Nightingale's environmental theory

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Florence Nightingale, also known as the Lady with the Lamp, providing care to wounded and ill soldiers during the Crimean War Florence Nightingale (1820±1910), considered the founder of educated and scientific nursing and widely known as "The Lady with the Lamp"[1], wrote the first nursing notes that became the basis of nursing practice and research. The notes, entitled Notes on Nursing: What it is, What is not (1860), listed some of her theories that have served as foundations of nursing practice in various settings, including the succeeding conceptual frameworks and theories in the field of nursing.[2] Nightingale is considered the first nursing theorist. One of her theories was the Environmental Theory, which incorporated the restoration of the usual health status of the nurse's clients into the delivery of health care²it is still practiced today.

Contents
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1 Environmental effects 2 Environmental factors affecting health 3 Provision of care by environment 4 See also 5 References

[edit] Environmental effects

She stated in her nursing notes that nursing "is an act of utilizing the environment of the patient to assist him in his recovery" (Nightingale 1860/1969),[3], that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development.[4]

[edit] Environmental factors affecting health

Adequate ventilation has also been regarded as a factor contributing to changes of the patient's process of illness recovery Defined in her environmental theory are the following factors present in the patient's environment:
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Pure or fresh air Pure water Sufficient food supplies Efficient drainage Cleanliness Light (especially direct sunlight)[5]

Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status.[6]

[edit] Provision of care by environment

The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.[7] Nightingale's theory was shown to be applicable during the Crimean War when she, along with other nurses she had trained, took care of injured soldiers by attending to their immediate needs, when communicable diseases and rapid spread of infections were rampant in this early period in the development of disease-capable medicines. The practice of environment configuration according to patient's health or disease condition is still applied today, in such cases as patients infected with Clostridium tetani (suffering from tetanus), who need minimal noise to calm them and a quiet environment to prevent seizure-causing stimulus. Theory of Interpersonal Relations
Hildegard. E. Peplau This page was last updated on November 6, 2010 ======================================================== Introduction Born in Reading, Pennsylvania [1909] Graduated from a diploma program in Pottstown, Pennsylvania in 1931.

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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

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In her book she discussed the phases of interpersonal process,

nursing is therapeutic in that it is a healing art. assisting an individual who is sick or in need of health care. y y y y According to Peplau. Definitions y y y 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. y Nursing: A significant therapeutic interpersonal process. Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.provides guidance and encouragement to make changes y Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. personal and community living. constructive. y y y 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 y Counselors : helps to understand and integrate the meaning of current life circumstances . The attainment of goal is achieved through the use of a series of steps following a series of pattern. productive.roles in nursing situations and methods for studying nursing as an interpersonal process. The nurse and patient work together so both become mature and knowledgeable in the 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. y Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way .

Researcher Theory of interpersonal relations Middle range descriptive classification theory Influenced by Harry Stack Sullivan's theory of inter personal relations (1953) y y y Also influenced by Percival Symonds . helps to identify problems and to use available resources and services Factors influencing orientation phase .asks questions. Tutor 5.Additional Roles include: 1. 4. Socializing agent 6. 3. Administrator 10.conveys needs . Technical expert 2. Health teacher 4. explains roles to client. shares preconceptions and expectations of past experiences y y y y y Nurse responds. Mediator 9. Abraham Maslow's and Neal Elger Miller Identified four sequential phases in the interpersonal relationship: 1. Manager of environment 8. Safety agent 7. Consultant 3. Orientation Identification Exploitation Resolution Orientation phase Problem defining phase Starts when client meets nurse as stranger Defining problem and deciding type of service needed Client seeks assistance . Recorder observer 11. 2.

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 y y y y y y y 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 y y y 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 y y y y y 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 .

nurse or family y Patient actively seeking and drawing help Patient initiated Evaluation y y Resolution y Based on mutually expected behaviors May led to termination and initiation of new plans y Occurs after other phases are completed successfully Leads to termination a . with the end purpose of meeting the patients needs y y y Both use observation communication and recording as basic tools utilized by nursing Assessment y Orientation y y y y Data collection and analysis [continuous] May not be a felt need Non continuous data collection Felt need Define needs Nursing diagnosis Planning y Identification y Mutually set goals Interdependent goal setting Implementation y Exploitation y y Plans initiated towards achievement of mutually set goals May be accomplished by patient .individuals Interpersonal theory and nursing process Both are sequential and focus on therapeutic relationship Both use problem solving techniques for the nurse and patient to collaborate on.

Phases and steps of experimental teaching to patients of a concept of anxiety: Findings revealed that when taught y . Four phases interrelate the different components of each phase. goals. y y Theories can be utilized by practitioners to guide and improve their practice. y y y y The nurse patient interaction can apply to the concepts of human being. This theory provides a logical systematic way of viewing nursing situations Key concepts such as anxiety. and principles but will leave open unanswered questions that need to be investigated. Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them.Peplau¶s work and characteristics of a theory Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. Leads to adaptability in any nurse patient relationship. In 1950¶s two third of the nursing research concentrated on N-P relation ship. laws. Consistent with various theories Limitations y y y y Intra family dynamics. tension.Has generated testable hypotheses. unconscious patients some areas are not specific enough to generate hypothesis Research Based on Peplau¶s Theory Hays . Peplau¶s anxiety continuum is still used in anxiety patients Theories must be consistent with other validated theories. With drawn patients. It provides simplicity in regard to the natural progression of the NP relationship. Theories must be logical in nature. y y y The basic nature of nursing still considered an interpersonal process Theories can be the bases for hypothesis that can be tested.D. personal space considerations and community social service resources are considered less Health promotion and maintenance were less emphasized Cannot be used in a patient who doesn¶t have a felt need eg. (1961). and frustration are indicated with explicit relationships among them and progressive phases y Theories should be relatively simple yet generalizable. health. environment and nursing.

it is the dayto-day expression of one's commitment to other persons and the ways in which human beings relate to one another in their daily interactions. and incompetent to care for the ill." . Return to Top Myra Levine's Conservation Theory "Ethical behaviour is not the display of one's moral rectitude in times of crisis. often considered the first nurse theorist. and its effect on the person. maintaining a noise-free environment. Her general concepts about ventilation. Nightingale set the stage for further work in the development of nursing theories.F.S. warmth. Develop and test a nursing intervention framework for working with anxious patients: Students developed competency in beginning interpersonal relationship Overview of Nurse Theorist Nightingale's Environmental Theory Florence Nightingale. and diet remain integral parts of nursing and health care today. cleanliness. especially direct sunlight Nightingale's environmental factors attain significance when one considers that sanitation conditions in hospitals of the mid-1800s were extremely poor and that women working in the hospitals were often unreliable. C. uneducated.Levine. y Burd . and attending to the client's diet in terms of assessing intake. She linked health with five environmental factors: A. Myra (1972) . B. E. timeliness of the food. In addition to those factors. defined nursing over 100 years ago as "the act of utilizing the environment of the patient to assist him in his recovery".by the experimental method. Nightingale also stressed the importance of keeping the client warm. the patients were able to apply the concept of anxiety after the group was terminated. D. pure or fresh air pure water efficient drainage cleanliness light. quiet.

1973 & 1989. Levine told others that she did not set out to develop a ´nursing theoryµ but had wanted to find a way to teach the major concepts in medical-surgical nursing and attempt to teach associate degree students a new approach for daily nursing activities. She had one sister and one brother. 2002) such as the University of Illinois at Chicago and Tel Aviv University in Israel. one of these is Myra Levine·s Conservational Theory which was completed on 1973. After earning an MS in nursing at Wayne State University in 1962. as a civilian nurse for the US Army. she taught nursing at many different institutions (George. Ever since Florence Nightingale started writing her notes on nursing. She authored 77 published articles which included ´An Introduction to Clinical Nursingµ with multiple publication years on 1969. Levine also wished to move away from nursing education practices that were strongly procedurally oriented and refocus on active problem solving and individualized patient care (George. Myra Estrin Levine (1920-1996) was born in Chicago. She also received an honorary doctorate from Loyola University in 1992. as a surgical nursing supervisor. Levine graduated from the Cook County School of Nursing in 1944 and obtained her BS in nursing from the University of Chicago in 1949. 2002). more theories and models about the nursing profession flourished during the last decade. Levine worked as a private duty nurse. COMPOSITION OF CONSERVATION MODEL Levine·s Conservation Model is focused in promoting adaptation and maintaining wholeness . She died on 1996. and in nursing administration.Myra Estrin Levine INTRODUCTION and BIOGRAPHY The nursing profession is continuously evolving and dynamic. Levine developed an interest in nursing because her father (who had gastrointestinal problems) was frequently ill and required nursing care on many occasions. Following graduation. Illinois. She was the oldest of three children.

p. pp. and a condition of health. the view of the individual as whole. Conservation. is the product of adaptation. The model guides the nurse to focus on the influences and responses at the organismic level. wholeness. p. nursing and health. permit ease³the assurance of integrity«in all the dimensions of life. The nurse accomplishes the goals of the model through the conservation of energy. and conservation is the outcome of adaptation. adapt accordingly. and maintain their uniqueness. exists when the interaction or constant adaptations to the environment. contained. p. nurses must also recognize the influence of other conservation principles (Levine. 11) stated that ´the unceasing interaction of the individual organism with its environment does represent an ¶open and fluid· system. Adaptation is the process whereby the patient maintains integrity within the realities of the environment (Levine.using the principles of conservation. all theories share four central or major concepts: person.µ Levine (1973.195). Levine·s Model also discussed that person and environment merge or become congruent over time. 1990). nurses (like Myra Levine) have developed various theories that provide different explanations of the nursing discipline.µ (Levine. 1967). ´Conservation describes the way complex systems are able to continue to function even when severely challenged. Adaptation is the process of change. p. ´The goal of conservation is health and the strength to confront disabilityµ as ´.. Although conservation is fundamental to the outcomes expected when the model is used. 192).. the rules of conservation and integrity holdµ in all situation in which nursing is requiresµ (Levine. 63) description of wholeness as an open system: ´Wholeness emphasizes a sound. 5). In addition to this. Adaptation is achieved through the ´frugal. economic. The person is a holistic being who constantly strives to preserve wholeness and integrity . structure. 1989a). the boundaries of which are open and fluid. meaning ´to keep togetherµ (Levine. 1990. organic. 193.µ This continuous dynamic. Through conservation. and controlled use of environmental resources by the individual in his or her best interestµ (Levine. Wholeness is based on Erikson·s (1964. environment. Levine also discussed two other important concepts critical to the use of her model ² adaptation and wholeness. Conservation is from the Latin word conservatio. MAJOR CONCEPTS Over the years. 1966. 1973. The primary focus of conservation is keeping together of the wholeness of the individual. Like her Conservation Model. and personal and social integrity (Levine. 1973). I. progressive mutuality between diversified functions and parts within an entirety. as it will be discussed below. individuals are able to confront obstacles. on the other hand. 1991. open interaction between the internal and external environment provides the basis for holistic thought. Although nursing interventions may deal with one particualr conservation principle.

The internal environment also is the integration of bodily functions that resembles homeorrhesis rather than homeostasis and is subject to challenges of the external environment. and pollutants. It describe the pattern of adaptation. touch. and concepts and inventions and encompasses the exchange of language. thinking and whole system of system. The perceptual environment is that portion of the external environment which individuals respond to with their sense organs and includes light. religious beliefs. which permit the individual·s body to sustain its well being with the vast changes which encroach upon it from the environment. and past-aware.and one ´who is sentient. and individual psychological patterns that come from life experiences. believing. The external environment is divided into the perceptual. value systems. The internal environment combines the physiological and pathophysiological aspects of the individual and is constantly challenged by the external environment. II. The conceptual environment is that portion of the external environment that consists of language. and conceptual environments. The person is also described as a unique individual in unity and integrity. The environment completes the wholeness of the individual. symbols. 17). and position sense and balance. the ability to think and experience emotion. operational. ideas. ethnic and cultural traditions. The internal environment emphasizes the fluidity of change within a space-time continuum. 1973. thinking. sound. chemical change that is smelled or tasted.µ The wholeness (integrity) of the individual demands that the ´individual life has meaning only in the context of social lifeµ (Levine. . The operational environment is that portion of the external environment which interacts with living tissue even though the individual does not possess sensory organs that can record the presence of these factors and includes all forms of radiation. In other words. The individual has both an internal and external environment. microorganisms. p. while homeorrhesis is a stabilized flow rather than a static state. future-oriented. feeling. Homeostasis is a state of energy sparing that also provides the necessary baselines for a multitude of synchronized physiological and psychological factors. these elements may physically affect individuals but are not perceived by the latter. temperature. which always are a form of energy.

1973. Levine·s Conservation Model discussed that the way in which the person and the environment become congruent over time. The goal of nursing is to promote health. It is the fit of the person with his or her predicament of time and space. ´The nurse enters into a partnership of human experience where sharing moments in time³some trivial. specificity and redundancy. Health is implied to mean unity and integrity and ´is a wholeness and successful adaptationµ. p. IV. The individual·s integrity is his/her abiding concern and it is the nurse·s responsibility to assist the patient to defend and to seek its realization. and the individual is free to pursue once more his or her own interests without constraint. realizing that every individual requires a unique and separate cluster of activities. and social. 4) clarified what she meant by health as: ´« the avenue of return to the daily activities compromised by ill health.1). These responses are based on three factors (Levine. Levine (1991. 1977. As it was mentioned above. disease is ´unregulated and undisciplined change and must be stopped or death will ensueµ. Health and disease are patterns of adaptive change. psychologic. 1989): historicity. The goal of nursing is to promote adaptation and maintain wholeness (health). 845). It is rather a return to self hood. Nursing involves engaging in ´human interactionsµ (Levine. and social integrity. The specific adaptive responses make conservation possible occur on many levels. structure. personal. V. p. The goal of nursing is accomplished through the use of the conservation principles: energy. molecular. some dramatic³leaves its mark forever on each patientµ (Levine. emotional. The goal of nursing is to promote wholeness. . where the encroachment of the disability can be set aside entirely. physiologic.µ On the other hand.III. p. It is not only the insult or the injury that is repaired but the person himself or herself« It is not merely the healing of an afflicted part.

and adaptive responses are the result of both. Responses are stimulated by specific stressors and are task oriented.1. (3) Stress: Response developed over time and influenced by each stressful experience encountered by person. Redundancy describes the notion that if one system or pathway. Each individual is made up of a combination of personal and genetic history. A change in behavior of an individual during an attempt to adapt to the environment is called an organismic response. then another pathway may be able to take over and complete the job. and (4) Perceptual: Involves gathering information from the environment and converting it in to a meaning experience.g.. 2. 1989). when autoimmune conditions cause a person·s own immune system to attack previously healthy tissue in the body).g. such as when previously failed responses are reestablished (e. KEY CONCEPTS (Conservational principle) The core. There are four types. When a . However. It helps individual to protect and maintain their integrity. or central concept. (2) Inflammatory: response intended to provide for structural integrity and the promotion of healing. This may be helpful when the response is corrective (e. Historicity refers to the notion that adaptive responses are partially based on personal and genetic past history. Specificity refers the fact that each system that makes up a human being has unique stimulus-response pathways. namely (1) Flight or fight: An instantaneous response to real or imagined threat. redundancy may be detrimental. the use of allergy shots over a lengthy period of time to diminish the effects of severe allergies by gradually desensitizing the immune system). of Levine·s theory is conservation (Levine.. is unable to ensure adaptation. 3. Responses that are stimulated in multiple pathways tend to be synchronized and occur in a cascade of complimentary (or detrimental in some cases) reactions. most primitive response.

Examples: Assist patient in ROM exercise. it means that individual adaptive responses conform change productively. It includes adequate rest. and with the least expenditure of effort. Conservation is achieved through successful activation of adaptive pathways and behaviors that are appropriate for the wide range of responses required by functioning human beings. Maintenance of adequate nutrition II.person is in a state of conservation. and social integrity. Conservation of energy: Refers to balancing energy input and output to avoid excessive fatigue. Her framework includes: energy. personal integrity. structural integrity. Examples: Availability of adequate rest. nutrition and exercise. These principles focus on conserving an individual's wholeness. while preserving optimal function and identity. Maintenance of patient·s personal hygiene . Myra Levine described the Four Conservation Principles. I. She advocated that nursing is a human interaction and proposed four conservation principles of nursing which are concerned with the unity and integrity of individuals. Conservation of structural integrity: Refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing.

selfhood and self determination.III. a religious group. Example: Recognize and protect patient·s space needs IV. an ethnic group. self awareness. Conservation of personal integrity: Recognizes the individual as one who strives for recognition. Conservation of social integrityAn: individual is recognized as some one who resides with in a family. respect. a community. a political system and a .

reflects. condition and situation Human being are agents who act deliberately to attain goal Adaptive changes involve the whole individual A human being has unity in his response to the environment Every person possesses a unique adaptive ability based on one·s life experience which creates a unique message There is an order and continuity to life change is not random A human being respond organismically in an ever changing manner A theory of nursing must recognized the importance of detail of care for a single patient with in an empiric framework that successfully describe the requirement of the all patient A human being is a social animal A human being is an constant interaction with an ever changing society Change is inevitable in life Nursing needs existing and emerging demands of self care and dependant care Nursing is associated with condition of regulation of exercise or development of capabilities of providing care . reason and understand Human being action are self determined even when emotional Human being are capable of prolonging reflection through such strategists raising questions Human being make decision through prioritizing course of action Human being must be aware and able to contemplate objects. and society. community.nation.condition and situation Human being sense . ASSUMPTIONS Myra Levine·s Model also discusses other assertions and assumptions: y y y y y y y y y y y y y y y y y y y y y y 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 . Example: Help the individual to preserve his or her place in a family.

provided with privacy. the nurse is expected to provide knowledge and the patient need to be respected. thus. Levine·s goal is to avoid fatigue or excessive use of energy. again. the person's structural integrity is compromised but it is the patient's choice seeking physical beauty and psychological satisfaction that is taken into consideration. For example. There are a number of limitations when it comes to the four principles. nursing interventions are limited to addressing only the presenting condition of an individual. On conservation of personal integrity. the model is not without limitation. Thus. even though these are essential components of current nursing practice. Levine's conservation model focuses on illness as opposed to health. the major limitation is the focus on individual in an illness state and on the dependency of patient. procedures should not be promoted. ADHD in children or those with limited movements such as paralyzed clients. This. In cases where energy needs to be utilized rather than conserved like in manic patients. this mismatch will be an area of conflict. Hence. the focus is to preserve the anatomical structure of the body as well as to prevent damage to the anatomical structure. the nurse has the responsibility for determining the patient ability to participate in the care. On conservation of energy. This is manageable in the bedside care of ill clients. has limitations. encouraged and psychologically s supported. Furthermore. In cases where the anatomical structure is not so perfect but without identified disfigurement or problems as in plastic surgeries. Otherwise such. and if the perception of nurse and patient about the patient ability to participate in care don·t match.LIMITATIONS Despite the comprehensiveness and wide application of Levine's theory. On conservation of structural integrity. Levine·s theory does not apply. The limitations here will center on clients who are psychologically impaired and . procedures like breast enhancements and liposuctions. nursing interventions under Levine's theory have a present and shortterm focus and do not support health promotion and illness prevention principles.

