MIDDLE RANGE THEORIES
demands, change, or growth, or to
DOROTHY JOHNSON
 Born in 1919 in Savannah Georgia
EDUCATION
 Received her B.S.S from Vanderbit
University in 1942 and her master’s
degree from Harvard in 1948
 She was a nursing instructor/assistant
professor focusing on pediatric nursing
 Published 4 books, more than 30
articles in periodicals, many other
papers, reports, and other
publications.
 1968: Proposed Behavioral System
Model
 1970: Book - Barriers and Hazards in
Counseling
 1978: Book - Theory Development:
What, why, how
 Received several awards for her
work 1977 Lulu Hassenplug
distinguished Achievement Award
from the California nurses
Association
 1981 Vanderbilt University School
of Nursing Award for Excellence in
Nursing
 1999: Died at the age of 80
CONCEPTS (Sub-concepts)
1. Structure
 The parts of the system that make
up the whole
2. Variables
 Factors outside the system
influence the system’s behavior,
but the system lacks the power to
change.
3. Boundaries
 The point that differentiates the
interior if the system from the
exterior.
4. Homeostasis
 Process of maintaining stability.
5. Stability
 Balance or steady state in
maintaining a balance of behavior
within an acceptable range.
6. Stressor
 A stimulus from the internal or
external world that results in stress
or instability.
7. Tension
 The system’s adjustment to
actual disruptions.
8. Instability
 State in which the system output
of energy depletes the energy
needed to maintain stability.
9. Set
 The predisposition to act. It implies
that despite having only a few
alternatives to select a behavioral
response, the individual will rank
those options and choose the
option considered most desirable.
10. Function
 Consequences or purpose of
action
ASSUMPTIONS
3 Categories
1. Assumptions about a system
 “Organization, interaction,
interdependency, and integration
of the parts and elements of
behaviors that go to make up the
system.”
 System “tends to achieve a
balance among the various forces
operating within and upon it, and
that man strives continually to
maintain a behavioral system
balance and steady-state by more
or less automatic adjustments and
adaptations to the natural forces
occurring on him.”
 Requires and results in regularity
and constancy in behavior are
essential to man
 “System balance reflects
adjustments and adaptations that
are successful in some way and to
some degree."
2. Assumptions about Structure and
Function
 “From the form the behavior takes
and the consequences it achieves
can be inferred what ‘drive’ has
been stimulated or what ‘goal’ is
being sought.”
 Each person has a “predisposition
to act concerning the goal, in
certain ways rather than the other
ways.” This predisposition is called
a “set.”
 Each subsystem has a repertoire
of choices called a “scope of
action.”
  The individual patient’s behavior
produces an outcome that can be
observed.
Functional Requirements for the Subsystems
 The system must be protected from
toxic influences with which the system
cannot cope. Each system must be
nurtured through the input of
appropriate supplies from the
environment.
 The system must be stimulated for use
to enhance growth and prevent
stagnation
DEFINITION
“an external regulatory force that acts to
preserve the organization and integrate the
patients’ behaviors at an optimum level under
those conditions in which the behavior
constitutes a threat to the physical or social
health or in which illness is found.”
BEHAVIORAL SYSTEM MODEL
 Proposed that Nursing Care facilitates
the client's maintenance of a state of
equilibrium
 Clients are stressed by a stimulus of
either an internal or external nature.
 These stressful stimuli created such
disturbances or "tensions" in the
patient that a state of disequilibrium
occurred.
7 Behavioral System
1. Affiliative/Attachment
 Forms the basis of all social
organizations. It provides survival
and security. Formation and
maintenance of a strong social
bond
2. Dependency
 Promotes helping behavior that
calls for a nurturing response.
 “Approval, attention or recognition
and physical assistance.”
 Dependency behavior evolves
from almost total dependence on
others to a greater degree of
dependence on self.
3. Ingestive
 “Emphasis on the meaning and
structure of the social events
surrounding the occasion when
the food is eaten.”
 “Has to do with when, how, what,
how much, and under what
conditions we eat.”
4. Eliminative
 “Human cultures have defined
different socially acceptable
behaviors for excretion of waste,
but the existence of such a pattern
remains different from culture to
culture.”
 It addresses “when, how, and
under what conditions we
eliminate.”
5. Sexual
 Has the dual functions of
procreation and gratification.
Including, but not limited to,
courting and mating
 Development of gender role
identity and includes a broad
range of sex-role behaviors.
6. Aggressive
 Relates to protection and self-
preservation, generating a
defense response when there is a
threat to life or territory. Its
function is protection and
preservation.
 Society demands limits and places
on self-protection mode so that
people and their property be
respected and protected.
7. Achievement
 Control or mastery of an aspect of
the self or environment to some
standard excellence.
Areas to focus
1. Reduce stressful stimuli
2. Support natural and adaptive processes
Goals
 To assist the patient whose behavior
is proportional to social demands.
