Nursing Theories

Introduction to the Theory of Culture Care, Diversity, and Universality
Nurses are in constant inte raction with different

clients from all walks of life. Regardless of their age, status or condition, we are bound to provide them
with the utmost care they deserve. It is a pledge that we made, and one that we have lived by. However,
sustaining the care we provide in ensuring that they maintain their well-being is an issue.
Health education and maintenance plays a major role in healthcare and one that is highly participated by
nurses. Taking into account our client’s differences in their beliefs, values and practices is tantamount to
the success of health promotion. It is with this premise that a sensitivity and knowledge on cultural
differences takes the stage.
Madeleine Leininger was the first to identify the impact of culture in relation to nursing. She spent years
understanding and developing their connection and how one can influence the other. In this regard, she
studied anthropology and utilized it in nursing. The combination of the two brought about her Theory of
Cultural Diversity and Universality.
In here, she defined Transcultural Nursing as a subjective area of study and practice focused on
comparative cultural care (caring) values, beliefs and practices of individuals or groups of similar or
different cultures with the goal of providing culture-specific and universal nursing care practices in
promoting health or well-being or to help people face unfavourable human conditions, illness or death in
culturally meaningful ways (Barnum, 1998). Moreover, it goes beyond an awareness state to that of
culture care nursing knowledge to practice culturally congruent and responsible care (Tomey, 1998).
Cultural Diversity and Universality is therefore the highlight of Leininger’s theory. Cultural Diversity is
defined as variations in each culture. In acknowledging these differences, the nurse is able to avoid
stereotyping and assume that all clients will respond to nursing care in the same manner. Culture
Universality on the other hand, pertains to the similarities. Both these concepts lead to the goal of the
theory and that is, “to discover similarities and differences about care and its impact on the health and
well-being of groups” (Leininger, 1995)
Internalizing the concepts on culture diversity and universality gives rise to culture-specific and culturally
congruent care. The former refers to the identification the client’s care practices brought about by their
culture and utilizing them to plan and apply nursing care. This in turn would bring about nursing care that
“fit the specific care needs and life ways” of the client (Leininger, 1995). The latter, speaks about
“cognitively based assistive, supportive, facilitative, or enabling acts or decisions in order for the nurse to
provide meaningful, beneficial, satisfying care that leads to health and well-being” (Leininger, 1995). This,
according to Leininger, is the central idea and goal of the Theory of Cultural Care.
The Sunrise-Enabler Model
Effective care is the ultimate task of nurses. We are the members of the health team who have direct
patient/client interaction and therefore it is through our knowledge & understanding of the values,
customs, beliefs & practices our patients’ culture that we can provide effective care. A better way of
understanding the factors that influence a person’s perception of well-being is the sunrise enabler of
Madeleine Leininger. Leininger’s model of cultural care can be viewed as a rising sun. When using this
model, the nurse can begin anywhere depending on the focus of nursing assessment. The model reflects
influences of one’s worldview on cultural and structure dimensions. The cultural and social structure
dimensions include technological, religious, philosophic, kinship, social, value and lifeway, political, legal,
economic, and educational factors. Each of these identified systems affects health. These cultural and
social structure dimensions in turn influences environment and language, wherein emphasis should be
placed since this is where the patient/client find themselves such as home conditions, access to particular
types of food and family access to transport. Environment and language influence the involved health
systems – the folk, professional and nursing systems. The folk health system includes the traditional
beliefs and practices on health care while the professional health systems are those practices we learned
cognitively through formal professional schools of learning. The combination of the folk health system and
the professional health system meets the biological, psychosocial, and cultural health needs of the
patient/client.
These factors influence the patterns and expressions of caring in relation to the health of individuals,
families, groups, and communities. To be able to make sound nursing care decisions and actions, these
factors should be assessed properly and always be taken into consideration.
To achieve culture congruent care, nursing actions are to be planned in one of three modes: culture care
preservation/maintenance, culture care accommodation/negotiation, or culture care
repatterning/restructuring.
A research project on health and social practices regarding dengue in 2008 on three countries in
Southeast Asia could be used as an example on how Leininger’s sunrise enabler can be applied on the
community level. Some of the cultural and social factors that were assessed are as follows:
Cultural and Social Structure

Dimensions
Technological lack of awareness of first aid remedies and

safety procedures on dengue prevention at
home
Religious community people view dengue as a bad omen
Kinship and Social women are always the caregivers, thus more
women are prone to psychological burden of
caring for the sick member of the family
Cultural Values health is of lesser priority; more priority is

given to basic needs such as food
Political and legal lack of policy programs by the local government

regarding dengue prevention practices
Economic more males acquire dengue since most of them

are night shift and farms/plantation workers
Educational low level of education is noted. Most are

secondary level graduates, knowledge and
comprehension on proper health practices on
dengue prevention is low
Proper assessment of the cultural and social structure dimensions will lead to good planning and intervention, leading to a
sustainable health care delivery to individual, families, or communities.
Orem’s Nursing Paradigm
By Allan Andan
Man
Orem viewed man as an integrated whole composed of an internal physical, psychologic, and
social nature with varying degrees of self-care ability. He/she has the potential for learning and
development as he/she is gifted with rational ability and capacity to reflect on his/her experience
and use symbols (ideas and words). Under normal conditions, man is self-reliant, responsible and
capable continuous self-care, not only of himself/herself, but also oh his/her dependents.
Orem viewed a patient as an individual with health related limitations that make him/her
incapable of continuous self care or dependent care. His/ her self-care requisites or demands are
beyond his/her self-care abilities which can be attributed to his/her lack of knowledge, skills,
motivation or orientation.
Health
Orem defined health as a state of wholeness or integrity of a human being: a state where one is
structurally and functionally whole or sound. She further added that a healthy being is one who
has the necessary self-care ability to meet his/her changing self-care demands. She supported the
concepts of health promotion and health maintenance and claimed that it is not just the
individual’s responsibility, but also the society as a whole, including its members.
Environment
Orem viewed the environment as not just the elements external to man. She viewed man and
environment as an integrated system. It includes conditions that can positively or negatively
affect a person’s ability to provide self-care. She enumerated certain conditions which are
conducive for one’s development and includes the following: opportunities to be helped; being
with other persons or group where care is offered; opportunities for solitude and companionship;
provision of help for personal and group concerns without limiting individual decisions and
personal pursuits; shared respect and trust; recognition and fostering of developmental potential.
Nursing
According to Orem, nursing consists of actions deliberately selected and performed by nurses to
help individuals or groups under their care to maintain or change conditions in themselves or
their environment. She further viewed nursing as an art, community service and a technology. As
an art, it has a theoretical base which serves as the basis in providing self-care towards
improvement of one’s functioning and development. As a community service, it is geared
towards deliberative actions of assisting another in maintaining or reestablishing balance
between self-care abilities and demands also leading to improvement in one’s functioning and
development. As a technology, it has specialized methods or practice of delivering self-care.
Theory of Self-care
By Rosinee Rosales
Self – care is the performance or practice of activities that individuals initiate and perform on
their own behalf to maintain life, health and well-being. When self-care is effectively performed,
it helps to maintain structural integrity and human functioning, and it contributes to human
development (Orem, 1991).
Self – care agency is the human’s ability or power to engage in self-care. The individual’s ability
to engage in self-care is affected by basic conditioning factors.
Basic conditioning factors are age, gender, developmental state, health state, sociocultural
orientation, health care system factors, family system factors, patterns of living, environmental
factors, and resource adequacy and availability. (Nursing theories, Julia George)
“Normally, adults voluntarily care for themselves. Infants, children, the aged, the ill, and the
disabled require complete care or assistance with self-care activities.” (Orem, 1991)
Two agents:
Self – care agent is a person who provides self-care
Dependent self-care agent is a person other than the individual who provides the care (e.g.
parent)
Therapeutic self – care demand is the totality of self-care actions to be performed for some
duration in order to meet known self-care requisites by using valid methods and related sets of
operation and actions. (Orem, 1991)
Self – care requisites are the actions or measures used to provide self-care, also called self – care
needs. It consist three categories which are:
Universal self – care requisites are associated with life processes and the maintenance and
integrity of human structure and functioning. They are common to all human beings during all
stages of life cycle and should be viewed as interrelated factors, each affecting the others. A
common term for these requisites is the activities of daily living. (Nursing theories, Julia George)
Orem identifies self – care requisites as follows: (Orem, 1991)

1. The maintenance of a sufficient intake of air
2. The maintenance of a sufficient intake of water
3. The maintenance of a sufficient intake of food
4. The provision of care associated with elimination processes and excrements
5. The maintenance of a balance between activity and rest
6. The maintenance of a balance between solitude and social interaction
7. The prevention of hazards to human life, human functioning, and human well-being
8. The promotion of human functioning and development within social groups in accord with
human potential, known human limitations, and the human desire to be normal.
Normalcy is used in the sense of that which is essentially human and that which accord with the
genetic constitutional characteristics and talents of individuals
Developmental self – care requisites are either specialized expressions of universal self-care
requisites that have been particularized for developmental processes or they are new requisites
derived from a new condition or associated with an event (Orem, 1991). In other words, these are
needs resulting from maturation or develop due to a condition or an event.
Two categories of developmental self-care requisites:
Conditions that¬ support life processes and promote specific developmental stages (Intrauterine
life, neonatal life, infancy, childhood, adolescence, adulthood)
Conditions affecting human development: (a) concerns the¬ provision of care to prevent
deleterious effects of adverse conditions (e.g. provision of adequate rest and sleep during
pregnancy) (b) concerns the provision of care to prevent or overcome existing or potential
deleterious effects of particular conditions or life events (e.g. adjusting in new job or change in
social status)
Health deviation self – care is required in conditions of illness, injury, or disease, or may result
from medical measure required to diagnose and correct the condition (e.g. learning to walk using
crutches following fractured leg)
Health deviation self – care requisites are as follows: (Orem, 1991)

1. Seeking and securing appropriate medical assistance
2. Being aware of and attending to the effects and results of pathologic conditions and states
3. Effectively carrying out medically prescribed diagnostic, therapeutic and rehabilitative
measures
4. Being aware of and attending to or regulating the discomforting or deleterious effects of
prescribed medical care measures
5. Modifying the self – concept in accepting oneself as being in a particular state of health and in
need of specific forms of health care
6. Learning to live with the effects of pathologic conditions and states of medical diagnostic and
treatment measures in a life-style that promotes continued personal development
References:
George, Julia B. (1995). Nursing theories: The base for professional practice (4th Ed.) Prentice-
Hall International
Orem, Dorothea E. (1991). Nursing: Concepts of practice (4th Ed.) St. Loius: Mosby
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Theory of Self-Care Deficit
By Rose Ann Bunye
When there is demand to care for oneself and the individual is able to meet that demand, self-
care is possible. If, on the other hand, the demand is greater than the individual’s capacity or
ability to meet it, an imbalance occurs and this is called a self care deficit.
The theory of self-care deficit is the core of Orem's grand theory of nursing because it delineates
when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the
parent or guardian) is incapable of or limited in the provision of continuous effective self-care
(George 1995). The term "deficit" refers to a particular relationship between self-care agency and
self-care demand that is said to exist when capabilities for engaging in self-care are less than the
demand for self-care (Parker, 2005, p. 149).
The self-care deficit may be actual or potential. For example:

1. In the case of premature birth, the actual infant-care deficit may be the parent’s lack of
knowledge of how to provide care for the preterm infant.
2. The potential infant-care deficit could result in increased risk of infant abuse or neglect.
Orem identifies 6 methods of helping:--

1. Doing for or acting for another
2. Guiding or directing another
3. Providing physical support
4. Providing psychological support
5. Providing an environment supportive of development
6. Teaching another
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Dorothea Orem's Theory of Self-Care (Illustrations)
By Russel de Lara
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Theory of Nursing System
By Therese A. Baulita
Theory of Nursing Systems

Refers to a series of actions a nurse¬ undertakes to aid in meeting a person’s self-care needs.
Describes¬ nursing responsibilities; roles of the nurse & patient
¬ Rationales for the nurse-patient relationship
The essential¬ organizing component of the Self-Care Deficit Theory of Nursing because it
establishes the form of nursing and the relationship between patient and nurse properties.
Focused on person¬
There are three¬ support modalities identified in theory: wholly compensatory; partly
compensatory; supportive-educative
Three Support Modalities:

¬ The client’s ability for self-care involvement will determine under which support modality
they would be considered
A person may¬ fluctuate between support modalities at any given time
Wholly compensatory system

The patient has no active role in the¬ performance of his care
The nurse acts for the patient¬
An¬ individual requires total nursing care to fulfill self-care needs
A¬ patient’s self-care agency is so limited that she or he depends on others for well-being
The nurse accomplishes patient’s therapeutic¬ self-care; compensates for patient’s inability to
engage in self-care; supports and protects patients
Partly compensatory system

¬ Both nurse and patient work together to perform activities to achieve desired self-care goals
A patient can do some self-care measures¬ but needs a nurse to assist her to meet others
It has a give and¬ take relationship between the nurse and the patient
The nurse¬ compensates for self-care limitations of patient
Supportive-educative system
Requires uses of resources and¬ educational tools to teach the person & family to perform their
own self-care
Indicates that the patient contributes mostly in his/her¬ self-care and the nurse’s role is merely
to monitor & regulate the patient’s self-care
The patient accomplishes self-care¬ & regulates the exercise & development of self-care agency
The¬ patient is able to perform, or can learn to perform, required measures of therapeutic self-
care but cannot do so without assistance
A¬ patient can meet self-care requisites but needs help in decision-making, behavior control, or
knowledge acquisition
Sources:
Theoretical Foundations of Nursing Module
http://faculty.ucc.edu/nursing-gervase/orem
www.slideshare.net/jben501/dorothea-orem-theory
http://jlerner.wordpress.com/2010/04/20/a-look-at-orem’s-self-care-deficit
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Orem's Self-Care Deficit Theory: Theoretical Assertions
By Rachelle Dogao
Dorothea Orem's Self Care Deficit Theory encompasses all aspect relating to the patient's health,
nursing and all the factors that affect which.
The concepts discussed revolve mainly around self care. It is the patient's ability to care for
himself and his dependents as well as others as dictated by the environment he lives in that
determines health or the need for assistance in maintaining health. On the other hand, the society
plays the major role into regulating the nursing care process as to when nursing care is needed
and when and how the nursing system is implemented. It is also the environment and the society
that directly affect the nurse-patient relationship and self care agency, which are all
interconnected into achieving, restoring, and maintaining health.
As shown in the figure below, health can be achieved if the person has knowledge and resources
to perform self care activities to meet self care deficits. On the other side, self care deficit results
when self care agency (ability to perform self-care) is not adequate to meet the known self care
demand and/or the failure to meet the health care requisites (Kozier et.al, 2002) This then
warrants the need for nursing intervention through the nursing system, which in turn is
empowered by the nurse-patient relationship. The end result of all of this is the maintenance,
restoration, or preservation of health.
references:
N207 manual on Theoretical Foundations of Nursing
Fundamentals of Nursing by Kozier et.al Fifth Edition
http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
Dorothea Orem's Self Care Deficit Theory by Jean Bridge et.al, Troy University
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Dorothea Orem's Theory of Self-Care (Illustrations)
By Russel de Lara
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Comparison of Orem’s Nursing Process and the Nursing Process

By Monaliza Pineda

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Five Major Assumptions of Orem’s General Theory of Nursing
By Yosef Brian Villanueva
Five major assumptions of Orem’s general theory of nursing are as follows:
(1) Human beings require continuous deliberate inputs to themselves and their environments to
remain alive and functions in accord with natural human endowments.
(2) Human agency, the power to act deliberately, is exercised in the form of care of self and
others in identifying needs for and in making needed inputs.
(3) Mature human beings experience privations in the form of limitations or action in care of self
and others involving and making of life sustaining and functioning- regulating inputs.
(4) Human agency is exercised in discovering, developing, and transmitting to others ways and
means to identify needs for and make inputs to self and others.
(5) Groups of human beings with structures relationships cluster tasks and allocate
responsibilities for providing care to group members who experience privation for making
required deliberate input to self and others
Self care is a requirement for every person

Universal self-care involves meeting basic human needs
Health-deviation self care is related to disease or injury
Each adult has both the right and the responsibility to care for his/her self in order to maintain
rational life and health. He/she also has responsibilities to dependents
Self-care is learned behavior processed by the ego and influenced by both self-concept and level
of maturity
Self-care is a deliberative action
Awareness of relevant factors and their meaning is a prerequisite condition for self-care action
References
http://prism.troy.edu/~scabell/Orem.pdf (Taylor et al, 1998, p. 179).
Theoretical Foundations of Nursing, p46
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Strengths and Limitations of Orem’s Theory
By Myrene Leviste Buban-Aseron
Strengths
Orem’s theory provide a comprehensive base to nursing practice. It is functional in the different
fields of nursing. May it be in clinical setting, education, research or administration. Moreover,
this theory is as applicable for nursing by the beginning practitioner as much as the advanced
clinician(George JB., 1995). Another major strength of Orem’s theory is it’s advocacy for the
use of the Nursing Process (Balabagno, et.al, 2006). Orem specifically identified the steps of this
process. She also mentioned that the nursing process involves intellectual and practical phases.
Limitations
The ambiguity of applying theory to nursing practice may lie in the fact that one theory does not
always specifically support all aspects of nursing care. Orem’s self care deficit theory may not
encompass all aspects of care and needs of a specific client. For instance, some dilemma with
Orem’s theory include having an unclear definition of family, the nurse-society relationship and
public education areas are weak. These issues are essential in the management and treatment
plan in caring for patients. Although the family, community and environment are considered in
self care action, the focus is primarily on the individual (Balabagno, et.al, 2006). Another
limitation is the definition of health as being dynamic and ever changing with states ranging
from health or non health, wellness or illness (Fitzpatrick JJ, 2005). This definition of health
directly contradicts the experience of some patients with varying needs and levels of care
requirements. One of the most obvious limitations of Orem’s theory is that throughout her work,
it can be said that a limited recognition of an individual’s emotional needs is present within the
theory (George JB., 1995). It focuses more on physical care and gives lesser emphasis to
psychological care. Other theories address this limitation quite adequately such as Jean Watson’s
Theory of Caring.
REFERENCES
Fitzpatrick JJ, Whall AL. Conceptual models of nursing, analysis

and application. 4th ed. Upper Saddle River, New Jersey:
Pearson Prentice-Hall; 2005.
George JB. Nursing theories, the basis for professional nursing

practice. 4th ed. Norwalk: Appleton & Lange; 1995.
Balabagno, et al., Pathophysiology, UP Open University; 2006
Application of Orem’s Self-Care deficit theory in the Nursing Profession
By Rosinee Rosales
As a staff nurse in a medical ward in Riyadh Military Hospital, many of our patients have
respiratory and heart problems. All of them present different health problems and needs, some of
them are intubated and some of them are in comatose condition after cerebrovascular accident or
cardiac arrest. These patients will not be able to verbalize their concerns and feelings. Orem’s
concept of self-care specified different self-care requisites, being acquainted in these concepts,
it’s easier for me to assess and recognize the needs of my patients and it will facilitate me in
selecting particular nursing interventions based on their needs. Orem’s theory of nursing systems
is also evident in my current practice. The concepts of wholly compensatory, partly
compensatory, and supportive-educative systems are relevant to various interventions that I
perform based on different needs and abilities of my patients thus it creates individualized
nursing care. In the case of bedridden patients, wholly compensatory nursing system is
appropriate to them, “the nurse is their hands and their feet”. Patients who had liver biopsy are
not allowed to ambulate 24 hours after the procedure. In this event, partly compensatory nursing
system can be applied. Supportive-educative nursing system is appropriate to patients who have
diabetes mellitus, they should be taught to correct their diet and lifestyle and how to check their
blood sugar and to administer insulin if needed.
These are some of the things how Orem’s theory could be beneficial in my current nursing
practice. Her contributions are indeed significant in our nursing profession.
Myra Levine's Conservation Theory
"Ethical behaviour is not the display of one's moral rectitude in times of crisis, it is the day-to-
day expression of one's commitment to other persons and the ways in which human beings relate
to one another in their daily interactions." - Levine, Myra (1972)
Myra Estrin Levine
INTRODUCTION and BIOGRAPHY
The nursing profession is continuously evolving and dynamic. Ever since Florence Nightingale
started writing her notes on nursing, more theories and models about the nursing profession
flourished during the last decade; one of these is Myra Levine’s Conservational Theory which
was completed on 1973.
Myra Estrin Levine (1920-1996) was born in Chicago, Illinois. She was the oldest of three
children. She had one sister and one brother. Levine developed an interest in nursing because her
father (who had gastrointestinal problems) was frequently ill and required nursing care on many
occasions. Levine graduated from the Cook County School of Nursing in 1944 and obtained her
BS in nursing from the University of Chicago in 1949. Following graduation, Levine worked as
a private duty nurse, as a civilian nurse for the US Army, as a surgical nursing supervisor, and in
nursing administration. After earning an MS in nursing at Wayne State University in 1962, she
taught nursing at many different institutions (George, 2002) such as the University of Illinois at
Chicago and Tel Aviv University in Israel. She authored 77 published articles which included
“An Introduction to Clinical Nursing” with multiple publication years on 1969, 1973 & 1989.
She also received an honorary doctorate from Loyola University in 1992. She died on 1996.
Levine told others that she did not set out to develop a “nursing theory” but had wanted to find a
way to teach the major concepts in medical-surgical nursing and attempt to teach associate
degree students a new approach for daily nursing activities. Levine also wished to move away
from nursing education practices that were strongly procedurally oriented and refocus on active
problem solving and individualized patient care (George, 2002).
COMPOSITION OF CONSERVATION MODEL
Levine’s Conservation Model is focused in promoting adaptation and maintaining wholeness

using the principles of conservation. The model guides the nurse to focus on the influences and
responses at the organismic level. The nurse accomplishes the goals of the model through the
conservation of energy, structure, and personal and social integrity (Levine, 1967). Although
conservation is fundamental to the outcomes expected when the model is used, Levine also
discussed two other important concepts critical to the use of her model – adaptation and
wholeness.
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
(Levine, 1966, 1989a). Adaptation is achieved through the “frugal, economic, contained, and
controlled use of environmental resources by the individual in his or her best interest” (Levine,
1991, p. 5).
Wholeness is based on Erikson’s (1964, p. 63) description of wholeness as an open system:

