and society as a
whole.

Concepts-Environment
Focal - internal or external and immediately confronting the person
Contextual- all stimuli present in the situation that contribute to effect of focal stimulus
Residual-a factor whose effects in the current situation are unclear
All conditions, circumstances, and influences surrounding and affecting the development and
behavior of persons and groups with particular consideration of mutuality of person and earth
resources, including focal, contextual and residual stimuli
Concepts-Health
Inevitable dimension of person's life
Represented by a health-illness continuum
A state and a process of being and becoming integrated and whole
Concepts-Nursing
To promote adaptation in the four adaptive modes
To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to
health, quality of life, and dying with dignity by assessing behaviors and factors that influence
adaptive abilities and by intervening to enhance environmental interactions
Concepts-Subsystems
Cognator subsystem A major coping process involving 4 cognitive-emotive channels: perceptual
and information processing, learning, judgment and emotion.
Regulator subsystem a basic type of adaptive process that responds automatically through
neural, chemical, and endocrine coping channels
Relationships
Derived Four Adaptive Modes
500 Samples of Patient Behavior
What was the patient doing?
What did the patient look like when needing nursing care?
Four Adaptive Modes
Physiologic Needs
Self Concept
Role Function
Interdependence

Diagram



















Betty Neuman's System Model



Introduction
Betty Neumans system model provides a comprehensive flexible holistic and
system based perspective for nursing.
It focuses 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.
HISTORY AND BACKGROUND OF THE THEORIST
Betty Neuman was born in 1924, in Lowel, Ohio.
BS in nursing in 1957
MS in Mental Health Public health consultation, from UCLA in 1966.
Ph.D. in clinical psychology
a pioneer in the community mental health movement in the late 1960s.
developed the model while working as a lecturer in community health nursing at University of
California, Los Angeles.
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.
DEVELOPMENT OF THE MODEL
Neumans 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 its potential for disturbing a
clients usual stability level or normal LOD (Line of Defence).
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.
MAJOR CONCEPTS
Content
the variables of the person in interaction with the internal and external environment comprise the
whole client system
Basic structure/Central core
The 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 (Neuman,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.
Flexible LOD
It is 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.
Line of Resistance-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.
o Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002).
o 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).
PREVENTION
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
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.
FOUR NURSING PARADIGMS
1. PERSON
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:
o Physiological - Refers of the physicochemical structure and function of the body.
o Psychological - Refers to mental processes and emotions.
o Socio-cultural - Refers to relationships; and social/cultural expectations and activities.
o Spiritual - Refers to the influence of spiritual beliefs.
o Developmental - Refers to those processes related to development over the lifespan.
2. 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 persons normal line of defense and so can affect the stability of the system.
o The internal environment exists within the client system.
o The external environment exists outside the client system.
o The created environment is an environment that is created and developed
unconsciously by the client and is symbolic of system wholeness.
3. HEALTH
Health as being equated with wellness. Health/wellness is defined as the condition in which all
parts and subparts (variables) are in harmony with the whole of the client (Neuman, 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
4. NURSING
Neuman 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 nurses perception will influence the care given, then not only
must the patient/clients 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