 To assist the patient who can modify
his behavior in ways that supports
biological imperatives.
 To assist the patient who can 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

METAPARDIGM
1. Human Beings
Two Major Systems
 Biological System: the role
of medicine focus on the
biological system.
 Behavioral System: focuses
on the behavioral system
 The concepts of a human being
was defined as a behavioral
system that strives to make
continual adjustments to achieve,
maintain, or regain balance to the
steady-state adaptation.
2. Environment
 Include all elements of the human
system’s surroundings and
includes interior stressors.
3. Health
 some degree of regularity and
constancy in behavior. The
behavioral system reflects
adjustments and adaptations that
are successful somehow, and to
some degree
4. Nursing
 External regulatory force that
accts to preserve the organization
and integrate the patient’s
behavior constitutes a threat to
physical or social or in which
illness is found
5. Behavioral System
 Man is a system that indicates the
state of the system through
behaviors.
6. System
 That which functions as a whole
under organized independent
interaction of its part.
7. Subsystem
 A mini system is maintained
concerning the entire system
when the environment is not
disturbed.
STRENGHTS
 guides nursing practice,
education, and research, generate
new ideas about nursing
 differentiates nursing from other
health professions.
 used in inpatient, outpatient, and
community settings as well as in
nursing administration.
 provided a frame of reference for
nurses concerned with specific
client behaviors.
 generalized across the lifespan
and cultures.
Weaknesses
o theory is potentially complex because
there are several possible
interrelationships among the
behavioral system
o there is a lack of clear definitions for
the interrelationships among them,
making it difficult to view the entire
behavioral system as an entity
IMOGENE KING
- Born in 1923
EDUCATION
 BSN – Saint Louis University (1948)
 MS – Saint Louis University (1957)
 Doctorate from Teacher’s college,
Columbia University
Theory describes a dynamic, interpersonal
relationship in which a person grows and
develops to attain certain life goals.
Factors which affects the attainment of goal
are: roles, stress, space & time
HOW DID SHE DEFINED HER THEORY?
“The interaction and relationship of person with
the environment to attain health and improve
human well-being.”
BASIC ASSUMPTIONS
 Nursing focus is the care if human
being
 Nursing goal is the health care of the
individuals and groups
 Human Beings: are open system
interacting constantly with their
environment
 Basic Assumption of Goal Attainment
Theory is that the nurse and client
communicate information, set goal
mutually and then act to attain those
goals, is also the basic assumption of
nursing process.
  “Each human being perceives the
world as a total person in making
transactions with individuals and
things in environment.”
 “Transaction represents a life situation
in which perceiver & thing perceived
are encountered and in which person
enters the situation as an active
participant and each is changed in the
process of these experiences.
MAJOR CONCEPTS
Interacting Systems
Personal System
 Perception, Self, Growth and
Development, Body image, Space and
Time
Interpersonal System
 Interaction, Communication,
Transaction, Role, Stress
Social System
 Organization, Authority, Power
Status, Decision making
NURSING PARADIGMS
Human
- Refers to social being who are rational
and sentient
- Has ability to: perceive, think, feel,
choose, set goal, means to achieve
goals and, to make decision
- Human being has 3 Fundamental
Needs:
a. The need for the health information
that is unable at the time when it is
needed and can be used.
b. The need for care that seek to
prevent illness
c. The need for care when human
beings are unable to help themselves.
Health
- involves dynamic life experiences of a
human being, which implies
continuous adjustment to stressors in
the internal and external environment
through optimum use of one’s
resources to achieve maximum
potential for daily living.
Environment
- background for human interactions
- Internal environment: transforms
energy to enable person to adjust to
continuous external environmental
changes.
- External environment: involves formal
and informal organizations. Nurse is a
part of the patient’s environment.
Nursing
- “A process of action, reaction and
interaction by which nurse and client
share information about their
perception in nursing situation.”
- “ A process of human interactions
between nurse and client whereby
each perceives the other and the
situation, and through communication,
they set goals, explore means, and
agree on means to achieve goals.”
Action:
Reaction:
- 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 nursing
process to plan, implement and
evaluate nursing care.”
THEORY OF GOAL ATTAINMENT AND
NURSING PROCESS
Assessment
- Assessment occur during interaction.
- The nurse brings special knowledge
and skills whereas client brings
knowledge of self and perception of
problems of concern, to this
interaction.
- During assessment nurse collects data
regarding client (his/her growth &
development, perception of self and
current health status, roles etc.)
- Perception is the base for collection
and interpretation of data.
Communication is required to verify
accuracy of perception, for interaction
and transaction.
Nursing Diagnosis Planning Decision making
about the goals. Be
- Data collected by assessment are agree on the means
used to make nursing diagnosis in to attain the goals
nursing process
- In process of attaining goal, the nurse
identifies the problems, concerns and Implementation Transaction made
disturbances about which person seek
help.
