Prayer Before Lecture

● God our Father, praise and Glory to you for

this day of lectures and clinical activities;
send us your Holy Spirit to enlighten our
minds to learn new things, to gain new
skills and most especially to have our hearts
formed anew and inclined unto you so we
may lovingly serve and care for the sick
among us. This we ask through the most
Holy Name of Jesus Christ your Son,
Forever and Ever. AMEN
● Our Lady of Fatima
● Pray for us
NURSING CONCEPTUAL MODEL
MODULE 7

MARTHA ROGERS
DOROTEA OREM
IMOGENE KING
Martha Rogers: Science of
Unitary Human Beings
Background
• Martha E. Rogers was born in 1914 in Dallas, Texas.
• She received her nursing diploma from the Knoxville General
Hospital School of Nursing in 1936, then earned her Public
Health Nursing degree from George Peabody College in
Tennessee in 1937.
• Her Master’s degree was from Teachers College at Columbia
University in 1945, and her Doctorate in Nursing was earned at
from Johns Hopkins University in Baltimore in 1954. Rogers
died on March 13, 1994.
• Rogers worked as a professor at New York University’s School
of Nursing. 
• She was also a Fellow for the American Academy of Nursing.
• Her publications include: Theoretical Basis of
Nursing (1970), Nursing Science and Art: A
Prospective (1988),Nursing: Science of Unitary, Irreducible,
Human Beings Update (1990), and Vision of Space Based
Nursing (1990).
Homodynamic
principles
Resonance is an arrangement for human and
environment that undergo transformation

Helicy is the nature of change is unpredictable,

continuous and innovative

Integrality is the energy fields of human and

environment in a continuous mutual process
Nursing
Metaparadigm
1. The life process of the unitary human
being is one of wholeness and continuity
as well as dynamic and creative change.
2. Environment defines as irreducible pan
dimensional energy field identified by
pattern and manifesting characteristics
different from those of the parts
3. Health symbolize wellness and the
absence of disease and major illness
4. Nursing is both art and science and the
nurse is a factor in healing environment
 Implications of Rogers
Nursing
Practice Education
• That students have
• Evaluative and individual personalities
diagnostic phase and patterns to their
work.
includes • They are all unitary
determining the human beings and
patients’ and their should be interacted with
family’s well-being differently
• Culture, family, and
status at the time experiences affect their
• Interventive how reasons and motives to
the nurse will go become a nurse
• Beings focuses on “the
about implementing
integrality of person and
nursing environment, the
interventions for individual’s active
the patient. participation in change,
and each person’s
individual pattern
Theory
Research
• It was found that the
theory applies to any
environment that
contains human
beings.
• Her theory focuses
nursing interventions
on the patient well -
being overall and not
just their disease state
• It encourages the use
of guided imagery,
relaxation, therapeutic
touch, and meditation
Analysis of the Theory
Clarity – It is difficult-to-understand principles, lack of operational
definitions, and inadequate tools for measurement model has passed
the test of time for the development of nursing science as nursing
matured as a science

Simplicity - when the model is examined in total perspective, some still

classify it as complex. With its continued use in practice, research, and
education, nurses will come to appreciate the model’s elegant simplicity

Generality - Rogers’ conceptual model is abstract and therefore

generalizable and powerful. It is broad in scope, providing a framework
for the development of nursing knowledge through the generation of
grand and middle-range theories
Importance- Rogers’ science has the fundamental intent of understanding human
evolution and its potential for human betterment. The science “coordinates a
universe of open systems to identify the focus of a new paradigm and initiate
nursing’s identity as a science”
Application to
Nursing
Mary is a 53-year-old woman who is in end stage leukemia. She has had two
failed bone marrow transplants and three rounds of chemotherapy. She is
moving into hospice home care, and the family and Mary become your client.
Mary is the mother of four children: 25, 23, 20, and 17. One child lives at home.
Pattern appraisal includes: Mary—frail, quiet, almost translucent in appearance,
resting comfortably in hospital bed in living room, nasal O2 in place Tom—
husband, quiet, pacing Home—clean, orderly, many personal articles, large
window facing north and looking into the yard. Noise level low. Dog sleeping
on floor
Analysis

1. End of life is a process of merging of the past, present, and future

2. Nursing care for Mary offers the opportunity to incorporate a variety of
patterning
3. As Mary nears and prepares for the end of her life, many patterning
concerns must be addressed for peaceful closure to her life and the change to
another energy form
4. The visible rhythmical pattern is a manifestation of peace (Mary) and a
human environmental manifestation of anxiety in husband
5. The unknown and preparation for loss is the focus. The pattern appraisal is
ongoing
6. Harmony is noted in her relationship with her husband and family and with
her sense of how she has progressed through this disease process.
DOROTEA OREM
Self Care Deficit
Background
• 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
degrees (honorary Doctorates awarded from different
Universities).
• She began her nursing career at Providence Hospital
School of Nursing in Washington, DC, where she
received a diploma of nursing in the early 1930s.
Background