) for families of patient in critical care setting Nursing practice y y y Conservational model has been used for nursing practice in different settings Bayley (n.in their study of incidence and prevalence of pressure ulcers in hospice patient Newport (n. is when the client has no significant others like family members.) used principle of conservation of energy and social integrity for comparing the body temperature of infant·s who had been placed on mother·s chest immediately after birth with those who were placed in warmer Nursing education y y y y y y y Conservational model was used as guidelines for curriculum development It was used to develop nursing undergraduate program at Allentown college of St. The limitation specific for this. Lastly.e.d. i. psychiatric patients who are unable to interact.) developed an assessment tool for data collection on the basis of four conservational principles to identify nursing care needs of epileptic patients Family assessment tool was designed by Lynn-Mchale and Smith (n.) used conservation model for guiding the nursing care of homeless at a clinic. comatose patients. Pennsylvania Used in nursing education program sponsored by Kapat Holim in Israel Nursing administration Taylor (n.) discussed the care of a severely burned teenagers on the basis of four conservational principles and discussed patient·s perceptual. shelters or streets . the focus here is no longer the patient himself but the people involved in his/her health care. operational and conceptual environment Pond (n. APPLICATIONS Nursing research y y y Principles of conservation have been used for data collection in various researches Conservational model was used by Hanson et al. suicidal individuals or clients. unresponsive clients like unconscious individuals. conservation of social integrity·s aim is to preserve and recognition of human interaction. Francis de Sales.) described an assessment guide for data collection of neurological patients which forms basis for development of comprehensive nursing care plan and thus evaluate nursing care McCall (n. significant others who comprise his support system.d.d.d.d. Abandoned children.d. particularly with the clients.incapacitated and cannot comprehend and absorb knowledge.

reads medical reports. talks to patient and family Assesses factors which challenges the individual Trophicognosis y y y Nursing diagnosis-gives provocative facts meaning A nursing care judgment arrived at through the use of the scientific process Judgment is made about patient·s needs for assistance Hypothesis y y y Planning Nurse proposes hypothesis about the problems and the solutions which becomes the plan of care Goal is to maintain wholeness and promoting adaptation Interventions y y y y Testing the hypothesis Interventions are designed based on the conservation principles Mutually acceptable Goal is to maintain wholeness and promoting adaptation Evaluation y y y Observation of organismic response to interventions It is assesses whether hypothesis is supported or not supported If not supported.Nursing Process Assessment y y y Collection of provocative facts through observation and interview of challenges to the internal and external environment using four conservation principles Nurses observes patient for organismic responses to illness. plan is revised. new hypothesis is proposed .

from Harvard University in Boston in 1948. Johnson was born August 21. structural. promote. and a professor of nursing at the University of California in Los Angeles. y y B. an associate professor of nursing. y y Dorothy Johnson has had an influence on nursing through her publications since the 1950s. 2010 =========================================== Introduction Dorothy E. The goal of nursing is to recognize.P. Georgia. in 1942. and support adaptive processes that benefit the patient.*** To summarize. and her M. personal and social integrity. 1919. assist. in Savannah. This guides nurses to focus on the influences and responses of a client to promote wholeness through the Conservation Principles. N.H. Johnson's Behaviour System Model This page was last updated on November 3. . The goal of this model is to accomplish this through the conservation of energy. from Vanderbilt University in Nashville. Levine expressed the view that within the nurse-patient relationship a patient·s state of health is dependent on the nurse-supported process of adaptation. S. Johnson stressed the importance of research-based knowledge about the effect of nursing care on clients. y From 1949 until her retirement in 1978 she was an assistant professor of pediatric nursing. Tennessee.

interaction. interdependency and integration of the parts and elements of behaviors that go to make up The system ´ 2. Whose behavior does not give evidence of unnecessary trauma as a consequence of illness Assumptions of behavioral system model There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system model Tthere are 4 assumptions of system: 1. A system ³tends to achieve a balance among the various . y In 1980 Johnson published her conceptualization of ³behavioral system of model for nursing´ this is the first work of Dorothy that explicates her definitions of the behavioral system model.Johnson¶s behavior system model In 1968 Dorothy first proposed her model of nursing care as fostering of ³the efficient and effective behavioral functioning in the patient to prevent illness". or in which illness is found´ Based on this definition there are four goals of nursing are to assist the patient: Whose behavior commensurate with social demands. y y She also stated that nursing was ³concerned with man as an integrated whole and this is the specific knowledge of order we require´. Definition of nursing She defined nursing as ³an 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. First assumption states that there is ³organization. Who is able to modify his behavior in ways that it supports biological imperatives y y y y Who is able to benefit to the fullest extent during illness from the physicians knowledge and skill.

repetitive ways of acting that comprise a behavioral system specific to that individual. This predisposition is called as ³set´. is essential to man that is to say. Johnson believes each individual has patterned.forces operating within and upon it'. in certain ways rather than the other ways´. 4. y y y y Each subsystem must be ³nurtured´ through the input of appropriate supplies from the environment.´ 3. .´ The integration of these assumptions provides the behavioral system with the pattern of action to form ³an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relation of the person to the objects. 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. A behavioral system. The final assumption states ³system balance reflects adjustments and adaptations that are successful in some way and to some degree. purposeful. Each subsystem has three functional requirements System must be ³protected" from noxious influences with which system cannot cope´. both in social life and for the individual. it is functionally significant in that it serves a useful purpose. Assumptions about structure and function of each subsystem ³from the form the behavior takes and the consequences it achieves can be inferred what ³drive´ has been stimulated or what ³goal´ is being sought´ y y Each individual has a ³predisposition to act with reference to the goal. y y Each subsystem has a repertoire of choices or ³scope of action´ The fourth assumption is that it produce ³observable outcome´ that is the individual¶s behavior. events and situations in his environment. which both requires and results in some degree of regularity and constancy in behavior. Each subsystem must be ³stimulated´ for use to enhance growth and prevent stagnation.

´ y y y Dependency subsystem: ³approval. creative.Set --. purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation´ Johnson¶s Behavioral Subsystem Attachment or affiliative subsystem: ³social inclusion intimacy and the formation and attachment of a strong social bond. y These behaviors are ³orderly. Representation of Johnson's Model Goal ----. physical.y These actions and behaviors form an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relationship of the person to the objects event situations in the environment.´ y y 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´ y Achievement subsystem: " provokes behavior that attempt to control the environment intellectual.Choice of Behavior --. attention or recognition and physical assistance´ Ingestive subsystem: ³the emphasis is on the meaning and structures of the social events surrounding the occasion when the food is eaten´ y Eliminative subsystem: ³human cultures have defined different socially acceptable behaviors for excretion of waste .Behavior Affiliation Dependency Sexuality Aggression y y y y . mechanical and social skills achievement are some of the areas that Johnson recognizes".but the existence of such a pattern remains different from culture to Culture.

the biological system and the behavioral system. y ³Nursing´ has a primary goal that is to foster equilibrium within the individual. .An assessment based on behavioral model does not easily permit the nurse to gather detailed information about the biological systems: Affiliation Dependency Sexuality Aggression Elimination Ingestion Achievement Restorative y y y y y y y y . Nursing process Assessment Grubbs developed an assessment tool based on Johnson¶s seven subsystems plus a subsystem she labeled as restorative which focused on activities of daily living. It is role of the medicine to focus on biological system where as Nursling's focus is the behavioral system.y y y Elimination Ingestion Achievement The four major concepts Johnson views ³human being´ as having two major systems. and socially to internal and external stimuli in order to maintain stability and comfort. physically mentally. ³Society´ relates to the environment on which the individual exists. but that the major focus is on maintaining a balance in the Behavior system when illness occurs in an individual. emotionally. According to Johnson an individual¶s behavior is influenced by the events in the environment y y ³Health´ is a purposeful adaptive response. She stated that nursing is concerned with the organized and integrated whole.

and observable behavior. . set behavior. these plan than have a goal . repertoire. the nurse may have goal for the individual to return to the baseline behavior. Dependency subsystem between mother and John Affiliative subsystem between Mrs. Diagnosis y Insufficient development of the affiliative subsystem.Diagnosis Diagnosis tends to be general to the system than specific to the problem. nurturance or stimulation of the identified subsystem.to bring about homeostasis in a subsystem.Kim and her mother. Assessment y y y y Affiliative subsystem between mother and John. Grubb has proposed 4 categories of nursing diagnosis derived from Johnson's behavioral system model: Insufficiency Discrepancy Incompatibility Dominance y y y y Planning and implementation Implementation of the nursing care related to the diagnosis may be difficult because of lack of clients input in to the plan. Johnson's behavioral model with the nursing process is a nurse centered activity. the nurse should be able to observe the return to the previous behavior patterns. based on nursing assessment of the individuals drive. If the baseline data are available for an individual. The plan may include protection. If the alterations in the behavior that are planned do occur. Insufficiency ingesion subsystem. the plan will focus on nurses actions to modify clients behavior. with the nurse determining the clients needs and state behavior appropriate for that need. Evaluation Evaluation is based on the attainment of a goal of balance in the identified subsystems.

The interaction of Mrs. It is difficult to test Johnson's model by development of hypothesis. y y y y y y The ±infant interaction could be reassessed. laws and principles but will leave unanswered questions that need to be investigated. The definition of concept is so abstract that they are difficult to use. Theories contribute to and assist in increasing the body of knowledge within the discipline through the research implemented to validate them y y Theories can be utilized by practitioners to guide and improve their practice. Theories must be consistent with other validated theories. Johnson¶s and Characteristics of a theory Interrelate concepts to create a different way of viewing a phenomenon. Limitation y y y y Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral system model. Evaluation Johnny's weight gain or weight loss will be carefully assessed. y y y y y Theories must be logical in nature. pat and cuddles etc.y Insufficient development of the dependency subsystem Planning and implementation Increasing mother¶s awareness of the baby¶s clues. Theories must be simple yet generalizable Theories can be bases of hypothesis that can be tested. Kim with her mother. Teach her to bring a bond between her and the baby by touch. using the nursing child assessment feeding scale. Assisting her to talk with the baby. The focus on the behavioral system makes it difficult for nurses to work with physically impaired individual to use this .

e. and practice wisdom of the discipline. choices and observable behavior. y Nursing knowledge is the inclusive total of the philosophies.(Smith & Liehr. 2008).it is nursing role to assist the client to return to the state of equilibrium. evidence-based practice is the hallmark of any professional discipline. y y y The model is very individual oriented so the nurses working with the group have difficulty in its implementation. theories. Each subsystem composed of four structural characteristics i. Johnson does not define the expected outcomes when one of the system is affected by the nursing implementation an implicit expectation is made that all human in all cultures will attain same outcome ±homeostasis. The model is very individual oriented so the family of the client is only considered as an environment.(Smith & Liehr. and (3) stimulation for growth. y Johnson¶s behavioral system model is not flexible. Introduction to Nursing Theories This page was last updated on November 13. 2010 ================================================= INTRODUCTION y Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study. (2) Provision for the nurturing environment.As a professional discipline this knowledge is important for guiding practice. research. The patient is defined as behavioral system composed of 7 behavioral subsystems. y Theory-guided. Three functional requirement of each subsystem includes (1) Protection from noxious influences. Summary Johnson¶s Behavioral system model is a model of nursing care that advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. set. 2008). y y y Any imbalance in each system results in disequilibrium .theory. . drives.

y y y y Nursing is a professional discipline (Donaldson & Crowley. Based on the knowledge structure levels the theoretical works in nursing can be studied under the following headings: y y y y Metaparadigm (Person. systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing. relationships. Nursing theory is the term given to the body of knowledge that is used to support nursing practice Almost 90% of all Nursing theories are generated in the last 20 years. 1978). A nursing theory is a set of concepts. predicting. and assumptions or propositions derived from nursing models or from other disciplines and project a purposive. definitions. and /or prescribing. Nursing theories and Middle range theories (Least abstract) . Environment. explaining.. constructed of theories and concepts COMPONENTS OF A THEORY A theory is a group of related concepts that propose action that guide practice. Nursing models are conceptual models. Conceptual models and Grand theories. Health & Nursing) ± (Most abstract) Nursing philosophies.

possibilities for giving and receiving help Described systematically five stages of skill acquisition in nursing practice ± novice. CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E.NURSING PHILOSOPHIES Theory Florence Nightingale¶s Legacy of caring Key emphasis Focuses on nursing and the patient environment relationship. Caring creates . Derived a definition of nursing Identified 14 basic human needs on which nursing care is based. Orem¶s Self Self±care maintains wholeness. Caring is a universal. Nurses should identify patients µneed-for ± help¶ by: Ernestine Wiedenbach: The helping art of clinical nursing y y y y Observation Understanding client behaviour Identifying cause of discomfort Determining if clients can resolve problems or have a need for help Virginia Henderson¶s Definition of Nursing Patients require help towards achieving independence. Hall :Care. care deficit theory in nursing Three Theories: Theory of Self-Care . social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring. Helping process meets needs through the art of individualizing care. It sets up what matters. Nursing care is person directed towards Core model self love. proficient and expert. advanced beginner. Cure. It creates possibility for mutual helpfulness. competent. Jean Watson¶s Philosophy Caring is moral ideal: mind -body ± soul and Science of caring engagement with one and other.Abedellah¶s Typology of twenty one Nursing problems Lydia E. enabling connection and concern. Patricia Benner¶s Primacy Caring is central to the essence of of caring nursing.possibilities of coping possibilities for connecting with and concern for others. Patient¶s problems determine nursing care Faye G.

ingestive-eliminative and Dorothy E.Johnson¶s Behavioural system model . achievement.Roger¶s: Person environment are energy fields that Science of unitary human evolve negentropically beings Martha proposed that nursing was a basic scientific discipline Nursing is using knowledge for human betterment. Individual as a behavioural system is composed of seven subsystems. aggressive. or the affiliative subsystems ± is the corner stone of social organisations. The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather than health and illness Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them. Behavioural system also includes the subsystems of dependency. Attachment.educative (Helping patient to learn self care and emphasizing on the importance of nurses¶ role Myra Estrin Levine¶s: The Holism is maintained by conserving conservation model integrity Proposed that the nurses use the principles of conservation of: y y y y y y y y Client Energy Personal integrity Structural integrity Social integrity A conceptual model with three nursing theories ± Conservation Redundancy Therapeutic intention Martha E.Theory of Self-Care Deficit Theory of Nursing Systems Wholly compensatory (doing for the patient) Partly compensatory (helping the patient do for himself or herself) Supportive.

regulator and cognator. role. A conceptual model of nursing from which theory of goal attainment is derived. perception. and A. Nursing is concerned with the whole person.J. Nancy Roper. Disturbances in these causes nursing problems. Secondary. Nursing actions (Primary. communication. stress. transaction. Transactions provide a frame of reference toward goal setting. WW. and transaction (Process of nursing).Logan Individuality in living. and Tertiary levels of prevention) focuses on the variables affecting the client¶s response to stressors. Stimuli disrupt an adaptive system The individual is a biopsychosocial adaptive system within an environment. residual and contextual. Through two adaptive mechanisms. Sister Callista: Royµs Adaptation model Betty Neuman¶s : Health care systems model Imogene King¶s Goal attainment theory . From her major concepts (interaction.sexual. Judgments and actions of the patient and the nurse lead to reaction. growth and development) derived goal attainment theory. an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions Reconstitution is a status of adaptation to stressors A conceptual model with two theories ³Optimal patient stability and prevention as intervention´ Neuman¶s model includes intrapersonal. The individual and the environment provide three classes of stimuli-the focal. · Perceptions. Living is an amalgam of activities of living (ALs).Tierney A model for nursing based A conceptual model of nursing from which on a model of living theory of goal attainment is derived. interpersonal and extrapersonal stressors. interaction.

