CLIENT CENTERED NURSING THEORY 5 ENVIRONMENTAL FACTORS

Person-centered care involves knowledge of the 1. Fresh air

individual as a whole person, involving them-and where 2. Pure water
appropriate their family and friends-in helping to assess their own 3. Efficient Drainage
needs and plan their own care. 4. Sanitation/Cleanliness
5. Light and direct sunlight
In person-centered care, caring is central to nursing
practice, and nurses’ relationships with the service user are NIGHTINGALE’S NURSING THEORY (Environmental Theory)
fundamental to that individual’s experience of care.
 The first published nursing theory (1860)
Florence Nightingale FLORENCE NIGHTINGALE’S MTAPARADIGM
 “The Lady of the Lamp” PERSON
 Made war rounds during the night to provide emotional o Are in relation with the environment
and physical comfort to the soldiers. o Stresses the healing properties of the physical
 Foundation/focus: the environment! environment (fresh air, light, warmth and cleanliness)
o Referred to by Nightingale as “the patient”
Theory basis: the inter-relationship of a healthful environment o A human being acted upon by a nurse or affected by
with nursing external influences and conditions can prevent, the environment.
suppress, or contribute to disease or death. o Has reparative powers to deal with disease.
o Recovery is patient’s power as long as safe
Theory goal: nurses to help patient retain their own vitality by
environment exists.
meeting their needs through control of the environment. *Mind over body
Nursing focus: control of the environment for individuals, families *Reparative - prevention
and the community. NURSING
o Puts patients in the “best conditions” for nature to act
Nursing “the act of utilizing the environment of the patient to upon them.
assist him in his recovery” o Nursing education belongs to the house of Nurses!
o Nursing is a discipline distinct from medicine focusing
on the patient’s reparative process rather than on their
disease.
o She wrote “Notes on nursing” with guidelines for
women in caring for their loved ones at home and gives
 advise for women to “think like a nurse”.
HEALTH
o Is the “positive of which the pathology is the negative”
“Nature cures”
o Maintained by using a person’s healing powers to their
fullest extent.
o Maintained by controlling the environment factors so
as to prevent disease
o Disease is viewed as a reparative process instituted by
nature.
o Nurses can help patient through their healing process.
ENVIRONMENT
o The foundation component of Nightingales’s theory.
o The external conditions and forces that affect one’s life
and development.
o Includes everything from a person’s food to a nurse’s
verbal and nonverbal interactions with the patient.

Faye Glenn Abdellah
 “A living legend”
 American Academy of Nursing
 Development of nursing research and Nursing as a
profession (US Public Health Service).
 An international expert on health problems.
“PATIENTS CENTERED APPROACHES”
 In 1960, influenced by the desire to promote client-
centered comprehensive nursing care.
 Abdellah described nursing as a service to individuals, to
families, and therefore, to society.
 Recognized as a leader in the development of nursing
research and nursing as a profession.
 Nursing is based on art and science that mold the
attitudes, intellectual competencies, and technical skills of
the individual nurse into desire and ability to help people,
sick or well, cope with their health needs.
ABDELLA’S TYPOLOGY OF 21 NURSING PROBLEMS
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, and
sleep.
3. To promote safety through the prevention of
accidents, injury, or trauma and through the
prevention of the spread of infection.
4. To maintain good body mechanics, prevent and
correct deformity (rehabilitate).
5. To facilitate the maintenance of supply of oxygen
to all body cells.
6. To facilitate the maintenance of nutrition for all
body cells.
7. To facilitate the maintenance of elimination
(sweat, urine, bowel).
8. To facilitate the maintenance of fluid and
electrolyte balance (diarrhea).
9. To recognize the physiologic responses of the
body to disease conditions – pathologic,
physiologic and compensatory.
10. To facilitate the maintenance of regulatory
mechanisms and functions.
11. To facilitate the maintenance of sensory function.
12. To identify and accept positive and negative
expression, feelings, and reactions.
13. To identify and accept the interrelatedness of
emotions and organic illness.
14. To facilitate the maintenance of effective verbal
and non-verbal communication.
15. To promote the development of productive
interpersonal relationship.
16. To facilitate the progress toward achievement of
personal spiritual goals.
17. To create and/or maintain a therapeutic
environment.
18. To facilitate awareness of self as an individual with
varying physical, emotional, and developmental
needs.
19. To accept the optimum possible goals in the light
of limitations, physical and emotional.
 20. To use community resources as an aid in resolving o However, as she further delineated her ideas, the focus
problems arising from illness. of nursing service is clearly the individual.
21. To understand the role of the social problems as o The environment is the home or community from which
influencing factors in the care of illness. patient comes.