“Wholeness emphasizes a sound, organic, progressive mutuality between diversified functions
and parts within an entirety, the boundaries of which are open and fluid.” Levine (1973, p. 11)
stated that “the unceasing interaction of the individual organism with its environment does
represent an ‘open and fluid’ system, and a condition of health, wholeness, exists when the
interaction or constant adaptations to the environment, permit ease—the assurance of integrity…
in all the dimensions of life.” This continuous dynamic, open interaction between the internal
and external environment provides the basis for holistic thought, the view of the individual as
whole.
Conservation, on the other hand, is the product of adaptation. Conservation is from the Latin
word conservatio, meaning “to keep together” (Levine, 1973). “Conservation describes the way
complex systems are able to continue to function even when severely challenged.” (Levine,
1990, p. 192). Through conservation, individuals are able to confront obstacles, adapt
accordingly, and maintain their uniqueness. “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” (Levine, 1973, pp. 193- 195). The primary focus of conservation is keeping
together of the wholeness of the individual. Although nursing interventions may deal with one
particualr conservation principle, nurses must also recognize the influence of other conservation
principles (Levine, 1990).
MAJOR CONCEPTS
Over the years, nurses (like Myra Levine) have developed various theories that provide different
explanations of the nursing discipline. Like her Conservation Model, all theories share four
central or major concepts: person, environment, nursing and health. In addition to this, Levine’s
Model also discussed that person and environment merge or become congruent over time, as it
will be discussed below.
I. The person is a holistic being who constantly strives to preserve wholeness and integrity and
one “who is sentient, thinking, future-oriented, and past-aware.” The wholeness (integrity) of the
individual demands that the “individual life has meaning only in the context of social life”
(Levine, 1973, p. 17). The person is also described as a unique individual in unity and integrity,
feeling, believing, thinking and whole system of system.
II. The environment completes the wholeness of the individual. The individual has both an
internal and external environment.
The internal environment combines the physiological and pathophysiological aspects of the
individual and is constantly challenged by the external environment. The internal environment
also is the integration of bodily functions that resembles homeorrhesis rather than homeostasis
and is subject to challenges of the external environment, which always are a form of energy.
Homeostasis is a state of energy sparing that also provides the necessary baselines for a
multitude of synchronized physiological and psychological factors, while homeorrhesis is a
stabilized flow rather than a static state. The internal environment emphasizes the fluidity of
change within a space-time continuum. It describe the pattern of adaptation, which permit the
individual’s body to sustain its well being with the vast changes which encroach upon it from the
environment.
The external environment is divided into the perceptual, operational, and conceptual
environments. The perceptual environment is that portion of the external environment which
individuals respond to with their sense organs and includes light, sound, touch, temperature,
chemical change that is smelled or tasted, and position sense and balance. The operational
environment is that portion of the external environment which interacts with living tissue even
though the individual does not possess sensory organs that can record the presence of these
factors and includes all forms of radiation, microorganisms, and pollutants. In other words, these
elements may physically affect individuals but are not perceived by the latter. The conceptual
environment is that portion of the external environment that consists of language, ideas, symbols,
and concepts and inventions and encompasses the exchange of language, the ability to think and
experience emotion, value systems, religious beliefs, ethnic and cultural traditions, and
individual psychological patterns that come from life experiences.
III. Health and disease are patterns of adaptive change. Health is implied to mean unity and
integrity and “is a wholeness and successful adaptation”. The goal of nursing is to promote
health. Levine (1991, p. 4) clarified what she meant by health as: “… the avenue of return to the
daily activities compromised by ill health. It is not only the insult or the injury that is repaired
but the person himself or herself… It is not merely the healing of an afflicted part. It is rather a
return to self hood, where the encroachment of the disability can be set aside entirely, and the
individual is free to pursue once more his or her own interests without constraint.” On the other
hand, disease is “unregulated and undisciplined change and must be stopped or death will
ensue”.
IV. Nursing involves engaging in “human interactions” (Levine, 1973, p.1). “The nurse enters
into a partnership of human experience where sharing moments in time—some trivial, some
dramatic—leaves its mark forever on each patient” (Levine, 1977, p. 845). The goal of nursing is
to promote adaptation and maintain wholeness (health).
The goal of nursing is to promote wholeness, realizing that every individual requires a unique
and separate cluster of activities. The individual’s integrity is his/her abiding concern and it is the
nurse’s responsibility to assist the patient to defend and to seek its realization. The goal of
nursing is accomplished through the use of the conservation principles: energy, structure,
personal, and social integrity.
V. As it was mentioned above, Levine’s Conservation Model discussed that the way in which the
person and the environment become congruent over time. It is the fit of the person with his or
her predicament of time and space. The specific adaptive responses make conservation possible
occur on many levels; molecular, physiologic, emotional, psychologic, and social. These
responses are based on three factors (Levine, 1989): historicity, specificity and redundancy.
1. Historicity refers to the notion that adaptive responses are partially based on personal and
genetic past history. Each individual is made up of a combination of personal and genetic
history, and adaptive responses are the result of both.
2. Specificity refers the fact that each system that makes up a human being has unique stimulus-
response pathways. Responses are stimulated by specific stressors and are task oriented.
Responses that are stimulated in multiple pathways tend to be synchronized and occur in a
cascade of complimentary (or detrimental in some cases) reactions.
3. Redundancy describes the notion that if one system or pathway, is unable to ensure adaptation,
then another pathway may be able to take over and complete the job. This may be helpful when
the response is corrective (e.g., the use of allergy shots over a lengthy period of time to diminish
the effects of severe allergies by gradually desensitizing the immune system). However,
redundancy may be detrimental, such as when previously failed responses are reestablished (e.g.,
when autoimmune conditions cause a person’s own immune system to attack previously healthy
tissue in the body).
A change in behavior of an individual during an attempt to adapt to the environment is called an

organismic response. It helps individual to protect and maintain their integrity. There are four
types, namely (1) Flight or fight: An instantaneous response to real or imagined threat, most
primitive response; (2) Inflammatory: response intended to provide for structural integrity and
the promotion of healing; (3) Stress: Response developed over time and influenced by each
stressful experience encountered by person; and (4) Perceptual: Involves gathering information
from the environment and converting it in to a meaning experience.
KEY CONCEPTS (Conservational principle)
The core, or central concept, of Levine’s theory is conservation (Levine, 1989). When a person
is in a state of conservation, it means that individual adaptive responses conform change
productively, and with the least expenditure of effort, while preserving optimal function and
identity. Conservation is achieved through successful activation of adaptive pathways and
behaviors that are appropriate for the wide range of responses required by functioning human
beings.
Myra Levine described the Four Conservation Principles. These principles focus on conserving
an individual's wholeness. She advocated that nursing is a human interaction and proposed four
conservation principles of nursing which are concerned with the unity and integrity of
individuals. Her framework includes: energy, structural integrity, personal integrity, and social
integrity.
I. Conservation of energy: Refers to balancing energy input and output to avoid excessive
fatigue. It includes adequate rest, nutrition and exercise.
Examples: Availability of adequate rest; Maintenance of adequate nutrition
II. Conservation of structural integrity: Refers to maintaining or restoring the structure of body
preventing physical breakdown and promoting healing.
Examples: Assist patient in ROM exercise; Maintenance of patient’s personal hygiene
III. Conservation of personal integrity: Recognizes the individual as one who strives for
recognition, respect, self awareness, selfhood and self determination.
Example: Recognize and protect patient’s space needs
IV. Conservation of social integrityAn individual is recognized as some one who resides :
with in a family, a community, a religious group, an ethnic group, a political system and a nation.
Example: Help the individual to preserve his or her place in a family, community, and society.
ASSUMPTIONS
Myra Levine’s Model also discusses other assertions and assumptions:
• The nurse creates an environment in which healing could occur

• A human being is more than the sum of the part
• Human being respond in a predictable way
• Human being are unique in their responses
• Human being know and appraise objects ,condition and situation
• Human being sense ,reflects, reason and understand
• Human being action are self determined even when emotional
• Human being are capable of prolonging reflection through such strategists raising
questions
• Human being make decision through prioritizing course of action
• Human being must be aware and able to contemplate objects, condition and situation
• Human being are agents who act deliberately to attain goal
• Adaptive changes involve the whole individual
• A human being has unity in his response to the environment
• Every person possesses a unique adaptive ability based on one’s life experience which
creates a unique message
• There is an order and continuity to life change is not random
• A human being respond organismically in an ever changing manner
• A theory of nursing must recognized the importance of detail of care for a single patient
with in an empiric framework that successfully describe the requirement of the all patient
• A human being is a social animal
• A human being is an constant interaction with an ever changing society
• Change is inevitable in life
• Nursing needs existing and emerging demands of self care and dependant care
• Nursing is associated with condition of regulation of exercise or development of
capabilities of providing care
LIMITATIONS
Despite the comprehensiveness and wide application of Levine's theory, the model is not without
limitation. For example, Levine's conservation model focuses on illness as opposed to health;
thus, nursing interventions are limited to addressing only the presenting condition of an
individual. Hence, nursing interventions under Levine's theory have a present and short-term
focus and do not support health promotion and illness prevention principles, even though these
are essential components of current nursing practice. Thus, the major limitation is the focus on
individual in an illness state and on the dependency of patient.
Furthermore, the nurse has the responsibility for determining the patient ability to participate in
the care, and if the perception of nurse and patient about the patient ability to participate in care
don’t match, this mismatch will be an area of conflict.
There are a number of limitations when it comes to the four principles. On conservation of
energy, Levine’s goal is to avoid fatigue or excessive use of energy. This is manageable in the
bedside care of ill clients. In cases where energy needs to be utilized rather than conserved like in
manic patients, ADHD in children or those with limited movements such as paralyzed clients,
Levine’s theory does not apply. On conservation of structural integrity, the focus is to preserve
the anatomical structure of the body as well as to prevent damage to the anatomical structure.
This, again, has limitations. In cases where the anatomical structure is not so perfect but without
identified disfigurement or problems as in plastic surgeries, procedures like breast enhancements
and liposuctions; the person's structural integrity is compromised but it is the patient's choice
seeking physical beauty and psychological satisfaction that is taken into consideration. Otherwise
such, procedures should not be promoted. On conservation of personal integrity, the nurse is
expected to provide knowledge and the patient need to be respected, provided with privacy,
encouraged and psychologically s supported. The limitations here will center on clients who are
psychologically impaired and incapacitated and cannot comprehend and absorb knowledge, i.e.
comatose patients, suicidal individuals or clients. Lastly, conservation of social integrity’s aim is
to preserve and recognition of human interaction, particularly with the clients, significant others
who comprise his support system. The limitation specific for this, is when the client has no
significant others like family members. Abandoned children, psychiatric patients who are unable
to interact, unresponsive clients like unconscious individuals, the focus here is no longer the
patient himself but the people involved in his/her health care.
APPLICATIONS
Nursing research
• Principles of conservation have been used for data collection in various researches
• Conservational model was used by Hanson et al.in their study of incidence and
prevalence of pressure ulcers in hospice patient
• Newport (n.d.) used principle of conservation of energy and social integrity for
comparing the body temperature of infant’s who had been placed on mother’s chest
immediately after birth with those who were placed in warmer
Nursing education
• Conservational model was used as guidelines for curriculum development

• It was used to develop nursing undergraduate program at Allentown college of St. Francis
de Sales, Pennsylvania
• Used in nursing education program sponsored by Kapat Holim in Israel
• Nursing administration
• Taylor (n.d.) described an assessment guide for data collection of neurological patients
which forms basis for development of comprehensive nursing care plan and thus evaluate
nursing care
• McCall (n.d.) developed an assessment tool for data collection on the basis of four
conservational principles to identify nursing care needs of epileptic patients
• Family assessment tool was designed by Lynn-Mchale and Smith (n.d.) for families of
patient in critical care setting
Nursing practice
• Conservational model has been used for nursing practice in different settings
• Bayley (n.d.) discussed the care of a severely burned teenagers on the basis of four
conservational principles and discussed patient’s perceptual, operational and conceptual
environment
• Pond (n.d.) used conservation model for guiding the nursing care of homeless at a clinic,
shelters or streets
Nursing Process
Assessment
• Collection of provocative facts through observation and interview of challenges to the
internal and external environment using four conservation principles
• Nurses observes patient for organismic responses to illness, reads medical reports. talks
to patient and family
• Assesses factors which challenges the individual
Trophicognosis
• Nursing diagnosis-gives provocative facts meaning

• A nursing care judgment arrived at through the use of the scientific process
• Judgment is made about patient’s needs for assistance
Hypothesis
• Planning
• Nurse proposes hypothesis about the problems and the solutions which becomes the plan
of care
• Goal is to maintain wholeness and promoting adaptation
Interventions
• Testing the hypothesis

• Interventions are designed based on the conservation principles
• Mutually acceptable
• Goal is to maintain wholeness and promoting adaptation
Evaluation
• Observation of organismic response to interventions

• It is assesses whether hypothesis is supported or not supported
• If not supported, plan is revised, new hypothesis is proposed
***
To summarize, Levine expressed the view that within the nurse-patient relationship a patient’s
state of health is dependent on the nurse-supported process of adaptation. This guides nurses to
focus on the influences and responses of a client to promote wholeness through the Conservation
Principles. The goal of this model is to accomplish this through the conservation of energy,
structural, personal and social integrity. The goal of nursing is to recognize, assist, promote, and
support adaptive processes that benefit the patient.
REFERENCES
Websites:
Current Nursing. (n.d.). Nursing theories: Levine’s four conservation principles. Retrieved from
http://currentnursing.com/nursing_theory/Levin_four_conservation_principles.htm on July 2009.
Leach, M.J. (n.d.) Wound management: Using Levine’s Conservation Model to guide practice.
Vol. 52, Issue No. 8. Retrieved from: http://www.o-wm.com/article/6024 on July 2009.
Sitzman, K. & Eichelberger, L.W. (2009). Understanding the work of nurse theorists: A creative
beginning. Retrieved from http://nursing.jbpub.com/sitzman/artGallery.cfm on July 2009. Jones
and Bartlett Publishers.
Yeager, S. (2002). Overview of nurse theorist: Myra Levine’s conservation model. Retrieved
from: http://www4.desales.edu/~sey0/levine.html on July 2009.
www.google.com
www.yahoo.com
Books:
Añonuevo, C. A., et al. (2005). Theoretical foundations of nursing. University of the Philippines
Open University: Quezon City, Philippines.
George, J. B. (2001). Nursing theories: Base for professional nursing. (5th ed). Pearson
Education.
Levine, M. E. (1973). Introduction to clinical nursing. F. A. Davis Company: Philadelphia, PA.
Parker, M. E. (2001). Nursing theories and nursing practice. F. A. Davis Company: Philadelphia,
PA.
Schaefer, K. M., Pond, J. B., et al. (1991). Levine’s conservation model: A framework of nursing
practice. F.A. Davis Company: Philadelphia, PA.
Tomey, A. M. & Alligood, M. R. (2006). Nursing theorists and their work. (6th ed.). Elsevier
Health Sciences.
Comfort Theory: An Overview
In the light of current nursing shortage, health care system should find the means to
address this problem in order to continue achieving the goal, which is to provide the
optimum level of health of a person or client.
During the 1900’s, comfort is considered the goal of both nursing and medicine because
it is believed that comfort will lead to recovery. Comfort is a complex term
and titled as one of the distinguishing characteristic of the nursing
profession yet, it has never been conceptualized, studied and researched
in the field.
In this part of the blog, you will notice that we include certain terms about the theory in
which you may get confused of but don’t worry because each will be discussed further as
you read the other posts in this blog.
Pioneering the work on theory of comfort in nursing is Dr. Katharine C. Kolcaba

PhD, RN, an American nursing scholar, a clinical nurse specialist who attained several
scholastic awards and achievements. With her collated readings, knowledge,
experiences and researches... she was able to provide a holistic definition for
comfort not only in nursing but for the whole health care team.
The theory of comfort is one of the many middle range nursing theory
because it is focused on a limited dimension of the reality of nursing. It is formulated to
provide guidance for everyday practice and scholarly research rooted in the discipline of
nursing.
According to Kolcaba, Comfort has 3 existing forms... Relief, Ease and

Transcendence. It also includes 4 contexts in which patient comfort can
occur... Physical, Psycho-spiritual, Environmental and Socio-cultural.
Similar to all other Nursing Theories, Kolcaba was also able to apply the 4 concepts
in the metaparadigm of nursing (Person, Health, Nursing and
Environment) according to her theory. In this theory, she proposed that the term
“Nursing Interventions” should be changed to “Comfort Interventions” as to
broaden its application and not specify the work only to nurses.
Her theory also talked about comfort considered to be a positive concept and is
associated with activities that nurture and strengthen patients.
Kolcaba’s Theory of Comfort has a real potential to direct the work and thinking
of all health care providers within one institution since, it appears that the
concept of comfort is universally present in all culture and appropriate
universal goal for healthcare.
As her study continues, it is speculated that if Comfort Theory is adapted to include all
health care providers and implemented as an institution-wide framework
for practice... Comfort for patients will be enhanced further, thus,
increasing their health-seeking behaviour--- A win-win situation for the patient,
the hospital/institution and the society.
There are a lot of benefits we can get in learning and applying Kolcaba’s Theory of
Comfort as it promotes greater understanding and collaboration between
health care team members addressing the current shortage in health care team. In
addition, it will improve societal acceptance and appreciation of the health
institution and increase patient satisfaction.
References:
March, A., & McCormack, D., (April 2009). Nursing theory-directed healthcare: Modifying
kolcaba's comfort theory as an institution-wide approach. Holistic Nursing Practice.
23(2). Retrieved from http://www.nursingcenter.com/prodev/ce_article.asp?
tid=851431
Smith, M., & Liehr, P. (2008). HMiddle range theory for nursing second edition. Retrieved
from www.springerpub.com/samples/9780826119162_chapter.pdf
MARGARET NEWMAN, RN, PHD, FAAN
Saturday, July 18, 2009 11:26 PM
Bibliography
-Margaret Newman was born on October 10, 1933 in Memphis Tennessee.
In 1954 She earned her first Bachelors degree in Home Economics and English from
Baylor University in Waco, Texas
-Margaret Newman felt a call to nursing for a number of years prior to her decision
to enter the field.
-During that time she became the primary caregiver for her mother, who became ill
with Lou Gehrig's Disease.
-Upon entering nursing at the University of Tennessee, Memphis, Dr. Newman knew
almost immediately that nursing was right for her
Education
• In 1962 she received her Bachelors degree in Nursing from the University of
Tennessee, Memphis.
• In 1964 she received her Masters Degree of Medical-Surgical Nursing and

Teaching at the University of California in San Francisco.
• In 1971 she completed her Doctorate of Nursing Science and Rehabilitation at

New York University
Employment
Ø 1971 to 1976- She completed her graduate studies at New York University. She
also worked and taught alongside nursing theorist Martha Rogers.
Ø Rehabilitation Nursing stemmed her interest in health, movement & time.
Ø 1977- Professor in charge of graduate study in nursing at Pennsylvania State.
Ø 1984- Nurse theorist at the University of Minnesota.
Ø 1996- Retired from teaching.
HEALTH AS AN EXPANDING CONSCIOUSNESS

Newman's Health as Expanding Consciousness was influenced by Martha Rogers.
Newman (2003) writes:
The theory of health as expanding consciousness stems from Rogers' theory of

Unitary Human Beings. Rogers' assumptions regarding patterning of persons in
interaction with the environement are basic to the view that consciousness is a
manifestation of an evolving pattern of person-environment
interaction...Consciouness includes not only the cognitive and affective awareness
normally associated with consciousness, but also the interconnectedness of the
entire libing system, which includes physiochemical maintenance and growth
processes as well as teh immune system. This pattern of information, which is the
consciousness of the system, is part of a larger,undivided pattern of an expanding
universe
Newman’s theory of pattern recognition provides the basis for the process of nurse-
client interaction. Newman suggested that the task in intervention is a pattern
recognition accomplished by the health professional becoming aware of the pattern
of the other person by becoming in touch with their own pattern. Newman
suggested that the professional should focus on the pattern of the other person ,
acting as the “reference beam in a hologram”.
Relationship to the Metaparadigm Concepts
Newman has designated “caring in the human health experience” as the focus of
nursing discipline and has specified the focus as the metaparadigm of the discipline.
Nursing
-to help clients get in touch with the meaning of their lives by the identification of
their patterns of relating
-Intervention is a form of non intervention whereby the nurse’s presence assists
clients to recognize their own patterns of interacting with the environment.
-facilitates pattern recognition in clients by forming relationships with them at

critical points n their lives and connecting with them in an authentic way.
-The nurse-client relationship is characterized by “a rhythmic coming together and

moving apart as clients encounter disruption of their organized predictable state.”
-Nurses are seen as partners in the process of expanding consciousness.
Person
-Person as individuals are identified by their individual patterns of consciousness.
-Persons are further defined as “centers of consciousness” within an overall pattern

of expanding consciousness”
-The definition of person has also been expanded to include family and community.
Environment
-Environment is not explicitly defined but is described as being the larger whole,
which is beyond the consciousness of the individual.
Health
-A fusion of disease and non-disease creates a synthesis that is regarded as health.
-Disease and non-disease are each reflections of the larger whole; therefore a new
concept “pattern of the whole” is formed.
-Newman has stated that pattern recognition is the essence of the emerging health.
Manifest health, encompassing disease and non-disease can be regarded as the
explication of the underlying pattern of person-environment.
Essence of Margaret Newman's Theory:
• An individual person in each situation, no matter how disordered and hopeless, is

part of the universal process of expanding consciousness.
• The expanding consciousness is a process wherein an individual becomes more

of his real self, as he finds greater meaning in his life and the lives of those people
around him.
• In his/her search for his/her real self, the individual's awareness expands to
include the interests of those people around him and the rest of the world.
• Self-awareness may eventually lead to acceptance of one's self and one's

circumstances and limitations.
• With self-awareness and self-acceptance, an in-depth understanding of one's
condition may pave the way for a person to engage into activities leading to
positive progression transcending
Supporting Theory
• The health of a human being is a unitary phenomenon, an evolving pattern of

human-environment (Rogers, 1970).
• Life is a process of expanding consciousness. Consciousness is the informational

capacity of the system and can be seen in the quality of interaction of the system
with the environment (Bentov, 1978).
• The explicate order is a manifestation of the implicate order (Bohm, 1980).
Assumptions
1. Health encompasses conditions heretofore described as illness, or, in medical
terms, pathology
2. These pathological conditions can be considered a manifestation of the total

pattern of the individual
3. The pattern of the individual that eventually manifests itself as pathology is

primary and exists prior to structural or functional changes
4. Removal of the pathology in itself will not change the pattern of the indivdual
5. If becoming ill is the only way an individual's pattern can manifest itself, then
that is health for that person
6. Health is an expansion of consciousness.