Diagram
Person / physiologic needs

Primary
Tertiary
Secondary


Betty Neuman's System Model





Goal Attainment Theory
By Imogene King

Introduction
Imogene King was born in 1923.
Completed her Bachelor in science of nursing from St. Louis University in 1948
Completed her Master of science in nursing from St. Louis University in 1957
Completed her Doctorate from Teachers college, Columbia University
Kings Conceptual Framework
It includes:
Several basic assumptions
Three interacting systems
Several concepts relevant for each system
Basic assumptions
Nursing focus is the care of human being
Nursing goal is the health care of individuals & groups
Human beings: are open systems interacting constantly with their environment
Interacting systems:
o personal system
o Interpersonal system
o Social system
Concepts are given for each system
Concepts for Personal System
Perception
Self
Growth & development
Body image
Space
Time
Concepts for Interpersonal System
Interaction
Communication
Transaction
Role
Stress
CORE
Concepts for Social System
Organization
Authority
Power
Status
Decision making
Major Theses of Kings conceptual framework
Each human being perceives the world as a total person in making transactions with individuals
and things in environment
Transaction represents a life situation in which perceiver & thing perceived are encountered and in
which person enters the situation as an active participant and each is changed in the process of
these experiences
Kings Theory of Goal Attainment
Theory of goal attainment was first introduced by Imogene King in the early 1960s.
Theory describes a dynamic, interpersonal relationship in which a person grows and develops to
attain certain life goals.
Factors which affects the attainment of goal are: roles, stress, space & time
Propositions of Kings Theory
From the theory of goal attainment king developed predictive propositions, which includes:
If perceptual interaction accuracy is present in nurse-client interactions, transaction will occur
If nurse and client make transaction, goal will be attained
If goal are attained, satisfaction will occur
If transactions are made in nurse-client interactions, growth & development will be enhanced
If role expectations and role performance as perceived by nurse & client are congruent, transaction
will occur
If role conflict is experienced by nurse or client or both, stress in nurse-client interaction will occur
If nurse with special knowledge skill communicate appropriate information to client, mutual goal
setting and goal attainment will occur.
Major concepts of kings theory
1. Human being /person: is social being who are rational and sentient. Person has ability to :
perceive
think
feel
choose
set goals
select means to achieve goals and
to make decision
According to King, human being has three fundamental needs:
(a) The need for the health information that is unable at the time when it is needed and can be
used
(b) The need for care that seek to prevent illness, and
(c) The need for care when human beings are unable to help themselves.
2. Health
According to King, health involves dynamic life experiences of a human being, which implies continuous
adjustment to stressors in the internal and external environment through optimum use of ones resources to
achieve maximum potential for daily living.
3. Environment
Environment is the background for human interactions. It involves:
(a) Internal environment: transforms energy to enable person to adjust to continuous external
environmental changes.
(b) External environment: involves formal and informal organizations. Nurse is a part of the
patients environment.
4. Nursing
Definition: A process of action, reaction and interaction by which nurse and client share information about
their perception in nursing situation. and a process of human interactions between nurse and client
whereby each perceives the other and the situation, and through communication, they set goals, explore
means, and agree on means to achieve goals.
Action: is defined as a sequence of behaviors involving mental and physical action.
Reaction: not specified, but might be considered as included in the sequence of behaviors
described in action.
In addition, king discussed:
(a) goal
(b) domain and
(c) functions of professional nurse
Goal of nurse: To help individuals to maintain their health so they can function in their roles.
Domain of nurse: includes promoting, maintaining, and restoring health, and caring for the sick,
injured and dying.
Function of professional nurse: To interpret information in nursing process to plan, implement
and evaluate nursing care.
King said in her theory, A professional nurse, with special knowledge and skills, and a client in
need of nursing, with knowledge of self and perception of personal problems, meet as strangers in
natural environment. They interact mutually, identify problems, establish and achieve goals.


Diagram

Social system
Interpersonal

Personal


Goal Attainment Theory




Theory of Interpersonal Relations
Hildegard. E. Peplau


Introduction
Born in Reading, Pennsylvania [1909]
Graduated from a diploma program in Pottstown, Pennsylvania in 1931.
Done BA in interpersonal psychology from Bennington College in 1943.
MA in psychiatric nursing from Colombia University New York in 1947.
EdD in curriculum development in 1953.
Professor emeritus from Rutgers university
Started first post baccalaureate program in nursing
Published Interpersonal Relations in Nursing in 1952
1968 :interpersonal techniques-the crux of psychiatric nursing
Worked as executive director and president of ANA.
Worked with W.H.O, NIMH and nurse corps.
Died in 1999.
Psychodynamic nursing
Understanding of ones own behavior
To help others identify felt difficulties
To apply principles of human relations to the problems that arise at all levels of experience
In her book she discussed the phases of interpersonal process, roles in nursing situations and
methods for studying nursing as an interpersonal process.
According to Peplau, nursing is therapeutic in that it is a healing art, assisting an individual who is
sick or in need of health care.
Nursing is an interpersonal process because it involves interaction between two or more individuals
with a common goal.
The attainment of goal is achieved through the use of a series of steps following a series of pattern.
The nurse and patient work together so both become mature and knowledgeable in the process.
Definitions
Person :A developing organism that tries to reduce anxiety caused by needs
Environment : Existing forces outside the organism and in the context of culture
Health : A word symbol that implies forward movement of personality and other ongoing human
processes in the direction of creative, constructive, productive, personal and community living.
Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other
human process that make health possible for individuals in communities
Roles of nurse
Stranger: receives the client in the same way one meets a stranger in other life situations provides
an accepting climate that builds trust.
Teacher: who imparts knowledge in reference to a need or interest
Resource Person : one who provides a specific needed information that aids in the understanding
of a problem or new situation
Counselors : helps to understand and integrate the meaning of current life circumstances
,provides guidance and encouragement to make changes
Surrogate: helps to clarify domains of dependence interdependence and independence and acts
on clients behalf as an advocate.
Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually
satisfying way
Additional Roles include:
1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10. Recorder observer
11. Researcher
Theory of interpersonal relations
Middle range descriptive classification theory
Influenced by Harry Stack Sullivan's theory of inter personal relations (1953)
Also influenced by Percival Symonds , Abraham Maslow's and Neal Elger Miller
Identified four sequential phases in the interpersonal relationship:
1. Orientation
2. Identification
3. Exploitation
4. Resolution
Orientation phase
Problem defining phase
Starts when client meets nurse as stranger
Defining problem and deciding type of service needed
Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations
of past experiences
Nurse responds, explains roles to client, helps to identify problems and to use available resources
and services