Evaluation Goal attained

Planning HILDEGARD PEPLAU

- After diagnosis, planning for - born September 1, 1909 in Reading,
interventions to solve those problems PA to immigrant parents of German
is done descent. Illiterate, A workaholic father
- In goal attainment planning is and an Oppressive, perfectionist
represented by setting goals and mother.
making decisions about and being - Raised in a paternalistic family and a
agreed on the means to achieve paternalistic society
goals.
- Though higher education was never
- This part of transaction and client’s
discussed at home, Hilda was strong-
participation is encouraged in making willed, with motivation and vision to
decisions on the means to achieve the grow beyond traditional women’s roles
goals.
- She wanted more out of life and knew
Implementations nursing was one of few career choices
for women in her day
- In nursing process implementation
involves the actual activities to achieve
the goals. INTERPERSONAL RELATIONS THEORY
- In goal attainment it is the continuation  Nurse -patient
 It is important that a nurse must have
of transaction.
the ability to understand their own
Evaluation behaviors to help and understand the
patients’ perceived difficulties.
- It involves to finding out whether goals  Peplau’s theory focuses on the
are achieved or not. interpersonal processes and
- In king description evaluation speaks therapeutic relationship that develops
about attainment of goal and between the nurse and client. The
effectiveness of nursing care. interpersonal focus of Peplau’s theory
requires that the nurse attend to the
NURSING PROCESS AND THEORY OF interpersonal processes that occur
GOAL ATTAINMENT between the nurse and client.
Interpersonal process is maturing
Nursing Process Nursing Process force for personality. It include the
Method Theory nurse- client relationship,
communication, pattern integration
A system of oriented A system of oriented and the roles of the nurse.
actions concepts Psychodynamic nursing is being able
to understand one’s own behavior to
help others identify felt difficulties and
Assessment Perception, to apply principles of human relations
communication and to the problems that arise at all levels
interaction of nurse of experience.This theory stressed the
and client importance of nurses’ ability to
understand own behavior to help
others identify perceived difficulties.
  Peplau believes “the behavior of the
nurse-as-a-person interacting with
the patient as-a-person has
significant impact on the patient’s
well-being and the quality
andoutcome of nursing care”.
Interpersonal process of therapeutic
interactions between an individual who is sick
or in need of health services and a nurse
especially educated to recognize, respond to
the need for help. “
Phases Of Nurse-Patient Relationship
1. ORIENTATION PHASE
➢Get acquainted phase of the nurse-patient
relationship
➢It is important that a professional
relationship is established
➢Parameters and boundaries are established
and met
➢Early levels of trust are developed
2. IDENTIFICATION PHASE
➢The client begins to identify problems to be
worked on within relationship
➢The goal of the nurse: help the patient to
recognize his/her participation role and
promote respossibility for self
3. EXPLOITATION PHASE or Working
phase
➢Client’s trust of nurse reached full potential
➢Client making full use of nursing services
➢Solving immediate problems
➢nurse and the patient work towards
discharge and termination goals.
➢Interventions of the problems are done
4. RESOLUTION PHASE/ TERMINATION
PHASE
➢Final phase of nurse-patient relationship
➢Client met needs
➢Mutual termination of relationship
➢Client has increased self-reliance to deal
with his/her problem
Factors Affecting the Orientation Phase
 Values, Culture, Race, Preconceived
Ideas, Past Experiences, Expectations
(Nurse)(Patient)
CONCEPTS
 The theory explains the purpose of
nursing is to help others identify their
felt difficulties.
 Nurses should apply principles of
human relations to the problems that
arise at all levels of experience.
 Peplau's theory explains the phases of
interpersonal process, roles in nursing
situations and methods for studying
nursing as an interpersonal process.
 Nursing is therapeutic in that it is a
healing art, assisting an individual who
is sick or in need of health care.
 Nursing is an interpersonal process
because it involves interaction
between two or more individuals with a
common goal.
 The attainment of a goal is achieved
through the use of a series of steps
following a series of patterns.
 The nurse and patient work together
so both become mature and
knowledgeable in the process.
NURSING METAPARADIGM
Human Beings
 Peplau defines man (used in generic
terms) as an organism that “strives its
own way to reduce tension generated
by needs
 An individual: a developing organism
who tries to reduce anxiety caused by
needs lives in unstable equilibrium
 Each individual may be viewed as a
unique biological-psychological-
spiritual structure, one that will not
react the same as any other individual.
Health
 is defined as “a word symbol that
implies forward movement of
personality and other ongoing human
processes in the direction of creative,
constructive, productive, personal, and
community living”.
