4 METAPARADIGMS:

GROUP 03 OUTLINE:
1. PERSON
HUMAN-TO-HUMAN RELATIONSHIP MODEL: – layered multidimensional being. Each layer consists of fiver person variables or
JOYCE TRAVELBEE subsystem.
born on 1926 - Each layer consists FIVE PERSON'S VARIABLES or subsystems;
psychiatric nurse, educator, and writer. 1. Physical/physiological
Bachelor of Science in Nursing degree at Louisiana State University. 2. Psychological
master of science degree in Nursing at Yale University in 1959. 3. Socio-cultural
1952 - instructor focusing in Psychiatric Nursing at DePaul Hospital Affiliate School, 4. Developmental
New Orleans, while working on her baccalaureate degree 5. Spiritual
1st and 2nd book: Interpersonal Aspect of Nursing – 1966 and 1971 - Neuman sees a person as an open system that works together with other parts of
2nd book: Intervention in Psychiatric Nursing: Process in the one–to–one its body as it interacts w/ the environment
relationship. - an open system that interacts w/ both internal and external environmental forces
and stressors. An open system is characterized by the presence of an exchange of
• 4 METAPARADIGMS: information and reaction w/ other factors surrounding a person.

1. PERSON – 2. Health
2. HEALTH- - a condition in which all parts and subparts (variables) are in harmony w/ the
3. ENVIRONMENT- whole of the client
4. NURSING - - Consider as dynamic in nature in which the person’s health is at the level of
health continuum, wellness, or illness.
• Nurse and patient undergo a SERIES OF INTERACTION PHASES: - Equated w/ wellness