Factors influencing orientation phase


Identification phase
Selection of appropriate professional assistance
Patient begins to have a feeling of belonging and a capability of dealing with the problem which
decreases the feeling of helplessness and hopelessness
Exploitation phase
Use of professional assistance for problem solving alternatives
Advantages of services are used is based on the needs and interests of the patients
Individual feels as an integral part of the helping environment
They may make minor requests or attention getting techniques
The principles of interview techniques must be used in order to explore, understand and
adequately deal with the underlying problem
Patient may fluctuates on independence
Nurse must be aware about the various phases of communication
Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step
Resolution phase
Termination of professional relationship
The patients needs have already been met by the collaborative effect of patient and nurse
Now they need to terminate their therapeutic relationship and dissolve the links between them.
Sometimes may be difficult for both as psychological dependence persists
Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated
and both becomes mature individuals





Nursing Process Theory
By Ida Jean Orlando


Introduction
Theorist, Ida Jean Orlando was born in 1926.
Ida J. Orlando was one of the first nursing theorists to write about
the nursing process.
Nursing diploma - New York Medical College
BS in public health nursing - St. John's University, NY,
MA in mental health nursing - Columbia University, New York.
Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental
Health Psychiatric Nursing.
Project investigator of a National Institute of Mental Health grant entitled: Integration of Mental
Health Concepts in a Basic Nursing Curriculum.
Her theory was published in her 1961 book, The Dynamic Nurse-Patient Relationship.
Further development of her theory at McLean Hospital in Belmont, MA as Director of a Research
Project: Two Systems of Nursing in a Psychiatric Hospital. The results were conceptualized in her
1972 book titled: The Discipline and Teaching of Nursing Processes
A board member of Harvard Community Health Plan, and served as both a national and
international consultant.
Theoretical Sources
Peplaus focus of interpersonal relationships in nursing
Peplau acknowledged the influence of Harry Stack Sullivan on the development of her ideas
Symbolic interactionism Chicago school
Use of field methodology
John Deweys theory of inquiry
Major Dimensions
The role of the nurse is to find out and meet the patient's immediate need for help.
The patient's presenting behavior may be a plea for help, however, the help needed may not be
what it appears to be.
Therefore, nurses need to use their perception, thoughts about the perception, or the feeling
engendered from their thoughts to explore with patients the meaning of their behavior.
This process helps nurse find out the nature of the distress and what help the patient needs.
Terms
Distress is the experience of a patient whose need has not been met.
Nursing role is to discover and meet the patients immediate need for help.
o Patients behavior may not represent the true need.
o The nurse validates his/her understanding of the need with the patient.
Nursing actions directly or indirectly provide for the patients immediate need.
An outcome is a change in the behavior of the patient indicating either a relief from distress or an
unmet need.
o Observable verbally and nonverbally.
CONCEPTS
Function of professional nursing - organizing principle
Presenting behavior - problematic situation
Immediate reaction - internal response
Nursing process discipline investigation
Improvement - resolution
Function of professional nursing - organizing principle
Finding out and meeting the patients immediate needs for help
Nursing.is responsive to individuals who suffer or anticipate a sense of helplessness, it is focused on the
process of care in an immediate experience, it is concerned with providing direct assistance to individuals in
whatever setting they are found for the purpose of avoiding, relieving, diminishing or curing the individuals
sense of helplessness
The purpose of nursing is to supply the help a patient requires for his needs to be met.
If the patient has an immediate need for help and the nurse finds out and meets that need ,the
function of professional nursing is achieved
Presenting behavior - problematic situation
To find out the immediate need for help the nurse must first recognize the situation as problematic
The presenting behavior of the patient, regardless of the form in which it appears, may represent a
plea for help
The presenting behavior of the patient, the stimulus, causes an automatic internal response in the
nurse, and the nurses behavior causes a response in the patient
Immediate reaction - internal response
Person perceives with any one of his five sense organs an object or objects
The perceptions stimulate automatic thought
Each thought stimulates an automatic feeling
Then the person acts
The first three items taken together are defined as the persons immediate reaction
Reflects how the nurse experiences her or his participation in the nurse patient situation
Domain concept
1. Nursing is responsive to individuals who suffer or anticipate a sense of helplessness
2. Health sense of adequacy or well being . Fulfilled needs. Sense of comfort
3. Environment not defined directly but implicitly in the immediate context for a patient
4. Person patients who are under medical care and who cannot deal with their
needs or who cannot carry out medical treatment alone



Human-To-Human Relationship Model
Joyce Travelbee(1926-1973)