 Society
Health is defined as “a word symbol
that implies forward movement of
personality and other ongoing human
processes in the direction of creative,
constructive, productive, personal, and
community living”
 Health is defined as “a word symbol
that implies forward movement of
personality and other ongoing human
processes in the direction of creative,
constructive, productive, personal, and
community living”.
  Health is defined as “a word symbol
that implies forward movement of
personality and other ongoing human
processes in the direction of creative,
constructive, productive, personal, and
community living”
Nursing
 Peplau considers nursing to be a
“significant therapeutic, interpersonal
process” that functions cooperatively
with others to make health possible
 According to Peplau, nursing is
therapeutic because it is a healing art,
assisting an individual who is sick or in
need of health care
 Purpose of nursing: to educate and be
a maturing force so that the patient
(person)gets a new view of himself
given the need that he has presented.
This is achieved when the nurse
enters a relationship with the person.
The nurse is viewed -as a medium for
change. The relationship brings
together two persons with different
goals. The idea is for both to develop
or assume congruent goals
NURSING ROLES
In the course of the nurse-patient relationship,
the nurse assumes several roles which
empower and equip her in meeting the needs
of the patient. This illustrates the dynamic
character roles typical to clinical nursing.
1. Stranger role - offering the client the
same acceptance and courtesy that
the nurse would respond to any
stranger.
2. Resource role- providing specific
answers to questions within a larger
context
3. Teaching role- helping the client to
learn formally or informally
4. Counseling role- promoting
experiences leading to health for the
client such as expression of feelings
5. Surrogate role- serving as a substitute
for another such as a parent or a
sibling
6. Active leadership- offering direction to
the client or group
7. Technical expert role- providing
physical care for the patient and
operates equipment
ADDITIONAL ROLES INCLUDES :
• Technical expert
• Consultant
• Health teacher
• Tutor
• Socializing agent
• Safety agent
• Manager of environment
• Mediator
• Administrator
• Recorder Observer
• Researcher
NURSING PROFESSION
 Focuses on the interpersonal
processes and therapeutic relationship
that develops between the nurse &
client.
 It requires that the nurse attends to the
interpersonal processes that occur
between the nurse and client.
 Interpersonal process is maturing
force for personality. It includes the
nurse- client relationship,
communication, pattern integration
and the roles of the nurse.
 Psychodynamic nursing is
understanding one’s own behavior to
help others identify felt and perceived
difficulties and to apply principles of
human relations to the problems that
arise at all levels of experience.
NURSING EDUCATIONS
 This theory teaches the nursing
student a humanistic way to connect
with their patients (If you don’t learn to
connect with your patients in a way
that is meaningful to them, you will not
teach them anything) Is used in
conjunction with the nursing process-
follows a systematic, logical approach
Peplau's theory has generated
testable hypotheses (Current nursing,
2012) Theories can be utilized by
practitioners to guide and improve
their practice.
NURSING RESEARCH
 Hays, D. (1961). Phases and steps of
experimental teaching to patients of a
concept of anxiety: Findings revealed
that when taught by the experimental
method, the patients were able to
apply the concept of anxiety after the
group was terminated. • Burd, S.F.
Develop and test a nursing
intervention framework for working
with anxious patients: Students
developed competency in beginning
interpersonal relationships.
JOYCE TRAVELBEE
- A psychiatric nurse, educator and
writer born in 1926.
EDUCATION
- 1956, she completed her BSN degree
at Louisiana State University
- 1959, she completed her Master of
Science Degree in Nursing at Yale
University
- She started a Doctoral program in
Florida in 1973. Unfortunately, she
was not able to finish it because she
died later that year. She passed away
at the prime age of 47 after a brief
sickness.
WORKING EXPERIENCE
- 1952, Psychiatric Nursing Instructor at
DePaul Hospital Affiliate School, New
Orleans. 1970, the Project Director of
Graduate Education at Louisiana State
University School of Nursing until her
death.
- Also, she taught at Charity Hospital
School of Nursing in Louisiana State
University, New York University and
University of Mississippi.
- 1970, the Project Director of Graduate
Education at Louisiana State
University School of Nursing until her
death.
PUBLICATIONS
- 1963, started to publish articles and
journals in nursing.
- 1966 and 1971, publication of her first
book entitled Interpersonal Aspects of
Nursing
- 1969, when she published her 2nd
book Intervention in Psychiatric
Nursing: Process in the One-to-One
Relationship.
THEORY CONCEPTS
- Travelbee believed the spiritual values
a person holds will determine to a
great extent, his perception of illness.
- The spiritual values of the nurse or her
philosophical beliefs about illness and
suffering will determine the degree to
which he or she will be able to help ill
persons find meaning, or no meaning,
in these situations.
- Travelbee extended the interpersonal
relationship theories of Peplau and
Orlando, but greatly emphasized on
the therapeutic human relationship
between the nurse and the patient.
