THEORETICAL

FOUNDATION
OF NURSING
Introduction
Opening Prayer
GENTLE
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Thank you!
DIRECTIONS
I. INTRODUCTION
II. ACHIEVEMENT OF ILO
THROUGH LECTURE
DISCUSSION OF SELECTED
NURSING THEORIES
III. CLARIFICATIONS OF THE
REQUIREMENTS
IV. NCM 110 MIDTERM EXAM
SCHEDULE
 V. Different Views of Person, Health,
Environment and Nursing by Various
Nursing Theorists
LESSON OUTLINE & TOPIC OUTLINE TARGET
SCHEDULES DATES
Lesson 1
A.Grand Theories &
WEEK 1
Conceptual Models in the
SEPTEMBER
Integrative – Interactive
21-25
Paradigm and Human Needs
 
1. Dorothea Orem
WEEK 2
2. Sr. Callista Roy
SEPTEMBER
3. Imogene King
28 –
4. Dorothy Johnson
OCTOBER 2
5. Betty Neuman
 
6. Myra Estrine Levine
 V. Different Views of Person, Health, Environment and
Nursing by Various Nursing Theorists
LESSON TOPIC OUTLINE
Lesson 2
TARGET DATES

OUTLINE & B. Grand Theories & Conceptual Models in

the Unitary – Transformative Paradigm
SCHEDULES 7. Martha Rogers
8. Rosemarie Rizzo Parse
WEEK 3
OCTOBER 5-9
C. Grand Theories about Care or Caring  
9. Madeline Leininger WEEK 4
D. Middle-Range Theories OCTOBER
10.Hildegard Peplau 12-16
11.Ida Jean Orlando
12.Joyce Travelbee
NOTE: VIDEO-CONFERENCE MIGHT BE SCHEDULED ON
WEEK 3 & 4. YOU WILL BE INFORMED SOON AT OUR
OFFICIAL GROUP CHAT. KEEP POSTED!
MIDTERM EXAM: OCTOBER 17, 2020 (10:00AM-12:00NN)
Intended
Learning Given actual clinical settings, the Level I
students will be able to:
Outcomes 1.Identify the highlights of the theorist’s
biography including her career path and the
development of her theory.
2.Determine the purpose of the theory
developed in nursing.
3.Create mnemonics or acronyms that will show
the highlights of the theory to facilitate faster
memory and easier.
4.Synthesize the theory through developing a
concise description of the theory.
5.Explain the application of the theory in the
nursing situations.
 Main Topics for Week 1
and 2:
A.Grand Theories & Conceptual Models in the
Integrative – Interactive Paradigm and Human
Needs
1.Dorothy Johnson
2.Imogene King
3.Myra Estrine Levine
4.Betty Neuman
5.Dorothea Orem
6.Sr. Callista Roy
Different Views of Person,
Health, Environment and
Nursing by Various Nursing
Theorists
 Grand Theories & Conceptual Models in the Integrative – Interactive
Paradigm and Human Needs
• WHO ARE THEY: Dorothy Johnson, Imogene King, Myra Estrin Lavine, Betty Neuman,
Dorothea Orem, and Sr. Calista Roy
• WHY?
 Their theories view persons as integrated wholes or integrated systems interacting with the larger environmental
system. The integrated dimensions of the person are influenced by environmental factors leading to some change
that impacts health or well-being. The subjectivity of the person and the multidimensional nature of any outcome are
considered. Most of the theories are based explicitly on a systems perspective. (Smith and Parker, 2015)
 The theories are also focused on human needs since the theories typically considered clients as biopsychosocial beings
who are the sum of their parts, who are experiencing disease or trauma, and who need nursing care. Further, clients
are thought of as mechanistic beings, and if the correct information can be gathered, the cause or source of their
problems can be discerned and measured. At that point, interventions can be prescribed that will be effective in
meeting their needs (Ewen and Wills, 2014).
 Dorothea Orem
Self Care Deficit Nursing Theory
DOROTHEA OREM: Who is she???
 Born: 1914, Baltimore,
Maryland.
 Father: construction, fishing
 Mother: homemaker , reading
 Youngest of two girls
 Died: June 22, 2007
Education
 Degrees:
 Diploma (1930's), Providence Hospital School of Nursing, Washington DC
 BSN Ed. (1939) and MSN Ed. (1945), Catholic University of America, Washington DC.
 Honorary Doctorates:
 Doctor of Science (1976) Georgetown University, (1980) Incarnate Word College in San
Antonio, Texas

