SYSTEMS THEORY (BETTY NEUMAN)- SYSTEM MODEL IN NURSING PRACTICE - It includes system variables & behaviors such as the

- It includes system variables & behaviors such as the individual’s usual coping patterns, lifestyles, &
developmental stage
“Health is a condition in which all parts and subparts are in harmony with the whole of the client.” E.) Stressors
• Born in 1924 on a farm near Lowell, Ohio. - Are forces that produce tensions, alterations or a potential problems causing instability with in the client’s
• 1947 - Received RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio system
experience as a hospital, staff, and head nurse; school nurse and industrial nurse; and as a clinical - They may be:
instructor in medical-surgical, critical care and communicable disease nursing 1. Intrapersonal stressors – are those stimuli that occur within the individual
General Information 2. Interpersonal stressors – are those stimuli that occur between individuals
• Person as a complete system, the subparts of which are interrelated physiological, psychological, 3. Extrapersonal stressors – are those stimuli that occur outside the person
sociocultural, spiritual, and developmental factors.” F.) Reaction
• Neuman’s model deals with stress & stress reduction & is primarily concerned with the effects of stress on - Are the outcomes or produced results of certain stressors & actions of the lines of resistance of a client
health - Can be positive or negative depending on the degree of reaction the client produces to adjust & adapt with
METAPARADIGM the situation
Person - Neuman specified these reactions as:
• Is viewed by Neuman as a whole multidimensional, dynamic system * negentropy – is set towards stability or wellness
• Can be an individual, family or group or community * egentropy – is set towards disorganization of the system producing illness
• She sees a person as an open system that works together with other parts of its body as it interact with the G.) Degree of Reaction
environment - Is the amount of energy required for the client to adjust to the stressors
• Is composed of basic core (genetic features, and the strengths and weaknesses of the system parts) as H.) Prevention
well as physiological, sociocultural, developmental & spiritual variables - interventions are purposeful actions to help the client retain, attain & or maintain system stability
Health - Used to attain balance within the continuum of health
• Neuman sees health as being equated with wellness. - These are the actions that generate good results or a re aimed towards hindering negative outcomes
• She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony
with the whole of the client (Neuman, 1995)". 3 Levels of Prevention
• Views health as a continuum of wellness to illness that is dynamic in nature & constantly subject to change 1. Primary Prevention
• “optimal wellness or stability indicates that total system needs are being met” - Refers to intervention before a reaction occurs
• The client is in a dynamic state of either wellness or illness in varying degrees at any given point of time. - Is carried out when a stressor is suspected or identified
Environment - It also aims to strengthen the capacity of a person to maintain an optimum level of functioning while being
• Defined as being all the internal & external factors that surround or interact with person & client interactive with the environment, like health promotion & disease prevention
*internal environment exists within the client system. 2. Secondary Prevention
*external environment exists outside the client system. - Refers to intervention after a reaction occurs
• Includes stressor, described as environmental forces that interact with & potentially alter system stability - Focuses on helping alleviate the actual existing effects of an action that altered that balance of health of a
Nursing person
• Neuman believes nursing is concerned with whole person (holistic approach), an approach that considers - It aims to reduce environmental influences that lead to the decline of the level of functioning of a person &
all factors affecting a client’s health status. strengthening or restoring a person’s resistance after the illness exposure
• Views nursing as a unique profession that is concerned with all of the variables affecting an individual’s Examples: early detection of disease & prompt treatment
response to stress. 3. Tertiary Prevention
• the primary aim is stability of the patient/client system, through nursing interventions to reduce stressors. - Refers to intervention that occurs after the system has been treated through secondary
- Focuses on actual treatments or adjustments to facilitate the strengthening of a person after being
Systems Model in Nursing Practice exposed to a certain or illness
A.) Client Variables - It aims to prevent the reoccurrence of the illness in the manner of rehabilitation, as in the case of disability
- The client variables can be one or combination of the following: avoidance & physical therapy
* physiological , sociocultural, psychological, spiritual & developmental
- These variables function to achieve stability in relation to the environmental stressors experienced by the I.) Reconstitution
client - Is the adjustment state from the degree of reaction
B.) Lines of Resistance - It is a state of going back to the actual state of health before the illness occurred
- Represent the internal factors of a person that help defend against a stressor
- It acts to facilitate coping to overcome the stressors that are present with in the individual
C.) Normal Line of Defense
- Represents a stability state for the individual or system THE BEHAVIORAL SYSTEM MODEL (Dorothy E. Johnson)
- It is maintained overtime & serves as a standard to assess deviations from the client’s usual wellness • Aug. 19, 1919 – Born in Savannah, Georgia
• 1942 – BSN from Vanderbilt University
• 1948 – MSN in Public Health from Harvard
D.) Flexible Line of Defense • 1949 – Faculty at UCLA
- Acts as a protective barrier to prevent stressors from breaking through the normal line of defense • 1977 – Retired in Florida
- Is dynamic and can change rapidly over a short time • Johnson first proposed her model in 1968 to foster the “efficient & effective behavioral functioning in the
- Can be affected by variables such as loss of sleep, that reduce a client’s ability to use a flexible line of patient to prevent illness”
defense against stressors • Stimulus from internal/external nature - stress – conflict or tension - disequilibrium
 • Nursing should facilitate the maintenance of equilibrium by:
> lessen the stimuli
> support normal defenses and adaptive process
• The person experiencing a disease is more important than the disease itself
• Each individual has a focusing and repeating ways of acting which is distinct to the individual.
• The person is a behavioral system comprised of a set of organized, interactive, interdependent, and
integrated subsystems
Metaparadigm
Person- views person as having two major systems: biological and behavioral system.
-As a behavioral system with patterned,repetitive & purposeful ways of behaving that
link the person to the environment
-An individual composed of seven open & interactive subsystems; a disturbance in
one usually affects the others.