Critique
Clarity
Semantic clarity is evident in the definitions, descriptions, and dimensions of the

concepts of the theory.
Simplicity
The deeper meaning of the theory of health as expending consciousness is

complex. The theory as a whole must be understood, nut just the isolated concepts.
If an individual wanted to use a positivist approach, Newman’s original propositions
would serve as guides for hypothesis development. However, researchers who tried
that approach have concluded that it is inadequate to study the theory. As Newman
have advocated in the 1994 edition of her book, Health as Expanding
Consciousness, the holistic approach of the hermeneutic dialectic method is
consistent with the theory and requires a high level of understanding the theory in
praxis research.
Generality
The concepts in Newman’s theory are broad in scope because they all relate to
health. The theory has been applied in several different cultures and is applicable
across the spectrum of nursing care situations. This renders her theory
generalizable.
Empirical Precision
In the early stages of development, aspects of the theory were operationalized and
tested within a traditional scientific method. However, quantitative methods are
inadequate in capturing the dynamic, changing nature of this theory.
Derivable Consequences
The focus of Newman’s theory of health as expanding consciousness provides an

evolving guide for all health-related disciplines. In the quest for understanding the
phenomenon of health, this unique view of health challenges nurses to make a
difference in nursing practice by the application of this theory.
Margaret Newman UPOU N207_09_groupF
Case Study/ Application

Alice is an 80-year old widow who has lived alone in a low-income apartment
complex in a small rural town since her husband’s death 8 years ago. She has one
surviving family member, a granddaughter who lives 30 miles away. Alice has
never learned to drive and depends on her granddaughter for all transpiration to
physician appointments, shopping and getting medications. Her income is $824
monthly, and she requires several expensive prescriptions for arthritis,
hypertension, and cardiac problems. She has osteoarthritis in her knees and
requires a quad cane for support and safety when getting around her apartment. A
visiting nurse stops by weekly to check her blood pressure and give her an injection
for her arthritis. The visiting nurse notes that Alice’s BP is elevated, and Alice states
that she has been unable to get her medication because her granddaughter’s car is
broken. Alice also mentions that she is running low on food in the apartment
because she can’t go out to shop.
Alice admits that she hardly knows or speaks to her neighbours despite having lived
there for 8 years, and she still feels like a stranger and doesn’t want to “push
myself in.” She says that she hates to bother people and “won’t hardly unless I just
have to.” She says that sometimes she gets lonely for “her people” who are all
deceased.
The visiting nurse, in working with Alice, recognized the current situation as a
choice point, with potential for increased interaction with other and increased
interaction with others and increased consciousness. The old ways no longer work
for Alice and new ways relating are necessary. The nurse incorporates the elements
of Newman’s method to assist Alice in pattern recognition for the purpose of
discovering new potentials for action. As the nurse has Alice relate her story,
through dialogue and interacting with Alice, she helps Alice recognize past patterns
of relating and how present circumstances have changed those patterns. Alice talks
about how she and her husband lived for 56 years in a rural mountain cabin with
few neighbours except for two sisters and their sole daughter. They were very self-
sufficient, grew large gardens, had their own livestock, and rarely went to town. All
these family members are now deceased except the granddaughter, who insisted
that Alice leave the cabin and move into town after the death of her husband. It is
apparent that Alice’s past patterns have been those of independence and limiting
social contact mainly to family members.
The nurse shares her perceptions with Alice and verifies the pattern identification.
Alice states, “I just don’t know long I am going to manage by myself anymore.” The
nurse helps her explore sources of help, besides the granddaughter, that will help
Alice remain in her apartment as independently as possible. Alice relates that there
is one man, a few doors away who has stopped several times to ask if she needed
anything from the grocery store, but she hadn’t asked him because she hates to
bother him and doesn’t want to be “beholden.”
After further discussion, she decides that she will ask him to pick up staples and
medications for her and pay him back by baking some bread saying, “I just love to
bake anyway and haven’t had anyone much to bake for.”
In subsequent weekly visits, Alice and the nurse explore the possibility of getting
medications at a reduced price through the local nurse-managed clinic. Alice
states that she might try getting to know some of her neighbours. The nurse helps
Alice make arrangements to be picked up by the Senior Van for physician
appointments. As Alice begins to build her own support system, she finds that she
relies on the nurse less for help with maintain her independence and they resume
their previous pattern of simply checking her BP and giving her injections weekly.
HTML Codes
Sources:
1.Tomey, A. M. & Alligood., M. R., (2006). Nursing Theorists and Their Work. 6th
edition. Mosby Inc.
2.George, Julia B. (1995) Nursing Theories - the base for professional nursing
practice. Norwalk, Connecticut. Appleton & Lange
3.Weingourt, Rita(1998) Using Margaret A. Newman's theory of health with elderly

nursing home residents. Perspectives in Psychiatric Care.
http://findarticles.com/p/articles/mi_qa3804/is_199807/ai_n8795466
4.http://books.google.com.ph/books?
id=pe4wvuhT01UC&dq=margaret+newman+nursing&printsec=frontcover&source
=in&hl=en&ei=sbxNSr2vDobq7APCm9yBBA&sa=X&oi=book_result&ct=result&resn
um=12
5.Picard, C and Jones, Dorothy (2004). Giving Voice to What We Know: Margaret
Newman’s Theory of Health as Expanding Consciousness in Nursing Practice,
Research, and Education, Jones and Bartlett Publishing.
6.http/www.healthasexpandingconsciousness.org/Downloads/HECPresentation.pdf
7.www.scrbd.com/doc/5611804/Models -and- Theories-of-Nursing
8.www.scrbd.com/doc/10899031/nursing-Theory
9.http://library.utmem.edu/exhibits/newman/
10.http://escholarship.bc.edu/dissertations/AAI3008589
11.http://wps.prenhall.com/chet_george_nurstheory_5/0,2535,88787,00.htm
12.http://www.healthasexpandingconsciousness.org/home/
13.http://www.enursescribe.com/nurse_theorists.htm
Toktam Madani
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LinK:
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Changing The World... One Step At A Time (Faye G. Abdellah)
Friday, August 28, 2009 5:44 AM
Faye Glenn Abdellah was one of the most influential nursing theorist and public
health scientist in our era. It is extremely rare to find someone who has dedicated
all her life to the advancement of the nursing profession and accomplish this feat
with so much distinction and merit. In fact, when she was inducted into the National
Women's Hall of Fame in 2000, Abdellah said, "We cannot wait for the world to
change.… Those of us with intelligence, purpose, and vision must take the lead and
change the world. Let us move forward together! … I promise never to rest until my
work has been completed!"
And she couldn’t have said it any better. Let us get to know this extraordinary
theorist by understanding her theory, appreciating how her life story influenced her
scientific pursuit, and discerning how her theory can be applied in the ever-dynamic
field of nursing.
BIOGRAPHY
Faye Glenn Abdellah was born on March 13, 1919, in New York City. Years later, on
May 6, 1937, the German hydrogen-fueled airship Hindenburg exploded over
Lakehurst, New Jersey, where 18-year-old Abdellah and her family then lived, and
Abdellah and her brother ran to the scene to help. In an interview with a writer for
Advance for Nurses, Abdellah recalled: "I could see people jumping from the
zeppelin and I didn't know how to take care of them, so it was then that I vowed
that I would learn nursing."
Educational Achievements
In 1942, Abdellah earned a nursing diploma and is magna cum laude from Fitkin
Memorial Hospital's School of Nursing New Jersey (now Ann May School of Nursing).
She received her Bachelor of Science Degree in 1945, a Master of Arts degree in
1947 and Doctor of Education in Teacher’s College, Columbia University. In 1947
she also took Master of Arts Degree in Physiology. With her advanced education,
Abdellah could have chosen to become a doctor. However, as she explained in her
Advance for Nurses interview, "I never wanted to be an M.D. because I could do all I
wanted to do in nursing, which is a caring profession.”
As an Educator and Researcher
Abdellah went on to become a nursing instructor and researcher and helped

transform the focus of the profession from disease centered to patient centered.
She expanded the role of nurses to include care of families and the elderly.
In 1957 Abdellah headed a research team in Manchester, Connecticut, that
established the groundwork for what became known as progressive patient care. In
this framework, critical care patients were treated in an intensive care unit, followed
by a transition to immediate care, and then home care. Abdellah is credited with
developing the first nationally tested coronary care unit as an outgrowth of her work
in Manchester.
Abdellah's first teaching job was at Yale University School of Nursing. At that time
she was required to teach a class called "120 Principles of Nursing Practice," using a
standard nursing textbook published by the National League for Nursing that
included guidelines that had no scientific basis. After a year Abdellah became so
frustrated that she gathered her colleagues in the Yale courtyard and burned the
textbooks. As she told Image: "Of the 120 principles I was required to teach, I really
spent the rest of my life undoing that teaching, because it started me on the long
road in pursuit of the scientific basis of our practice."
Established Nursing Standards
In another innovation within her field, Abdellah developed the Patient Assessment of
Care Evaluation (PACE), a system of standards used to measure the relative quality
of individual health-care facilities that was still used in the health care industry into
the 21st century. She was also one of the first people in the health care industry to
develop a classification system for patient care and patient-oriented records.
Military Nursing Service
Abdellah served for 40 years in the U.S. Public Health Service (PHS) Commissioned
Corps, a branch of the military. In 1981 she was named deputy surgeon general,
making her the first nurse and the first woman to hold the position and hold the
position for eight years. As deputy surgeon general, it was Abdellah's responsibility
to educate Americans about public-health issues, and she worked diligently in the
areas of AIDS, hospice care, smoking, alcohol and drug addiction, the mentally
handicapped, and violence.
She was also the former Chief Nurse Officer for the U.S. Public Health Service,
Department of Health and Human Services, Washington D.C. She was one of the
first to talk about gerontological nursing, to conduct research in that area, and to
influence public policy regarding nursing homes. She was responsible for
establishing nursing-home standards in the United States.
Abdellah has frequently stated that she believes nurses should be more involved in
public-policy discussions. In her government position, Abdellah also continued her
efforts to improve the health and safety of America's elderly.
What has influenced Faye Abdellah in the development her own model of nursing?
1937 – She wanted to be a nurse on the day she saw Hindenburg explode. In this
time she was 18 years old on an outing with her family in New Jersey. The fire and
injuries that resulted from this horrific event inspired in her wish to never again be
helpless when people needed assistance.
1949 – She spent 40 years in Public Health Service where she first became involved
in research, being assigned to perform studies to improve nursing practices.
1960 – She was influenced by the desire to promote client-centered comprehensive

nursing care. Abdellah described nursing as a service to individuals, to families and
therefore to, to society. Acknowledging the influence of Henderson, expanded
Henderson's 14 needs into 21 problems that she believed would serve as a
knowledge base for nursing. Throughout her career, she strongly supported the idea
that nursing research would be the key factor in helping nursing to emerge as a
true profession. The research done regarding these common needs and problems
has served as a foundation for the development of what is now known as nursing
diagnosis.
Now that we have learned her influences, let’s get to know her concepts on the
nursing concepts of man, health, environment, and nursing:
MAN/PERSON
Abdellah describes people as having physical, emotional, and sociological needs.
These needs may overt, consisting of largely physical needs, or covert, such as
emotional, sociological and interpersonal needs- which are often missed and
perceived incorrectly. The patient is described as the only justification for the
existence of nursing. The individuals (and families) are the recipients of nursing,
and health, or achieving of it, is the purpose of nursing services
HEALTH
Abdellah’s concept of health maybe defined as the dynamic pattern of functioning

whereby there is a continued interaction with internal and external forces that
results in the optimal use of necessary resources that serve to minimize
vulnerabilities (George, 1990).
In Patient–Centered Approaches to Nursing, Abdellah describes health as a state

mutually exclusive of illness. Emphasis should be placed upon prevention and
rehabilitation with wellness as a lifetime goal. Holistic approach must be taken by
the nurse to help the client achieve state of health (George, 1990). However in
order to effectively perform these services, the nurse must accurately identify the
lacks or deficits regarding health that the client is experiencing. These lacks or
deficits are the client’s health needs.
Although Abdellah does not give a definition of health, she speaks to “total health
needs” and “a healthy state of mind and body” in her description of nursing as a
comprehensive service.
ENVIRONMENT/SOCIETY
The environment is implicitly defined by Abdellah as the home or community from

which patient comes. Society is included in “planning for optimum health on local,
state, national and international levels.” However, as Abdellah further delineated
her ideas, the focus of nursing service is clearly the individual. Society is integrated
when she discusses the implementation.
NURSING
GOAL OF NURSING:
To Abdellah, nursing is a service to individuals, to families and therefore to society.

The goal of nursing according to Abdellah is the fullest physical, emotional,
intellectual, social and spiritual functioning of the client which pertains to holistic
care.
She stated that nursing is based on an art and science that molds the attitudes,
intellectual competencies, and technical skills of the individual nurse into the desire
and ability to help people, sick or well, cope with their health needs (George, 1990).
These would mean a comprehensive nursing service, this would include:
1. Recognizing the nursing problems of the patient.
2. Deciding the appropriate actions to take in terms of relevant nursing principles.
3. Providing continuous care of the individual’s total health needs.
4. Providing continuous care to relieve pain and discomfort and provide immediate
security for the individual.
5. Adjusting total nursing care plan to meet the patient’s individual needs.
6. Helping the individual to become more self directing in attaining or maintaining a

healthy state of mind and body.
7. Instructing nursing personnel and family to help the individual do for himself that
which he can with his limitations.
8. Helping the individual to adjust to his limitations and emotional problems.
9. Working with allied health professional in planning for optimum health on local,
state, national and international needs.
10. Carrying out continuous evaluation and research to improve nursing techniques
and to develop new techniques to meet all the health needs of the people.
Nursing care for Abdellah is doing something to or for the person or providing
information to the person with the goals of meeting needs, increase or restoring
self-help ability or alleviating impairment.
Her theory also stated that the nurse needs knowledge on basic science and
specific nursing skills, as well as knowledge skills in the communication, psychology,
sociology, growth and development and interpersonal relations. These 11 nursing
skills that a nurse must possess includes the following:
1. Observation of health status
2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel resources
8. Problem-solving
9. Direction of work of others
10. Therapeutic use of the self
11. Nursing procedures

Nursing is broadly grouped into the 21 problem areas to guide care and promote
use of nursing judgment. These deals with biological, psychological, and social
areas of individuals.
KEY CONCEPTS AND MODEL
Faye Abdellah proposed a classificatory framework for identifying nursing problems,

based on her idea that nursing is basically oriented to meeting an individual client’s
total health needs. Her major effort was to differentiate nursing from medicine and
disease orientation.
Abdellah’s patient-centred approach to nursing was developed inductively from her

practice and is considered a human needs theory. Although it was intended to guide
care of those in the hospital, it also has relevance for nursing care in community
settings. Abdellah was clearly promoting the image of the nurse who was not only
kind and caring, but also intelligent, competent, and technically well prepared to
provide service to the patient.
ABDELLAH'S TYPOLOGY OF 21 NURSING PROBLEMS
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, and sleep.
3. To promote safety through prevention of accident, injury, or other trauma and

through the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body to disease conditions—

pathological, physiological, and compensatory.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory function.
12. To identify and accept positive and negative expressions, feelings, and
reactions.
13. To identify and accept interrelatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement of personal spiritual goals
17. To create and/or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical, emotional,

and developmental needs.
19. To accept the optimum possible goals in the light of limitations, physical, and
emotional.
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors in the cause of
illness.
Abdellah's typology was divided into three areas:
1. Physical, sociological,and emotional needs of the patients;
2. Types of interpersonal relationship between the nurse and the patient;
3. Common elements of patient care.

Theoretical Assertions
Several assertions were repeatedly stated by Abdellah although they were not
labeled as such. These assertions are:
1. The nursing problem and nursing treatment typologies are the principles of
nursing practice and constitute the unique body of knowledge that is nursing.
2. Correct identification of the nursing problem influences the nurse's judgment in

selecting steps in solving the patient's problem.
3. The core of nursing is patient/client problems that focus on the patient and
his/her problems.
With this knowledge, how, then, can we apply Abdellah’s theory in our field of
practice?
Nursing Practice
First and foremost, Abdellah’s main goal is the improvement of the nursing
education. She believed that as the education of nurses improves, nursing practice
improves as well.
The most important impact of Abdellah’s theory to the nursing practice is that it
helped transform the focus of the profession from being “disease-centered” to
“patient-centered.” The patient-centered approach was constructed to be useful to
nursing practice as it helped bring structure and organization to what was often
been a disorganized collection of nursing care experiences. She categorized nursing
problems based on the individual’s needs and developed a typology of nursing
treatment and nursing goals which served as a basis for determining and organizing
nursing care.
Her twenty one nursing problems made nurses look at patients’ problems and come
up with nursing plan of care in a thorough and organized way. Abdellah’s
identification of health needs as overt and covert assists nurses in exploring
unmasked conditions about the client and plan appropriate interventions to address
them. Client centered care emphasizes the principle that every nursing goal should
be geared towards treating the patient and not just the mere illness. It has been
viewed that if all 21 problems are investigated, the patient would be likely to be
thoroughly assessed and thus will aid the nurse organize appropriate nursing
strategies. Currently, the 21 nursing problems have been updated to focus on the
patient and nursing diagnosis. It has ultimately helped nurses develop their
individual critical-thinking skills leading to increase in job satisfaction and more
productive nurse-patient and nurse-family interaction.
The application of Abdellah’s theory in nursing practice is greatly attributed to its

strong influence to a patient-centered nurse-focused problem-solving approach.
Abdellah’s problem-solving process of identifying the problem, selecting pertinent
data, formulating hypotheses through collection of data, and revising hypotheses on
the basis of conclusions obtained from the data parallels the steps of the nursing
process of assessment, diagnosis, planning, implementation and evaluation
(Abdellah and Levine, 1986; George, 1995). Because of the strong nurse-centered
orientation in the 21 nursing problems, their use in the nursing process is primarily
to direct the nurse; indirectly, the client benefits (George, 1995). If the nurse assists
the client in meeting the goals states in the nursing problems, then the client will be
moved toward good, optimum health.
In the end, Abdellah’s theory helps the practicing nurse organize the administration
of care, nursing strategies and provides a scientific base for making decisions. As a
theorist who was actively involved on nursing and health care internationally,
Abdellah gave credence to the use of the model and is an advocate of applying new
knowledge to improve practice.
Nursing Education
Abdellah’s theories and concepts were developed in the 1950’s to present a

comprehensive clinical record for nursing students, thus, providing structure to the
nursing curriculum. The patient-centered approach that was based from her
concepts supported and facilitated the move from the medical model that was used
at the time to a nursing model. The major focus of her book, Patient-Centered
Approaches (Abdellah, et al., 1960), was on the implementation of the model in
baccalaureate, associate degree and diploma nursing programs. Abdellah’s
extraordinary researches, publications and other works and her worldwide
reputation have been instrumental in disseminating the patient-centered approach
to educational programs around the world.
Abdellah’s typology of twenty one nursing problems was an awakening call for
revisions and amendments of the nursing educational system in her era. Professors
and educators realized the importance of client centered care rather than focusing
on medical interventions. Nursing education then slowly deviated its concentration
from the complex, medical concepts, into exercising better attention to the client as
the primary concern.
One of Abdellah’s theory’s major limitation—it’s very strong nurse-centered

orientation—is, on the other hand, it’s major contribution to nursing education. With
this orientation, the theory can be used to organize teaching contents for nursing
students, to evaluate a student’s performance in a clinical area, or both (George,
1995).
Nursing Research
Research played a great part in the selection of the 21 problem classifications. Her
researches were actually the major strengths of her works. In fact, her framework
continues to stimulate research about the role and responsibilities of the nurse. The
broad nature of the concepts in her framework offers opportunities to identify
directional relationships in nursing interventions. Her theories continue to guide
researchers to focus on the body of nursing knowledge itself, the identification of
patient problems, the organization of nursing interventions, the improvement of
nursing education, and the structure of the curriculum.
Abdellah strongly believed the idea that nursing research would be the key factor in
helping nursing emerge as a true profession. The extensive research done
regarding the patient’s needs and problems has served as a foundation for the
development of what is now known as nursing diagnoses.
Her Typology gave birth to more nursing research and studies. The concepts are
very precise and straight forward, making it simple and applicable, thus, stimulating
similar disciplines and researches. Her typology was also utilized by some clinical
institutions in establishing their staffing outline, namely, the intensive care,
intermediate care, long term care, self care and home care units. These were
identified according to how Abdellah ideates patient’s needs in her concept of care.
Now patients in varied medical institutions are categorized with similar client needs,
than by their medical diagnosis and diseases. Also it helped nurses provide better
patient care and improve critical thinking skills.
Let us see how nurses in various settings can use Abdellah’s Typology of Needs
Theory in their own work settings.
From an ICU nurse:
Ruff Joseph Cajanding, RN
As an ICU nurse, Abdellah's model of nursing care equips me with specific

