TFN MIDTERM TOPIC

REVIEW MATERIAL TFN

THEORETICAL FOUNDATIONS OF NURSING Present values of asceticism

 24hrs nursing duty hour
Legend:  Self-discipline for professional growth
Remember
Lecturer Book
Previous Trans  Devotion to duty
(Exams) Trans Comm
 Quality care and service
      Accept to bear hardships of life o

MIDTERM A. Philosophies of Nursing

• Philosophy is derived from Greek word “philos” means love

o This era was closely identified hardships.
“Sophia” means wisdom
o Nurses gave up home, family and features devoted
• Philosophy is the science of knowledge
themselves to duty for the sake of god and orders were
• Philosophy is the science of all sciences
accepted as ascetics (saints)
• Philosophy is an effort to discern the general truth that lies
o Nurse often thought of themselves as the salves of God o
behind the particular facts. (That is the reality that lies behind
They motivated by a spiritual objective of all serving all people
the appearances)
without selfishness
• Knowledge is a constituent of wisdom → wisdom helps us to
analyze facts → finding relationships
 Romanticism (1890-1940) o Period of natural or logical
• Philosophy is defined as “love and pursuit of wisdom by
transition for nursing philosophy. o A movement in the arts and
intellectual means and moral discipline”
literature that originated in the late 28th century, emphasizing
• Philosophy is a science that compromises logic, ethics,
inspiration, subjectivity and the primacy of the primacy of the
aesthetics, metaphysics, and the theory of knowledge.
individual
• Philosophy is a set of beliefs and values that guide the way
o Thinking of hardship was derived to liberal thinking o
in which we operate in the world.
Romantic title for Florence Nightingale “the lady with lamp”
•Philosophy is a statement of beliefs that guide one’s behavior
and in case, influence the practice of nursing. Values:
B. Significance of Philosophy on Nursing  Increase dependance on physician, decrease
autonomy in nursing
 Support idealistic trait of women which affect
• To achieve intellectual enlightenment
strongly nursing value system
• The individual is afforded an opportunity to exercise both
 Idealistic romanticized view of woman is strongly
understanding and value judgements
attached with idealistic romanticized view of
• Sciences benefit philosophy essentially because philosophy nursing as soft, feminine or romantic.
governs their methods through logic and ethics
o o Nurses practice diverted to feeling of an attitude of
C. Four basic philosophies influencing nursing values

• Asceticism romance, adventure, more towards social expectations, being

• Romanticism
• Pragmatism
• Human existentialism loyal to physician, to school of nursing and to the clients.

 Asceticism (1859-1890 AD) o Asceticism existed from

nursing interception (beginning) and strongly supported
during ‘pre-nightingale era’
 Pragmatism (1940 AD onwards-second world war) o
Pragmata (Greek word): acts, function, activities o Its directly
o The principle mainly focused on way of life
based on its use, function and practical consequences of the
 As self-denial
fact and ideas. o Increased need of nurses to work, shortages
 Willing to sacrifice life’s comfort and safety for
of trained nurses increased need of more manpower to provide
the sake of god
care of sick people. o