 Doctor of Humane Letters (1988) Illinois Wesleyan University, Bloomington, Illinois

 Doctor of Nursing Honoris Causae, (1998) University of Missouri-Columbia
Special Awards
 Catholic University of America Alumni Achievement
Award for Nursing Theory (1980)
 Linda Richards Award, National League for Nursing
(1991)
 Honorary Fellow of the American Academy of Nursing
(1992).
Nursing Experiences
 OR nurse
 Hospital staff nurse (pedia & adult MS units)
 Private duty nurse
 Night supervisor in the ER
 Biological science teacher
 Professor of nursing education
Nursing Experiences
1940 – 49 = directorship: both nursing school and
department at Providence Hospital, Detroit
 1949 – 57(Indiana) = Division of Hospital and institutional
Services (Indiana State Board of Health)
1957 –curriculum consultant: Office of Education, US
DHEW
1958 – 60 = project (Guides for Developing Curricula for the
Education of Practical Nurses)
CUA
 Member of the Nursing Models Committee (CUA)
 Improvement in Nursing Group
 1971 – Nursing: Concepts of Practice
Her Story
…she was asked a substantive question and didn’t
have an answer because she “had no
conceptualization of nursing” (McLaughlin-
Renpenning & Taylor, 2002, p. xii).
she noted (Indiana University) that nurses had
 difficulty articulatingneeds to hospital administrators in
the face of demands made upon them regarding such
issues as length of stay, scheduling admissions and
discharges, etc.
Her Thoughts
What is nursing?”

“What is the domain and what are the

boundaries of nursing as a field of
practice and a field of knowledge?”
Orem (cited in Fawcett 2005)
commented that the task required
identification of the domain and
boundaries of nursing as a science and
an art (1978).
Theoretical Sources
 Orem says her ideas are primarily the result of
reflecting upon her experiences and she was not
influenced by any one person (Hartweg, 1991).
 Parsons’ structure of social action
 Von Bertalnfy’s System Theory
 Eugenia K. Spalding = a friend and teacher
 Other nursing theorists
 Moderate realism (Kantian Philosophy)
 Assumptions
1. Human beings require continuous, deliberate
inputs to themselves and their environments to
remain alive and function according to their capacity.
2. Human agency is exercised in the form of care for
self and others in identifying and meeting needs.
3. Mature human beings experience privations in the
form of limitations for action and care for self and
others involving life-sustaining and function
regulating inputs.
Assumptions
4. Human agency is exercised in discovering, developing,
and transmitting ways and means to identify needs and
make inputs to self and others.
5. Groups of human beings with structured relationships of
clustered tasks and allocate responsibilities for providing
care to group members who experience privations for
making required deliberate input to self and others.
Orem’s General Theory of Nursing
Three Interrelated Theories:
1. Theory of Self-Care = why and how people care
for themselves
2. Theory of Self-Care Deficit = why people can
be helped through nursing
3. Theory of Nursing Systems = describes and
explains relationships that must be made and
maintained for nursing to be produced
Theory no. 1: Self-Care Theory
 Based on the concepts of:
 SELF-CARE
 SELF-CARE AGENCY
 SELF-CARE REQUISITES
 THERAPEUTIC SELF-CARE
DEMAND
Self Care Theory Concepts
Self Care
 Definition: the
performance of activities
that individuals initiate
and perform on their
behalf to maintain life,
health, and well-being.
Self Care Theory Concepts
Self-Care Agency
 Definition: the individual’s ability to perform
self-care activities
 Consists of TWO agents:
 Self-care Agent - person who provides the self-care
 Dependent Care Agent - person other than the
individual who provides the care (such as a parent)
 Affected by basic conditioning factors
Basic Resource
Resource
Age
Age