-Continually strives to maintain a steady state by adapting & adjusting to
environmental forces that cause an imbalance; when an imbalance or health problem
occurs, the person’s physical, social or psychological integrity is threatened.
Health- A state that is affected by social, biological, psychological, and physiological factors.
-The individual strives to maintain stability in these factors
Environment -Consists of all the factors that are not part of the individual’s behavioral system,
but influence the system, some of which can be manipulated by the nurse to achieve
the health goal for the patient.
-An individual’s behavior is influenced by all the events in the environment. It varies
from culture to culture.
Nursing -Is an external force acting to preserve the organization of the patient’s behavior by
means of imposing regulatory mechanisms or by providing resources while the
patient is under stress
Johnson’s 7 Subsystems
• Attachment or Affiliative Subsystem
- Forms the basis for all social organization
- Promotes survival & provides a sense of security
- Results in social inclusion, intimacy & the formation of strong bonds
• Dependency Subsystem
- promotes helping or nurturing behavior from others
- Results in approval, attention, recognition & physical assistance
• Ingestive Subsystem
- Involves food intake
- Relates to the biological need for food & the psychological meanings & structures of social events
surrounding food consumption
- Results in appetite satisfaction
• Eliminative Subsystem
- involves behavior surrounding the excretion of waste from the body
- Includes the psychological meanings & structures of socially acceptable behaviors for waste elimination
• Sexual Subsystem
- involves behavior associated with procreation & sexual gratification
- includes psychologically & socially acceptable behaviors such as courtship & mating
- results in the development of sex role identity & sex role behavior
• Aggressive Subsystem
- involves behavior related to self- protection & preservation of the self & society
- includes the belief that aggression is learned & harmful & that people & property must be respected &
protected
- includes acknowledgment of realor imaginary dangers todevelop defenses to thesethreats
• Achievement Subsystem
- involves behavior related to manipulation of the environment to gain mastery & control over some
aspectof oneself or environment, this control ismeasured against a standard of excellence
-includes intellectual, physical, creative, mechanical & social skills
3 Functional Requirements of Humans
To be protected from noxious influences with which the person cannot cope
To be nurtured through the input of supplies from the environment
To be stimulated to enhance growth and prevent stagnation
GOAL ATTAINMENT THEORY (IMOGENE KING)
⮚ St. John's Hospital School of Nursing in St. Louis, Missouri (1946)
>St. Louis University
- BS in Nursing Education (1948)
MS in Nursing (1957)
> Teachers College, Columbia University, New York: - EdD (1961)
- Postdoctoral study in research design, statistics, and computers.
Nursing Metaparadigm
PERSON
- Individuals are spiritual being
- have the capacity to think, know, make choices & select alternative courses of action
- have the ability through their language & other symbols to record their history & preserve their culture
- open system in transaction with the environment
unique& holistic, are of intrinsic worth & are capable of rational thinking & decision making in most
situations
- Individuals differ in their needs, wants & goals
3 fundamental health needsof human beings
>Need for information
>Need for care for illness prevention
>Need for total care when a person doesn’t have the capacity to help themselves.
HEALTH
- Is a dynamic state in the life cycle; illness is an interference in the life cycle
- Implies continuous adjustment to stress in the internal and external environments, using personal
resources to achieve optimal daily living
ENVIRONMENT
  >The process of balance involving internal & external interactions inside the social system
>Interpreted from the general systems theory as an open system with permeable boundaries that allow the
exchange of matter, energy, and information
NURSING
- Is an act wherein the nurse interacts & communicates with the client
- The nurse helps the client identify the existing health condition, exploring & agreeing on activities that
promote health
- The goal of the nurse in King’stheory is to help the clientmaintain health through health
promotion& maintenance,restoration & caring for the sick& dying
King's Goal Attainment Theory
>Involves the nurse and the patient mutually communicating information, establishing goals, and taking
action to obtain goals.
 >Two people who are usually strangers come together in a health care organization to help or to be helped 1. The ability to perceive – perceptions will influence behavior and thus life and health.
to a mutual state of health. 2. The ability to think – thinking is based upon the inquiring mind of man.
3. The ability to feel- have emotions.
Central focus of the theory 4. The ability to choose between alternative course of action.
⮚ man as a dynamic human being whose perceptions of objects, persons, and events influence his behavior, 5. The ability to set goals.
social interaction, and health 6. The ability to select means of accomplishing goals.
three basic premises; man is:
1. A reactive being - aware of other things; persons and events in the environment Propositions of King’s Goal Attainment Theory
2. A time oriented being - influenced by time orientation. Each person is influenced by his past actions. 1. If perceptual accuracy is present In nurse-client interactions, transactions will occur.
3. A social being - has a continuous exchange with persons in the environment. Language is a social link 2. If nurse & client make transactions, goals will be attained
and facilitates interpersonal communication. 3. If goals are attained, satisfactions will occur
4. If goals are attained, effective nursing care will occur
3interacting system: 5. If transactions are made in nurse-client interactions, growth & development will be enhanced
6. If role expectations & role performance as perceived by nurse & client are congruent, transactions will
A.PERSONAL SYSTEM – individuals, how the nurse views & integrates self based from personal goals & beliefs occur
Concepts of Personal system: 7. If role conflict is experienced by the nurse & client or both, stress in nurse-client interactions will occur
a.The Individual's Perception--the person's representation of reality and it is unique to each individual 8. If nurses with special knowledge & skills communicate appropriate information to clients, mutual goal
b. Self--The person's subjective environment, values, ideas, attitudes, and commitment. setting & goal attainment will occur
c. Growth and Development--involves all the changes that occur . These change are usually orderly and
predictable, but may vary with individuals.
d. Body Image--The way a person perceive their body . Body image is subjective and changes as the
person changes physically or emotionally. SELF-CARE DEFICIT THEORY (Dorothea E. Orem)
e. Space--is the immediate physical territory occupied by the person and person's behavior. ⬥ Born on 1914 in Baltimore, Maryland
f. Time--is the order of events and their relationship to each other. ⬥ Began her nursing education at Providence Hospital School of Nursing in Washington,DC
⬥ 1939 – she earned her BSN education at the Catholic University of America
⬥ 1946 – earned her M.S.N. from Catholic University of America.