The nurse is responsible for helping the patient avoid and alleviate the distress of
unmet needs. - Travelbee
Introduction
Joyce Travelbee (1926-1973) developed the Human-to-Human Relationship
Model presented in her bookInterpersonal Aspects of Nursing (1966, 1971).
She dealt with the interpersonal aspects of nursing.
She explains human-to-human relationship is the means through which the purpose of nursing if
fulfilled
Abou the Theorist
A psychiatric nurse, educator and writer born in 1926.
1956, she completed her BSN degree at Louisiana State University
1959, she completed her Master of Science Degree in Nursing at Yale University.
1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate School, New Orleans.
Later in Charity Hospital School of Nursing in Louisiana State University, New York University and
University of Mississippi.
Travelbee died at age 47.
Development of the Theory
Travelbee based the assumptions of her theory on the concepts of existentialism by Soren
Kierkegaard and logotherapy by Viktor Frankl.
Existential theory believes that that humans are constantly faced choices and conflicts and is
accountable to the choices we make in life
Logotherapy theory was first proposed by Viktor Frankel, a survivor of Auschwitz, in his book Man's
Search for Meaning (1963).
Logotherapy
Basic Concepts
Suffering
o "An experience that varies in intensity, duration and depth ... a feeling of unease, ranging
from mild, transient mental, physical or mental discomfort to extreme pain and extreme
tortured ..."
Meaning
o Meaning is the reason as oneself attributes
Nursing
o is to help man to find meaning in the experience of illness and suffering.
o has a responsibility to help individuals and their families to find meaning.
o The nurses' spiritual and ethical choices, and perceptions of illness and suffering, is
crucial to helping to find meaning.
Hope
o Nurse's job is to help the patient to maintain hope and avoid hopelessness.
o Hope is a faith that can and will be change that would bring something better with it.
o Hope's core lies in a fundamental trust the outside world, and a belief that others will help
someone when you need it.
o Six important factors charecteristics of hope are:
It is strongly associated with dependence on other people.
It is future oriented.
It is linked to elections from several alternatives or escape routes out of its
situation.
The desire to possess any object or condition, to complete a task or have an
experience.
Confidence that others will be there for one when you need them.
The hoping person is in possession of courage to be able to acknowledge its
shortcomings and fears and go forward towards its goal

Communications
o "a strict necessity for good nursing care"
Using himself therapeutic
o " one is able to use itself therapeutic."
o Self-awareness and self-understanding, understanding of human behavior, the ability to
predict one's own and others' behavior are imporatnt in this process.
Targeted intellectual approach
o Nurse must have a systematic intellectual approach to the patient's situation.
Nursing Metaparadigms
1. Person
o Person is defined as a human being.
o Both the nurse and the patient are human beings.
2. Health
o Health is subjective and objective.
o Subjective health is an individually defined state of well being in accord with self-appraisal
of physical-emotional-spiritual status.
o Objective health is an absence of discernible disease, disability of defect as measured by
physical examination, laboratory tests and assessment by spiritual director or
psychological counselor.
3. Environment
o Environment is not clearly defined.

4. Nursing
o "an interpersonal process whereby the professional nurse practitioner assists an
individual, family or community to prevent or cope with experience or illness and suffering,
and if necessary to find meaning in these experiences.

Description of the theory
Travelbee believed nursing is accomplished through human-to-human relationships that begin with
the original encounter and then progress through stages of emerging identities, developing feelings
of empathy, and later feelings of sympathy.
The nurse and patient attain a rapport in the final stage. For meeting the goals of nursing it is a
prerequisite to achieving a genuine human-to-human relationships.
This relationship can only be established by an interaction process.
It has five phases.
o The inaugural meeting or original encounter
o Visibility of personal identities/ emerging identities.
o Empathy
o Sympathy
o Establishing mutual understanding and contact/ rapport
Travelbee's ideas have greatly influenced the hospice movement in the west



Transcultural Nursing
By Madeleine Leininger


Introduction
Transcultural nursing is both a specialty and a general practice area. It focuses
on worldwide cultures and comparative cultural caring, health, and nursing
phenomena. ( Murphy, 2006).
Madeleine Leininger is considered as the founder of the theory of transcultural nursing.
Her theory has now developed as a discipline in nursing.
Her theory first appeared in her theory book Culture Care Diversity and Universality (1991) but
originated in the 1950s. The theory was further expanded in her book Transcultural Nursing (1995)
In the third edition of her book Transcultural Nursing (2002) explains the theory-based research
and practice applying the concepts of the transcultural theory.
Transcultural nursing theory is also known as Culture Care theory.
Theoretical framework is depicted in her model called the Sunrise Model (1997).
ABOUT THE THEORIST
a pioneering nursing theorist and transcultural global nursing consultant.
MSN from Catholic University in Washington DC.
PhD in anthropology from the University of Washington.
She developed the concept of transcultural nursing and the ethnonursing research model.

