SYSTEMS THEORY (BETTY NEUMAN)- SYSTEM MODEL IN

NURSING PRACTICE
Health is a condition in which all parts and subparts are in
harmony with the whole of the client.

Born in 1924 on a farm near Lowell, Ohio.

1947 - Received RN Diploma from Peoples Hospital

School of Nursing, Akron, Ohio
experience as a hospital, staff, and head nurse;
school nurse and industrial nurse; and as a clinical
instructor in medical-surgical, critical care and
communicable disease nursing
General Information

Person as a complete system, the subparts of which

are interrelated physiological, psychological,
sociocultural, spiritual, and developmental factors.

Neumans model deals with stress & stress reduction

& is primarily concerned with the effects of stress on
health
METAPARADIGM
Person

Is viewed by Neuman as a whole multidimensional,

dynamic system

Can be an individual, family or group or community

She sees a person as an open system that works

together with other parts of its body as it interact
with the environment

Is composed of basic core (genetic features, and the

strengths and weaknesses of the system parts) as
well as physiological, sociocultural, developmental &
spiritual variables
Health

Neuman sees health as being equated with wellness.

She defines health/wellness as "the condition in

which all parts and subparts (variables) are in
harmony with the whole of the client (Neuman,
1995)".

Views health as a continuum of wellness to illness

that is dynamic in nature & constantly subject to
change

optimal wellness or stability indicates that total

system needs are being met

The client is in a dynamic state of either wellness or

illness in varying degrees at any given point of time.
Environment

Defined as being all the internal & external factors

that surround or interact with person & client
*internal environment exists within the client
system.
*external environment exists outside the client
system.

Includes stressor, described as environmental forces

that interact with & potentially alter system stability
Nursing

Neuman believes nursing is concerned with whole

person (holistic approach), an approach that
considers all factors affecting a clients health status.

Views nursing as a unique profession that is

concerned with all of the variables affecting an
individuals response to stress.

the primary aim is stability of the patient/client

system, through nursing interventions to reduce
stressors.
Systems Model in Nursing Practice
A.) Client Variables
The client variables can be one or combination of the
following:
* physiological , sociocultural, psychological, spiritual
& developmental
- These variables function to achieve stability in
relation to the environmental stressors experienced
by the client
B.) Lines of Resistance
Represent the internal factors of a person that help
defend against a stressor
It acts to facilitate coping to overcome the stressors
that are present with in the individual
C.) Normal Line of Defense
- Represents a stability state for the individual or
system
- It is maintained overtime & serves as a standard to
assess deviations from the clients usual wellness
D.) Flexible Line of Defense
Acts as a protective barrier to prevent stressors from
breaking through the normal line of defense
Is dynamic and can change rapidly over a short time
Can be affected by variables such as loss of sleep,
that reduce a clients ability to use a flexible line of
defense against stressors

It includes system variables & behaviors such as the

individuals usual coping patterns, lifestyles, &
developmental stage
E.) Stressors
Are forces that produce tensions, alterations or a
potential problems causing instability with in the
clients system
They may be:
1. Intrapersonal stressors are those stimuli that
occur within the individual
2. Interpersonal stressors are those stimuli
that occur between individuals
3. Extrapersonal stressors are those stimuli
that occur outside the person
F.) Reaction
Are the outcomes or produced results of certain
stressors & actions of the lines of resistance of a
client
Can be positive or negative depending on the degree
of reaction the client produces to adjust & adapt with
the situation
Neuman specified these reactions as:
* negentropy is set towards stability or wellness
* egentropy is set towards disorganization of the
system producing illness
G.) Degree of Reaction
- Is the amount of energy required for the client to
adjust to the stressors
H.) Prevention
interventions are purposeful actions to help the
client retain, attain & or maintain system stability
Used to attain balance within the continuum of
health
These are the actions that generate good results or a
re aimed towards hindering negative outcomes
-