B.INTERPERSONAL SYSTEM - Two or more interacting individuals. ⬥ her nursing experiences included
-How the nurse interrelates with a co-worker or patient, particularly in a nurse-patient relationship a. operating room nursing,
Concepts of Interpersonal system: b. private duty nursing (home & hospital),
a.Interaction – any situation wherein the nurse relates & deals with a patient c. hospital staff nursing on pediatric and adult medical and surgical units,
b.Communication – refers to the transmission of information from one person to another; either directly or d. evening supervisor in the E.R.
indirectly e. biological science teacher
c.Transaction – refers to the interaction between a person & the environment for the purpose of goal ⬥ 1958-1960 curriculum consultant
attainment ⬥ 1959 – “Guides for developing the curricula for the Education of Practical Nurses” was published
d.Role – refers to the expected behaviors of a person in a specific position & to the rules that govern the 1971 – “Nursing Concepts of Practice” which is Orem’s first book was published.
position & affect interaction between two or more persons ⬥ Orem’s theory addresses client’s self-care needs
e.Stress – refers to an exchange of energy, either positive or negative between a person & the ⬥ It is defined as Goal-oriented activities that are set towards generating interest in the part of the client to
environment; objects , persons & events can serve as stressors maintain life & health development
⬥ The theory is aimed towards making the clients perform self-care activities in order to live independently
C.SOCIAL SYSTEM - Composed of larger group of individuals with common interests or goals. METAPARADIGM
-How the nurse interacts with co-workers, superiors, subordinates & the client environment in PERSON
general – Defined as the patient- a being who functions biologically, symbolically & socially & who has the
potential for learning & development
A social system comprises the: – Is an individual subject to the forces of nature, with a capacity for self-knowledge, who can
1.social roles engage in deliberate action, interpret experiences & perform beneficial actions
2.behaviors – Is an individual who can learn to meet self-care requisites; if for some reason, the person cannot
3. practices learn self-care measures, others must provide the care
Concepts of Social System HEALTH
a.Organization – refers to a group of people with similar interest who have prescribed roles & positions & who use -Orem supports the WHO’s definition of health as “the state of physical, mental, and social
resources to achieve personal & organizational goals well-being and not merely the absence of disease or infirmity”.
b.Authority – refers to the observable behavior of providing guidance & order & being responsible for actions -Consists of physical, psychological, interpersonal & social aspects; according to Orem , these
c.Power – is characterized by the ability to use resources for goal achievement; also a means by which one or more aspects are inseparable
persons can influence others. -Includes promotion & maintenance of health, treatment of illness & prevention of complications
d.Status – refers to the position occupied by a person in a group or the position occupied by a group in relation to ENVIRONMENT
other groups in an organization; it is accomplished by certain duties, privileges & obligations – Consists of environmental factors, environmental elements, environmental conditions (external
e.Decision Making – results from developing & acting on perceived choices for goal attainment physical & psychosocial surroundings) & 9developmental environment (promotion of personal
development through motivation to establish appropriate goals & to adjust behavior to meet
6 CHARACTERISTICS OF MAN
 these goals; includes formation of or change in attitudes & values, creativity, self-concept & - requisites that result from illness, injury or disease or its treatment; they include such actions as seeking
physical development) medical assistance, carrying out a prescribed treatment or learning to live with the effects of illness or
NURSING treatment
-helping clients to establish or identify ways to perform self-care activities. - These health care deviations set standards to which the degree of self-care demand is needed.
-Nursing actions are geared towards the independence of the client.
-Nursing is a human service-its focus is on persons with inabilities to maintain continuous Therapeutic Self-Care Demand
provision of healthcare.
-Nursing is based on values ⬥ Refers to all self-care activities required to meet existing self-care requisites
⬥ Involves the use of actions to maintain health & well-being, each patient’s therapeutic self-care demands
Major Concepts & Definitions varies throughout life.
⬥ Self – Care
⬥ Self – Care Requisite THE THEORY OF SELF-CARE DEFICIT
⬥ Universal Self-CareRequisites - which describes & explains why people can be helped through nursing
⬥ Developmental Self – Care Requisites Self-care deficit: arises when the self-care agency cannot meet self-care requisites
⬥ Health Deviation Self – Care Requisites Helping Methods:
⬥ Therapeutic Self – Care Demand 1. Acting or doing for another
⬥ Self-Care Agency 2. Guiding and directing
⬥ Agent 3. Providing physical or psychological support
⬥ Dependent-Care Agent 4. Teaching
⬥ Self-Care Deficit 5. Providing and maintaining an environment that supports personal development
⬥ Nursing Agency
⬥ Nursing Design THEORY OF NURSINGSYSTEMS
⬥ Nursing System - describes and explains relationships that must be brought about & maintained for nursing to be produced
⬥ Helping Methods - refers to the series of actions a nurse takes to meet a patient’s self-care requisites
Nursing Agency: set of established capabilities of a nurse who can legitimately perform activities of care for a client.
Self-care deficit theory as a general theory is composed of 3 related theories: - Helps a person achieve their health care demand.