DEFINITIONS
Transcultural Nursing
Transcultural nursing is a comparative study of cultures to understand similarities (culture
universal) and difference (culture-specific) across human groups (Leininger, 1991).
Culture
Set of values, beliefs and traditions, that are held by a specific group of people and handed down
from generation to generation.
Culture is also beliefs, habits, likes, dislikes, customs and rituals learn from ones family.
Culture is the learned, shared and transmitted values, beliefs, norms and life way practices of a
particular group that guide thinking, decisions, and actions in patterned ways.
Culture is learned by each generation through both formal and informal life experiences.
Language is primary through means of transmitting culture.
The practices of particular culture often arise because of the group's social and physical
environment.
Culture practice and beliefs are adapted over time but they mainly remain constant as long as they
satisfy needs.
Religion
Is a set of belief in a divine or super human power (or powers) to be obeyed and worshipped as the
creator and ruler of the universe.
Ethnic
refers to a group of people who share a common and distinctive culture and who are members of a
specific group.
Ethnicity
a consciousness of belonging to a group.

Cultural Identify
the sense of being part of an ethnic group or culture
Culture-universals
commonalities of values, norms of behavior, and life patterns that are similar among different
cultures.
Culture-specifies
values, beliefs, and patterns of behavior that tend to be unique to a designate culture.
Material culture
refers to objects (dress, art, religious arti1acts)

Non-material culture
refers to beliefs customs, languages, social institutions.
Subculture
composed of people who have a distinct identity but are related to a larger cultural group.
Bicultural
a person who crosses two cultures, lifestyles, and sets of values.
Diversity
refers to the fact or state of being different. Diversity can occur between cultures and within a
cultural group.
Acculturation
People of a minority group tend to assume the attitudes, values, beliefs, find practices of the
dominant society resulting in a blended cultural pattern.
Cultural shock
the state of being disoriented or unable to respond to a different cultural environment because of its
sudden strangeness, unfamiliarity, and incompatibility to the stranger's perceptions and
expectations at is differentiated from others by symbolic markers (cultures, biology, territory,
religion).
Ethnic groups
share a common social and cultural heritage that is passed on to successive generations.
Ethnic identity
refers to a subjective perspective of the person's heritage and to a sense of belonging to a group
that is distinguishable from other groups.
Race
the classification of people according to shared biologic characteristics, genetic markers, or
features. Not all people of the same race have the same culture.
Cultural awareness
It is an in-depth self-examination of one's own background, recognizing biases and prejudices and
assumptions about other people.
Culturally congruent care
Care that fits the people's valued life patterns and set of meanings -which is generated from the
people themselves, rather than based on predetermined criteria.
Culturally competent care
is the ability of the practitioner to bridge cultural gaps in caring, work with cultural differences and
enable clients and families to achieve meaningful and supportive caring.
Nursing Decisions
Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care.
1. Cultural preservation or maintenance.
2. Cultural care accommodation or negotiation.
3. Cultural care repatterning or restructuring.

MAJOR CONCEPTS
Illness and wellness are shaped by a various factors including perception and coping skills, as well
as the social level of the patient.
Cultural competence is an important component of nursing.
Culture influences all spheres of human life. It defines health, illness, and the search for relief from
disease or distress.
Religious and Cultural knowledge is an important ingredient in health care.
The health concepts held by many cultural, groups may result in people choosing not to seek
modern medical treatment procedures.
Health care provider need to be flexible in the design of programs, policies, and services to meet
the needs and concerns of the culturally diverse population, groups that are likely to be
encountered.
Most cases of lay illness have multiple causalities and may require several different approaches to
diagnosis, treatment, and cure including folk and Western medical interventions..
The use of traditional or alternate models of health care delivery is widely varied and may come
into conflict with Western models of health care practice.
Culture guides behavior into acceptable ways for the people in a specific group as such culture
originates and develops within the social structure through inter personal interactions.
For a nurse to successfully provide care for a client of a different cultural or ethnic to background,
effective intercultural communication must take place.
PURPOSES OF KNOWING THE PATIENTS CULTURE AND RELIGION FOR HEALTH CARE
PERSONNEL
To heighten awareness of ways in which their own faith system. Provides resources for encounters
with illness, suffering and death.
To foster understanding, respect and appreciation for the individuality and diversity of patients
beliefs, values, spirituality and culture regarding illness, its meaning, cause, treatment, and
outcome.
To strengthen in their commitment to relationship-centered medicine that emphasizes care of the
suffering person rather than attention simply more to the pathophysiology of disease, and
recognizes the physician as a dynamic component of that relationship.
To facilitate in recognizing the role of the hospital chaplain and the patient's clergy as partners in
the health care team in providing care for the patient.
To encourage in developing and maintaining a program of physical, emotional and spiritual self-
care introduce therapies such as ayurveda and pancha karma