BASIC CONCEPTS
The main concepts of the nursing theory are
suffering, meaning, nursing, hope,
communications, self-therapy, and a targeted
intellectual approach. Each of these concepts
is defined by Travelbee to help nurses
understand the model.
1. Suffering
 "An experience that varies in intensity,
duration and depth...a feeling of
unease ranging from mild, transient
mental, physical or mental discomfort
to extreme pain and extreme
tortured... "
2. Meaning
 is the reason as oneself attributes. 3.
Nursing is to help man to find meaning
in the experience of illness and
suffering. has a responsibility to help
individuals and their families to find
meaning. The nurses' spiritual and
ethical choices, and perceptions of
illness and suffering, is crucial to
helping to find meaning.
3. Nursing
 is to help man to find meaning in the
experience of illness and suffering.
 Has a responsibility to help individuals
and their families to find meaning.
 The nurses’ spiritual and ethical
choices, and perceptions of illness and
suffering, is crucial to helping to find
something.
4. Hope
 The nurse's job is to help the patient to
maintain hope and avoid
hopelessness. Hope is a faith that can
and will be changed that would bring
something better with it. Hope's core
lies in a fundamental trust in the
outside world, and a belief that others
will help someone when you need it.
5. Communications
 “a strict necessity for good nursing
care.”
6. Using himself as therapy
 Self-awareness and self-
understanding of human behavior, the
 ability to predict one’s own and others’
behavior are important in this process.
7. Targeted intellectual approach
 Nurse must have a systemic
intellectual approach to the patient’s
situation
NURSING METAPARADIGM
Person
 A person is defined as a human being
 Both the nurse and the patient are
human beings.
 Unique, irreplaceable individual who is
in the 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 or disability, or
defect as measured by physical
examination, laboratory tests, and
assessment by the spiritual director or
psychological counselor.
Environment
This can be indirectly equated to the
environment. She defined human conditions
and life experiences encountered by all men
as illness, sufferings, pain and hope.
 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 disdainful “not caring” and
apathetic indifference
 Pain – is not observable, unique
experience; 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
Nursing
 Defined as "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 to find
meaning in these experiences.
HUMAN-TO HUMAN RELATIONSHIP MODEL
1. Original encounter – first impressions
2. Emerging identities – perceiving each
other’s uniqueness
3. Empathy – ability to share in the
person’s experience; to emphasize is
to gain an intellectual understanding of
the mental world & psychological state
of another
4. Sympathy – when the nurse wants to
lessen the cause of the patient’s
suffering; “When one sympathizes,
one is involved but not incapacitated
by the involvement.”
5. Rapport - is described as nursing
interventions that lessen the patient's
suffering. Relation as human being to
human being.
MAJOR CONCEPTS & DEFINITION
“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.”
“A nurse does not only seek to alleviate
physical pain or render physical care – she
ministers “…human-to-human relationship is
the means through which the purpose of
nursing is fulfilled.
PHENOMENON
 Believed that “Every human being
suffers because he is a human being,
and suffering is an intrinsic aspect of
the human condition.”
ASSUMPTIONS
 “The purpose of nursing is achieved
through the establishment of human-
to-human relationships.”
 The communication process enables
the nurse to establish a human-to-
human relationship.
IMPLICATIONS
Clinical Setting:
 Helps inform how nurses can build
relationships
 Help setting goals for nurses
Education:
 Teaches nurses to understand the
meaning of illness and suffering.
Research
 This theory is used in research to
explore how patients gains meaning
after a recent diagnosis and illness.
NOLA PENDER
-Nola Pender was born in Lansing
Michigan on August 16,1941
EDUCATION
- Nola Pender received her nursing
diploma in 1962 in the school of
Nursing West Suburbar Hospital
- In 1965 she received her master’s
degree in human growth and
development
- She gets her PH. D in Psychology in
Evanston Illinois 1969
- Nola Pender and her unit developed
the program called "Girls on the move"
- Nola Pender became a president in
Midwest Nursing Research Society
From 1985-1987 and became a board
member of Research Americas Board
of Directors from 1991-1993
- She became a Dean For research in
her old University and a Co-founder at
Midwest Nursing Research Society in
1990-2001
- In 1972 she received the Distinguish
Alumni Award
- In 1988 she received the Midwest
Nursing Research Society Award
- In 1992 the University of Widener
Awarded her of Honorary Doctorate of
CONCEPT
 Person, Environment, Nursing,
Health, and Illness
The Health Promotion Model notes that each
person has unique personal characteristics
and experiences that affect subsequent
actions. The set of variables for behavioral
specific knowledge and effect have important
motivational significance. These variables can
be modified through nursing actions. - Health
promoting behavior is the desired behavioral
outcome and is the endpoint in the Health
Promotion Model.
Health-promoting behaviors should result in
improved health, enhanced functional ability,
and better quality of life at all development
stages. The final behavioral demand is also
influenced by the immediate competing
demand and preferences, which can derail
intended health-promoting actions.