1. THE THEORY OF SELF-CARE Nursing Design: these are professional functions that must be performed by the nurse in order to meet client’s needs
- Describes why & how people care for themselves - it serves as a guideline of needed & foreseen results in the production of nursing toward the
Self- Care: refers to those activities an individual performs independently throughout life to promote & achievement of nursing goals
maintain personal well-being
Self- Care agency: the complex acquired ability of mature & maturing persons to know & meet their 3 Types of Nursing Systems:
continuing requirements for deliberate, purposive action to regulate their own functioning & development 1. A wholly compensatory nursing system
- consists of two agents: An agent (individual who is engage in meeting the need of a person; - is used when a patient’s self-care agency is so limited that the patient depends on others for well-being
like bridges that facilitate what has been done and what needs to be done) 2. A partly compensatory nursing system
❖ self-care agent – person who provides the self-care - is used when a patient can meet some self-care requisites but needs a nurse to help meet others
❖ Dependent care agent – person other than the individual who provides cares - the nurse & the patient play major roles in performing self-care
Self-care requisites or Self-care needs: are insights of actions or requirements that a person must be able 3. Supportive – Educative Nursing System
to meet and perform in order to achieve well-being. - is used when a patient can meet self-care requisites but needs assistance with decision making,
behavior control or knowledge acquisition skills
Categories of Self-care requisites:
A.Universal Self-care requisites Major Assumptions
- These are universally set goals that must be undertaken in order for an individual to function in 1. Human beings require continuous, deliberate inputs to themselves and their environments to remain alive
scope of healthy living and function in accordance with natural human endowments.
1. Maintenance of sufficient intake of air. 2. Human agency, the power to act deliberately, is exercised in the form of care for self and others in
2. Maintenance of sufficient intake of food. identifying needs and making needed inputs.
3. Maintenance of sufficient intake of water. 3. Mature human beings experience privations in the form of limitations for action in care for self and others
4. Provision of care associated with elimination. involving and making of life sustaining and function-regulating inputs.
5. Maintenance of balance between activity and rest. 4. Human agency is exercised in discovering, developing, and transmitting ways and means to identify needs
6. Maintenance of balance between solitude and social interaction. and make inputs to self and others.
7. Prevention of hazards to human life, human functioning and human well-being; 5. Groups of human beings with structured relationship cluster tasks and allocate responsibilities for providing
8. Promotion of human functioning and development. care to group members who experience privations for making required, deliberate input to self and others.
B. Developmental Self-care requisites
- result from maturation or associated with conditions or events such as adjusting to a change in body Acceptance by the Nursing Community
image or loss of a spouse ⬥ Practice - The first documented use of Orem’s theory as the basis for structuring practice is found in
- they promote processes for life & maturation & prevent conditions deleterious to maturation or those that descriptions of nurse-managed clinics at John Hopkins Hospital in 1973.
lessens those effects Research articles on the use of SCDNT or components in clinical practice include
a. Teaching self-care to individuals with DM,ESRD, hemodialysis, peritoneal dialysis, renal transplant
C. Health deviation self-care requisites b. Pain assessment
 c. Cardiac research
d. Oncology – focus cancer prevention, self-care after being diagnosed with malignancies.
e. Psychiatry etc..
⬥ Education - “Guides for Developing Curriculum for the Education of Practical Nurses”
Orem worked on a book“Foundations of Nursing Practice”
⬥ Research - First instrument to measure the exercise of Self-care agency (ESCA) was published in 1979
ADAPTATION MODEL (Sr. CallistaRoy)
◻ born on October 14, 1939 in Los Angeles California
◻ She is a nurse theorist and a professor
◻ She is a fellow in the American Academy of Nursing, an honorary nursing society that elects nursing
leaders annually
◻ Has numerous publications, including books & journal articles on nursing theory & other professional topics
METAPARADIGM
◻ PERSON
🞑 Is the recipient of nursing care; main focus of nursing
🞑 A biopsychosocial being in constant interaction with a changing environment.
🞑 The person is an open adaptive system who uses coping skills to deal with stressors.
🞑 It includes people as individuals or in groups (families, organizations, communities, nations &
society as a whole)
🞑 An adaptive system has cognator and regulator subsystems to maintain the 4 adaptive modes.
◻ ENVIRONMENT
🞑 Conditions, circumstances and influences that surround and affect the development and
behavior of the person.
🞑 Consists of internal & external environments, which provide input in the form of stimuli
🞑 Stressors are stimuli that are significant in human adaptation: stages of development, family &
culture
◻ HEALTH
🞑 Was originally described by Roy as a health-illness continuum; health & illness were considered
an inevitable dimension of the person’s life
🞑 More recently, Health is the process of being and becoming an integrated and whole person.
🞑 Is it a reflection of adaptation that is the interaction of the person & the environment
🞑 Adaptation is defined as the process and outcome whereby thinking and feeling, as individuals
and groups, use conscious awareness and choice to create human and environmental
integration.
◻ NURSING
🞑 Nursing is the science and practice that expands adaptive abilities and enhances person and
environment transformation.
🞑 Roy’s goal of nursing is the promotion of adaptation in each of the 4 modes thus contributing to
health, quality of life and dying with dignity
🞑 Nursing is about the increase, enhancement, modification and alteration of the stimulus to
achieve adaptation.
THE KEY CONCEPTS:
◻ The person is adapting in a stable interaction with the environment, either internal or external.
◻ The environment serves as the source of a range of stimuli that will either threaten or promote the
person’s unique wholeness.
◻ The person’s major task is to maintain integrity in face of these stimuli.
INTEGRITY - the degree of wholeness achieved by adapting to changes in needs.
