NCMA111 ~ AQM Homodynamic principles
● Resonance is an arrangement for human and
Martha Rogers - (Unitary Human Beings )
Dorotea Orem - (Self Care Deficit )
Imogene King - (Goal Attainment Theory)
Dorothy Johnson - (Behavioral System Model)
Sister Callista Roy - (Adaptation Model)
Betty Neuman - (System Model)
Hildegard Peplau - (Interpersonal Relations Theory)
Ida Jean Orlando - (Nursing Process Theory)
Virginia Henderson - (Nursing Need Theory)
Rosemarie Rizzon Parse - (Human Becoming
Theory)
Madeleine Leininger - (Transcultural Nursing Theory)
Joyce Travelbee - (Human To Human Relationships
Model)
Faye Glenn Abdellah - (Patient-Centered Approaches
In Nursing Model)
Myra Estrin Levine - (Conservation Model)
Lydia Hall - (Core, Care And Cure Theory)
Margaret Newman - (Health As Expanding
Consciousness)
MODULE 7:
MARTHA ROGERS : (SCIENCE OF UNITARY HUMAN
BEINGS)
Background
● Martha E. Rogers was born in 1914 in Dallas, Texas.
● She received her nursing diploma from the Knoxville
General Hospital School of Nursing in 1936, then
earned her Public Health Nursing degree from
George Peabody College in Tennessee in 1937.
● Her Master’s degree was from Teachers College at
Columbia University in 1945, and her Doctorate in
Nursing was earned at Johns Hopkins University in
Baltimore in 1954. Rogers died on March 13, 1994.
● Rogers worked as a professor at New York
University’s School of Nursing.
● She was also a Fellow for the American Academy of
Nursing.
● Her publications include: Theoretical Basis of Nursing
(1970), Nursing Science and Art: A Prospective
(1988),Nursing: Science of Unitary, Irreducible,
Human Beings Update (1990), and Vision of Space
Based Nursing (1990).
environment that undergo transformation
● Helicy is the nature of change is unpredictable,
continuous and innovative
● Integrality is the energy fields of human and
environment in a continuous mutual process
Martha Rogers’ Nursing Metaparadigm
Person
➢ The life process of the unitary human being is
one of wholeness and continuity as well as dynamic
and creative change.
Environment
➢ Environment defines as an irreducible pan
dimensional energy field identified by pattern and
manifesting characteristics different from those of the
parts.
Health
➢ Health symbolizes wellness and the absence
of disease and major illness.
Nursing
➢ Nursing is both art and science and the nurse
is a factor in the healing environment.
Implications of Rogers Theory
● Nursing Practice
○ Evaluative and diagnostic phase includes
determining the patients’ and their family’s
well-being status at the time
○ Interventive how the nurse will go about
implementing nursing interventions for the
patient.
● Education
○ That students have individual personalities
and patterns to their work.
○ They are all unitary human beings and
should be interacted with differently
○ Culture, family, and experiences affect their
reasons and motives to become a nurse
○ Beings focuses on “the integrality of person
and environment, the individual’s active
participation in change, and each person’s
individual pattern.
● Research
○ It was found that the theory applies to any
environment that contains human beings.
○ Her theory focuses nursing interventions on
the patient well -being overall and not just
their disease state
○ It encourages the use of guided imagery,
relaxation, therapeutic touch, and meditation
Analysis of the Theory
● Clarity – It is difficult-to-understand principles, lack of
operational definitions, and inadequate tools for
measurement model has passed the test of time for
the development of nursing science as nursing
matured as a science
● Simplicity - when the model is examined in total
perspective, some still classify it as complex. With its
continued use in practice, research, and education,
nurses will come to appreciate the model’s elegant
simplicity
 ● Generality - Rogers’ conceptual model is abstract
and therefore generalizable and powerful. It is broad
in scope, providing a framework for the development
of nursing knowledge through the generation of grand
and middle-range theories
● Importance- Rogers’ science has the fundamental
intent of understanding human evolution and its
potential for human betterment. The science
“coordinates a universe of open systems to identify
the focus of a new paradigm and initiate nursing’s
identity as a science”
Application to Nursing
Mary is a 53-year-old woman who is in end stage leukemia.
She has had two failed bone marrow transplants and three
rounds of chemotherapy. She is moving into hospice home
care, and the family and Mary become your client. Mary is the
mother of four children: 25, 23, 20, and 17. One child lives at
home. Pattern appraisal includes Mary—frail, quiet, almost
translucent in appearance, resting comfortably in the hospital
bed in living room, nasal O2 in place of Tom—husband, quiet,
pacing Home—clean, orderly, many personal articles, large
window facing north and looking into the yard. Noise level
low. Dog sleeping on floor.
Analysis
1. End of life is a process of merging of the past,
present, and future
2. Nursing care for Mary offers the opportunity to
incorporate a variety of patterning
3. As Mary nears and prepares for the end of her life,
many patterning concerns must be addressed for
peaceful closure to her life and the change to another
energy form
4. The visible rhythmical pattern is a manifestation of
peace (Mary) and a human environmental
manifestation of anxiety in husband
5. The unknown and preparation for loss is the focus.
The pattern appraisal is ongoing
6. Harmony is noted in her relationship with her
husband and family and with her sense of how she
has progressed through this disease process.
DOROTEA OREM : (SELF CARE DEFICIT)
● focuses on each “individual's ability to perform
self-care, defined as 'the practice of activities that
individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.
● Suggests patients are better able to recover when
they maintain some independence over their own self
care
Background
● Dorothea E. Orem (1914-2007), one of the prime US
theorists born in Baltimore, Maryland
● Obtain her basic diploma in nursing at School of
Nursing Washington, BSN (1939) and MSN in 1945
from Catholic University of America, and Doctorate
degrees (honorary Doctorates awarded from different
Universities).
● She began her nursing career at Providence Hospital
School of Nursing in Washington, DC, where she
received a diploma of nursing in the early 1930s.
● She published her theory in 1959 for the first time
and revised it in 1971, 1983, 1987, and 2001. Her
contributions enabled her to achieve Excellency from
prominent societies like Sigma Theta Tau
International Society, the National League for
Nursing, and the American Academy of Nursing.
Orem Philosophy
● “Nursing is the ability to care for another human
being, most importantly when they are unable to care
for themselves. The ultimate goal is achieving an
optimal level of health and wellness for our patients”.
Orem (1971)
Concepts of Orem’s Model
1. The Self-Care Deficit Theory developed as a result of
working toward her goal of improving the quality of
nursing in general hospitals in her state.
2. The model interrelated concepts in such a way as to
create a different way of looking at a particular
phenomenon.
3. The theory is relatively simple, but generalizable to
apply to a wide variety of patients.
4. It can be used by nurses to guide and improve
practice, but it must be consistent with other validated
theories, laws and principles
Concepts and Definition
● The self-care deficit nursing theory is a general
theory composed of the following four related
theories
● The theory of self-care, which describes why and
how people care for themselves
● The theory of dependent-care, which explains how
family members and/or friends provide
dependent-care for a person who is socially
dependent
● The theory of self-care deficit, which describes and
explains why people can be helped through nursing
● The theory of nursing systems, which describes and
explains relationships that must be brought about and
maintained for nursing to be produced
Theory of Self Care
● “Self –care comprises the practice of activities that
maturing and mature persons initiate and perform,
within time frames, on their own behalf in the interest
of maintaining life, healthful functioning, continuing
personal development and well-being through
meeting known requisites for functional and
developmental regulations.
● The Theory of Self-Care has three components:
universal self-care needs, developmental self-care
needs and health deviation.
3 Components of Self Care
● Universal Self Care Needs
○ Air, food, water, elimination/excretion, activity
& rest, solitude /social interaction,
functioning/well being, normalcy
● Developmental Self Care Requisites
○ more specific to the process of growth and
○ development and are influenced by what is
happening during the life cycle, It can be
positive or negative.
● Health Deviation Self Care Requisites
○ When a condition permanently or temporarily
alters structural, physiological or
psychological function
Self Care
● Self Care Agent provides the foundation for
understanding the action requirements and action
limitations of persons who may benefit from nursing.
● Theory of dependent care “explains how the self-care
system is modified when it is directed toward a
person who is socially dependent and needs
assistance in meeting his or her self-care requisites”
● Therapeutic self-care demand is the 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.
Theory of Dependent Care
● Dependent care refers to the care that is provided to
a person who, because of age or related factors, is
unable to perform the self-care needed to maintain
life, healthful functioning, continuing personal
development, and well-being.
Dependent-Care Demand
● Summation of care measures at a specific point in
time or over a duration of time for meeting the
dependent’s therapeutic self-care demand when his
or her self-care agency is not adequate or
operational.