3 Levels
1.
-

of Prevention
Primary Prevention
Refers to intervention before a reaction occurs
Is carried out when a stressor is suspected or
identified
It also aims to strengthen the capacity of a person to
maintain an optimum level of functioning while being
interactive with the environment, like health
promotion & disease prevention
2. Secondary Prevention
- Refers to intervention after a reaction occurs
- Focuses on helping alleviate the actual existing effects
of an action that altered that balance of health of a
person
- It aims to reduce environmental influences that lead to
the decline of the level of functioning of a person &
strengthening or restoring a persons resistance after the
illness exposure
Examples: early detection of disease & prompt treatment
3. Tertiary Prevention
Refers to intervention that occurs after the system
has been treated through secondary
Focuses on actual treatments or adjustments to
facilitate the strengthening of a person after being
exposed to a certain or illness
It aims to prevent the reoccurrence of the illness in
the manner of rehabilitation, as in the case of
disability avoidance & physical therapy

I.) Reconstitution
Is the adjustment state from the degree of reaction
It is a state of going back to the actual state of
health before the illness occurred

THE BEHAVIORAL SYSTEM MODEL (Dorothy E. Johnson)

Aug. 19, 1919 Born in Savannah, Georgia

1942 BSN from Vanderbilt University

1948 MSN in Public Health from Harvard

1949 Faculty at UCLA

1977 Retired in Florida

Johnson first proposed her model in 1968 to foster

the efficient & effective behavioral functioning in
the patient to prevent illness

Stimulus from internal/external nature - stress

conflict or tension - disequilibrium

Nursing should facilitate the maintenance of

equilibrium by:
> lessen the stimuli
> support normal defenses and adaptive process

The person experiencing a disease is more important

than the disease itself

Each individual has a focusing and repeating ways of

acting which is distinct to the individual.

The person is a behavioral system comprised of a set

of organized, interactive, interdependent, and
integrated subsystems

Metaparadigm

Person- views person as having two major

systems: biological and behavioral system.
-As a behavioral system with
patterned,repetitive & purposeful
ways of behaving that link the
person to the environment
-An individual composed of seven
open & interactive subsystems; a
disturbance in one usually affects
the others.
-Continually strives to maintain a
steady state by adapting &
adjusting to environmental forces
that cause an imbalance; when an
imbalance or health problem
occurs, the persons physical,
social or psychological integrity is
threatened.
Health- A state that is affected by social,
biological, psychological, and physiological
factors.
-The individual strives to maintain
stability in these factors
Environment -Consists of all the factors that
are not part of the individuals
behavioral system, but influence
the system, some of which can be
manipulated by the nurse to
achieve the health goal for the
patient.
-An individuals behavior is
influenced by all the events in the
environment. It varies from culture
to culture.
Nursing -Is an external force acting to
preserve the organization of the
patients behavior by means of
imposing regulatory mechanisms
or by providing resources while
the patient is under stress

Johnsons 7 Subsystems

Attachment or Affiliative Subsystem

Forms the basis for all social organization
Promotes survival & provides a sense of
security
Results in social inclusion, intimacy & the
formation of strong bonds

Dependency Subsystem
- promotes helping or nurturing behavior from others
- Results in approval, attention, recognition &
physical assistance

Ingestive Subsystem
Involves food intake
Relates to the biological need for food & the
psychological meanings & structures of social
events surrounding food consumption
Results in appetite satisfaction

Eliminative Subsystem
- involves behavior surrounding the excretion of
waste from the body
- Includes the psychological meanings & structures of
socially acceptable behaviors for waste elimination
Sexual Subsystem
- involves behavior associated with procreation &
sexual gratification
- includes psychologically & socially acceptable
behaviors such as courtship & mating
- results in the development of sex role identity & sex
role behavior

Aggressive Subsystem
- involves behavior related to self- protection &
preservation of the self & society
- includes the belief that aggression is learned &
harmful & that people & property must be respected
& protected
- includes acknowledgment of realor imaginary
dangers todevelop defenses to thesethreats

Achievement Subsystem
- involves behavior related to manipulation of the
environment to gain mastery & control over some
aspectof oneself or environment, this control
ismeasured against a standard of excellence
-includes intellectual, physical, creative,
mechanical & social skills

3 Functional Requirements of Humans

To be protected from noxious influences with which the person
cannot cope
To be nurtured through the input of supplies from the
environment
To be stimulated to enhance growth and prevent stagnation

