• Person

THEORETICAL FOUNDATION OF
NURSING: MIDTERM • Environment

• Health

• Nursing
MARTHA ROGERS
IMPLICATIONS OF ROGERS THEORY
"SCIENCE OF UNITARY HUMAN BEINGS"
Nursing Practice
• Martha E. Rogers was born in 1914 in Dallas, Texas.
Evaluative and diagnostic phase includes determining
• She received her nursing diploma from the Knoxville the patients'and their family's wellbeing status at the
General Hospital School of Nursing in 1936. time.

• Rogers died on March 13, 1994. Education

Her publications include: That students have individual personalities and patterns
to their work.
√ Theoretical Basis of Nursing (1970).
Research
√ Nursing Science and Art: A Prospective (1988).
It was found that the theory applies to any environment
√ Nursing: Science of Unitary, Irreducible, Human Beings that contains beings.
Update (1990).

√ Vision of Space Based Nursing (1990).

ANALYSIS OF THE THEORY.
Assumptions:
Clarity - It is difficult-to-understand principles, lack of
1. wholeness operational definitions.
2. openness Simplicity - when the model is examined in total
perspective, some still classify it as complex.
3. Unidirectionality

4. Pattern and Generality - Rogers' conceptual model is abstract and

therefore generalizable and powerful.
5. organization
Importance -Rogers' science has the fundamental intent
6. Sentence and thought of understanding human evolution and its potential for
human betterment.
HOMEODYNAMIC PRINCIPLES

Resonance is an arrangement for human and

environment that undergo transformation.

Helicy is the nature of change is unpredictable, DOROTHEA OREM

continuous and innovative.
"SELF CARE DEFICIT"
Integrality is the energy fields of human and
environment in a continuous mutual process. BACKGROUND:

Roger's theory and nursing metaparadigm:

• Dorothea E. Orem (1914-2007), one of the prime US
theorists born in Baltimore, Maryland.
• Obtain her basic diploma in nursing at School of
Nursing Washington, BSN (1939)and MSN in 1945 from
Catholic University of America, and Doctorate (honorary
Doctorates different Universities).
• She published her theory in 1959 for the first time and
revised in 1971, 1983, 1987, and 2001.
OREM PHILOSOPHY
"Nursing is the ability to care for another human being,
most importantly when they are unable to care for
themselves. The ultimate goal is achieving an optimal
level of health and wellness for our patients". Orem
(1971).
THEORY OF SELF CARE
Self -care comprises the practice of activities that
maturing and mature persons initiate and perform.
The Theory of Self-Care has three components:
1. universal self-care needs - air, food, water, etc.
2. developmental self-care needs -process of growth
and development
3. health deviation - permanently or temporarily alters
structural, physiological or psychological function.
SELF CARE
Self Care Agent - provides the foundation for
understanding the action requirements and action
limitations of persons who may benefit from nursing.
Theory of dependent care - explains' how the self-care
system is modified when it is directed toward a person
who is socially dependent and needs assistance.
Therapeutic self-care demand - is the totality of self-
care actions to be performed for some duration in order
to meet self-care requisites by using valid methods and
related sets of operations and actions.
THEORY OF SELF-CARE DEFICIT
A self-care deficit occurs when an individual cannot
carry out self-care requisites.
Orem Identifies method of helping:
1. Acting for and doing for others
2. Guiding and directing
3. Providing Physical and Psychological support
4. Environment of promoting personal development
5. Teaching
Examples of self-care requisites are:
1. Wound care