Self-Care Agency
● The self-care agency is a complex acquired ability of
mature and maturing persons to know and meet their
continuing requirements for deliberate, purposive
action to regulate their own human functioning and
development
Dependent-Care Agency
● Refers to the acquired ability of a person to know and
meet the therapeutic self-care demand of the
dependent person and/or regulate the development
and exercise of the dependent’s self-care agency
Theory of Self-Care Deficit
● A self-care deficit occurs when an individual cannot
carry out self-care requisites.
● Orem identifies method of helping:
● Acting for and doing for others o Guiding and
directing
● Providing Physical and Psychological support
○ Environment of promoting personal
development
○ Teaching
● Examples of self-care requisites are:
○ Wound care
○ Activities of Daily Living o Bowel program
○ Glucose monitoring
Theory of Nursing Systems
● Wholly compensatory support- patient is unable to
complete any self-care independently; nursing
compensates for patient’s inability to perform
self-care.
● Partial compensatory support- patient is able to
perform self-care tasks with partial or no assistance
from nursing.
● Supportive/educative compensatory– patient able to
perform tasks independently. Nursing provides
ongoing education and support.
Four major Concepts of Orem: (Dorotea Orem’s Nursing
Metaparadigm)
Health
➢ Health is a state characterized by soundness or
wholeness of developed human structures and of bodily and
mental functioning.
Person
➢ People is viewed biologically, symbolically and
socially but still as a whole person. This person is considered
to be able to provide self-care
Nursing
➢ Nursing is how a healthcare professional develops a
plan of care to meet the patient’s self-care needs .
Environment
➢ Environment is the physical, chemical, biologic and
social factors that make up who a person is.
Significance of the Theory
Nursing Practice
● Has achieved a significant level of acceptance by the
international nursing community, as evidenced by the
magnitude of published material and presentations at
the International Orem Society World Congresses.
Education
● The SCDNT was introduced as the basic structure of
nursing management in German hospital DRG
(diagnosis-related group) implementation. The
movement toward SCDNT-based nursing
management.
● The influence of Orem’s SCDNT has continued at the
international level through the translation of Nursing
Concepts of Practice into several languages.
Research
Using the SCDNT or components, Biggs (2008) found more
than 800 references. Berbiglia identified selected practice
settings and SCDNT conceptual foci from a review of more
than 3 decades of use of the SDNT in practice and research
and publicized selected international SDNT practice models
for the twenty-first century.
Analysis of the Theory
1. Clarity- Orem defined the term and elaborated the
substantive structure of the concept in a way that is unique
while also congruent with other interpretations.
2. Simplicity- Orem’s theory is expressed in a limited
number of terms. These terms are defined and used
consistently in the expression of the theory. Orem’s general
theory, the SCDNT, comprises the following four constituent
theories: self-care, dependent-care, self-care deficit, and
nursing systems
3. Generality As a general theory, it serves nurses
engaged in nursing practice, in development and validation of
nursing knowledge, and in teaching and learning nursing
4. Accessibility - As a general theory, the SCDNT
provides a descriptive explanation of why persons require
nursing and what processes are needed for the production of
required nursing care.
The SCDNT differentiates the focus of nursing from other
disciplines. Although other disciplines find the theory of
self-care helpful and contribute to its development, the theory
of nursing systems provides a unique focus for nursing.
Application to Nursing Social system
An organized system of social role, behavior and practices
Mr. Shoaib is a 62 years old male patient admitted to a • Organization
medical ward. He has right ischemic CerebroVascular • Authority
Accident (CVA) and a resultant left sided body paralysis. • Power
• Status
He has no sensations or movement in the left side of the • Decision Making
body. He has lost his gag reflux and is unable to swallow
food. A nasogastric (N/G) tube is placed for providing him Assumptions
nutrition. Mr. Shoaib is not able to change his position and is 1. Basic Assumptions of goal attainment theory is that
dependent on caregivers for changing his position. He is also the nurse and patient communicate information, set mutual
not able to carry out his routine daily life activities. His family goal act to achieve these goals it is the basic assumption of
is worried whether he would be able to regain control of his Nursing Process.
life or not. They are also worried whether they would be able 2. Each human being perceives the world as a total
to provide him the care he needs when he is discharged from person in making transaction with individual and things in the
hospital environment.

Apply the case utilizing Nurse Patient Transaction Model

1. Action is a means of behavior or activities that are
1. Universal Self care requisite towards the accomplishments of certain act. It is both
2. Health deviant self care physical and mental.
3. Development of self care requisite 2. Reaction is a form of reacting or a response to a
certain stimuli.
IMOGENE KING: (GOAL ATTAINMENT THEORY) 3. Interaction is any situation wherein the nurse relates
and deals with a clientele or patient.
Background 4. Transaction is a unique observable in which human
● Theorist : Imogene King being communicate with the environment
● born in 1923.
● Bachelor in science of nursing from St. Louis Imogen King’s Nursing Metaparadigm
University in 1948
● Master of science in nursing from St. Louis University Person
in 1957 •Person existing in an open system who makes
● Doctorate from Teachers college, Columbia choices and select alternative action
University. Health
● Theory describes a dynamic, interpersonal •Health as continuous adjustment to stress in the
relationship in which a person grows and develops to internal and external environment
attain certain life goals.
● Factors which affects the attainment of goal are: Environment
roles, stress, space & time’ •Environment as the process of balance involving
internal and external interactions inside the social
King's Open System Framework system
1. Nursing Focus is the care of human being Nursing
2. Nursing Goal is the health of the individual and health •Nursing is an observable behavior found in the
care for the group health care systems in society”. The goal of nursing
3. Human Beings are an open system in constant “is to help individuals maintain their health so they
interaction with the environment. can function in their roles”

Interacting systems in the Theory of Goal Attainment Significance

Personal System Nursing Practice
• Perception •Individualized the plans of care while encouraging
• Self active participation from clients
• Growth and Development •The profession of nursing functions through
• Body Image individuals and groups within the environment.
• Time
• Space Education
•It is used in curriculum design in nursing programs
Interpersonal system •It provides a systematic means of viewing nursing as
• How the nurse interrelates with a co-worker or profession, an organized body of knowledge and
patient, particularly in a nurse-patient relationship clarifying nursing as discipline
• Interaction
• Communication Research
• Transaction •It is design and conducted to implement this system
• Role in hospital, ambulatory, community and home care
• Stress nursing

Analysis of the theory
1. Clarity- Theory of Goal Attainment is the ease with
which it can be understood by nurses. Concepts are
concretely defined and illustrated.
2. Simplicity- King’s definitions are clear and are
conceptually derived from research literature.
3. Generality – It has been criticized for having limited
application in areas of nursing in which patients are
unable to interact competently with the nurse.
4. Accessibility - A descriptive study was conducted to
identify the characteristics of transaction and whether
nurses made transactions with patients
5. Importance- middle-range Theory of Goal Attainment
focused on all aspects of the nursing process:
assessment, planning, implementation, and
evaluation. The body of literature clearly establishes
King’s work as important for knowledge building in
the discipline of nursing.
Application to Nursing
1. Communication between nurse and patient is the
cornerstone of the interpersonal system and the most
important prerequisite for a transaction to occur. It
can be established both verbally and nonverbally.
2. A middle-aged female patient referred to the
emergency room with weakness and feebleness. The
attending physician gave the diagnosis of acute
pulmonary edema. Emergency staff needed to start
invasive interventions to manage her acute condition.
However, they failed to understand her conditions
and did not provide her with adequate
treatment-related information. She did not give
consent for treatments and treatments were not
administered. This example shows that nurses and
physicians need to give high priority to the
establishment of effective communication with
patients to help them make wiser decisions to retain
their own health as their main goal. Moreover, they
need to allow patients to articulate their perceptions
of their illnesses, personal illness-related
experiences, and the level of their stress. It is only in
this way that nurses and patients can help each other
and create a favorable environment for
decision-making.. Consequently, the goal of health is
attained when both sides of a relationship properly
interact with each other and collaboratively work
together to attain their goals.
DOROTHY JOHNSON: (BEHAVIORAL SYSTEM MODEL)
BACKGROUND
● Dorothy Johnson was born on August 21, 1919, in
Savannah, Georgia.
● She was the youngest of seven children. Her father
was the superintendent of a shrimp and oyster
factory, and her mother was very involved and
enjoyed reading.
● In 1938, she finished her associate’s degree at
Armstrong Junior College in Savannah, Georgia. Due
to the Great Depression, she took a year off from
school to be a governess, or teacher, for two children
in Miami, Florida.
● This was when she began to realize her love for
children, nursing, and education.
● Dorothy Johnson’s professional nursing career began
in 1942 when she graduated from Vanderbilt
University School of Nursing in Nashville, Tennessee.
● She was the top student in her class and received the
prestigious Vanderbilt Founder’s Medal.
● In 1948, she received her master’s in public health
from Harvard University in Boston, Massachusetts.
● Johnson’s theory and her related writings reflect her
knowledge about both development and general
systems theories.
