UNIT 3

NURSING
CONCEPTUAL
MODELS
CONCEPTUAL MODELS

ARE SETS OF CONCEPTS THAT ADDRESS

PHENOMENA CENTRAL TO NURSING IN
PROPOSITIONS THAT EXPLAIN THE
RELATIONSHIP AMONG THEM.
CHAPTER 12

Myra Estrin Levine:

THE
CONSERVATION
MODEL
❑“Nursing is a human
interaction that promotes
adaptation and maintains
wholeness either by acting in
the therapeutic sense or by
providing supportive care in
order to influence adaptation
favourably, or toward
renewed social wellbeing.”
❑ Myra Levine’s Conservation Model is focused
on the preservation of the individual’s
wholeness or totality.

❑ Levine proposed the use of

four Conservation Principles
to guide nursing practice.

❑ She believed that nursing activities were

conservation activities – a keeping-together
function that promotes wholeness in the
patient.
The four Conservation Principles are:
1.Conservation of Energy
⮚All physiologic and
psychological processes that
sustain life depend on the
body’s energy balance
(adjusting to life in the nursing
home; improving nutritional
status, balancing resident
activity, controlling resident
anxiety and pain.)
2. Conservation of Structural
Integrity
⮚All body systems decline
with aging. Chronic illness
also produces bodily
structural changes
(maintaining or promoting
mobility, preventing injury,
preventing infection,
maintaining skin integrity.
3.Conservation of Personal Integrity
⮚Self-identity is intrinsically bound to
wholeness and all individuals
cherish the sense of self (respecting
one’s privacy and property;
enhancing self-esteem through good
personal hygiene, grooming and
dressing; fostering independence
through choice and rehabilitation;
promoting self-identity for those
who are cognitively impaired;
obtaining advance directives for
treatment.)
4.Conservation of Social Integrity
⮚Individual life has meaning
only in the context of social life
(providing meaningful social
activities for residents and
staff, considering the family
and resident as a unit).
 Concepts and Definitions
❑Conservation describes the way
complex systems are able to
continue to function even when
severely challenged.

❑It is through conservation that

man is able to confront
obstacles, adapt accordingly, and
maintain their uniqueness and
individuality.
❑Wholeness emphasizes a sound,
organic, progressive, mutuality
between diversified functions and
parts within an entirety, the
boundaries of which are open and
fluent.
❑It connotes integrity – the
oneness of persons, highlighting
their capacity to respond in an
integrated and singular fashion to
environmental challenges.
❑ Adaptation is the process of change wherein
the person is able to keep his integrity within
situations and circumstances of his
environment, both internal and external.
❑ The result of adaptation is conservation.

❑ There are three characteristics of

adaptation:
1.Historicity
2.Specificity
3.Redundancy
❑Environment refers to the
internal and external
environments of the person.

❑Internal environment is
composed of the physiologic and
pathophysiologic domains of the
person.
❑External environment has three levels:
1.Perceptual levels
⮚Includes all aspects of the world
wherein the person is able to intercept
and interpret with his sense organs.

2.Operational levels
⮚Refers to things that physically affect
the individual but may not be perceived
by the individual himself.
❖ An example of these are microorganisms.
❖ We can get an infection because of a
microorganism but we cannot really perceive
what a microorganism really is.
3.Conceptual level
⮚The environment is the product
of cultural patterns,
characterized by spirituality,
and moderated by language,
history, and thought.
❑Organismic response refers to
the person’s ability to adapt to
his or her environment and is
made up of four levels of
integration.
1.Fight or flight – the most
primitive response. The person
either “fights” or “flies away”
from a perceived stressor in
order to ensure his own safety
and well-being.
2. Inflammatory response
⮚ A body defense mechanism that protects the
body tissue from insults in an unfriendly
environment.
3.Response to stress
Refers to the wear and tear of body tissues
that reflect the body’s continued response
and adaptation to stressful situations. It is
characterized by irreversibility . It
influences the way the patients respond to
nursing care.
4.Perceptual awareness
⮚ It occurs as the person experiences life and the
world around him.
• Trophicognosis - it is a scientific
method of reaching a nursing
care judgement.alternative
recommendation of Levine to
Nursing Diagnosis
• Major Assumptions
>"A holistic approach to care of all people,
well or sick".
> Decisions for nursing interventions must be
based on the unique behavior of the
individual patient...Patient centered nursing
care means individualized nursing care... and
requires a unique constellation of skills,
techniques, and ideas designed specifically
for the patient.
• Nursing
> is a human interaction.
>practice is based on nursing's unique
knowledge .
. Person
> described as a holistic being; wholeness is
integrity that the person has freedom of
choice and movement, with sense of identity
and self worth.
. Health
> socially determined by the ability to function
in a reasonably normal manner
• Theoretical Assertions
"Nursing intervention is based on
conservation of the individual patient's":
1. energy
2. structural integrity
3. personal integrity
4. social integrity
•Application to the Nursing Community
Conservation principles have been used as a
framework for numerous practice settings by
identifying the activities it encompasses and
giving the scientific principles behind them.
CHAPTER 13