GOAL ATTAINMENT THEORY (IMOGENE KING)

St. John's Hospital School of Nursing in St. Louis,

Missouri (1946)

>St. Louis University

- BS in Nursing Education (1948)
MS in Nursing (1957)
> Teachers College, Columbia University, New York: - EdD
(1961)
- Postdoctoral study in research design, statistics,
and computers.
Nursing Metaparadigm
PERSON
Individuals are spiritual being
have the capacity to think, know, make choices &
select alternative courses of action
have the ability through their language & other
symbols to record their history & preserve their
culture
open system in transaction with the environment
unique& holistic, are of intrinsic worth & are capable
of rational thinking & decision making in most
situations
Individuals differ in their needs, wants & goals
3

fundamental health needsof human beings

>Need for information
>Need for care for illness prevention
>Need for total care when a person doesnt have the
capacity to help themselves.
HEALTH
Is a dynamic state in the life cycle; illness is an
interference in the life cycle
Implies continuous adjustment to stress in the
internal and external environments, using personal
resources to achieve optimal daily living
ENVIRONMENT
>The process of balance involving internal & external
interactions inside the social system
>Interpreted from the general systems theory as an open
system with permeable boundaries that allow the exchange
of matter, energy, and information
-

NURSING
Is an act wherein the nurse interacts &
communicates with the client
The nurse helps the client identify the existing health
condition, exploring & agreeing on activities that
promote health
The goal of the nurse in Kingstheory is to help the
clientmaintain health through health
promotion& maintenance,restoration & caring for the
sick& dying
King's Goal Attainment Theory
>Involves the nurse and the patient mutually
communicating information, establishing goals, and
taking action to obtain goals.
>Two people who are usually strangers come
together in a health care organization to help or to be
helped to a mutual state of health.
Central focus of the theory
man as a dynamic human being whose perceptions
of objects, persons, and events influence his
behavior, social interaction, and health
three basic premises; man is:
1. A reactive being - aware of other things; persons
and events in the environment
2. A time oriented being - influenced by time
orientation. Each person is influenced by his past
actions.

3. A social being - has a continuous exchange with

persons in the environment. Language is a social link
and facilitates interpersonal communication.
3interacting system:
A.PERSONAL SYSTEM individuals, how the nurse views &
integrates self based from personal goals & beliefs
Concepts of Personal system:
a.The Individual's Perception--the person's
representation of reality and it is unique to
each individual
b. Self--The person's subjective environment, values,
ideas, attitudes, and commitment.
c. Growth and Development--involves all the changes
that occur . These change are usually
orderly and predictable, but may vary with
individuals.
d. Body Image--The way a person perceive their body
. Body image is subjective and changes as
the person changes physically or
emotionally.
e. Space--is the immediate physical territory
occupied by the person and person's
behavior.
f. Time--is the order of events and their relationship
to each other.
B.INTERPERSONAL SYSTEM - Two or more interacting
individuals.
-How the nurse interrelates with a co-worker or
patient, particularly in a nurse-patient
relationship
Concepts of Interpersonal system:
a.Interaction any situation wherein the nurse
relates & deals with a patient
b.Communication refers to the transmission of
information from one person to another; either
directly or indirectly
c.Transaction refers to the interaction between a
person & the environment for the purpose of
goal attainment
d.Role refers to the expected behaviors of a person
in a specific position & to the rules that govern
the position & affect interaction between two or
more persons
e.Stress refers to an exchange of energy, either
positive or negative between a person & the
environment; objects , persons & events can
serve as stressors
C.SOCIAL SYSTEM - Composed of larger group of individuals
with common interests or goals.
-How the nurse interacts with co-workers,
superiors, subordinates & the client
environment in general
A social system comprises the:
1.social roles
2.behaviors
3. practices
Concepts of Social System
a.Organization refers to a group of people with similar
interest who have prescribed roles & positions & who
use resources to achieve personal & organizational
goals
b.Authority refers to the observable behavior of providing
guidance & order & being responsible for actions
c.Power is characterized by the ability to use resources for
goal achievement; also a means by which one or
more persons can influence others.
d.Status refers to the position occupied by a person in a
group or the position occupied by a group in relation
to other groups in an organization; it is accomplished
by certain duties, privileges & obligations
e.Decision Making results from developing & acting on
perceived choices for goal attainment
1.
2.
3.
4.
5.
6.