1. Original encounter 3. Environment:

- first impression by the nurse of the sick persona /
- the nurse and patient see each other in stereotyped or traditional roles.
2. Emerging Identities:
- the N and P, perceive each other as a unique individual
- link of relationship begins to form.
3. Empathy
- Ability to share in the person’s experience
- the ability to expect behavior with whom he or she emphasizes.
4. Sympathy
- happens when the nurse wants to lessen the cause of one
- use of a discipline intellectual approach together with the therapeutic
use of self.
5. Rapport
- nursing interventions that lessen the patients suffering
- relating of human-to-human being, nurse and the patient
- sick person shows trust and confidence.
SYSTEM MODEL IN NURSING:
BETTY NEUMAN
Born 1924
Education, 1947, became RN from DIPLOMA in OH
1957- BSN, UCLA mental health and public health
1966- MSN, UCLA
1967-1973 , UCLA Faculty
1985- Ph. D Western Pacific University-clinical Psychology
1970- develop as a teaching tool to integrate four variables of man.
1974- published and classified as a systems model called “The Betty Neuman
Healthcare Systems Model: A total approach to patient problems.”
1982- published first book detailing NSM. Notable change: “patient” now referred
to us “client”. The Neuman systems model 2nd edition, 1989. Spiritual variable
added to diagram as fifth variable.
- 3rd, 4th, 5th editions of The Neuman Systems Model published in 1995, 2002 and
2010.
- The totality of internal and external forces w/c surround a person and w/ w/c
they interact at any given time. These forces include:
- Intrapersonal
- Interpersonal
- Extra personal stressors
Which can affect the person’s normal line of defense and so can affect the
stability of the system.
INTERNAL ENVIRONMENT
- Exist within the system, all forces and interactive influences that are solely
within the boundaries of the client system.
EXTERNAL ENVIRONMENT
- exist outside the client system
CREATED ENVIRONMENT
- develop unconsciously by the client and is symbolic of system wholeness, it
represents open system exchange of energy with both the internal and
external environments.
4. Nursing
- A unique profession that is concerned with all of the variables which
influence the response a person might have to a stressor.
- Neuman believes that nursing requires a holistic approach that considers all
factors affecting a client's health physical, physiological, psychological,
mental, social, cultural, developmental, and spiritual well-being.
NEUMAN SYSTEM MODEL IN NURSING:
- The goal of the model was to provide a holistic overview of the
physiological, psychological, sociocultural, and developmental aspects
of human beings.
- Neuman’s Systems Model’s two major components are stress and the
reaction to stress. The client in Neuman Systems Model is viewed as an
open system in which repeated cycles of input, process, output, and
feedback constitute a dynamic organizational pattern.
- Using the systems perspective, the client may be an individual, a group,
a family, a community, or any aggregate. As they become more
complex, internal conditions of regulations become more complex.
Exchanges with the environment are reciprocal; both the client and the
environment may be affected either positively or negatively by the
other. The system may adjust to the environment or adjust the
environment to itself.
MAJOR CONCEPTS:
1. Intrapersonal - occur within the person e.g emotions and feelings
1. Person Variables 2. Interpersonal - occur within individuals e.g role expectations
- Each layer or concentric circle of the Neuman Model is made up of the five-person 3. Extra personal- occurs outside the individual e.g job or finance pressure.
variables. Ideally, each of the person’s variables should be considered
simultaneously and comprehensively. 8. Prevention
FIVE-PERSON VARIABLES: - Primary nursing intervention.
A. Physiological - Prevention focuses on keeping stressors and the stress response from having a
- refers to the physicochemical structure and function of the body. detrimental effect on the body.
B. Psychological 1. Primary- occurs before the system reacts to the stressor
- refers to mental processes and emotions. 2. Secondary - occurs after the system reacts to a stressor and is provided in
C. Socio-cultural terms of existing systems.
- refers to the relationship and socio/cultural expectations and activities. 3. Tertiary - occurs after the system has been treated through secondary
D. Spiritual prevention strategies.
- refers to the influence of spiritual beliefs.
E. Developmental
- processes related to development over the lifespan. BEHAVIORAL SYSTEM MODEL:
DOROTHY JOHNSON
2. Central Core • Born on August 21, 1919, at Savannah, Georgia and died on February 1999 at
- The basic structure, or central Core, is made up of the basic survival factors that the age of 80
are common to the species • 1942 - B.S.N. From Vanderbilt University, Nashville, Tennessee.
- These factors include: • 1948 - M.P.H. From Harvard University, Boston, Mass. Massachusetts
system variables,
• Assistant professor of pediatrics at Vanderbilt University
genetic features, and
• Assistant professor of pediatrics nursing, an associate Professor of Nursing,
the strength and weaknesses of the system parts.
and a professor of Nursing at the University of California
e g: hair color, body temperature, regulation ability, functioning of the body
• Pediatric Nursing advisor for Christian Medical School of Nursing in Vellore,
systems homeostatically, cognitive ability, physical strength, and value
South India
system.
• The BSM of Nsg was first proposed in 1968
• Influenced heavily by Florence Nightingale’s book, Notes on Nursing.
A HOMEOSTATIC of body system is constantly in a dynamic process of input,
• Used the work of a behavioral scientist, psychology, sociology, and ethnology
output, feedback, and compensation, which leads to a state of balance
to form her seven subsystems.
• The nurse’s role is to help the patient maintain his/her equilibrium.
3. Flexible lines of defense
-is the outer barrier or cushion to the normal line of defense, the line of resistance,
METAPARADIGM OF NURSING:
and the core structure.
- if the flexible line of defense fails to provide adequate protection to the normal
1. PERSON
line of defense, the lines of resistance become activated.
- Johnson views human beings as having two majors systems:
- the flexible line of defense act as a cushion and is described as accordion-like as it
THE BIOLOGICAL SYSTEM and
expands away from or contracts closer to the normal line of defense.
THE BEHAVIORAL SYSTEM.
- It is the role of:
4. Normal line of defense
MEDICINE to focuses on the BIOLOGICAL SYSTEM, whereas
-represents system stability over time.
NURSING’S focus is on the BEHAVIORAL SYSTEM.
- it is considered to be the usual level of stability in the system
-the normal line of defense can change over time in response to coping or
2. HEALTH
responding to the environment.
- It is an elusive state that is determined by psychological, social, biological, and
An example is a skin that is stable and fairly constant but can thicken into a callus
physiological factors.
over time.
- Johnson’s BEHAVIORAL model supported the idea that the individual is attempting
to maintain some balance or equilibrium.
5. Lines of Resistance
- The individual’s goal is to maintain the entire BEHAVIORAL system efficiently and
-The lines of resistance protect the basic structure and become activated when
effectively but with enough flexibility to return to an acceptable balance if a
environmental stressors invade the normal line of defense.
malfunction disrupts the original balance.
Example: activation of the immune response after the invasion of
3. ENVIRONMENT