◻ SYSTEM – is a set of parts connected to function as a whole for some purpose & that does so by
virtue of the interdependence of its parts
- Roy considers the recipient of care to be an open adaptive system
- react & interact with other systems in the environment
- have boundaries that are flexible & open to permit interaction with other systems
- employ a feedback cycle of input, throughput & output
Input – defined as stimuli which can come from the environment or from within a person
Throughput – makes use of a person’s processes & effectors
Processes refer to the control mechanisms that a person uses as an adaptive system
Effectors refer to the physiologic function, self-concept & role function involves in
adaptation
Output – is the outcome of the system, when the system is a person, the output refers to the
person’s behaviors
Categories of Output:
❖ Adaptive responses – those that promote integrity in terms of the goals of the human system
❖ Ineffective responses – those that do not contribute to integrity in terms of the goals of the
human system
The three types of stimuli act together and influence the adaptation level which is defined as the ability to respond
positively in a situation.
a. FOCAL – the internal or external stimulus most immediately confronting the person, it attracts the
most attention.
b. CONTEXTUAL – all other stimuli present in the situation that strengthens/contribute the effect of the
focal stimulus.
c. RESIDUAL - those stimuli that can affect the focal stimulus but the effects are unclear.
COPING MECHANISM AND CONTROL PROCESSESS
Coping mechanism – are the processes that a person uses for self-control
- are innate or acquired ways of interacting with the changing environment
- innate coping mechanisms are genetically determined or common to the species & are genetically viewed
as automatic process
-acquired coping mechanisms are developed through strategies such as learning
◻ REGULATOR SUBSYSTEM - major coping process involving the neural, chemical, and endocrine system
◻ COGNATOR SUBSYSTEM – is a major coping process involving four cognitive-emotive channels:
perceptual & information processing; learning; judgment & emotion
◻ CONTROL PROCESSES – stabilizer subsystem & innovator subsystem
❖ Stabilizer subsystem – analogous to regulator : concerned with stability
❖ Innovator subsystem – analogous to cognator:: concerned with creativity, change & growth
ADAPTATION LEVEL
1. Integrated - Adaptation level at which the structures and functions of a life process are working as a whole to meet
human needs.
2. Compensatory - Adaptation level at which the cognator and regulator have been activated by a challenge to the
integrated life processes
3. Compromised- Adaptation level resulting from inadequate integrated and compensatory life processes; adaptation
problem.
◻ ADAPTIVE MODES – are categories of behavior to adapt to stimuli
- can be used to determine a person’s adaptation level
- can be used to identify adaptive or ineffective responses by observing a person’s behavior in relation to
the adaptive modes
1. PHYSIOLOGICAL – the way a person responds as a physical being to stimuli from the environment.
🞑 GOAL: Physiological Integrity
🞑 Five Physiologic Needs: oxygenation, nutrition, activity & rest & protection
🞑 Four Complex Processes: senses; fluids, electrolytes & acid-base balance; neurologic function;
endocrine function
2. SELF-CONCEPT – GROUP IDENTITY MODE - focuses specifically on the psychological & spiritual aspects of the
human system
 Self- concept – defined as the composite of beliefs & feelings about oneself at a given time & is formed 6. EVALUATION
from internal perceptions of other’s reaction ◻ Judging the effectiveness of the nursing intervention in relation to the behavior after it was performed in
Two components: comparison with the goal established.
1. physical self (body sensation and body image)
2. personal self (self consistency, self ideal, and moral ethical spiritual self)

Group Identity – reflects how people in groups perceive themselves based on environmental feedback TFN FINALS HANDOUT
- comprised of interpersonal relationships, group self-image & culture
GOAL: Psychological Integrity FAYE ABDELLAH- TWENTY ONE NURSING PROBLEMS
- Born on March 13, 1919 in New York City
3. ROLE FUNCTION MODE – a role is a set of expectations about how a person occupying one’s position behaves. - Began her nursing career in 1942 when she received her diploma in nursing from Fitkin Memorial
◻ GOAL: Social Integrity Hospital school of Nursing in Neptune, New Jersey
- Roles are carried out with both instrumental behaviors (the actual physical performance of a - BSN – 1945, MA-1947 , doctoral of Education -1955 from Teacher's College, Columbia University,
behavior) and expressive behaviors ( are the feelings, attitudes, likes or dislikes that a person has about a New York CityBecame the 1st nurse & 1st woman to serve as Deputy Surgeon General of the United
role or about the performance of a role) States
- Persons perform primary, secondary & tertiary roles - Was inducted into the US National Women’s Hall of Fame in 2000 due to her contributions in the field
❖ Primary – determines the majority of behavior engaged in by the person during a particular period of life of Education & Nursing
❖ Secondary – are those that a person assumes to complete the task associated with a developmental stage - She was motivated to develop her typology by a desire to promote comprehensive, client-centered
& primary role nursing care – she used the problem solving approach as basis for her typology
❖ Tertiary – related primarily to secondary roles & represent ways in which individuals meet their role - Her typology of Nursing problems was 1st published in 1960 in Patient Centered Approaches in
associated obligations Nursing
- temporary in nature, freely chosen by the individual
METAPARADIGM ON NURSING
4. INTERDEPENDENCE MODE– focuses on close relationships which results to giving & receiving of love, respect, PERSON
value, nurturing, knowledge, skills, commitments, material possessions, time & talents Is the recipient of nursing care
- Occurs between the person and the most significant other or between the person and the One who has physical, emotional or sociological needs, helping a person with these needs is
support system. nursing’s only justfication
◻ GOAL: Affectional Adequacy. According to Abdellah: the typology of nursing problems evolve from the recognition of a need
for patient-centered approaches to nursing
POINTS TO REMEMBER Includes families as well as individuals
Is capable of learning & of self-help to varying degrees
◻ Adaptive or ineffective responses result from the 4 modes of coping mechanisms.