Nurses must stay connected to patients and assure that patients get what they need. Stranger 2. Nurse reactions 3. Peplau: Psychodynamic Nursing Theory y y y y y The four phases of nurse-patient relationships are: 1. Elements of nursing situation: 1.Most individuals experience significant life events which can affect ALs causing actual and potential problems. Surrogate 6. Interpersonal process is maturing force for personality. solving actual problems and helping to cope. To Human Relationship Model Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of . Patient 2. Resolution The six nursing roles are: y y y y y y Ida Jean Orlando¶s Nursing Process Theory 1. focused on patient¶s verbal and non verbal expressions of need and nurse¶s reactions to patient¶s behaviour to alleviate distress. Counselor Interpersonal process alleviates distress. Leader 5. Hildegard E. Identification 3. This affects dependence ± independence continuum which is bi-directional. Teacher 4. Nursing helps to maintain the individuality of person by preventing potential problems. Nursing actions Joyce Travelbee¶s Human Therapeutic human relationships. Orientation 2. Exploitations 4. Resource person 3. Stressed the importance of nurses¶ ability to understand own behaviour to help others identify perceived difficulties.

caring. Care is the essence and the dominant. Health care needs are needs for comfort. Barnard¶s Parent Child Interaction Model Individual characteristics of each member influence the parent±infant system and adaptive behaviour modifies those characteristics to meet the needs of the system. culture.Emerging identities Developing feelings of empathy and sympathy. cultural values and cultural variations Caring serves to ameliorate or improve human conditions and life base. arising from stressful health care situations that cannot be met by recipients¶ traditional support system. social and environmental needs. Major concepts include care.Mercer¶s Parenting and maternal role attainment in :Maternal Role Attainment diverse populations A complex theory to explain the factors impacting the development of maternal role over time. The nurse assists the client in interaction with the environment and co creating health Promoting optimum health supersedes Katharine Kolcaba¶s Theory of comfort Madeleine Leininger¶s Transcultural nursing. psycho spiritual. mutual and in constant interaction with environment.Pender¶s :The . Caring is universal and varies transculturally. becoming A theory of nursing derived from Roger¶s conceptual model. Clients are open. Growth and development of children and mother±infant relationships Kathryn E. These needs include physical. Comfort is desirable holistic outcome of care. distinctive and unifying feature of nursing Rosemarie Rizzo Parse¶s Indivisible beings and environment co:Theory of human create health. Ramona T. until the nurse and patient attained rapport in the final stage. culture-care theory Nola J. Comfort measures include those nursing interventions designed to address the specific comfort needs.

2010 ======================================== ³Nursing theories mirror different realities. guide research and curriculum and identify the goals of nursing practice. The state of art and science of nursing theory is one of continuing growth. D. she accepted a position teaching nursing at the Norfolk Protestant Hospital in Virginia. model disease prevention. Washington. perceptual factors in clients which are modified by demographical and biological characteristics." "little Miss 3x5" Born in Kansas City. Using the internet the nurses of the world can share ideas and knowledge.C. used. and applied in the theory based practice for the profession and the continued development of nursing and academic discipline Virginia Henderson's Need Theory This page was last updated on November 6. Missouri. Worked at the Henry Street Visiting Nurse Service for 2 years after graduation.´ Introduction y y y y y y y y y ³The Nightingale of Modern Nursing´ ³Modern-Day Mother of Nursing. Identifies cognitive. they reflected the interests of nurses of that time. situational and behavioural factors that help predict in health promoting behaviour CONCLUSION The conceptual and theoretical nursing models help to provide knowledge to improve practice.´ "The 20th century Florence Nightingale. throughout their development. where she remained for several years In 1929. in 1921. in 1897 and is the 5th child of a family of 8th children but spent her formative years in Virginia Received a Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital. It is important the nursing knowledge is learnt. carrying on the work begun by nursing theorists and continue the growth and development of new nursing knowledge. In 1923.Health promotion. Henderson determined that she needed . interpersonal influences.

incorporating her personal definition of nursing (Henderson. and later wrote the 5th. where she remained until 1948(Herrmann.. Master¶s Degree in 1934. Yale University In 1985. she joined Columbia as a member of the faculty. She has received honorary doctoral degrees from the Catholic University of America. she revised: Harmer¶s classic textbook of nursing for its 4th edition. University of Rochester. VH was a well known nursing educator and a prolific author. Miss Henderson was honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association. In 1978 the fundamental concept of nursing was revisited by Virginia Henderson from Yale . Bachelor¶s Degree in 1932. Died: March 19.1991) In 1939. 1996. edition.y y y more education and entered Teachers College at Columbia University where she earned her.1998) Since 1953. she has been a research associate at Yale University School of Nursing. Contribution y y y y y In 1937 Henderson and others created a basic nursing curriculum for the National League for Nursing in the US in which education was ³patient centered and organized around nursing problems rather than medical diagnoses´ (Henderson. Achievements y y y y Is the recipient of numerous recognitions for her outstanding contributions to nursing. University of Western Ontario. Subsequently. Pace University.1991) Her work influenced the nursing profession in America and throughout the world The founding members of ICIRN (Interagency Council on Information Resources for Nursing) and a passionate advocate for the use and sharing of health information resources.

University School of Nursing ( USA ). 1966-The Nature of Nursing. y y y School of thought in Nursing Theories-1950-1970 Need theorists Abdellah Henderson Orem interaction Theorists King Orlando Peterson and Outcome theorists Johnson Levine . the care provided by nurses is required. A definition and its implication for practice. Research and Education 1991. When any of these needs are unmet and when a person is unable to fulfill his own needs. Conceptualizing functions led theorists to consider nursing client in terms of a Hierarchy of needs. Harmer)-Textbook for the principles and practices of Nursing.The Nature of Nursing Reflections after 20 years Analysis of Nursing Theory Images of Nursing. 1950-1970 The First School of Thought: Needs This school of thought includes theories that reflect an image of nursing as meeting the needs of clients and were developed in response to such questions as: y y y y What do nurses do? What are their functions? What roles do nurses play? Answers to these questions focused on a number of theorists describing functions and roles of nurses. Nurses then provide the necessary functions and play those roles that could help patients meet their needs. Publications y y y y 1956 (with B.

Role of nurse Beginnings of independent functions Fulfill needs requisites Decision making Primarily health care professional Problems A set of needs or problems. her work is inductive. 1966). she worked as a visiting nurse in New York City. Patient Orientation Need Deficit Illness. ..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. Henderson¶s Theory Background y y y y y Henderson¶s concept of nursing was derived form her practice and education therefore.Zderad Paplau Travelbee Wiedenbach Rogers Roy Analysis of nursing theories according to 1st School Focus Human being A developmental being. This experience enlarges Henderson¶s view to recognize the importance of increasing the patient¶s independence so that progress after hospitalization would not be delayed (Henderson. disease Dependent on medical practice. She called her definition of nursing her ³concept´ (Henderson1991) Although her major clinical experiences were in medical-surgical hospitals.

. She described the nurse's role as substitutive (doing for the person). she was concerned that many states had no provision for nursing licensure to ensure safe and competent care for the consumer. supplementary (helping the person). with the goal of helping the person become as independent as possible. complementary (working with the person). y y First. 1966). she participated in the revision of a nursing textbook. And to do this in such a way as to help him gain independence as rapidly as possible" (Henderson. 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.y y y y She was one of the first nurses to point out that nursing does not consist of merely following physician's orders. In the revision she recognized the need to be clear about the functions of the nurse and she believed that this textbook serves as a main learning source for nursing practice should present a sound and definitive description of nursing. based on human needs. She categorized nursing activities into 14 components. Second. sick or well. The development of Henderson¶s definition of nursing Two events are the basis for Henderson¶s development of a definition of nursing. will or knowledge. He believed the principles and practice or nursing must be built upon and derived from the definition of the profession. 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.

In 1955. Select suitable clothes-dress and undress. discover. Henderson¶s first definition of nursing was published in Bertha Harmer¶s revised nursing textbook. to recover. needs. Work in such a way that there is a sense of accomplishment. but this assumption is not explicitly . or satisfy the curiosity that leads to normal development and health and use the available health facilities. Eat and drink adequately. or to achieve peaceful death. 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. The first 9 components are physiological. Move and maintain desirable postures. Sleep and rest. Communicate with others in expressing emotions. The 14 components y y y y y y y y y y y y y Breathe normally. 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 aret: y "Nurses care for patients until patient can care for themselves once again. Eliminate body wastes.Henderson's focus on individual care is evident in that she stressed assisting individuals with essential activities to maintain health. Patients desire to return to health. Play or participate in various forms of recreation. Learn. Worship according to one¶s faith. fears. She proposed 14 components of basic nursing care to augment her definition. or opinions.

Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided 3. and spiritual components. Individuals in relation to families Minimally discusses the impact of the community on the individual and family. All external conditions and influences that affect life and development. . psychological. Supports tasks of private and public agencies Society wants and expects nurses to act for individuals who are unable to function independently.Environment: y y y y y y Settings in which an individual learns unique pattern for living. In return she expects society to contribute to nursing education. Mind and body are inseparable and interrelated. Requiring assistance to achieve health and independence or a peaceful death. Health: y y Definition based on individual¶s ability to function independently as outlined in the 14 components. 2. Individual : y y y y y Have basic needs that are component of health. and the patient is neither client nor consumer.y stated. Nurses need to stress promotion of health and prevention and cure of disease. Henderson¶s theory and the four major concepts 1. Nurses are willing to serve and that ³nurses 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. sociological. Considers the biological. The theory presents the patient as a sum of parts with biopsychosocial needs.

or making a prognosis. Nursing y y y y y y y y y y Temporarily assisting an individual who lacks the necessary strength. and emotional balance Is the individual¶s ability to meet these needs independently? 4. In the Nature of Nursing ³ that the nurse is and should be legally. physical. Assists and supports the individual in life activities and the attainment of independence. help individual meet their health need. or "independent. and or provide an environment in which the individual can perform activity .´ to get inside the patient¶s skin and supplement his strength will or knowledge according to his needs.´ In the Nature of Nursing Nurse role is. the will. Affected by age. and intellectual capacities.´ ³Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver." The nurse is expected to carry out physician¶s therapeutic plan Individualized care is the result of the nurse¶s creativity in planning for care. cleanliness and serving food.y Good health is a challenge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible. will and knowledge to satisfy 1 or more of 14 basic needs. an independent practitioner and able to make independent judgments as long as s/he is not diagnosing. cultural background. prescribing treatment for disease. Use nursing research o Categorized Nursing : nursing care o Non nursing: ordering supplies. Nurse serves to make patient ³complete´ ³whole". and the knowledge. for these are the physicians function." 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.´ And nurse has responsibility to assess the needs of the individual patient.

taking into consideration strength. The steps are those of the scientific method. the will. But I go on to say that the nurse makes the patient independent of him or her as soon as possible. emotional balance. age. and physical and intellectual capacities. Carry out treatment prescribed by the physician.nursing and appropriate laws related to the practice of nursing. Assist the sick or well individual in to performance of activities in meeting human needs to maintain health. Successful outcomes of nursing care are based on the speed with which or degree to which the patient performs independently the activities of daily living Comparison with Maslow's Hierarchy of Need . recover from illness. The quality of care is drastically affected by the preparation and native ability of the nursing personnel rather that the amount of hours of care. Implementation based on the physiological principles. cultural background. and the knowledge. sick or well. ´Summarization of the stages of the nursing process as applied to Henderson¶s definition of nursing and to the 14 components of basic nursing care. will or knowledge. Document how the nurse can assist the individual.´ ³Nursing process stresses the science of nursing rather than the mixture of science and art on which it seems effective health care service of any kind is based. Nursing evaluation Henderson¶s 14 components and definition of nursing Use the acceptable definition of ." Henderson¶s and Nursing Process Henderson views the nursing process as ³really the application of the logical approach to the solution of a problem. or to aid in peaceful death. Identify individual¶s ability to meet own needs with or without assistance. Nursing Process Nursing Assessment Nursing Diagnosis Nursing plan Nursing implementation Nursing implementation Nursing process Henderson¶s 14 components and definition of nursing Henderson¶s 14 components Analysis: Compare data to knowledge base of health and disease.y y 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.

nurse-patient relationship Theories must be logical in nature. discover. culture. Maslow¶s Hierarchy of human needs. biophysiology. Her work can be applied to the health of individuals of all ages. communication and is borrowed from other discipline. concept of interaction-communication i.E. Theories should be relatively simple yet generalizable.e. Concepts of fundamental human needs. and interaction. .. or satisfy curiosity Characteristic of Henderson¶s theory y Belongingness and love needs y y y y y Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon.Maslow's Henderson Breathe normally Eat and drink adequately Eliminate by all avenues of elimination Move Physiological and maintain desirable posture needs Sleep and rest Select suitable clothing Maintain body temperature Keep body clean and well groomed and protect the integument Safety Needs Avoid environmental dangers and avoid injuring other Communicate with others worship according to one's faith Work at something providing a sense of accomplishment Esteem needs Play or participate in various forms of recreation Learn.g. Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chosen goal.

Philosophical claims y The philosophy reflected in Henderson's theory is an integrated approach to scientific study that would capitalize on nursing's richness and complexity. Is the sequence of the 14 components followed by nurses in the USA and the other countries? What priorities are evident in the use of the basic nursing functions? Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. laws. However. Values and Beliefs y Henderson believed nursing as primarily complementing the patient by supplying what he needs in knowledge. therefore. the "doing" of nursing from the "knowing". and principles but will leave open unanswered questions that need to be investigated. will or strength to perform . and not to separate the art from the science. the psychological from the physical and the theory from clinical care. Ideally the nurse would improve nursing practice by using her definition and 14 components to improve the health of individuals and thus reduce illness. it is impossible to generate testable hypotheses. the impact of the definition and components has not been established through research. Her ideas of nursing practice are well accepted throughout the world as a basis for nursing care. Theories must be consistent with other validated theories.y y y y y y y y y y Theories can be the bases for hypotheses that can be tested. Theories can be utilized by practitioners to guide and improve their practice. Her definition of nursing cannot be viewed as theory. However some questions to investigate the definition of nursing and the 14 components may be useful.

y y y his daily activities and to carry out the treatment prescribed for him by the physician.16) had an influence on her beliefs.. Usefulness y y y Nursing education has been deeply affected by Henderson¶s clear vision of the functions of nurses. Others concepts that Henderson (1966) proposed have been used in nursing education from the 1930s until the present O'Malley. the leg of the amputee. a means of locomotion for the infant and the knowledge and confidence for the young mother." Henderson stated that ³Thorndike¶s fundamental needs of man´ (Henderson. Like she said. Her contributions to nursing literature extended from the 1930s through the 1990s and has had an impact on nursing research by strengthening the focus on nursing practice and confirming the value of tested interventions in assisting individuals to regain health. She strongly believed in "getting inside the skin" of her patients in order to know what he or she needs. The principles of Henderson¶s theory were published in the major nursing textbooks used from the 1930s through the 1960s. The nurse should be the substitute for the patient. 1996) . helper to the patient and partner with the patient.. 1991. and the principles embodied by the 14 activities are still important in evaluating nursing care in thee21st centaury... her concept of nursing enhanced nursing science this has been particularly important in the area of nursing education. p. the love of life for the suicidal. the eyes of the newly blind. "The nurse is temporarily the consciousness of the unconscious. Value in extending nursing science y y From an historical standpoint.

Assisting the individual in the dying process she contends that the nurse helps. which are essential for effective decision making and implementation. PURPOSES OF NURSING THEORIES In Practice: y y y y y Assist nurses to describe. rather than on.Testability y y y Henderson supported nursing research. explain. If the assumption is made that the 14 components prioritized. Written in testable terms. Much of the research before her time had been on educational processes and on the profession of nursing itself. but there is little explanation of what the nurse does. Lacks inter-relate of factors and the influence of nursing care. and she worked to change that. Each of the 14 activities can be the basis for research. Although the statements are not. the relationship among the components is unclear. interventions. Limitations y y y y y y Lack of conceptual linkage between physiological and other human characteristics. ³Peaceful death´ is curious and significant nursing role. No concept of the holistic nature of human being. Help to describe criteria to measure the quality of nursing care. Further. and evaluation of nursing care. they may be reformulated into researchable questions. Serve to guide assessment. and predict everyday experiences. Help build a common nursing terminology to use . Provide a rationale for collecting reliable and valid data about the health status of clients. the practice and outcomes of nursing . 1996). the theory can guide research in any aspect of the individual¶s care needs. but believed that it should be clinical research (O¶Malley.