Values:
 Decision was still remained under physician
Page 1 of 10 need not for patients need
 Focus was on problem, disease, disability and
diagnosis, not to patients, his family, his need.
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
o Pressure prepares the various categories of group of
nurses like nursing assistance, nursing aids, emergency nurse
etc.
 Humanism
o Nursing values focuses towards the patient as a wholesome
not towards physicians or the institution.
o A great change or transition in nursing service is noted in
this era it moved to non-hospital setting in community for
individual, family and neighborhood.
o Values:
 Clients accepted as human being, a
biopsychosocial being not only a spiritual
being.
 Nursing – not a service to god, country or
physician, disease and diagnosis, but it is for
individual family and community including
their environment.
 Teaching – content integrated curriculum
model with the patient problem centered
(comprehensive nursing care)
 Service – more accountable, decision making
and autonomy.
 Human existentialism o It’s a
modern philosophy o It believes
that person is unique o Holistic
approached used
o Basic priority is given to people centered during nursing
activities.
o This philosophy is made acceptable for each individual client
to make personal choice about nursing care healing method.
o Nursing become more accountable, more decision makes
and autonomy in function.
THEORIST
A. Florence Nightingale (Environmental theory) 1860
• The environmental theory defined nursing as “the act of
utilizing the environment of the patient to assist him in his
recovery.
• Considered as the first nursing theorist focus on
manipulation of the environment to promote wellness
• She is known as the mother of Modern Nursing
• Lady of the lamp
• 5 major components of a healthful environment o
Proper ventilation – importance
room temperature. The patient should not be too warm or
too cold.
o Adequate light – the sick needed light. Direct
sunlight was what patients wanted.
o Sufficient warmth – appropriate balance between
burning fires and ventilation from windows.
o Control of infection – nurses ought to wash her
hands very frequently
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o Control of noise – patients should never be
“waked intentionally”. Unnecessary noise is cruel
and irritating to the patient.
Metaparadigm
• Person – one who receives care, dynamic and complex
being
• Environment – physical components of the environment
such as ventilation, warm, light, nutrition, medicine,
simulation, room temperature and activity.
• Health – she believes on the prevention and health
promotion from illness to health
• Nursing – nursing is a spiritual calling that provides
essential principles from rendering and implementing an
effective nursing care
B. Jean Watson (Theory of Human Caring) 1977
• Conceptualized that nursing is an application of an art and
human science through transpersonal transactions
• Caring is a special way of being-in-relation with one’s self,
with other’s and the broader environment → requires both
intention and commitment to care and to promote health and
healing.
Major assumptions
1. Caring can be effectively demonstrated and practiced only
interpersonally
2. Caring consists of carative factors that result in the satisfaction
of certain human needs
3. Effective caring promotes health and individual or family
growth
4. Caring responses accept the patient as he or she is now, as
well as what he or she may become
5. A caring environment offers the development of potential while
allowing the patient to choose the best action for themselves
at a given point in time.
6. The science of caring is complementary to the science of
curing.
7. The practice of caring is central to nursing
Major concepts a. The carative factor
• Guides for core of nursing
• Attempted to honor the human dimensions of nursing’s
work and the inner life world and subjective experiences
of the people we serve. 1. Humanistic-altruism system
of value
2. Faith-hope
3. Sensitivity to self and others
4. Helping-trusting, human care relationship
5. Expressing positive and negative feelings
of 6. Creative problem-solving caring process
7. Transpersonal teaching-learning
8. Supportive, protective and corrective mental,
physical, societal and spiritual environment
9. Human needs assistance
10. Existential-phenomenological-spirit
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
b. Transpersonal caring relationship
• Characterizes a special kind of human care relationship that
depends on nurse’s moral commitment in protecting and
enhancing human dignity as well as deeper/higher self.
o Means to go beyond one’s ego and here and
now, as it allows one to reach deeper spiritual
connections in promoting the client’s comfort and
healing.
o The goal of transpersonal caring relationship
corresponds to protecting, enhancing and
preserving the person’s dignity, humanity,
wholeness and inner harmony.
c. Caring occasions
• Is the moment when the nurse and another person come
together in such a way than an occasion for human
caring is created.
Metaparadigm
• Person – viewed human being to be valued, care for,
respected, nurture, understand and to be assisted in one’s
need.
• Environment – defined as society, that encompasses social,
cultural and spiritual aspects
• Health – encompasses a high level of overall physical,
mental, and social functioning.
• Nursing – concerned on promoting and restoring health.