Conditionin
Adequacy
Adequacy Gender
Gender
and
and Ability
Ability

g Factors Environ-
Environ-
mental
mental
Develop-
Develop-
mental
mental State
State
Factors
Factors
Self-
Care
Agency
Patterns
Patterns Health
Health
of
of living
living State
State

Family
Family Socio-
Socio-
system
system cultural
cultural
factors
factors Health-
Health- Factors
Factors
care
care
system
system
factors
factors
Self Care Theory Concepts
Self-Care Requisites
 Definition: reasons for which self-care is done; these express
the intended or desired results
 Consists of THREE categories:
 Universal - requisites/needs that are common to all individuals (e.g.
air, water, food, elimination, rest, activity, etc.)
 Developmental - needs resulting from maturation or develop due to a
condition or event (e.g. adjustment to new job, puberty)
 Health Deviation - needs resulting from illness, injury & disease or its
treatment (e.g. learning to walk with crutches after a leg fracture)
Self Care Theory Concepts
Therapeutic Self-Care Demand
 Definition: the totality of “care measures” necessary
at specific times or over a duration of time for meeting an
individuals self-care requisites by using appropriate methods
and related sets and actions.”

Therapeutic
Care Care
Self Care
measures measures
Demand
Theory #2: Self-Care Deficit Nursing Theory

“The condition that validates the existence of a

requirement for nursing in an adult is the
health associated absence of the ability to
maintain continuously the amount and quality of
therapeutic self-care in sustaining life and
health, in recovering from disease or injury, or in
coping with their effects.”
 Self-Care Deficit Nursing Theory
FOR CHILDREN:

“…the condition is the inability of

the parent (or guardian)
associated with the child’s health
state to maintain continuously for
the child the amount and quality of
therapeutic care.”
Self-Care Deficit Nursing Theory
Is the central focus of Orem’s grand theory of nursing
Nursing is required when adults (parent/guardian) are
incapable of or limited in their ability to provide continuous
effective self-care.
Describesand explains how people can be helped
through nursing
Nursing meets these self-care needs through five
methods of help
Five Methods of Nursing Help

1. Acting or doing for another

2. Guiding and directing
3. Providing physical or psychological support
4. Providing and maintaining an environment that supports
personal development
5. Teaching
Theory #3: Theory of Nursing Systems
 This describes:
 How the patient’s self care needs will be met by the nurse , the patient,
or both
 Nursing responsibilities
 Roles of the nurse and patient
 Rationales for the nurse-patient relationship
 Types of actions needed to meet the patient’s demands
 Designed by the nurse
 Based on the assessment of patient’s ability to perform self-
care activities
The Nursing Agency Concept
Acomplex property of people
educated and trained as nurses
that enables them to act, to know,
and to help others meet their
therapeutic self-care demands by
exercising or developing their own
self-care agency.
Three Classifications of Nursing Systems
1. Wholly Compensatory: a patient’s self-care agency is so
limited that s/he depends on others for well-being.
a. Unable to engage in any form of action (e.g. coma)
b. Aware and who may be able to make observations or judgments, and
decisions about self-care but cannot/should not perform actions
requiring ambulation and manipulative movements (e.g. patients
with C3-C4 vertebral fractures)
c. Unable to attend to themselves and make reasonable judgments about
self-care but who can be ambulatory and able to perform some self-
care with guidance (e.g. severely mentally retarded)
Wholly Compensatory Nursing System
Accomplishes
patient’s Patient action
therapeutic self- limited
care

Compensates for
patient’s inability
Nurse Action
to engage in self-
care

Supports and
protects patient
Three Classifications of Nursing
Systems
2.Partly Compensatory: a patient can meet
some self-care requisites but needs a nurse to
help meet others; either the nurse or the
patient have the major role in the
performance of self-care
 E.g. a patient with recent abdominal
surgery
Partly Compensatory Nursing System
Performs some self-care
measures for patient
Compensates for self-care
limitations of patient
Nurse action
Assists patient as required

Regulates self-care agency

Performs some self-care

Patient Action agency
Accepts care and
assistance from nurse
Three Classifications of Nursing Systems
3.Supportive-educative: a patient can meet self-care
requisites but needs help in decision-making,
behavior control, or knowledge acquisition; the
nurse’s role is to promote the patient as a self-care
agent (teacher/consultant)
 E.g. a 16-year-old who is requesting birth
control information
Supportive-Educative Nursing System
Accomplishes self-
care