ABDELLAH’S MTAPARADIGM

PERSON/PEOPLE
o Having physical, emotional, and sociological needs.
o These needs may overt, consisting of largely physical
needs, or covert, such as emotional and social needs.
o Patient is described as the only justification for the
existence of nursing.
o Individuals and families are the recipients of nursing,
health or achieving of it, is the purpose of nursing
services.
NURSING
o Nursing is a helping profession.
o 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.
o 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.
HEALTH
o A state mutually exclusive of illness.
o 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.
ENVIRONMENT
o Society is included in “planning for optimum health on
local, state, national, and international level”.
 9. Avoiding dangers in the environment and avoiding
injuring others
Virginia Henderson 10. Communicating with others in expressing emotions,
needs, fears, or opinions
(NURSING NEEDS THEORY) 11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of
 First truly international nurse
accomplishment
 “First Lady of Nursing”
13. Playing or participating in various forms of recreation
 “Twentieth century Florence Nightingale”
14. Learning, discovering, or satisfying the curiosity that leads
The unique function of the nurse is to assist the individual, to normal development and health using available health
sick or well, in the performance of activities contributing to
HENDERSON’S METAPARADIGM
health, recovery or peaceful death that she had the strength, will
or knowledge. And help gain independence as rapidly as possible. PERSON
o Individual requiring assistance to achieve health and
3 LEVELS OF NURSING-PATIENT RELATIONSHIP in which the
independence or a peaceful death. Mind and body are
nurse acts:
inseparable.
1. Substitute for the patient NURSING
2. A helper to the patient o Assist and support the individual in life activities and
3. A partner with the patient the attainment of independence.
HEALTH
14 COMPONENTS OF BASIC NURSING CARE o Equated with independence, viewed in terms of the
client’s ability to perform components of nursing care
1. Breathing normally unaided.
2. Eating and drinking adequately o “Breathing, eating, drinking, maintaining comfort,
3. Eliminating body wastes sleeping, resting, clothing, maintaining body
4. Moving and maintaining a desirable position temperature, ensuring safety, communicating,
5. Sleeping and resting worshiping, working, recreation, and continuing
6. Selecting suitable clothes development.”
7. Maintaining body temperature within normal range by ENVIRONMENT
adjusting clothing and modifying the environment o All external conditions and influences that affect life
8. Keeping the body clean and well groomed to protect and development.
integuments
Dorothea Orem
OREM’S SELF CARE DEFICIT THEORY OF NURSING
Orem’s goal was to upgrade the quality of nursing in
general hospitals. Her career included various experiences in
pediatrics, adult medical and surgical units, ER, OR and private
duty.
Orem’s general theory of nursing in 3 RELATED PARTS.
1. Theory of self-care
2. Theory of self care deficit
3. Theory of nursing systems
~THEORY OF SELF CARE~
 Describes WHY and HOW people care for themselves
 Suggests that nursing is required in case of INABILITY TO
PERFORM self care as a result of limitations
Includes concept of:
 SELF-CARE AGENCY
 THERAPEUTIC SELF-CARE DEMAND
 BASIC CONDITIONING FACTORS
a.) SELF-CARE AGENCY – 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.
3 DIMENSIONS
1) Development
2) Operability – identified in terms of the kinds of self care
operations individuals can perform consistently and
effectively
3) Adequacy – measured in terms of the number and kinds
of operations in which person can engage and operations
required to meet self care demands
b.) THERAPEUTIC SELF-CARE DEMAND – consists of the
summation of care measures necessary to meet all of an
INDIVIDUAL’S KNOWN SELF CARE REQUISITES
3 TYPES OF SELF CARE REQUISITES
i. Universal self-care requisites
Maintenance of:
 Sufficient intake of air
 Sufficient intake of water
 Sufficient intake of food
 Care associated with elimination process and excrements
 Balance of activity and rest
 Balance of solitude and interaction
 Prevention to human life, functioning and well being
 Promotion of human functioning and development
ii. Developmental self-care requisites
  Related to different stages in human life
 Maintenance of living conditions supporting life cycle
 Prevention of occurrence of deleterious effects of
conditions that affect human development 5 Methods of Helping
iii. Health deviation self-care requisites – related to
1. Acting for and doing for others
deviation in structure or function of human being
2. Guiding others
6 Categories of Health Deviation Requisites 3. Supporting another
4. Providing an environment promoting personal
Seeking / securing appropriate medical assistance
development in relation to meet future demands
Being aware / attending to the effects and results of
5. Teaching another
illness states
Effectively carry out medically prescribed treatments ~THEORY OF NURSING SYSTEMS~
Be aware of and attend to side effects of treatment
Describes and explains relationships that must exist and
Modify self concept to accept oneself in a particular state
be maintained for the PRODUCT or NURSING to occur,
of health
Learn to live with the effects of illness and medical 3 SYSTEMS
treatment
a. WHOLLY COMPENSATORY – patient is unable to perform
c.) BASIC CONDITIONING FACTORS – affect the value of the any self-care activities and relies on the nurse to perform.
therapeutic self-care demand or self-care agency of an individual. b. PARTIALLY COMPENSATORY – both patient and nurse
participate in self-care activities
 Age
c. SUPPORTIVE-EDUCATIVE – patient has the ability for self-
 Gender
care but requires assistance from the nurse in decision
 Developmental state
making knowledge and still acquisition.
 Health state pattern of living
 Healthcare system factors
 Family system factors
 Socio-cultural factors
 Availability of resources
 External environmental factors