C. Patricia Benner (Expertise Model) 1982
• Noted that in application of nursing model to nursing skill
acquisition based on experience is safe if it is grounded in a
sound situation. • Novice o The person has no
background experience of the situation
o Applies to nursing students
• Advance beginner
o Sufficient experience easily understands aspect of
the situation, yet still rely on the help of those who
have more experienced.
o Challenge their abilities and the demands of the
situation placed on the,
o They also feel more responsible for managing patient
care
o Newly graduate nurse
• Competent
o Sense of mastery is acquired thru planning, display
more responsible more than realistic
o One’s performance considers consistency,
predictability and time management are the essential
components
o Knows how to recognize pattern and identify which
elements of the situation needs attention and which
one to ignore
o Develop new rules and reasoning procedures
• Proficient o The performer identifies the most
significant aspects and has a better understanding of
the situation
o Shows increase of confidence in knowledge and skills
o This stage perceives the situation as a whole rather
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than in terms of aspects. o Proficient level is qualitive
leap beyond the competent
• Expert
o No longer relies on analytical principles like rules,
guidelines have a deep understanding of total
situation
o The expert operates from a deep understanding of
the total situation
D. Helen Erickson (Caritative Caring Theory) 1997
• She asserted that each individual is a unique has some
selfcare knowledge that need to be attached and separated
and have some adoptive potential.
• Her theories facilitate, nurture and accept the person
unconditionally
Caring Ethics:
• Nursing ethics are the ethical principles that guide a nurse’s
decision-making abilities
• Carative caring consists of love and charity, which is also
known as caritas, and respect and reverence for human
holiness and dignity.
Metaparadigm
• Person – based on the axiom that the human being is an
entity of body, soul and spirit
• Nursing – love and charity or caritas, as the basic motive of
caring.
• Environment – based on “ethos”; ethos is the sounding
board of all caring.
• Health – the subjective dimension or well-being; health
implies being whole in body, soul and spirit
D. Martha Elizabeth Rogers (Science of Unitary Human
Beings) 1990
•Known as the science of unitary human beings (SUHB)
•Views nursing as both science and an art
•The unitary human being and his/her environment are one
•Nursing focuses on people and the manifestations that
emerge from the mutual human-environmental field process.
• Was considered profound and was too ambitious when first
introduced, but now it is thought to be ahead of its time
2 Dimensions
•
Nursing as “an art and science that is humanistic and
humanitarian. It is directed toward the unitary human and is
concerned with the nature and directions of human
development.
• The goal of nurses it’s to participate in the process of change
SUBH Addresses
• The important of environment as an integral part of patient
• Uses that knowledge to help nurse blend to science and art
of nursing to ensure patients have a smooth recovery and
get back to the best health possible
Components 1. Energy Field
• Fundamental unit of both the living and non-living
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
• Provides a way to view people and the environment as
irreducible wholes.
• Energy fields continuously vary in intensity, density and
extent
2. Openness
• No boundaries that stop energy flow between human
and environmental fields
• Refers to qualities exhibited by open system
• Human beings and their environment are open system
3. Pattern
• A distinguished characteristic of an energy field seen
as a single wave.
• It is an abstraction and gives identity to the field.
4. Pan Dimensionality
• Defined as a “non-linear domain without spatial or
temporal attributes”
• Human parameters to describes events are arbitrary;
and the present is relative; there is no temporal
ordering of lives.
5. Principles of homedynamics
• Postulate a way of viewing unitary human
beings
• Three principles of homedynamics o
Resonance o Helicy o Integrality
o It should be understood as a dynamic
version of homeostasis (a relatively
steady state of internal operation in the
living system)
6. Principle of resonance
• constant change in flow from lower to higher
frequency
• changing of wave patterns
7. Principle of helicy
• any small change in any of the environmental
fields causes a ripple effect
• constant interchange, an open system is never
the same at any two moments, rather it is
continually new or different
8. Principle of integrality (synchrony + reciprocity)
• human and environmental energy fields that are
mutually and continuously changing; we effect
our environment and our environment affects us.
Assumptions
1. wholeness – human beings are whole which cannot be
viewed as subparts.
2. Openness – energy continuously flows between human and
environment.
3. Unidirectionally – life process of human beings is one way
and irreversible.
4. Pattern and organization – identify man and reflect his
innovative wholeness.
5. Sentence and thought – human beings have the ability to
think, imagine, sense, feel and use language for expression.
Metaparadigm
Person – a unitary human being is an “irreducible, indivisible, pan
dimensional energy field by pattern and manifesting