• She published her theory in 1959 for the first time and
revised in 1971, 1983, 1987, and 2001. Her
contributions enabled her to achieve Excellency from
prominent societies like Sigma Theta Tau
International Society, the National League for
Nursing, and the American Academy of Nursing.
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)
Concepts of Orem’s
Model
1. The Self-Care Deficit Theory developed as a result of working
toward her goal of improving the quality of nursing in general
hospitals in her state.
2. The model interrelates concepts in such a way as to create a
different way of looking at a particular phenomenon.
3. The theory is relatively simple, but generalizable to apply to a
wide variety of patients.
4. It can be used by nurses to guide and improve practice, but it
must be consistent with other validated theories, laws and
principles
Concepts and Definition
The self-care deficit nursing theory is a general theory composed of the
following four related theories

• The theory of self-care, which describes why and how people care for
themselves
• The theory of dependent-care, which explains how family members
and/or friends provide dependent-care for a person who is socially
dependent
• The theory of self-care deficit, which describes and explains why
people can be helped through nursing
• The theory of nursing systems, which describes and explains
relationships that must be brought about and maintained for nursing
to be produced
Theory of Self
Care
“Self –care comprises the practice of activities
that maturing and mature persons initiate and
perform, within time frames, on their own
behalf in the interest of maintaining life,
healthful functioning, continuing personal
development and well-being through meeting
known requisites for functional and
developmental regulations.
The Theory of Self-Care has three components:
universal self-care needs, developmental self-
care needs and health deviation.
3 Components of Self
Care
• Universal Self Care Needs
Air, food, water, elimination/excretion, activity & rest,
solitude /social interaction, functioning/well being, normalcy
• Developmental Self Care Requisites: more specific to the process
of growth and development and are influenced by what is
happening during the life cycle, It can be positive or negative.
• Health Deviation Self Care Requisites: When a condition
permanently or temporarily alters structural, physiological or
psychological function
Self Care

1. Self Care Agent provides the foundation for understanding the

action requirements and action limitations of persons who may
benefit from nursing.
2. 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 in meeting his or her self-care
requisites”
3. 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 Dependent Care

Dependent care refers to the care that is provided to a

person who, because of age or related factors, is unable
to perform the self-care needed to maintain life,
healthful functioning, continuing personal development,
and well-being.
Dependent-Care Self-Care Agency Dependent-Care
Demand Agency
The self-care agency is Refers to the
Summation of care a complex acquired acquired ability of a
measures at a specific ability of mature and person to know and
point in time or over a maturing persons to meet the therapeutic
duration of time for know and meet their self-care demand of
meeting the continuing the dependent
dependent’s requirements for person and/or
therapeutic self-care deliberate, purposive regulate the
demand when his or action to regulate their development and
her self-care agency is own human functioning exercise of the
not adequate or and development dependent’s self-care
operational. agency
Theory of Self-Care
Deficit
1. A self-care deficit occurs when an individual cannot
carry out self-care requisites.
2. Orem identifies method of helping:
Acting for and doing for others
Guiding and directing
Providing Physical and Psychological support
Environment of promoting personal development
Teaching
Examples of self-care requisites are:
Wound care
Activities of Daily Living
Bowel program
Glucose monitoring
Theory of Nursing
Systems
1. Wholly compensatory support- patient is unable to
complete any self-care independently; nursing
compensates for patient’s inability to perform self-care.
2. Partial compensatory support- patient is able to perform
self-care tasks with partial or no assistance from nursing.
3. Supportive/educative compensatory– patient able to
perform tasks independently. Nursing provides ongoing
education and support.
Four major Concepts of
Orem
Health is a state characterized by soundness or
wholeness of developed human structures and of
bodily and mental functioning.

People is viewed biologically, symbolically and

socially but still as a whole person. This person is
considered to be able to provide self-care

Nursing is how a healthcare professional

develops a plan of care to meet the patient’s self-
care needs

Environment is the physical, chemical, biologic

and social factors that make up who a person is.
 Significance of the Theory
Nursing Practice
has achieved a significant level of
acceptance by the international
nursing community, as evidenced
by the magnitude of published
material and presentations at the
International Orem Society World
Congresses
Education
The SCDNT was introduced as the
basic structure for nursing
management in German hospital
DRG (diagnosis-related group)
implementation. The movement
toward SCDNT-based nursing
management.
The influence of Orem’s SCDNT has
continued at the international level
through the translation of Nursing
Concepts of Practice into several
languages.
Research
Research
using the SCDNT or components,
Biggs (2008) found more than 800
references. Berbiglia identified
selected practice settings and
SCDNT conceptual foci from a
review of more than 3 decades of
use of the SCDNT in practice and
research and publicized selected
international SCDNT practice
models for the twenty-first century
Analysis of the Theory