microorganisms. If the lines of resistance are effective, the system can
- refers to the environment in which an individual exists.
reconstitute, and if the lines of resistance are not effective, the resulting
- according to Johnson, an individual’s behavior is influenced by all events in the
energy loss can result in death.
environment.
- Cultural influences on the individual’s behavior are viewed as profound; however, it
6. Reconstitution
is felt that there are many paths, varying from culture to culture, that influence
-is the increase in energy that occurs in relation to the degree of reaction to the
specific behaviors in a group of people, although the outcome for all the groups or
stressor.
individuals is the same.
-Reconstitution begins at any point following initiation of treatment for invasion of
stressors.
4. NURSING
- Nursing is “an external regulatory force which acts to preserve under the organization
7. Stressors
and integration of the patient’s behavior at an optimal level under those conditions in
-The Neuman Systems Model looks at the impact of stressors in health and
which the behavior constituents a threat to physical or social health or in which illness
addresses stress and the reduction of stress (in the form of stressors) .
was found”.
- Stressors are capable of having either a positive or negative effect on the client
- viewed as part of the external environment that can assist the client in returning to
system.
a state of equilibrium or balance.
 - the major focus is obtaining a balance in the behavioral system when illness occurs
in the individual.
- Johnson believes that nurses need to be well grounded in the physical and social
sciences; the particular emphasis should be placed on knowledge from both the
physical and social sciences that are found to influence behavior.
- Nursing’s primary goal is to foster equilibrium within the individual.
JOHNSON’S BEHAVIORAL SYSTEM MODEL
- Johnson believes that each individual has patterned, purposeful, repetitive ways
of acting that comprise a behavioral system specific to that individual.
- These actions or behaviors form an “organized and integrated functional unit that
determines and limits the interaction between the person and his environment and
establishes the relationship of the person to the objects, events, and situations in
his environment.”
- Johnson identified SEVEN SUBSYSTEMS within the Behavioral System Model:
• ATTACHMENT OR AFFILIATIVE
- identified as the first response system to develop in the individual.
- the optimal functioning of the affiliative subsystem allows “social inclusion,
intimacy, and the formation and maintenance of a strong social bond”
- Attachment to a significant caregiver has been found to be critical for the
survival of an infant.
• DEPENDENCY
-Dependency behaviors are “succoring” behaviors that precipitate nurturing
behaviors from other individuals in the environment.
-The result of dependency behavior is “approval, attention or recognition and
physical assistance”.
-It is difficult to separate the dependency subsystem from the affiliative or
attachment subsystem because, without someone invested in or attached to the
individual to respond to that individual’s dependency behaviors, the
dependency subsystem has no intimate environment in which to function.
• INGESTIVE
- relates to the behavior’s surroundings and the intake of food.
- It is related to the biological system, however, the emphasis for nursing, from
Johnson’s perspective, is the meanings and structures of the social events
surrounding the occasions when food is eaten.
- Behaviors related to the ingestion of food may relate more to what is socially
acceptable in a given culture than to the biological needs of the individual.
• ELIMINATIVE
- relates to behaviors surrounding the excretion of waste products from the body.
- Johnson admits this may be difficult to separate from a biological system
perspective; however, as with behaviors surrounding the ingestion of food,
there are socially acceptable behaviors for the time and place for humans to
excrete waste.
• SEXUAL
- reflect a behavior to procreation.
- Both biological and social factors affect behaviors in the sexual subsystem.
- The key is that the goal in all societies has the same outcome — behaviors
acceptable to society at large.
• AGGRESSIVE
- relates to behaviors concerned with protection and self-preservation.
- Johnson views the aggressive subsystem as one that generates defensive
responses from the individual when life or territory is threatened.
- The aggressive subsystem does not include those behaviors with a primary
purpose of injuring other individuals, but rather those whose purpose is to protect
and preserve self and society.
• ACHIEVEMENT
- provokes behaviors that attempt to control the environment.
- Intellectual, physical, creative, mechanical, and social skills are some of the
areas that Johnson recognizes.
3 FUNCTIONAL REQUIREMENTS FOR EACH SUBSYSTEM:
1. Protection from noxious influences
2. Provision for a nurturing environment
3. Stimulation for growth
GOAL ATTAINMENT THEORY:
IMOGENE KING
● January 30, 1923 — December 24, 2007
● Nursing Diploma, St. John's Hospital School of Nursing, St. Louis, Missouri in 1945
● Bachelor of Science in Nursing Education, St. Louis, Missouri 1948
● Master of Science in Nursing, St. Louis University, 1957
● Doctorate of Education, Teachers College, Columbia University, NY 1961 St.
John’s hospital school of Nursing - assistant director
● Ohio State University school nursing Director
● Loyola University professor
● University of South Florida (Professor emeritus)
METAPARADIGMS:
1. PERSON
• A spiritual being and rational thinker.
• King believes that individuals have the ability to think, choose, feel, set goals,
perceive, make decisions and achieve goals.
2. HEALTH
• Involves a patient’s life experiences and ongoing assessments of internal and
external environmental stressors through the use of resources available for the
patient to maximize their daily living potential.
3. ENVIRONMENT
• The atmosphere where human interaction takes place.
a. Internal: patient’s inner coping skills to adjust to the conditions of the
external environment.
b. External: patient’s surroundings, such as the nurse.
4. NURSING
• Goal of nurse: “To help individuals to maintain their health so they can function in
their roles.”
• Domain of nurse: “includes promoting, maintaining, and restoring health and
caring for the sick, injured, and dying.”
• Function of professional nurse: “To interpret information in the nursing process to
plan, implement and evaluate nursing care.”
PROPOSITIONS:
● If continuous accuracy is currently a nurse-patient interaction, a transaction will
happen:
● If the nurse and patient build a transaction, goals will be attained.
● If goals are achieved, satisfaction will happen.
● If goals are met, efficient nursing care will happen.
● If transactions are done in a nurse-client interaction, growth and development will
increase.
● If role anticipation and performance in the nurse and patient are the same, the
transaction will happen.
● If role disagreement happens in both nurse and patient, stress would be the result.
● If nurse with exceptional skill and knowledge correspond adequate information to
the patient, the same goals and accomplishments will happen.
ACTION
● Means of behavior or activities that are towards the accomplishment of a certain act.
● Both physical and mental.
● Are aimed towards setting goals.
REACTION
● Not specified but somehow relates reaction as part of the action
INTERACTION
● Any situation wherein the nurse relates and deals with a client or patient.
OPEN SYSTEM SELF-CARE DEFICIT THEORY OF NURSING
● The absence of boundary existence.