~THEORY OF SELF-CARE DEFICIT~

 OREM’S METAPARADIGM

PERSON
o A unity that can function biologically, symbolically and
socially.
o Human being – has the capacity to reflect, symbolize
and use symbols.
o Conceptualized as total being with universal
developmental needs and capable of continuous self-
care.
NURSING
o Is art, a helping service, and a technology.
o Actions deliberately selected and performed by nurses
to help individuals or groups under their care to
maintain or change conditions.
HEALTH
o A state characterized by soundness and wholeness of
developed human structures and bodily and mental
functioning.
o It includes that which makes a person human,
operating in conjunction with physiological and
psychophysiological mechanisms and a material
structure and in relation to and interacting with other
human beings.
ENVIRONMENT
o Includes the physical, chemical, biologic and social
contexts within which human being exists.
o Environmental components include environmental
factors, elements, conditions and developmental
environment.

Myra E. Levine
(CONSERVATION PRINCIPLES: a model for health)
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.
 Every individual has a unique range of adaptive responses.
 The responses will vary by heredity, age, gender,
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 response is unique for each
individual pulse rate).
ADAPTATION
 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
 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 within the unique biological
realities of the individual.
3 CHARACTERISTICS OF ADAPTATION
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.
4 TYPE OF ADAPTATION
1) Fight or Flight: 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) Sensory-Perceptual: involves gathering of information
from the environment and converting it into meaningful
experience.