● The combination of nursing, development, and
general systems introduces some of the specifics into
the rhetoric about nursing theory development that
make it possible to test hypotheses and conduct
critical experiments
4 Goals of Nursing
● To assist the patient whose behavior is proportional
to social demands.
● To assist the patient who is able to modify his
behavior in ways that it supports biological
imperatives.
● To assist the patient who is able to benefit to the
fullest extent during illness from the physician’s
knowledge and skill.
● To assist the patient whose behavior does not give
evidence of unnecessary trauma as a consequence
of illness
Concepts and Definition
● Behavior as expressed by the behavioral and
biological scientists; that is, the output of intra
organismic structures and processes as they are
coordinated and articulated by and responsive to
changes in sensory stimulation.
● A system is a whole that functions as a whole by
virtue of the interdependence of its parts, that there is
“organization, interaction, interdependency, and
integration of the parts and elements
● A behavioral system is a patterned, repetitive, and
purposeful way of behaving.
● These ways of behaving form an organized and
integrated functional unit that determines and limits
the interaction between the person and his or her
environment and establishes the relationship of the
person to the objects, events, and situations within
his or her environment.
● A subsystem is “a mini system with its own particular
goal and function that can be maintained as long as
its relationship to the other subsystems or the
environment is not disturbed”
Stressor
● Internal or external stimuli that produce tension and
result in a degree of instability
Subsystem of Behaviors
● Subsystem are parts of the behavioral system.
● It carry out specialized task/function needed to
maintain the integrity of the whole system
● It has a set of behavioral responses that re
developed through motivation, experience and
learning
Subsystem 4 structural components
● The goal of a subsystem is defined as the desired
result or consequence of the behavior
● The behavioral set is a predisposition to act in a
certain way in a given situation
 ● Choice refers to the individual’s repertoire of
alternative behaviors in a situation that will best meet
the goal and attain the desired outcome
● The concern is with the efficiency and effectiveness
of the behavior in goal attainment. Actions are any
observable responses to stimuli.
Functional Subsystem
● Protection from noxious stimuli influences with which
the system cannot cope
● Nurturance through the input of appropriate supplies
form environment
● Stimulation to enhance growth and prevent
stagnation
Dorothy Johnson’s Nursing Metaparadigm
Person
➢ Human beings have two major systems, the
biological system and the behavioral system. It is role
of the medicine to focus on biological system
whereas Nursling's focus is the behavioral system
Environment
➢ Environment is any factor influencing the
behavioral subsystem manipulated by the nurse to
achieve health.
Health
➢ Health is the lack of balance in the structural
or functional requirements of the subsystems leads to
poor health.
Nursing
➢ Nursing is an external regulatory force which
acts to preserve the organization and integration of
the patient’s behaviors at an optimum level under
those conditions in which the behaviors constitute a
threat to the physical or social health, or in which
illness is found.
Application to Nursing
● By elderly people, those from the age of 65 and
above, most of which have retired. These people are
normally seen as a bother to their loved ones as their
needs increase from the normal. They thus need
more care which cannot be provided at home so they
are often taken to nursing homes where they can get
the proper care. Because of old age and stress from
retirement. These people have difficulty coping with
the changes around them and their behavior
changes. Some become aggressive while others
develop mental problems making long-term nursing
homes the best to take proper care of these
individuals.
● Nurses have to pay keen attention to such
aggressive behavior and identify which of the seven
subsystems is not functioning properly thus helping
these patients restore balance in their systems.
● It could be dependence, attachment, or
aggressiveness causing a change in behavior. The
dependence in the sense that the patient who was
used to taking care of himself now finds it frustrating
when he has to rely on others for all his needs.
● The attachment comes in when the patient struggles
to form new relationships at the care facilities and
being kept away from the existing relationships.
● Normally the patient plays a role in the behavioral
system model of treatment but in dealing with mental
complications, especially the ones accompanied by
aggressive behavior. Most of the effort is required
from the part of the nurse who has to be patient with
the patient.
SISTER CALLISTA ROY: (ADAPTATION MODEL)
BACKGROUND
● Sister Callista L. Roy (born October 14, 1939) is a
nursing theorist, professor, and author.
● She is known for her groundbreaking work in creating
the Adaptation Model of Nursing.
● She received her Bachelor of Arts Major in
● Nursing from Mount Saint Mary’s College in Los
Angeles in 1963 and her master’s degree in nursing
from the University of California in 1966.
● After earning her nursing degrees, she began her
sociology education, receiving both a master’s
degree in sociology in 1973 and a doctorate in
sociology in 1977 from California.
● She developed the model’s basic concepts while she
was a graduate student at the University of California
from 1964 to 1966.
● She was an associate professor and chairperson of
the Department of Nursing at Mount Saint
● Mary’s College until 1982 and was promoted to the
professor’s rank in 1983 at both Mount Saint Mary’s
College and the University of Portland.
● The RAM focuses on the inter relatedness of four
adaptive systems
● It focuses on persons coping(adaptative)abilities in
response to constantly to changing environment (
Lopes, Pagliuca, Araujo,2006)
● Nursing can promote effective coping by asking” How
can I modify this patient’s environment to facilitate his
adaptation (Chitty & Black, 2011)
Major Concepts and Definition
● A system is “a set of parts connected to function as a
whole for some purpose and that does so by virtue of
the interdependence of its part.”
● “Adaptation level represents the condition of the life
processes described on three levels as integrated,
compensatory, and compromised”
Types of Stimuli
● Focal Stimulus is the degree of change or stimulus
more immediately confronting the person and the one
to which the person must make adaptive response
● Contextual Stimuli are present to contribute to the
behavior caused or precipitated by the focal stimuli
● Residual Stimuli are factors that may be affecting
behavior but whose efforts are not validated.
Coping Processes “are innate or acquired ways of interacting
with the changing environment”
○ Innate Coping Mechanisms Innate coping
mechanisms “are genetically determined or
common to the species and are generally
viewed as automatic processes; humans do
not have to think about them”
○ Acquired coping mechanisms “are developed
through strategies such as learning. The
experiences encountered throughout life
contribute to customary responses to
particular stimuli”
Subsystem
 ● Regulator subsystem is a major coping mechanism
which responds automatically through physiological
adaptive mode, responds automatically through
neural, chemical, and endocrine coping processes
● ● Neuman
● The cognator is a major coping subsystem responds
to complex processes of perception and information
processing, judgement and emotions
● Implication to Nursing Practice, Education and
Research
Sister Callista Roy’s Nursing Metaparadigm
Person
➢People, both individually and in groups, as holistic
adaptive systems, complete with coping processes
acting to maintain adaptation and to promote person
and environment transformations
Health
➢ Health is the reflection of personal and
environmental interactions that are adaptive.
Environment
➢ Environment are conditions, circumstances,
and influences surrounding and affecting the
development and behavior of individuals and groups
Nursing
➢ The goal of nursing was the first major
concept of her nursing model to be described. She
identifies the unique function of nursing in promoting
health
Application to Nursing
● A a 23-year-old male patient is admitted with a
fracture of C6 and C7 that has resulted in
quadriplegia. He was injured during a football game
at the university where he is currently a senior. His
career as a quarterback had been very promising. At
the time of the injury, contract negotiations were in
progress with a leading professional football team.
1. Use Roy’s criteria to identify focal and
contextual stimuli for each of the four
adaptive modes.
2. Consider what adaptations would be
necessary in each of the following four
adaptive modes: (1) physiological, (2)
self-concept, (3) interdependence, and (4)
role function.
BETTY NEUMAN: (SYSTEM MODEL)
BACKGROUND
● Betty Neuman was born in 1924 near Lowell, Ohio.
● She grew up on a farm which later encouraged her to
help people who are in need.
● Her father was a farmer who became sick and died at
the age of 36.
● Her mother was a self-educated midwife that led the
young Neuman to be always influenced by the
commitment that took her away from home from time
to time.
● In 1957, she received a baccalaureate degree in
public health and psychology with honors.
● She also earned a master’s degree in mental health,
public health consultation in 1966 from the University
of California, Los Angeles (UCLA).
● After her graduation, she was hired as a department
chair in the UCLA School of Nursing graduate
program
● In 1985, Betty Neuman concluded a doctoral degree
in clinical psychology at Pacific Western University.
She was a pioneer of nursing involvement in mental
health.
Systems Model as “a unique,
open-system-based perspective that provides a
unifying focus for approaching a wide range of
concerns.
● A system acts as a boundary for a single client, a
group, or even several groups;
● It can also be defined as a social issue.
● A client system in interaction with the environment
delineates the domain of nursing concerns.”
Betty Neuman’s Systems Model
● Neuman System Model focuses on the different
stressors patients have and ways to relieve the stress
from the different stressors.
● The model also focuses on how the patient may react
to the stress.
● Internal and external affects the patient are stressors
● The role of the nurse is to keep the system stable
throughout the three levels of prevention; primary,
secondary, and tertiary.