Offer a systematic approach to identify questions for study. Abilities and Experiences What will it be like to think about nursing theory in nursing practice? Will my work with nursing theory be worth the effort? . interpret findings.y y in communicating with other health professionals. and validate nursing interventions. select variables. Assist in discovering knowledge gaps in the specific field of study. Enhance autonomy (independence and selfgovernance) of nursing through defining its own independent functions. In Education: y y Provide a general focus for curriculum design Guide curricular decision making. Questions from practicing Nurse about using Nursing theory Practice y y y y y y Does this theory reflect nursing practice as I know it? Will it support what I believe to be excellent nursing practice? Can this theory be considered in relation to a wide range of nursing situation? Personal Interests. In Research: y y y y y y y y Offer a framework for generating knowledge and new ideas. Ideas are developed and words are defined. Inductively looking at nursing practice to discover theories/concepts to explain phenomena. Deductively looking for the compatibility of a general nursing theory with nursing practice. Approaches to developing nursing theory Borrowing conceptual frameworks from other disciplines.

description. could facilitate this through observation. Please help improve this article by adding citations to reliable sources.1 Peplau's Seven Nursing Roles o 2. interpretation. and intervention.D (September 1. Contents [hide] y y y 1 Life 2 Peplau's model o 2.2 Peplau's Developmental Stages of the Nurse-Client Relationship 3 References [edit] Life . Dr. she thought. formulation. Nurses.Hildegard Peplau From Wikipedia. validation. Unsourced material may be challenged and removed. improved coping strategies. Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment (and the nurse passively acting out doctor's orders). The nurse then validates his or her inferences by checking with the client for accuracy. At the time. and personal growth for both parties. The result may be experiential learning. as the nurse listens to her client she or he develops a general impression of the client's situation. Pennsylvania ± 17 March 1999) was a nursing theorist whose seminal work Interpersonal Relations in Nursing was published in 1952. 1909. her research and emphasis on the give-and-take of nurse-client relationships was seen by many as revolutionary. Reading. search This article does not cite any references or sources. the free encyclopedia Jump to: navigation. The essence of Peplau's theories is the creation of a shared experience. Ed. (September 2009) Hildegard Peplau. For example. Peplau died in 1999. aged 89. Peplau emphasized the nurse-client relationship as the foundation of nursing practice.

she witnessed the devastating flu epidemic of 1918. After her retirement from Rutgers. and clinical training workshops. Air Force. she conducted summer workshops for nurses throughout the United States. and one of six children. 1909. As a child. Peplau began her career in nursing in 1931 as a graduate of the Pottstown. She then worked as a staff nurse in Pennsylvania and New York City.[citation needed] [edit] Peplau's model Peplau's model has proved of great use to later nurse theorists and clinicians in developing more sophisticated and therapeutic nursing interventions . Peplau held master¶s and doctoral degrees from Teachers College. Peplau was a member of the faculty of the College of Nursing at Rutgers University from 1954 to 1974. speeches. PA. She was also certified in psychoanalysis at the William Alanson White Institute of New York City. Peplau vigorously advocated that nurses should become further educated so they could provide truly therapeutic care to patients rather than the custodial care that was prevalent in the mental hospitals of that era. There she helped establish the first graduate nursing program in Europe.S. There she earned a bachelor¶s degree in interpersonal psychology in 1943. She was a prolific writer and was equally well known for her presentations. and throughout the United States. mostly in state psychiatric hospitals. the second daughter of immigrants Gustav and Ottylie Peplau. PA. a private psychiatric facility. and the National Institutes of Mental Health. and group therapy. Frieda FrommReichmann. she served as a consultant to the U. After the war. family. At Bennington and through field experiences at Chestnut Lodge. A strong advocate for graduate education and research in nursing. where the American School of Military Psychiatry was located. From 1943 to 1945 she served in the Army Nurse Corps and was assigned to the 312th Field Station Hospital in England. Columbia University. she served as a visiting professor at the University of Leuven in Belgium in 1975 and 1976. Dr. Peplau was an advisor to the World Health Organization and was a visiting professor at universities in Africa. A summer position as nurse for the New York University summer camp led to a recommendation for Peplau to become the school nurse at Bennington College in Vermont. She participated in many government policy-making groups.Hildegard Peplau was born September 1. as well as individual. Here she met and worked with all the leading figures in British and American psychiatry. At Rutgers. In the early 1950s. Belgium. and Harry Stack Sullivan. Peplau developed and taught the first classes for graduate psychiatric nursing students at Teachers College. Latin America. In these seminars. Peplau¶s life-long work was largely focused on extending Sullivan¶s interpersonal theory for use in nursing practice. Peplau created the first graduate level program for the preparation of clinical specialists in psychiatric nursing. a personal experience that greatly influenced her understanding of the impact of illness and death on families. she studied psychological issues with Erich Fromm. in Reading. During the 1950s and 1960s. she taught interpersonal concepts and interviewing techniques. Surgeon General.S. Peplau was at the table with many of these same men as they worked to reshape the mental health system in the United States through the passage of the National Mental Health Act of 1946 and so on. School of Nursing. the U.

interdependence. and independence and acts on clients behalf as advocate. 3. Stranger role: Receives the client the same way one meets a stranger in other life situations. 2010 ======================================== ³Nursing theories mirror different realities. in 1897 and is the 5th child of a family of 8th children but spent her formative years in Virginia y y y y y y y y Received a Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital. provides an accepting climate that builds trust. 6. 5. Missouri. throughout their development. 7. Teaching role: Gives instructions and provides training.C. gives information. Counseling role: Helps client understand and integrate the meaning of current life circumstances. Surrogate role: Helps client clarify domains of dependence. in 1921. Working Phase -Identification Phase -Exploitation Phase 3.´ "The 20th century Florence Nightingale." "little Miss 3x5" Born in Kansas City. In 1923.[edit] Peplau's Seven Nursing Roles Peplau's Seven Nursing Roles illustrate the dynamic character roles typical to clinical nursing. they reflected the interests of nurses of that time. Resource role: Answers questions. provides guidance and encouragement to make changes. Washington. involves analysis and synthesis of the learner's experience.´ Introduction ³The Nightingale of Modern Nursing´ ³Modern-Day Mother of Nursing. D. Termination / Resolution Phase Virginia Henderson's Need Theory This page was last updated on November 6. 1. she accepted a position teaching nursing at the Norfolk . Active leadership: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way. Operates equipment [edit] Peplau's Developmental Stages of the Nurse-Client Relationship 1. interprets clinical treatment data. 4. Worked at the Henry Street Visiting Nurse Service for 2 years after graduation. 2. Orientation Phase 2. Technical expert role: Provides physical care by displaying clinical skills.

Publications 1956 (with B. VH was a well known nursing educator and a prolific author. Achievements y y y Is the recipient of numerous recognitions for her outstanding contributions to nursing. A definition and its implication for practice. and later wrote the 5th. incorporating her personal definition of nursing (Henderson. Died: March 19. Contribution y In 1937 Henderson and others created a basic nursing curriculum for the National League for Nursing in the US in which education was ³patient centered and organized around nursing problems rather than medical diagnoses´ (Henderson. Miss Henderson was honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association.. Harmer)-Textbook for the principles and practices of Nursing.1998) Since 1953. Henderson determined that she needed more education and entered Teachers College at Columbia University where she earned her. Pace University. Bachelor¶s Degree in 1932.Protestant Hospital in Virginia. Master¶s Degree in 1934. University of Rochester. she joined Columbia as a member of the faculty. Yale University y In 1985. where she remained for several years y In 1929. edition. y In 1978 the fundamental concept of nursing was revisited by Virginia Henderson from Yale University School of Nursing ( USA ). y y 1966-The Nature of Nursing. she revised: Harmer¶s classic textbook of nursing for its 4th edition. .1991) y In 1939. 1996. She has received honorary doctoral degrees from the Catholic University of America. where she remained until 1948(Herrmann.1991) y y Her work influenced the nursing profession in America and throughout the world The founding members of ICIRN (Interagency Council on Information Resources for Nursing) and a passionate advocate for the use and sharing of health information resources. y y y Subsequently. she has been a research associate at Yale University School of Nursing. University of Western Ontario.

A developmental being. y y y y y y y Conceptualizing functions led theorists to consider nursing client in terms of a Hierarchy of needs. When any of these needs are unmet and when a person is unable to fulfill his own needs. the care provided by nurses is required. 1950-1970 The First School of Thought: Needs This school of thought includes theories that reflect an image of nursing as meeting the needs of clients and were developed in response to such questions as: What do nurses do? What are their functions? What roles do nurses play? Answers to these questions focused on a number of theorists describing functions and roles of nurses.Research and Education y y 1991. School of thought in Nursing Theories-1950-1970 Need theorists interaction Theorists King Orlando Outcome theorists Johnson Levine Rogers Roy Abdellah Henderson Orem Peterson and Zderad Paplau Travelbee Wiedenbach Analysis of nursing theories according to 1st School Focus Human being Problems A set of needs or problems. Nurses then provide the necessary functions and play those roles that could help patients meet their needs.The Nature of Nursing Reflections after 20 years Analysis of Nursing Theory Images of Nursing. .

Patient Orientation Need Deficit Illness. And to do this in such a way as to help him gain independence as rapidly as possible" (Henderson. She categorized nursing activities into 14 components. She described the nurse's role as substitutive (doing for the person). supplementary (helping the person). 1966).. This experience enlarges Henderson¶s view to recognize the importance of increasing the patient¶s independence so that progress after hospitalization would not be delayed (Henderson. will or knowledge. sick or well. disease Dependent on medical practice. with the goal of helping the person become as independent as possible. Role of nurse Beginnings of independent functions Fulfill needs requisites Decision making Primarily health care professional Henderson¶s Theory Background Henderson¶s concept of nursing was derived form her practice and education therefore.1991) y Virginia Henderson defined nursing as "assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery" (Henderson. y y y y She called her definition of nursing her ³concept´ (Henderson1991) Although her major clinical experiences were in medical-surgical hospitals. based on human needs. y 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. y y y She was one of the first nurses to point out that nursing does not consist of merely following physician's orders. she worked as a visiting nurse in New York City. her work is inductive. The development of Henderson¶s definition of nursing . 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. complementary (working with the person). 1966).

Work in such a way that there is a sense of accomplishment. In the revision she recognized the need to be clear about the functions of the nurse and she believed that this textbook serves as a main learning source for nursing practice should present a sound and definitive description of nursing. 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 . needs. Move and maintain desirable postures. The 14 components Breathe normally. Second. to recover. she participated in the revision of a nursing textbook. Select suitable clothes-dress and undress. Eat and drink adequately. Worship according to one¶s faith. Learn. First. She proposed 14 components of basic nursing care to augment her definition. The first 9 components are physiological. Sleep and rest. fears. or satisfy the curiosity that leads to normal development and health and use the available health facilities. In 1955.Two events are the basis for Henderson¶s development of a definition of nursing. Henderson's focus on individual care is evident in that she stressed assisting individuals with essential activities to maintain health. Henderson¶s first definition of nursing was published in Bertha Harmer¶s revised nursing textbook. Eliminate body wastes. He believed the principles and practice or nursing must be built upon and derived from the definition of the profession. Maintain body temperature within normal range by adjusting clothing and modifying environment y y y y y y y y y y y y y y y Keep the body clean and well groomed and protect the integument Avoid dangers in the environment and avoid injuring others. or opinions. Play or participate in various forms of recreation. Communicate with others in expressing emotions. she was concerned that many states had no provision for nursing licensure to ensure safe and competent care for the consumer. or to achieve peaceful death. discover.

and the patient is neither client nor consumer. y y y y y Supports tasks of private and public agencies Society wants and expects nurses to act for individuals who are unable to function independently. y y y y y Mind and body are inseparable and interrelated. and spiritual components. In return she expects society to contribute to nursing education. The theory presents the patient as a sum of parts with biopsychosocial needs. y y Nurses are willing to serve and that ³nurses 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. psychological. Individuals in relation to families Minimally discusses the impact of the community on the individual and family. Requiring assistance to achieve health and independence or a peaceful death. Individual : Have basic needs that are component of health. Health: Definition based on individual¶s ability to function independently as outlined in the 14 components. but this assumption is not explicitly stated. 2. All external conditions and influences that affect life and development. Henderson¶s theory and the four major concepts 1. y .Environment: Settings in which an individual learns unique pattern for living. sociological. Patients desire to return to health. y Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided 3.oriented to occupation and recreation Assumption The major assumptions of the theory aret: "Nurses care for patients until patient can care for themselves once again. Considers the biological.

´ y y y ³Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver.´ And nurse has responsibility to assess the needs of the individual patient. Affected by age." Henderson¶s and Nursing Process . y y y y Assists and supports the individual in life activities and the attainment of independence." y The nurse is expected to carry out physician¶s therapeutic plan Individualized care is the result of the nurse¶s creativity in planning for care. an independent practitioner and able to make independent judgments as long as s/he is not diagnosing. cultural background. and the knowledge. Nurse serves to make patient ³complete´ ³whole". y Use nursing research o o y Categorized Nursing : nursing care Non nursing: ordering supplies. physical. and the knowledge. or making a prognosis. But I go on to say that the nurse makes the patient independent of him or her as soon as possible. will and knowledge to satisfy 1 or more of 14 basic needs. In the Nature of Nursing ³ that the nurse is and should be legally. help individual meet their health need. and or provide an environment in which the individual can perform activity unaided y 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. for these are the physicians function. and intellectual capacities. the will. Nursing Temporarily assisting an individual who lacks the necessary strength. y But I go on to say that the nurse makes the patient independent of him or her as soon as possible.y y Nurses need to stress promotion of health and prevention and cure of disease. Good health is a challenge. prescribing treatment for disease. and emotional balance Is the individual¶s ability to meet these needs independently? 4. cleanliness and serving food.´ to get inside the patient¶s skin and supplement his strength will or knowledge according to his needs." 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.´ In the Nature of Nursing Nurse role is. the will. or "independent.

taking into consideration strength. Identify individual¶s ability to meet own needs with or without assistance. recover from illness. Nursing evaluation Use the acceptable definition of . Successful outcomes of nursing care are based on the speed with which or degree to which the patient performs independently the activities of daily living Comparison with Maslow's Hierarchy of Need . ´Summarization of the stages of the nursing process as applied to Henderson¶s definition of nursing and to the 14 components of basic nursing care. or to aid in peaceful death. emotional balance. Assist the sick or well individual in to performance of activities in meeting human needs to maintain health.nursing and appropriate laws related to the practice of nursing. cultural background. and physical and intellectual capacities. The steps are those of the scientific method. Nursing process Implementation based on the physiological principles.´ ³Nursing process stresses the science of nursing rather than the mixture of science and art on which it seems effective health care service of any kind is based.Henderson views the nursing process as ³really the application of the logical approach to the solution of a problem. age. Nursing Process Nursing Assessment Nursing Diagnosis Nursing plan Henderson¶s 14 components and definition of nursing Henderson¶s 14 components Analysis: Compare data to knowledge base of health and disease. Henderson¶s 14 components and definition of nursing The quality of care is drastically affected by the preparation and native ability of the nursing personnel rather that the amount of hours of care. Carry out treatment prescribed by the physician. will or knowledge. sick or well. Nursing implementation Nursing implementation Document how the nurse can assist the individual.

or satisfy curiosity Characteristic of Henderson¶s theory y y Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. Theories can be the bases for hypotheses that can be tested. nurse-patient relationship y y y y y Theories must be logical in nature. communication and is borrowed from other discipline. culture.. Concepts of fundamental human needs. Maslow¶s Hierarchy of human needs. Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chosen goal. therefore. concept of interactioncommunication i. and interaction.Maslow's Henderson Breathe normally Eat and drink adequately Eliminate by all avenues of elimination Move and maintain desirable posture Sleep and rest Select suitable clothing Maintain body temperature Keep body clean and well groomed and protect the integument Avoid environmental dangers and avoid injuring other Communicate with others worship according to one's faith Work at something providing a sense of accomplishment Physiological needs Safety Needs Belongingness and love needs Esteem needs Play or participate in various forms of recreation Learn. discover. Her definition of nursing cannot be viewed as theory. Her work can be applied to the health of individuals of all ages.g.E. biophysiology.e. Is the sequence of the 14 components followed by nurses in the USA and the other countries? . it is impossible to generate testable hypotheses. y y However some questions to investigate the definition of nursing and the 14 components may be useful. Theories should be relatively simple yet generalizable.

y Theories must be consistent with other validated theories. "The nurse is temporarily the consciousness of the unconscious. the impact of the definition and components has not been established through research. y y y y Her ideas of nursing practice are well accepted throughout the world as a basis for nursing care. a means of locomotion for the infant and the knowledge and confidence for the young mother. laws. the psychological from the physical and the theory from clinical care. will or strength to perform his daily activities and to carry out the treatment prescribed for him by the physician... p. and principles but will leave open unanswered questions that need to be investigated. 1991. Philosophical claims The philosophy reflected in Henderson's theory is an integrated approach to scientific study that would capitalize on nursing's richness and complexity.. The nurse should be the substitute for the patient.16) had an influence on her beliefs.. However. the "doing" of nursing from the "knowing". Values and Beliefs Henderson believed nursing as primarily complementing the patient by supplying what he needs in knowledge." y Henderson stated that ³Thorndike¶s fundamental needs of man´ (Henderson. Theories can be utilized by practitioners to guide and improve their practice. and not to separate the art from the science. the eyes of the newly blind.y y What priorities are evident in the use of the basic nursing functions? Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. Ideally the nurse would improve nursing practice by using her definition and 14 components to improve the health of individuals and thus reduce illness. y y y She strongly believed in "getting inside the skin" of her patients in order to know what he or she needs. y Like she said. helper to the patient and partner with the patient. the leg of the amputee. Value in extending nursing science . the love of life for the suicidal.

y y Each of the 14 activities can be the basis for research. Further. Usefulness y y Nursing education has been deeply affected by Henderson¶s clear vision of the functions of nurses. the practice and outcomes of nursing . the relationship among the components is unclear. they may be reformulated into researchable questions. No concept of the holistic nature of human being. her concept of nursing enhanced nursing science this has been particularly important in the area of nursing education.y From an historical standpoint. . Although the statements are not. Written in testable terms. 1996). Lacks inter-relate of factors and the influence of nursing care. and she worked to change that. rather than on. 1996) Testability y Henderson supported nursing research. and the principles embodied by the 14 activities are still important in evaluating nursing care in thee21st centaury. y Her contributions to nursing literature extended from the 1930s through the 1990s and has had an impact on nursing research by strengthening the focus on nursing practice and confirming the value of tested interventions in assisting individuals to regain health. Much of the research before her time had been on educational processes and on the profession of nursing itself. but there is little explanation of what the nurse does. The principles of Henderson¶s theory were published in the major nursing textbooks used from the 1930s through the 1960s. but believed that it should be clinical research (O¶Malley. Assisting the individual in the dying process she contends that the nurse helps. the theory can guide research in any aspect of the individual¶s care needs. y Others concepts that Henderson (1966) proposed have been used in nursing education from the 1930s until the present O'Malley. Limitations y y y y y y Lack of conceptual linkage between physiological and other human characteristics. If the assumption is made that the 14 components prioritized. ³Peaceful death´ is curious and significant nursing role.

y y y y y y y y Practice Approaches to developing nursing theory Borrowing conceptual frameworks from other disciplines. and evaluation of nursing care. Questions from practicing Nurse about using Nursing theory y y y y y y Does this theory reflect nursing practice as I know it? Will it support what I believe to be excellent nursing practice? Can this theory be considered in relation to a wide range of nursing situation? Personal Interests. Assist in discovering knowledge gaps in the specific field of study. Serve to guide assessment. Inductively looking at nursing practice to discover theories/concepts to explain phenomena. Abilities and Experiences What will it be like to think about nursing theory in nursing practice? Will my work with nursing theory be worth the effort? . Deductively looking for the compatibility of a general nursing theory with nursing practice. select variables. which are essential for effective decision making and implementation. Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions. and predict everyday experiences. and validate nursing interventions. interventions. Ideas are developed and words are defined. interpret findings. In Education: Provide a general focus for curriculum design Guide curricular decision making. Help build a common nursing terminology to use in communicating with other health professionals. Offer a systematic approach to identify questions for study. Provide a rationale for collecting reliable and valid data about the health status of clients. y y y y y y y Help to describe criteria to measure the quality of nursing care.PURPOSES OF NURSING THEORIES In Practice: Assist nurses to describe. y y In Research: Offer a framework for generating knowledge and new ideas. explain.

