TFN WEEK 8
holistic to wholistic in the second edition.
BETTY NEUMAN : SYSTEM MODEL
- Betty Neuman was born in 1924 (Ohio).
- Baccalaureate degree in public health
and psychology with honors (1957);
- MA in mental health, public health
consultation (1966), (UCLA)
- PhD in clinical psychology at Pacific
Western University in 1985
NEUMAN’S SYSTEM MODEL
- is a unique, open systems-based
perspective that provides a unifying
focus for approaching a wide range of
concerns.
- A system acts as a boundary for a single
client, a group, or even a number of
groups; it can also be defined as a social
issue.
- A client system in interaction with the
environment delineates the domain of
nursing concerns.
- Focuses on different stressors patients
have and ways to relieve the stress from
the different stressors.
- How patients may react to stress
- The role of the nurse is to keep the
system stable throughout the 3 levels of
prevention: Primary, Secondary, and
Tertiary.
MAJOR CONCEPTS & DEFINITIONS:
● Wholistic Approach -Clients are
viewed as wholes whose parts are in
dynamic interaction.
- The model considers all variables
simultaneously affecting the client
system: physiological, psychological,
sociocultural, developmental, and
spiritual.
- She changed the spelling of the term
● Function of Process- The client as a
system exchanges energy, information,
and matter with the environment as well
as other parts and subparts of the
system as it uses available energy
resources to move toward stability and
wholeness
● Open System-there is a continuous flow
of input and processes, output, and
feedback. Stress and reaction to stress
are basic components of an open
system
● Input and Output -are the matter,
energy, and information that are
exchanged between the client and the
environment
● Feedback -output in the form of matter,
energy, and information serves as future
input for corrective action to change,
enhance, or stabilize the system
● Negentropy-The process of energy
conservation that assists the system in
the progression toward stability or
wellness is negentropy
● Stability-Stability is a dynamic and
desirable state of balance in which
energy exchanges can take place
without disruption of the character of the
system, which points toward optimal
health and integrity
● Environment-Internal and external
forces surrounding the client, influencing
and being influenced by the client, at
any point in time.
● Created Environment - developed
unconsciously by the client to express
system wholeness symbolically. Its
purpose is to provide protection for the
client’s system functioning and to
insulate the client from stressors.
● Client System - a composite of five
variables (physiological, psychological,
sociocultural developmental, and
spiritual) in interaction with the
environment.
● Basic Structure-The client as a system
is composed of a central core
surrounded by concentric rings.
● Lines of Resistance-rings represent
resource factors that help the client
defend against a stressor; serve as
protection factors that are activated by
stressors penetrating the normal line of
defense
● Normal Line of Defense-It represents
the adaptational level of health
developed over the course of time and
serves as the standard by which to
measure wellness devi ation
● Flexible Line of Defense- It is
perceived as serving as a protective
buffer for preventing stressors from
 breaking through the usual wellness
state as represented by the normal line
of defense.
● Health- a continuum of wellness to
illness that is dynamic in nature. Optimal
wellness exists when the total system
needs are being completely met;
● Wellness- exists when all system
subparts interact in harmony with the
whole system and all system needs are
being met
● Illness- exists at the opposite end of the
continuum from wellness and represents
a state of instability and energy
depletion
● Stressors- are tension-producing stimuli
that have the potential to disrupt system
stability, leading to an outcome that may
be positive or negative Stressors may
arise from the following:
- Intrapersonal Forces
- Interpersonal Forces
- Extrapersonal Forces
● Degree of Reaction- The degree of
reaction represents system instability
that occurs when stressors invade the
normal line of defense
● Prevention As Intervention-
Interventions are purposeful actions to
help the client retain, attain, or maintain
system stability. They can occur before
or after protective lines of defense and
resistance are penetrated. Interventions
are based on the possible or actual
degree of reaction, resources, goals,
and anticipated outcomes.
Neuman identifies three levels of
intervention: (1) primary, (2)
secondary, and (3) tertiary
- Primary Prevention- used
when a stressor is suspected or
identified. A reaction has not yet
occurred, The purpose is to
reduce the possibility of
encounter with the stressor or to
decrease the possibility of a
reaction.
- Secondary Prevention-
involves interventions or
treatment initiated after
symptoms from stress have
occurred.
- Tertiary Prevention- occurs
after the active treatment or
secondary prevention stage. It
focuses on readjustment toward
optimal client system stability.
The goal is to maintain optimal
wellness by preventing the
recurrence of reactions or
regression.
METAPARADIGM
PERSON
- “the client” ( individual, family, group,
community, or social issue). The client
system is a dynamic composite of
interrelationships among physiological,
psychological, sociocultural,
developmental, and spiritual factors
HEALTH
- a continuum of wellness to illness that is