MAJOR ASSUMPTIONS
 Individuals Seek to regulate their
own behavior actively
 Individuals in all their
biopsychosocial complexity
interact with the environment,
progressively transforming the
environment and being
transformed over time.
 Health professionals constitute a
part of the interpersonal
environment, which influences
persons throughout their life span
 Self-initiated reconfiguration of
person-environment interactive
patterns is essential to behavior
change
DEFINITION
• aims to explain the factors underlying
motivation to engage in health-
promoting behaviors and it focuses on
people’s interactions with their
physical and interpersonal
environments during attempts to
improve health.
• was designed to be a “complementary
counterpart to models of health
protection.”
• “a positive dynamic state not merely
the absence of disease.”
THEORY
A. Individual Characteristics and Experiences
- This first category explores the
concept that everyone has his or her
own set of characteristics and
experiences, which in turn help shape
their actions.
- Pender emphasized that one’s past
actions have a direct link to whether
they would partake in future health-
promoting behaviors. Personal
attributes and habits can also be a
barrier to health-promoting behaviors.

B. Behavior-Specific Cognitions and Affect
- This involves the behavior-specific
cognitions and affect which have a
direct impact on the individual’s
motivation for change.
- 3 variables of that have a direct impact
on the individual’s motivation for
change: Observed benefits and
barriers to the action; Self-worth; and
Activity related result.
C. Behavioral Outcome-Health Promoting
Behavior
- The start of the outcome begins with
the person committing to taking the
steps necessary to make a change.
- During this phase the individual must
be supported with barriers addressed
to produce a positive health-promoting
behavior.
- The goal of the health promotion
model is to stimulate a behavioral
change that results in a positive health
outcome.
METAPARADIGM
Person
- A biopsychosocial organism that is
influenced by the environment in some
ways but also works to improve the
environment so that human potential,
both innate and acquired, can be
completely realized. As a result, there
is a mutual link between a person and
their surroundings. Behaviors,
including those relating to one's
health, are influenced by both
personal traits and life experiences.
Health
- -Realizing human potential, both
innate and learned, through goal-
directed behavior, skillful self-care,
and fulfilling interpersonal
connections, while making necessary
modifications to preserve structural
integrity and harmony with pertinent
contexts. A changing aspect of life is
health.
Environment
- The environment can be influenced by
the person to provide cues and
facilitators for activities that promote
health thus physical, social, and
cultural surroundings in which a
person's life progresses.
Nursing
- Collaboration with individuals, families,
and communities to create the most
favorable conditions for the expression
of optimal health and high-level
wellbeing.
IMPLICATIONS
Nursing Practice
In practice Nola Pender’s theory helps us to
understand and analyze what kind of behavior
or quality of life we need to help the patient to
achieve a higher levels of well being. This
explain or show us on how to observe the
patient on what kind of lifestyle that she/he
need to have a better healthy behavior,
Prevent readmission and maintain the quality
of life of a patient
Nursing Education
On Nola Pender’s theory it comes of ways to
recognize or perceive the behavior of the
patient to know even more of what behavior or
attention that we can give to them, Like what
are they goals in life, what are the hobbies or
what makes them happy in this way we can
come up with a solution on what to do.
Nursing Research
According the research if the behavior of a
patient is abnormal like don’t have a time to
eat, down to themselves.it comes in many
ways on why the behavior of a patient can be
a treat to their life.
JOYCE FITZPATRICK
- Dr. Joyce Fitzpatrick is a nurse
educator and advocate for nursing,
geriatrics, psychological care, and
nursing theory.
- Born in 1944, she developed her
interest in health care at an early age,
and she had a great desire to learn
and participate in nursing as an
educator and leader to her peers.
- She continued to obtain higher
degrees in nursing, including serving a
year as Fulbright scholar.
- She has become best known for her
new theory of nursing that involves
lifetime health and care.
- Her writing has won her numerous
mentions and awards. She has
published 13 books on her own,
including 301 Careers in Nursing,
Nursing Leadership: Views from the
Outside and Advancing Professional
Nursing Practice. Some of these
books are written with other health
 professionals, and some are written on
her own.
- This nursing professor has won the
National Journal of Nursing’s Book of
the Year 18 times.
- Her most unusual book is likely
Fundraising Skills for Health Care
Executives, about setting up
foundations to improve health care in
a community. She also has written a
textbook on the practice of nursing at
the doctorate level and other
advanced nursing practice texts.
CONCEPT
Rhythm
- Movement, fluctuation, or variation of
natural flow
- Regular recurrent quantitative change-
variable biological process
CORE-CONCEPTS
Person
- Includes both self and others
- Is seen as an open system, a unified
whole characterized by a basic human
rhythm
- The model recognizes individuals as
having unique biological,
psychological, emotional, social,
cultural, and spiritual attitudes.