1. 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.
2. 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 systems
3. 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
The SCDNT differentiates the focus of nursing from other
disciplines. Although other disciplines find the theory of
self-care helpful and contribute to its development, the
theory of nursing systems provides a unique focus for
nursing
Application to
Nursing
Mr. Shoaib is a 62 years old male patient admitted to a medical ward.
He has right ischemic Cerebro Vascular Accident (CVA) and a resultant
left sided body paralysis. He has no sensations or movement in the left
side of the body. He has lost his gag reflux and is unable to swallow
food. A nasogastric (N/G) tube is placed for providing him nutrition.
Mr. Shoaib is not able to change his position and is dependent on care
givers for changing his position. He is also not able to carry out his
routine daily life activities. His family is worried whether he would be
able to regain control of his life or not. They are also worried whether
they would be able to provide him the care he needs when he is
discharged from hospital
Apply the case utilizing

1. Universal Self care requisite

2. Health deviant self care
3. Development of self care requisite
 IMOGENE KING
GOAL ATTAINMENT THEORY
Background

• Theorist : Imogene 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
• Doctorate from Teacher’s college, Columbia University.
• 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
Kings Open System
Framework
1. Nursing Focus is the care of human being
2. Nursing Goal is the health of the individual and
health care for the group
3. Human Beings are open system in constant
interaction with the environment
Interacting systems in the Theory of Goal
Attainment
Personal System
1. Perception
2. Self
3. Growth and Development
4. Body Image
5. Time
6. Space
Interpersonal system Social system
• How the nurse
interrelates with a co- • An organized system of
worker or patient, social role, behavior and
particularly in a nurse- practices
patient relationship • Organization
• Interaction • Authority
• Communication • Power
• Transaction • Status
• Role • Decision Making
• Stress
Assumptions

1. Basic Assumptions of goal attainment theory is that the

nurse and patient communicate information, set mutual
goal act to achieve these goals it is the basic assumption
of Nursing Process
2. Each human being perceives the world as a total person
in making transaction with individual and things in the
environment
Nurse Patient Transaction
Model
1. Action is a means of behavior or activities that are
towards the accomplishments of certain act. It is
both physical and mental.
2. Reaction is a form of reacting or a response to a
certain stimuli.
3. Interaction is any situation wherein the nurse relates
and deals with a clientele or patient.
4. Transaction is a unique observable in which human
being communicate with the environment
Metaparadigm
1. Person existing in an open system who makes choices
and select alternative action
2. Health as continuous adjustment to stress in the internal
and external environment
3. Environment as the process of balance involving internal
ad external interactions inside the social system
4. Nursing is an observable behavior found in the health
care systems in society”. The goal of nursing “is to help
individuals maintain their health so they can function in
their roles”
 Significance
Nursing Practice Education Research

• It is used in curriculum
• Individualized the plans of It is design and
design in nursing
care while encouraging conducted to
programs
active participation from implement this
• It provides a systematic
clients system in hospital,
means of viewing
• The profession of nursing ambulatory,
nursing as profession,
function through community and
an organize body of
individuals and groups home care nursing
knowledge and
within the environment clarifying nursing as
discipline
Analysis of the
theory
1. Clarity- Theory of Goal Attainment is the ease with which it can be
understood by nurses. Concepts are concretely defined and illustrated.
2. Simplicity- King’s definitions are clear and are conceptually derived from
research literature.
3. Generality – It has been criticized for having limited application in areas of
nursing in which patients are unable to interact competently with the nurse.
4. Accessibility - A descriptive study was conducted to identify the
characteristics of transaction and whether nurses made transactions with
patients
5. 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.
Application to
Nursing
1. Communication between nurse and patient is the cornerstone of the interpersonal
system and the most important prerequisite for transaction to occur. It can be
established both verbally and nonverbally.
2. A middle-aged female patient referred to the emergency room with weakness and
feebleness. The attending physician gave the diagnosis of acute pulmonary edema.
Emergency staffs needed to start invasive interventions to manage her acute condition.
However, they failed to understand her conditions and did not provide her with
adequate treatment-related information. She did not give consent for treatments and
treatments were not administered. This example shows that nurses and physicians
need to give high priority to the establishment of effective communication with patients
to help them make wiser decisions to retain their own health as their main goal.
Moreover, they need to allow patients articulate their perceptions of their illnesses,
personal illness-related experiences, and the level of their stress. It is only in this way
that nurse and patient can help each other and create a favorable environment for
decision-making.. Consequently, the goal of health is attained when both sides of
relationship properly interact with each other and collaboratively work together to attain
their goals.
HAVE A NICE DAY TO ALL