HEALTH PRACTICES IN DIFFERENT CULTURES
Use of Protective Objects
Protective objects can be worn or carried or hung in the home- charms worn on a string or chain
around the neck, wrist, or waist to protect the wearer from the evil eye or evil spirits.
Use of Substances .
It is believed that some food substances can be ingested to prevent illness.
People from many ethnic backgrounds eat raw garlic or onion In an effort to prevent illness or wear
them on the body or hang them in the home.
Religious Practices
practices such as from a divine source the burning of candles, rituals of redemption, and In many
instances a heritage consistent person may prayer.
Traditional Remedies
The use of folk or traditional medicine is seen among people from all walks of life and cultural
ethnic back ground.
Many plants are used by specific communities.
Healers
Within a given community, specific people are known to have the power to heal.
These approach may originate in culture, ethnicity or religion.
Immigration
Every immigrant group has its own cultural attitudes ranging beliefs and practices regarding these
areas.
Gender Roles
In many cultures, the male is dominant figure and often they take decisions.The female usually is
passive.
In some other cultures females are dominant.
Beliefs about mental health
In the traditional belief system, mental illnesses are caused by a lack of harmony of emotions or by
evil spirits.
Another belief that problems in this life are most likely related to transgressions committed in a past
life.
Economic Factors
Factors such as unemployment, underemployment, homelessness, lack of health insurance
poverty prevent people from entering the health care system.
Time orientation
It is varies for different cultures groups.
People from different cultures have there own time management plans.
Personal Space
The nurse should try, to respect the client's personal space as much as possible, especially when
performing nursing procedures.
The nurse should also welcome visiting members of the family and extended family.

NURSING PROCESS AND ROLE OF NURSE
The nurse should begin the assessment by attempting to determine the client's cultural heritage
and language skills.
The client should be asked if any of his health beliefs relate to the cause of the illness or to the
problem.
The nurse should then determine what, if any, home remedies the person is taking to treat the
symptoms.
Nurses should evaluate their attitudes toward ethnic nursing care.
The process of self-evaluation can help the nurse become more comfortable when providing care
to clients from diverse backgrounds
Nurses have a responsibility to understand the influence of culture, race &ethnicity on the
development of social emotional relationship child rearing practices &attitude toward health.
A child's self concepts evolves from ideas about his or her social roles
Important sub culture influences on children include ethnicity social class, occupation school peers
and mass culture
Socioeconomic influences play major role in ability to seek opportunity for health promotion for
wellness
Religious practices greatly influences health promotion belief in families.
Many ethnic and cultural groups in country retain the cultural heritage of their original culture.
How culture influences behaviors, attitudes, and values depends on many factors and thus is not
the same for different members of a cultural group.
The nurse should have an understanding of the general characteristics of the major ethnic groups,
but should always individualize care rather than generalize about all clients in these groups.
Before assessing the cultural background of a client, nurses should assess how they are
influenced by their own culture.
The nursing diagnosis for clients should include potential problems in their interaction with the
health care system and problems involving the effects of culture.
The planning and implementation of nursing interventions should be adapted as much as possible
to the client's cultural background.
Evaluation should include the nurse's self-evaluation of attitudes and emotions toward providing
nursing care to clients from diverse sociocultural backgrounds.
The clients educational level and language skills should be considered when planning teaching
activities.
Discussing cultural questions related to care with the client and family during the planning stage
helps the nurse understand how cultural variables are related to the client's health beliefs and
practices, so that interventions can be individualized for the client.
Evaluation continues throughout the nursing process and should include feedback from the client
and family.
Self-evaluation by the nurse is crucial as he or she increases skills for
interaction.