6 CHARACTERISTICS OF MAN
The ability to perceive perceptions will influence
behavior and thus life and health.
The ability to think thinking is based upon the
inquiring mind of man.
The ability to feel- have emotions.
The ability to choose between alternative course of
action.
The ability to set goals.
The ability to select means of accomplishing goals.
Propositions of Kings Goal Attainment Theory

1.
2.
3.
4.
5.
6.
7.
8.

If perceptual accuracy is present In nurse-client

interactions, transactions will occur.
If nurse & client make transactions, goals will be
attained
If goals are attained, satisfactions will occur
If goals are attained, effective nursing care will occur
If transactions are made in nurse-client interactions,
growth & development will be enhanced
If role expectations & role performance as perceived
by nurse & client are congruent, transactions will
occur
If role conflict is experienced by the nurse & client or
both, stress in nurse-client interactions will occur
If nurses with special knowledge & skills
communicate appropriate information to clients,
mutual goal setting & goal attainment will occur

SELF-CARE DEFICIT THEORY (Dorothea E. Orem)

Born on 1914 in Baltimore, Maryland

Began her nursing education at Providence Hospital

School of Nursing in Washington,DC

1939 she earned her BSN education at the Catholic

University of America

1946 earned her M.S.N. from Catholic University of

America.

her nursing experiences included

a. operating room nursing,
b. private duty nursing (home & hospital),
c. hospital staff nursing on pediatric and adult
medical and surgical units,
d. evening supervisor in the E.R.
e. biological science teacher

1958-1960 curriculum consultant

1959 Guides for developing the curricula for the

Education of Practical Nurses was published
1971 Nursing Concepts of Practice which is
Orems first book was published.

Orems theory addresses clients self-care needs

It is defined as Goal-oriented activities that are set

towards generating interest in the part of the client
to maintain life & health development

The theory is aimed towards making the clients

perform self-care activities in order to live
independently
METAPARADIGM
PERSON

Defined as the patient- a being who

functions biologically, symbolically &
socially & who has the potential for learning
& development

Is an individual subject to the forces of

nature, with a capacity for self-knowledge,
who can engage in deliberate action,
interpret experiences & perform beneficial
actions

Is an individual who can learn to meet selfcare requisites; if for some reason, the
person cannot learn self-care measures,
others must provide the care
HEALTH
-Orem supports the WHOs definition of
health as the state of physical, mental,
and social well-being and not merely the
absence of disease or infirmity.
-Consists of physical, psychological,
interpersonal & social aspects; according to
Orem , these aspects are inseparable
-Includes promotion & maintenance of
health, treatment of illness & prevention of
complications
ENVIRONMENT

Consists of environmental factors,

environmental elements, environmental
conditions (external physical & psychosocial
surroundings) & 9developmental
environment (promotion of personal
development through motivation to
establish appropriate goals & to adjust
behavior to meet these goals; includes
formation of or change in attitudes & values,
creativity, self-concept & physical
development)
NURSING
-helping clients to establish or identify ways
to perform self-care activities.
-Nursing actions are geared towards the
independence of the client.

-Nursing is a human service-its focus is on

persons with inabilities to maintain
continuous provision of healthcare.
-Nursing is based on values

1.

Major Concepts & Definitions

Self Care
Self Care Requisite
Universal Self-CareRequisites
Developmental Self Care Requisites
Health Deviation Self Care Requisites
Therapeutic Self Care
Demand
Self-Care Agency
Agent
Dependent-Care Agent
Self-Care Deficit
Nursing Agency
Nursing Design
Nursing System
Helping Methods
Self-care deficit theory as a general theory is
composed of 3 related theories:
THE THEORY OF SELF-CARE
- Describes why & how people care for
themselves
Self- Care: refers to those activities an individual
performs independently throughout life to promote &
maintain personal well-being
Self- Care agency: the complex acquired ability of
mature & maturing persons to know & meet their
continuing requirements for deliberate, purposive
action to regulate their own functioning &
development
- consists of two agents: An agent
(individual who is engage in meeting the need of a
person; like bridges that facilitate what has been
done and what needs to be done)
self-care agent person who provides the self-care
Dependent care agent person other than the
individual who provides cares
Self-care requisites or Self-care needs: are insights of
actions or requirements that a person must be able
to meet and perform in order to achieve well-being.