guidelines as to how I can better manage various patient conditions with adeptness
and grace. The spectrum of cases I have and will handle in the ICU is diverse and
multidimensional, ranging from the extremely common myocardial infarction, up
until the most devastating Stevens-Johnson Syndrome, or porphyria, and their
management could not get any more complicated. However, in planning for their
care, I could utilize the principles underlying Abdellah's Typology inasmuch as it is
synonymous to Maslow's hierarchy of needs. I will be guided by the fact that the
basic needs should be met first (oxygenation, hydration, nutrition, etc.) before
proceeding to higher level needs. Moreover, I will utilize the principle of treating
patients in holistic manner, minding their psychosocio-spiritual needs inasmuch as I
cater to their physical needs. Ultimately, Abdellah's typology provides nurses a
framework as to how we can better organize our work in order to deliver quality
nursing care to our clientele—the individual, the family, and the community in
general.
From an OR nurse:
Francis Lloyd Borcelas, RN
“As an OR suite nurse, my responsibilities are not only confined on being a scrub,
circulating, or anesthetist nurse in the PACU. Managing the OR is a big
responsibility, and we do function similarly to the bedside nurses in the ward. Once
the patient is scheduled for a procedure, an hour should be rendered for pre-
operative preparation including giving of pre-operative medications, performing
physical as well as emotional, psychological and spiritual assessment, and
reviewing the patient’s history and laboratory results, referrals and co-management
needed. In this manner, we learn more about the patient through our review of
relevant data and consequently uncover nursing problems presented by the patient.
Through this, we will be able to identify the therapeutic plan of care that needs to
be delivered pre-operative, intra-operative and post-operatively. The applicability of
Abdellah’s nursing theory is of valuable to patient care and management, and this
allows nurses to manage patients in a holistic manner.
From a medical-surgical nurse:
Mae Claire N. Cabatania, RN
I would like to cite a case of my client (a stroke patient) in the medical-surgical

ward. He is 45 year old male patient diagnosed with CVA and was a trans-out from
ICU. He is receiving oxygen therapy via nasal cannula and hooked to NGT for
feeding, and there are times when the client would be restless. Upon receiving the
client during endorsement I have identified the possible nursing problems of my
client. First thing on the line is the performance of self care needs and safety. Self
care needs such as personal hygiene is very important for client to maintain their
integrity and enhance their recovery. Another nursing problem identified is the risk
for injury. At times the patient is restless, raising of side rails is very important to
prevent falls and injuries. Stroke patients are at risk for falls due to altered level of
consciousness. To maintain my client’s nutrition to support his recovery, he is fed
via nasogastric tube as prescribed by physician. Also, my patient is at risk for
aspiration that is why before feeding it is a must to check for the placement of
nasogastric tube to avoid aspiration during feeding.
From a medical-surgical nurse ward:
Patricia Cornejo, RN
In this setting where clients receive direct nursing care, nurses provide a variety of
measures to maintain good hygiene and physical comfort. For clients who are
totally dependent and require total hygiene care such as clients with alteration in
level of sensorium, a complete bed bath is rendered. While bathing the client,
exposing only the areas being bathed, closing the door or pulling room curtains
around the bathing area promote physical comfort. Clients in a hospital setting have
their normal rest and sleep routine disrupted, which generally leads to sleep
problems. The nurse can control the hospital environment in several ways. As an
example, the nurse can close the curtains between clients in semiprivate rooms.
Lights on the nurse’s station and client’s room can be dimmed at night. To reduce
noise, nurses can conduct conversations and reports in a private area away from
the client’s rooms and keep necessary conversations to a minimum, especially at
night. Keeping bed clean and dry and in a comfortable position may help clients
relax. Some clients suffer painful illnesses requiring special comfort measures such
as application of dry or moist heat, use of supportive dressings or sprints, and
proper positioning before retiring. In the rehabilitation unit, the nurse, in
collaboration with other health care professionals such as physical therapists,
promotes activity and exercise by teaching the use of canes, walkers, or crutches,
depending on the assistive device most appropriate for the client’s condition.
Nursing interventions to facilitate supply of oxygen to all body cells include
positioning and coughing techniques. Initially placing a dyspneic client in high-
fowlers position can relieve dyspnea whereas deep breathing and coughing
techniques for postoperative client prevent further complications such as
pneumonia. To create and/or maintain a therapeutic environment, a nurse can allow
relatives to remain at client’s bedside during hospitalization. To facilitate the
maintenance of sensory function in the older adult clients, it helps to reduce any
background noise by turning off or lowering the volume of any TV, appliance, or
radio during a conversation. Since bedridden clients are at risk for sensory
deprivation, a nurse routinely stimulates them through range-of-motion exercises,
positioning, and self-care activities (as appropriate). To prevent the spread of
infection, nurses can teach aseptic practices. Medical asepsis, which includes hand
hygiene and environmental cleanliness, reduces the transfer of microorganisms.
Proper disposal of body secretions such as sputum should be taught as well. Safety
bars on toilets, locks on beds and wheelchairs, and call lights are examples of safety
features found in the hospital to prevent accident, injury, or other trauma.
To further examine how Abdellah’s Typology of 21 Nursing Problems can

individually be applied in a specific nursing area, the following scenario is
presented:
In my experience as a staff nurse in the endoscopy unit, Faye Abdellah's 21 nursing

problems were applied in the following ways:
Katherine D, RN
1. To maintain good hygiene and physical comfort – After colonoscopy, patients are
usually soiled from the procedure. It is therefore important to clean them properly
and change their diapers if applicable. Physical comfort through proper positioning
in bed, adjusting the air-conditioning unit, as well as proper lighting are also
provided to the patient, especially if they were sedated and have to stay in the unit.
2. To promote optimal activity: exercise, rest, and sleep – Patients who were
sedated during the procedure stay in the unit until the effect of the sedation has
decreased to a safe level. During this time, patients are allowed to stay in the room
and rest. As a nurse, I make sure the patients are able to rest and sleep well by
providing a conducive environment for rest, such as decreasing environmental
noise and dimming the light if necessary.
3. To promote safety through prevention of accident, injury, or other trauma and

through the prevention of the spread of infection – Making sure the siderails are
always up when leaving the patient keeps them from fall accidents. In our unit, one
way we prevent the spread of infection is through proper disinfection of the
equipments we use. We use products such as Cidezime to disinfect the instruments.
4. To maintain good body mechanics and prevent and correct deformity –

Positioning the patient properly, allowing for the normal anatomical position of body
parts.
5. To facilitate the maintenance of a supply of oxygen to all body cells – when

patients manifest breathing problems, oxygen is attached to them, usually via nasal
cannula. Sedated patients are attached to cardiac monitor and pulse oximeter while
having the oxygen delivered. When the oxygen saturation falls below the normal
levels, the rate of oxygen is increased accordingly, as per physician's order.
6. To facilitate the maintenance of nutrition of all body cells – patients undergoing

endoscopic procedures are on NPO. For this reason it is important to monitor the
blood glucose level through HGT. When the patient's blood glucose falls from the
normal value, we inject D50W to the patient or we change the patient's IVF to a
dextrose containing fluid.
7. To facilitate the maintenance of elimination – Providing bedpans or urinals to

patients and at times, insertion of foley catheter when the patient is not able to void
8. To facilitate the maintenance of fluid and electrolyte balance – Proper regulation
of the intravenous solutions as well as proper incorporations it may have. An
example is when patients have low serum potassium, KCl is incorporated in the
solution
9. To recognize the physiological responses of the body to disease conditions—

pathological, physiological, and compensatory – it is important to check the patients
for signs of internal gastrointestinal bleeding by monitoring the blood pressure and
cardiac rate.
10. To facilitate the maintenance of regulatory mechanisms and functions – When a

patient has a difficulty in breathing and is showing an increase respiratory rate,
elevating the head part of the bed is done to facilitate the respiratory function.
11. To facilitate the maintenance of sensory function – Sometimes there are semi-
conscious patients, in these cases, it is still necessary to talk to them while
performing nursing interventions to maintain their auditory sense
12. To identify and accept positive and negative expressions, feelings, and reactions
– most patients feel anxious before undergoing the procedures. It is necessary to
listen to the patients' expressions and allow them to ask questions. To decrease
their anxiety, proper instructions are given, what they are to expect, how long the
procedure will take, what they should do during and after the procedure as well as
other concerns.
13. To identify and accept interrelatedness of emotions and organic illness –

Encourage patients to verbalize their feelings and allow them to cry when they have
the need to do so will help them emotionally. Some patients are diagnosed with
malignancy after the procedure and during this time the emotional needs of the
patient is a priority.
14. To facilitate the maintenance of effective verbal and nonverbal communication –

when patients are not able to express themselves verbally, it is important to assess
for nonverbal cues. For instance when patients are in pain, assessing for facial
grimacing. Touch and eye contact are also done for a good patient care.
15. To promote the development of productive interpersonal relationships – allow

the patient's significant others to stay with the patient before and after the
procedure. This allows for bonding and promotes interpersonal relationship.
16. To facilitate progress toward achievement of personal spiritual goals – our

supervisor is a nun and she usually visits the patients in the unit. Catholic patients
may benefit from this, allowing them time to practice their faith
17. To create and/or maintain a therapeutic environment - providing proper lighting,

proper room temperature, a quiet environment are done to patients staying in the
unit.
18. To facilitate awareness of self as an individual with varying physical, emotional,

and developmental needs – care to patients vary according to their developmental
needs. Allowing the parents to stay during the procedure help the pediatric patients
in their emotional and developmental needs.
19. To accept the optimum possible goals in the light of limitations, physical, and
emotional – The goals for each patient vary depending on the capability of the
patient. The nutritional goal for a patient with a PEG tube for instance will be
different, knowing that the patient has limited feeding options.
20. To use community resources as an aid in resolving problems arising from illness
– Some patients live far from the city and thus referral to health centers is
sometimes done
21. To understand the role of social problems as influencing factors in the cause of
illness – Some patients who are diagnosed with amoebic colitis for instance are
advised to avoid buying street foods to which the preparation they are not sure of,
and also avoid drinking water that are not safe.
***
In conclusion, using Abdellah’s concepts of health, nursing problems, and problem

solving, the theoretical statement of nursing that can be derived is the use of the
problem-solving approach with key nursing problems related to the health needs of
people. From this framework, 21 nursing problems, which are comparable to
Henderson’s 14 components of nursing and Maslow’s hierarchy of needs, are
developed. Her theory and framework provides a basis for determining and
organizing nursing care. It is anticipated that by solving the nursing problems
through appropriate and organized nursing strategies, the client will be moved
towards ultimate health.
Isn’t health everything that we all aspire for?
Sources:
Abdellah, F. G. & Levine, E. (1965). Better patient care through nursing research.
New York: Macmillan.
George, J. (2002). Nursing Theories: The Base for Professional Nursing Practice.
Upper Saddle River, NJ: Prentice-Hall, Inc.
George, J. (1995). Nursing theories: The base for professional nursing practice, 4th
ed. USA: Prentice-Hall Intl.
George, J.B. (1990). Nursing theories: The base for professional nursing practice 3rd
edition. Norwalk, CN: Appleton and Lange.
_____________. (1998). Image. USA: ____________.
Johnson, B. & Webber, P. (2005). An Introduction to Theory and Reasoning in

Nursing 2nd Ed. Philadelphia, PA: Lippincott Williams and Wilkins.
Octaviano, O. & Balita, C. (2000). Theoretical Foundations of Nursing: The Philippine

Perspective. Philippines: ___________.
_____________. (2000). Advance for Nurses. USA: ___________.
Parascandola, J (1994). "Women in the Public Health Service". Leadership in Public

Health. Chicago: Illinois Public Health Leadership Institute.
Submitted by Group B: UPOU N207 batch 2009 group B.
THE QUEEN WHO IS KING
Friday, July 17, 2009 12:13 PM

IMOGENE KING: The Queen of Goal Attainment Theory
A little Man in the Making
An Application of King’s Theory
By Melvina Ceceilia R. Manayan and Karen Katrina A. Manlapaz

Young boys playing happily in a park… a lovely picture to glance at. Their youth,
energy and innocence seem to linger through my veins- a feeling that I have been
longing to sense for a while now. One boy was kicking the soccer ball with great
confidence that he would reach the goal. Another was manning him, preparing all
his might to block the kick. There was one who was just running around the field
with bare feet, enjoying the strokes of the grass on his soles. It seemed that their
world evolves only on what they were doing, so soft and gullible.
This is the vision that I saw before I went to work one day, a perfect image of how
children should be. They play, enjoy life and do not have any struggles. At their very
young age, they are supposed to be just “kids”.
Little did I know that at that same day I would change my usual perception about
children.
Randolf was this first patient that I attended to. He was 10 years old, incidentally,
just came from a soccer tryout where he injured his left knee after hitting another
kid. He was sitting on a stretcher and was sobbing. As I approached to attend to
him, I was sure that he was crying because of the excruciating pain brought about
by his injury. “Piece of cake,” I thought to myself. I was to assess him first and
provide some comfort measures. Then, he would surely be better. But, after doing
what I thought would make him well- wound care and antiseptics, and some pain
medications, he still went on with his crying.
I decided to pull a chair and started talking to him. He managed to look at me and
said “the pain is still there but it isn’t as intense as before you gave me some
medications. That’s a relief. But… will I ever play again?”
With his tear drenched face he continued, “My leg never hurt that much before. I’m
scared that I won’t be able to play. You see, I have always dreamt of being a famous
soccer player. My dad used to say that if I would just put my heart into it, master
the rules, have discipline and relate with my peers well, it wouldn’t be hard to reach
for my dream…but this morning.. it was just my first day at soccer tryout. And
everything went wrong. Not to mention missing school and my friends… I’ll be left
behind!”
I froze for a moment. I never thought that at a very young age, a child would say
those words. He speaks of his concerns and his plans. I underestimated him. He
wanted to get involved in a team and is willing to play by the rules. I was too
judgmental. He speaks about not wanting to miss school. He wanted to learn and
do his homework. I was enlightened. He is a little man in the making.
I didn’t realize, until then, that I had to include Randolf’s concerns in the plan of his
care. He wanted to play again, to go to school and to reach for his dreams. He
wanted his leg to be better. I continued to sit with Randolf to indentify his other
concerns. We talked, exchanged some views and planned his rehabilitation
schedule before I discharged him. As he left the emergency room, I felt that he
lightened up—seeing a bit of hope for his concerns. He left with a smile painted on
his face.
A few months later, a familiar face greeted me in the emergency room. He wasn’t in
any way ill- no pain neither any injury. He was wearing a medal and was holding a
soccer ball. It was Randolf and he got his first medal as his team won 3rd in the
soccer competition.
“I forgot to say thanks the last time.” He went on talking proud about his
accomplishments after completing the rehabilitation program. He was happy.
Children, as little and innocent as they seem, are not kids anymore. They are slowly
exploring their self, learning the social rules and capable of decision- making. They
are not that responsible enough thus guidance is still needed. They have needs to
be helped with. They have lots of things to learn. With the proper assistance, they
will be self directed.
Kids will not be kids forever. They will be a man soon.

HERE’S A GLIMPSE OF THE LIFE OF IMOGENE KING…
BIBLIOGRAPHY
(January 30, 1923 – December 24, 2007)
* Imogene King completed her diploma nursing education in 1945, at St.

John's Hospital in St. Louis, Mo.
* She received her BS and MS in nursing from St. Louis U. in 1957,
* She obtained her Doctorate in Education from Columbia U. N.Y.
* She has practiced as a staff nurse, nurse educator, and nurse administrator.
* She formulated her theory while she was an associate professor of nursing at
Loyola U. in Chicago.
* This was at the time nursing was emerging as a profession and some nurses
sought to challenge the existing role of nurses.
* King began her work in nursing theory with a conceptual framework.
* King considers her theory as a deviation from systems theory, with emphasis
on interaction theory.
* In 1981 she refined her concepts into a nursing theory that consisted of the
following basis:
1. An open system framework as the basis of goal attainment.
2. Nursing as a major system within the health care system.
3. Nursing process emphasis on interpersonal processes.
HER THEORY…
Goal Attainment Theory
•Theory of goal attainment was first introduced by Imogene King in the early
1960’s.
•Theory describes a dynamic, interpersonal relationship in which a person grows

and develops to attain certain life goals.
• Factors which affect the attainment of goal are: roles, stress, space & time
From the theory of goal attainment king developed predictive propositions, which
includes:
• If perceptual interaction accuracy is present in nurse-client interactions,

transaction will occur
• If nurse and client make transaction, goal will be attained
• If goal are attained, satisfaction will occur
• If transactions are made in nurse-client interactions, growth & development will

be enhanced
• If role expectations and role performance as perceived by nurse & client are
congruent, transaction will occur
• If role conflict is experienced by nurse or client or both, stress in nurse-client

interaction will occur
• If nurse with special knowledge skill communicate appropriate information to
client, mutual goal setting and goal attainment will occur.
Many people believe King's theory of goal attainment to be a productive and

empowering way for nurses and patients to interact. There has been some
discussion about how well the theory applies across all groups of patients, as it is
necessary for the patient to be able to interact with the nurse to develop and agree
on goals, and on ways to work toward those goals. Others contend that King's
theory can be applied to all groups because a large portion of communication
involves nonverbal behavior, so being able to communicate through spoken
language is not a prerequisite for transactions to occur.
Goal Attainment Theory Conceptual Framework

It includes:
• Several basic assumptions
• Three interacting systems
• Several concepts relevant for each system
Basic assumptions
• Nursing focus is the care of human being.
• Nursing goal is the health care of individuals & groups.
• Human beings: are open systems interacting constantly with their environment.
• Interacting systems: Personal system, Interpersonal system, Social system
• Concepts are given for each system :
o Concepts for Personal System: Perception, Self, Growth & development, Body
image, Space, Time
o Concepts for Interpersonal System: Interaction, Communication, Transaction,

Role, Stress
o Concepts for Social System: Organization, Authority, Power, Status, Decision

making
The theory of goal attainment, which lies at the heart of King's theory of
nursing, exists in the context of her conceptual framework. The essence of goal
attainment theory is that the nurse and the patient work together to define and
reach goals that they set together. The patient and nurse each perceive, judge, and
act, and together the patient and nurse react to each other and interact with each
other. At the end of this process of communication and perceiving, if a goal has
been set a transaction is said to have occurred. The nurse and patient also decide
on a way to work toward the goal that has been decided upon, and put into action
the plan that has been agreed upon. King believes that the main function of nursing
is to increase or to restore the health of the patient, so then, transactions should
occur to set goals related to the health of the patient. After transactions have
occurred and goals have been defined by the nurse and patient together, both
parties work toward the stated goals. This may involve interactions with other
systems, such as other healthcare workers, the patient's family, or larger systems.
After the transaction has occurred, and the goal has been set, King
believes that it is important for good documentation to be practiced by the nurse.
She believes that documenting the goal can help to streamline the process of goal
attainment, making it easier for nurses to communicate with each other and other
healthcare workers involved in the process. It also helps to provide a way to
determine if the goal is achieved. This assessment of whether or not the goal has
been successfully achieved plays an important end stage in King's goal attainment
theory.
Theoretical Framework
Dynamic Interacting System
The essence of Goal Attainment Theory is for the nurse to promote health
by using initially the nurse's personal system. It begins with self-awareness of all
the components of his personal self. It is only after self awareness that the nurse
will be effective in the assessment of the client.
The nurse then interacts with the client and begins communicating. Upon
communicating, the interpersonal system will then exist, which is basically the
overlap of the personal system of the nurse and the client. It is imperative then
that the nurse has a solid awareness of himself before communicating with the
client so that the interpersonal system will be created in a sense that the nurse
provides confidence to the care that he will be providing.
The Social System then builds up from the interaction that was created. It
is where clear and distinct roles will be defined and the client will realize that he is a
patient who, with his actions; permitted himself to be in an institution that has the
same goal as what he wants. The client wants to get well or be healthy that is why
he is in a caring institution (e.g. hospital, clinic, etc) where he has to follow certain
rules as well as to communicate his needs to the nurse; which is a part of the caring
social system. It is then when transaction occurs; which is the process of
purposeful, goal-directed interaction with the environment to achieve mutually
acceptable goals.
APPLICATION – FROM THEORY TO PRACTICE…
Imogene King’s Goal Attainment Theory in Application to the Care of the Elderly in
the Emergency Room
Situation: An 80-year-old female patient came in the Emergency Room lying on a

stretcher. She was brought to the hospital by her son because she was no longer
responding to verbal stimulations. She had a nasogastric tube because she is no
longer capable of feeding orally. Upon assessment, we found out that she
responded to pain stimulation. Her vital signs were BP-140/60, RR-25, PR-108 and T-
38.2. The patient’s Glasgow Comma Scale was 8.
Application of Imogene King’s Theory
In this situation, the patient can no longer speak or decide for herself, so her
son can provide the necessary information and decisions for both of us to formulate
goals that are necessary for the patient’s care and later on act on them. Through
proper interaction and effective communication with the patient’s son, we were able
to understand each others ideas and concerns and we came up with the goals (for
their time being at the ER) : to stabilize the patients situation, preserve the patients
integrity and carry out necessary laboratory examinations to know the underlying
cause of the patient’s current problem.
In the care of my elderly patient, I was very careful with the procedures that I
executed especially with the invasive ones such as IV insertion, since elderly
patients are very susceptible to infection. Through this, I can prevent doing further
harm to her.
I then promoted an environment where I maintained the patient’s integrity
through providing her physiologic needs. I also interacted with the patient despite
the fact that she is unconscious because I believe that by doing such, I acknowledge
and respect the value of my client. Not only that, I allowed her significant others to
be involved in the assessing, planning and execution of the plan of care for the
patient.
After carefully assessing the status of my client, interacting with his son and
formulating goals, I started deliberating on what nursing procedures are best for the
patient while at the emergency room. So I decided to carry out the physician’s
orders (medications, laboratories, IV fluids, etc.). Then I promoted a safe and clean
environment for the patient. And since the patient can no longer provide her basic
physiologic needs, I fed her via the nasogastric tube and changed her diapers and
clothing to maintain her body’s integrity despite her disability. I also allowed her son
to participate in the planning and intervention so that she may feel loved and well
taken cared of.
After 3 hours of attending to the patient at the Emergency Room, the patient’s
vital signs were stable, the laboratory examinations necessary for knowing the
client’s status were executed, and the patient was transported safely to the ward
department. I then endorsed the care of my patient to the ward nurse.
Imogene King’s Goal Attainment Theory in Application to the Primary Health Care
setting
Imogene King's model is a model of three interacting systems: personal,