Concepts and Definition
● Holistic Approach
○ Clients are viewed as wholes whose parts
are in dynamic interaction.
○ The model considers all variables
simultaneously affecting the client system:
physiological, psychological, sociocultural,
developmental, and spiritual
● Open System
○ A system is open when there is a continuous
flow of input and processes, output, and
feedback. Stress and reaction to stress are
basic components of an open system.
● Function or Process
○ The client as a system exchanges energy,
information, and matter with the environment
as well as other parts and subparts of the
system as it uses available energy resources
to move toward stability and wholeness.
● Input and Output
○ For the client as a system, input and output
are the matter, energy, and information that
are exchanged between the client and the
environment.
● Feedback
○ System output in the form of matter, energy,
and information serves as feedback for future
input for corrective action to change,
enhance, or stabilize the system.
● Client System
○ The client system is a composite of five
variables (physiological, psychological,
sociocultural, developmental, and spiritual) in
interaction with the environment.
5 types of stressor
● Physiological stressors
● Psychological stressors
● Socio-cultural stressors
● Developmental stressors
● Spiritual stressors
Major Assumptions
Nursing
 ➢ Nursing is concerned with the whole person.
She views nursing as a “unique profession in that it is
concerned with all of the variables affecting an
individual’s response to stress.
Health
➢ Health as a continuum of wellness to illness
that is dynamic in nature and is constantly changing.
Client System
➢ The client system is a dynamic composite of
interrelationships among physiological, psychological,
sociocultural, developmental, and spiritual factors.
Environment
➢ Environment as all the internal and external
factors that surround and influence the client system.
Stressors (intrapersonal, interpersonal, and
extrapersonal)
Application to Nursing
● Mr ABC, a 47 year old male was admitted in COVID
-19 ward, was admitted through the emergency
department after being referred from a private
hospital. The presenting chief complaints of the
patient were fever for 9 days associated with chills
and rigors and shortness of breath for 6 days. There
was no history of orthopnea or paroxysmal nocturnal
dyspnea [PND] or cough or hemoptysis, but
complained of some epigastric discomfort. He also
complained of loss of appetite and wheezing.
However there was documented weight loss.
● Comprehensive nursing care was provided by a team
of nursing personnel posted in COVID unit. Nursing
care was given to the patient as per the identified
stressors and his reaction to the stressors.
HILDEGARD PEPLAU : (INTERPERSONAL RELATIONS
THEORY)
● Hildegard Peplau (1909-1999) 90 years-old
● Pennsylvania-flu
● 1931 - Pennsylvania School of Nursing
● 1943 - Bachelors in Interpersonal Psychology
● 1947 - M.A. Psychiatric Nursing
● 1953 - Ed.D in Curriculum development
● 1950-70's - Clinical Specialist in Psychiatric Nursing
● Career
○ Army Corps Nurse, Professor, Advisor to
WHO, USSG, US Air Force, NIMH, and US
policy.
○ Nursing Profession (Petiprin, 2016: Sitzman
& Eicchelberger, 2017)
● What is Interpersonal Relations Theory?
○ Emphasized the nurse-client relationship as
the foundation of nursing practice.
○ The interpersonal model emphasizes 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).
○ Shared experience - Nurses could facilitate
this through observation, description,
formulation, interpretation, validation, and
intervention.
HILDEGARD PEPLAU’S NURSING METAPARADIGM
Person
● A man who is an organism that lives in an unstable
balance of a given system.
Heath
● Symbolizes movement of the personality and other
ongoing human processes that directs the person
towards creative, constructive, productive and
community living.
Environment
● Forces outside the organism and in context of the
socially-approved way of living, from which vital
human social processes are derived such as norms,
customs, and beliefs.
Nursing
● Significant, therapeutic, interpersonal process. It
functions cooperatively with human processes that
present health as a possible goal for individuals.
Phases of Nurse-Patient Relationship
A. Orientation Phase
● Get acquainted with the nurse-patient relationship.
● Preconceptions are worked through.
● Parameters are established and early levels of trust
are developed.
● Roles begin to be understood.
B. Identification Phase
● The client begins to identify problems to be worked
on within the relationship.
● The goal of the nurse: help the patient to recognize
his/her own independent/participation role and
promote responsibility for self.
C. Exploitation Phase
● Client's trust in the nurse reached full potential.
● Client making full use of nursing services.
● Solving immediate problems.
● Identifying and orienting self to [discharge] goals.
D. Resolution Phase
● Client met needs.
● Mutual termination of relationship.
● Sense of security is formed.
● Patient is less reliant on the nurse.
● Increased self-reliance to deal with own problems.
Interpersonal Therapeutic Process
● This type of process is based on the theory proposed
by Peplau and Particularly useful in helping
psychiatric patients become receptive for therapy.
● Often referred as "Psychological Mothering" it
includes the following steps:
● The patient is accepted unconditionally as a
participant in a relationship that satisfies his needs;
● There is recognition of and response to the patient's
readiness for growth, as his initiative; and
● Power in the relationships shift to the patient, as the
patient is able to delay gratification and to invest in
goal achievement.
NURSING ROLES
● Stranger Role
○ Receives the client the same way one meets
a stranger in other life situations; provides an
accepting climate that builds trust.
● Resource role
○ Answers questions, interprets clinic treatment
data, gives information.
● Teaching Role
○ Gives instructions and provides training;
involves analysis and synthesis of the
learner's experience.
● Counseling Role
 ○ Helps client understand and integrate the
meaning of current life circumstances;
provides guidance and encouragement to
make changes.
● Surrogate Role IDA JEAN ORLANDO: (NURSING PROCESS THEORY)
○ Helps clients clarify domains of dependence,
interdependence, and independence and Background:
acts on clients behalf as advocates. ● Ida Jean Orlando (1926-2007)
● Active Leadership Role ● 1947 - Diploma in nursing from New York Medical
○ Helps clients assume maximum responsibility College, Flower Fifth Avenue Hospital School of
for meeting treatment goals in a mutually Nursing
satisfying way. ● 1951 - Bachelor of Science in Public Health from St.
● Technical Expert Role John's University, Brooklyn.
○ Provides physical care by displaying clinical ● 1954 - Master of Arts in Mental Health consultation in
skills; Operates equipment. Columbia University Teachers College.
Assumptions: Nursing Process Theory
● Nurse and patient can interact. ● Nursing Process discipline is rooted in the interaction
● Both the patient and nurse mature as the result of the between a nurse and a patient at a specific time and
therapeutic interaction. place
● Communication and interviewing skills remain ● The nurse then decides on an appropriate action to
fundamental nursing tools. resolve the need in cooperation with the patient.
● Nurses must clearly understand themselves to ● This action is evaluated after it is carried out.
promote their client's growth and to avoid limiting ○ If the patient’s behavior improves, the action
client's choices to those that nurses value. is successful and the process is completed.
Interpersonal Theory and Nursing Process ○ If there is no change or the behavior gets
● Both are sequential and focus on therapeutic worse, the process recycles with new efforts.
relationships. Assumptions
● Both use problem solving techniques for the nurse ● When patients cannot cope with their needs without
and patient to collaborate on, with the end purpose of help, they become distressed with feelings of
meeting the patients needs. helplessness.
● Both use observation communication and recording ● Nursing, in its professional character, does add to the
as basic tools utilized by nursing. distress of the patient. Patients are unique and
individual in their responses.
● Nursing offers mothering and nursing analogous to
Assessment: Orientation:
an adult mothering and nurturing of a child. Nursing
● Data collection and ● Non continues
deals with people, environment and health.
analysis [continues] data collected.
● Patient need help in communicating needs, they are
May not be a felt ● Felt need.
uncomfortable and ambivalent about dependency
need. ● Define needs.
needs.
● Human beings are able to secretive or explicit about
Nursing diagnosis Planning: Identification
their needs, perception, thoughts and feelings.
● Mutually set goals. ● Interdependent goal
● The nurse — patient situation is dynamic, actions and
setting
reactions are influenced by both nurse and patient.
● Human beings attach meanings to situations and
Implementation: Exploitation:
actions that are not apparent to others. Patient's entry
● Plans initiated ● Patient actively
into nursing care is through medicine.
towards seeking and
● The patient cannot state the nature and meaning of
achievement of drawing help.
his distress for his need without the nurses help or
mutually set goals. Patient initiated.
without her first having established a helpful
● May be
relationship with him.
accomplished by
● Any observation shared and observed with the
patient, nurse or
patient is immediately useful in ascertaining and
family..
meeting his need or finding out that he is not in need
at that time.
Evaluation: Resolution:
● Nurses are concerned with needs that patients
● Based on mutually ● Occurs after other
cannot meet on their own.
expected phases are
Major Dimensions of Orlando’s theory
behaviors. May led completed
● Function of Professional Nursing – Organizing
to termination and successfully. Leads
Principle
initiation of new to termination.