CONSERVATION PRINCIPLE
HEALTH
Conservation of Energy – “all of life’s processes are
fundamentally dependent upon the production and expenditure
of energy”
Conservation of Structural Integrity – “structure and function are
strongly interrelated complementary aspects of human
organism.”
ENVIRONMENT
Conservation of Personal Integrity – “the body does not exist
separately from mind, emotions and soul”
Conservation of Social Integrity – “Family is a critical social unit
and the life of each individual is woven in the fabric of family and
with the constitution of social group the is family defined by each
individual patient”
LEVINE’S METAPARADIGM
human being in his relationships with other human
beings.
o Nursing involves engaging in “human interactions”.
o Health is a wholeness and successful adaptation.
o 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 in his or her own interest without
constraints
o Disease: it is unregulated and undisciplined change and
must be stopped or death will ensure.
o Operational Environment – consists of those
undetected natural forces that impinge on an
individual.
o Perceptual Environment – consists of information that
is recorded by sensory organs.
o Conceptual environment – is influenced by language,
culture, ideas and cognition.

PERSON
o A holistic being who constantly strives to preserve
wholeness and integrity.
o A unique individual in unity and integrity, feeling,
believing, thinking and whole system of system.
NURSING
o “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”
o The human interaction relying on communication,
rooted in the organic dependency of the individual

Martha E. Rogers
(SCIENCE OF UNITARY HUMAN BEINGS)
EARLY NURSING CAREER
 Focused on rural public health nursing and visiting
nursing.
 University professor
 Emerged form interrelationship of Sciences such as
anthropology, sociology, psychology, religion, philosophy,
literature.
 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 lived is in a natural forerunner of an organized
abstract system encompassing people and the
environments.
OVERVIEW OF ROGERIAN MODEL
Rogers’ model provides the way of viewing the UNITARY
HUMN BEING.
Humans are viewed as integral with the universe: The
unitary human being and the environment are one, not
dichotomous.
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.
Nursing focus on people and the manifestations that emerge
from the mutual human/environmental field process.
The basic characteristics that describe the life process of the
patient are:
THE ENERGY FIELD
 Is the fundamental unit of all, both the living and unliving.
 It provides a way to view patient and his or her
environment as wholes, and it continuously changes in
intensity, density, and extent.
 It is inevitable part of life. Human and environment both
have energy field which is open i.e. energy can freely flow
between human and the environment.
OPENNESS
 Refers to the fact that the human and environmental
fields are constantly exchanging their energies.
 There is no boundary of barrier that can inhibit the flow of
energy between human and environment which leads to
the continuous movement or matter of energy.
PATTERN
 The distinguishing characteristic of energy field that is
seen as a single wave
 “pattern is an abstraction and it gives identity to the
field.”
PAN DIMENSIONALITY
  A domain that has no spatial or temporal attributes. o Seeks to promote symphonic interaction between
human and environmental fields.
o Strengthen integrity of human field.
NONINVASIVE MODALITIES FOR NURSING o Direct and redirect patterning of human and
environmental fields for realization of maximum health
 Therapeutic touch potential.
 Humor HEALTH
 Music o Views the concepts of health and illness as
 Meditation manifestations of pattern.
 Guided imagery ENVIRONMENT
 Use of color o “Irreducible, pan dimensional energy field identified by
pattern and integral with the human field”.
ROGERS’ IDENTIFIED PRINCIPLES o The field coexist and are integral. Manifestation
emerge from this field and are perceived.
THE HELICY PRINCIPLE – describes the unpredictable but
continuous, nonlinear evolution of energy fields, as evidenced by
a spiral development that is continuous, nonrepeating, and
innovative patterning that reflects the nature of change.

THE RESONANCY PRINCIPLE – described as a wave frequency and

an energy field pattern evolution from lower-to-higher-frequency
wave patterns.

THE PRINCIPLE OF INTEGRALITY – emphasizes the continuous

mutual process of person and environment.