dynamic in nature and is constantly
changing. “Optimal wellness or stability
indicates that total system needs are
being met. A reduced state of wellness
is the result of unmet systemic needs
ENVIRONMENT
- all the internal and external factors that
surround and influence the client
system. Stressors (intrapersonal,
interpersonal, and extrapersonal) are
significant to the concept of environment
and are described as environmental
forces that interact with and potentially
alter system stability
NURSING
- is concerned with the whole person. She
views nursing as a “unique profession in
that it is concerned with all of the
variables affecting an individual’s
response to stress”
EXAMPLE:
1. Health teaching on proper nutrition and exercise
2. Immunization
3. Pap Smear
4. Case Finding
5. Blood examination of cholesterol every 6 months
6. Advising the client to quit smoking in order to
prevent respiratory diseases
7. Speech therapy after throat surgery
8. Conducting a seminar for dietary modifications
9. Rang-of-motion exercises for a post- accident
patient
10. Handwashing teaching among patients
SISTER CALLISTA ROY: ADAPTATION
MODEL
- “God is intimately revealed in the diversity of
creation and is the common destiny of creation;
persons use human creative abilities of
awareness, enlightenment, and faith; and
persons are accountable for the process of
deriving, sustaining, and transforming the
universe”
- a member of the Sisters of Saint Joseph of
Carondelet, was born on October 14, 1939, in LA
- She received a bachelor’s degree in nursing in
1963 from Mount Saint Mary’s College in Los
Angeles and a master’s degree in nursing from
the University of California, Los Angeles, in 1966.
- After earning her nursing degrees, Roy began
her education in sociology, receiving both a
master’s degree in sociology in 1973 and a
doctorate degree in sociology in 1977 from the
University of California.
- While working toward her master’s degree, Roy
was challenged in a seminar with Dorothy E.
Johnson to develop a conceptual model for
nursing. While working as a pediatric staff nurse,
Roy noticed the great resiliency of children and
their ability to adapt in response to major
physical and psychological changes
- Roy explained that adaptation occurs when
people respond positively to environmental
changes, and it is the process and outcome of
individuals and groups who use conscious
awareness, self-reflection, and choice to create
human and environmental integration.
MAJOR CONCEPTS AND DEFINITIONS:
● System - A system is “a set of parts
connected to function as a whole for
some purpose and that does so by virtue
of the interdependence of its parts”
● Adaptation Level -“A constantly
changing point, made up of focal,
contextual, and residual stimuli, which
represent the person’s own standard of
the range of stimuli to which one can
respond with ordinary adaptive
responses”
● Adaptation problems- are “broad areas
of concern related to adaptation. These
describe the difficulties related to the
indicators of positive adaptation”
● Focal stimulus -the focal stimulus is the
internal or external stimulus most
immediately confronting the human
system”
● Contextual stimuli -“Are all other
stimuli present in the situation that
contribute to the effect of the focal
stimulus”
● Residual Stimuli -“Are environmental
factors within or without the human
system with effects in the current
situation that are unclear”
EXAMPLE:
Group of young women contemplating smoking
cessation
Focal Stimuli: Nicotine Addiction
Contextual Stimuli: Belief that smoking is enjoyable,
makes them feel good, relaxes them, brings them a
sense of comfort, and is part of their routine Residual
Stimuli: Beliefs and attitudes about their body image
and that smoking cessation causes weight gain
● Coping Processes -“Are innate or
acquired ways of interacting with the
changing environment”
● Initiate Coping Mechanism - are
genetically determined or common to the
species and are generally viewed as
automatic processes
● Acquired Coping Mechanisms -“Are
developed through strategies such as
learning. The experiences encountered
throughout life contribute to customary
responses to particular stimuli
● Regular Subsystem
- Regulator is “a major coping
process involving the neural,
chemical, and endocrine
systems”
● Cognator Subsytem
- Cognator is “a major coping
process involving four
cognitive-emotive channels:
perceptual and information
processing, learning, judgment,
and emotion”
 2. Assesses the stimuli for those behaviors and
categorizes them as focal, contextual, or
4 HUMAN ADAPTIVE SYSTEM residual stimuli
3. Makes a statement or nursing diagnosis of
the person’s adaptive state
- The purpose of the four adaptive modes is to achieve 4. Set goals to promote adaptation
physiological, psychological, and social integrity. The
person as a whole is made up of six subsystems.
5. Implements interventions aimed at managing
These subsystems (the regulator, the cognator, and
the stimuli to promote adaptation
the four adaptive modes) are interrelated to form a
6. Evaluates whether the adaptive goals have
complex system for the purpose of adaptation.
been met By manipulating the stimuli and not
Relationships among the four adaptive modes occur
the patient, the nurse enhances “the
when internal and external stimuli affect more than one
interaction of the person with their
mode, when disruptive behavior occurs in more than
environment, thereby promoting health”
one mode, or when one mode becomes the focal,
contextual, or residual stimulus for another mode.
DOROTHY JOHNSON : BEHAVIORAL SYSTEM
MODEL
METAPARADIGM