2. Activities of Daily Living
3. Bowel program
4. Glucose monitoring
THEORY OF NURSING SYSTEMS
Wholly compensatory support - patient is unable to
complete any self-care independently; hursing
compensates for patient's inability to perform self-care.
Partial compensatory support - patient is able to
perform self-care tasks with partial or no assistance
from nursing.
Supportive/educative compensatory - patient able to
perform tasks independently. Nursing provides ongoing
education and support.
SIGNIFICANCE OF THE THEORY
Research Practice - It has achieved a significant level of
acceptance by the international nursingcommunity.
Education - The SCDNT was introduced as the basic
structure for nursing management in German hospital
DRG (diagnosis-relatedgroup) implementation.
Research - It uses the SCDNT or components,Biggs
(2008) found more than 800 references.
ANALYSIS OF THE THEORY
Clarity- Orem defined the term and elaborated the
substantive structure of the concept in a way that is
unique while also congruent with other interpretations.
Simplicity-Orem's theory is expressed in a limited
number of terms. These terms are defined and used
consistently in the expression of the theory.
Orem's general theory, the SCDNT, comprises the
following four constituent theories: self-care,
dependent-care, self-care deficit, and nursing
systerns Generality - As a general theory, it serves
nurses engaged in nursing practice, in development and
validation of nursing knowledge, and in teaching and
learning nursing.
Accessibility- As a general theory, the SCDNT provides a
descriptive explanation of why persons require nursing
and what processes are needed for the production of
required nursing care.
IMOGENE KING
"GOAL ATTAINMENT THEORY"
• King - born in 1923.
• Bachelor in science of nursing from St. Louis University
in 1948.
• Master of science in nursing from St. Louis University
in 1957.
• Theory describes a dynamic, interpersonal relationship
in which a person grows and develops to attain certain
life goals.
Factors which affects the attainment of goal are:
✓ Roles
✓ Stress
✓ Space
✓ Time
OPEN SYSTEM FRAMEWORK
•Nursing Focus is the care of human being
• Nursing Goal is the health of the individual and health
care for the group • Human Beings are open system in
constant interaction with the environment.
INTERACTING SYSTEMS;
✓ Personal
✓ Interpersonal
✓ Social
ANALYSIS OF THE THEORY
Clarity- Theory of Goal Attainment is the case with
which it can be understood by nurses. Concepts are
concretely defined and illustrated.
Simplicity- King's definitions are clear and are
conceptually derived from research literature.
Generality-It has been criticized for having limited
application in areas of nursing in which patients are
unable to interact competently with the nurse.
Accessibility - A descriptive study was conducted to
identify the characteristics of transaction and whether
nurses made transactions with patients
Importance- middle-range Theory of Goal Attainment
focused on all aspects of the nursing process:
assessment, planning, implementation, and evaluation.
The body of literature clearly establishes King's work as
important for knowledge building in the discipline of
nursing.
MYRA ESTRIN LEVINE
"CONSERVATION MODEL"
• After earning an MS in nursing at Wayne State
University in 1962, she authored 77 published
articles which included"An Introduction to Clinical
Nursing" with multiple publication years in 1969,
1973, and 1989.
• She also received an honorary doctorate from Homeorhesis- is the orchestrated or coordinated control
Loyola University in 1992. in metabolism of body tissues necessary to support a
physiological state.
• She died in 1996.