Human Becoming Theory
Rosemarie Rizzo Parse


Introduction
The Parse theory of human becoming guides nurses In their practice to
focus on quality of life as it is described and lived (Karen &
Melnechenko, 1995).
The human becoming theory of nursing presents an alternative to both
the conventional bio-medical approach and the bio-psycho-social-
spiritual (but still normative) approach of most other theories of
nursing.(ICPS)
The human becoming theory posits quality of life from each person's own perspective as the goal
of nursing practice.(ICPS)
Rosemarie Rizzo Parse first published the theory in 1981 as the "Man-living-health" theory (ICPS)
The name was officially changed to "the human becoming theory" in 1992 to remove the term
"man," after the change in the dictionary definition of the word from its former meaning of
"humankind."
ABOUT THE THEORIST
Educated at Duquesne University, Pittsburgh
MSN and Ph.D. from University of Pittsburgh
Published her theory of nursing, Man-Living-Health in 1981
Name changed to Theory of Human Becoming in 1992
Editor and Founder, Nursing Science Quarterly
Has published eight books and hundreds of articles about Human Becoming Theory
Professor and Niehoff Chair at Loyola University, Chicago
THEORY DEVELOPMENT
The human becoming theory was developed as a human science nursing theory in the tradition of
Dilthey, Heidegger, Sartre, Merleau-Ponty, and Gadamer and Science of Unitary Human Beings by
Martha Rogers .
The assumptions underpinning the theory were synthesized from works by the European
philosophers, Heidegger, Sartre, and Merleau-Ponty, along with works by the pioneer American
nurse theorist, Martha Rogers.
The theory is structured around three abiding themes: meaning, rhythmicity, and transcendence.
ASSUMPTIONS
About man
The human is coexisting while coconstituting rhythmical patterns with the universe.
The human is open, freely choosing meaning in situation, bearing responsibility for decisions.
The human is unitary, continuously coconstituting patterns of relating.
The human is transcending multidimensionally with the possibles
About Becoming
Becoming is unitary human-living-health.
Becoming is a rhythmically coconstituting human-universe process.
Becoming is the humans patterns of relating value priorities.
Becoming is an intersubjective process of transcending with the possibles.
Becoming is unitary humans emerging

Three Major Assumptions of Human Becoming
Meaning
o Human Becoming is freely choosing personal meaning in situations in the intersubjective
process of living value priorities.
o Mans reality is given meaning through lived experiences
o Man and environment cocreate
Rhythmicity
o Human Becoming is cocreating rhythmical patterns of relating in mutual process with the
universe.
o Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns
Transcendence
o Human Becoming is cotranscending multidimensionally with emerging possibles.
o Refers to reaching out and beyond the limits that a person sets
o One constantly transforms
SUMMARY OF THE THEORY
Human Becoming Theory includes Totality Paradigm
o Man is a combination of biological, psychological, sociological and spiritual factors
Simultaneity Paradigm
o Man is a unitary being in continuous, mutual interaction with environment
Originally Man-Living-Health Theory
NURSING PARADIGMS AND PARSE'S THEORY
Person
o Open being who is more than and different from the sum of the parts
Environment
o Everything in the person and his experiences
o Inseparable, complimentary to and evolving with
Health
o Open process of being and becoming. Involves synthesis of values
Nursing
o A human science and art that uses an abstract body of knowledge to serve people

SYMBOL OF HUMAN BECOMING THEORY











Black and white = opposite paradox significant to ontology of human becoming and green is hope
Center joined =co created mutual human universe process at the ontological level & nurse-person
process
Green and black swirls intertwining = human-universe co creation as an ongoing process of
becoming
STRENGTH AND WEAKNESSES
Strengths
Differentiates nursing from other disciplines
Practice - Provides guidelines of care and useful administration
Useful in Education
Provides research methodologies
Provides framework to guide inquiry of other theories (grief, hope, laughter, etc.)
Weaknesses
Research considered to be in a closed circle
Rarely quantifiable results - Difficult to compare to other research studies, no control group,
standardized questions, etc.
Does not utilized the nursing process/diagnoses
Negates the idea that each person engages in a unique lived experience
Not accessible to the novice nurse
Not applicable to acute, emergent care


Life Perspective Rhythm Model
Joyce Fitzpatrick


Introduction
Life Perspective Rhythm Model is a nursing model developed by Joyce J
Fitzpatrick.
She conceptualized her model from Martha Rogers' Theory of Unitary Human
beings.
About the Theorist
Born in 1944
BSN - Georgetown University
MS in psychiatric-mental health nursing - Ohio State University
PhD in nursing - New York University and an MBA from Case Western Reserve University.
Fellow in the American Academy of Nursing - 1981
Presently, Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing,
Case Western Reserve University, Cleveland, OH.
Major Assumptions
"The process of human development is characterized by rhythms that occur within the context of
continuous person-environment interaction."
Nursing activity focuses on enhancing the developmental process toward health.
A central concern of nursing science and the nursing profession is the meaning attributed to life as
the basic understanding of human existence.
The identification and labeling of concepts allows for recognition and communication with others,
and the rules for combining those concepts permits thoughts to be shared through language.
Core Concepts
Rhythm Model includes four content concepts and they are:
person
health
wellness-illness and
metaparadigm.
1. Person
Person includes both self and others.
Person is seen as an open system , a unified whole characterized by a basic human rhythm.
The model recognizes individuals as having unique biological, psychological, emotional, social,
cultural, and spiritual attitudes.
2. Health
Health is a dynamic state of being that results from the interaction of person and the environment.
a human dimension under continuous development, a heightened awareness of the
meaningfullness of life.
Optimum health is the actualization of both innate and obtained human potential gathered from
rewarding relationships with others, goal directed behavior, and expert personal care.
3. Wellness-llness
Professional nursing is rooted in the promotion of wellness practices.
4. Nursing
"A developing discipline whose central concern is the meaning attached to life (health)
Primary purpose of nursing is the promotion and maintenance of an optimal level of wellness.
5. Metaparadigm
It refers to the transitions through basic metaparadigm concepts of person, environment, health
and nursing.