Categories of Self-care requisites:

A.Universal Self-care requisites
- These are universally set goals that must
be undertaken in order for an individual to function in
scope of healthy living
1. Maintenance of sufficient intake of air.
2. Maintenance of sufficient intake of food.
3. Maintenance of sufficient intake of water.
4. Provision of care associated with elimination.
5. Maintenance of balance between activity and rest.
6.
Maintenance of balance between solitude and social
interaction.
7. Prevention of hazards to human life, human
functioning and human well-being;
8. Promotion of human functioning and development.
B. Developmental Self-care requisites
- result from maturation or associated with conditions
or events such as adjusting to a change in body image
or loss of a spouse
- they promote processes for life & maturation &
prevent conditions deleterious to maturation or those
that lessens those effects
C. Health deviation self-care requisites
- requisites that result from illness, injury or disease
or its treatment; they include such actions as seeking
medical assistance, carrying out a prescribed treatment
or learning to live with the effects of illness or treatment
- These health care deviations set standards to which
the degree of self-care demand is needed.

2.
3.
4.
5.

THEORY OF NURSINGSYSTEMS
- describes and explains relationships that must be brought
about & maintained for nursing to be produced
- refers to the series of actions a nurse takes to meet a
patients self-care requisites
Nursing Agency: set of established capabilities of a nurse who
can legitimately perform activities of care for a client.
- Helps a person achieve their health care demand.
Nursing Design: these are professional functions that must be
performed by the nurse in order to meet clients needs
- it serves as a guideline of needed & foreseen
results in the production of nursing toward the achievement
of nursing goals
3 Types of Nursing Systems:
1. A wholly compensatory nursing system
- is used when a patients self-care agency is so
limited that the patient depends on others for well-being
2. A partly compensatory nursing system
- is used when a patient can meet some self-care
requisites but needs a nurse to help meet others
- the nurse & the patient play major roles in
performing self-care
3. Supportive Educative Nursing System
- is used when a patient can meet self-care
requisites but needs assistance with decision
making, behavior control or knowledge acquisition
skills
Major Assumptions
1. Human beings require continuous, deliberate inputs
to themselves and their environments to remain alive
and function in accordance with natural human
endowments.
2. Human agency, the power to act deliberately, is
exercised in the form of care for self and others in
identifying needs and making needed inputs.
3. Mature human beings experience privations in the
form of limitations for action in care for self and
others involving and making of life sustaining and
function-regulating inputs.
4. Human agency is exercised in discovering,
developing, and transmitting ways and means to
identify needs and make inputs to self and others.
5. Groups of human beings with structured relationship
cluster tasks and allocate responsibilities for
providing care to group members who experience
privations for making required, deliberate input to
self and others.
Acceptance by the Nursing Community

Practice - The first documented use of Orems theory

as the basis for structuring practice is found in
descriptions of nurse-managed clinics at John
Hopkins Hospital in 1973.
Research articles on the use of SCDNT or components in
clinical practice include
a. Teaching self-care to individuals with DM,ESRD,
hemodialysis, peritoneal dialysis, renal transplant
b. Pain assessment
c. Cardiac research
d. Oncology focus cancer prevention, self-care after
being diagnosed with malignancies.
e. Psychiatry etc..

Education - Guides for Developing Curriculum for

the Education of Practical Nurses
Orem worked on a bookFoundations of
Nursing Practice

Therapeutic Self-Care Demand

Refers to all self-care activities required to meet

existing self-care requisites
Involves the use of actions to maintain health & wellbeing, each patients therapeutic self-care demands
varies throughout life.