characteristics that are specific to whole
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- Human beings are an open system which continuously
interact with environment.
Environment – an irreducible, indivisible, pan dimensional
energy field identified by pattern and integral with human field.
Health – an expression of life process; they are the”
characteristics and behavior emerging out of the mutual,
simultaneous interaction of the human and environment fields.”
• Health and illness are part of the same continuum.
• Unitary human benefit signifies an irreducible human
field Nursing – both science and art
• A good nursing practice will constantly maintain an
energy field that is conductive the patient.
• Purpose is to promote health and well-being of all
persons
• Nursing actions directs the interaction of person and
environment to maximize health potentials.
F. Dorothea Orem’s (General Theory of Nursing) 1971
• The Self-Care or Self-Care Deficit Theory of Nursing is
composed of three interrelated theories:
1. The theory of self-care
2. The self-care deficit theory
3. The theory of nursing systems
Theory of Nursing System
• The actions and interactions of nurses and patients in nursing
practice situations
o Wholly Compensatory – consist of complete care to
the patients by the nurse because the patient is not
able to perform any of their self-care activities.
Ex: New born, care of patient recovering from
surgery
o Partially Compensatory – consist of the provision of
some care when the patient can perform some but not
all the needed self-care activities.
Ex: nurse can assist the postoperative client in
ambulating, nurse can bring a meal tray for a client who
can feed himself
o Supportive-educative – consist of helping actions
that include combinations of support, guidance,
provision of developmental environment and teaching.
Ex: nurse guides a mother on how to breastfeed her
baby
Theory of Self-Care Deficit
• This theory delineates when nursing is needed. Nursing is
required when an adult (or in the case of a dependent, the
parent or guardian) is incapable of or limited in providing
continuous effective self-care. o 5 methods of helping:
 Acting for and doing for others
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
 Guiding others
 Supporting others
 Providing an environment promoting personal
development about meet future
demands
 Teaching others
Theory of Self-Care
• Self-care – the acts individuals perform to maintain their
well-being, such as showering, eating, moving, etc.
• Self-care agency – the ability for individuals to practice
self-care, which can be affected by their environment or
health considerations.
• Self-care requisites – can be defined as actions directed
toward the provision of self-care. It is presented in three
categories:
o Universal self-care requisites – associated
with life processes and the maintenance of the
human structure and functioning integrity. o
Developmental self-care requisites – either
specialized expressions of universal self-care
requisites that have been particularized for
developmental processes or they are new
requisites derived from a condition or associated
with an event.
o Health deviation self-care requisites – are
required in conditions of illness, injury, or disease
or may result from medical measures to diagnose
and correct the condition.
• Therapeutic self-care demand – the totality of “care
measures” necessary at specific times or over a duration
of time for meeting an individual’s self-care requisites by
using appropriate methods and related sets and actions.
Metaparadigm
Person – recipient of nursing care. Integrated human functioning
includes physical, psychological, interpersonal and social aspects
Environment – environmental conditions - external physical &
psychosocial surroundings. Developmental environment –
promotion of personal development through motivation to
establish appropriate goals & to adjust behavior to meet those
goals; concludes formation of or change in attitudes and values,
creativity, self-concept and physical development.
Health – Orem’s supports WHO definition of health as the state
of physical, mental, and social well-being and not merely the
absence of disease or infirmity. She states physical,
psychological, interpersonal and social aspects of health are
inseparable in the individual.
Nursing – in modern society, adults are expected to be self-
reliant and responsible for themselves and for well-being of their
dependents. Most social groups further accept that person who
are helpless, sick, aged, handicapped or deprived should be
helped to attain or regain responsibility within their existing
capacities.
Components
Nursing art – the intellectual quality of nurses which allows them
to make creative investigations, analysis, and synthesis of
variables and conditioning factors in nursing situations.
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Nursing prudence – the quality that enables the nurse to seek
advice in new or difficult situations, to make correct judgements,
to decide, to act in a particular manner.
Nursing service – a human service that focuses on a person’s
inabilities to maintain health care.
Nursing agency – a complex property or attribute of people
educated and trained as nurses that enables them to act, know,
and help others meet their therapeutic self-care demands by
exercising or developing their own self-care agency.
G. Imogene King (Goal attainment theory/grand theory) 1960