2010 =============================================== INTRODUCTION Faye Glenn Abdellah.C. Faye Glenn Abdellah's Theory Twenty-One Nursing Problems This page was last updated on November 5. Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the person and how nursing can assist in meeting those needs. D. a leader in nursing research and has over one hundred publications y . pioneer nursing researcher. She didn¶t intend to develop a theory of nursing but rather she attempted to define the unique focus of nursing. Department of Health and human services. nursing care and nursing education y y y y Birth:1919 Dr Abdellah worked as Deputy Surgeon General Former Chief Nurse Officer for the US Public Health Service . y Her definition of nursing and the 14 components of basic nursing care are uncomplicated and self-explanatory. Henderson provides the essence of what she believes is a definition of nursing.Summary y y y y y y y y y y y y y y Background Achievements Publications Analysis of Nursing theories Development of Henderson¶s definition of nursing 14 components Major four concepts Nursing process with Henderson¶s theory Comparison with Maslow's Hierarchy need Assumptions Usefulness Testability Characteristics Limitation Conclusion y y y In conclusion. helped transform nursing theory. Washington.

y According to her. 4. and technical skills of the individual nurse into the desire and ability to help people . influenced by the desire to promote client-centred comprehensive nursing care. the item 3. y y y The theory was created to assist with nursing education and is most applicable to the education of nurses. Recognizing the nursing problems of the patient Deciding the appropriate course of action to take in terms of relevant nursing principles 3. and. sick or well. Although it was intended to guide care of those in the hospital. to families. it also has relevance for nursing care in community settings. Providing continuous care of the individuals total needs Providing continuous care to relieve pain and discomfort and provide immediate security for the individual 5. . 2. . education for advanced practice in nursing and nursing research.) PHILOSOPHICAL UNDERPINNINGS OF THE THEORY Abdellah¶s patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory. Helping the individual to adjust to his limitations and emotional problems Working with allied health professions in planning for optimum health on local. national and international levels 10. therefore to. to society. y In 1960. 6. intellectual competencies. state.related to nursing care. nursing is based on an art and science that mould the attitudes. Adjusting the total nursing care plan to meet the patient¶s individual needs Helping the individual to become more self directing in attaining or maintaining a healthy state of mind & body 7. 9. cope with their health needs.³providing continuous care of the individual¶s total health needs´ was eliminated. As a comprehensive service nursing includes: 1. Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations 8. Abdellah described nursing as a service to individuals. Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet the health needs of peop (In 1973.

The need to appreciate the interconnectedness of social enterprises and social problems. y y y She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses¶ prerogative. µhe¶ for doctors and patients. and refers to the object of nursing as µpatient¶ rather than client or consumer.They also identified 10 steps to identify the client¶s problems. She uses the term µshe¶ for nurses. pollution.MAJOR ASSUMPTIONS. y y y y y y the impact of problems such as poverty. CONCEPTS & RELATIONSHIPS The language of Abdellah¶s framework is readable and clear. 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. education. 11 nursing skills to be used in developing a treatment typology 10 steps to identify the client¶s 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 y y y y y y y y y y Identify the therapeutic plan Test generalizations with the patient and make additional generalizations Validate the patient¶s 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 patient¶s and family¶s reaction to the therapeutic plan and involve them in the plan Identify how the nurses feels about the patient¶s nursing problems Discuss and develop a comprehensive nursing care plan 11 nursing skills Observation of health status Skills of communication y y . Assumptions were related to change and anticipated changes that affect nursing. racism. and so forth on health care delivery.

or other trauma and through the prevention of the spread of infection y y y y y y y To maintain good body mechanics and prevent and correct deformitiy 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 y y y y y y y To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function. injury. and emotional needs of clients Types of interpersonal relationships between the nurse and patient Common elements of client care 21 NURSING PROBLEMS BASIC TO ALL PATIENTS To maintain good hygiene and physical comfort To promote optimal activity: exercise. and reactions y . sociological. REMEDIAL CARE NEEDS To identify and accept positive and negative expressions. feelings. rest and sleep To promote safety through the prevention of accidents.y y y y y y y y y 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 The twenty-one Nursing Problems Three major categories Physical.

sick or well. cope with their health needs. and technical skills of the individual nurse into the desire and ability to help people. and developmental needs RESTORATIVE CARE NEEDS To accept the optimum possible goals in the light of limitations.y y y y y y 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 . HEALTH Health is a dynamic pattern of functioning whereby there is a continued interaction with internal and external forces that results in the optimum use of necessary resources that serve to minimize vulnerabilities NURSING PROBLEMS Nursing problem presented by a client is a condition faced by the client or client¶s family that the nurse through the performance of professional y . a theoretical statement can be derived by using her three major concepts of health. But. NURSING y y Abdellah¶s theory states that nursing is the use of the problem solving approach with key nursing problems related to health needs of people. and problem solving. physical and emotional y y y 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 ABDELLAH¶S THEORY AND NURSING Abdellah¶s writings are not specific as to a theoretical statement. Acc to her. nursing is based on an art and science that mould the attitudes. emotional. nursing problems. intellectual competencies.

which the nurse can assist him or them to meet through the performance of her professional functions. Individuals (and families) are the recipients of nursing Health. . In Abdellah¶s model. cope with their health needs. testing hypothesis through the collection of data. emotional. or alleviating impairment. y y y y Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. or achieving of it. 5. and revising hypothesis where necessary on the basis of conclusions obtained from the data. such as emotional and social needs. y An overt nursing problem is an apparent condition faced by the patient or family. y y y y Patient is described as the only justification for the existence of nursing.ss ABDELLAH¶S THEORY AND THE FOUR MAJOR CONCEPTS NURSING Nursing is a helping profession. selecting pertinent data. increasing or restoring self-help ability. which the nurse can assist him or them to meet through the performance of her professional functions PROBLEM SOLVING The problem solving process involves 1. The problem can be either an overt or covert nursing problem. identifying the problem. nursing care is doing something to or for the person or providing information to the person with the goals of meeting needs. and sociological needs. She considers nursing to be comprehensive service that is based on art and science and aims to help people. These needs may overt.functions can assist them to meet. formulating hypothesis. PERSON Abdellah describes people as having physical. or covert. sick or well. y The covert nursing problem is a concealed or hidden condition faced. 4. 2. is the purpose of nursing services. consisting of largely physical needs. by the patient or family. 3.

and international levels´. as she further delineated her ideas. ABDELLAH¶S WORK AND CHARACTERISTICS OF A THEORY Characteristic 1 Abdellah¶s theory has interrelated the concepts of health. and problem solving as she attempts to create a different way of viewing nursing phenomenon y y Nursing is the use of problem solving approach with key nursing problems related to health needs of people. Characteristic 5 The results of testing such hypothesis would contribute to the general body of nursing knowledge Characteristic 6 y y y y .HEALTH In Patient ±Centered Approaches to Nursing. Characteristic 4 The role of client within the framework. the focus of nursing service is clearly the individual. Characteristic 2 Problem solving is an activity that is inherently logical in nature. y y Although Abdellah does not give a definition of health. SOCIETY AND ENVIRONMENT Society is included in ³planning for optimum health on local. However. Abdellah describes health as a state mutually exclusive of illness. she speaks to ³total health needs´ and ³a healthy state of mind and body´ in her description of nursing as a comprehensive service. nursing problems. y y The environment is the home or community from which patient comes. state. Characteristic 3 Framework focus on nursing practice and individuals. national.

Once the problem has been diagnosed. y y y y This would be extremely difficult if not impossible to do for Abdellah¶s . EVALUATION According to the American Nurses¶ Association Standards of Nursing Practice. This step is consistent with that involved in nursing diagnosis PLANNING PHASE The statements of nursing problems most closely resemble goal statements.y Abdellah¶s problem solving approach can easily be used by practitioners to guide various activities within their practice that deals with clients who have specific needs and specific nursing problems. IMPLEMENTATION Using the goals as the framework. y y y These specific problems would be grouped under one or more of the broader nursing problems. a plan is developed and appropriate nursing interventions are determined. y y y y The overt or covert nature of the problems necessitates a direct or indirect approach. the plan is evaluated in terms of the client¶s progress or lack of progress toward the achievement of the stated goals. NURSING DIAGNOSIS The results of data collection would determine the client¶s specific overt or covert problems. many questions remain unanswered USE OF 21 PROBLEMS IN THE NURSING PROCESS ASSESSMENT PHASE Nursing problems provide guidelines for the collection of data. A principle underlying the problem solving approach is that for each identified problem. pertinent data are collected. respectively. the nursing goals have been established. Characteristic 7 Although consistency with other theories exist.

tachycardia and profuse diaphoresis y y y y y y Stage of illness is basic to care Selected Abdellah nursing problem To maintain good hygiene and personal comfort Classification and approach Overt problem of pain.Amount of pain CONCEPT OF PROGRESSIVE PATIENT CARE PPC is defined as better patient care through the organization of hospital facilities. close and frequent if not constant. not the client goals. One patient in an ICU requires at least three nurses to observe him in 24 hrs y y Intermediate care Patients assigned to this unit are both the moderately ill .nursing problem approach since it has been determined that the goals are nursing goals. services and staff around the changing medical and nursing needs of the patient y y y y y y y y y y PPC is tailoring of hospital services to meet patients needs PPC is caring for the right patient in the right bed with the right services at the right time PPC is systematic classification of patients based on their medical needs ELEMENTS OF PPC INTENSIVE CARE Critically and seriously ill patients requiring highly skilled nursing care. Direct and indirect method Selected Nursing Interventions administer oxygen elevate headrest reposition client administer prescribed analgesic remain with client Criterion measure. nursing observation are assigned to the ICU. the most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals AN illustration of the implementation of Abdellah¶s framework in Ryan¶s care Consider a case of Ryan who experienced severe crushing chest pain µshortness of breath. y Thus.

and family to solve problems job satisfaction in-service education COMMUNITY continuity with hospital services y y y y y y y y y y y y y y y y y . in nursing homes. or in their own homes and who would benefit by care in a hospital environment to achieve its maximum potential y Home care This programme makes it possible to extend needed services to the patient after he leaves the hospital and returns to his home in the community BENEFITS OF PPC PATIENT better attention better adjustment minimized problems life saving care constant medical and nursing care PHYSICIAN assuring best nursing care drugs and equipments at hand orders carried out effectively better clinical an team service HOSPITAL effective and efficient use of staff improved public image NURSING PERSONNEL individual skills can be used more time with patient helping pt.and those for whom the treatment can only be palliative y y Self care Ambulatory patients who are convalescencing or require diagnosis or therapy may be cared for in this unit Long term care unit This unit will provide services to certain patients now cared for in the general hospital.

She has been a strong advocate for improving nursing practice through nursing research VALUE IN EXTENDING NURSING SCIENCE It helped to bring structure and organization to what was often a disorganized collection of lectures and experiences. y In the long-term care unit are concentrated patients requiring prolonged care. The grouping of such patients will permit staffing patterns that are less costly y Home care. the critically ill patients are concentrated regardless of diagnosis. with impetus for it being nursing education. These patients are under the constant audio-visual observation of the nurse. y y y Abdellah¶s publications on nursing education began with her dissertation. with life saving techniques and equipment immediately available In the intermediate care unit are concentrated patients requiring a moderate amount of nursing care. not of an emergency nature. nursing research. her interest in education for nurses continues into the present. and who are beginning to participate in he planning of their own care y The self-care unit provides for patients who are physically self-sufficient and require diagnostic and convalescent care in hotel-type accommodations. who are ambulatory for short periods. y y y y y y The three month assignment of professional nurses may no longer be realistic in such a setting. Organization of hospital and community services based on patients needs In the intensive care unit. y . extends hospital services into the home to assist the physician in the care of his patients USEFULNESS The patient centered approach was constructed to be useful to nursing practice. the fifth element of progressive patient care.y minimize the need of hospitalization IMPLICATIONS OF PPC FOR NURSING EDUCATION Many nurse educators feel that the PPC hospital where all five phases of care are available can provide clinical experience in which the nurse can learn to solve basic nursing problems in meeting patients¶ needs. Abdellah has also published on nursing. This unit serves as a link between the hospital and the home. and public policy related to nursing in several international publications.

and problem solving. NURSING RESEARCH She has been a leader in nursing research and has over one hundred publications related to nursing care. LIMITATIONS Very strong nursing centered orientation Little emphasis on what the client is to achieve Her framework is inconsistent with the concept of holism Potential problems might be overlooked SUMMARY Using Abdellah¶s concepts of health. the theoretical statement of nursing that can be derived is the use of the problem solving approach with key nursing problems related to health needs of people. Ida J. 21 nursing problems were developed CONCLUSIONS Abdellah¶s theory provides a basis for determining and organizing nursing care. 2010 =============================================== INTRODUCTION Ida Jean Orlando. nursing problems. The nurse¶s philosophical frame of reference would determine whether this theory and the 21 nursing problems could be implemented in practice. y y It is anticipated that by solving the nursing problems. Orlando was one of the first nursing theorists to write about the nursing process based on her own research. y y y Nursing diploma from New York Medical College . y y y y y y From this framework.. The problems also provide a basis for organizing appropriate nursing strategies. Orlando's Nursing Process Theory This page was last updated on November 13. ( Faust C. was born in 1926. the client would be moved toward health. 2002) . education for advanced practice in nursing and nursing research.y She categorized nursing problems based on the individual¶s needs and developed developed a typology of nursing treatment and nursing skills.

y y It was from this research that she developed her theory which was published in her 1961 book. The Dynamic Nurse-Patient Relationship. Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health Psychiatric Nursing. y This process helps nurse find out the nature of the distress and what help the patient needs. y y y The patient's presenting behavior may be a plea for help. MAJOR DIMENSIONS OF THE THEORY Distressis the experience of a patient whose need has not been met. y y Nursing actions directly or indirectly provide for the patient¶s immediate need. however. New York. thoughts about the perception. Aat Yale she was project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic Nursing Curriculum. Therefore. y Orlando's theory was developed in the late 1950s from observations she recorded between a nurse and patient. the help needed may not be what it appears to be. . y y The results of this research are contained in her 1972 book titled: The Discipline and Teaching of Nursing Processes Orlando held various positions in the Boston area. nurses need to use their perception. Nursing role is to discover and meet the patient¶s immediate need for help. or the feeling engendered from their thoughts to explore with patients the meaning of their behavior. was a board member of Harvard Community Health Plan. She furthered the development of her theory when at McLean Hospital in Belmont. MA as Director of a Research Project: Two Systems of Nursing in a Psychiatric Hospital. NY. and served as both a national and international consultant. y y o o Patient¶s behavior may not represent the true need. INTRODUCTION TO THEORY The role of the nurse is to find out and meet the patient's immediate need for help. The nurse validates his/her understanding of the need with the patient. John's University. MA in mental health nursing from Columbia University. An outcome is a change in the behavior of the patient indicating either a relief from distress or an unmet need.y y y y BS in public health nursing from St.

is responsive to individuals who suffer or anticipate a sense of helplessness. 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 y y y The perceptions stimulate automatic thought Each thought stimulates an automatic feeling . Function of professional nursing . may represent a plea for help The presenting behavior of the patient.organizing principle Presenting behavior .Does the patient have an immediate need for help or not? If the patient has an immediate need for help and the nurse finds out and meets that need .resolution FUNCTIONS OF PROFESSIONAL NURSING ± ORGANIZING PRINCIPLE Finding out and meeting the patients immediate needs for help y Nursing«. it is focused on the process of care in an immediate experience. relieving.internal response Nursing process discipline ± investigation Improvement .problematic situation Immediate reaction . causes an automatic internal response in the nurse. it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding. 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 Nursing thought . the stimulus.o y y y y y Observable verbally and nonverbally. regardless of the form in which it appears.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 y y y y y The presenting behavior of the patient.

Her own individuality and that of the patient requires that she go through this each time she is called upon to render service to those who need her.y y y Then the person acts The first three items taken together are defined as the person¶s immediate reaction Reflects how the nurse experiences her or his participation in the nurse patient situation NURSING PROCESS DISCIPLINE . environment and health Patient need help in communicating needs. ASSUMPTIONS When patients cannot cope with their needs without help. does add to the distress of the patient Patients are unique and individual in their responses Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child Nursing deals with people.RESOLUTION It is not the nurses activity that is evaluated but rather its result : whether the activity serves to help the patient communicate her or his need for help and how it is met y y y In each contact the nurse repeats a process of learning how to help the individual patient. helpful or appropriate until she checks the validity of it in exploration with the patient y y The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does Automatic reactions are not effective because the nurses action is decided upon for reasons other than the meaning of the patients behavior or the patients immediate need for help y When the nurse does not explore with the patient her reaction it seems reasonably certain that clear communication between them stops IMPROVEMENT . they become distressed with feelings of helplessness y y y y y y Nursing . they are uncomfortable and .INVESTIGATION Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time y y The nurse does not assume that any aspect of her reaction to the patient is correct. in its professional character .

ambivalent about dependency needs

y y y y y

Human beings are able to be secretive or explicit about their needs, perceptions, thoughts and feelings The nurse ± patient situation is dynamic, actions and reactions are influenced by both nurse and patient Human beings attach meanings to situations and actions that are not apparent to others Patients entry into nursing care is through medicine The patient cannot state the nature and meaning of his distress for his need without the nurses help or without her first having established a helpful relationship with him

y

Any observation shared and observed with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time

y

Nurses are concerned with needs that patients cannot meet on their own DOMAIN CONCEPTS

1.

Nursing ± is responsive to individuals who suffer or anticipate a sense of helplessness

2.

Process of care in an immediate experience«.. for avoiding, relieving, diminishing or curing the individuals sense of helplessness. Finding out meeting the patients immediate need for help

3.

Goal of nursing ± increased sense of well being, increase in ability, adequacy in better care of self and improvement in patients behavior

4.