interpersonal, and social. In her theory of goal attainment, she states that client
goals are met through the transaction between nurse and client. The model can be
applied to all settings. King describes her model as a conceptual system and the
goal of nursing as bringing a person closer to a healthy state (King, 1997, 2001).
The nurse and the person interact toward a goal. The end-point of this interaction,
which occurs over time, is transaction, at which the person's goal is met.
Working as a staff nurse in a Primary Health Center, Imogene’s theory is

realized through the importance of interaction, perception, communication,
transaction, self, role, stress, growth and development, time, and personal space
with our patients. Most of them are for regular check-up and follow ups which give
us opportunity to plan nursing care and set goals to be achieved by the patients for
a certain period of time. Middle-East countries especially gulf area are known to
have one of the highest mortality and morbidity rates in Diabetes. Most of them are
obese, non-working, and has inactive lifestyle. Diabetic patients are carefully
managed in our diabetic clinic. Each of them are given monthly appointments to
follow up with the nurse and the doctor to evaluate the care that is planned both by
the nurse and the patient to establish a controlled blood sugar, prevent diabetic
foot and engage patients in healthy lifestyle. Patients are encouraged and
motivated to participate in the care of plan that is most comfortable with them and
most importantly within the norms of their society and acceptable to their culture
and tradition. They are usually taught to self-inject themselves with insulin or a
family member is asked and taught to give insulin to the patient. Patient or a family
member is also taught to check and record the blood sugar everyday and to keep a
record about the food that the patient has eaten. During their monthly appointment
we evaluate all that is taught to the patient and revise everything if it is important
and necessary for the health of the patient or we refer them to Hamad General
Hospital if it is deemed necessary. Each of them has a registration book where we
document everything and where all records are kept. Patients are involved and
empowered in a way that they get to have a chance to participate in deciding the
plan of care for them. Since working in a primary health care, prevention and health
education are strengthened and greatly emphasized to the patients and interaction
is necessary to set goals and prioritize plan of care.
Imogene King’s Goal Attainment Theory in Application to the care of the Child
King’s Goal Attainment Theory emphasized the ten concepts as the essential
knowledge that nurses must use in concrete nursing situations. In the community
setting, some of these concepts are applicable: perception, growth and
development, time, communication and interaction. They are useful in promoting
and preventing occurrence of health problems which is the prime focus of
community health nursing.
In care of children in the community setting, promotion of health activities is of
priority. Handwashing and cough etiquette lectures are very timely activities today
because of the pandemic spread of Influenza A (H1N1).
In interacting with children, we utilized colorful instructional materials and terms

appropriate for their ages for easier comprehension. Children are encouraged to
participate and are recognized when they are able to do the procedures properly.
Time is also a basic consideration; lectures were conducted at the early part of the
day to assure that there energy levels are still high and that they are prepared
mentally.
In applying King’s theory, nurses must understand the extent of the children’s
understanding about the importance of handwashing and cough etiquette practice.
It is also important that nurses must have self-awareness on how he/she perceives
the health behavior as well.
In dealing with children, the supporting persons are part of the decision making
process because children are not yet capable of making decisions concerning their
care. If the child and their support system together with the nurse mutually agree to
meet a certain goal, then the process outcome will be goal attainment like in our
case practice of handwashing and cough etiquette is achieved.
Imogene King’s Goal Attainment Theory in Application to the care of the Adult
Working as a staff nurse in a Primary Health Center, Imogene’s theory is realized

through the importance of interaction, perception, communication, transaction, self,
role, stress, growth and development, time, and personal space with our patients.
Most of them are for regular check-up and follow ups which give us opportunity to
plan nursing care and set goals to be achieved by the patients for a certain period
of time. Middle-East countries especially gulf area are known to have one of the
highest mortality and morbidity rates in Diabetes. Most of them are obese, non-
working, and has inactive lifestyle. Diabetic patients are carefully managed in our
diabetic clinic. Each of them are given monthly appointments to follow up with the
nurse and the doctor to evaluate the care that is planned both by the nurse and the
patient to establish a controlled blood sugar, prevent diabetic foot and engage
patients in healthy lifestyle. Patients are encouraged and motivated to participate in
the care of plan that is most comfortable with them and most importantly within the
norms of their society and acceptable to their culture and tradition. They are usually
taught to self-inject themselves with insulin or a family member is asked and taught
to give insulin to the patient. Patient or a family member is also taught to check and
record the blood sugar everyday and to keep a record about the food that the
patient has eaten. During their monthly appointment we evaluate all that is taught
to the patient and revise everything if it is important and necessary for the health of
the patient or we refer them to Hamad General Hospital if it is deemed necessary.
Each of them has a registration book where we document everything and where all
records are kept. Patients are involved and empowered in a way that they get to
have a chance to participate in deciding the plan of care for them. Since working in
a primary health care, prevention and health education are strengthened and
greatly emphasized to the patients and interaction is necessary to set goals and
prioritize plan of care.
----------
I was able to understand that Imogene King’s conceptual system was used to build
a world community of nurses who respect cultural differences and share the mutual
goal of health in each nation. Last July 2008, I was given the opportunity to join a
Medical Mission held in Phnom Penh, Cambodia for 1 week. It was organized by
Youth With A Mission (YWAM), a Christian organization. Together with the health
team, we were able to know what the main problem of the community was after the
ocular survey. Khmer people living in the slum area were not particular with their
hygiene. They don’t have proper clothing, took a bath in a muddy river, and they
don’t brush their teeth. Henceforth, dealing with them was not that easy because of
language barrier and culture differences. They don’t know how to speak English and
part of their culture is to take a bath in the Mekong River from time to time because
they believed that the said river can heal their disease. The truth is they don’t have
enough knowledge and understanding of what could happen to them if they
continue it. To solve this matter, we planned to coordinate with their town leader
and did some health teachings to the community with the help of an interpreter. We
gave them much information about the diseases they could get when they
immersed with that kind of water. We also taught them how to brush their teeth
properly. Clothes were given and some vitamins as well. We talked with several
people and fortunately, they gave us good feedbacks. They were able to understand
that the health team had no intention to disrupt their culture but instead, showed
them a better way of having healthy bodies through clean-living lifestyle. Through
that, I was also able to appreciate one of Imogene King’s assumptions of an
individual: that they have the capacity to think, to know, to make choices, and to
select alternative courses of action. It was such a great experience as a nurse!
Imogene King’s Goal Attainment Theory in Application to the care of the Elderly
Caring for the elderly must be done with love and respect. It is a skill that
may or may not come naturally to an individual, but either way, members of the
family move ahead and do the best they can for their loved one.
Three years back, I have a patient who had Alzheimer’s disease for two
years already. As for me, it is one of the difficult patient to encounter since the
disease is incurable, degenerative and terminal. She has been in and out of the
hospital for several months due to complications of the disease. It has been
stressful on the part of the family, looking at the patient day and night suffering
from the dreaded disease. One could only imagine how many nights they could not
sleep well worrying what will happen the next day. Despite all of what they are
facing, they should stay strong. In the midst of what happened those days, I could
remember some of the things that I have done for the patient. I can remember the
way she greeted me with a smile and simply say hi every time I entered the room.
Although sat times she’s cranky. I can remember the way she tells stories with
enthusiasm. And I can remember the way her family showed their love and
affection to her. They hug and kiss her. They try to give the best for her. And I
salute them for their patience, love, and generosity. As a nurse and as a person, I
never thought I could encounter such patient. I never imagined that it was difficult
to approach and manage a patient with Alzheimer’s. I was depressed then that I
could not do anything about the disease. But then again on second thought, why
think of the things that I could not even answer?! What I did was, I talked to her
family instead. I reached out to her family because I understand what they
feel...and I sympathize with them even if I know that this is not good and not a
therapeutic way of communicating. I tried my best to attend to the needs of the
patient, may it be in physical, emotional, spiritual, and intellectual aspect. Day by
day I was beginning to understand the disease per se and eventually the patient. I
thought of making a plan and set goals for the patient. My problem then was the
patient cannot follow the things that I have to tell her for us to be able to attain our
goals. So, I thought of another plan, why not involve the entire family in rendering
care to the patient. I told the folks about these and they gladly said yes. Although I
could not change the status of the patient in relation to the disease itself, I manage
to somehow change a little bit the condition of the patient. Physically, she was able
to move some parts of her body to prevent muscle atrophy through the simple
exercises and massage that we do to her every morning. Somehow we managed to
talk to her even at the peak of her mood swings and let her tell stories of her past
experiences as a wife and mother. We managed to let her out of the bed hassle
free for quite some time. For some, this might be insignificant changes, but for me
and for the family as well, meant a lot already. At times we cannot do all the
activities for the day because of her mood swings. We can only react to what
actions she showed to us. If she does not pull her hands and shout at you during
the massage of the hands then we continue the massage. If she does not grab the
blanket and cover herself during the exercises then we continue the exercise until
we’re done. There are days that we cannot do anything at all. But there are days
that we fortunately finish all the activities for the day. These is the way I together
with her family, manage the patient.
REFERENCES
1. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed.
Mosby, Philadelphia, 2002.
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice ,
3rd ed. Norwalk, Appleton & Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing

Philadelphia. Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd
ed. Philadelphia, Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Philadelphia, Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts

Process & Practice 3rd ed. London Mosby Year Book.
7. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby,
Philadelphia, 2002.
8. http://www.muw.edu/nursing/tupelo/NU433KING%27S.htm
9. Kozier, Barbara et. al. (2004). Fundamentals of Nursing: Concepts, Process and
Practice (7th Ed). Philippines: Pearson Education South Asia PTE LTD.
10.
http://www.novelguide.com/a/discover/genh_0002_0003_0/genh_0002_0003_0_0048
7.html
11. http://www.sandiego.edu/nursing/theory〉
12. Murray, Ruth L.E. and Marjorie Baier. "King's Conceptual Framework Applied to a
Transitional Living Program." Perspectives in Psychiatric Care 32: 15-20.
Martha Rogers
Welcome to N207_2009_Group E's Headquarters. You came just in time! We nurse

detectives were just about to start an investigation on one of the theories of nursing
and it would be great if you could join us! Our main objective would be to know
what the Science of Unitary Human Beings theory is all about.
Are you ready?
Let's begin by getting to know some facts about the main proponent of the theory,
Dr. Martha Elizabeth Rogers
Whew! Now that was a lot of useful information. We're getting to know more and
more about the theory. Before we move on with our investigation, let's take a
breather! Time for an intermission brought to you by our very own team members!
Just click on the slide below to start the show!
Create Your Own GushyGram
Visit MushyGushy.com
A round of applause for our performers!*CLAP* *CLAP* *CLAP* Now back to work
guys. So far we've learned about the author of the theory, her theoretical sources
and her major concepts and definitions. Now it's time to learn more about the
theory.
Major Concepts and Theoretical Assumptions
So now we know about the theory. We need to find out what the community thinks
about it. How did the nursing community accept this theory?
Group E
We're almost done! Here are a few insights from the detectives in our headquarters.
(if you can't see the picture clearly, CLICK HERE.)
EUREKA! We've received word from our intelligence
unit that there is a way to communicate with the main proponent of the theory!
Thanks to the University of Pennsylvania School of Nursing,
for interviewing Martha Rogers for us! Let's hear what she has to say.
Who better to get insights about the theory
than the theorist herself!
Now let's STOP for a moment.
Before we draw our conclusion,
let's review a few of the facts that we know so far.
More flashcards, word search, and hangman provided by StudyStack.com
Did you get the answers correctly? Great! Have you figured it out already?
Gathering all the data we've acquired, we are now ready to make our conclusion.
We have a guest detective, Afaf ibrahim Meleis, the author of Theoretical Nursing:
Development & Progress, who will help us in closing our investigation. He states:
"In addition to Florence Nightingale, who introduced nursing to the notion of the
centrality of environment in nurses' domain of practice, Martha Rogers is the
person-environment relationship guru. Furthermore, her theory supports the
essentiality of patterns and patterning in understanding the experiences in health
and illness. She also reinforced the idea that nursing is based on science. She
pioneered the connection between physics and nursing, and she provided the
optimistic view of health that empowers the individual as well as the professional
nurse. She was a visionary thinker, an inspiring leader, and a theorist who was
ahead of her time. She saw the world of nursing very differently, and provided a
framwork for others ot experience this perspective. Despite many critics, many of
her concepts and propositions continue to stimulate innovative nursing research."
CONGRATULATIONS! You've made it to the end! We hope you learned a lot about
this case as we did. Because you did a good job, we have a game for you to enjoy!
=)
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And now, Ladies and Gentlemen, it is with great pleasure to present to you the
Group E detectives!!!
PEPLAU's LEGACY
Monday, July 21, 2008 10:20 AM
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TO BE OF SERVICE: Team E Utilizing
The Three C’s of Lydia Hall
(Introduction by Rose de Leon)

It was the 1st week of July 2008 when we had the chance to introduce ourselves in
the group. It amazes me that we will have this actual grouping to be able to work
together interactively, though a little bit hesitant at first, if this could really work for
us and if we can really hang-on with each other. Thus, I grab this opportunity with a
delightful heart to introduce my team members for our Group Blog, FMA 1 for N207.
Most of my team mates are located in our beloved native land. Truly, one of the
best countries where an excellent foundation for Nursing Education could exists
nowadays. And also highly diversified in experience with each of us coming from
different fields yet we shared one common vision…to come-up with a substantive
output and to fulfill our nursing dream. The team, although far from ideal, showed
their best efforts in putting the blog together, not minding the hindrances such as
work schedules, family and personal lives. These are the talented and hardworking
people of Team E:
ROSE: An offshore student who works as a Nursing Service Director, coordinates all
group activities, and yes, even posting forums in MOODLE, just to keep everyone
updated.
SHANDZ: Working as a CI in one of the nursing schools in Rizal, she took the
challenge to become the group’s first Team Manager and formulated a
questionnaire to help us ponder deeply into our assigned theory.
JOY: also an offshore student taking up graduate studies in London, through

communication by far hinders, she made he way to make it up with the team
through technical layout support and collaborative idea of its final picture that
comes to reality.
ANNA: A bank executive from the South, she took the challenge of being the
secretary, buzzing everyone in time for the conferences; and she does it even while
working overtime!
CAYE: Despite working 2 shifts in the Neonatal Intensive Care unit of one of the
country’s top hospital, took the challenge of being the team editor (in between
naps).
DOC LOREL: A physician and a nurse, shared very clear and interesting point of view
about the CURE model. Truly, she’s heaven-sent.
ELOISE: Shares with Rose the same operating room experiences, putting the theory
to use in their perioperative patients.
JAN: A dialysis nurse on training, inspired the team to come up with the best that it
can do, challenging the limitations to be able to present a blog that is short, concise
and unique.
RANDULF: Together with Jan, he injected some masculinity in the predominantly
woman team and encouraged everyone to come up with a personalized insight on
the applicability and relevance of Lydia Hall’s theory in our practice.
These are the team members, and this is our TEAM BLOG.
ON LYDIA HALL AND HER THEORY: BY ANNA ESTOY and NHINA DE ROSAS
Lydia Hall was born in New York City on September 21, 1906 and grew up in
Pennsylvania. She was an innovator, motivator, and mentor to nurses in all phases
of their careers, and advocate for the chronically ill patient. She promoted
involvement of the community in health-care issues. She derived from her
knowledge of psychiatry and nursing experiences in the Loeb Center the framework
she used in formulating her theory of nursing. These experiences might have given
her insight in on the distinct roles of nurses in providing care for the patients and
how the nurses can be of utmost importance in caring for these patients.
The theory of all, as they say, contains of three independent but interconnected
circles—the core, the care and the cure. But what do these terms mean? According
to the theory, the core is the person or patient to whom nursing care is directed and
needed. The module has mentioned that the core has goals set by himself and not
by any other person, and that these goals need to be achieved. The core, in
addition, behaved according to his feelings, and value system. The cure, on the
other hand is the attention given to patients by the medical professionals. The
module has been explicit in stating that the cure circle is shared by the nurse with
other health professionals. These are the interventions or actions geared on treating
or “curing” the patient from whatever illness or disease he may be suffering from.
Some interventions I can think of in relation to this are the surgeries performed to
treat a tumors or other malignancies, prescribing pharmacologic therapies and
performing diagnostic tests. The highlight, however is the care model. This is the
part of the model reserved for nurses, and focused on performing that noble task of
nurturing the patients, meaning the component of this model is the “motherly” care
provided by nurses, which may include, but is not limited to provision of comfort
measures, provision of patient teaching activities and helping the patient meet their
needs where help is needed.
That means that if all three circles exhibit harmony and balance, the patient will be
the one to benefit from it all since his needs are being put into priority but the
meeting of it depends on which circle of the model is responsible for meeting such
activities. It was hard not to see that in all of the circles of the model, the nurse is
always presents, but the bigger role she takes belongs to the care circle where she
acts a professional in helping the patient meet his needs and attain a sense of
balance.
THE THEORY AT WORK: APPLICATION TO OUR INDIVIDUAL PRACTICE
ELOISE ENCARNACION AND ROSE DE LEON, Operating Room Nurses:
The theory can be applied in all the phases of the operative experience. The CARE
can be utilized when providing patient care and teaching at each phase of the
surgery, providing comfort both physiologically and psychosocially. The CORE model
can be realized when he patient is able to express his feelings about the procedure
and participates in exploring these feelings, helping him towards a faster recovery.
The CURE model is used when we provided medication therapy to the patient,
nurses assuming our roles as either scrub or circulating nurse.
CAYE ELLIMA, Critical Care/NICU Nurse: The patient with congestive heart failure
usually has health problems related to the ineffective pumping mechanism of the
blood, pooling of the blood in the lower extremities and a vast array of systemic
symptoms. The cure model can be applicable in this case when the nurse would
perform assessment and formulate care plans based on the patient’s needs and
against limitations set by the physicians. The cure model will also require the nurse
to closely monitor the patient’s response to the treatments and any untoward
symptoms and relay these with the other members of the health team. In the care
model, the nurse can help the patient or the family in accepting and adapting to the
emotional and other stresses the condition may bring. It will be the nurse’s task to
open channels of communication to allow expression of feelings and help the
patient/family work out through it. It is also in this model that health teachings are
imparted. The core model dominates when the patient and/or family are able to
address the emotional concerns and issues related to the perception of the effects
of the disease process such as activity restrictions. It will be, therefore, the sole role
of the nurse to help the patient/family maintain or achieve his sense of balance.
NHINA SANDEEP DE ROSAS, Nursing Education/Clinical Instructor: The core, care
and cure model can be applied into nursing education by utilizing its concepts in the
mode of instruction given to students. The care model can be materialized in
education by having clinical instructors provide “real-world” learning experiences to
students. This would provide the students more opportunities for learning and
encourages feedbacks about learning topics. Doing this would institute measures to
further explore learning needs and help students develop confidence in assuming
their roles as nurses. The cure model can be used by nursing educators when they
plan for learning activities for their students. This can be done through
implementation of diagnostic examinations to ascertain the students’ learning
needs not only on nursing practice but also on other fields of science affecting the
practice of nursing. The core model can be fully realized only when the clinical
instructors are successful in helping the student meet his learning needs and thus
providing him with an increased sense of accomplishment in terms of knowledge.
RANDULF ERGUIZA, Community Health Nursing/Clinical Instructor: Care becomes

effective when we show sincerity and genuineness in out approach not only towards
students but also to patients. We listen, we communicate and we make them feel a
part helping the patients. Core is strengthened when we make them (students and
patients) realize their potentials as individuals by reflecting not only on things that
they can do but also on things that they were not able to do, and what things they
still can do. Cure is provided when measures such as encouraging people in the
community to utilize the services offered by the health centers and; and teaching
them compliance to treatment regimens.
JAN STANLEY DIARESCO, Dialysis Nurse: Lydia Hall’s Care, Core and Cure theory can
also be seen and identified in this kind of setting. Patients undergoing hemodialysis
experiences problems such as physical vulnerability, feeling of being a burden to
the family and being hopeless. Being a nurse one should use therapeutic
communication when dealing with the patient, and family, provide proper care to
the client as he or she undergoes dialysis and create an environment that would
promote holism as the procedure is being done.
As soon as the patient arrives in our unit we explain the treatment and how would it
benefit her and the risks involve so that he/she would be ready once the consent is
being explained to her the physician. The therapeutic use of self of a nurse is shown
here. As a practitioner in the Kidney Unit, we perform dual responsibility, one as
nurse and the other as a technician. Being a nurse technician, we provide care to
our clients by understanding the concept of dialysis with the use of the machine,
how to troubleshoot technical problems, understanding water treatment,
cannulation and priming the machine When priming the machine we wash out the
renalin and residues present in the dialyzer to protect the client from its harmful
effects that could lead to anaphylactic shock. Injecting innohep and heparinizing the
tubings makes it safer for the client since clotting will be prevented, which could
cause blood loss or wastage. Monitoring vital signs of the client 15 min for the first
hour and 30 min thereafter to check for hypotension or hypertension (common
complications during HD) would easily alert the nurse to provide initial interventions
such as positioning, flushing and notifying the physician for medications to be given
or any procedure to be carried out. Upon removal of the cannula’s from the patient
site, the nurse should properly apply pressure dressing on the site so as to prevent
blood loss and promote healing of the site. Educating the client not to scratch the
site, exercise her are so that the fistula site would be bigger and prevent any injury
to the site would be ways of preventing future complications to the site.
References:
Anonuevo, et al., Theoretical Foundations of Nursing; UP Open University Press;