● Finding out and meeting the patients’ immediate
plans
needs for help.
● "Nursing... is responsive to individuals who suffer or
anticipate a sense of helplessness, it is focused on
the process of care in an immediate experience, it is
concerned with providing direct assistance to
individuals in whatever setting they are found for the
 purpose of avoiding, relieving, diminishing or curing
the individuals sense of helplessness." -Orlando
● Presenting behavior – problematic situation
● To find out the immediate need for help the nurse
must fist recognize the situation as problematic.
● The presenting behavior of the patient, regardless of
the form in which it appears, may represent a plea for
help.
● The presenting behavior of the patient, the stimulus,
cause and automatic internal response in the nurse,
and the nurses behavior causes a response in the
patient.
● Presenting Behavior - Problematic Situation
Patient Behavior
➢ This sets the nursing process discipline in
motion.
➢ All patient behavior, no matter how
insignificant, must be considered an expression of
need for help until its meaning to a particular patient
in the immediate situation is understood.
Distress
➢ The patient’s behavior reflects distress when
the patient experiences a need that he cannot
resolve, a sense of helplessness occurs.
➢ Some categories of patient distress are:
○ “physical limitations,... adverse reactions to
the setting and ... experiences which prevent
the patient from communicating his needs”
Nurse Reaction
➢ The patient's behavior stimulated a nurse
reaction, which marked the beginning of the nursing
process discipline.
➢ This reaction is composed of three sequential
parts (Orlando, 1972).
❖ First, the nurse perceives the behavior
through any of her senses.
❖ Second, perception leads to automatic
thought.
❖ Finally, the thought produces an automatic
feeling.
Three criteria to ensure that the nurse’s exploration of her
reaction with the patient is unsuccessful:
1. What the nurse says to the individual in the
contact must match any or all of the items contained
in the immediate reaction, and what the nurse does
nonverbally must be verbally expressed and the
expression must match one or all of the items
contained in the immediate reaction.
2. The nurse must clearly communicate to the
individual that the item being expressed belongs to
herself.
3. The nurse must ask the individual about the
item expressed in order to obtain correction or
verification from that same individual.
Nurse’s Action
● Orlando (1990) includes “only what she [the nurse]
says or does with or for the benefit of the patient” as
professional nursing action. “The nurse initiates a
process of exploration to ascertain how the patient is
affected by what she says or does.”
● The nurse can act in two ways: automatic or
deliberative. Only the second manner fulfills her
professional function.
● Automatic actions are “those decided upon for
reasons other than the patient’s immediate need,”
whereas
● Deliberative actions ascertain and meet this need.
● Criteria for Deliberative Actions:
➢ Deliberative actions result from the correct
identification of patient needs by validation of the
nurse’s reaction to patient behavior.
➢ The nurse explores the meaning of the action
with the patient and its relevance to meeting his
needs.
➢ The nurse validates the action’s effectiveness
immediately after completing it.
➢ The nurse is free of stimuli unrelated to the
patient’s needs when she acts.
Immediate reaction – internal response
➢ A person perceives with any one of his five
sense organs an object or objects.
➢ The perceptions stimulate automatic thought.
➢ Each thought stimulates an automatic feeling.
➢ Then the person acts.
➢ The first three items taken together are
defined as the person's immediate reaction.
Nursing process discipline – 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.
➢ The nurse does not assume that any aspect
of her reaction to the patient is correct, helpful or
appropriate until she checks the validity of it in
exploration with the patient.
➢ The nurse initiates a process of exploration to
ascertain how the patient is affected by what she
says or does.
➢ When the nurse does not explore with the
patient her reaction it seems reasonably certain that
clear communication between them stops.
Improvement ‐ 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.
➢ Each contact the nurse repeats a process of
learning how to help the individual patient.
➢ Improvement – Resolution. The outcome is
evaluated not the nurse activity
IDA JEAN ORLANDO’S NURSING METAPARADIGM
Human Being
➢ Humans in need are the focus of nursing
practice.
Health
➢ Health is replaced by a sense of
helplessness as the initiator of a necessity for
nursing.
➢ She stated that nursing deals with individuals
who require help.
Environment
➢ not defined directly but implicitly in the
immediate context for a patient
Nursing
➢ as unique and independent in its concerns for
an individual’s need for help in an immediate
situation.
 ➢ The efforts to meet the individual’s need for
help are carried out in an interactive situation and in a
disciplined manner that requires proper training.
Steps in Nursing Process
Assessment
➢ the nurse completes a holistic assessment of
the patient’s needs.This is done without taking the
reason for the encounter into consideration. The
nurse uses a nursing framework to collect both
subjective and objective data about the patient.
Diagnosis
➢ the nurse’s clinical judgment about health
problems. The diagnosis can then be confirmed using
links to defining characteristics, related factors, and
risk factors found in the patient’s assessment.
Planning
➢ each of the problems identified in the
diagnosis is given a specific goal or outcome, and
each goal or outcome is given nursing interventions
to help achieve the goal. By the end of this stage, the
nurse will have a nursing care plan.
Implementation
➢ the nurse begins using the nursing care plan
{ Independent, Dependent, Collaborative}
Evaluation
➢ the nurse looks at the progress of the patient
toward the goals set in the nursing care plan.
➢ E.g Met or Not Met
VIRGINIA HENDERSON: (NURSING NEED THEORY
● The nightingale of Modern Nursing
● Modern- Day Mother of Nursing
● The 20th century Florence Nightingale
● Virginia Henderson Biography
○ Virginia Henderson was born on November
30, 1897 in Kansas City, Missouri, and was
the fifth of eight children in her family.
○ In 1921, Henderson graduated from the Army
School of Nursing at Walter Reed Hospital in
Washington, D.C in 1932, she earned her
Bachelor's Degree and in 1934 earned her
Master's Degree in Nursing Education, from
Teachers College at Columbia University.
○ Henderson died on March 19, 1996.
○ Introduced the "The Nature of Nursing Model
(definitions and components of nursing)"
● Identified 14 basic needs on which nursing care is
based.
● Unique function of the nurse is to assist the clients,
sick or well, in the performance of activities
contributing to health or to its recovery.
● Nursing involves assisting clients to gain
independence, & achieve peaceful death.
● Henderson defined nursing as "doing things for
patients that they would do for themselves if they
could, that is if they were physically able or had the
required knowledge.
● She believed that patient-focused nursing was the
most beneficial kind of nursing.
Assumptions of the Need Theory
➔ Nurses care for patients until they can care
for themselves once again. Although not precisely
explained,
➔ Patients desire to return to health.
➔ Nurses are willing to serve, and “nurses will
devote themselves to the patient day and night.”
➔ Henderson also believes that the “mind and
body are inseparable and are interrelated.”
VIRGINIA HENDERSON'S NURSING METAPARADIGM
Person
➢ Individuals requiring assistance to achieve
health and independence and peaceful death.
Health
➢ Equated with independence, in terms of the
client's ability to perform 14 components of nursing
care unaided.
Environment
➢ All external conditions and influences that
affect life and development.
Nursing
➢ Assist and support the individual in life
activities & attainment of independence.
➢ In the Nature of Nursing, nurse role is to get inside
the patient's skin and supplement his strength, will or
knowledge according to his needs."
➢ The nurse is and should be legally, an
independent practitioner and able to make
independent judgements.
Values and Beliefs
● She believed nursing as primarily complementing the
patient by supplying what he needs.
● Strongly believes in getting inside the skin of her
patients.
● "I believed that the function the nurse performs is
primarily an independent one – that of acting for the
patient when he lacks knowledge, physical strength,
or the will to act for himself (Henderson, 1966).
ROSEMARIE RIZZO PARSE: (Human Becoming Theory)
Background:
● Graduated from Duquesne University in Pittsburgh,
where she later served as the dean of nursing.
● Master’s and Doctorate from the University of
Pittsburgh.
● Professor and Coordinator of the Center for Nursing
Research at Hunter College of the City of New York
(1983-1993)
● Professor and Niehoff Chair at Loyola University
Chicago (1993-2006).
Origin of the Human becoming Theory
● Originally Published in 1981 and was entitled
● “Man-living- health”
● Renamed in 1992 to remove the word “man” which
was formerly in the dictionary as human kind.
● Developed as a human science nursing theory in the
tradition of Dilthey, Heidegger, Sartre, Merleau-Ponty
and Gadamer.
● Assumptions were synthesized from works of
European philosophers: Heidegger, Sartre,
Merleau-Ponty
● Along with the works of American nurse theorist
Martha Rogers.
● Called a “School of Thought” because it
encompasses: otology, epistemology and
methodology
Assumptions
● The human is:
○ Coexisting while co-constituting rhythmical
patterns.
○ Open, freely choosing meaning with situation,
bearing responsibility for decisions.