◻ Adaptive responses support the integrity of the person and the goals of adaptation. HEALTH
◻ Ineffective responses neither promote integrity nor contribute to the goals of adaptation. Defined as the center & purpose of nursing services
She speaks to a “total health needs” & a “healthy state of mind & body”
NURSING PROCESS Viewed as a state that excludes illness
A problem-solving approach for gathering data, identifying the capacities and needs of the human adaptive Can also be described as a state in which the person has no unmet needs & no anticipated or
system, selecting and implementing approaches for nursing care, and evaluation of the outcome of care actual impairments
provided. ENVIRONMENT
Least discussed concept in Abdellah’s model
6 STEPS in the NURSING PROCESS Includes the atmosphere of a client’s room, home & community
1. ASSESSMENT OF BEHAVIOR NURSING
Data gathering about the behavior of the person as an adaptive system in each of the adaptive modes. Is a helping profession
❑ Observable behavior: vital signs Considers nursing to be an all-inclusive service that is based on the disciplines of art & science
❑ Non-observable behavior: feelings experienced by the person (anxiety) that serves individuals sick or well, cope with their health needs
2. ASSESSMENT OF STIMULI Uses the nursing process, a problem-solving approach
◻ A STIMULUS is defined as any change in the internal and external environment that induces a response in Can use the 21 nursing problems as a guide from nursing care
the adaptive system. It is classified as focal, contextual or residual.
◻ In this level of assessment, the nurse analyzes the subjective and objective behaviors and look more General Information
deeply for possible causes of a particular set of behaviors. - A theoretical statement from Abdellah’s works can be created by utilizing her 3 chief concepts of
3. NURSING DIAGNOSIS Health, Nursing Problems, and Problem Solving
◻ Formulation of statements that interpret data about the adaptation on status of the person, including the - Abdellah’s theory proposes that nursing is the “utilization of the problem-solving techniques with chief
behavior and the most relevant stimuli. nursing problems related to the health requirements of clients.
4. GOAL SETTING - It gives much importance to problem-solving as medium for the nursing problems as the client is
◻ Establishment of clear statements of the behavioral outcomes for nursing care which is realistic and geared in the direction of health, which is the outcome
attainable. This is done together with the client.
5. INTERVENTION NURSING PROBLEMS
◻ Determination of how best to assist the person in attaining the established goals.
 - A Nursing Problem is defined as any condition presented or faced by a client or family for which a
nurse can offer assistance
Health needs are seen as problems, which may be:
A.) overt – obvious or can be seen condition
B.) covert – unseen or masked one
- According to Abdellah, the practice of competent nursing care in the future is for the nursing student to
realize that identifying & answering overt & covert nursing problems is the core of Nursing
- The Typology of 21 Nursing Problems: the identification & classification of problems
- Abdellah’s typology as divided into three areas:
a.) physical, sociological & emotional needs of the patient
b.) types of interpersonal relationships between the nurse & the patient
c.) common elements of patient care
TYPOLOGY OF 21 NURSING PROBLEMS
- To maintain good hygiene & physical comfort
- To promote optimal activity: exercise, rest, sleep
- To promote safety through prevention of accident, injury or other trauma & through the prevention of
the spread of infection
- To maintain good body mechanics & prevent & correct deformity
- To facilitate the maintenance of a supply of oxygen to all body cells.
- To facilitate the maintenance of nutrition of all body cells
- To facilitate the maintenance of elimination.
- To facilitate the maintenance of fluid & electrolyte balance
- To recognize the physiological responses of the body to disease conditions – pathological,
physiological & compensatory
- To facilitate the maintenance of regulatory mechanisms & functions
- To facilitate the maintenance of sensory function.
- To identify & accept positive & negative expression, feelings & reactions.
- To identify & accept interrelatedness of emotions & organic illness
- To facilitate the maintenance of effective verbal & nonverbal communication.
- To promote the development of productive interpersonal relationships
- To facilitate progress toward achievement & personal spiritual goals
- To create or maintain a therapeutic environment
- To facilitate awareness of self as individual with varying physical, emotional & developmental needs
- To accept the optimum possible goals in the light of limitations, physical & emotional
- To use community resources as an aid in resolving problems arising from illness
- To understand the role of social problems as influencing factors in the cause of illness
PROBLEM SOLVING
- The process of identifying overt & covert nursing problems & interpeting, analyzing & selecting
appropriate actions to solve these problems
- The steps resemble the pace of the Nursing process of Assessment, Diagnosis, Planning,
Implementation & Evaluation
The Problem Solving Process includes:
- Identifying the problem
- Selecting relevant data
- Devising hypotheses
- Testing hypotheses through the assessment of data
- Revising hypotheses when necessary on the basis of conclusions obtained from the data
MARGARET JEAN WATSON - PHILOSOPHY AND SCIENCE OF CARING
Born in Southern West Virginia
1964 – BSN in Colorado
1966 – MS in Psychiatric – Mental Health Nsg
1973 – PhD in Educational Psychology
PERSON - Human being to be valued, cared for, respected, nurtured, understood and assisted
Must be viewed according to the client’s development & the conflicts arising in this development
ENVIRONMENT - Defined as society with all its influences
It provides the values that determine how one should behave and what goals one should strive
toward.
Encompasses social, cultural & spiritual aspect
HEALTH - Refers to unity & harmony with in the mind, body & soul
Watson, in addition to WHO’s definition, include these three elements:
A higher level of over-all physical, mental & social functioning
A general adaptive- maintenance level of daily functioning; and
The absence of illness (or the presence of efforts that lead to its absence)
NURSING - Providing holistic health care
A human science of people & human health-illness experiences that are mediated by
professional, personal, scientific, aesthetic & ethical human care transactions
Major Assumptions
Caring can be demonstrated and practiced only interpersonally
Caring consists of carative factors that result in the satisfaction of certain human needs
Effective caring promotes health & individual or family growth
A caring environment accepts a person as he is and looks to what the person may become
A caring environment offers development of potential while allowing the person to choose the best action
for himself/herself at a given time
Caring is more “healthogenic” than is curing. The practice of caring integrates biophysical knowledge with
knowledge of human behavior to generate or promote health & to provide ministrations of those
who are ill. A science of caring is therefore complementary to the science of curing
Caring is central to nursing
CARATIVE FACTORS
CARATIVE – means caring with LOVE ; originated from the term “ caritas” which means to
cherish , appreciate and give special attention ; serve as GUIDE for the CORE OF NURSING
.