Patient action
Regulates the
exercise and
development of
self-care agency
Nurse action
Orem’s General Theory of Nursing
Self
care

Conditioning factors
R R
Conditioning factors

Self
Care / R Therapeutic
Dep. Self care
demands
Care
Agency
Deficit

R R
Conditioning

Nursing
factors

Agency
Nursing’s Metaparadigm - PERSON
 “…an integrated whole • Reflects
composed of an internal Man
physical, psychologic, and
social nature with varying • Symbolizes
experiences
degrees of self-care ability Is
(1971 def.)” (Chinn &
Kramer, 2004) • Uses symbols in
communication
Unique
Nursing’s Metaparadigm - PERSON
 The recipient of nursing care
 A being who functions biologically, symbolically, and socially
 Has the potential for learning & development
 Is subject to the forces of nature
 Has a capacity for self-knowledge
 Can engage in deliberate actions, interpret experiences, and

perform beneficial actions

 Can learn to meet self-care needs (requisites)
 also referred to as individual, patient, multiperson unit, self-care
agent, dependent-care agent
Nursing’s Metaparadigm - ENVIRONMENT

“…prevailing internal and external conditions in some

time and place frame of reference.”
encompassed by two dimensions ---
 Environmental: physical, chemical and biologic features
 atmosphere, pollutants, weather conditions, pets, infectious organisms, etc.
 Developmental: socioeconomic features
 family & community
 gender and age roles, cultural roles, and cultural prescriptions of authority
Nursing’s Metaparadigm - ENVIRONMENT
terms used are
environment and
environment
features
physical,
chemical and socioeconomi
biologic c features
features
Orem’s Theory & Nursing’s Metaparadigm - HEALTH

 “a state of physical, mental, and

social well-being, and not merely
the absence of disease or infirmity”
 a state of well-being, which refers
to a person’s perceived condition of
existence, characterized by
experiences of contentment,
pleasure, happiness, and movement
toward self ideals and continuing
personalization
Nursing’s Metaparadigm - HEALTH
Includes promotion & Promotion,
Treatment,
maintenance of health, treatment Prevention
of disease and prevention of Wholistic
WHO
complications well-being

also referred toas health, health

state, and well- being Health
Nursing’s Metaparadigm - NURSING
“an art through which the
practitioner of nursing gives
specialized assistance to persons
with disabilities of such a character
that greater than ordinary
assistance is necessary to meet daily Human service
needs for self care and to
intelligently participate in the Providing self-
medical care they are receiving care/assistance
from the physician”
Components of NURSING
 NURSING ART
 The intellectual quality of nurses which allows them to make creative
investigations, analyses, and syntheses of variables and conditioning factors
in nursing situations
 NURSING PRUDENCE
 The quality that enables the nurse to seek advice in new or difficult situations,
to make correct judgments, to decide to act in a particular manner, and/or to
act
 NURSING SERVICE
 A human service that focuses on a person’s inabilities to maintain health care
 NURSING AGENCY
Orem’s Nursing Process
Consists of 3 steps:
 Step 1: determine why a patient needs care
 Step 2: design a nursing system & plan the delivery
of care
 Step 3: management of nursing systems - planning,
initiating, & controlling nursing actions
OREM’S THEORY APPLIED
CASE STUDY
For Mrs. Yamson
She came to the hospital with complaints of pain over all the joints, stiffness which
is more in the morning and reduces by the activities.
She has these complaints since 5 years and has taken treatment from local hospital.
Thesymptoms were not reducing and came to –MJ Santos Hospital for further
management.
Patientwas able to do the ADL by herself but the way she performed and the posture
she used was making her prone to develop the complications of the disease.
She also was malnourished and was not having awareness about the deficiencies
and effects.
APPLICATION OF OREM’S THEORY
Areas Patient details
Name Mrs. Yamson
Age 56 years
Sex Female
Education No formal education
Occupation House hold
Marital status Married
Religion Hindu
Diagnosis Rheumatoid arthritis
Theory applied  Orem’s theory of self
care deficit.
BASIC CONDITIONING FACTORS
Age 56 year
Gender Female
Health state Disability due to health condition,
therapeutic self care demand
Development state Ego integrity vs despair
Sociocultural orientation No formal education, Indian, Hindu
Health care system Institutional health care
Family system Married, husband working
Patterns of living At home with partner
Environment Rural area, items for ADL not in easy reach,
no special precautions to prevent injuries
Resources Husband, daughter, sister’s son
UNIVERSAL SELF-CARE REQUISITES
Air