Health ± sense of adequacy or well being . Fulfilled needs. Sense of comfort

5.

Environment ± not defined directly but implicitly in the immediate context for a patient

6.

Human being ± developmental beings with needs, individuals have their own subjective perceptions and feelings that may not be observable directly

7.

Nursing client ± patients who are under medical care and who cannot deal with their needs or who cannot carry out medical treatment alone

8.

Nursing problem ± distress due to unmet needs due to physical limitations, adverse reactions to the setting or experiences which prevent the patient from communicating his needs

9.

Nursing process ± the interaction of 1)the behavior of the patient, 2) the reaction of the nurse and 3)the nursing actions which are assigned for the patients benefit

10. Nurse ± patient relations ± central in theory and not differentiated from nursing therapeutics or nursing process 11. Nursing therapeutics ± Direct function : initiates a process of helping the

patient express the specific meaning of his behavior in order to ascertain his distress and helps the patient explore the distress in order to ascertain the help he requires so that his distress may be relieved. 12. Indirect function ± calling for help of others , whatever help the patient may require for his need to be met 13. Nursing therapeutics - Disciplined and professional activities ± automatic activities plus matching of verbal and nonverbal responses, validation of perceptions, matching of thoughts and feelings with action 14. Automatic activities ± perception by five senses, automatic thoughts, automatic feeling, action THEORY ANALYSIS PARADIGMATIC ORIGINS Paplau¶s focus of interpersonal relationships in nursing Paplau acknowledged the influence of Harry Stack Sullivan on the development of her ideas

y y y y y

Symbolic interactionism ± Chicago school Use of field methodology John Dewey¶s theory of inquiry ORLANDO'S WORK AND CHARACTERISTICS OF A THEORY Theories can interrelate concepts in such a way in such a way as to create a different way of looking at a particular phenomenon

y y y y y

Theories must be logical in nature Theories should be relatively simple yet generalizable Theories can be the bases for hypotheses that can be tested Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them

y y

Theories can be utililized by practitioners to guide and improve their practice Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated INTERNAL DIMENSIONS Analyzed 2000 nurse ± patient interactions to identify the properties, dimensions and goals of interactions

y y

Use of field approach

y y y y

Focus on describing psychosocial aspects of nurse - patient interaction Used a mixture of operational and problematic methods of theory development Focus on how to deliver care not on what care to be given Nursing process theory of low to medium level abstraction STRENGTHS Use of her theory assures that patient will be treated as individuals and that they will have active and constant input into their own care

y y y y y y

Prevents inaccurate diagnosis or ineffective plans because the nurse has to constantly explore her reactions with the patient Assertion of nursing¶s independence as a profession and her belief that this independence must be based on a sound theoretical frame work Guides the nurse to evaluate her care in terms of objectively observable patient outcomes Make evaluation a less time consuming and more deliberate function, the results of which would be documented in patients charts Nursing can pursue Orlando's work for retesting and further developing her work THEORY CRITIQUE Lack of operational definitions for concepts ± limits development of research hypothesis

y y

Theory is more congruent in guiding nurse ± patient interactions for assessing needs and in providing nursing therapeutics deemed necessary to patient care

y

Focus on short term care, particularly aware and conscious individuals and on the virtual absence of reference group or family members LIMITATIONS Highly interactive nature Orlando's theory makes it hard to include the highly technical and physical care that nurses give in certain settings

y y

Her theory struggles with the authority derived from the function of profession and that of the employing institution¶s commitment to the public EXTERNAL COMPONENTS Value of nursing shifted from task oriented to patient oriented nursing process

y y

Theory is culturally bound

y y Misinterpretation of continuous validation as lack of knowledge and expertise The uniqueness of individuals assumed by the theory could counteract automatic responses of nurses Use in Clinical Practice Nursing care plan Case studies Progressive patient care settings Nursing process Assessment Diagnosis Planning Implementation Evaluation SUMMARY Theorist ± IDA JEAN ORLANDO Development of theory Dimensions of theory Assumptions Concepts Theory analysis Characteristics of a theory Paradigmatic origins Strengths and limitations Internal and external components Comparison with nursing process Theory testing and uses of theory CONCLUSION TO THEORY Orlando's Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient. Orlando's key focus was to define the function of nursing. . perception validation. The use of her theory keeps the nurse's focus on the patient. 2002) y y y y y y y y y y y y y y y y y y y y y y y Orlando's theory remains one the of the most effective practice theories available.. and the use of the nursing process to produce positive outcomes or patient improvement. (Faust C.

She was influenced by Ida Orlando in her works on the framework. CONCEPTS AND DEFINITIONS Wiedenbach defined key terms commonly used in nursing practice. teaching. Education: y o o o o Career: B.A.." y y y The patient is any person who has entered the healthcare system and is receiving help of some kind. 2010 =============================================== INTRODUCTION Ernestine Wiedenbach was born in August 18. o o She wrote Family-Centered Maternity Nursing in 1958.N. Germany. y o Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity nursing. .y y The strength of the theory is that it is clear. concise. 1900. from Johns Hopkins School of Nursing in 1925 M. from Teachers College. o Assistant professor of obstetric nursing in 1954 and an associate professor in 1956. such as care. and easy to use. Columbia University in 1934 Certificate in nurse-midwifery from the Maternity Center Association School for Nurse-Midwives in New York in 1946. instruction or advice from a member of the health profession or from a worker in the field of health. in Hamburg. The patient "Any individual who is recieving help of some kind. y She died on March 8. 1998. The Helping Art of Clinical Nursing Ernestine Wiedenbach Last updated on November 13. or advice. the use of her theory does not exclude nurses from using other theories while caring for the patient. While providing the overall framework for nursing.A. be it care. from Wellesley College in 1922 R. y y Wiedenbach's conceptual model of nursing is called ' The Helping Art of Clinical Nursing".

but thinks and feels as well. Nurse The nurse is functioning human being. y y y y Knowledge may be : o o o factual speculative or practical Judgment y y y Clinical Judgment represents the nurse¶s likeliness to make sound decisions. 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. y y Skills are made up of a variety of actions. and improves with expanded knowledge and increased clarity of professional purpose. Sound Judgment is the result of disciplined functioning of mind and emotions. and characterized by harmony of movement. and effective use of self. Sound decisions are based on differentiating fact from assumption and relating them to cause and effect. precision. Knowledge Knowledge encompasses all that has been percieved and grasped by the human mind. The nurse no only acts. Person . 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. y y It is crucial to nursing profession that a need-for-help be based on the individual perception of his own situation.y The patient need not be ill since someone receiving health-related education would qualify as a patient.

is endowed with a unique potential to develop self-sustaining resources. The Art The Art of nursing includes y y o understanding patients needs and concerns . Whatever an individual does at any given moment represents the best available judgment for that person at the time. y o o o o a philosophy a purpose a practice and the art.y y y y Each Person (whether nurse or patient). Wiedenbach believed that there were 3 essential components associated with a nursing philosophy: o o Reverence for life Respect for the dignity. It is all of the activities directed towards the overall good of the patient. autonomy and individuality of each human being and o resolution to act on personally and professionally held beliefs. The Purpose y y Nurses purpose is that which the nurse wants to accomplish through what she does. The Practice Practice are those observable nursing actions that are affected by beliefs and feelings about meeting the patient¶s need for help. worth. KEY ELEMENTS Wiedenbach proposes 4 main elements to clinical nursing. The Philosophy y y The nurses' philosophy is their attitude and belief about life and how that effected reality for them. People generally tend towards independence and fulfillment of responsibilities. Self-awareness and self-acceptance are essential to personal integrity and self-worth.

y y y The prescription for the fullfillment of central purpose. and determining the patient¶s ability to resolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals. . The realities in the immediate situation that influence the central purpose.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. y Nursing primarily consists of identifying a patient¶s need for help. y The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns. PRESCRIPTIVE THEORY Wiedenbach's prescriptive theory is based on three factors: The central purpose which the practitioner recognizes as essential to the particular discipline. Diagram CONCLUSION Nursing is the practice of identification of a patient¶s need for help through y o o o o observation of presenting behaviors and symptoms exploration of the meaning of those symptoms with the patient determining the cause(s) of discomfort.

2. The cure. and value system. The core has goals set by himself and not by any other person. . 3. Cure and Core The Three C¶s of Lydia Hall This page was last updated on November 6. These are the interventions or actions geared on treating or ³curing´ the patient from whatever illness or disease he may be suffering from. The model explains that the cure circle is shared by the nurse with other health professionals. y It is easy to understand from the model that in all of the circles of the model. the nurse is always presents the bigger role she takes belongs to . and that these goals need to be achieved. She promoted involvement of the community in health-care issues. the care and the cure y The core is the person or patient to whom nursing care is directed and needed. 2010 ===================================================== LYDIA HALL AND HER THEORY Lydia Hall was born in New York City on September 21. in addition. on the other hand is the attention given to patients by the medical professionals.According to the theory. y y y y The theory contains of three independent but interconnected circles: 1. y y y The cure is the attention given to patients by the medical professionals. the core is the person or patient to whom nursing care is directed and needed. The core has goals set by himself and not by any other person. and focused on performing that noble task of nurturing the patients.Care. The core behaved according to his feelings. 1906. y The care circle explains the role of nurses. behaved according to his feelings. and value system. The theory contains of three independent but interconnected circles²the core. the care and the cure. provision of patient teaching activities and helping the patient meet their needs where help is needed. y y The core. meaning the component of this model is the ³motherly´ care provided by nurses. the core. She derived from her knowledge of psychiatry and nursing experiences in the Loeb Center the framework she used in formulating her theory of nursing. which may include imited to provision of comfort measures.

Catholic University of American 1945 ± MSN Ed. Dorothea Orem's Self-Care Theory Dorothea Orem (1914-2007) This page was last updated on November 13. Earned her diploma at Providence Hospital ± Washington. y Orem¶s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980.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 1971. 1991. Her goal was to upgrade the quality of nursing in general hospitals throughout the state. Catholic University of American Involved in nursing practice.the care circle where she acts a professional in helping the patient meet his needs and attain a sense of balance. and nursing education During her professional career . 1985.and finally in 1995 DEVELOPMENT OF THEORY y y 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health.. MAJOR ASSUMPTIONS y y y y y 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 person¶s knowledge of potential health problems is necessary for promoting self-care behaviors .second in 1980. y 1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant professor of nursing education at CUA.she worked as a staff nurse . 1995. Born 1914 in Baltimore. She continued to develop her concept of nursing and self care during this time.. and 2001. During this time she developed her definition of nursing practice. nursing service. 2010 ========================================== INTRODUCTION y y y y y y y y y One of foremost nursing theorists.private duty nurse . DC 1939 ± BSN Ed.

or minimize the effects of chronic poor health or disability Health ± health and healthy are terms used to describe living things « y It is when they are structurally and functionally whole or sound « wholeness or integrity. and a technology y 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 y y y y y Encompasses the patient¶s perspective of health condition . environnemental éléments. and développemental environnent Human being ± has the capacity to reflect. y A human being is the focus of nursing only when a self ±care requisites . and the nursing perspective Goal of nursing ± to render the patient or members of his family capable of meeting the patient¶s 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 . conditions.includes that which makes a person human. symbolically and socially Nursing client y 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. symbolize and use symbols y y Conceptualized as a total being with universal.control . . developmental needs and capable of continuous self care A unity that can function biologically. a helping service.y Self care and dependent care are behaviors learned within a socio-cultural context DEFINITIONS OF DOMAIN CONCEPTS Nursing ± is art.the physician¶s perspective .«operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings Environnent y environnent components are environnemental factors.

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. Universal y y Developmental Health deviation 2.(3)the implementation of care Nursing therapeutics y deliberate. developmental. 3 categories of self care requisites are:-1. and health derived or health related conditions Nursing process y a system to determine (1)why a person is under care (2)a plan for care . Theory of Self Care This theory Includes :-- y y Self care ± practice of activities that individual initiates and perform on their own behalf in maintaining life . systematic and purposeful action OREM¶S GENERAL THEORY OF NURSING Orem¶s general theory of nursing in three related parts:- y y y Theory of self care Theory of self care deficit Theory of nursing syste A. life experience sociocultural orientation health and available resources y 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" y Self care requisites-action directed towards provision of self care. Universal self care requisites y Associated with life processes and the maintenance of the integrity of .exceeds self care capabilities Nursing problem y deficits in universal.

water. Or associated with an event o o y E. the parent) is incapable or limited in the provision of continuous effective self care.human structure and functioning y y y y y y y Common to all . Theory of Nursing Systems y y Describes how the patient¶s self care needs will be met by the nurse . adjusting to a new job adjusting to body changes Health deviation self care o Required in conditions of illness. injury.these include:-- o o Seeking and securing appropriate medical assistance Being aware of and attending to the effects and results of pathologic conditions o o Effectively carrying out medically prescribed measures 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. or disease .g. food Provision of care assoc with elimination process Balance between activity and rest. Theory of self care deficit y y Specifies when nursing is needed Nursing is required when an adult (or in the case of a dependent. Developmental self care requisites y Associated with developmental processes/ derived from a condition«. Orem identifies 5 methods of helping:-- o o o o Acting for and doing for others Guiding others Supporting another Providing an environment promoting personal development in relation to meet future demands o Teaching another C. ADL Identifies these requisites as: Maintenance of sufficient intake of air . the patient. between solitude and social interaction Prevention of hazards to human life well being and Promotion of human functioning 3. or both Identifies 3 classifications of nursing system to meet the self care .

. Regulatory technologies y y y y Maintaining and promoting life processes Regulating psycho physiological modes of functioning in health and disease Promoting human growth and development Regulating position and movement in space OREM¶S THEORY AND NURSING PROCESS y Orem¶s approach to the nursing process presents a method to determine the self care deficits and then to define the roles of person or nurse to meet the self care demands. health status Maintaining interpersonal. Social or interpersonal y y y y Communication adjusted to age.requisites of the patient:- y y y y y y y y 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 y y 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 endeavour .with or without use of materials or instruments Categories of technologies 1.action abilities and limitations 2. y The steps within the approach are considered to be the technical component of the nursing process. intragroup or intergroup relations for coordination of efforts Maintaining therapeutic relationship in light of psychosocial modes of functioning in health and disease Giving human assistance adapted to human needs .

determine why nursing is needed. Comparison of Orem¶s Nursing Process and the Nursing Process Nursing Process Orem¶s Nursing.y Orem emphasizes that the technological component "must be coordinated with interpersonal and social processes within nursing situations. Process y Assessment y y y Diagnosis and prescription.life style. The 2 actions are:Bringing out a good organization of the components of patients¶ therapeutic self care demands Selection of combination of ways of helping that will be effective and efficient in compensating for/ overcoming patient¶s self care deficits y y Implementation evaluation Step 3 y y y Nurse assists the patient or family in self care matters to achieve identified and described health and health related results. analyze and interpret ± make judgment regarding care Design of a nursing system and plan for delivery of care Production and management of nursing systems Step 1-collect data in six areas:- y y y y y y y y Nursing diagnosis Step 2 Plans with scientific rationale y The person¶s health status The physician¶s perspective of the person¶s health status The person¶s perspective of his or her health The health goals within the context of life history . and health status The person¶s requirements for self care The person¶s capacity to perform self care y y y Nurse designs a system that is wholly or partly compensatory or supportiveeducative. collecting evidence in evaluating results achieved against results specified in the nursing system design Actions are directed by etiology component of nursing diagnosis evaluation Application of Orem¶s theory to nursing process .

Guiding & directing. P/F UTI teaching P/F ¯ adherence in teaching self catheterization & OPD RT Actual deficit in . R/T Providing psy support early parenthood Level of education Providing physical.Personal factors Health Medical Self care deviation problem & deficits plan 29 yr. 32pack /yr Teenage Seeks Female Water-no pregnancy-2 medical Early restrictions OC-10 yrs attention adulthood Food ±nil Husband for overt transition Wt89lb emotionally away s/s Wt loss-19% Aware of nauseated disease No evidence 8th grade Urinary No BSE ability to Surgery on Difference Teenage retention Infrequent manage reproductive between pregnancy Intermittent physical effects organs knowledge No work self examination base & Married catheterization No HRT lifestyle Child-2 Pain Poor health Lives at Tearful EDU deprivation Will receive mother¶s Husband Oppressive living RT . psy support Dev deficit r/t loss of reproductive organs P/F contd. abusive conditions intermittent Environment Dissatisfied catheterization unclean with home Limited RT resources Universal self Developmental care self care Therapeutic self care demand Air Maintain effective respiration Water No problem Food maintain sufficient intake Adequacy of self care agency Inadequate Adequate Inadequate Nursing Methods of helping diagnosis Potential for Guiding & directing impaired respiratory status P F fluid imbalance Actual nutritional Teaching deficit r/t ausea Providing physical support Personal development P/F injury Guiding & directing Guiding & directing Hazards Prevent spouse abuse Promotion of normalcy Inadequate Inadequate Maintain Inadequate developmental environment Support ed normalcy in Inadequate environment Prevent /manage dev threat Maintenance of Inadequate health status Management of Inadequate disease process Adherence to med Inadequate regimen A/d in environment Shared housing Actual delay in Guiding & directing normaldev.perform home. alterations in health teaching status Guiding & directing.

nursing education administration .Awareness of Inadequate potential problems Adjust to loss of Inadequate reproductive ability & dev Guiding & directing healthy view of Actual self deficit in illness planning for future Adjust life style to Inadequate needs cope with change OREM¶S WORK AND THE CHARACTERISTICS OF A THEORY awareness of teaching advisability of HRT & RT effects Actual threat to self Providing psy support image y y y y y Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon Theories must be logical in nature Theories must be relatively simple yet generalizable Theories are the basis for hypothesis that can be tested Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them y y Theories can be used by the practitioners to guide and improve their practice Theories must be consistent with other validated theories . degree programs also in many nursing schools Strengths y y y y y y Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of nursing practice nursing curricula .laws and principles Theory Testing y y Orem¶s theory has been used as the basis for the development of research instruments to assist researchers in using the theory A self care questionnaire was developed and tested by Moore(1995) for the special purpose of measuring the self care practice of children and adolescents y The theory has been used as a conceptual framework in assoc.and nursing research Specifies when nursing is needed Also includes continuing education as part of the professional component of nursing education Her self care approach is contemporary with the concepts of health promotion and health maintenance Expanded her focus of individual self care to include multiperson units .