SUMMARY
● The Goal Attainment Theory is based on the philosophy of human beings and a
conceptual system.

● The goal of nursing is to help individuals and groups attain, maintain, and regain a
healthy state.

● King’s theory uses concepts of self, perception, communication, interaction,

transaction, role and decision making.

● This theory is widely generalizable and relevant in different health care situations.

● Each individual brings a different set of values, ideas,

attitudes, perceptions to exchange.

SELF-CARE DEFICIT THEORY: Dorothea Orem’s theory is based on the belief that the individual has a need for self-care
DOROTHEA ELIZABETH OREM actions and that nursing can assist the person in meeting that need to maintain life,
• Born in Baltimore, Maryland in 1914 health, and well-being.
• One of America’s foremost nursing theorists
• 1939 - BS Nursing Education 1) THE THEORY OF SELF-CARE
• 1945 - Master of Science in Nursing
• 1976 - Doctor of Science Degree ● SELF-CARE – activities that individuals carry out on their own behalf. These actions
• Staff nurse, Private duty nurse, Nurse educator, Administrator, Nurse consultant are deliberate, have patterns and sequences, and are developed from day-to-day
• Recognized the need to continue developing a conceptualization of Nursing living.
• 1971 - “Nursing: Concepts of Practice”
• 1980 - second formal articulation of her idea ● SELF-CARE AGENCY – the human’s acquired ability or power to engage in self-care.
This ability to engage in self-care is affected by basic conditioning factors (age,
• 1995 - recent formal articulation of her idea
gender, developmental state, health state, socio-cultural, health care system,
• Developed the SCDNT (Self-Care Deficit Nursing Theory)
family system, patterns of living, environment and resource adequacy, and
• Died on June 22, 2007, at the age of 92
availability). For instance, infants and children, as well as aged, ill, and disabled
people, require help with self-care activities.
Metaparadigm of Nursing