Water

Food

Elimination

Activity/
rest

Social
interaction
Prevention
of hazards

Promotion
of normalcy
DEVELOPMENTAL SELF-CARE REQUISITES

Maintenance of
 developmental environment

Prevention/management of the
conditions threatening the normal
development
UNIVERSAL SELF-CARE REQUISITES
Air Breaths without difficulty, no pallor cyanosis
Water Fluid intake is sufficient. Edema present over ankles.
Turgor normal for the age
Food Hb – 9.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious.
Elimination Voids and eliminates bowel without difficulty.
Activity/ rest Frequent rest is required due to pain.
Pain not completely relieved,
Activity level ha s come down.
Deformity of the joint secondary to the disease process and use of the joints.
Social Communicates well with neighbors and calls the daughter by phone Need for medical care is
interaction communicated to the daughter.
Prevention of Need instruction on care of joints and prevention of falls.  Need instruction on improvement of
hazards nutritional status. Prefer to walk bare foot.

Promotion of Has good relation with daughter

normalcy
DEVELOPMENTAL SELF-CARE REQUISITES

Maintenance of Able to feed self , Difficult to

 developmental environment perform the dressing,
toileting etc

Prevention/management of the Feels that the problems are due

conditions threatening the normal to her own behaviors and
development discusses the problems with
husband and daughter.
HEALTH DEVIATION SELF CARE
REQUISITES

Adherence to medical regimen

Awareness of potential problem associated

with the regimen

Modification of self image to incorporates

changes in health status

Adjustment of lifestyle to accommodate

changes in the health status and medical
regimen.
 HEALTH DEVIATION SELF
CARE REQUISITES
Adherence to medical
regimen
Awareness of potential problem
associated with the regimen
Modification of self image to
incorporates changes in health
status
Adjustment of lifestyle to
accommodate changes in the
health status and medical regimen.
Reports the problems to the physician when in the hospital. Cooperates with
the medication, Not much aware about the use and side effects of
medicines
Not aware about the actual disease process.  
Not compliant with the diet and prevention of hazards. Not aware about the
side effects of the medications
Has adapted to limitation in mobility.
 
The adoption of new ways for activities leads to deformities and
progression of the disease.
Adjusted with the deformities.
Pain tolerance not achieved
MEDICAL PROBLEM AND PLAN
Physician’s perspective of the condition:
Diagnosed with rheumatoid arthritis and is on the following
medications:
T. Valus SR OD
T. Pan 40 mg OD
T. Tramazac 50 mg OD

T. Recofix Forte BD

T. Shelcal BD

 Syp. Heamup 2tsp TID

Medical Diagnosis: Rheumatoid arthritis
Medical Treatment: Medication and physical therapy.
AREAS AND PRIORITY ACCORDING TO
OREM’S THEORY OF SELF-CARE DEFICIT
A
A
ir
ir
Water
Water

Food
Food

Elimination
Elimination

Activity/
Activity/ Rest
Rest

Solitude/
Solitude/ Interaction
Interaction

Prevention
Prevention of
of hazards
hazards

Promotion
Promotion of
of normalcy
normalcy

Maintain
Maintain a
a developmental
developmental environment.
environment.

Prevent
Prevent or
or manage
manage the
the developmental
developmental threats
threats

Maintenance
Maintenance of
of health
health status
status

Awareness
Awareness and
and management
management of
of the
the disease
disease process.
process.

Adherence
Adherence to
to the
the medical
medical regimen
regimen

Awareness
Awareness of
of potential
potential problem.
problem.