It focuses attention on the response of the client system to actual or potential environmental stressors. nursing and society . Orem: thoughts on her theory Orem's theory in practice. Hospice nursing care Solving the Orem mystery: an educational strategy Orem's family evaluation Betty Neuman's System Model This page was last updated on November 9. Self-care requirements for activity and rest: an Orem nursing focus Nursing diagnoses in patients after heart catheterization--contribution of Orem 3. 4. Self-care--the contribution of nursing sciences to health care Self-care: a foundational science Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science 6.Orem¶s visual presentation of the boxed nursing systems implies three static conditions of health y Appears that the theory is illness oriented rather with no indication of its use in wellness settings Summary y Orem¶s general theory of nursing is composed of three constructs . health. And the use of primary. It has a broad scope in clinical practice and to lesser extent in research . 2. Dorothea E. attainment.thing Health is often viewed as dynamic and ever changing . 2010 =============================================== INTRODUCTION y y y Betty Neuman¶s system model provides a comprehensive flexible holistic and system based perspective for nursing.Throughout her work . 5.and has defined 3 steps of nursing process.she interprets the concepts of human beings. secondary and tertiary nursing prevention intervention for retention.Limitations y y In general system theory a system is viewed as a single whole thing while Orem defines a system as a single whole .education and administration RESEARCH ON OREM'S THEORY 1. 9. 7. 8. and maintenance of optimal client .

y y The model was published in 1972 as ³A Model for Teaching Total Person Approach to Patient Problems´ in Nursing Research. and Lazlo on general system theory. Los Angeles. She holds a Ph. Von Bertalanfy. and universal stressors exist. Ohio. in clinical psychology y y y She was a pioneer in the community mental health movement in the late 1960s. Each differ in it¶s potential for disturbing a client¶s usual stability level or normal LOD The particular inter-relationships of client variables at any point in time can affect the degree to which a client is protected by the flexible LOD against possible reaction to stressors. She completed BS in nursing in 1957 and MS in Mental Health Public health consultation. a composite of factors and characteristics within a given range of responses contained within a basic structure. Lararus on stress and coping. the stressor breaks through the normal LOD . The models was initially developed in response to graduate nursing students expression of a need for course content that would expose them to breadth of nursing problems prior to focusing on specific nursing problem areas. 1974. y When the flexible LOD is no longer capable of protecting the client/ client system against an environmental stressor. from UCLA in 1966. unknown. HISTORY AND BACKGROUND OF THE THEORIST y y Betty Neuman was born in 1924. It was refined and subsequently published in the first edition of Conceptual Models for Nursing Practice. The philosophy writers deChardin and cornu (on wholeness in system). BASIC ASSUMPTIONS y y y Each client system is unique. Betty Neuman began developing her health system model while a lecturer in community health nursing at University of California. Many known. The normal LOD can be used as a standard from which to measure health deviation.D. DEVELOPMENT OF THE MODEL y y y y y Neuman¶s model was influenced by a variety of sources. Selye on stress theory. y Each client/ client system has evolved a normal range of responses to the environment that is referred to as a normal LOD. and in the second edition in 1980.system wellness. in Lowel.

2002). range.Response pattern. CONCEPTS y y y y y y y y y y Content: . Flexible LOD: . The basis structure.a process of energy depletion and disorganization moving the system toward illness or possible death. A homeostatic body system is constantly in a dynamic process of input.y The client whether in a state of wellness or illness. y The client as a system is in dynamic.Normal temp. y Tertiary prevention relates to adjustive processes taking place as reconstitution begins and maintenance factors move the back in circular manner toward primary prevention. output. y Implicit within each client system are internal resistance factors known as LOR. constant energy exchange with the environment. These factors include:. that is applied in client assessment and intervention. or central core.K. . It is considered dynamic because it can expand or contract over time. y Primary prevention relates to G. occurs when the amount of energy that is available exceeds that being used by the system. y LOR: . Entropy: .It represents what the client has become over time. which leads to a state of balance. or the usual state of wellness.. and compensation. feedback. Ego structure Stability. Organ strength or weakness. or homeostasis. accordion like mechanism that surrounds and protects the normal LOD from invasion by stressors. Genetic structure.the variables of the person in interaction with the internal and external environment comprise the whole client system Basic structure/Central core: . Normal LOD: . Degree to reaction: . which function to stabilize and realign the client to the usual wellness state. 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.the amount of system instability resulting from stressor invasion of the normal LOD. in identification and reduction of possible or actual risk factors.a protective.common client survival factors in unique individual characteristics representing basic system energy resources.The series of concentric circles that surrounds the basic structure. y Secondary prevention relates to symptomatology following a reaction to stressor. appropriate ranking of intervention priorities and treatment to reduce their noxious effects. is made up of the basic survival factors that are common to the species (Neuman.

output and feedback. 2002). and extra personal (job or finance pressure) in nature. y y A stressor is any phenomenon that might penetrate both the F and N LOD. resulting either a positive or negative outcome. feeling).The matter. and information exchanged between client and environment that is entering or leaving the system at any point in time.output: . It is a system of organized complexity where all elements are in interaction. Wellness/Illness: . inter (role expectation).A process of energy conservation that increase organization and complexity. attain. y Open system:. which may result in a higher or lower level of wellness. E. On the one hand. causing a reaction symptomatology. y Stressors: . PRIMARY PREVENTION y Primary prevention occurs before the system reacts to a stressor.Wellness is the condition in which all system parts and subparts are in harmony with the whole system of the client. it strengthens the person (primary the flexible LOD) to enable . following treatment for stressor reaction. that have potential for disrupting system stability. PREVENTION y According to Neuman¶s model.A system in which there is continuous flow of input and process.The return and maintenance of system stability. y Stability: . 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. o Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman. mobilization of WBC and activation of immune system mechanism y Input. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body.A state of balance of harmony requiring energy exchanges as the client adequately copes with stressors to retain.g. y Negentropy: . or maintain an optimal level of health thus preserving system integrity. y y Prevention as intervention: . Reconstitution: .Interventions modes for nursing action and determinants for entry of both client and nurse in to health care system. prevention is the primary nursing intervention. 2002). moving the system toward stability or a higher degree of wellness. energy.y Protection factors activated when stressors have penetrated the normal LOD.environmental factors. intra (emotion. the outcome may be death (Neuman.

interpersonal and extra-personal stressors which can affect the person¶s normal line of defense and so can . FOUR MAJOR CONCEPTS PERSON y The focus of the Neuman model is based on the philosophy that each human being is a total person as a client system and the person is a layered multidimensional being. and social/cultural expectations and activities. y These forces include the intrapersonal. Socio-cultural. Primary prevention includes health promotion and maintenance of wellness. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.Refers to mental processes and emotions.Refer of the physicochemical structure and function of the body. ENVIRONMENT y 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.Refers to the influence of spiritual beliefs. o o Psychological. o o Spiritual. TERTIARY PREVENTION y y Tertiary prevention occurs after the system has been treated through secondary prevention strategies.him to better deal with stressors y y On the other hand manipulates the environment to reduce or weaken stressors.Refers to those processes related to development over the lifespan. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor. Developmental.Refers to relationships. SECONDARY PREVENTION y y Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing system. y Each layer consists of five person variable or subsystems: o Physiological.

HEALTH y Neuman sees health as being equated with wellness. and it is the task of nursing to address the whole person. o o o The internal environment exists within the client system. maintain flexible line of defense. y y Variances from wellness (needs and problems) are determined by correlations and constraints through synthesis of theory and data base. and the primary aim is stability of the patient/client system. classifies. because the nurse¶s perception will influence the care given. and evaluates the dynamic interaction of the five variables.affect the stability of the system. Neuman defines nursing as ³action which assist individuals. y y The person is seen as a whole. but so must those of the caregiver (nurse). assesses. Broad hypothetical interventions are determined.¶¶ y Neuman states that. y The client system moves toward illness and death when more energy is needed than is available. the diagnosis identifies. . i. The client system moved toward wellness when more energy is available than is needed NURSING y 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. y The role of the nurse is seen in terms of degree of reaction to stressors. She defines health/wellness as ³the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman. secondary and tertiary interventions STAGES OF NURSING PROCESS (BY NEUMAN) NURSING DIAGNOSIS y It depends on acquisition of appropriate database. then not only must the patient/client¶s perception be assessed. families and groups to maintain a maximum level of wellness. Neuman also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness. through nursing interventions to reduce stressors. 1995)´.e. The external environment exists outside the client system. and the use of primary.

lines of resistance. Health seeking behaviors. NURSING DIAGNOSIS y y y y y The data collected are then interpreted to condition and formulate the Nursing diagnosis. Interaction between client and environment. Condition and strength of basic structure factors and energy sources. Life process and coping factors (past. Activity intolerance. Ineffective coping. Confirmation of prescriptive change or reformulation of nursing goals. ASSESSMENT y y y y y y Potential and actual stressors. A client outcome validates nursing process. Short term goal outcomes influence determination of intermediate and long ± term goals. degree of reaction and potential for reconstitution. PLANNING y Planning is focused on strengthening the lines of defense and resistance. . Characteristics of flexible and normal line of defenses. NURSING OUTCOMES y y y y Nursing intervention using one or more preventive modes. present and future) actual and potential stressors (internal and external) for optimal wellness external. and take account of patient¶s and nurse¶s perceptions of variance from wellness. Neuman¶S SYSTEM MODEL FORMAT Neuman¶s nursing process format designates the following categories of data about the client system as the major areas of assessment. Ineffective thermoregulation. GOAL y In Neuman¶s systems model the goal is to keep the client system stable.NURSING GOALS y These must be negotiated with the patient. Perceptual difference between care giver and the client.

Because this model requires individual interaction with the total health care system. public health. critical care. y The patient is being relabeled as a consumer with individual needs and wants.IMPLEMENTATION The goal of stabilizing the client system is achieved through three modes of prevention y y y Primary prevention : actions taken to retain stability Secondary prevention : actions taken to attain stability Tertiary prevention : actions taken to maintain stability EVALUATION y The nursing process is evaluated to determine whether equilibrium is restored and a steady state maintained. and hospital nursing. education. renal. EDUCATION y y The model has also been widely accepted in academic circles. It has often been selected as a curriculum guide for a conceptual framework oriented more toward wellness than toward a medical model . it is indicative of the futuristic direction the nursing profession is taking. and research and Neuman¶s model does. and hospital medical units. ACCEPTANCE BY THE NURSING COMMUNITY y y Neuman¶s model has been described as a grand nursing theory by walker and Avant. y y The role of the nurse in the model is to work with the patient to move him as far as possible along a continuum toward wellness. PRACTICE y The Neuman systems model has been applied and adapted to various specialties include family therapy. One of the model¶s strengths is that it can be used in a variety of settings y Using this conceptual model permits comparison of a nurse¶s interpretation of a problem with that of the patient. rehabilitation. Grand theories can provide a comprehensive perspective for nursing practice. so the patient and nurse do not work on two separate problems. y The sub specialties include pulmonary.

y At northwestern State University in Shreveport. This helps prepare the students for developing a frame of reference centered on holistic care. o To test the model/assessment¶ tool for its usefulness as a unifying method of collecting and analyzing data for identifying client problems. the faculty determined that a systems model approach was preferred for their master¶s program because of the universality framework. y y y Results indicated that the model can help categorize data for assessing and planning care and for guiding decision making. y y The interrelationships between the concepts of person. Louisiana. health. o To test the assessment tool for its usefulness in the identification of congruence between the client¶s perception of stressors and the care giver¶s perception of client stressors. Neuman¶s model can easily generate nursing research. One of the objectives for nursing graduate is to demonstrate ability to use the Neuman health care system in nursing practice. Acceptance by the nursing community for research applying this model is in the beginning stages and positive. Theories must be logical in nature y o Neuman¶s model in general presents itself as logically consistent. RESEARCH y y A study was published by Riehl and Roy to test the usefulness of the Neuman model in nursing practice. y y In the associate degree program at Indiana University.and has been used at various levels of nursing education. o There is a logical sequence in the process of nursing wherein . y Acceptance by the nursing community for education therefore is evident. The Neuman model represents a focus on nursing interest in the total person approach to the interaction of environment and health. It does this by providing a framework to develop goals for desired outcomes. nursing and society/environment are repeatedly mentioned throughout the Neuman model and are considered to be basically adequate according to the criteria. Neuman¶S AND THE CHARACTERISTICS OF A THEORY y Theories connects the interrelated concepts in such a way as to create a different way of looking at a particular phenomenon. There were two major objectives of the study.

however. o One of the most significant attributes of the Neuman model is the assessment/intervention instrument together with comprehensive guidelines for its use with the nursing process. education and administration. y Theories can be the bases for hypotheses that can be tested. o One drawback in relation to simplicity is the diagrammed model since it presents over 35 variables and tends to be awesome to the viewer. this is its primary contribution to nursing knowledge. o In general. comprehensive guidelines for nursing education and practice in a variety of settings. due to its high level and breadth of abstraction. y Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. lends itself to theory development. y Theories can be utilized by the practitioner to guide and improve their practice. subsequent to basis concept refinement in the Neuman model. and administration) is testimony in itself to its broad applicability.emphasis on the importance of accurate data assessment is basic to the sequential steps of the nursing process. little research explicitly derived from this model has been published to date. There is. a lack of specificity in systems concepts such as ³boundaries´ which are indirectly addressed throughout the . y Theories must be consistent with other validated theories. o The multiple use of the model in varied nursing situations (practice. o The model has provided clear. o The concept within the guidelines is clearly explicated and many applications of the theory have been published. o The potential use of this model by other health care disciplines also attests to its generalizability for use ion practice. o Neuman¶s model. o o Neuman¶s model is fairly simple and straightforward in approach. o One are for future consideration as a beginning testable theory might be the concept of prevention as intervention. o These guidelines have provided a practical resource for many nursing practitioners and have been used extensively in a variety of setting in nursing practice. curriculum. laws and principles but will leave open unanswered questions that need to be investigated. there is no direct conflict with other theories. The terms used are easily identifiable and for the most part have definitions that are broadly accepted. y Theories should be relatively simple yet generalizable.

³A community needs assessment for a SANE program using Neuman's model´ J Am Acad Nurse Pract. o These case studies illustrate how nurses' actions. Ume-Nwagbo. o The purpose of the study was to present guidelines for a community needs assessment for a Sexual Assault Nurse Examiner (SANE) program using Neuman's Systems Model. 1939 as the 2nd child of Mr. writer. and guidelines using a nursing model were not found in the literature Roy's Adaptation Model This page was last updated on November 13.model. 19. one case is directed toward family care.Callista Roy. 2010 ============================================ Introduction y y y y Sr. integrate evidence-based practice and generate high quality care y Melton L. Mary's College. o Guidelines for conducting such an assessment related to implementation of a SANE program are rare. 1. a prominent nurse theorist. No. o Sexual assault is a problem faced by almost every community. DeWan. Andersen B. directed by Neuman's wholistic principles. lecturer. researcher and teacher Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill Born at Los Angeles on October 14. A thorough community assessment is an important first step in establishing programs that adequately meet a community's needs. . Fabien Roy she earned a Bachelor of Arts with a major in nursing from Mount St. and Mrs. 31-35 (2006).13(4):178-86. Chien A. Nursing Science Quarterly. Research Articles y ³Using the Neuman Systems Model for Best Practices¶¶--Sharon A. 2001 Apr. Los Angeles in 1963. Vol. and the other demonstrates care with an individual. Pearl N. o The purpose of this study was to present two case studies based upon Neuman systems model. Theory-based exemplars serve as teaching tools for students and practicing nurses. Secrest J.

y y y y

a master's degree program in pediatric nursing at the University of California ,Los Angeles in 1966. She also earned a master¶s 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.

y y y y y y y

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 µAdaptation 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. Mary¶s College 1970-The model was implemented in Mount St. Mary¶s school 1971- she was made chair of the nursing department at the college. Influencing Factors

y y y y y

Family Education Religious Background Mentors Clinical Experience THEORY DESCRIPTION

y

The central questions of Roy¶s theory are:

o o o y y y y

Who is the focus of nursing care? What is the target of nursing care? When is nursing care indicated?

Roy¶s 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)

y y y y y y y y y

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 person¶s life. To respond positively to environmental changes, the person must adapt. The person¶s adaptation is a function of the stimulus he is exposed to and his adaptation level The person¶s 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

y

There is a dynamic objective for existence with ultimate goal of achieving dignity and integrity. Implicit assumptions

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A person can be reduced to parts for study and care. Nursing is based on causality. Patient¶s values and opinions are to be considered and respected. A state of adaptation frees an individual¶s energy to respond to other stimuli. ROY ADAPTATION MODEL CONCEPTS: EARLY AND REVISED

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Adaptation -- goal of nursing Person -- adaptive system Environment -- stimuli Health -- outcome of adaptation Nursing -- promoting adaptation and health Concepts-Adaptation

y y

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

y

Bio-psycho-social being in constant interaction with a changing

environment

y y y y

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

y y y y

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

y y y

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

y y

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

y

Cognator subsystem ² A major coping process involving 4 cognitiveemotive channels: perceptual and information processing, learning, judgment and emotion.

y

Regulator subsystem ² a basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels Relationships

y y y

Derived Four Adaptive Modes 500 Samples of Patient Behavior What was the patient doing?