Watson’s 10 Carative Factors
1. Forming humanistic-altruistic value system
Occurs early in life with values shared by parents but can be greatly influenced by nursing
educators
Mediated through one’s own life experiences
Provides satisfaction through giving & extending oneself
2. Instillation of faith-hope
Describes the nurse’s role in developing effective nurse-patient interrelationships& in promoting wellness
Is accomplished by helping a client adopt health seeking behaviors, by positively using the powers of
suggestion & positively supporting the client
3. Cultivating sensitivity to self and others
The recognition of feelings leads to self-actualization through self-acceptance for both the nurse & the
patient
As Nurses acknowledge their sensitivity & feelings, they become more genuine, authentic & sensitive
to others
4. Development of a helping-trust relationship
Establishes rapport & caring
Helps promote expression of positive & negative feelings
Is accomplished through congruence, empathy, nonpossesive warmth, & effective communication
5. Promotion & acceptance of the expression of positive & negative feelings
Involves sharing of feelings
Includes being prepared for negative as well as positive feelings
6. Systematic use of the scientific problem-solving method for decision making
Scientific problem solving method allows for control and prediction and permits self correction
7. Promotion of interpersonal teaching-learning
Gives a client maximum health control because it provides information & alternatives
Distinguishes caring from curing by assigning responsibility for health to the client
 Enables a client to provide self-care, determine personal needs & provide opportunities for their
personal growth
8. Provision for supportive, protective & corrective mental, physical, sociocultural & spiritual environment
Involves assessing & facilitating a client’s coping abilities to support & protect mental & physical well-being
Requires understanding that a person’s environment includes internal & external independent variables
Includes providing comfort, privacy, safety & a clean, aesthetic surroundings
9. Assisting with gratification of human needs
Addresses the needs of both the nurse & the client
Requires meeting lower-order needs before attaining higher-order needs
10. Allowance for existential-phenomenological forces
Permits one to understand people from the way things appear to them; their experiences shape their
individual perceptions
Leads to better understanding of oneself & of others
MADELEINE LEININGER - CULTURE CARE DIVERSITY AND UNIVERSALITY THEORY
1948 - Diploma in Nursing from St. Anthony’s School of Nursing, Denver
1950 - BS in Biological Science from Benedictine College, Atchison, Kansas
1953 - MSN from Catholic University, Washington, D.C.
1965 - Ph.D. in Anthropology from U of Seattle
1966 - offered first course in transcultural nursing at the U of Colorado
A major contributor to other schools in transcultural nursing curriculum
Developed her theory, Culture Care Diversity and Universality from a combination of anthropology & nursing beliefs &
principles
1985 - first published her theory in Nursing Science Quarterly
1988 - further explained her theory in same journal
1991 - published her book Culture Care Diversity and Universality: A Theory of Nursing
Leininger’s Definition of Theory
Defines theory differently from other nursing theorists
Theory is a systematic and creative way to discover knowledge about something or to account for some
vaguely know phenomenon
Nursing theory must take into account the cultural beliefs, caring, behaviors, and values of individuals,
families, and groups to provide effective, satisfying, and culturally congruent nursing care
METAPARADIGM
PERSON
Is referred to as a human being
Is caring and capable of being concerned about desires, welfare and continued existence of others;
although care of human beings is universal, ways of caring vary across cultures
ENVIRONMENT
Environmental framework – the totality of an event, situation, or experience that gives meaning to human
expressions, interpretations & social interactions particularly physical, ecological & sociopolitical &/or
cultural settings
Culture – centers on groups and the patterning of actions, thoughts and decisions that occurs as the result
of “learned, shared and transmitted values, beliefs, norms and lifeways”.
HEALTH
Is viewed as a state of well-being that is culturally defined, valued, & practiced and reflects the ability of
individuals or groups to perform their daily roles
Includes health systems, health care practices, health patterns, and health promotion & maintenance
Is universal across cultures but distinct with in each culture in a way that represents the beliefs, values &
practices of the particular culture….health is both universal & diverse
NURSING
Is defined as a learned humanistic art & science that focuses on personalized behaviors, functions, &
processes to promote and maintain health or recovery from illness
Uses 3 modes of action that are culturally-based & thus consistent with the needs & values of the client to
deliver care in the manner best suited to a client’s culture
Cultural care preservation/maintenance
Cultural care accommodation/negotiation
Cultural care repatterning/restructuring
Culture Care Diversity and Universality Theory
- Leininger presented her assumptions which support her claim that “ different cultures perceive, know
& practice care in different ways, yet there are some commonalities about care among all cultures of
the world”
- Based on transcultural nursing model
- Transcultural nursing: a learned branch of nursing that focuses on the comparative study & analysis
of cultures as they apply to nursing and health-illness practices, beliefs, and values
- Goal of Transcultural Nursing: to provide care that is congruent with cultural values, beliefs, and
practices
CarE
- Refers to assisting, supporting, or enabling behaviors that ease or improve a person’s condition
- Is essential for a person’s survival, development, and ability to deal with life’s events
- Has different meanings in different cultures which can be determined by examining the group’s view
of the world, social structure, and language
Caring
- Refers to actions & activities directed toward assisting, supporting or enabling another individual or
group with evident or anticipated needs to improve the human condition either to recover or face
death.
Culture
- Refers to the learned, shared & transmitted values, beliefs, norms & lifeways of a particular
- Guides thinking, decisions, and actions in specific ways
- Provides the basis for cultural values, which identify ways of thinking or acting
- These values are usually held for a long time and help guide decision-making in the culture
- Cultures exhibit both diversity and universality
- Diversity - perceiving, knowing, and practicing care in different ways
- Universality - commonalities of care
Cultural Care
- The subjectively and objectively obtained values, beliefs, and outlines of the lifeways that assist,
support, facilitate, or empower another individual/group to maintain well-being, health and deal with
illness, handicaps or death.