● Becoming is:
○ Human-living-health
○ Rhythmically co-constituting human universe
○ Human’s value priority patterns
○ Transcending with possibles
○ Human’s emerging
Basic Concepts of the Human Becoming Theory
● “Nurses live the art of human becoming in true
presence with the unfolding of illuminating meaning,
synchronizing rhythms, and mobilizing
transcendence.” (Cody and Bournes, 2010)
Meaning
➢ “Structuring meaning is the imaging and
valuing of languaging” (Cody and Bournes, 2010)
➢ People co-participate in creating what is real
for them through self-expression in living their values
in a chosen way.
Rhythmicity
➢ Configuring rhythmical patterns of relating is
the revealing-concealing and enabling-limiting of
connecting-separating.
➢ Living moment to moment one shows and
does not show self as opportunities and limitations
emerge in moving with and apart from others.
TRANSCENDENCE
➢ “Co-transcending with possibles is the
powering and originating of transforming”
● ○ extensive and diverse nursing experiences
● ➢ Moving beyond the “now” moment is forging
a unique personal path for oneself in the midst of
ambiguity and continuous change.
Principles
➢ Structuring meaning is the imaging and
valuing of languaging.
➢ Configuring rhythmical patterns is the
revealing-concealing and enabling-limiting of
connecting-separating.
➢ Contransceding with possibles is the
powering and originating of transforming.
ROSEMARIE RIZZO PARSE’S NURSING METAPARADIGM
Person
➢ Open being who is more than and different
from the sum of the parts
Environment
➢ Everything in the person and his experiences
➢ Inseparable, complimentary to and evolving
with
Health
➢ Open process of being and becoming,
involves synthesis of values.
➢ Health is not static but, rather, is
ever-changing as humans choose ways of living.
Nursing
➢ A human science and art that uses an
abstract boy of knowledge to serve people.
Theory Overview:
Parse Scholars Beliefs
➢ Quality of Life from patient’s perspective
➢ Diagnostic practice fails to respect
humankind
➢ Standardized nursing interventions disregard
human dignity
➢ Understanding human experience= individual
freedom
➢ Humans are change with the process of living
➢ Inherent freedom is to be honored by nurses
Theory Overview:
● Real World Example
○ Chronic Pain
○ Nurses should ask patient to describe pain in
detail
○ Physiological, psychological, situational
factors
○ Nurses should be aware of patient’s life
situation
○ By listening to patients, pain can be improved
○ Treatment plan can be developed
○ Patients feel closer to nurses who listen.
MADELEINE LEININGER: (TRANSCULTURAL NURSING
THEORY)
What is Transcultural Nursing?
● ”A discipline of study and practice focused on
comparative culture care differences and similarities
among and between cultures in order to assist
human beings to attain and maintain meaningful and
therapeutic health care practices that are culturally
based" (Leininger, 2008, p.9).
Philosophical Roots of Leininger's Theory
➢ Leininger states that the philosophical roots
of her theory are:
○ anthropological insights
○ life experiences and values
○ reflection upon spiritual insights and beliefs
➢ The theorist created a theory to develop "new
practices for nursing to meet diverse cultural needs
and to provide therapeutic care with comprehensive
and holistic care practices in a caring discipline"
Leininger, 2008, p.10)
Transcultural Nursing Theory Concepts
➢ Transcultural nursing theory incorporates
research from numerous scientific disciplines:
1. Nursing
2. Medicine
3. Education
4. Psychology
5. Public Health
6. Epidemiology
INTERRELATIONSHIP
● Culturally Competent Nursing Care
○ promote human rights and quality health care
through cultural awareness
○ centered on universal aspect of human
caring as defined within each culture
○ assess cultural needs and integrate nursing
care that is congruent with cultural values
Transcultural Nursing Research
● address cultural conflicts within healthcare beliefs
● nursing care that is beneficial and meaningful to all
cultures
● increase knowledge base to improve cultural
competence
● impact global healthcare policy and practices.
Culturally Congruent Nursing Care
● Culturally congruent nursing care occurs when
nurses integrate information from individuals, family,
community, or institution based on cultural:
○ Beliefs
○ Values
○ Norms
○ patterns/lifeways
○ practices
● to provide appropriate and meaningful nursing care.
Metaparadigm Concepts: CARING
● essence of nursing
● universal concept within all cultures
● assisting, supporting, or enabling behaviors to
improve a person's condition
● essential for survival, development, ability to deal
with life's events
● a greater level of wellness is achieved when caring is
in line with the patient's cultural values and beliefs.
MADELEINE LEININGER’S NURSING METAPARADIGM
Person
➢Some cultures do not recognize the concept of
"person".
➢ Leininger's definition includes:
○ individuals
○ families
○ groups
○ communities
➢Human being - Nurses need humanistic and
scientific transcultural knowledge in order to
adequately care for patients in the 21st century.
Environment
➢The environmental context includes any events:
○ physical
○ ecological
○ sociopolitical
○ cultural
➢Care values are influenced by many things
including worldview, spirituality, and environment.
Health
➢Care specific to one's culture promotes health, as
valued and defined by each culture.
Nursing
➢Since 1989 nurses have been able to receive
global certification in transcultural nursing.
➢Occurs when nurses integrate information from
individuals, family, community, or institution based on
cultural beliefs, values, norms, patterns/lifeways and
practices.
Clarification of Origin
● Originally developed in 1950s
● Leininger's 1st book, Cultural Care Diversity and
Universality - Published 1991
● Transcultural Nursing (2nd ed.) - Published 1995
● Transcultural Nursing (3rd ed.) - Published 2002
VIEW
● The transcultural nursing model can be used in all
aspects of nursing care, but proper use of the model
can only be achieved if the patient's values are
known and meaningfully used in an appropriate way
by the nurse with the patient.
JOYCE TRAVELBEE: (HUMAN-TO-HUMAN
RELATIONSHIP MODEL)
● Both the nurse and the patient are human beings.
● A human being is a unique, irreplaceable individual
who is in a continuous process of becoming, evolving
and changing.
Health
● Health is subjective and objective.
● Subjective health—is an individually defined state of
well being in accord with self-appraisal of
physical-emotional-spiritual status.
● Objective health—is an absence of discernible
disease, disability or defect as measured by physical
examination, laboratory tests and assessment by
spiritual director or psychological counselor.
Environment
● Environment is not clearly defined. She defined
human conditions and life experiences encountered
by all men as sufferings, hope, pain and illness.
● Illness – being unhealthy, but rather explored the
human experience of illness
● Suffering – is a feeling of displeasure which ranges
from simple transitory mental, physical or spiritual
discomfort to extreme anguish and to those phases
beyond anguish—the malignant phase of dispairful
“not caring” and apathetic indifference.
Nursing
● An interpersonal process whereby the professional
nurse practitioner assists an individual, family or
community to prevent or cope with experience or
illness and suffering, and if necessary, find meaning
in these experiences.
JOYCE TRAVELBEE’S NURSING METAPARADIGM
Person
● Person is defined as a human being.
Pain – is not observable. A unique experience. Pain is a
lonely experience that is difficult to communicate fully to
another individual.
Hope – the desire to gain an end or accomplish a goal
combined with some degree of expectation that what is
desired or sought is attainable
Hopelessness – being devoid of hope
● human-to-human relationships begin with the original
encounter and then progress through stages of
emerging identities, developing feelings of empathy,
and later feelings of sympathy.
● It has five phases which include: the inaugural
meeting or original encounter; visibility of personal
identities/ emerging identities; empathy; sympathy;
and establishing mutual understanding and contact/
rapport
Interactional Phases of Human-to-Human Relationship
Model:
1. Original Encounter
○ First impression by the nurse of the sick
person and vice-versa.
 ○ Stereotyped or traditional roles
2. Emerging Identities
○ the time when relationship begins
○ the nurse and patient perceives each others
uniqueness
3. Empathy
○ the ability to share in the person’s experience
4. Sympathy
○ when the nurse wants to lessen the cause of
patient’s suffering.
○ it goes beyond empathy—“When one
sympathizes, one is involved but not
incapacitated by the involvement.”
○ therapeutic use of self
5. Rapport
○ Rapport is described as nursing interventions
that lessens the patient’s suffering.
○ Relation as human being to human being
○ “A nurse is able to establish rapport because
she possesses the necessary knowledge and
skills required to assist ill persons and
because she is able to perceive, respond to
and appreciate the uniqueness of the ill
human being.”
FAYE GLENN ABDELLAH : (PATIENT-CENTERED
APPROACHES IN NURSING MODEL)
● Introduced “Patient-Centered Approaches in Nursing
Model
● Identified 21 nursing problems which determines
nursing care
● Nursing as service to individuals and families,
therefore to society
● Conceptualized nursing as an art and science
● Nursing is based on an art and science that molds
the attitudes, intellectual competencies, and technical
skills of the individual nurse into the desire and ability
to help people sick or well cope with their health
needs.