2005
Potter and Perry; Fundamentals of Nursing, Fifth Edition; Mosby Publishers; 2001
George, J.B.; Nursing Theories: The Base for Professional Nursing Practice; 2000
http://www.napnes.org/practice/news/clinical_articles/care_of_the
%20_congestive_heart_failure_patient.html
AND THIS IS OUR TEAM…

Shandz, Anna, Caye, Rhose, Eloise, Doc Lorel, Joy, Jan, & Randulf
Betty Neuman's Systems Model
Betty Neuman
"Health is a condition in which all parts and subparts are in harmony
with the whole of the client.”
BIOGRAPHY
1924 - Born in Lowell, a village in Washington County, Ohio, United States, along
the Muskingum River
1947 - Obtained her Registered Nurse Diploma from the Peoples Hospital School of
Nursing, in Akron Ohio. After that, she went to California where she worked in a
hospital as a staff nurse, and eventually became the head nurse. She also explored
other fields, and experienced being a school nurse, industrial nurse, and clinical
instructor.
1957 - She went to the University of California at Los Angeles (UCLA) and took a
double major in psychology and public health. She received her BS Nursing from
this institution.
1966 - She completed her Masters degree in Mental Health, Public Health
Consultation, also at UCLA. She became recognized as a pioneer in the field of
nursing involvement in community mental health.
1970 - Started developing The Systems Model as a way to teach an introductory

nursing course to nursing students. The goal was to provide a Holistic overview of
the physiological, psychological, sociocultural, and developmental aspects of human
beings.
1972 - After a two-year evaluation of her model, it was eventually published in

Nursing Research.
1985 - She completed her doctorate in Clinical Psychology from Pacific Western
University.
1988 - She founded the Neuman Systems Model Trustee Group, Inc. They are
dedicated to the support, promotion and integrity of the Neuman Systems Model to
guide nursing education, practice and research.
1992 - She was given an Honorary Doctorate of Letters, at the Neumann College,
Aston, Pennsylvania.
1993 - Because of her important contributions to the field on Nursing, Dr. Neuman
was named Honorary Member of the Fellowship of the American Academy of
Nursing.
1998 - Received an Honorary Doctorate of Science from the Grand Valley State
University in Michigan. For the past years, Dr. Betty Neuman has continuously
developed and made famous the Neuman systems model through her work as an
educator, author, health consultant, and speaker. Her model has been very widely
accepted, and though it was originally designed to be used in nursing and is now
being used by other health professions as well.
As keynote speaker at the University of Maine (2004)
INFLUENCES
Betty Neuman took inspiration in developing her theory from the following theories/
philosophers:
1. Pierre Tielhard deChardin : a philosopher-priest that believed human beings are

continually evolving towards a state of perfection – an Omega Point
2. Gestalt Theory : A theory of German origin which proposes that the dynamic
interaction of the individual and the situation determines experience and behavior.
3. General Adaptation Syndrome mainly talks about an individual’s reaction to

stress on the 3 levels a) alarm b) resistance c) exhaustion
4. General Systems Theory postulates that the world is made up of systems that are
interconnected and are influenced by each other.
The Neuman System Model

KEY CONCEPTS
Viewed the client as an open system consisting of a basic structure or central

core of energy resources which represent concentric circles
Each concentric circle or layer is made up of the five variable areas which are
considered and occur simultaneously in each client concentric circles. These are:
1.
Physiological - refers of bodily structure and function.
2.
Psychological - refers to mental processes, functioning and emotions.
3.
Sociocultural - refers to relationships; and social/cultural functions and activities.
4.
Spiritual - refers to the influence of spiritual beliefs.
5.
Developmental - refers to life’s developmental processes.
Basic Structure Energy Resources

This is otherwise known as the central core, which is made up of the basic survival
factors common to all organisms. These include the following:
1.
Normal temperature range – body temperature regulation ability
2.
Genetic structure – Hair color and bodily features
3.
Response pattern – functioning of body systems homeostatically
4.
Organ strength or weakness
5.
Ego structure
6.
Knowns or commonalities – value system
The person's system is an open system - dynamic and constantly changing and
evolving
Stability, or homeostasis, occurs when the amount of energy that is available

exceeds that being used by the system.
A homeostatic body system is constantly in a dynamic process of input, output,

feedback, and compensation, which leads to a state of balance
Flexible Lines of Defense
Is the outer boundary to the normal line of defense, the line of resistance, and
the core structure.
Keeps the system free from stressors and is dependent on the amount of sleep,
nutritional status, as well as the quality and quantity of stress an individual
experiences.
If the flexible line of defense fails to provide adequate protection to the normal
line of defense, the lines of resistance become activated.
Normal Line of Defense
Represents client’s usual wellness level.
Can change over time in response to coping or responding to the environment,

which includes intelligence, attitudes, problem solving and coping abilities. Example
is skin which is constantly smooth and fair will eventually form callous over times.
Lines of Resistance
the last boundary that protects the basic structure

*
Protect the basic structure and become activated when environmental stressors
invade the normal line of defense. An example would is that when a certain bacteria
enters our system, there is an increase in leukocyte count to combat infection.
If the lines of resistance are effective, the system can reconstitute and if the
lines of resistance are not effective, the resulting energy loss can result in death.
Stressors
Are capable of producing either a positive or negative effect on the client

system.
Is any environmental force which can potentially affect the stability of the
system:
1.
Intrapersonal - occur within person, example is infection, thoughts and feelings
2.
Interpersonal - occur between individuals, e.g. role expectations
3.
Extrapersonal - occur outside the individual, e.g. job or finance concerns
*
A person’s reaction to stressors depends on the strength of the lines of defense.
When the lines of defense fails, the resulting reaction depends on the strength
of the lines of resistance.
As part of the reaction, a person’s system can adapt to a stressor, an effect

known as reconstitution.
Reconstitution
Is the increase in energy that occurs in relation to the degree of reaction to the
stressor which starts after initiation of treatment for invasion of stressors.
May expand the normal line of defense beyond its previous level, stabilize the
system at a lower level, or return it to the level that existed before the illness.
Nursing interventions focus on retaining or maintaining system stability.
By means of primary, secondary and tertiary interventions, the person (or the
nurse) attempts to restore or maintain the stability of the system.
Prevention
Is the primary nursing intervention.

*
Focuses on keeping stressors and the stress response from having a detrimental
effect on the body.
1.
Primary prevention focuses on protecting the normal line of defense and

strengthening the flexible line of defense. This occur before the system reacts to a
stressor and strengthens the person (primarily the flexible line of defense) to enable
him to better deal with stressors and also manipulates the environment to reduce or
weaken stressors. Includes health promotion and maintenance of wellness.
2.
Secondary prevention focuses on strengthening internal lines of resistance,

reducing the reaction of the stressor and increasing resistance factors in order to
prevent damage to the central core. This occurs after the system reacts to a
stressor. This includes appropriate treatment of symptoms to attain optimal client
system stability and energy conservation.
3.
Tertiary prevention focuses on readaptation and stability, and protects

reconstitution or return to wellness after treatment. This occurs after the system
has been treated through secondary prevention strategies. Tertiary prevention
offers support to the client and attempts to add energy to the system or reduce
energy needed in order to facilitate reconstitution.
Betty Neuman's System Model
view presentation
APPLICATION
The main use of the Neuman Model in practice and in research is that its concentric
layers allow for a simple classification of how severe a problem is. For example,
since the line of normal defense represents dynamic balance, it represents
homeostasis, and thus a lack of stress. If a stress response is perceived by the
patient or assessed by the nurse, then there has been an invasion of the normal line
of defense and a major contraction of the flexible line of defense. Infection or other
invasion of the lines of resistance indicates failure of both lines of defense. Thus,
the level of insult can be quantified allowing for graduated interventions.
Furthermore each person variable can be operationalized and the relationship to the
normal line of defense or stress response can be analyzed. The drawback of this is
that there is no way to know whether our operationalization of the person variables
is a good representation of the underlying theoretical structures.
For example, Eileen Gigliotti published a research article in 1999 based on the
Neuman Systems Model. The study investigated the relationship of multiple role
stress to the psychological and sociocultural variables of the flexible line of defense.
If multiple role stress had occurred, then the normal line of defense had been
invaded. Questionnaire instruments were used to operationalize the psychological
component with perceived role as a student and as a mother; the sociocultural
component with social support, the normal line of defense as perceived multiple
role stress.
Upon analysis, no conclusions could be made about the normal line of defense
simply on the basis of the psychological component and sociocultural component.
By dichotomizing the data by median age, however, a relationship between them
could be described. Thus the relationship between the normal line of defense and
the psychological and sociocultural components could only be described by taking
into account the developmental component. It indicates that the components of the
flexible line of defense interact in very complex ways and it may be difficult and
dangerous to overgeneralize their interaction.
PERSONAL EXPERIENCES
Experience #1
I’m assigned at the service/charity ward of PDMMMC few months ago. As a staff in
the ward of a government hospital, I noticed many weaknesses and shortcomings in
the medical management and nursing care as well maybe due to the city
government’s not prioritizing health care. They say it is maybe due to “lack of
budget” but I really don’t believe in that same old music. I know there is, but the
question is where is it going? We are badly lacking of resources, instruments and
material so we need to improvise. And most of all, we are under staff so proper
nursing care is compromised to every patient plus the fact that the environment is
not conducive to the nurses and the patients. At that time, a 25 year old female
patient was transferred to our ward from the ICU. The case was PTB advanced and
heart problem. I was very curious why? They said that the patient is stable but the
catch is she was admitted to the isolation room of the charity ward together with
other PTB cases and with minimum nursing care because of the overwhelming
census. Based on my own assessment, the patient is not yet stable, I think the true
reason for transfer is that the patient can no longer withstand the demands for her
medication in ICU because she is the one who is availing that, or maybe there is a
much priority patient who will be placed in ICU, because it is only two – bed capacity
so they need to manage and decide very well on admissions and discharge. And if
they want to transfer the patient post ICU, why in service ward that is not so
conducive? Of course the patient is financially incapable to be admitted to pay
ward.
The client’s flexible line of defense is compromised here; she had a hard time
resting because the temperature in the isolation room is very warm and humid even
if she has an electric fan. Her nutritional level is also not good and quantity of stress
increases. Her normal line of defense is also unstable, she is not well and we can
assess she is not. And her line of resistance is severely debilitated; she has PTB
infection and dyspnea. Her environment to isolation room further worsens her
condition.
Extrapersonal stressors like the isolation room environment where infection is

floating around the room and also the nursing care that nurses wasn’t able to
render because of the nurse to patient ratio of 1:30 which is not very ideal. She also
has interpersonal stressors like the problem of broking up with his husband and for
not having the opportunity to see her son because children are restricted to ward
premises especially in isolation room. And her intrapersonal stressors like disturbed
emotional status, deteriorating physical ability and financial problems.
These factors disrupted the reconstitution of the patient. In this situation, primary
prevention is not given priority, because her admission to charity ward, isolation
room increases her risk to infection and stress and limited nursing care. In
secondary prevention, we succeed in the first part in ICU but wasn’t able to
continue in the ward because of many factors as stated above. Even the prescribed
medications are not purchased because of financial constraints. In tertiary
prevention, sometimes we nurses do our best, but fate will still prevail. Patient died
that evening during endorsement before we receive her case. Nursing goal is not
met. And lessons are learned.
Neuman system model is a delicate tool to be used in nursing care especially in

identifying the stressors, the interventions, and the affectation in the line of
defenses of the client that we must protect to maintain quality of life, reconstitution
and optimum level of functioning of our clientele and much better in disease
prevention. Holistic care should be given to all of our patients at all times in any
setting.
Experience #2
About a week ago I had in my care the wife of the captain of the ill-fated Princess of
the Stars. In this case, I was able to identify the following stressors:
1. Psychological-Emotional:
Anxiety which stemmed from the uncertainty about the fate of her husband.
A sense of guilt because relatives of the passengers are blaming her husband
for the tragedy.
Ambivalence in the sense that she would be happy if her husband survived and
at the same time worried too that if he did survive he would be subjected to court
litigation.
2. Financial Stress: Her husband is the breadwinner of the family and in a brood of 5
children, only one is employed; the rest are still in school.
3. Physical Stress manifested as:
a. Insomnia
b. Elevated blood pressure unresponsive to maintenance medications
c. Persistent chest pains
Nursing interventions are carried out on three preventive levels:
Primary Prevention would not be applicable because the accident causing the
stressors has already occurred and the patient has already developed the
reactions/symptoms of stress.
Secondary Prevention is applicable in this case. Because of the persistent

elevated blood pressure ( above 200/110) accompanied by severe chest pains, the
patient was admitted to the hospital for both diagnostic and therapeutic
management. Nursing intervention centered initially on the round the clock
monitoring of the blood pressure and giving of the ordered anti- hypertensive drugs.
Since the EKG showed ischemia, the patient was closely watched for worsening of
the pain because of the possibility of a myocardial infarction. Immediate referral of
the patient to the resident physician is to be made if chest pain persisted despite
giving isosorbide dinitrate for proper evaluation. Aside from giving anxiolytics to
decrease the anxiety of the patient, I have to warn visiting relatives to refrain from
talking about the tragedy. Sedatives were given before bedtime to prevent
insomnia.
*
Tertiary Prevention: Upon discharge, I gave the patient and the immediate
family members the following advice:
1. If possible to stay in a relative’s house for a few weeks because they were
being hounded by media who were camped outside their home.
2. Regular monitoring of the patient’s blood pressure by a daughter who is a

student-nurse who should also monitor her intake of medications as prescribed by
the physician.
3. Avoid watching TV shows that mention about the tragedy.
4. Avoid answering the phone.
5. She should have a close relative with her aside from the children who will
manage their affairs in the meantime.
Experience #3
In the Community...
In one of the rotations of my students in the community, we encountered this very

interesting newly married young couple (both are 18 years old). They have been
married only for 3 months, but the supposed to be happy pair is already facing a lot
of stressors.
One condition that brings extrapersonal stress is the unemployment of the

husband. Their financial source is not enough to meet their needs. The woman
somzd enough for her son. This relationship poses as an interpersonal stress to her.
The wife is also pregnant at that time, and her poor nutritional (underweight) and
emotional status (sadness and anger at her mother-in-law) create intrapersonal
stresses.
We know, based on Neuman’s Systems Model, that the reaction to stressors would
depend on the strength of the lines of defense. The woman, due to financial
constraints, is suffering from poor nutritional status. She usually lacks enough sleep
due to the nature of her work. This creates a breach to her flexible line of defense.
The normal line of defense also becomes unreliable because of her uncaring
attitude toward her pregnancy and sexual behaviors that predispose her to a lot of
possible illnesses. Her coping abilities are also affected because she is sometimes
preoccupied with her relationship problems with her mother-in-law.
These conditions put not only our client but also her unborn child on the verge of
developing various illnesses. Hence, our interventions focused on restoring system
stability, by helping the client’s system adapt to the stressors.
Starting with primary prevention, we tried to educate their family on the importance
of having good nutrition. We suggested some nutritious but cheap food choices. We
also tried to advice her on possible alternative jobs that would not jeopardize her
health and that of her unborn baby.
For the secondary prevention, we advised that she seek pre-natal check-up, and
make use of the available services of the nearby health center.
After about 1 month of constant visits to these clients, we really observed

noticeable improvements in their health conditions. The woman began to show
weight gains consistent with her age of gestation. The couple has also learned to
plant and eat nutritious food such as fruits and vegetables. The husband started to
work as a production operator in a nearby factory, allowing his wife to take a break
from her old job.
Before our duty in the community ended, we were able to initiate tertiary
prevention by supporting and commending the positive behavioral changes
exhibited by the couple. We also dwelt on strengthening the positive attributes of
the family, such as their unwavering faith in God, and their strong devotion to each
other. We learned from this experience that no problem is unsolvable with the use
of consistent and well-contemplated nursing care.
REFERENCES:
Websites:
http://www. google.com
http://www.neumansystemsmodel.org
http://www.neumansystemsmodel.org/NSMdocs/nsm_powerpoint_overview.htm
http://www.patheyman.com/essays/neuman/index.htm
Patrick Heyman and Sandra Wolfe, University of Florida, April 2000

http://www.patheyman.com/essays/neuman/implications.htm
Books
Añonuevo, C. et. Al (2000). N207 Theoretical Foundations of Nursing. Philippines: UP

Open University
Balita, Carlito E. (2005). Ultimate Learning Guide to Nursing Review. Ultimate

Learning Series
Kozier, B. et. Al (2004). Fundamentals of Nursing: Concepts, Process, and Practice

(4th ed.) New Jersey: Pearson
Marriner-Tomey, A. (1994). Nursing Theorists and Their Work (2nd edition). St.
Louis: Mosby
Octaviano, Eufemia F. and Balita, Carlito E. Theoretical Foundations of Nursing: The
Philippine Perspective. Ultimate Learning Series, 2008
CONTRIBUTORS
Reyes, Jose Richard III
Ricana, Ryan
Rico, Ron Paulo
Rimas, Ma. Filipina
Rosales, Ava
“Too often we underestimate the power of a touch, a smile, a kind word, a listening
ear, an honest compliment, or the smallest act of caring, all of which have the
potential to turn a life around.”
Sunday, July 20, 2008 5:11 PM
A Close Encounter: Orlando's Dynamic Nurse-Patient Relationship
Monday, July 21, 2008 3:32 PM
"I can't move, I can't speak, I need help..."
An origami design is used to express Orlando-Pelletier’s Nursing Theory. The three

large folds represents the three steps or processes of patient behavior, nurse
reaction, and nurse action.
Subsequent smaller folds would include the assumptions associated with the theory.
The finished object might resemble a silhouette of two people connected to one
another, alluding to the ongoing nurse and client interaction required for
deliberative care to effectively take place.
Understanding Ida Jean Orlando-Pelletier’s
Dynamic Nurse-Patient Relationship
Know the THEORIST
Ida Jean Orlando, a first-generation American of Italian descent was born in 1926.
She received her nursing diploma from New York Medical College, Lower Fifth
Avenue Hospital, School of Nursing, her BS in public health nursing from St. John's
University, Brooklyn, NY, and her MA in mental health nursing from Teachers
College, Columbia University, New York. Orlando was an Associate Professor at Yale
School of Nursing where she was Director of the Graduate Program in Mental Health
Psychiatric Nursing. While at Yale she was project investigator of a National Institute
of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic
Nursing Curriculum. It was from this research that Orlando developed her theory
which was published in her 1961 book, The Dynamic Nurse-Patient Relationship.
She furthered the development of her theory when at McLean Hospital in Belmont,
MA as Director of a Research Project: Two Systems of Nursing in a Psychiatric
Hospital. The results of this research are contained in her 1972 book titled: The
Discipline and Teaching of Nursing Processs. Orlando held various positions in the
Boston area, was a board member of Harvard Community Health Plan, and served
as both a national and international consultant. She is a frequent lecturer and
conducted numerous seminars on nursing process. She is married to RobertPelletier
and lives in the Boston area. She passed away on November 28 , 2007.
Distinguish the THEORY
Case Scenario
“Nurse, can you give me my morphine,” cried out Mrs. So. “Can you tell how painful
it is using the 0 ‐10 pain scale, where 0 being not painful and 10 being severely
painful?”replied the nurse. “Ummm... I think it’s about 7. Can I have my morphine
now?” “Mrs. So, I think something is bothering you besides your pain. Am I correct?”
Mrs. So cried and said, “I can’t help it. I’m so worried about my 3 boys. I’m not sure
how they are or who’s been taking care of them. They’re still so young to be left
alone. My husband is in Yemen right now and he won’t be back until next month.”
“Why don’t we make a phone call to your house so you could check out on your
boys?” Mrs. So phoned his sons. “Thank you nurse. I don’t think I still need that
morphine. My boys are fine. Our neighbour, Mrs. Yee, she’s watching over my boys
right now.”
The focus of Orlando’s paradigm hubs the context of a dynamic nurse-patient

phenomenon constructively realized through highlighting the key concepts such as :
Patient Behavior, Nurse Reaction , Nurse Action.
1. The nursing process is set in motion by the Patient Behavior. All patient
behavior, verbal ( a patient’s use of language ) or non-verbal ( includes
physiological symptoms, motor activity, and nonverbal communication) , no matter
how insignificant, must be considered an expression of a need for help and needs to
be validated . If a patient’s behavior does not effectively assessed by the nurse then
a major problem in giving care would rise leading to a nurse-patient relationship
failure. Overtime . the more it is difficult to establish rapport to the patient once
behavior is not determined. Communicating effectively is vital to achieve patient’s
cooperation in achieving health.
Remember : When a patient has a need for help that cannot be resolved without
the help of another, helplessness results
2. The Patient behavior stimulates a Nurse Reaction . In this part, the beginning
of the nurse-patient relationship takes place. It is important to correctly evaluate
the behavior of the patient using the nurse reactions steps to achieve positive
feedback response from the patient. The steps are as follows:
The nurse perceives behavior through any of the senses -> The perception leads
to automatic thought -> The thought produces an automatic feeling ->The nurse
shares reactions with the patient to ascertain whether perceptions are accurate or
inaccurate -> The nurse consciously deliberates about personal reactions and
patient input in order to produce professional deliberative actions based on mindful
assessment rather than automatic reactions.
Remember : Exploration with the patient helps validate the patient’s behavior.
3. Critically considering one or two ways in implementing Nurse Action. When

providing care, nursing action can be done either automatic or deliberative.
Automatic reactions stem from nursing behaviors that are performed to satisfy a
directive other than the patient’s need for help.
For example, the nurse who gives a sleeping pill to a patient every evening
because it is ordered by the physician, without first discussing the need for the
medication with the patient, is engaging in automatic, non-deliberative behavior.
This is because the reason for giving the pill has more to do with following medical
orders (automatically) than with the patient’s immediate expressed need for help.
Deliberative reaction is a “disciplined professional response” It can be argued

that all nursing actions are meant to help the client and should be considered
deliberative. However, correct identification of actions from the nurse’s assessment
should be determined to achieve reciprocal help between nurse and patient’s
health. The following criterias should be considered.
o
Deliberative actions result from the correct identification of patient needs by
validation of the nurses’s reaction to patient behavior.
The nurse explores the meaning of the action with the patient and its
relevance to meeting his need.
The nurse validates the action’s effectiveness immediately after compelling

it.
The nurse is free of stimuli unrelated to the patient’s need (when action is
taken).
Remember : for an action to have been truly deliberative, it must undergo

reflective evaluation to determine if the action helped the client by addressing the
need as determined by the nurse and the client in the immediate situation.
Learn more about the THEORY
METAPARADIGM CONCEPTS
Human/Person An individual in need. Unique individual behaving verbally or

nonverbally. Assumption is that individuals are at
times able to meet their own needs and at other
times unable to do so.
Health Assumption is that being without emotional or physical

discomfort and having a sense of well-being
contribute to a healthy state. She further assumed that
freedom from mental or physical discomfort and feelings of adequacy and
well being contribute to health. she also noted that repeated experiences of
having been helped undoubtedly culminate over periods of time in greater
degrees of improvement
Environment Orlando assumes it as a nursing situation that occurs when there

is a nurse-patient contact and that
both nurse and patient perceive, think, feel and act
in the immediate situation. any aspect of the environment, even though
its designed for therapeutic and helpful purposes, can cause the patient to
become distressed. She stressed out that when a nurse observes a patient
behavior, it should be perceived as a signal of distress.
Nursing A distinct profession "Providing direct assistance to individuals

in whatever setting they are found for he
purpose of avoiding, relieving, diminishing, or
curing the individual's sense of helplessness" (Orlando, 1972, p. 22).
Professional nursing is conceptualized as finding out and meeting the client’s
immediate need for help.
Cite the Applications of the THEORY
In Nursing Research
1. In a Veterans Administration (VA) ambulatory psychiatric practice in