Modify
Modify self
self image
image

Adjust
Adjust life
life style
style to
to accommodate
accommodate health
health status
status
Area of Inadequacy!!!!
Air Breaths without difficulty, no pallor cyanosis
Water Fluid intake is sufficient. Edema present over ankles.
Turgor normal for the age
Food Hb – 9.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious.
Elimination Voids and eliminates bowel without difficulty.
Activity/ Frequent rest is required due to pain.
rest Pain not completely relieved,
Activity level ha s come down.
Deformity of the joint secondary to the disease process and use of the joints.
Social Communicates well with neighbors and calls the daughter by phone Need for
interaction medical care is communicated to the daughter.
Prevention Need instruction on care of joints and prevention of falls.  Need instruction on
of hazards improvement of nutritional status. Prefer to walk bare foot.

Promotion Has good relation with daughter

of normalcy
NURSING CARE PLAN
 Therapeutic self care
demand: Deficient area:
food

 Adequacy of self care

agency: Inadequate
NURSING DIAGNOSIS
 Inabilityto maintain the ideal nutrition
related to inadequate intake and knowledge
deficit
 OUTCOMES AND PLAN
Outcome:
improved nutrition
Maintenance of a balanced diet with adequate iron supplementation.
Nursing Goals and objectives
Goal: to achieve optimal levels of nutrition.
Objectives: Mrs. Yamson will:  
 state the importance of maintaining a balanced diet.  
 List the food items rich in iron , that are available in the locality.

Design of the nursing system:

supportive educative
Method of helping:
guidance

Support

Teaching

Providing developmental environment

IMPLEMENTATION
 Mutually planned and
identified the objectives
and the patient were made
to understand about the
required changes in the
behavior to have the
requisites met.
EVALUATION
 Mrs. Yamson understood the importance of maintaining
an optimum nutrition.  
 She verbalized that she will select the iron rich diet for her
food. 
 She listed the foods that are rich in iron and that are
locally available.  
 The self care deficit in terms of food is decreased with the
initiation of the nutritional intake.
 The supportive educative system was useful for Mrs.
Yamson .
CONCLUSION???
Betty Neuman’s
Systems Model
 Unique focus of Neuman systems model
according to Betty Neuman, (2001)
 
 "The Neuman system model reflects nursing's interest in well
and ill people as holistic systems and in environmental
influences on health.  Clients' and nurses' perceptions of
stressors and resources are emphasized, and clients act in
partnership with nurses to set goals and identify relevant
prevention interventions. The individual, family or other
group, community or social issues, all are client systems
which are viewed as composites of interacting physiological,
psychological, sociocultural, developmental and spiritual
variables".  
 What shaped Betty Neuman
    Born in 1924 on a farm in rural Ohio - this background helped
her develop compassion for those in need.
 
Education
• 1947- RN from diploma program in OH  
• 1957-BSN, UCLA mental health & public health
• 1966-MSN, UCLA
• 1967-1973, UCLA faculty.
• Developed first community
      mental health program for
      graduate students at UCLA.
• 1985- PhD Western Pacific University-clinical
psychology.
History of the Neuman's Systems Model
•  Developed in 1970 as a teaching
       tool to integrate four variables of
       man.
•  1974 - published and classified as a   
       systems model called "The Betty
       Neuman Health-Care Systems
       Model: A Total Approach to Patient
       Problems"
 
•  Published first book detailing NSM in 1982.  Notable
change: "patient" now referred to as "client"
•  The Neuman Systems Model, 2nd ed.,1989. Spiritual
variable added to diagram as fifth variable.   
•  3rd, 4th & 5th editions of The Neuman Systems Model
published in 1995, 2002 & 2010
 
Who and what influenced the NSM?
• The writings of philospher de Chardin on the wholeness
of life.
• Marxist Cornu's views on the oneness of man and
nature.
• Gestalts theories on the interaction between man and the
environment.
• Von Bertalannfy's, Emery's and Lazarus' views on
systems.
•  Selye's concept of stress and Caplan's levels of
prevention. 
 