● Nursing is the use of problem-solving approach with
key nursing problems related to the health needs of
people.
● Abdellah and colleagues developed a list of 21
nursing problems,
● They identified 10 steps to identify the client’s
problems and 11 nursing skills to be used in
developing a treatment typology.
● 11 nursing skills
1. Observation of health status
2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of works
6. Use of resource materials
7. use of personnel services
8. Problem solving
9. Direction of work of others
10. therapeutic use of the self
● 11. Nursing procedures
● Three major categories
1. Physical sociological and emotional needs of
the client
2. Types of interpersonal relationships between
the nurse and the patient
3. Common elements of client care.
Classification of the 21 Nursing Problems
Basic to all patients
● To maintain good hygiene and physical comfort
● To promote optimal activity ; rest, exercise, sleep
●
● To promote safety
● To maintain good body mechanics
Sustenal Care needs
● To facilitate the maintenance of a supply of oxygen
● To facilitate the maintenance of nutrition
● To facilitate the maintenance of elimination
● To facilitate maintenance of fluid and electrolyte
balance
● To recognize the physiological responses of the body
to disease
● To facilitate the maintenance of regulatory
mechanisms & functions
● To facilitate maintenance of sensory function
Remedial care needs
● To identify and accept positive and negative
expressions, feelings, and reactions
● To identify and accept interrelatedness of emotions
and organic illness
● To facilitate the maintenance of effective verbal &
nonverbal communication
● To promote the development of productive
interpersonal relationships
● To facilitate progress toward achievement of personal
spiritual goals
● To create or maintain a therapeutic environment
● To facilitate awareness of self as an individual with
varying physical, emotional, & developmental needs
Restorative care needs
● To accept the optimum possible goals in the light of
limitations, physical, & emotional
● To use community resources as an aid in resolving
problems that arise from illness
● To understand the role of social problems as
influencing factors in the case of illness.
● To accept the optimum possible goals in the light of
limitations, physical, and emotional.
● To use community resources as an aid in resolving
problems arising from illness.
● To understand the role of social problems as
influencing factors in the cause of illness.
MYRA ESTRIN LEVINE: (CONSERVATION MODEL)
Background:
● After earning an MS in nursing at Wayne State
University in 1962
● She authored 77 published articles which included
“An Introduction to Clinical Nursing “ with multiple
publication years in 1969, 1973, & 1989.
● She also received an honorary doctorate from Loyola
University in 1992.
● She died in 1996.
Adaptation
● Adaptation is the process of change, and
conservation is the outcome of adaptation.
Adaptation is the process whereby the patient
maintains integrity within the realities of the
environment.
Historicity
 ● Adaptation is a historical process, response are
based on past experiences, both personal and
genetic.
Specificity
● Adaptation is also specific. Each system has very
specific responses. The physiologic responses that
"defend oxygen supply to the brain are distinct from
those that maintain the appropriate blood glucose
levels".
Redundancy
● Although the changes that occur are sequential, they
should not be viewed as linear. Rather, Levine
describes them as occurring in "cascades" in which
there is an interacting and evolving effect in which
one sequence is not yet completed when the next
begins.
Wholeness
● Levine stated that "the unceasing interaction of the
individual organism with its environment does
represent an 'open and fluid' system, and a condition
of health, wholeness, exists when the interaction or
constant adaptations to the environment permit ease
—the assurance of integrity...in all the dimensions of
life.
Conservation
● The product of adaptation. Conservation is from the
Latin word "conservatio", meaning "to keep together
". Conservation describes the way complex systems
are able to continue to function even when severely
challenged.
● "Through conservation m, individuals are able to
confront obstacles, adapt accordingly, and maintain
their uniqueness. "The goal of conservation is health
and the strength to confront disability" as "the rules of
conservation and integrity hold" in all situations in
which nursing is required.
MYRA ESTRIN LEVINE’S NURSING METAPARADIGM
Person
➢ The person is a holistic being who constantly strives
to preserve wholeness and integrity and one "who is sentient,
thinking, future-oriented, and past aware." The wholeness
(integrity) of the individual demands thatbthe "individual life
has meaning only in the context of social life" The person is
also described as a unique individual in unity and integrity,
feeling, believing, thinking, and whole system of system.
Environment
➢ The environment completes the wholeness of the
individual. The individual has both an internal and external
environment.
● External Environment
○ Homeostasis
■ Stable state normal alterations in
physiologic parameters respond to
environment changes; an energy
sparing state, a state of
conservation.
○ Homeorhesis
■ Homeorhesis is the orchestrated or
coordinated control in metabolism of
body tissues necessary to support a
physiological state.
Health
➢ Levine (1991) clarified what she means by health as:
"the avenue of return to daily activities compromised by ill
health. It is not only the insult or the injury that is repaired but
the person himself or herself... It js not merely the healing of
an afflicted part. It is rather a return to self-hood, where the
encroachment of the disability can be set aside entirely, and
the individual is free to pursue once more his or her own
interests without constraint."
➢ Disease is "unregulated and undisciplined change
and must be stopped or death will ensure".
Nursing
➢ Nursing involves engaging in "human interactions"
"The nurse enters into a partnership of human experience
where sharing moments in time — some trivial, some
dramatic — leaves its mark forever on each patient". The goal
of nursing is to promote adaptation and maintain wholeness
(health).
Person and Environment
➢ Person and the environment become congruent over
time. It is the fit of the person with his or her predicament of
time and space. The specific adaptive responses make
conservation possible occur on many levels; molecular,
physiologic, emotional, and social.
Conservation of Energy
➢ Refers to balancing energy input and output to avoid
excessive fatigue. It includes adequate rest, nutrition and
exercise.
➢ Examples: Availability of adequate rest; Maintenance
of adequate nutrition.
Conservation of Structural Integrity
➢ Refers to maintaining or restoring the structure of the
body , preventing physical breakdown and promoting healing.
➢ Examples: Assist patient in ROM exercise;
Maintenance of patient's personal hygiene.
Conservation of Personal Integrity
➢ Recognizes the individual as one who strives for
recognition, respect, self awareness, selfhood and self
determination.
➢ Example: Recognize and protect patient's space
needs.
Conservation of Social Integrity
➢ An individual is recognized as someone who resides
within a family; a community, a religious group, an ethnic
group, a political system and a nation.
➢ Example: Help the individual to preserve his or her
place in a family, community, and society.
Assumptions About Individuals
➢ Each individual is an active participant in interactions
with the environment... constantly seeking information from
it". (Levine, 1969)
➢ The individual "is a sentient being, and the ability to
interact with the environment seems ineluctably tied to his
sensory organs".
➢ "Change is the essence of life, and it is unceasing as
long as life goes on.
➢ Change is the character of life". (Levine 1973)
Assumptions About Nursing
➢ "Ultimately, the decisions for nursing intervention
must be based on the unique behavior of the individual
patient".
➢ "Patient-centered nursing care means individualized
nursing care. It is predicated on the reality of common
experience: every man is a unique individual, and as such he
requires a unique constellation of skills, techniques, and
ideas designed specifically for him". (Levine, 1973)
LYDIA HALL: (CORE, CARE AND CURE THEORY)
Background:
● Was born in New York City on 21st sept 1906.
● Basic nursing education in 1927
● Bachelor in public health nursing in 1937
● Master's in teaching natural sciences in 1942
● First director of the Leob center for nursing.
● Nursing experience in clinical, education, research
and supervisor roles.
Lydia Hall’s Nursing Theory
● As Hall (1965) says; “To look at and listen to self is
often too difficult without the help of a significant
figure (nurturer) who has learned how to hold up a
mirror and sounding board to invite the behavior to
look and listen to himself.
● If he accepts the invitation, he will explore the
concerns in his acts and as he listens to his
exploration through the
● reflection of the nurse, he may uncover in sequence
his difficulties, the problem area, his problem, and
eventually the threat which is dictating his
out-of-control behavior.”
Care (The Body)
● Represents nurturance & exclusive to nursing
Core (The Person)
● Involves therapeutic use self & the use of reflection
Cure (The Disease)
● Nurses related to physician’s order
The Care
● Nurturing component of care and is exclusive to
nursing.
● Motherly care and comfort of patient.
● Provides teaching and learning activities.
● Nurses goal is to give care and comfort to the patient.
● Nurses provides bodily care for the patient.
● Patient may explore and share feelings with the
nurse.
● When functioning in the care circle, the nurses apply
knowledge of the natural and biological sciences.
● The patient views the nurse as a potential comforter,
one who provides care and comfort through the lying
of hands.
The Core
● Patient care is based on social sciences.
● Involves therapeutic use of self and is shared with
other team members.
● By developing interpersonal relationship with the
patient, the nurse is able to help the patient verbally
express feelings regarding the disease process and
its effects.
● Patient is ale to gain self identity and further develop
maturity.
● Patient is able to make conscious decisions.