MARTHA E. ROGERS
SCIENCE of
UNITARY BEINGS
 SCIENCE OF
UNITARY HUMAN
BEINGS
“Nursing is an art and science that
seeks to promote symphonic
interaction between the environment
and man, to strengthen the coherence
and integrity of the human beings, and
to direct and redirect patterns of
interaction between man and his
environment for the realization of
maximum health potential.”
❑ Martha Roger’s Science of Unitary Human
Beings provides a radical vision of nursing
reality.

❑ It provides a framework for nursing practice,

education, and research that promises a
move away from the previous predominant
medical model approach to the delivery of
nursing care.
❑ Rogers formulated five basic assumptions
that describe man and the life process in
man.

❑ These assumptions or “building blocks”

underlay the conceptual framework and
consist of the concepts of wholeness,
openness, unidirectionality, pattern and
organization, and sentience and thought.
❑ According to Rogers, a person is an
irreducible whole, the whole being greater
than the sum of its parts.
❑ Man is dynamic energy field in constant
exchange with environmental energy fields.
❑ Four “Critical elements” that are basic in the
theory:
1.Energy fields
2.Open system
3.Pattern
 4.Pandimensionality – was previously known as
multidimensionality, and prior to that, four-
dimensionality.

Concepts and Definitions

❑ Wholeness refers to the state in which the
human being is regarded as a unified
whole which is more than and different
from the sum of the parts.
❑Openness is where the individual
and the environment are
continuously exchanging matter
and energy with each other.

❑Open systems (openness)

describe the open nature of the
fields, the preferred terminology
being that there is a “continuous
process” without the mention of
energy or matter.
❑Unidirectionality refers to where
the life process exists along an
irreversible space time
continuum.
❑Pattern and organization identify
individuals and reflect their
innovative wholeness.
❑Pattern is the “distinguishing
characteristic of the energy field
perceived as a single wave”,
which gives identity to the field.
❑Human behavior can be regarded
as manifestations of changing
pattern.
❑The pattern is constantly
changing and might be regarded
as an indication of pain, illness or
disease.
❑Sentience and thought states
that all of life, human beings are
the only ones capable of
abstraction and imagery,
language and thought, sensation
and emotion.
❑ Energy fields are the “fundamental unit of
the living and the non-living”.
⮚They consist of the human energy
field and the environment energy
field.
⮚The human field is an “irreducible,
indivisible, pandimensional energy
field identified by pattern and
manifesting characteristics that are
specific to the whole and which
cannot be predicted form
knowledge of the parts”.
❑The environmental field is
integral with the human field.
⮚Each environmental field is
specific to its given human field.
❑Pandimensionality is a nonlinear
domain without spatial or
temporal attitudes.
❑It describes an infinite domain
without limits. It short, it is a
unitary whole.
 Theory Assertions
❑ Rogers viewed the person as an open system
in constant process with the open system of
the environment. She added that man is:
1.A unified whole possessing his own
integrity and manifesting
characteristics more than and
different from the sum of his parts.
2.In continuously exchanging matter
and energy with the environment.
3.Identified by pattern and
organization and reflects his
innovative wholeness.