Health
- Health is a dynamic state of being that
results from the interaction of person
and the environment.
- 'a human dimension under continuous
development, a heightened awareness
of the meaningfulness of life.
- Optimum health is the actualization of
both innate and obtained human
potential gathered from rewarding
relationships with others, goal directed
behavior, and expert personal care.
Wellness
- Professional nursing is rooted in the
promotion of wellness practices.
Nursing
- "A developing discipline whose central
concern is the meaning attached to life
(health)
- Primary purpose of nursing is the
promotion and maintenance of an
optimal level of wellness.
MAJOR ASSUMPTIONS
"The process of human development is
characterized by rhythms that occur within the
context of continuous person-environment
interaction."
Nursing activity focuses on enhancing the
developmental process toward health.
The identification and labeling of concepts
allows for recognition and communication with
others, and the rules for combining those
concepts permits thoughts to be shared
through language
A central concern of nursing science and the
nursing profession is the meaning attributed to
life as the basic understanding of human
existence
Life Perspective Rhythm Model
- is constructed to assist with the
professional practice of nursing
correlating in field work.
- The use of life perspective rhythm
model helps nurses in integrating a
professional action plan for each
client.
- The medical field is consulted when a
disruption in rhythm occurs. The job of
nurse is to understand and assist the
client in putting their rhythms back
towards equilibrium.
METAPARADIGM
Totality of the Person or Client
- Everything known about the client and
his life.
Environment of the Client
- Social construct that surrounds the
client and its effect on the client
Client’s current level of wellness
- Established which items of health care
workers need to address.
Nursing’s Responsibility and Duty Toward the
Client.
- nursing theory, actions and treatments
that the nurse needs to bring to bear
to return the client to the top level of
wellness possible
IMPLICATIONS
Nursing Practice
The theory is that individuals who derive
meaning in their life experience optimum level
wellness, and that this wellness concept can
be translated within the bio-psycho-social-
cultural-spiritual dimensions of being. Applying
these understandings to professional nursing
practice would lead to nursing interventions
focused on enhancing high level wellness
through an understanding of the life
experience and aspects of personal behavior
that interfere with deriving meaning at a
personal, interpersonal and social level.
Understanding of this theory not only will
benefit the patients cared for by nurses, but it
also will assist nurses to strengthen their
therapeutic relationships with patients, thus
enhancing their own professional development
and life satisfaction
Nursing Education
Life Perspective Rhythm Model is a complex
nursing model which contribute to nursing
knowledge by providing taxonomy for
identifying and labeling nursing concepts to
allow for their universal recognition and
communication with others. This theory led
nursing schools to teach holistic care. That
nurses should not just focus on the physical
aspect of their patients but also the psycho-
social-cultural well being of each patient. It
allows the nurse to plan and implement care
purposefully and proactively. When nurses
practice purposefully and systematically, they
are more efficient, have better control over the
outcomes of their care, and are better able to
communicate with others
Nursing Research
This theory became a precursor in different
studies related to the well-being of nurses and
patients in different care settings testing
interventions to enhance purpose-in-life,
including interventions focused on reducing
stress and enhancing spiritual well-being. The
interventions being designed include aspects
of meditation and relaxation. The interventions
are being examined among individuals
experiencing life-threatening illnesses and
chronic illnesses; differences in cultural
backgrounds, as well as individuals from
different developmental stages. A current
study is underway to teach nurses who work
with elders in long-term care to recognize the
signs of silent suicide and intervene as
appropriate. It is expected this research will be
extended to additional groups of nurses and
older patients so that the phenomenon of silent
suicide can be better understood and nurses
can employ methods of direct intervention.
This theory could have been further tested
during the peak of the COVID pandemic when
nurses and patients alike are at the height of
seeking purpose in their life and in their line of
work.
PRACTICE LEVEL
SR CALLISTA ROY
- born on October 14, 1939, in Los
Angeles, California
- She is a highly respected nurse
theorist, writer, lecturer, researcher,
and teacher.
- Member of Sisters of Saint Joseph of
Candondelet.
EDUCATION
- 1963 - She gained her BSN at Mount
Saint Mary’s College in L.A., California
- 1966 - She gained her Master’s
degree in Pediatric nursing
- 1973-1997 - She gained her Master’s
degree and PhD in Sociology
- She completed a 2-year postdoctoral
program as a clinical nurse scholar in
neuroscience nursing at the University
of California.
CONCEPTS
Adaptation
- The process and outcome whereby
thinking and feeling persons as
individuals or in groups,
Use conscious awareness and choice to
create human and environmental integration.
- It leads to optimal health and well-
being, to quality of life, and to death
with dignity.