Fawcett, J. (2001). The nurse theorists: 21st-century updates-Betty Neuman.
    Nursing Science Quarterly, 14(3), 211-214.   
 More on the origins of NSM
(Neuman, 1995)
"The development of the wholistic systemic perspective of the
Neuman systems model was motivated by my own basic
philosphy of helping each other live, many diverse observations
and clinical experiences in teaching and encouraging positive
aspects of human variables in a wide variety of community
settings, and theoretical perspectives and stress related to the
interactive, interrelated, interdependent, and wholistic nature of
systems theory.  The significance of perception and behavioral
consequences [also] cannot be overestimated" (p. 675-676)
 
 
Neuman, B. (1995). The Neuman systems model (3rd ed.). Norwalk, CT:
    Appleton and Lange.
 To provide a holistic overview of the
physiological, psychological,
sociological and development
aspects of human being.
 To teach an introductory nursing
course to nursing students.
 Interrelated concept.
 Logically consistent.
 Logical sequence.
 Fairly simple and straightforward
in approach.
 Easily identifiable for nursing education
and practice.
 Applicable in the practice.
 Key Concepts of the Neuman Systems
Model
 
Each client system is made up of 5 variables
•  Physiological variables
o bodily structure & function
•  Psychological variables
o mental processes & relationships
•  Sociocultural variables
o social & cultural funtions
•  Developmental variables
o developmental processes of life
•  Spiritual variables
o continuum of spirituality - from complete
unawareness to full spiritual understanding.
MAJOR CONCEPTS
 Person
• an open system that works together with other parts of its body
as it interact with the environment

• a dynamic composite of the interrelationship of five variables: (1.)

physiological, (2.) psychological, (3.) sociocultural, (4.)
developmental, and (5.) spiritual

• has protective mechanisms for the basic structure, and maintains

client’s system stability: (1.) flexible line of defense, (2.) normal
line of defense, and (3.) lines of resistance
 Flexible Line of Defense

Normal Line of Defense

CORE
CORE Lines of Resistance
 The central core structure consists
of basic survival factors (normal
temp range, genetic structure,
response pattern, organ
strength/wellness, ego structure ).
That are surrounded by-
 Several lines of resistance.
 The normal line of defense.
 The flexible line of defense.
 A protective mechanism that attempts to
stabilize the client system and foster a
return to the usual wellness.

 Lines of resistance certain know and

unknown internal and external
resource factors that support client’s
basic structure.
 The client/ client system normal or
usual wellness level.
 This line represents what the
client has become evolved over
time.
 This normal defense line is the
standard against determining
 Forms the outer boundary of the
defined client system.
 Act as a protective buffer system for
the client’s normal line of defense or
wellness state.
 This normal defense line is the
standard against determining any
variance from wellness.
 Health
• dynamic condition

• equated with stability of normal line of defense

• Wellness exists when all the part or system of person

works harmoniously
 Health

Sta
ony bil
ity
arm
H
Flexible Line of Defense

Normal Line of Defense

CORE
CORE Lines of Resistance

W
ce

el
n

lness
Bala

Health
 Environment
• can be internal, external, and created force
(stressors) that interacts with a person’s state of
health

• has the potential to alter or improve stability of

systems
 Interperson S
al
Intraperson T
al
Extraperson R
al
E
Flexible Line of
Defense S
Normal Line of
Defense S
CORE
CORE
Lines of Resistance
O
Interperson
al
R
Intraperson
al S
Extraperson
al
 Nursing
• a unique profession that requires
holistic approach – considers all
factors affecting a client’s health

• aims to promote optimal wellness to

its client through retention, attainment,
or maintenance of the stability of
client’s system
 Nursing
• nurse helps the different levels of clientele:
individual, family, and groups in achieving and
maintaining an optimal wellness through intervention
with the goal of reducing stress factors and its
adverse effects to the optimal functioning of an
individual in any given situation

• nursing consists of intervention modalities of

prevention which can be: (1.) primary, (2.) secondary,
(3.) tertiary
 Primary
prevention

Secondary Tertiary
prevention prevention
 How it's done: Prevention as Intervention
•    Primary prevention as intervention- nursing actions 
o  preventing stressor invasion; providing resources to retain or strengthen existing client/client system
strengths; supporting positive coping and functioning; motivating the client system toward wellness; 
educating the client system
 