Margaret Newman


Introduction
-Margaret Newman was born on October 10, 1933 in Memphis Tennessee.
In 1954 She earned her first Bachelors degree in Home Economics and English from Baylor University in
Waco, Texas
-Margaret Newman felt a call to nursing for a number of years prior to her decision to enter the field.
-During that time she became the primary caregiver for her mother, who became ill with Lou Gehrig's
Disease.
-Upon entering nursing at the University of Tennessee, Memphis, Dr. Newman knew almost immediately
that nursing was right for her

Education
In 1962 she received her Bachelors degree in Nursing from the University of Tennessee, Memphis.
In 1964 she received her Masters Degree of Medical-Surgical Nursing and Teaching at the University of
California in San Francisco.
In 1971 she completed her Doctorate of Nursing Science and Rehabilitation at New York University


Employment

1971 to 1976- She completed her graduate studies at New York University. She also worked and taught
alongside nursing theorist Martha Rogers. Rehabilitation Nursing stemmed her interest in health, movement
& time.
1977- Professor in charge of graduate study in nursing at Pennsylvania State.
1984- Nurse theorist at the University of Minnesota.
1996- Retired from teaching.

HEALTH AS AN EXPANDING CONSCIOUSNESS

Newman's Health as Expanding Consciousness was influenced by Martha Rogers. Newman (2003) writes:
The theory of health as expanding consciousness stems from Rogers' theory of Unitary Human Beings.
Rogers' assumptions regarding patterning of persons in interaction with the environement are basic to the
view that consciousness is a manifestation of an evolving pattern of person-environment
interaction...Consciouness includes not only the cognitive and affective awareness normally associated with
consciousness, but also the interconnectedness of the entire libing system, which includes physiochemical
maintenance and growth processes as well as teh immune system. This pattern of information, which is the
consciousness of the system, is part of a larger,undivided pattern of an expanding universe

Newmans theory of pattern recognition provides the basis for the process of nurse-client interaction.
Newman suggested that the task in intervention is a pattern recognition accomplished by the health
professional becoming aware of the pattern of the other person by becoming in touch with their own pattern.
Newman suggested that the professional should focus on the pattern of the other person , acting as the
reference beam in a hologram.

Metaparadigm Concepts

Newman has designated caring in the human health experience as the focus of nursing discipline and
has specified the focus as the metaparadigm of the discipline.

1. Nursing
-to help clients get in touch with the meaning of their lives by the identification of their patterns of relating
-Intervention is a form of non intervention whereby the nurses presence assists clients to recognize their
own patterns of interacting with the environment.
-facilitates pattern recognition in clients by forming relationships with them at critical points n their lives and
connecting with them in an authentic way.
-The nurse-client relationship is characterized by a rhythmic coming together and moving apart as clients
encounter disruption of their organized predictable state.
-Nurses are seen as partners in the process of expanding consciousness.
2. Person
- as individuals are identified by their individual patterns of consciousness.
-Persons are further defined as centers of consciousness within an overall pattern of expanding
consciousness
-The definition of person has also been expanded to include family and community.
3. Environment
-Environment is not explicitly defined but is described as being the larger whole, which is beyond the
consciousness of the individual.
4. Health
-A fusion of disease and non-disease creates a synthesis that is regarded as health.
-Disease and non-disease are each reflections of the larger whole; therefore a new concept pattern of the
whole is formed.

-Newman has stated that pattern recognition is the essence of the emerging health. Manifest health,
encompassing disease and non-disease can be regarded as the explication of the underlying pattern of
person-environment.

Essence of Margaret Newman's Theory:
An individual person in each situation, no matter how disordered and hopeless, is part of the universal
process of expanding consciousness.
The expanding consciousness is a process wherein an individual becomes more of his real self, as he
finds greater meaning in his life and the lives of those people around him.
In his/her search for his/her real self, the individual's awareness expands to include the interests of those
people around him and the rest of the world.
Self-awareness may eventually lead to acceptance of one's self and one's circumstances and limitations.
With self-awareness and self-acceptance, an in-depth understanding of one's condition may pave the way
for a person to engage into activities leading to positive progression transcending


Project
In
Theoretical Foundations
Of
Nursing



Submitted by:
Irish Jane B. Cubillo
BSN 1-1

Submitted to:
Mr. Reymund Kristopher Samonte, RN.