• The general systems theory from the behavioral sciences
led to the development of her dynamic interacting systems.
• King developed a general systems framework and a theory
of goal attainment where the framework refers to the three
interacting systems; individual or personal, group or
interpersonal, and society or social
• The theory of goal attainment pertains to the importance of
interaction, perception, communication, transaction, self,
role, stress, growth and development, time and personal
space.
Personal system
• Personal systems are individuals, who are regarded as rational,
sentient, social beings. Concepts related to the personal
systems are:
o Perception – a process of organizing, interpreting
and transforming information from sense data and
memory that gives meaning to one’s experience,
represents one’s image of reality, and influences
one’s behavior. o Self – a composite of thoughts and
feelings that constitute a person’s awareness of
individual existence, of who and what he or she is.
o Growth and development – cellular, molecular and
behavioral changes in human beings that are a
function of genetic endowment, meaningful and
satisfying experiences, and an environment
conducive to helping individuals move toward
maturity.
o Body image – a person’s perceptions of his/her body.
o Time – the duration between the occurrence of one
event and the occurrence of another event.
o Space – the physical area called territory that exist in
all directions
o Learning – gaining knowledge
Interpersonal system
• The concepts associated for the interpersonal systems
are: interaction, communication, transaction, role and
stress.
• King refers to two individuals as dyads, three as triads and
four or more individuals as small group or large group.
• This shows how the nurse interrelates with a co-worker or
patient, particularly in a nurse-patient relationship.
• Communication between the nurse and the client can be
verbal or non-verbal.
• Collaboration between the Dyads (nurse-patient) is very
important for the attainment of the goal.
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
o Interactions – the acts of two or more persons in
mutual presence; a sequence of verbal and
nonverbal behaviors that are goal directed.
o Communication – the vehicle by which human
relations are developed and maintained;
encompasses intrapersonal, interpersonal, verbal
and nonverbal communication.
o Transaction – a process of interaction in which
human beings communicate with the environment to
achieve goals that are valued; goal-directed human
behaviors.
o Role – a set of behaviors expected of a person
occupying a position in a social system.
o Stress – a dynamic state whereby a human being
interacts with the environment to maintain balance
for growth, development, and performance, involving
an exchange of energy and information between the
person and the environment for regulation and
control of stressors.
o Coping – a way of dealing with stress
Social system
• The final interacting system is the social system.
• This shows how the nurse interacts with co-workers,
superiors, subordinates and the client environment in
general.
• These are groups of people within the community or
society that share a common goals, values and interests.
• Social systems are organized boundary systems of social
roles, behaviors, and practices developed to maintain
values and the mechanisms to regulate the practices and
roles.
o Authority – a transactional process
characterized by active, reciprocal relations in which
member’s values, backgrounds, and perceptions play a
role in defining, validating, and accepting the authority of
individuals within an organization. o Power – the process
whereby one or more persons influence other persons in
a situation.
o Status – the position of an individual in a group
or a group in relation to other groups in an organization.
o Decision making – a dynamic and systematic process
by which goal directed choice of perceived alternatives is
made and acted upon by individuals or groups to answer
a question and attain a goal. o Control – being in charge.
• Among the three systems, the conceptual framework of
interpersonal system had the greatest influence on the
development of her theory.
• Two people, who are usually strangers, come together in
a health care organization to help and to be helped to
maintain a state of health that permits functioning in roles
(King,1981)
Major assumptions
• King’s conceptual framework and theory of goal attainment
“are based on an overall assumption that the focus of
nursing is human beings interacting with their environment
leading to a state of health for individuals, which is an
ability to function in social roles.
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Assumptions
• Nursing focus is the care of human being
• Nursing goal is the health care of individuals & groups
• Human beings: are open systems interacting constantly
with their environment
• 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.
Metaparadigm
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. o Action – defined as a
sequence of behaviors involving mental and physical action.
o Reaction – which is considered as included in the
sequence of behaviors described in action. o Goal of
nurse – to help individuals to maintain their health so
they can function in their roles.
o Domain of nurse – includes promoting, maintaining, and
restoring health, and caring for the sick, injured and
dying.
o Function of professional nurse – to interpret information