The Cure
● Cure based on pathological and therapeutic
sciences.
● Application of medical knowledge by nurses.
● Nurse assisting the doctors in performing different
procedures.
● Nurse is patient advocate in this circle.
● The cure aspect is different from the care circle
because many of nurse's actions changes from a
negative quality of avoidance of pain rather than a
positive quality of comfort.
● Nurses' role changes from positive quality to negative
quality.
LYDIA HALL'S NURSING METAPARADIGM
Individual
● Persons who are more than 16 years old and in the
long-term illness are the focus of Hall's work.
● Hall emphasizes the importance of an individual as
unique, capable of growth, learning and requiring a
total person approach.
Health
● Inferred to be a state of self-awareness with
conscious selection of behaviors.
● Hall stresses the need to help the person explore the
meaning of his or her behavior to identify and
overcome problems through developing self-identity
and maturity.
Environment
● The concept of society/environment is dealt with in
relation to the individual.
● Hall is credited with developing the concept of Loeb
Center because she assumed that the hospital
environment during treatment of acute illness creates
a difficult psychological experience for the ill
individual.
● In such a setting, the focus of the action of the nurses
is the individual, so that any actions taken in relation
to society or environment are for the purpose of
assisting the individual in attaining a personal goal
Nursing
● Identifies and consists of participation in the care,
core and cure aspects of patient care.
● Care is the sole function of nurses
● Major purpose of care is to achieve an interpersonal
relationship with the individual.
Assumptions
● The motivation and energy necessary for healing
exist within the patient, rather than in the health care
team.
● The three aspects of nursing should not be viewed as
functioning independently but as interrelated.
● The three aspects interact, and the circles
representing them change size, depending on the
patient's total course of progress.
● "Health is the expansion of consciousness".
-Newman, 1983
MARGARET NEWMAN: (HEALTH AS EXPANDING
CONSCIOUSNESS)
Background:
● Born on October 10, 1933
● Bachelor's degree - University of Tennessee in 1962
● Master's degree - University of California in 1964
● Doctorate - New York University in 1971 She has
worked in University of Tennessee, New York
University, Pennsylvania State University, University
of Minnesota
● Theoretical Sources
Martha Rogers - Theory Unitary Human Beings
 ● The main basis of the development of Newman's
theory.
● The health of a human being is a unitary
phenomenon, an evolving pattern of human -
environment (Rogers, 1970).
● Itzgak Bentov - The concept of evolution of
consciousness "Life is a process of expanding
consciousness. Consciousness is the informational
capacity of the system and can be seen in the quality
of interaction of the system with the environment"
(Bentov, 1978)
Arthur Young - The theory of Process
● A person moves through stages of consciousness
involving the loss of freedom in the development of
self-identity until a turning point is reached when the
'old rules' don't work anymore. The life task is to
discover the 'new rules' and move toward increasing
freedom and higher consciousness (Young, 1976).
David Bohm - The Theory of Implicate
● The explicate order is a manifestation of the implicate
order. (Bohm, 1980)
Prigogine - Theory of Dissipative Structure
● A system fluctuates in an orderly manner until the
occurence of a disruptive event, at which time the
system moves in seemingly random, disorderly ways
until it chooses a new direction at a higher level of
organization (Prigogine, 1976).
● The theory of health as expanding consciousness
was stimulated by concern for those whom health as
the absence of disease or disability is not possible.
Nurses often relate to such people: people facing the
uncertainty, debilitation, loss and eventual death
associated with chronic illness. (Newman, 2010)
● Use of Empirical Evidence
● Evidence for the theory of health emanated from
Newman's early personal family experiences. Her
mother's struggle with chronic illness and her
dependency on Newman sparked an interest in
nursing. From that experience evolved the idea that
"illness reflected the life patterns of the person and
that what was needed was the recognition of that
pattern and acceptance of it for what it meant to that
person." Research has been conducted on the
theoretical sources used.
Major concepts and definition
Health
● Rogers' insistence that health and illness are simply
manifestations of the rhythmic fluctuations of the life
process is the foundation for viewing health and
illness as a unitary process moving through variations
in order-disorder. From this standpoint, one can no
longer think of health and illness in the dichotomous
way characterized by medical science; that is, health
as absence of disease or health as a continuum from
wellness to illness. Health and the evolving pattern of
consciousness are the same.
Pattern
● A person is identified by her or his pattern, which
reflects the pattern of the person within the larger
pattern of the environment. The pattern is evolving
through various permutations of order and disorder,
including what in everyday language is called health
and disease. Pattern recognition emerges from a
process of uncovering meaning in a person's life.
Meaning is inherent in pattern , and vice versa
Consciousness
● Defined as the informational capacity of the system
(in this case, the human being); that is, the ability of
the system to interact with the environment (Bentov,
1978). Consciousness includes not only the cognitive
and affective awareness normally associated with
consciousness, but also the interconnectedness of
the entire living system, which includes
physicochemical maintenance and growth processes
as well as the immune system. This pattern of
information, which is the consciousness of the
system, is a part of a larger, undivided pattern of an
expanding universe.
Three Correlates of Consciousness
● Movement
● Time
● Space
● The relevance of movement, time and space was
part of the original explication and has re-emerged in
the evolving patterning of unfolding consciousness.
● To see health as the pattern of the whole, one needs
to see disease not as a separate entity but as a
manifestation of the evolving pattern of person -
environment interaction. The paradigm shift is:
● From treatment of symptoms to a search for pattern.
● From viewing disease and disruption as negative to
viewing them as part of the self-organizing process of
expanding consciousness.
● From viewing the nursing role as addressing the
problems of disease to assisting people to get in
touch with their own pattern of expanding
consciousness.
Major Assumptions
1. Health encompasses conditions heretofore described
as illness or, in medical terms, pathology.
2. These pathological conditions can be considered a
manifestation of the total pattern of the individual.
3. The pattern of the individual that eventually manifests
itself as pathology is primary and exists prior to
structural or functional changes.
4. Removal of the pathology in itself will not change the
pattern of the individual.
5. If becoming ill is the only way an individual's pattern
can manifest itself, then that is health for that person.
6. Health is an expansion of consciousness.
MARGARET NEWMAN'S NURSING METAPARADIGM
Person/Human
● "The human is unitary, that cannot be divided into
parts, and is inseparable from the larger unitary field."
● "Persons as individuals, and human beings as a
species are identified by their patterns of
consciousness "
● "The person does not possess consciousness- the
person is consciousness "
● Persons are "centers of consciousness" within an
overall pattern of expanding consciousness.
Health
● "Health and illness are synthesized as health - the
fusion of one state of being (disease) with its
opposite (non-disease) results in what can be
regarded as health".
Environment
 ● Environment is described as a "universe of open ● Cooperative inquiry or interactive, integrative
systems" participation
Nursing ● Newman stated that research should center around
● Nursing is "caring in the human health experience". "participatory investigations in which subjects (clients)
● Nursing is seen as a partnership between the nurse are our partners, our core-searchers, in our search
and client, with both grow in the "sense of higher for health patterns."
levels of consciousness"
● "The theory has progressed to include the health of
all persons regardless of the presence or absence of
disease. The theory asserts that every person in
every situation, no matter how disordered and
hopeless it may seem, is part of the universal
process of expanding consciousness
● a process of becoming more of oneself, of finding
greater meaning in life, and of reaching new
dimensions of connectedness with other people and
the world" (Newman, 2010).

● Humans are open to the whole energy system of the

universe and constantly interacting with the energy.
With this process of interaction humans are evolving
their individual pattern as a whole.
● According to Newman, understanding the pattern is
essential. The expanding consciousness is the
pattern recognition.
● The manifestation of disease depends on the pattern
of individual so the pathology of the diseases exists
before the symptoms appear so removal of disease
symptoms does not change the individual structure.
● According to her, nursing is the process of
recognizing the individual in relation to environment
and it is the process of understanding of
consciousness.
● The nurse helps to understand people to use the
power within to develop the higher level of
consciousness.
● Thus, it helps to realize the disease process, its
recovery and prevention.
● Newman also explains the interrelatedness of time,
space and movement.
● Time and space are the temporal pattern of
individual, both have complementary relationship.
● Humans are constantly changing through time and
space and it shows a unique pattern of reality.

Practice
● Newman's model of Health is useful in the practice of
nursing because it contained concepts used by the
nursing profession. Movement and time are an
intrinsic part of nursing intervention, that is,
range-of-motion, ambulation, turning, coughing, and
deep-breathing. These parameters are used each
day by the nurse in practice.
Education
● Newman did not advocate one model as the sole
basis for curriculum. Rather, students should have
the opportunity to study various approaches to health
and nursing and to choose what is relevant to them in
their practice and research.
Research
● Some researchers have attempted to test Newman's
prepositions of time, space, and movement.
● A negative correlation was found between depression
and subjective time — findings do not support an
increasing level of consciousness with age.