THE THEORY OF SELF-CARE DEFICIT

- which describes & explains why people can be
helped through nursing
Self-care deficit: arises when the self-care agency cannot
meet self-care requisites
Helping Methods:
1. Acting or doing for another

Guiding and directing

Providing physical or psychological support
Teaching
Providing and maintaining an environment that
supports personal development

Research - First instrument to measure the exercise

of Self-care agency (ESCA) was published in 1979

ADAPTATION MODEL (Sr. CallistaRoy)

born on October 14, 1939 in Los Angeles California
She is a nurse theorist and a professor
She is a fellow in the American Academy of Nursing,
an honorary nursing society that elects nursing
leaders annually
Has numerous publications, including books & journal
articles on nursing theory & other professional topics
METAPARADIGM
PERSON

Is the recipient of nursing care; main focus

of nursing

A biopsychosocial being in constant

interaction with a changing environment.

The person is an open adaptive system who

uses coping skills to deal with stressors.

It includes people as individuals or in groups

(families, organizations, communities,
nations & society as a whole)

An adaptive system has cognator and

regulator subsystems to maintain the 4
adaptive modes.
ENVIRONMENT

Conditions, circumstances and influences

that surround and affect the development
and behavior of the person.

Consists of internal & external

environments, which provide input in the
form of stimuli

Stressors are stimuli that are significant in

human adaptation: stages of development,
family & culture
HEALTH

Was originally described by Roy as a healthillness continuum; health & illness were
considered an inevitable dimension of the
persons life

More recently, Health is the process of being

and becoming an integrated and whole
person.

Is it a reflection of adaptation that is the

interaction of the person & the environment

Adaptation is defined as the process and

outcome whereby thinking and feeling, as
individuals and groups, use conscious
awareness and choice to create human and
environmental integration.
NURSING

Nursing is the science and practice that

expands adaptive abilities and enhances
person and environment transformation.

Roys goal of nursing is the promotion of

adaptation in each of the 4 modes thus
contributing to health, quality of life and
dying with dignity

Nursing is about the increase,

enhancement, modification and alteration of
the stimulus to achieve adaptation.

THE KEY CONCEPTS:

The person is adapting in a stable interaction
with the environment, either internal or external.
The environment serves as the source of a range
of stimuli that will either threaten or promote the
persons unique wholeness.
The persons major task is to maintain integrity
in face of these stimuli.
INTEGRITY - the degree of wholeness
achieved by adapting to changes in
needs.
SYSTEM is a set of parts connected to function
as a whole for some purpose & that does so by
virtue of the interdependence of its parts
- Roy considers the recipient of care to be
an open adaptive system
- react & interact with other systems in the
environment
- have boundaries that are flexible & open to
permit interaction with other systems
- employ a feedback cycle of input,
throughput & output
Input defined as stimuli which can come
from the environment or from within a
person
Throughput makes use of a persons
processes & effectors
Processes refer to the control
mechanisms that a person uses as
an adaptive system
Effectors refer to the physiologic
function, self-concept & role
function involves in adaptation
Output is the outcome of the system,
when the system is a person, the
output refers to the persons
behaviors
Categories of Output:

Adaptive responses those that promote

integrity in terms of the goals of the human
system
Ineffective responses those that do not
contribute to integrity in terms of the goals
of the human system
The three types of stimuli act together and influence the
adaptation level which is defined as the ability to respond
positively in a situation.
a. FOCAL the internal or external stimulus most
immediately confronting the person, it attracts
the most attention.
b. CONTEXTUAL all other stimuli present in the
situation that strengthens/contribute the effect
of the focal stimulus.
c. RESIDUAL - those stimuli that can affect the
focal stimulus but the effects are unclear.