•  Secondary prevention as intervention-nursing actions
o protecting the client system's basic structure; mobilizing and optimizing the client system's internal
and external resources to attain stability and energy conservation; facilitating purposeful manipulation
of stressors and reactions to stressors; motivating, educating, and involving the client system in mutual
establishment of health care goals; facilitating appropriate treatment and intervention measures
•     Tertiary prevention as intervention-nursing actions
o attaining and maintaining the highest possible level of client system wellness and stability during
reconstitution; educating, reeducating, and/or reorienting the client system as needed; supporting the
client system toward appropriate goals; coordinating and integrating health services resources;
providing primary and/or secondary preventive intervention as required. The nurse evaluates the
outcome goals by: confirming attainment of outcome goals with the client system and reformulating
goals as necessary with the client system
 Once an individual is exposed to stress,
the flexible line of defense will be “alarmed” to protect
the normal (solid) line of defense to keep the system
free from stressor reactions. However, if this individual
is continuously exposed to stress and if the flexible line
of defense is unable anymore to cope up with the
stressors, the normal line of defense will be altered. If
this happens, there will be a threat to the wall that
protects the basic structure of the individual and
therefore causing instability of the systems and illness
develops.
 Flexible Line of
Defense

Normal Line of
Defense
CORE
CORE
Lines of
STRESSOR Resistance
S
(Intrapersonal,
Interpersonal,
Extrapersonal)

ILLNESS
 CASE STUDY
Mr. Yoso is a 38 year-old business executive. His
colleagues describe him as hard working,
perfectionist, and very dedicated to work. His day
starts by leaving the house very early from Laguna to
Makati and begins work by delegating various tasks
with firm expectations and deadlines that somewhat
impossible to meet. He usually responds with
pressure and intimidating remarks for works not
perfectly done. He smokes and drinks alcohol
whenever he is stressed. Recently, the company
experienced continuous dropped in their sells and his
bosses started to put blame to him.
continuation…

Mr. Yoso began exhibiting weird mannerisms and

behaviors that appear strange to his family and people
around him. He misses breakfast and lunch very often
and sleeps very late at night while doing work. He has
no time anymore for his family and focuses to hard on
meeting deadlines and his preconceived objectives.
Because of these weird changes in him, the company
decided to temporarily relieve him from his position as
executive manager. A week later, he started to have
periods of mania and depression. His family becomes
worried and called up the hospital to seek assistance
after he locked himself in the room, refusing to eat, and
most of the time quiet and staring blankly on the wall.
Later, he developed pneumonia.
Guide Questions:
• Identify the stressors classified according to the
effects on:
– Flexible line of defense
– Normal Line of defense
– Line of resistance
• Give at least 3 nursing actions grouped
according to:
– Primary prevention
– Secondary Prevention
– Tertiary Prevention
 Using Neuman’s System Model in the
above situation, the identified possible
stressors that contributed to Mr.
Yoso’s condition were as follows:
work, personality, and attitude. Mr.
Yoso is not anymore able to handle the
stressors and that had caused the
“breakdown” of his lines of defense.
Without seeking help from his family
and friends, he was not able to
maintain his flexible line of defense
and brought instability to his system.
Primary Prevention:
•Stress management Tertiary Prevention
activities •Re-assessing patient’s ability
•Relaxation techniques to independently perform and
•Anger-management maintain variables of health.
techniques •Regular consult to
•Smoking cessation psychologist.
•Maintaining client’s support
Effects on Flexible Line of system
Defense:
•sleeps very late at night
•misses breakfast and lunch
•responds with pressure and
intimidating remarks for works not Effects on Lines of
perfectly done
•smokes and drinks alcohol
CORE
CORE Resistance:
•weakened immune
whenever he is stressed
response
•developed
Work-related stressors pneumonia

Effects on Normal Line of Secondary

Defense: Prevention
•exhibiting weird
•Medication (to treat
mannerisms and behaviors
•periods of mania and symptoms)
depression •Opportunities to
verbalize feelings
and concerns
 Flexible Line of
Defense

Normal Line of
Defense
CORE
CORE
Lines of
STRESSOR Resistance
S
(Intrapersonal,
Interpersonal,
Extrapersonal)

ILLNESS
CONCLUSION???