ROGERS PARADIGM

PERSON
o 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.
NURSING
 6. Aggressive: 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
Dorothy E. Johnson territory is being threatened.
7. Achievement: provokes behavior that attempt to
(BEHAVIORAL SYSTEM THEORY) control the environment intellectual, physical,
creative, mechanical and social skills achievement
 From 1949 until her retirement in 1978 she was an are some of the areas that she recognizes.
assistant professor of pediatric nursing, associate
professor and professor. Functional requirements to be met for continued
 She has stresses the importance of research-based growth, development and viability:
knowledge about the effect of nursing care on clients.
1. Protection from noxious influences with which the
 This model for nursing presents the client as a living open
system cannot cope
system, which is in turn a collection of behavioral 2. Nurturance through input of supplies from the
subsystems that interrelated to form a behavioral system. environment
 Behavioral subsystems are linked and open. 3. Stimulation by experiences, events and behavior that
 Goal: the goal of nursing is to maintain or restore would enhance growth and prevent stagnation
behavioral system balance.
Nursing diagnostic and treatment problems:
7 SUBSYSTEMS OF BEHAVIOR 1. Determine existence of the problem
2. Diagnostic classification of problems
1. Attachment or Affiliative: social inclusion intimacy
3. Management of nursing problems
and the formation and attachment of a strong social
4. Evaluation of behavioral system balance and stability
bond
2. Dependency: approval, attention or recognition and
physical assistance
3. Ingestive: the emphasis is on the meaning and
structure of the social events surrounding the
occasion when food is eaten
4. Eliminative: human cultures have defined different
socially acceptable behaviors for excretion of waste,
but the existence of such pattern remains different
from culture to culture
5. Sexual: both biological and social factor affect the
behavior in the sexual subsystem
PERSON
o “Human being” is having two major systems, the
biological system and the behavioral system with 7
subsystems of behavior.
o It is role of the medicine to focus on biological
system where as NURSING’S FOCUS IS THE
BEHAVIORAL SYSTEM.
NURSING
o An external regulatory force that acts to preserve
the organization and integrity of patient’s behavior
at an optimal level.

HEALTH
o Refers to both physical and social health in
defining this metaparadigm.
o Effective and efficient functioning of the system
resulting in behavioral system balance and
stability.
ENVIRONMENT
o Society “relates to the environment on which the
individual exists; includes both internal and
external that are not a part of the individual’s
behavioral system but influence the system”.
o Strong environmental forces can disturb the
balance of behavioral system and threaten its
stability.
Lydia Hall
(CORE, CURE & CARE MODEL)
 A rehabilitation nurse who her nursing philosophy to
establish the rehabilitation center/hospital.
o Similar to primary nursing
 Nursing experience in clinical, education, research
and supervisor role.
THE CARE
Represents the client’s body.
Nurse function by giving hands on bodily care to the
patient in relation to performance of ADLs.
THE CURE
Represents the disease that affects the patients
physical system.
Nursing’s function by applying medical knowledge to
treatment of the person.
THE CORE
Represents the inner feelings and management
of the person.
Nursing functions by addressing the social and
emotional need of the patient.
PERSON
o Client is composed of body, pathology, and person.
People set their own goals and are capable of
learning and growing.
NURSING
o Caring is nurse’s primary function.
o Consisting of participation in the care, core aspects
of patient care
o Professional nursing is most important during the
recuperative period
HEALTH
o Development of a mature self-identity that assists
in the conscious selection of actions that facilitates
growth.
o State of self-awareness with conscious selection of
behaviors that are optimal for the individual.
ENVIRONMENT
o Should facilitate achievement of the clients
personal goals.
o Establish environment conducive to self-
development.
Rosemarie Rizzo Parse
(HUMAN BECOMING THEORY)
 Faculty member, Professor, professor emeritus,
consultant
 Founder and current editor of NURSING SCIENCE
QUARTERLY
 Founded the institute of Humanbecoming
 She developed the Theory of Human Becoming
through a combination of concepts from Martha
Rogers and from existential-phenomenological
thought.
 Her nine assumptions are based on the three main
themes of MEANING, RHYTHIMICITY and
TRASCENDENCE.
HUMAN BECOMING THEORY
Theory was based on Dr. Parse’s lived experience in
nursing & its poor fit with the existing paradigms.
Central concept of theory is “human becoming”.
The theory focuses on the human-universe-health
process and is based on the premise that the human being
pursues and creates his own process of being with the
world.
Presents an alternative to both the conventional bio-
medical approach as well as the bio-psycho-social-spiritual
approach of most other theories and models of nursing.
The theory provides a transformative approach to all
levels of nursing. It differs from the traditional nursing
process, particularly in that it does not seek to “fix”
problems. The model gives nurses the ability to see the
patient’s perspective. This allows the nurse to be “with” the
patient and guide him or her toward the health goals. The
nurse-patient relationship co-creates changing health
patterns. Nurses live the art of human becoming in
presences with the unfolding of meaning, synchronizing
rhythms, and the transcendence.
MEANING – human becoming is freely choosing personal
meaning in situations in the intersubjective process of living
value priorities.
RHYTHMICITY – human becoming is co-creating rhythmical
patterns of relating in mutual process with the universe.
Relates to revealing-concealing, engaging-limiting, and
connecting-separating
TRANSCENDENCE – relates to powering, originating, and
transforming.
The human becoming theory makes the following
assumptioms about MAN:
 The human is coexisting while reconstituting
rhythmical patterns with the universe. – Individuals
take active party in creating their own patterns and
reality.
 The human is open, freely choosing meaning in
situation, bearing responsibility for decisions –
human beings make choices on how to act and react.
They are responsible for the outcome of their
choices.
 The human is unitary, continuously reconstituting
patterns of relating. – People are more than a sum of
their parts. One can be distinguished from another
by patterns of appearance, mannerisms, voice and
other characteristics
  The human is transcending multidimensional with the
possible – The human is capable of changing and
growing beyond their limitations.