. usefulness.y What did the patient look like when needing nursing care? Four Adaptive Modes y y y y Physiologic Needs Self Concept Role Function Interdependence Four Adaptive Mode Categories y y Tested in practice for 10 years Criteria of significance. and completeness were met Sample Proposition and Hypothesis for Practice y y Self Concept Mode: Increased quality of social experience leads to increased feelings of adequacy Providing support for new mothers can lead to positive parenting THEORY DEVELOPMENT Derived Theory y y y 91 Propositions Described relationships between and among regulator and cognator and four adaptive modes 12 Generic propositions Questions Raised by 21st Century Changes y y y How can ethics and public policy keep pace with developments in science? How can nurses focus on human needs not machines? How can nurses contribute to creating meaning and purpose in a global society? Scientific Assumptions for the 21st Century y y y y Systems of matter and energy progress to higher levels of complex self organization Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Human decisions are accountable for the integration of creative processes.

nations. and fostering of interdependence Persons and the earth have common patterns and integral relations Person and environment transformations are created in human consciousness Integration of human and environment meanings results in adaptation Philosophical Assumptions y y y y y Persons have mutual relationships with the world and God Human meaning is rooted in an omega point convergence of the universe God is intimately revealed in the diversity of creation and is the common destiny of creation Persons use human creative abilities of awareness. and faith Persons are accountable for the processes of deriving. communities. partners. Groups y y y y Physical Group Identity Role Function Interdependence Role Function Mode y y Underlying Need of Social integrity The need to know who one is in relation to others so that one can act . sustaining. families. Persons y y y y Physiologic Self Concept Role Function Interdependence B. and society as a whole Adaptive Modes A. and transforming the universe Adaptation and Groups y Includes relating persons. enlightenment.y y y y y Thinking and feeling mediate human action System relationships include acceptance. organizations. protection.

growth in a new role Compromised Processes y y y y y y y Adaptation level resulting from inadequate integrated and compensatory life processes Adaptation problem Compromised Adaptation Examples Hypoxia Unresolved Loss Stigma Abusive Relationships THE NURSING PROCESS y y y y y RAM offers guidelines to nurse in developing the nursing process. higher levels of adaptation and transcendence Role transition. The elements : First level assessment Second level assessment Diagnosis .y The need for role clarity of all participants in group Adaptation Level y y y y y A zone within which stimulation will lead to a positive or adaptive response Adaptive mode processes described on three levels: Integrated Compensatory Compromised Integrated Life Processes y y y y Adaptation level where the structures and functions of the life processes work to meet needs Examples of Integrated Adaptation Stable process of breathing and ventilation Effective processes for moral-ethical-spiritual growth Compensatory Processes y y y y Adaptation level where the cognator and regulator are activated by a challenge to the life processes Compensatory Adaptation Examples: Grieving as a growth process.

Research studies using RAM y y y Middle range theories have been derived from RAM 1998-Ducharme et al described a longitudinal model of psychosocial determinants of adaptation 1998-Levesque et al presented a MRT of psychological adaptation .y y y Goal setting Intervention evaluation Usefulness of Adaptation Model y y y y y y Scientific knowledge for practice Clinical assessment and intervention Research variables To guide nursing practice To organize nursing education Curricular frame work for various nursing colleges Characteristics of the theory y y y y y Theories can interrelates concepts in such a way as to present a new view of looking at a particular phenomenon. Theories must be logical in nature Theories should be relatively simple yet generalizable Theories can be the basis for the hypotheses that can be tested Theories contribute to and assist in increasing the general body of knowledge of a discipline through the research implemented to validate them y y Theories can be utilized by the practitioners to guide and improve their practice Theories must be consistent with other validated theories. so nursing interventions can be specifically targeted. RAM is complete and comprehensive It explains the reality of client. laws and principles but will leave open unanswered questions that need to be investigated Testability y y y y RAM is testable BBARNS (1999) reported that 163 studies have been conducted using this model.

reproduction. N. 141-148. nursing activities. y Samarel. Adaptation in children with cancer: research with Roy's model.. Fawcett. D. 13(3). Health is a process of becoming integrated and able to meet goals of survival. These mechanisms work with in 4 adaptive modes. y y y Nursing activities involve manipulation of these stimuli to promote adaptive responses. C. These behaviors are derived from regulator and cognator mechanisms. (1997).y y 1999-A MRNT . (2000).. 28(6). B. Zhan. . Piacentino. the urine control theory by Jirovec et al Dunn. Eliasof. using information about person¶s adaptation level. and various stimuli.. J. and Dunn. (1998). growth. C. y Chiou. K. H. L.. health and environment Persons are viewed as living adaptive systems whose behaviours may be classified as adaptive responses or ineffective responses. 74-78. Nursing Science Quarterly. The environment consists of person¶s internal and external stimuli. Summary y y y y y 5 elements -person. H.. 6(2). Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made. Journal of Ophthalmic Nursing and Technology. goal of nursing. Hughes. Kowitski. (2000).. P. 1259-1268. We all harbour greater stores of strength than we think. Nursing Science Quarterly. Women's perception of group support and adaptation to breast cancer. J.. G. (2001). 252258 y y Yeh. E. Cognitive adaptation and self-consistency in hearingimpaired older persons: testing Roy's adaptation model. 14. The goal of nursing is to promote adaptive responses in relation to 4 adaptive modes. C. A meta-analysis of the interrelationships between the modes in Roy's adaptation model. Krippendorf. and Ziegler. Nursing Science Quarterly.C. we will seldom disappoint ourselves. Journal of Advanced Nursing. 13(2).C. The Roy Adaptation Model and its application to clinical nursing practice. and mastery. SISTER CALLISTA ROY: ADAPTATION THEORY When push comes to a shove. 158-165.

So is the daughter who even lets her dad listen to praise songs as if he is not comatose. He s bleeding and God knows how many units of blood have been transfused to him. and a master·s degree and doctorate in sociology from UCLA (Philips. a master of science in nursing from UCLA. Amazing? What could it be? A miracle? Or could it be the medications working. or the transfusion? Or the family s fervent prayers? We couldn t tell but one thing is certain: human beings are made to persist. Many days passed and to our amazement. He was transferred to a regular room and eventually discharged with a clean bill of health. It s been uphill from there. She received a bachelor of science in nursing from Mount Saint Mary·s College in Los Angeles California. the pastor woke up from coma. where Dorothy Johnson challenged students to develop conceptual models of nursing (Philips. 2002). Everything just fell into the right place. Time is running out and the pastor is slipping fast. Roy & Andrew. 1999). too. And that is what Sister Callista Roy believed. . 2002. Sister Callista Roy is a member of the Sisters of Saint Joseph of Carondelet. and so were we. I remember a particular a particular patient when I was still an ICU nurse. School of Nursing (Roy. We ve primed the family but they just won t give up yet. He went into coma. He was a pastor afflicted with a serious liver problem. The wife is always there at his side during visiting hours.Do not underestimate the power of a person to cope. He may be dependent now but deep within him lies the energy to adapt. 2000). Doctors were giving up. Roy first proposed the RAM while studying for her master·s degree at UCLA. She received many honors and awards for her scholarly and professional work and is currently the Graduate Faculty Nurse Theorist at Boston College. always cheerful and full of hope. Specialists come and go at his ICU bed but they cannot seem to diagnose the problem.

PHILOSOPHICAL UNDERPINNINGS OF THE THEORY Johnson s nursing model was the impetus for the development of Roy s Adaptation Model. Roy also incorporated concepts from Helson s adaptation theory, von Bertalanffy s system model, Rapoport s system definition, the stress and adaptation theories of Dohrenrend and Selye, and the coping model of Lazarus (Philips, 2002).

MAJOR ASSUMPTIONS, CONCEPTS AND RELATIONSHIPS ASSUMPTIONS In the Adaptation Model, assumptions are specified as scientific assumptions or philosophical assumptions. Scientific Assumptions 
       

Systems of matter and energy progress to higher levels of complex self- organization. Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Humans by their decisions are accountable for the integration of creative processes. Thinking and feeling mediate human action System relationships include acceptance, protection, and fostering of interdependence Persons and the earth have common patterns and integral relationships Persons and environment transformations are created in human consciousness Integration of human and environment meanings results in adaptation (Roy&Andrew, 1999, p.35).

Philosophical Assumptions

    

Persons have mutual relationships with the world and God Human meaning is rooted in the omega point convergence of the universe. God is intimately revealed in the diversity of creation and is the common destiny of creation. Persons use human creative abilities of awareness, enlightenment, and faith. Persons are accountable for the processes of deriving, sustaining and transforming the universe (Roy & Andrew, 1999, p. 35).

Reading through Roy s adaptation theory, I now understand man s immense capacity to adapt. I believe in a higher power, I believe in miracles, but I believe, too, that the greater miracle is the perfect interplay of all the factors that push a person to adapt at various modes.

The Four Modes of Adaptation 1. Physiologic-Physical Mode Physical and chemical processes involved in the function and activities of living organisms; the underlying need is physiologic integrity as seen in the degree of wholeness achieved through adaptation to change in needs. 2. Self-concept- Group Identity Mode

Focuses on psychological and spiritual integrity and sense of unity, meaning, and purposefulness in the universe. 3. Role Function Mode 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 groups.

So how did the pastor recover? At the physiologic level, it was good that he was brought to the ICU immediately since the basic physiologic needs are met at once. He was intubated (for oxygenation), an NGT was put in place (for nutrition), a foley catheter was inserted (for elimination), and enema was also done to facilitate elimination of wastes. Visitors were restricted early on to provide optimum rest and to minimize cross contamination. Isolation measures were also instituted. Routine ICU care, so to speak. Every time the patient is assigned to me, I try to talk to him as if he listens and can answer. His churchmates were also there every time they are allowed to see him telling him that they are waiting for him at their church. The wife and the daughter never gave up on him. They are always there to tell him how much they love and need him. The adaptation process was a long one, but he did adapt and went on to recover. The ICU environment is not a very ideal place for adaptation, but given the situation and condition of the patient at that time, it was the best place to support the body s power to adapt.

ROY S THEORY AS APPLIED TO:

The last step in the nursing process is evaluation. so that none was excluded. nursing interventions are aimed at managing the stimuli to promote adaptation. By manipulating the stimuli and not the patient. the nurse enhances the interaction of the person with their environment. In a third step the nurse makes a statement or nursing diagnosis of the person s adaptive state and fourth. Hamner describes the model as enhancing care in the CCU and being consistent with the nursing process. Hamner found that the model assessed all patients behavior. The model puts emphasis on identifying and reinforcing positive behavior which speeds recovery. Hamner in 1989 discussed the Roy model and how it could be applied to nursing care in a cardiac unit (CCU). Fifth. sets goals to promote adaptation. The author discovered that the Roy model provides a structure in which manipulation of stimuli are not overlooked. EDUCATION . thereby promoting health.NURSING PRACTICE Using Roy s six step nursing process. the nurse assesses first the behaviors and second the stimuli affecting those behaviors.

3. learning tools content Sequencing 4. The model must be able to regenerate testable hypotheses for it to be researchable. The professors had to meet four challenges during this change: 1. Roy has stated that theory development and the testing of developed theories are nursing s highest priorities. Roy states that the model defines for students the distinct purpose of nursing which is to promote man s adaptation in each of the adaptive modes in situations of health and illness. it must be directed at testing and retesting conceptual models for nursing practice. Adapting Developing the course teaching of to be congruent suitable for with for the student student Roy model. learning. In the early 1980 s the School of Nursing at the University of Ottawa experienced a major curriculum change. This change included incorporating a nursing model by which to base their new curriculum. The change included incorporating a nursing model by which to base their new curriculum. 2. The Roy adaptation model was one of the models to be included in the first year of the baccalaureate program. RESEARCH If research is to affect practitioners behavior. Obtaining competent role models.The adaptation model is also useful in educational setting. .

Fawcett and Tulman used the model for the design of studies measuring functional status after childbirth. The model facilitated the selection of study variables and clarified thinking about the classification of study variables." ABOUT THE THEORIST .(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.(ICPS) y y y The human becoming theory posits quality of life from each person's own perspective as the goal of nursing practice. 2010 ======================================== 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. The model was a useful guide for the design and conduct of studies of functional status. The model was also used for ongoing studies of functional status during pregnancy and after the diagnosis of breast cancer." after the change in the dictionary definition of the word from its former meaning of "humankind. y y The human becoming theory of nursing presents an alternative to both the conventional bio-medical approach and the bio-psychosocial-spiritual (but still normative) approach of most other theories of nursing. Human Becoming Theory Rosemarie Rizzo Parse This page was last updated on November 13. 1995). They also used the model for retrospective and longitudinal studies of variables associated with functional status during the postpartum period.

Sartre. Becoming is the human¶s patterns of relating value priorities. from University of Pittsburgh Published her theory of nursing. and Merleau-Ponty. Man-Living-Health in 1981 Name changed to Theory of Human Becoming in 1992 Editor and Founder. along with works by the pioneer American nurse theorist. The human is transcending multidimensionally with the possibles About Becoming Becoming is unitary human-living-health.y y y y y y y Educated at Duquesne University. Sartre. rhythmicity. MerleauPonty. y The assumptions underpinning the theory were synthesized from works by the European philosophers. Heidegger. ASSUMPTIONS About man The human is coexisting while coconstituting rhythmical patterns with the universe. and transcendence. The human is unitary. bearing responsibility for decisions. y y y y The human is open. Martha Rogers. Nursing Science Quarterly Has published eight books and hundreds of articles about Human Becoming Theory Professor and Niehoff Chair at Loyola University. continuously coconstituting patterns of relating. Pittsburgh MSN and Ph. and Gadamer and Science of Unitary Human Beings by Martha Rogers . Chicago THEORY DEVELOPMENT y The human becoming theory was developed as a human science nursing theory in the tradition of Dilthey. Becoming is an intersubjective process of transcending with the possibles. y The theory is structured around three abiding themes: meaning. y y y y y Becoming is unitary human¶s emerging .D. freely choosing meaning in situation. Heidegger. Becoming is a rhythmically coconstituting human-universe process.

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

etc. emergent care APPLICATION OF THE THEORY Nursing Practice A transformative approach to all levels of nursing y .Provides guidelines of care and useful administration Useful in Education Provides research methodologies Provides framework to guide inquiry of other theories (grief. no control group.Difficult to compare to other research studies. y y y y y y 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. etc.) Weaknesses Research considered to be in a ³closed circle´ Rarely quantifiable results .o A human science and art that uses an abstract body of knowledge to serve people SYMBOL OF HUMAN BECOMING THEORY y y y 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 y y y y y Differentiates nursing from other disciplines Practice . laughter. hope. standardized questions.

quality of life and quality of nursing practice Expands the theory of human becoming Builds new nursing knowledge about universal lived experiences which may ultimately contribute to health and quality of life CRITIQUE y y Congruence with personal values o Nurse must subscribe to this world view to truly use it Congruence with other professional values o Complements and competes with other health care professionals¶ values o o y y Exoteric foundations Esoteric utility Congruence with social values o Fulfills society¶s expectations of nursing role Social Significance o Makes a substantial difference in the lives of clients and nurses RESEARCH ON PARSE'S THEORY 1. 4. A Human Becoming perspective on quality of life Feeling respected: a Parse method study Nursing theory . health. Nursing practice in human becoming: the "Parse nurse" in French Switzerland 2. The lived experience of suffering: a parse research method study On joy-sorrow: a paradoxical pattern of human becoming Human becoming criticism--a critique of Florczak's study on the lived experience of sacrificing something important 5. 3. 6. particularly in that it does not seek to ³fix´ problems Ability to see patients perspective allows nurse to ³be with´ patient and guide them toward desired health outcomes Nurse-person relationship cocreates changing health patterns Research y y y Enhances understanding of human lived experience.y y y Differs from the traditional nursing process.

From Wikipedia. the free encyclopedia Jump to: navigation. search Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing. [edit] Mid-range nursing theories Middle-range nursing theories are narrower in scope than grand nursing theories and offer an effective bridge between grand nursing theories and nursing practice. explaining.2 Mid-range nursing theories o 1. and predicting nursing in particular situations. This limits the use of grand nursing theories for directing.1 Grand nursing theories o 1. Theories at this level may both reflect and provide insights useful for practice but are not designed for empirical testing. [edit] Nursing practice theories Nursing practice theories have the most limited scope and level of abstraction and are developed for use within a specific range of nursing situations. and predict outcomes and the impact of nursing practice. Contents [hide] y y y y y 1 Types of nursing theories [1] o 1. Theories at this level are intended to be pertinent to all instances of nursing.3 Nursing practice theories 2 Major nursing theorists and theories 3 See also 4 References 5 External links [edit] Types of nursing theories [1] [edit] Grand nursing theories Grand nursing theories have the broadest scope and present general concepts and propositions. They present concepts and propositions at a lower level of abstraction and hold great promise for increasing theory-based research and nursing practice strategies. Nursing practice theories provide frameworks for nursing interventions. .

Health as expanding consciousness theory Dorothea Orem .Self-care deficit nursing theory Ida Jean Orlando (Pelletier) Ramona T Mercer .Theory of interpersonal relations Rosemarie Rizzo-Parse .McGill model of nursing Erickson. Winifred W.Science of unitary human beings Callista Roy .[edit] Major nursing theorists and theories y y y y y y y y y y y y y y y y y y y y y y y y Helen Erickson Virginia Henderson . Florence Nightingale.Tidal Model Moyra Allen . and Alison J.Modeling and Role-Modeling Katie Eriksson Dr.Human becoming theory Isabel Hampton Robb Nancy Roper.Roper-Logan-Tierney model of nursing Martha E.Maternal role attainment theory Anne Casey . Newman . Nightingale never actually formulated a theory of nursing science but was posthumously accredited with same by others who categorized her personal journaling and communications into a theoretical framework. Tomlin & Swain . Jean Watson Paterson & Zderad Boykin & Schoenhofer Purposely omitted from this list is that most famous of all nurses. Rogers . Tierney . Also not included are the many nurses who improved on these theorists' ideas without developing their own theoretical vision .Henderson's need theory Imogene King Madeleine Leininger Betty Neuman . Logan.Adaptation model of nursing Katharine Kolcaba Phil Barker .Neuman systems model Margaret A.Casey's model of nursing Hildegard Peplau .

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