COPING MECHANISM AND CONTROL PROCESSESS

Coping mechanism are the processes that a person uses for
self-control
- are innate or acquired ways of interacting with the
changing environment
- innate coping mechanisms are genetically
determined or common to the species & are
genetically viewed as automatic process
-acquired coping mechanisms are developed through
strategies such as learning
REGULATOR SUBSYSTEM - major coping process
involving the neural, chemical, and endocrine system

COGNATOR SUBSYSTEM is a major coping process

involving four cognitive-emotive channels:
perceptual & information processing; learning;
judgment & emotion

CONTROL PROCESSES stabilizer subsystem &

innovator subsystem
Stabilizer subsystem analogous to
regulator : concerned with stability
Innovator subsystem analogous to
cognator:: concerned with creativity, change
& growth
ADAPTATION LEVEL
1. Integrated - Adaptation level at which the structures and
functions of a life process are working as a whole to meet
human needs.
2. Compensatory - Adaptation level at which the cognator and
regulator have been activated by a challenge to the
integrated life processes
3. Compromised- Adaptation level resulting from inadequate
integrated and compensatory life processes; adaptation
problem.

level

ADAPTIVE MODES are categories of behavior to

adapt to stimuli
- can be used to determine a persons adaptation
- can be used to identify adaptive or ineffective
responses by observing a persons behavior in
relation to the adaptive modes

1. PHYSIOLOGICAL the way a person responds as a physical

being to stimuli from the environment.

GOAL: Physiological Integrity

Five Physiologic Needs: oxygenation,

nutrition, activity & rest & protection

Four Complex Processes: senses; fluids,

electrolytes & acid-base balance; neurologic
function; endocrine function
2. SELF-CONCEPT GROUP IDENTITY MODE - focuses
specifically on the psychological & spiritual aspects of the
human system
Self- concept defined as the composite of beliefs &
feelings about oneself at a given time & is formed
from internal perceptions of others reaction
Two components:
1. physical self (body sensation and body
image)
2. personal self (self consistency, self ideal,
and moral ethical spiritual self)
Group Identity reflects how people in groups
perceive themselves based on environmental
feedback
- comprised of interpersonal relationships,
group self-image & culture
GOAL: Psychological Integrity

3. ROLE FUNCTION MODE a role is a set of expectations

about how a person occupying ones position behaves.
GOAL: Social Integrity
- Roles are carried out with both
instrumental behaviors (the actual physical
performance of a behavior) and expressive behaviors
( are the feelings, attitudes, likes or dislikes that a
person has about a role or about the performance of
a role)
Persons perform primary, secondary & tertiary roles
Primary determines the majority of behavior
engaged in by the person during a particular period
of life
Secondary are those that a person assumes to
complete the task associated with a developmental
stage & primary role
Tertiary related primarily to secondary roles &
represent ways in which individuals meet their role
associated obligations
- temporary in nature, freely chosen by the
individual
4. INTERDEPENDENCE MODE focuses on close relationships
which results to giving & receiving of love, respect, value,
nurturing, knowledge, skills, commitments, material
possessions, time & talents
- Occurs between the person and the most
significant other or between the person and the
support system.
GOAL: Affectional Adequacy.
POINTS TO REMEMBER

Adaptive or ineffective responses result from the 4

modes of coping mechanisms.
Adaptive responses support the integrity of the
person and the goals of adaptation.
Ineffective responses neither promote integrity nor
contribute to the goals of adaptation.

NURSING PROCESS
A problem-solving approach for gathering data,
identifying the capacities and needs of the human
adaptive system, selecting and implementing
approaches for nursing care, and evaluation of the
outcome of care provided.
6
STEPS in the NURSING PROCESS
1. ASSESSMENT OF BEHAVIOR
Data gathering about the behavior of the person as
an adaptive system in each of the adaptive modes.
Observable behavior: vital signs
Non-observable behavior: feelings
experienced by the person (anxiety)
2. ASSESSMENT OF STIMULI
A STIMULUS is defined as any change in the internal
and external environment that induces a response in
the adaptive system. It is classified as focal,
contextual or residual.
In this level of assessment, the nurse analyzes the
subjective and objective behaviors and look more
deeply for possible causes of a particular set of
behaviors.
3. NURSING DIAGNOSIS
Formulation of statements that interpret data about
the adaptation on status of the person, including the
behavior and the most relevant stimuli.
4. GOAL SETTING
Establishment of clear statements of the behavioral
outcomes for nursing care which is realistic and
attainable. This is done together with the client.
5. INTERVENTION
Determination of how best to assist the person in
attaining the established goals.
6. EVALUATION
Judging the effectiveness of the nursing intervention
in relation to the behavior after it was performed in
comparison with the goal established.