in nursing process to plan, implement and evaluate
nursing care.
Person – human being or person refers to social being who are
rational and sentient.
Human beings have three fundamental needs:
o The need for the health information that is unable at the
time when it is needed and can be used
o The need for care that seek to prevent illness o 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 – the background for human interactions o Internal
environment – transforms energy to enable person to
adjust to continuous external environmental changes. o
External environment – involves formal and informal
organizations. Nurse is a part of the patient’s environment.
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
H. Betty Neuman (Neuman system model) 1892
• The Neuman systems model is a unique, open
systemsbased perspective that provides unifying focus of
approaching a wide range of international health concerns.
• Neuman sees each client system as being unique. It is a
combination of characteristics and factors that have created
a range of responses within each patient.
• Its nature focuses on the patient’s mental well-being and the
stressors that major components that affect it. It is made to
treat the optimal stability of a patient.
Metaparadigm
Person – an open system that works together with other parts of
its body as it interacts with the environment.
• A dynamic composite of the interrelationship of five
variables: physiological, psychological, sociocultural,
developmental and spiritual.
• Has protective mechanisms for the basic structure
and maintain client’s system stability: the flexible line
of defense, normal lines of defense and lines of
resistance.
Health – dynamic condition
• Equated with stability of normal line of defense
• Wellness exists when all part or system of person
works harmoniously.
Environment – can be internal, external and created force
(stressors) that interacts with a person’s state of health.
• Has the potential to improve or after stability of
systems
Stressors in Betty Neuman’s Nursing Theory
• Neuman’s definition of a stressor is any phenomenon that
may penetrate a patient’s defensive mechanisms. A
stressor can provide either a positive or a negative
outcome. Neuman identifies three specific types of
stressors that may be present in the environment of a
patient at a given time.
o Intrapersonal stressors – these are the
stressors which occur within a patient
boundary. They will directly correlate with the
internal environment of the patient.
o Interpersonal stressors – these occur outside
of the established patient defensive boundary.
They have a certain proximity to the patient and
will impact, but from an external approach
instead of an internal approach. o
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Extrapersonal stressors – occur with a great
distance than interpersonal stressors.
I. Sister Callista Roy (Roy’s adaption model) 1976
• It presents the person as a holistic adaptive system in constant
interaction with the internal and the external environment.
• The main task of the human system is to maintain integrity in
the face of environmental stimuli.
• The goal of nursing is to foster successful adaption. Adaption
leads to optimal health and well-being, to quality of life and to
death with dignity.
• Adaption refers to “the process and outcome whereby thinking
and feeling persons as individual or in groups, use conscious
awareness and choice to create human environmental
integrations.
• The adaption level represents the condition of the life
processes. Three level are described by Roy: integrated,
compensatory and compromised life process.
• The processes for coping in Roy’s adaption model are further
categorized as “the regulator and cognator subsystems as
they apply to individuals, and the stabilizer and innovator
subsystem as applied to groups.”
• The cognator-regulator and stabilizer-innovator subsystem
function to maintain integrated life processes. These life
processes whether integrated, compensatory or compromised
are manifested in behaviors of the individual or group.
Nature of the theory
• It is a prominent nursing theory.
• It aims to explain or define the provision of nursing science.
• She sees the individual as a set of interrelated systems that
maintain a balance between various stimuli.
Scientific assumptions
• Awareness of self and environment is rooted in thinking and
feeling.
• Humans, by their decision, are accountable for the integration
of creative processes.
• Persons and environment transformations are created in
human consciousness.
Philosophical assumptions
• Persons have mutual relationships with the world and God
• God is intimately revealed in the diversity of creation and is
the common destiny of creation.
• Persons are accountable for the processes of deriving,
sustaining and transforming the universe.
Components of the theory
Person – human systems have thinking and feeling capacities,
rooted in consciousness and meaning by which they adjust
effectively to changes in the environment and, in turn affect the
environment.
- Humans are holistic beings that are in constant
interaction with their environment.
- Uses innate and acquired mechanism to adapt.
- The model includes people as individuals, as well, as
in groups such as families, organizations and
communities.
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
Health – health is not freedom from the inevitability to death,
disease, unhappiness and stress, but the ability to cope with them