3.Characterized by the
capacity for abstraction and
imagery, language and
thought, sensation, and
emotion.
SESSION 6 - CHAPTER 14

DOROTHEA OREM

SELF CARE DEFICIT

THEORY of NURSING
❑Dorothea E. Orem
❑“Nursing is a helping
profession of assisting
patients overcome or
compensate for their health-
associated limitations and
engaging in actions to
regulate their own functioning
and development or that of
their dependents.”
❑ Dorothea Orem’s model is a collection of
three interrelated theories.
❑ These are nursing systems, self-care, and
self-care deficit.
❑ The focus of Orem’s model is to enhance the
person’s ability for self-care and this also
extends to the care of dependents.
❑ A person’s self-care deficits are the result of
environmental situations.
❑ There are three systems that exist within this
professional nursing practice model.
1.Wholly compensatory system –
nurse provides total care
2.Partially compensatory system –
nurse and patient share
responsibility for care
3.Educative-development system –
client has primary responsibility for
personal health, with nurse acting
as a consultant.
Wholly Compensatory System
NURSE ACTION
⮚Accomplishes patient’s
therapeutic self-care
⮚Compensates for the
patient’s inability to
engage in self- care
⮚Supports and protects the
patient
Partially Compensatory System
• NURSE ACTION
⮚Performs some self-care measures for the
patient
⮚Compensates for self-care limitations of
the patient
⮚Assists the patient as required
NURSE - PATIENT ACTION
>Performs some self-care measures
⮚ Regulates self-care agency
⮚ Accepts care and assistance from nurse
Supportive-Educative System

NURSE - PATIENT ACTION

⮚Accomplishes self-care
⮚Regulates the exercise and
development of self-care
agency
❑The basic premise of the model is
that individuals can take
responsibility for their health and
the health of others.

❑In a general sense, individuals

have the capacity to care for
themselves or their dependents.
❑It is based upon the philosophy
that all “patients wish to care for
themselves.”
❑ Self-care requisites are groups of needs or
requirements that Orem Identified. They are
classified as:
1.Universal self-care requisites –
those needs that all people have
2.Developmental self-care requisites –
those needs that relate to the
development of the individual
3.Health deviation requisites – those
needs that arise as a result of a
patient’s condition.
❑ When an individual is unable to meet his own
self-care requisites, a self-care deficit
occurs.

❑ It is the duty and obligation of the

professional nurse to recognize and identify
these deficits in order to define a support
modality or intervention.
❑ Self-care is composed of the practice of
activities that maturing and mature
individuals initiate and perform, within time
periods, on their behalf.
*****This is to ensure maintaining life,
healthful functioning, continuing personal
development, and well-being.

❑ Self-care requisites are formulated and

expressed insights about actions to be
performed which are known to be relevant
and vital to human functioning.
❑ The universal self-care requisites include air,
water, food, elimination, activity and rest,
solitude and social interaction, hazard
prevention, and promotion of normal
functioning.
❑ Developmental self-care requisites include
conditions that promote development,
engagement in self-development, and
prevention of or overcoming effects of
human conditions and life situations that can
adversely affect human development.
❑Health deviation self-care
requisites include all pathologic
conditions or disorders which
include defects, deformities, and
disabilities. These require
medical intervention and
management.
❑Therapeutic self-care demand is
composed of the totality of
nursing care measures important
at certain times or over a period
of time for meeting all of the
individual’s known self-care
requisites. It uses methods
appropriate for managing the
factors identified in the requisites
and fulfilling the activity element
of the requisite.
❑ Nursing agency refers to the developed
capabilities of nurses that empower them to
meet the therapeutic self-care demands of
the patient.

❑ Self-care agency is a complex acquired

ability of mature and maturing individuals to
know and meet their continuing
requirements for deliberate and purposive
action to regulate their own human
functioning and development.
❑ Dependent-care agent is a maturing
adolescent of adult who accepts and fulfills
the responsibility to know and meet the
therapeutic self-care demand of significant
others who are socially dependent on them.

❑ Nursing systems are series and sequences of

deliberate practical actions of nurses
performed at times.
 Theory Assertions
❑ Nursing systems are action systems formed
by nurses through the exercise of their
nursing agency for persons with health-
derived or health-associated limitations in
self-care or dependent care.