The human becoming theory makes the following

assumptioms about BECOMING:

 Becoming is an open process, experienced by the

human. – Becoming is continuous growth towards
more diversity & complexity. Growing includes
choosing who one will be in a given situation.
 Becoming is a rhythmically reconstituting human
universe process – Health & becoming are
intertwined. The elements of our environment in
which we connect and separate from, change us.
With these elements we reconstitute our health.
 Becoming is the human’s patterns of relating value
priorities. – Health is living the ideals chosen by the
individual.
 Becoming is an intersubjective process of
transcending with the possible– Health is reaching
beyond the actual to the possible through subject to PARSE’S METAPARADIGM
subject interchange. This interchange can occur PERSON
through two persons or with another element of the o Defines the person (referred to as “man”
environment. throughout the theory) as an open being who is
 Becoming is human unfolding – We are continuously more than and different from the sum of the parts.
changing, never to return to our previous state NURSING
o Described as a human science and art that uses an
abstract body of knowledge
HEALTH
o Health is the open process of being and becoming,
and involves the synthesis of values.
ENVIRONMENT
o The environment is everything in the person and
his or her experiences.
o Is inseparable from the person, as well as
complementary to and evolving with the person.
Nola Pender
(HEALTH PROMOTION MODEL)
Purpose: assist nurses in understanding the major
determinants of health as a basis for behavioral counseling
3 MAJOR CATEGORIES TO CONSIDER IN PENDER’S
to promote healthy lifestyle.
HEALTH PROMOTIONAL MODEL
Philosophical Roots: reciprocal interaction world view in
which human are viewed holistically but parts can be
studied in the context of the whole.
Human beings interact with their environment and shape it
to meet their needs and goals.
HEALTH PROMOTION MODEL
 Identifies background factors that influence health
behavior.
 Using the model and working collaboratively with the
patient/client, the nurse can assist the client in
changing behaviors to achieve a healthy lifestyle.
ASSUMPTIONS:
1. Persons seek to create conditions of living through
which they can express their unique human health
potential.
2. Persons have the capacity for reflective self-
awareness, including assessment of their own
competencies.
3. Person’s value growth in directions viewed as positive
and attempt to achieve a personally acceptable
balance between change and stability.
4. Individuals seek to actively regulate their own
behavior.
5. Individuals in all their biopsychosocial complexity
interact with the environment, progressively
transforming the environment and being transformed
over time.
6. Health professionals constitute a part of the
interpersonal environment, which exerts influence on
persons throughout their lifespan.
7. Self-initiated reconfiguration of person-environment
interactive patterns is essential to behavior change.
1. Individual Characteristics and Experiences
a. Prior related behavior
b. Personal factors
i. Biological factors – age, BMI, pubertal
or menopausal status, aerobic
capacity, balance
ii. Personal-Psychological – self-esteem,
self motivation
iii. Personal sociocultural factors – like
race, ethnicity, education,
acculturation, and socioeconomic
status
2. Behavioral Specific and Affect – have motivational
significance and are target of nursing interventions
because they are amenable to change.
a. Perceived benefits of action – magmamask ba
ako?
b. Perceived barriers to action – papasukan parin
ng alikabok.
c. Perceived self-efficacy – refers to judgment of
personal capability to organize and execute to
a health promoting behavior.
d. Activity related affect – refers to subjective
positive or negative feeling that occur before,
during and following behavior based on
stimulus properties.
3. Behavioral Outcome – the commitment of a person
to a plan of action. Be committed to change a certain
behavior.
 - Not being ningas cugon (sa umpisa
lang magaling)
a. Personal factors
b. Behavioral Impact
c. Behavioral Outcome