ASSUMPTIONS
1. Philosophical Assumption
- Persons have mutual relationships
with the world and a God-figure
- Human meaning is rooted in an
omega point convergence of the
universe
- Persons use human creative abilities
of awareness, enlightenment, and faith
2. Scientific Assumption
- Consciousness and meaning are
constitutive of person and environment
integration Awareness of self and
environment is rooted in thinking and
feeling System relationships include
acceptance, protection, and fostering
interdependence.
3. Cultural Assumption
- Experiences within a specific
culture will influence how each
element of the RAM model is
expressed
 - Within a culture there may be a
concept that is central to the
culture and will influence some or
all of the elements of the RAM to a
greater or less extent
- Cultural expressions of the
elements of the RAM may lead to
changes in practice activities such
as nursing assessment
ROY’S ADAPTATION MODEL OF NURSING
 Definition: developed by Sister
CallistaRoy in 1976.
 It is a prominent nursing theory aiming
to explain or define the provision of
nursing science.
 It sees the individual as a set of
interrelated systems that maintain a
balance between various stimuli.
 This model asks three central
questions: Who is the focus of nursing
care, what is the target of nursing
care, when is nursing care indicated.
 In this theory, the aim of nursing is to
increase compliance and life
expectancy.
 This model has been in use for more
than 50 years, providing direction for
nursing practice, education, and
research.
 Stimuli: is anything which is going to
trouble an individual, it can be positive,
or it can be negative. Something that
stirs or urges to action.
 Smoking: Focal Stimuli – Nicotine
Addiction; Contextual Stimuli – cool;
Residual – body image.
THEORY
4 adaptive modes
1. Physiological Mode
- Is associated with the physical
answers of the person, given to
stimuli from the environment which
includes basic needs and complex
senses.
2. Role-function Mode
- covers the individual’s role in
society for social integrity which is
divided into 3: Primary,
Secondary, and Tertiary
3. Self-concept Mode
- defined as the individual’s mixture
of beliefs and feelings about
himself or others at a certain time
which consists of physical self and
personal identity.
4. Interdependence Mode
- includes relationships with others
that are meaningful to the person,
and support systems.
METAPARADIGM
- Human Being (Adaptive Person),
Environment (Stimuli), Health
(Outcome of Adaption), Nursing
(Its goal)
IMPLICATIONS
Nursing Profession
- The enhancement of compliance
and life expectancy
Nursing Education
- To increase knowledge and better
comprehend the idea of theory-
based nursing practice.
Nursing Research
- Research provides theory-guided
nursing practice that is
fundamental in providing the
framework for developing superior
and quality nursing care.
LYDIA HALL
Born on September 21, 1906, in
New York City
- Died on February 27, 1969, at 62
years old.
EDUCATION
- Basic Nursing Education - 1927
- Bachelors in public health nursing
– 1937
- Masters in teaching natural
sciences – 1942
- First director of Loeb Center for
Nursing
- Nursing experience in clinical,
education, research and
supervisor role.
CONCEPTS
Behavior
- Everything that is said or done.
 - Dictated by feelings both
conscious and unconscious.
Self-Awareness
- The state of being that nurses
endeavor to help their patients
achieve.
- The more self-awareness a person
has of their feelings, the more
control they have over their
behavior.
Reflection
- Acts as a mirror to the patient
selected verbalizations of patients
are repeated back to them with
different phraseology to invite
them to explore feelings further.
Second-Stage Illness
- Once the doctors begin giving only
follow-up care
- Non-acute recovery phase of
illness
- Conductive to learning and
rehabilitation
- The need for medical care is
minimal, although the need for
nurturing and learning is great.
Wholly Professional Nursing
- Nursing care given exclusively by
professional registered nurses,
educated in the behavioral
sciences who take the
responsibility and opportunity to
coordinate and deliver the total
care of their patients.
- This concept includes the roles of
nurturing, teaching, and advocacy
in the fostering of healing.
ASSUMPTIONS
- The motivation and energy
necessary for healing exist within
the patient rather than in the
healthcare 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
the size, depending on the
patient’s total course of progress.
DEFINITION
- “Participation in care, core, and
cure aspects of patient care,
where CARE is the sole function of
nurses, whereas the CORE and
CURE are shared with other
members of the health team.
- The major purpose of care is to
achieve an interpersonal
relationship with the individual to
facilitate the development of the
core.
-
CARE, CORE, CURE THEORY
Care
- Addressed the role of nurses
- Focused on performing the task of
nurturing patients.
- “Motherly” care provided by
nurses.
Core
- Patient receiving nursing care
- Has goals set by him or herself
rather than by any other person
- Behaves according to their
feelings and values
Cure
- Attention given to patients by
medical professionals
- Physician or physical therapists.
- Interventions or actions geared
toward treating the patient.
METAPARADIGM
Person/Client
- 16 years of age or older and
passes the acute stage of a long-
term illness
- Individual as unique, capable of
growth and learning and requiring
a total person approach.
Health