❑ It includes deliberate action, intentionality,

diagnosis, prescription, and regulation.
❑ Self-care is a regulatory function by man. It is
deliberate and is performed by the person
himself or have them performed by another
person or them in order to maintain life, health,
development, and well-being.
Application of the Theory
❑ What is clear in the model of Orem is the
emphasis on education and supportive
measures. It becomes clear that nurses today
should not move away from this very important
aspect of clinical nursing – health teachings.
CHAPTER 15

IMOGENE M. KING

CONCEPTUAL SYSTEM and

MIDDLE RANGE THEORY
OF GOAL ATTAINMENT
 INTERACTING SYSTEMS
FRAMEWORK AND GOAL
ATTAINMENT THEORY

❑Imogene King
❑“Nursing is an observable
behavior found in the health care
systems in society that aims to
help individuals maintain their
health so they can function in
their roles.”
Interacting System Framework
❑ Imogene King’s “General Systems
Framework” theory emphasizes the
importance of the interaction between the
nurse and patients.
❑ It views this interaction as an open system
which is in constant interaction with a
variety of environmental factors.
There are three interrelated systems that
represent the domain of nursing:
1.Personal system 2. Interpersonal system
2.Social system
❑Personal systems are composed
of body image, growth and
development, perception, self,
space, and time.

❑When two or more persons

interact, they from an
interpersonal system.
❑ Interpersonal system is composed of the
concepts of communication, interaction, role,
stress, and transaction.

****A comprehensive interacting system is

comprised of groups that make up a society.
This results into the social system.
❑ Social system is composed of the concepts
of authority, decision-making, organization
power, and status.
 Goal Attainment Theory
❑ King’s Goal Attainment Theory is a Middle-
Range Theory that is the product of
developments from her first Interacting
Systems Theory.
❑ The Theory stated that mutual goal-setting
between a nurse and a client is based on:
1.The nurse’s assessment of a client’s
concerns, problems, and
disturbances in health
2.The nurse’s and client’s perceptions of the
interference, and

2.The nurse’s and client’s sharing of

information wherein each functions to help
the client attain the goals identified.

❑ The theory also maintained that nurses

interact with family members when client
cannot verbally participate in the goal-
setting.
❑ As such, the Goal Attainment Theory is
focused on the interpersonal system and the
interactions that take place between
individuals, more specifically in the nurse-
client relationship.

❑ The system is an open one in that it allows

feedback because each phase of the nurse-
patient activity has the potential to influence
perception.
❑ There are eight propositions related to the
Goal Attainment Theory:
1.If perceptual accuracy is present in
the nurse-client interactions, then
transactions will occur.
2.If nurse and client make
transactions, then goals will be
attained.
3.If goals are attained, then
satisfaction will occur.
4.If goals are attained, then effective nursing
care will occur.
5.If transactions are made in nurse-client
interactions, then growth and development
will be enhanced.
6.If role expectations and role performance as
perceived by nurse and client are congruent,
then transactions will result.
4.If role conflict is experienced by nurse
and client or both, then stress in nurse-
relationship interactions will occur.
5.If nurses with special knowledge and
skills communicate appropriate
information to clients, then mutual goal
setting and goal attainment will occur.
 Concepts and Definitions

❑ Perception is a process in which data

obtained through the senses and from
memory are organized, interpreted, and
transformed.

❑ The self is made up of thoughts and feelings

related to one’s awareness of being a person
separate from others and influencing one’s
view of who and what he or she is.
❑ Growth and development are processes in
people’s lives through which they move from
a potential for achievement to actualization
of self.

❑ Body image includes both the way one

perceives one’s body and others’ reactions
to one’s appearance.

❑ Space is the physical area known as territory

and by the behaviors of those who occupy it.
❑ Time is an interval between the two events
that is experienced differently by each
person.
❑ Interactions are observable behaviors of two
or more persons in mutual presence.
❑ Communication is verbal and non-verbal
situational, perceptual, transactional,
irreversible, or moving forward in time,
personal, and dynamic.
>Transactions are a series of exchanges
between human beings and the environment
that include observable behaviors that seek
to reach goals of worth to the participants.
❑ Role is characterized by reciprocity in that a
person may be a giver at one time and a
taker at another time, with the relationship
between two or more individuals who are
functioning in two or more roles that are
learned social, complex, and situational.
❑ Stress is an ever changing condition in which
an individual, through environmental
interaction, seeks to keep equilibrium to
support growth and development and activity.
❑ An organization is made up of individuals who
have prescribed roles and positions and who
make use of resources to meet goals-both
personal and organizational.
❑ Authority refers to the active, reciprocal
process of transaction in which the
actors’ experience, understanding, and
values influence the meaning, legitimacy
and acceptance of those in
organizational positions associated with
authority.
❑ Status is the relationship of one’s place
in a group to others in the group or of a
group to other groups.
❑ Decision-making is a changing and
orderly process through which choices
related to goals are made among toward
the goal.
THANK YOU!