- Cultural care diversity: different meanings, patterns, values, beliefs or symbols of care within concepts
that are related in supporting, assisting humna care(such a role of sick person)
- Cultural care universality: commonalities or similarities in meanings, patterns, values, beliefs, or
symbols of care that is observed among many cultures & reflect assistive ways to help people
World View
- Refers to the outlook of a person or group on the world or their universe to form a picture or a value
perception about their life or world around them
- Consists of social structure and environmental context
- Social Structure: organizational factors of a particular culture (e.g., religion, economics, education),
and how these factors give meaning and order to the culture
- Environmental Context: refers to the totality of an event, situation, or experience that give meaning to
human expressions, interpretations & social interactions particularly physical, ecological, sociopolitical
& or cultural settings
Ethnohistory
- Past facts, events and experiences of individuals, groups, and various cultures and institutions that
are mainly people-centered and that explains, interprets human lifeways within particular cultural
trends.
Generic (Folk or Lay) Care System
- Refers to culturally learned & transmitted , indigenous (or traditional) folk (community & home based)
knowledge & skills used to provide assistive, supportive, enabling acts toward another individual,
group or institution with evident needs to improve a human lifeway or health condition (well-being) or
to deal with handicaps & death situations
Professional Care System
 - Refers to formally taught, learned & transmitted professional care, health, illness, wellness & related Benner's Stages of Clinical Competence (1984; 2004)
knowledge & practice skills that prevail in professional institutions usually with multidisciplinary 1. Novice - no experience of the situations in which they are expected to perform
personnel to give service to others - Learn context-free rules to guide action (stimulus-response thinking)
3 Modes of Nursing Action - Rule-governed behavior is typical, tends to be inflexible
1. Cultural care preservation or maintenance - Has difficulty discriminating between relevant & irrelevant aspects of a situation
- refers to those assistive, supporting, facilitative or enabling professional actions & decisions
that help people of a particular culture to retain and/or preserve relevant care values so that they can 2. Advance beginner - Can demonstrate marginally acceptable performance
maintain their well-being, recover from illness or face handicaps and/or death - Have begun to identify recurring meaningful situational aspects and apply these in new
2. Cultural care accommodation or negotiation situations
- refers to those assistive, supporting, facilitative or enabling professional actions & decisions - Unable to see the entirety of a new situation (may miss some critical details)
that help people of a designated culture to adapt to or to negotiate with others for a beneficial or satisfying - They feel more responsible for managing patient care, yet they still rely on the help of those
health outcome with professional care providers who have more experienced-
3. Cultural care restructuring or repatterning 3. Competent - Considers consistency, predictability & time management as essential components & gaining a
- refers to those assistive, supporting, facilitative or enabling professional actions & decisions sense of mastery
that help clients change or greatly modify their lifeways for new, different & beneficial health care patterns - There is an increased level of efficiency but the focus is on time management & the nurses
while respecting the client’s cultural values & beliefs & still providing a beneficial or healthier lifeway before organization of the task are more important rather than on timing in relation to the patient’s
the changes were laid out with the clients needs
- This stage is critical because the nurse must know how to recognize the patterns & identify
which element of the situation needs attention & which ones to ignore
PATRICIA BENNER - FROM NOVICE TO EXPERT: EXCELLENCE AND POWER IN CLINICAL NURSING 4. Proficient - Perceives situations as wholes rather than in terms of aspects
PRACTICE - Performance is guided by maxims (cryptic instructions that make sense only if there is already
- Patricia Benner, R.N., Ph.D., F.A.A.N. a deep understanding of the situation)
- Professor, University of California-San Francisco - Perception is a key word
-  obtained a Bachelor of Arts degree from Pasadena College in 1964 -Possesses a web of perspectives on a situation
- Earned a master’s degree in nursing from the University of California, San Francisco Schoolof -demonstrate an increased confidence in their knowledge & abilities
Nursing in 1970 5. Expert - - No longer relies on an analytic principle (rule, guideline, maxim) to connect understanding of a
situation to appropriate action
- She published From Novice to Expert in 1984 and became a Fellow in the American Academy of
- Operates from a deep understanding of the total situation
Nursing in 1985. - Possessing an intuitive grasp of the problem
- There is a qualitative change as the expert performer “knows the patient”, which means that
METAPARADIGM knowing typical patterns of responses & knowing the patient as a person
- Key aspects of the expert nurse practice:
Person ⮚ Demonstrating a clinical grasp and resource-based practice
- “ a self-interpreting being, that is, the person does not come into the world predefined but gets defined ⮚ Possessing embodied knowledge
in the course of living a life. ⮚ Seeing the big picture
- “ has an effortless and non-reflective understanding of the self in the world “ ⮚ Seeing the unexpected
- The four major aspects of understanding that the person must deal with:
a. The role of the situation SEVEN DOMAINS OF NURSING PRACTICE
b. The role of the body - Helping role
c. The role of personal concerns - Diagnostic client-monitoring function
d. The role of temporality. - Effective management of rapidly changing situations
- Administering & monitoring therapeutic interventions & regimens
Health - Monitoring & ensuring quality health care practices
- Health – what can be assessed - Organizational & work-role performance
- Well-being – human experience of health or wholeness. - Teaching or coaching function
- Illness – the human experience of loss or dysfunction.
- Disease – is what can be assessed at the physical level
Environment
- She used the word situation because it suggests a social environment with social definition and
meaning.
- Situation – defined by the person’s engaged interaction, interpretation and understanding of the
situation.
- Persons enter into situations with their own sets of meaning, habits & persperctives
Nursing
- She described nursing as a caring relationship, an “enabling condition of connection and concern.
- Viewed nursing practice as the care and study of the lived experience of health, illness, and disease
and the relationships among these three elements