Providence, RI Shea, McBride, Gavin, and Bauer (1987) used Orlando’s
theoretical model with patients having a bipolar disorder.Their research results
indicate that there were: higher patient retention, reduction of emergency
services, decreased hospital stay, and increased satisfaction. They
recommended its use throughout the VA system.Currently Orlando’s model is
being used in a multi-million dollar research study of patients with a bipolar
disorder at 12 sites in the VA system (McBride, Telephone interview, July, 2000).
McBride and colleagues continue its use in practice and research at the Veteran
Administration Hospital in Providence, RI.
2. In a pilot study, Potter and Bockenhauer (2000) found positive results

after implementing Orlando’s theory. These included:positive, patient-centered
outcomes, a model for staff to use to approach patients, and a decrease in
patient’s immediate distress. The study provides variable measurements that
might be used in other research studies.
in Nursing Education
1. Orlando's theory has a continuing influence on nursing education.
Through e-mail communication it was found that the Midwestern State University
in Wichita Falls, Texas, is using Orlando's theory for teaching entering nursing
students. According to Greene (e-mail communication, June, 2000) she became
aware, when taking a doctoral course about nursing theories, that it was Orlando
theory used by its school.
2. Through networking the author found that for over 10 years South Dakota
State University in Brookings, SD has been using Haggerty’s (1985) description
of the communication based on Orlando’s theory for entering nursing students
as well as re-enforcing it in their junior year (e-mail communication, (J. Fjelland,
June, 2000). Joyce Fjelland, MS, RN. After working with Schmieding at Boston City
Hospital, Lois Haggerty used Orlando’s theory in her teaching of students and in
conducting a research study of students’ responses to distressed patients at
BostonCollege in Chestnut Hill, Massachusetts.
in Nursing Practice
From an ICU nurse: “Patients have an initial ability to communicate their need for
help”. Consider a case of an immediate post Coronary Artery Bypass Graft (CABG)
patient. Once relieved from the effects of anesthetic sedation, though intubated,
you would realize his excruciating retort from the sternotomy incisional pain
through implicit cues. Morphine Sulfate 1 to 2 mg To be given via slow IV push
every 1 to 2 hours or Ketorolac 15 mg IV every 6 hours is the typical pro re nata
(PRN) order of a cardiac intensivist to relieve the client from pain. Automatic
response of a nurse is to calm the client and encourage relaxation through deep
breathing while splinting the chest with a pillow. Being Deliberate in your actions
include knowing the pharmacokinetics of an ordered drug in relation to the client’s
physiologic standing. If the creatinine level were elevated, would you administer
ketorolac? If the client is on respiratory precaution, would you administer Morphine?
You would ask yourself, what other alternatives do I have to ease my client from
pain? “The client’s behavior is meaningful”. If such “need” would be fittingly dealt
with, the intervention is thriving. “When patient’s needs are not met, they become
distressed.”
Analyze the THEORY

Case Study
A relative of a patient at the emergency room went to the nurse’s station and
began complaining in a loud shouting voice that their patient being a charity case is
not being given the same quality of care as that of the other patients who are under
private consultants. He claimed that their patient who was hyperventilating and was
complanining of difficulty of breathing due to neurocirculatory astheinia was just
forced to sit in the cubicle, while the rich-looking patient was a gomey.
Question
How will you handle this kind of situation and avoid conflict? How can Orlando’s
dynamic nurse-patient interaction theory be utilized in this type of situation?
This Group Blog is Submitted to Ms. Sheila Bonito, FIC,
in Partial Fulfillment of the Requirements in N207.
Manager: Aux Lizares
Editor: Maria Mae Juanich
Contributors:
Katrina Anne Limos
Ginno Paulo Maglaya
Diana Jasmin Lee
Acknowledgment
We would like to acknowledge the following people: Ma’am Shiela Bonito, for
coming up with this group work which really challenged not only our knowledge,
understanding and creativity but also our ability to stay connected despite the
distance, Ms. Aux Lizares, for diligently sorting out the articles, Ms. Maria Mae
Juanich, for organizing the articles into a working blog, and for Ms. Katrina Anne
Limos, Mr. Gino Paulo Maglaya, and Ms. Diana Jasmin Lee, for tirelessly contributing
their thoughts, ideas, and resources. Without all of you, this blog would have never
been possible. Thank you very much!!!
Dear classmates,
Let us learn together. Have we done justice to Ida J. Orlando in presenting her
theory this way? We would like to invite you to share with us your thoughts,
feelings, comments or reactions on our blog entitled, “Understanding Ida Jean
Orlando-Pelletier’sDynamic Nurse-Patient Relationship.” Thank you for your
participation!
Regards,
Group G
Reference:
Orlando, I. J. (1972). The discipline and teaching of nursing process: An evaluative

study. New York: G. P. Putnam.
http://www.enursescribe.com/orlando.htm
George, J.B. (2002). Nursing Process Discipline: Ida Jean Orlando. In George, J.B.
(Ed.). Nursing Theories: the Base for professional nursing practice (5th Ed.). Upper
Saddle River, New Jersey: Prentice Hall, pp. 189-208.
Schmieding, N.J. (2002). Ida Jean Orlando (Pelletier): Nursing Process Theory. In
Tomey, A.M., & Alligood, M.R.. Nurse theorists and their work (5th Ed.). St. Louis:
Mosby, pp. 399-417.
http://www.uri.edu/nursing/schmieding/orlando/
Orlando, I.J. (1961). The dynamic nurse-patient relationship, function, process and
principles. New York: G. P. Putnam.]
Haggerty, L.A. (1985). A theoretical model for developing students’

communication skills. Journal of Nursing Education, 24(7), 296-298.
Haggerty, L.A. (1987). An analysis of senior nursing students’ immediate

responses to distressed patients.. Journal of Advanced Nursing, 12, 451-461.
Nancy M. Shea, Linda McBride, Christopher Gavin, and Mark Bauer
Bauer, M. S. (2001). The collaborative practice model for bipolar disorder-Design

and implementation in a multisite randomized controlled trial. Bipolar Disorders
3(5), 233-244. Bauer, M.S., & McBride, L.(2002). Structured group psychotherapy for
bipolar disorder (2nd Ed). New York: Springer Publishing Co. Shea, N. M., McBride, L.
Gavin, C., & Bauer, M. (1997). The effects of ambulatory collaboration practice
model on process and outcome of care for bipolar disorder. Journal of the American
Psychiatric Nurses Association 3(2), 49-57. Mertie. L. Potter, ND, ARNP, CS and
Barbara Jo Bockenhauer, MS, RNC
Potter, M.L. & Bockenhauer, B.J. (2000). Implementing Orlando’s nursing process
theory: A pilot study. Journa
l of Psychosocial Nursing nd Mental Health Services, 38(3), 14-21
DULCIUS EX ASPERIS--(sweetness after difficulties)
‘Use the word nursing for want of a better. It has been limited to signify little more
than the administration of medicines and the application of poultices. It ought to
signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper
selection and administration of diet — all at the least expense of vital power to the
patient.’
Florence Nightingale--Notes on Nursing (1860)

The Lady with the Lamp and the Nursing Profession
The Nursing profession—a science and an art practiced by both man and women—
Tiring, arduous, demanding, tough, eye-bag forming, yet fulfilling, a vocation of
honor and dignity entwined with humility.
When??...
It was in mid 1800’s with the leadership of Florence Nightingale that organized
nursing started. Before her era, nursing care was done by paupers and drunkards:
persons unfit for any type of work. Hospitals were placed where the poor frequently
suffered more from the environment than from the disease that brought them
there.
‘No man, not even a doctor, ever gives any other definition of what a nurse should
be than this — 'devoted and obedient'. This definition would do just as well for a
porter. It might even do for a horse. It would not do for a policeman.’
Nightingale’s efforts to uplift the nursing profession were indeed admirable. At that
time, nursing was viewed as a kind of work that requires menial tasks or routinely
actions but Nightingale saw it as a vocation aided by proper use of assessment and
empowered by skills, knowledge and attitude acquired from proper schooling. In
her book, she takes limelight away from the Physicians, and places it on the nurses.
Notes on Nursing—What It is and What It is not

Her most frequently cited work, Notes on Nursing, was written not as a nursing text
but to “give hints for thoughts of women who have personal charge of the health of
others.”
Nightingale’s notes on nursing covers all the basic necessities of human lives. It
explains how to deal with sick people which can be applied not just to simple cough,
colds and flues but to all types of human illnesses. And yes if one can read between
the lines (as we always do), the book offers tips on how to survive a hospital
experience.
Nightingale’s environmental model has always been applied in the hospital setting.
One setting would include the care of our patients in the Intensive Care Unit
wherein all chapters of the book can be applied—ventilation and warming, noise
management, observation of the sick etc. And even if we are not in the hospital
setting whether we are just in our office or at home, Nightingale’s vision of nursing
is always present. We can even relate it to a song by Chris Brown and Jordin Sparks
entitled No Air… and the lyric goes like this
“Tell me how I’m supposed to breathe with no air? Can’t live, can’t breath with no
air That’s how I feel whenever ain’t there There’s no air, no air”
See? Nightingales contribution is so wide that the realization of her vision is not only
limited to us nurses. And with that, her vision should inspire, motivate and direct
every interaction we make and every intervention we do to be able to provide a
wholistic nursing care to our patients and help them in their need for identifying
their health concerns without them telling us what we can do for them but doing it
automatically.
………………
Although Nightingale’s book was more of a lecture, a sermon, or even a plea put
into writing, she backed up her concepts with well researched studies to prove her
points.
She is also a skilled statistician- used statistics to present her case for hospital
reform. According to Cohen, “the idea of using statistics for such a purpose- to
analyze social conditions and the effectiveness of public policy- is common place
today, but at that time it was not” (Marie L. Lobo: NURSING THEORIES; The Base for
Professional Nursing Practice; Fourth Edition; 1995)
The notes on nursing by Nightingale repeatedly emphasize on its aim to empower

women to take control of the care not only the sick but also the healthy members of
the family especially the children. We understand that this highlight is because the
children are ought to be the foundation of the future. She used statistics to support
her claims. These lines are lifted from the first pages of Notes on Nursing to show
how extensive Nightingale’s research is for her to come up with such data; “--- do
you know that in every seven infants in this civilized land of England perishes
before it is one year old? That in London, two in every five die before they are five
years old? And, in the other great cities of England, nearly one out of two?----More
than 25,000 children die every year in London under 10 years of age” These are just
some but they prove that Nightingale’s craft is based on thorough research and
statistics.
Basing on today’s world, though advance techniques are being used in the nursing
profession, still Nightingales thoughts are being applied. In a hospital in Dubai
where one of our groupmates work (Ms. Elvie Abanico), still-life paintings are
displayed in the patient’s room and nurses look at how long tentatively patients will
stay in the hospital, the longer they stay the nurses will plan to give a room with a
view—where flowers and tress can be seen from the patients window since basing
on research variety of colors and pictures can help to make a patient feel well. As
supported by Nightingales Notes on Nursing variety section page 44: "Variety of
form and brilliancy of colors in objects presented to patients are actual means of
recovery and that "Variety is just like food for a starving stomach, just like a sick
patient who wants to see a variety, just like a starving eye”.
Indeed, one could simply say that Florence Nightingale is Nursing and Nursing is
Florence Nightingale. So would it not be sensible if we also try to looked at her well-
known work—‘Notes in Nursing’, in a whole new perspective that goes beyond the
scope of Nursing?
No Place for a Woman: The Femme Fatal
During Nightingales time, women are considered second class in short they have no
right to assert something—near helpless with lethargic lifestyle—a life of
thoughtless comfort for the world of social service. During her time, she
encountered a lot of problem just because she is a woman. Though she took part
on influencing the decisions of the War Department by providing information to Sir
Sidney Herbert by giving any of the position papers and reports, because of the
position of women in Victorian England, she was not permitted to submit her
findings under her own name.
(-Marie L. Lobo: NURSING THEORIES; The Base for Professional Nursing Practice;
Fourth Edition; 1995)
In her book entitled Cassandra, she wrote:

“Women are never supposed to have any occupation of sufficient importance not to
be interrupted, except ‘suckling their fools’; and women themselves have accepted
this”
The above quote shows the displeasure of Nightingale on how women of her times
accepted their roles at the society without even exerting an effort to show what
they are capable of. In fact, she stated that there were even books written on the
acceptance of role that women play in the society then. But Nightingale never
conformed to the society nor did she accept. In fact, her writings as well as actions
showed her firm disagreement with how society regarded women. So Nightingale
was also one of great women in history who did her part to lobby for the rights of
women.
Nightingale had a strong conviction that woman have the mental capacities to
achieve whatever they wish to achieve. Out of this conviction came her resolve and
action to establish nursing as a profession wherein women could develop the
intellectual abilities to contribute meaningful service to society.
With her book—Notes on Nursing, a glimpse of feminism can be seen since the book
empowers women to have personal charge of the health of others though it does
not teach them how, but it asks women to teach herself. Thanks to Florence
Nightingale, women now realize that they must gain control over their own time in
order to change the social and political structures over their lives—it can be
observed that majority of the nurses of today are women living what Florence
Nightingale had stated in her book though it is a fact that men also share her vision
of what nursing is.
Voluminous texts were written on Florence Nightingale and her contribution to the
Nursing profession. What many nurses fail to realize is that she did more than just
that. We hope our little blog could help them see and appreciate another aspect of
her life and her contributions not just to nursing, but to the world.
“Nurses we are love serves—this is the essence of nursing. For what ever reason we
pursue this course, regardless of where we practice it, the essence of nursing
should be internalized…”
Jordin Sparks duet with Chris Brown - No Air

SISTER CALLISTA ROY: ADAPTATION THEORY
“When push comes to a shove, we will seldom disappoint ourselves. We all harbour
greater stores of strength than we think. Adversity brings the opportunity to test our
mettle and discover for ourselves the stuff of which we are made.”
Do not underestimate the power of a person to cope. He may be dependent now but
deep within him lies the energy to adapt.
I remember a particular a particular patient when I was still an ICU nurse. He was a
pastor afflicted with a serious liver problem. Specialists come and go at his ICU bed
but they cannot seem to diagnose the problem. Time is running out and the pastor
is slipping fast. He’s bleeding and God knows how many units of blood have been
transfused to him. He went into coma. Doctors were giving up, and so were we.
We’ve primed the family but they just won’t give up…yet. The wife is always there
at his side during visiting hours, always cheerful and full of hope. So is the daughter
who even lets her dad listen to praise songs as if he is not comatose. Many days
passed and to our amazement, the pastor woke up from coma. It’s been uphill from
there. Everything just fell into the right place. He was transferred to a regular room
and eventually discharged with a clean bill of health.
Amazing? What could it be? A miracle? Or could it be the medications working, or

the transfusion? Or the family’s fervent prayers? We couldn’t tell but one thing is
certain: human beings are made to persist. And that is what Sister Callista Roy
believed, too.
Sister Callista Roy is a member of the Sisters of Saint Joseph of Carondelet. She
received a bachelor of science in nursing from Mount Saint Mary’s College in Los
Angeles California, a master of science in nursing from UCLA, and a master’s degree
and doctorate in sociology from UCLA (Philips, 2002). Roy first proposed the RAM
while studying for her master’s degree at UCLA, where Dorothy Johnson challenged
students to develop conceptual models of nursing (Philips, 2002; Roy & Andrew,
1999). She received many honors and awards for her scholarly and professional
work and is currently the Graduate Faculty Nurse Theorist at Boston College, School
of Nursing (Roy, 2000).
PHILOSOPHICAL UNDERPINNINGS OF THE THEORY
Johnson’s nursing model was the impetus for the development of Roy’s Adaptation
Model. Roy also incorporated concepts from Helson’s adaptation theory, von
Bertalanffy’s system model, Rapoport’s system definition, the stress and adaptation
theories of Dohrenrend and Selye, and the coping model of Lazarus (Philips, 2002).
MAJOR ASSUMPTIONS, CONCEPTS AND RELATIONSHIPS ASSUMPTIONS

In the Adaptation Model, assumptions are specified as scientific assumptions or
philosophical assumptions.
Scientific Assumptions
* Systems of matter and energy progress to higher levels of complex self-

organization.
* Consciousness and meaning are constitutive of person and environment

integration
* Awareness of self and environment is rooted in thinking and feeling
* Humans by their decisions are accountable for the integration of creative

processes.
* Thinking and feeling mediate human action
* System relationships include acceptance, protection, and fostering of

interdependence
* Persons and the earth have common patterns and integral relationships
* Persons and environment transformations are created in human

consciousness
* Integration of human and environment meanings results in adaptation

(Roy&Andrew, 1999, p.35).
Philosophical Assumptions
* Persons have mutual relationships with the world and God
* Human meaning is rooted in the omega point convergence of the universe.
* 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.
* Persons are accountable for the processes of deriving, sustaining and

transforming the universe (Roy & Andrew, 1999, p. 35).
Reading through Roy’s adaptation theory, I now understand man’s immense

capacity to adapt. I believe in a higher power, I believe in miracles, but I believe,
too, that the greater miracle is the perfect interplay of all the factors that push a
person to adapt at various modes.
The Four Modes of Adaptation
1. Physiologic-Physical Mode
Physical and chemical processes involved in the function and activities of living
organisms; the underlying need is physiologic integrity as seen in the degree of
wholeness achieved through adaptation to change in needs.
2. Self-concept- Group Identity Mode
Focuses on psychological and spiritual integrity and sense of unity, meaning, and
purposefulness in the universe.
3. Role Function Mode
Roles that individuals occupy in society, fulfilling the need for social integrity. It is
knowing who one is in relation to others.
4. Interdependence Mode
The close relationships of people and their purpose, structure and

development
individually and in groups and the adaptation potential of these groups.