in a competent way.
- Health is an inevitable dimension of a person’s life, and
is represented by a health-illness continuum/
- Health is also described as a state of process of being
and becoming integrated and whole.
Environment – conditions, circumstances and influences that
affects the development and behavior of people and groups as an
adaptive system. It is a stimulus or input that requires a person to
adapt.
• Focal stimuli – is the immediate confrontation with the
person’s internal and external environment.
• Contextual – are all stimuli that influence or is present
with the focal stimuli and contribute to its effect.
• Residual stimuli – include the individual’s belief or
attitudes that may influence the situation but whose
effect is unclear.
Nursing – the promotion of adaption for individuals and groups in
each of the four adaptive modes, thus contributing to health,
quality of life and dying with dignity.
Paradigm of the theory
• consider the concept of a system in the context of an
individual.
• Roy’s views the individual from a comprehensive
standpoint.
• Individual parts work together to create a unified being.
Furthermore, as living system, people are constantly in
contact with their surroundings.
J. Dorothy E. Johnson (Behavioral System Model) 1968
• It advocates fostering efficient and effective behavioral
functioning in the patient to prevent illness and stresses the
importance of research-based knowledge about the effect of
nursing care on patients.
• Nursing defined as “an external regulatory force which acts
to preserve the organization and integration of the patients’
behaviors at an optimum level under those conditions in
which the behavior constitutes a threat to the physical or
social health, ow in which illness is found”
• The patient is defined as a behavioral system composed of
seven behavioral subsystems: affiliative, dependency,
ingestive, eliminative, sexual, aggressive and achievement.
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Structure & Function Assumption
• From the form the behaviors takes and the
consequences it achieves can be inferred what ‘drive’
has been stimulated or what ‘goal’ is being sought.
• The individual patient’s behavior produces an outcome
that can be observed.
• 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 choice called of
choices called a “score of action”
System assumption
• There is “organization, interaction, interdependency and
integration of the parts and elements of behaviors that
go to make up the system”
• A behavior system requires and results in regularity and
constancy in behavior, is essential to man. It is
functionally significant because it serves a useful
purpose in social life and the individual.
• System balance reflects adjustments and adaption that
are successful in some way and to some degree.
Three functional requirements for the subsystems
1. The system must be protected from the toxic influences
with which the system cannot cope.
2. Each system has to be nurtured through the input of
appropriate supplies from the environment.
3. The system must be stimulated for use to enhance
growth and prevent stagnation.
7 Behavioral Subsystems
• Attachment or affiliative subsystem o “Social
inclusion intimacy and the formation and attachment of
a strong social bond”
 Probably the most critical, because it forms
the basis for all social organization.
 It provides survival and security. Its
consequences are social inclusion, intimacy
and formation and maintenance of a strong
social bond.
• Dependency subsystem o “Approval, attention
or recognition and physical assistance”
 Promotes helping behavior that calls for a
nurturing response.
 Its consequences are approval, attention or
recognition, and physical assistance.
• Ingestive subsystem o “Emphasis on the
meaning and structures of the social events
surrounding the occasion when the
food is eaten.”
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
 it should not be seen as the input and output
mechanisms of the system.
 The ingestive subsystem “has to do with when,
how, what, how much, and under what
conditions we eat.”
• Eliminative subsystem o “Human cultures
have defined different socially acceptable behaviors for
excretion of waste, but the existence of such a pattern
remains different from the
culture to culture”
 it addresses “when, how, and under what
conditions we eliminate”
 the social and psychological factors influence
the biological aspects of this subsystem and
may conflict with the eliminative subsystem.
• Sexual subsystem o Both a biological and social
factor that affects behavior. o It has the dual functions
of procreation and gratification.
o Including, but not limited to courting and mating, this
response system begins with the development of
gender role identity and includes a broad range of
sex-role behaviors.
• Aggressive subsystem
o Function is protection and preservation.
o It holds that aggressive behavior is not only
learned, but has a primary intent to harm others.
o However, society has placed limits when dealing
with self-protection and that people and their
property be respected and protected.
• Achievement subsystem
o Attempts to manipulate the environment
o Its function is control or mastery of an aspect of
self or environment to some standard of
excellence.
o Areas of achievement behavior include
intellectual, physical, creative, mechanical and
social skills.
Goals of nursing according to behavioral system model:
• 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 form the physician’s knowledge and skill.
• To assist the patient whose behavior does not give
evidence of unnecessary trauma as a consequence of
illness.
Metaparadigm
Person – Johnson views human beings as having two major
systems: the biological system and the behavioral system.
Environment – the environment is not directly defined, but it is
implied to include all elements of the human systems surroundings
and includes interior stressors.
Health - is seen as the opposite of illness, and Johnson defines it
as “some degree of regularity and constancy in behavior”
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Nursing – an external regulatory force that acts to preserve the
organization and integrate the patient’s behavior at an optimal level
under those conditions in which the behavior constitutes a threat to
physical or social health or in which illness is found.
K. Hidegard Peplau (Theory of Interpersonal Relations) 1952
• Peplau’s model for nursing, which helped later nursing theorists
and clinicians develop more therapeutic interventions,
includes seven nursing roles, which show the dynamic
character roles typical in clinical nursing.
Therapeutic nurse-client relationship
• A professional and planned relationship between client and
nurse focuses on the client’s needs, feelings, problems and
ideas. It involves interaction between two or more individual
with a common goal. The attainment of this goal, or any goal,
is achieved through a series of steps following a
sequential pattern
• Hildegard Peplau’s Interpersonal Relations Theory
emphasized the nurse-client relationship as the foundation
of nursing practice. It emphasized the give-and-take of
nurseclient relationships that was seen by many as
revolutionary. Peplau went on to form an interpersonal model
emphasizing the need for a partnership between nurse and
client as opposed to the client passively receiving treatment
and the nurse passively acting out doctor’s orders.
Four Phases of Therapeutic Nurse-Patient Relationship:
1. Orientation Phase o The nurse’s orientation phase
involves engaging the client in treatment, providing
explanations and information and answering questions.
 Problem defining phase
 It starts when the client meets the nurse as a
stranger.
 Defining the problem and deciding the type of
service needed.
 Client seeks assistance, conveys needs, asks
questions, shares preconceptions and
expectations of past experiences.
 Nurse responds, explain roles to the client,
identifies problems and uses available
resources and services.
2. Identification Phase o The identification phase
begins when the client works interdependently with the
nurse, expresses feelings and begins to feel stronger.
 Selection of appropriate
professional assistance.
 Patients begins to have a feeling of belonging
and capability of dealing with the problem,
1.02 THEORETICAL FOUNDATIONS OF NURSING – Mr. Menor
which decreases the feeling of helplessness Health – defined as “a word symbol that implies forward movement
and hopelessness. of personality and other ongoing human processes in the direction
3. Exploitation phase o In the exploitation phase, the of creative, constructive, productive, personal, and community
client makes full use of the services offered. living.”
 In the exploitation phase, the client makes full Environment - Although Peplau does not directly address
use of the services offered. society/environment, she does encourage the nurse to consider the
 Use of professional assistance for patient’s culture and mores when the patient adjusts to the hospital
problemsolving alternatives. routine.
 Advantages of services are used based on the Nursing - Hildegard Peplau considers nursing to be a “significant,
needs and interests of the patients. therapeutic, interpersonal process.” She defines it as a “human
 The individual feels like an integral part of the relationship between an individual who is sick, or in need of health
helping environment. services, and a nurse specially educated to recognize and to
 They may make minor requests or respond to the need for help.”
attentiongetting techniques.
 The principles of interview techniques must be
used to explore, understand and adequately
deal with the underlying problem.
 Patient may fluctuate on independence.
 Nurse must be aware of the various phases of
communication.
 Nurse aids the patient in exploiting all avenues
of help, and progress is made towards the final
step.

Anxiety – was defined as the initial response to a psychic threat.

There are four levels of anxiety described below.

Four Levels of Anxiety

Mild Anxiety - is a positive state of heightened awareness and
sharpened senses, allowing the person to learn new behaviors and
solve problems. The person can take in all available stimuli
(perceptual field).
Moderate Anxiety - involves a decreased perceptual field (focus
on the immediate task only); the person can learn a new behavior
or solve problems only with assistance. Another person can
redirect the person to the task.
Severe Anxiety - involves feelings of dread and terror. The person
cannot be redirected to a task.
Panic Anxiety - can involve loss of rational thought, delusions,
hallucinations, and complete physical immobility and muteness.

Metaparadigm
Person – Peplau defines man as an organism that “strives in its
own way to reduce tension generated by needs” the client is an
individual with a felt need.

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