Nursing's role in conservation is to help the person with

the process of "keeping together" the total person
through the least amount of effort.

Adaptation is the process of change,and conservation is

the outcome of adaptation. Adaptation is the process
whereby the patient maintains integrity within the
realities of the environment.

THREE CHARACTERISTICS OF

ADAPTATION;

1. HISTORICITY- past experience

2. SPECIFICITY- basis of specific genetic structure.

3. REDUNDANCY- fail-safe options available to the

patient.

The physiologic responses that "defend oxygen supply

to the brain are distinct from those that maintain the
appropriate blood glucose levels." (Levine, 1989).

WHOLENESS- the assurance of integrity.

CONSERVATION- "The goal of conservation is health

and the strength to confront disability" as "the rules of
conservation and integrity hold" in all situation in which
nursing is requires".

PERSON- The person is also described as a unique

individual in unity and integrity, feeling, believing,
thinking and whole system of system.

ENVIRONMENT- completes the wholeness of

individual.

INTERNAL ENVIRONMENT

Homeostasis- Stable state normal alterations in

physiologic parameters respond to environmental
changes; an energy sparing state, a state of
conservation.
Three Aspects of Environment Drawn upon Bates'
(1967)
> The perceptual environment consists of information
that is recorded by the sensory organs.
> The operational environment consists of the
undetected natural forces and that impinge on the
individual.
> The conceptual environment is influenced by language,
culture, ideas, and cognition.
disease is "unregulated and undisciplined change and
must be stopped or death will ensue".
Nursing involves engaging in "human interactions"
person and the environment become congruent over
time.
Each individual "is an active participant in interactions
with the environment...constantly seeking information
from it."(Levine, 1969).
Betty Neuman: System Model
• Born in 1924 near Lowell, Ohio.
• Her father was a farmer who became sick and died at
the age of 36.
• Her mother was a self-educated midwife that led the
young Neuman.
• In 1957, she received a baccalaureate degree in public
health and psychology with honors.
✓ Neuman Systems Model as "a unique, open-system-
based perspective that provides a unifying focus for
approaching a wide range of concerns.
✓ Internal and external affects the patient are stressors
✓ The role of the nurse is the to keep the system stable
through out the three level of prevention; primary,
secondary, and tertiary.
Concepts and Definition
Wholistic Approach- Clients are viewed as wholes
whose parts are in dynamic interaction.
Open system- A system is open when there is a
continuous flow ofinput and processes, output, and
feedback.
Function or process- The client as a system exchanges
energy, information,and matter with the environment
as well as other partsand subparts of the system.
Feedback- System output in the form of matter, energy,
andinformation serves as feedback for future input.
Input and output- For the client as a system, input and
output are the matter, energy, and information that are
exchanged.
Client system- The client system is a composite of five
variables(physiological, psychological,
sociocultural,developmental, and spiritual).
5 types of stressor:
> Physiological stressors
> Psychological stressors
> Socio-cultural stressors
> Developmental stressors
> Spiritual stressors
Stressors-Intrapersonal, Interpersonal, Extrapersonal
LEVELS OF PREVENTION AS INTERVENTIONS
Primary prevention occurs before the system reacts to
a stressor; it includes health promotion and wellness
maintenance.
Secondary prevention occurs after the system reacts to
a stressor and is provided in terms of existing symptoms.
Tertiary prevention occurs after the system has been
treated through secondary prevention strategies.
Major Assumptions
• The client system
• Health
• Environment
• Nursing
Sister Callista Roy: Adaptation
Model
• (born October 14, 1939) is a nursing theorist,
professor, and author.
• She is known for her groundbreaking work in creating
the Adaptation Model of Nursing.
• She developed the model's basic concepts while she
was a graduate student at the University of California
from 1964 to 1966.
It inter focuses on persons coping (adaptative) abilities
in response to constantly to changing environment
(Lopes, Pagliuca, Araujo,2006).
Major Concepts and Definition
A system is "a set of parts connected to function as
awhole for some purpose
"Adaptation level represents the condition of the life
processes described on three levels as
integrated,compensatory, and compromised."
Types of Stimuli
Focal Stimulus is the degree of change or stimulus
moreimmediately confronting the person
Contextual Stimuli are present to contribute to the
behavior caused or precipitated by the focal stimuli.
Residual Stimuli are factors that may be affecting
behavior but whose efforts are net validated.
Coping Processes "are innate or acquired ways of
interacting with the changing environment"
Innate Coping Mechanisms Innate coping mechanisms
"are genetically determined or common to the species
and are generally viewed as automaticprocesses;
Acquired coping mechanisms developed through
strategies such as learning. life contribute to customary
responses to particular stimuli".
Four Adaptation Modes
> Physiological mechanism
> Self-concept
> Interdependence
> Role function
Subsystem
Regulator subsystem is a major coping mechanism
which responds physiological adaptive automatically
mode, through responds automatically through neural,
chemical, and endocrine coping processes."
The cognator is a major coping subsystem responds to
complex processes of perception and information
processing, judgement and emotions.
Dorothy Johnson: Behavioral
System Model
•Dorothy Johnson was born on August 21, 1919, in
Savannah, Georgia.
• She was the youngest of seven children
• Due to the Great Depression, she took a vear of from
school to be a governess, or teacher, for two children in
'Miami, Florida.
• Dorothy Johnson's professional, nursing career began
in 1942 when she faduated from Vahderbilt University"
School of Nursing in Nashville,Tennessee.
• Johnson's theory and her related writings reflect her
knowledge about both development and general
systems theories.
4 Goals of Nursing

1. To assist the patient whose behavior is proportional

to social demands.

2. To assist the patient who is able to modify his

behavior in ways that it supports biological imperatives.

3. To assist the patient who is able to benefit to the

fullest extent during illness from the physician's
knowledge and skill.

4. To assist the patient whose behavior does not give

evidence of unnecessary trauma as a consequence of
illness.

Concepts and Definition

A subsystem is "a mini system with its own particular

goal and function that can be maintained. Subsystem
are parts of the behavioral system.

Stressor Internal or external stimuli that produce

tension and result in a degree of instability.

Behavior as expressed by the behavioral and biological

scientists; that is, the output of intraorganismic
structures and processes.

A system is a whole that functions as a whole by virtue

of the interdependence of its parts, that there is
"organization, interaction, interdependency, and
integration of the parts and elements.

A behavioral system is a patterned, repetitive, and

purposeful ways of behaving. These ways of behaving
form an organized and integrated functional unit that
determines and limits the interaction between the
person and his or her environment.

Functional Subsystem.

• Protection

• Nurturance

• Stimulation