● SELF-CARE REQUISITES – can be defined as “the reasons for which self-care is

Person
undertaken: they express the intended or desired results”.
• distinguished from other living things by their capacity to:
1. Reflect upon themselves and their environment.
THREE CATEGORIES OF SELF-CARE REQUISITES:
2. Symbolize what they experience.
3. Use symbolic creations (ideas, words) in thinking, in communicating, and in
1. UNIVERSAL SELF-CARE REQUISITES – universally set goals that must be undertaken
guiding efforts to do and to make things that are beneficial for themselves or
in order for an individual to function in the scope of healthy living. Common to all
others.
human beings during all stages of the life cycle and should be viewed as interrelated
4. Integrated human functioning includes physical, psychological, interpersonal,
factors, each affecting the others.
and social aspects.
• Orem believes that individuals have the potential for learning and developing.
1. The maintenance of a sufficient intake of air.
2. The maintenance of a sufficient intake of water.
2. Environment
3. The maintenance of a sufficient intake of food.
• An external source of influence in the internal interaction of a person’s different
4. The provision of care associated with elimination.
aspects.
5. The maintenance of balance between activity and rest.
6. The maintenance of balanced solitude and social interaction.
3. Health
7. The prevention of hazards to human life, human functioning, and human well-being.
• Orem supports the WHO’s definition of health as “a state of physical, mental, and
8. The promotion of human functioning and development.
social well-being and not merely the absence of disease or infirmity.”
• She states that “the physical, psychological, interpersonal, and social aspects of
2. DEVELOPMENTAL SELF-CARE REQUISITES – actions to be undertaken that will
health are inseparable in the individual.”
provide developmental growth, provision of conditions that promote development,
• Orem also presents health based on the concept of preventive health care.
engagement in self-development, and prevention of the effects of human conditions
• Helping clients establish or identify ways to perform self-care activities.
that threaten life.

4. Nursing
3. HEALTH DEVIATION SELF-CARE REQUISITES – required in illness or injury or as a
• Nursing actions are geared towards the independence of the client. If the client is
result of medical tests or treatments to correct a condition (e.g., right upper quadrant
highly dependent, there is a need for the nurse to assist and address the needs of
abdominal pain when foods with high-fat content are eaten or learning to walk using
the client. Nursing is a distinguished human service since its focus is on persons with
crutches following a casting of a fractured leg).
inabilities to maintain the continuous provision of health care.
• Nursing is based on values.
2) THE THEORY OF SELF-CARE DEFICIT

● The basic element of Orem’s (20010 general theory of nursing because it delineates
when nursing is needed.
● Nursing is required when adults (or in the case of a dependent, the parent or
guardian) are incapable of or limited in their ability to provide continuous effective
self-care.
● Orem (2001) identifies the following five methods of helping that nurses may use:
1. Acting for or doing for another.
2. Guiding and directing.
3. Providing physical or psychological support.
4. Providing and maintaining an environment that supports personal
development.
5. Teaching.

3) THEORY OF NURSING SYSTEMS

Designed by the nurse, is based on the assessment of an individual’s self-care needs
and on the assessment of the abilities of the patient to perform self-care activities.
Describes how the patient’s self-care needs will be met by the nurse, the patient, or
both.

3 Classifications of Nursing Systems

A.WHOLLY COMPENSATORY – the nurse gives total care to meet all needs.
B.PARTLY COMPENSATORY – both nurse and the patient perform care measures or
other actions.
C.SUPPORTIVE-EDUCATIVE – the person can carry out self-care activities but requires
assistance.

This is also known as a supportive developmental system. The

“patient’s requirements for help are confined to decision making, behavior control,
and acquiring knowledge and skills”. The nurse’s role, then, is to promote the patient
as a self-care agent.

NURSING AGENCY is a complex property or attribute of people educated or trained

as nurses that enables them to act, to know, and to help others meet their therapeutic
self-care demands by exercising or developing their own self-care agency. It is similar
to self-care agency in that both symbolize characteristics and abilities for specific
types of deliberate action.

Nursing Agency vs. Self-Care Agency

A. NURSING AGENCY – carried out for the benefit and well-being of others.
B. SELF-CARE AGENCY – is employed for one’s own benefit.