PENDER’S METAPARADIGM

PERSON
o Individual as primary focus of the model.
o Each person having unique personal
characteristics and experiences that affect
subsequent actions.
NURSING
o The expected role of the nurse within the context
of the health promotion model revolves around
raising consciousness related to health promoting
behaviors, promoting efficacy and enhancing
benefits change.
HEALTH
o Viewed as a positive high level state.
o The person’s definition of health for himself or
herself is more important than any general
definition of health.
ENVIRONMENT
o Refers to physical, interpersonal and economic
circumstances in which persons live.

Sister Callista Roy

(ADAPTATION MODEL)
 Roy developed her theory after she was challenged
by Johnsons in a seminar.
 She continued to define and redefine her model.
 She credits Harry Helson’s adaptation theory for
playing a key role in the development of her theory,
Rapoport’s definition of systems and concepts from
Lazarus and Selye.
ADAPTATION MODEL
Presents the PERSON AS A HOLISTIC ADAPTIVE
SYSTEM IN CONSTANT INTERACTION WITH THE INTERNAL IN
CONSTANT INTERACTION WITH THE INTERNAL AND
EXTERNAL ENVIRONMENT.
The main task of the human system is TO MAINTAIN
INTEGRITY IN THE FACE OF THE ENVIRONMENTAL STIMULI
The goal of nursing is TO FOSTER SUCCESSFUL
ADAPTATION.
ADAPTATION
 The process and outcome whereby thinking and
feeling person as individuals or in groups, use
conscious awareness and choice to create human
and environmental integration.
 Leads to optimal health and well-being, to quality of
life and to death with dignity.
COPING PROCESSES
1. Innate Coping Mechanisms
- Genetically determined or common to all
species or automatic responses.
2. Acquired Coping Mechanisms
- These are learned or developed through
customary responses.
4 ADAPTIVE MODES
1. Physiologic-physical mode: physical and chemical
processes involved in the function and activities of
living organisms (CELLS, TISSUES, ORGANS OR
SYSTEMS)
a. Basic needs like oxygenation, nutrition,
elimination, activity and rest, protection
b. Four Processes like:
i. The senses
ii. Fluid, electrolyte and acid-base
balance
iii. Neurologic function
iv. Endocrine function
2. Self-concept-group identity mode: focuses on
psychological and spiritual integrity and a sense of
unity, meaning, purposefulness in the universe.
3. Role function mode: refers to the roles that
individuals occupy in society fulfilling the need for
social integrity; it is knowing who one is, in relation
to others.
4. Interdependence mode: the close relationships of
people and their purpose, structure and development
individually and in groups and the adaptation
potential of these relationships.
ROY’S METAPARADIGM
PERSON
o “The human adaptive system”
o “A whole with parts that function as a unity for
 some purpose. Human systems include people,
groups, organizations, communities and society as
a whole.” (Roy & Andrews, 1999)
NURSING
o The “promotion of adaptation in each four modes”s
HEALTH
o A state and process of being and becoming
integrated and whole.
ENVIRONMENT
o Conditions, circumstances and influences that
affect the development and behaviour of humans
adaptive systems.