PERSON
- Humans are holistic, adaptive systems.
“As an adaptive system, the human
system is described as a whole with
parts that function as unity for some
purpose. Human systems include people
as individuals or in groups, including
families, organizations, communities,
and society as a whole”;

HEALTH
- “Health is a state and a process of being
and becoming integrated and a whole
person. It is a reflection of adaptation,
that is, the interaction of the person and
the environment. Roy derived this
definition from the thought that
adaptation is a process of promoting
physiological, psychological, and social
integrity, and that integrity implies an
unimpaired condition leading to
completeness or unity.
ENVIRONMENT
- Environment -According to Roy, the
environment is “all the conditions,
circumstances, and influences
surrounding and affecting the
development and behavior of persons or
groups, with particular consideration of
the mutuality of person and earth
resources that includes focal, contextual,
and residual stimuli” “It is the changing
environment [that] stimulates the person
to make adaptive responses”
NURSING
- nursing broadly as a “health care
profession that focuses on human life
processes and patterns and emphasizes
the promotion of health for individuals,
families, groups, and society as a whole”
ROY 6 STEPS OF THE NURSING PROCESS
1. Assesses the behaviors manifested from the
four adaptive modes
CONCEPTS AND DEFINITION
● Equilibrium - Johnson stated that
equilibrium is a key concept in nursing’s
specific goal. It is defined as “a
stabilized but more or less transitory,
resting state in which the individual is in
harmony with himself and with his
environment”
“It implies that biological and
psychological forces are in balance with
each other and with impinging social
forces”
● Functional
Requirements/SustenalImperatives
-For the subsystems to develop and
maintain stability, each must have a
constant supply of function
requirements. The environment supplies
sustenalimperatives such as protection,
nurturance, and stimulation. Johnson
notes that the biological system and all
other living systems have the same
requirements.
● Regulation/Control -The interrelated
behavioral subsystems must be
regulated in some fashion so that its
goals can be realized. Regulation
implies that deviations will be detected
and corrected. Feedback is, therefore, a
requirement of effective control.
 ● Tension a state of being stretched or - aims to maintain and restore the
strained and can be viewed as an person’s behavioral system balance and
end-product of a disturbance in stability or to help the person achieve a
more optimum level of balance and
equilibrium.
functioning.
- Constructive in adaptive change or
- Destructive in inefficient use of
energy, hindering adaptation and
causing potential structural damage
(Johnson, 1961a).
- Tension is the cue to a disturbance

in equilibrium.

● Stressor -Internal or external stimuli

that produce tension and result in a
degree of instability are called
stressors.
- “Stimuli may be positive in that
they are present; or negative in
that something desired or
required is absent.

METAPARADIGM

PERSON

- Person-Johnson (1980) viewed the.

person as a behavioral system with
patterned, repetitive, and purposeful
ways of behaving that link the person
with the environment.
- She also acknowledged that prior
experience, learning, and physical and
social stimuli also influence behavior
- She noted that a prerequisite to using
this model is the ability to look at a
person as a behavioral system, observe
a collection of behavioral subsystems,
and be knowledgeable about the
physiologic, psychological, and
sociocultural factors operating outside
them

HEALTH

- as an elusive, dynamic state influenced

by biological, psychological, and social
factors; reflected by the organization,
interaction, interdependence, and
integration of the subsystems of the
behavioral system.
- An individual attempts to achieve a
balance in this system, which will lead to
functional behavior.

ENVIRONMENT

- consists of all the factors that are not

part of the individual’s behavioral
system, but that influence the system.

NURSING