So how did the pastor recover? At the physiologic level, it was good that he was
brought to the ICU immediately since the basic physiologic needs are met at once.
He was intubated (for oxygenation), an NGT was put in place (for nutrition), a foley
catheter was inserted (for elimination), and enema was also done to facilitate
elimination of wastes.
Visitors were restricted early on to provide optimum rest and to minimize cross
contamination. Isolation measures were also instituted. Routine ICU care, so to
speak. Every time the patient is assigned to me, I try to talk to him as if he listens
and can answer. His churchmates were also there every time they are allowed to
see him telling him that they are waiting for him at their church. The wife and the
daughter never gave up on him. They are always there to tell him how much they
love and need him. The adaptation process was a long one, but he did adapt and
went on to recover. The ICU environment is not a very ideal place for adaptation,
but given the situation and condition of the patient at that time, it was the best
place to support the body’s power to adapt.
ROY’S THEORY AS APPLIED TO:
NURSING PRACTICE
Using Roy’s six –step nursing process, the nurse assesses first the behaviors and
second the stimuli affecting those behaviors. In a third step the nurse makes a
statement or nursing diagnosis of the person’s adaptive state and fourth, sets goals
to promote adaptation. Fifth, nursing interventions are aimed at managing the
stimuli to promote adaptation. The last step in the nursing process is evaluation. By
manipulating the stimuli and not the patient, the nurse enhances the interaction of
the person with their environment, thereby promoting health.
Hamner in 1989 discussed the Roy model and how it could be applied to nursing
care in a cardiac unit (CCU). Hamner describes the model as enhancing care in the
CCU and being consistent with the nursing process. Hamner found that the model
assessed all patients’ behavior, so that none was excluded. The author discovered
that the Roy model provides a structure in which manipulation of stimuli are not
overlooked. The model puts emphasis on identifying and reinforcing positive
behavior which speeds recovery.
EDUCATION
The adaptation model is also useful in educational setting. Roy states that the
model defines for students the distinct purpose of nursing which is to promote
man’s adaptation in each of the adaptive modes in situations of health and illness.
In the early 1980’s the School of Nursing at the University of Ottawa experienced a
major curriculum change. This change included incorporating a nursing model by
which to base their new curriculum. The change included incorporating a nursing
model by which to base their new curriculum. The Roy adaptation model was one of
the models to be included in the first year of the baccalaureate program. The
professors had to meet four challenges during this change:
1. Adapting the course to be congruent with the Roy model,
2. Developing teaching tools suitable for student learning.
3. Sequencing of content for student learning
4. Obtaining competent role models.
RESEARCH
If research is to affect practitioners’ behavior, it must be directed at testing and

retesting conceptual models for nursing practice. Roy has stated that theory
development and the testing of developed theories are nursing’s highest priorities.
The model must be able to regenerate testable hypotheses for it to be
researchable.
Fawcett and Tulman used the model for the design of studies measuring functional
status after childbirth. They also used the model for retrospective and longitudinal
studies of variables associated with functional status during the postpartum period.
The model was also used for ongoing studies of functional status during pregnancy
and after the diagnosis of breast cancer. The model facilitated the selection of study
variables and clarified thinking about the classification of study variables. The
model was a useful guide for the design and conduct of studies of functional status.
GROUP D
Cortez, Joyzen
Cutay, Rose Ann
Cristobal, Maureen
De Jesus, David
Daniel, Jane
Dayao, Genevieve
Thank you for your contributions.
Group K:Transcultural Nursing...... a bridge to reach clients globally
Saturday, July 19, 2008 11:07 AM

Transcultural Nursing...... A bridge to reach clients globally
Madeleine M. Leininger
PhD, LHD, DS, CTN, RN, FAAN, FRCNA
Madeline Leininger was a pioneer nurse anthropologist. Appointed dean of the

University of Washington, School of Nursing in 1969, she remained in that position
until 1974. Her appointment followed a trip to New Guinea in the 1960’s that
opened her eyes to the need for nurses to understand their patients’ culture and
background in order to provide care. She is considered by some to be the "Margaret
Mead of nursing" and is recognized worldwide as the founder of transcultural
nursing, a program that she created at the School in 1974. She has written or edited
27 books and founded the Journal of Transcultural Nursing to support the research
of the Transcultural Nursing Society, which she started in 1974.
Every human race has his/her different beliefs and culture may it be taught and
passed on from one generation to the other. Even if we have the same language or
dialect spoken we all have different culture and beliefs being followed as one of the
norms in our society. And a part of our culture was our health beliefs and practices.
In our group we categorize some of the health beliefs and practices into different
age group based on experiences and research. This will give us awareness on how
we could be able to render effective care to our clients, with certain age and
background.
PRESCHOOL AND SCHOOL AGE
An ethnographic study of Latino pre-school children’s oral health in rural California

revealed that, Latino children experienced a higher prevalence of caries than do
children in any other racial groups in the U.S. The study conducted in 2005 focus on
both recent immigrants and longer term residents of a small agricultural town in the
central valley of California. Around 95% of the population of approximately 9,000 is
of Latino largely Mexican origin.
Rural immigrant parents tend not to recognize dental caries in their children as a
disease, but rather classified as visible discoloration on teeth and tend not to seek
help unless this were accompanied with swelling and pain. Because tooth decay is
viewed as a stain, when treatment is sought, parents often requested and expected
cleaning. The high cost of restorative work therefore, is a surprise.
The mothers were educated by health care workers about baby bottle decay but
claimed that the problem is the bottle nipple and not the sweet fluid content of the
bottle. Many mothers claimed that as adults they never had a dental treatment nor
dental caries when young and now their children have dental caries and they are
unsure how to prevent it.
Migrant parent also reported major changes in diet since moving to the U.S., and
also commented on how different their children’s diet is from their own when
growing up. Major differences between their diets were the high consumption of
sugar, sodas, and less access to fresh fruits and vegetable. Parents did not
specifically associate these broad dietary changes with their children’s problems
although they did connect the consumption of sweet substances with the
subsequent advent of dental caries. Collectively all these understanding and actions
on the part of care givers sets up Latino children for high rates of unrecognized and
untreated oral disease.
ADOLESCENT
As depicted in Leininger’s Sunrise model culture, worldview, and social structure

influences the individual’s care behaviors and beliefs which in turn affects their
health and illness status. The nurse needs to clearly understand universal and
specific cultural views of adolescents and clarify values in order to promote wellness
in a culturally acceptable manner.
One of the most pressing problems of adolescence in many societies is engaging in

risky sexual behaviors at an early age. In some societies, adolescent participation in
risky sexual behaviours are treated as a measure of ‘manhood’, a sense of
‘belongingness’, a sign of ‘friendship’. The nurse through applying transcultural care
concepts of Leininger should bear in mind these problems and study the deeply
rooted societal and cultural origins of these.
Cultural beliefs and practices leading to risky sexual behavior do not only lead to
this specific problem but to a myriad of problems related to such health practice
including teenage pregnancy, sexually transmitted diseases, poor maternal and
child health, etc. The nurse in these situations should devise a strategy in teaching
adolescents about the effects of risky sexual behavior and actions to curb such
incidents in ways that are meaningful to them.
There are a lot of universal and culture-specific issues concerning adolescents

today. It is very important for a nurse applying transcultural care concepts to be
sensitive not just to cultural and social background but also to the adolescent’s
developmental issues and concerns.
Being an adolescent is indeed a big transition in our lives from an adventurous kid
to a growing up girl/boy. We experience a lot of challenges like peer pressure and a
lot of changes in our body. One of the things as an adolescent is when I have my
menarche my mother asked me to jump in the stairs 3 times ,a part of our family’s
culture I guess which I find very amusing.
As adolescents, we are expected to mingle with other person with the same age but
some of us have a different upbringing so some tend not to "go with the flow"
wherein others tend to be depressed and commit irrational behavior like suicide.
Some committed suicide because of family problems, school, and failed
relationships. Aside from personal and social challenges an adolescent faces, he/she
also learn a lot of new things like drinking alcohol and smoking but it depends on
how he/she will handle this, the parent's guidance will be of important issue here.
Because not only this will affect personal relationships but also their health is at
risk. I have this patient, 17 year old male who seek treatment in the emergency
room who attempted to commit suicide by drinking sleeping pills because of a failed
relationship with his girlfriend. As nurses we should understand them what they are
experiencing now. We should treat them with empathy. Our responsibility is
teaching them the importance of life and health. We should understand them
because they behave differently depends on their family values, personal
experiences and beliefs.
ADULTHOOD
A common theory is that adulthood is the real test of life, to experience the world
from a first-person standpoint instead of through the parents. Then the adult can
pass those experiences down to younger people and they can experience them
when they become adults. In this stage, there are noticeable changes in how adults
view on their careers / finances and Marriage/ family. Most of these adult live their
life in a fast pace. As a nurse I encounter clients who are an American businessman
who is an occasionally smoker and drinker for annual physical check up. Despite
admitted in the hospital he’s still focusing his attention on his work rather than his
health. He’s the breadwinner of the family. He has 4 kids studying in a private
school and his wife works as a cashier in a grocery store I didn’t stopped him in
doing his work but when laboratory test and physical assessment will be given to
him I just told him to stop for a while and cooperate. I oriented him the importance
of annual check-up and having a healthy lifestyle.
Another situation experienced among expectant mothers in Filipino-Chinese women

they consult a Chinese conception calendar because some would like to have their
first born to be a boy. An experience of one of our groupmates also told us when
she was caring for a Filipino-Chinese woman who had been admitted to their floor.
She asked her to contact her obstetrician because she have to give birth before
lunch even if she’s not in active labor, as one of the many beliefs that Chinese have
about labor and delivery. She was quite surprised by her request but she found out
that it was just one of the many beliefs that the Chinese have about labor and
delivery. She was brought to the delivery room before 10 am.
Some would like their first born to be a boy, others say that they consult a Chinese
conception calendar for this. The calendar is supposed to predict whether you will
have a girl or boy. Personally she was able to consult this when she was pregnant
with my first born, the sex of my baby was accurately predicted.
OLDER ADULTHOOD/ GERIATRIC
The theory of Leininger paved its way in the study of human culture. Culture of an
individual shapes ones view of aging. Which explains that older adult is also a
heterogeneous group of people. With the increasing population of baby boomers,
nurses should expand their roles in the care of individual or group of older adults
not only in the hospital but in the community as well. As you read the succeeding
text of my blog, I hope this will make you understand why older adults behave the
way they do and how nurses should deliver personalized care.
Among older adults, one of us had been able to care for a 70 y/o white American
client who was due for a cataract extraction. She oriented the client with the
physical set-up and hospital policy. Her wife visited her and left after 2 hours. The
client told me that in the United States visitors do not stay for a long time on the
patient’s room in which he is fine with it. Looking at this patient we will notice that
as long as they can do things by themselves they won’t bother in asking for
assistance. In this situation older people experience a feeling of fulfillment if they
can have a sense of control even with alteration in health condition.
Another adult patient she had was a 69 y/o who is due for CABG, three days prior to
operation he was already admitted in the hospital to undergo clearance before he
undergo surgery. She oriented him with the physical setup and rules. She discussed
to the client visiting hours and number of visitors and companionallowed. He asked
if he could have some considerations because he is expecting a lot of relatives. The
request was granted. In this scenario as nurses we act as advocate of our clients,
though there are rules to follow sometimes we will have to bend some as long as we
are not bypassing any authority. We should know how to assert ourselves in behalf
of our patients. Her Filipino client was used to that culture wherein there is strong
family ties especially in times of health illness the presence provides comfort and
security being the head of the family.
REFERENCES:
Isaacs B. An introduction to geriatrics. London: Balliere, Tindall and Cassell, 1965
Geiger, J.N. & Davidhizar, R.E. (1991). Transcultural nursing: assessment in

intervention. St. Louis: Mosby-Year Book.
Leininger, M. (1991). Transcultural nursing: the study and practice field. Imprint,
38(2), 55-66.
Merck $ Co. The Merck Manual of Geriatrics.1995-2007 Merck & Co., Inc.,
Whitehouse Station, NJ, USA
www.baby-talk.co.uk/chinese_calendar.htm
http://www.tcns.org/
Andrews,M. and Boyle,J. "Competence in Transcultural Nursing Care" The American

Journal of Nursing vol 97 no.8 august 1997.pp16AAA,16BBB,16DDD,Lippincott
Williams and Wilkins
Silvestri,L. (2006). Saunders Comprehensive Review for the NCLEX-RN Examination.

3rd Edition. Singapore :Elsevier.
Añonuevo,C.et al(2000).Theoretical Foundations of Nursing.Philippines:UP Open

University.
Group members: Cherry Sagge, Marlon Salazar, Michael San Juan, Jay Ar Santiguel,
Laarni Sarad, Marie Jam Separa, Clarisse Elise Sintor, Ma. Cristina Setubal, Elsie
Santiago
Health Promotion Model: Heuristic Device for Health Care Professionals
Friday, July 18, 2008 6:11 PM
Ourselves, our body, our health….. enhancing self usage towards prevention of
illnesses & promoting well-being.
Nora J. Pender developed the Health Promotion Model that is proposed as a holistic
predictive model of health-promoting behavior for use in research and practice. She
is Professor Emeritus in the School of Nursing at the University of Michigan, and an
advocate of health promotion.
“I committed myself to the proactive stance of health promotion and disease

prevention with the conviction that it is much better to experience exuberant well-
being and prevent disease than let disease happen when it is avoidable and then try
and cope with it.”
Nola J. Pender, PhD, RN, FAAN
Health Promotion Model has given health care a new direction. According to her,
Health Promotion and Disease Prevention should be the primary focus in health
care, and when health promotion and prevention fail to prevent problems, and then
care in illness becomes the next priority. She defined 2 concepts: health promotion
& health protection.
Health promotion is defined as behavior motivated by the desire to increase well-

being and actualize human health potential. It is an approach to wellness. On the
other hand, health protection or illness prevention is described as behavior
motivated desire to actively avoid illness, detect it early, or maintain functioning
within the constraints of illness. (Kozier, 2004)
Figure 1 – Health Promotion Model
This model (Figure 1) is moving towards understanding multi-faceted nature of

persons correlating with their interpersonal nature and interacting with their
interpersonal & physical environments as they trail towards health.
Because of the model, nurses have already advanced their health approaches,
addressing not only the curative side, but as well as prevention of diseases &
promotion of well-being. Application of this theory is varied and substantive on its
own.
Applications
Nursing Practice
“We are moving toward an era of science-based practice in nursing that

incorporates the latest findings from the behavioral and biological sciences into
practice to assist people of varying cultural backgrounds to adopt healthy
lifestyles.” – Pender
As what they say, prevention is better than cure. Thus, health promotion is valued
much. But how? Question seems hard…hard as if you don’t know how to solve the
problems of the world…But how, again? If super heroes could save life using their
super powers, we nurses could do more by using our caring touch, and therapeutic
talks. Health teachings are always part of nurses’ experience in the workplace.
Despite of various clinical & community health care settings, we nurses are always
interacting with our patient/client.
Community health care setting is the best avenue in promoting health & preventing
illnesses. Using Pender’s Health Promotion Model, community program may be
focused on activities that can improve the well-being of the people. Health
promotion and disease prevention can more easily be carried out in the community,
as compared to programs that aim to cure disease conditions. This is because the
people in the rural area tend to veer away from modern medical methods. Most of
them, due to financial reasons, choose to avail of the services offered by
“herbolarios” and other folk healers. In our local setting, promoting health to our
fellow Filipinos is very crucial. Though, there are campaigns provided by our
government’s health agency, which is the Department of Health (DOH), there’s still
a big percentage in the population who live unhealthily and many are suffering from
different type of diseases.
Nurses, though are scattered in different fields, have common primary concern: to
promote health to every individual. The following are just examples of methods on
how to promote health to our fellows.
Insight from an Academe nurse teaching CHN… A group of students taught the
families the value of eating a balanced diet. They introduced the concept of
including the different food groups in all their meals. They also stressed the benefits
and advantages of the various vitamins and minerals found in those food. Another
group encouraged the community to practice lifestyle modification. They discussed
the disadvantages of vices such as smoking and drinking alcoholic beverages. For
disease prevention and health protection, one group tried to inculcate the
importance of early detection of illnesses. They taught the women the proper way
and timing of self-breast examination. The mothers were also encouraged to avail of
the vaccination services offered by the nearby health center. These programs
proved to be very beneficial to the community. Because one can truly build a
healthier tomorrow through good community health practice.
Insight from an ICU nurse… Although most patients admitted in the ICU are
experiencing health problems, Health Promotion Model may still be applied in one
way or another. This is projected towards improving health condition and prevention
of further debilitating conditions. Diet modifications and performing passive &
active range of motion exercises are examples of its application.
Nursing Education
“I believe that the future will be very bright and productive for nurses who direct
their careers toward understanding disease prevention and health promotion
processes.” – Pender
Nurses are expected to be adaptive. Indeed, changes are always constant. In health
care settings, patients come & go. Meet & greet. Recover or expire. As this theory
advocated, we should not allow our patients to experience severe conditions if we
could only prevent them from encountering such. We are expected to know, if not in
depth, the disease processes. Because of this know-how, we could apply health
promotion and worsening prevention before the hands of the clock stop moving.
Percentage of nurses is geared towards continuing professional education.

Attending seminars & conventions. Enrolling to masteral & doctoral classes. All are
goaled towards becoming competent nurses. Nursing education is not a one-phase
process. It does not end after passing the licensing exam. It is continuous.
Unending. Ever changing. We must be abreast with new technologies, new
approaches, and new techniques. Because of this theory, we nurses could address
more the needs and problems of the client before it progresses to exacerbation.
This model could be a basis for structuring nursing protocols and interventions.
Nursing Research
“I was committed to health promotion and encouraged other scholars to move in

that direction long before health promotion and risk reduction became popular.” -
Pender
Research help Health Care provider to develop a systematic problem-solving

approach to improve and develop strategies to promote good health to individuals.
Through research we will be able to clarify and verify the phenomenon.
Evidenced-based practice is fast emerging because of its factual and substantive

results. These researches yield fruitful outcome that of great help in addressing
arising problems and in setting nursing protocols. Much more research must be
done to tailor interventions to individuals rather than to group stereotypes.
If we could remember, common research topics in our nursing college days are
health promotion techniques and disease prevention. To name a few, some geared
their research on effectiveness of Expanded Program on Immunization, others on
health practices of mothers and families, some on efficiency of early detection of
common illnesses. These are all but few of the model’s application to research.
Of all the theories presented in the module, Health Promotion Model is the easiest
of them, yet substantive & useful. In our day-to-day experiences as nurses, we are
always promoting health, preventing illnesses, and upholding well-being. We are
seen by the public as health advocates. We have knowledge on health & illnesses,
thus, we are expected to share this to laymen and contribute to their well-being. As
what Pender said, “We cannot continue to let people become ill when we have the
means to keep many people well--particularly when problems are environmentally
and behaviorally induced”. Thus, the theory of Pender on Health Promotion is
indeed a great to advocate to prolong and preserve life. This theory really manifests
the noble work of a NURSE. Remember, nurses we are LOVE SERVES.
JEAN WATSON'S THEORY OF HUMAN CARING
Friday, July 18, 2008 11:03 AM
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References:
George, J. (1990). Nursing Theories: The Base for Professional Nursing Practice; 4th
Edition. London: Prentice-Hall International, Inc. p. 317.
McEwen, M. & Wills, E. (2007). Theoretical Basis for Nursing; 2nd Edition.
Philadelphia, USA: Lippincott Williams & Wilkins. p. 191.
Tomey, A.M. & Alligood, M. (2002). Nursing Theorists and their Work; 5th Edition.
Singapore: Mosby, Inc. p. 145.
Tomey, A.M. & Alligood, M. (2006). Nursing Theory Utilization and Application; 3rd
Edition. Missouri, USA: Mosby, Inc. p. 103
Watson, J. (1985). Nursing: Human Science and Human Care. Connecticut, USA:
Appleton-Century-Crofts.
http://www2.uchsc.edu/son/caring/content/evolution.asp
CONTRIBUTORS:
MARIABELEN QUIZON
ARIANE PANGANIBAN
ALLAN PECSON
CHARMAINE PECSON
JUDY PEDALIZO
LAARNI PICZON
Thank you for taking time in reading our blog. We hope you learned something from
it. Have a nice day. Take care!!! :)

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Introduction to the Theory of Culture Care, Diversity, and Universality

Nurses are in constant inte raction with different

Cultural and Social Structure

Technological lack of awareness of first aid remedies and

Religious community people view dengue as a bad omen

Cultural Values health is of lesser priority; more priority is

Political and legal lack of policy programs by the local government

Economic more males acquire dengue since most of them

Educational low level of education is noted. Most are

Orem identifies self – care requisites as follows: (Orem, 1991)

Health deviation self – care requisites are as follows: (Orem, 1991)

Theory of Self-Care Deficit

By Rose Ann Bunye

The self-care deficit may be actual or potential. For example:

Orem identifies 6 methods of helping:--

Dorothea Orem's Theory of Self-Care (Illustrations)

Theory of Nursing Systems

Three Support Modalities:

Wholly compensatory system

Partly compensatory system

Orem's Self-Care Deficit Theory: Theoretical Assertions

Dorothea Orem's Theory of Self-Care (Illustrations)

Comparison of Orem’s Nursing Process and the Nursing Process

Posted by Rhutzuji at 4:09 AM 0 comments

Five Major Assumptions of Orem’s General Theory of Nursing

By Yosef Brian Villanueva

Five major assumptions of Orem’s general theory of nursing are as follows:

Self care is a requirement for every person

Strengths and Limitations of Orem’s Theory

By Myrene Leviste Buban-Aseron

Fitzpatrick JJ, Whall AL. Conceptual models of nursing, analysis

George JB. Nursing theories, the basis for professional nursing

Balabagno, et al., Pathophysiology, UP Open University; 2006

Application of Orem’s Self-Care deficit theory in the Nursing Profession

Myra Levine's Conservation Theory

Myra Estrin Levine

INTRODUCTION and BIOGRAPHY

COMPOSITION OF CONSERVATION MODEL

Levine’s Conservation Model is focused in promoting adaptation and maintaining wholeness

Wholeness is based on Erikson’s (1964, p. 63) description of wholeness as an open system:

A change in behavior of an individual during an attempt to adapt to the environment is called an

KEY CONCEPTS (Conservational principle)

Myra Levine’s Model also discusses other assertions and assumptions:

• The nurse creates an environment in which healing could occur

• Conservational model was used as guidelines for curriculum development

• Nursing diagnosis-gives provocative facts meaning

• Testing the hypothesis

• Observation of organismic response to interventions

Levine, M. E. (1973). Introduction to clinical nursing. F. A. Davis Company: Philadelphia, PA.

Comfort Theory: An Overview

Pioneering the work on theory of comfort in nursing is Dr. Katharine C. Kolcaba

According to Kolcaba, Comfort has 3 existing forms... Relief, Ease and

Saturday, July 18, 2009 11:26 PM

-Margaret Newman was born on October 10, 1933 in Memphis Tennessee.

• In 1964 she received her Masters Degree of Medical-Surgical Nursing and

• In 1971 she completed her Doctorate of Nursing Science and Rehabilitation at

Ø Rehabilitation Nursing stemmed her interest in health, movement & time.

Ø 1977- Professor in charge of graduate study in nursing at Pennsylvania State.

Ø 1984- Nurse theorist at the University of Minnesota.

Ø 1996- Retired from teaching.

HEALTH AS AN EXPANDING CONSCIOUSNESS

The theory of health as expanding consciousness stems from Rogers' theory of

-facilitates pattern recognition in clients by forming relationships with them at