Nursing Theorist

Theoretical Foundations of Nursing
Compilation of Nursing Theorist and Their Work
Prepared by: Venice Joy T. Malonzo, RN
VIRGINIA A. HENDERSON
Definition of Nursing
Theoretical Foundations of Nursing Theorist/Theory/ Conceptual Framework Major concepts Sub Concepts Assumptions Strengths and Weaknesses
Analysis The Theory of Virginia Henderson is very simple and easy to understand. And it opens the door for other nursing theorist to improve her theory. Hendersons definitions of nursing try to explain the acceptable nursing behavior or the focus of nursing, the patient.
The Nightingale of Modern Nursing Modern-Day Mother of Nursing. "The 20th century Florence Nightingale." "little Miss 3x5" Born in Kansas City, Missouri, in 1897 and is the 5th child of a family of 8th children but spent her formative years in Virginia Received a Diploma in Nursing from the Army School of Nursing at Walter Reed
Human The theory presents the patient as a sum of parts with biopsychosocial needs, and the patient is neither client nor consumer. Environment Settings in which an individual learns unique pattern for living. Health Definition based on individuals ability to function independently as outlined in the 14 components. Nursing Henderson's classic definition of nursing: "I say that the nurse does for
14 Basic Needs

Breathe normally. Eat and drink adequately. Eliminate body wastes. Move and maintain desirable postures. Sleep and rest. Select suitable clothes-dress and undress. Maintain body temperature within normal range by adjusting clothing and modifying environment Keep the body clean and well groomed and protect the integument Avoid dangers in the environment and avoid injuring others. Communicate with others in expressing emotions, needs, fears, or opinions. Worship according
Nurses care for patients until patient can care for themselves once again. Patients desire to return to health, but this assumption is not explicitly stated. Nurses are willing to serve and that nurses will devote themselves to the patient day and night A final assumption is that nurses should be educated at the university level in both arts and sciences.
Strengths Her work can be applied to the health of individuals of all ages. Theories can be the bases for hypotheses that can be tested. Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. Weaknesses
Lack of conceptual linkage between physiological and other human characteristics. No concept of
Hospital, Washington, D.C. in 1921.
others what they would do for themselves if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible."
to ones faith. Work in such a way that there is a sense of accomplishment. Play or participate in various forms of recreation. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.
the holistic nature of human being.
Lacks interrelate of factors and the influence of nursing care. Peaceful death is curious and significant nursing role
CONCEPTUAL MODEL
14 Basic Needs

Breathe normally. Eat and drink adequately. Eliminate body wastes. Move and maintain desirable postures. Sleep and rest. Select suitable clothes-dress and undress. Maintain body temperature within normal range by adjusting clothing and modifying environment Keep the body clean and well groomed and protect the integument Avoid dangers in the environment and avoid injuring others. Communicate with others in expressing emotions, needs, fears, or opinions. Worship according to ones faith. Work in such a way that there is a sense of accomplishment. Play or participate in various forms of recreation. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities
HEALTH
DOROTHEA E. OREM
Self Care Deficit Theory of Nursing
Theoretical Foundations of Nursing Theorist/Theory/ Conceptual Framework Major concepts Sub Concepts Assumptions Strengths and Weaknesses Analysis
One of Americas foremost nursing theorists. Dorothea Orem earned her Bachelor of science in nursing education in 1939 and Master of science in nursing in 1945 During her profession al career ,she worked as a staff nurse ,private duty nurse ,nurse educator and administrat or and nurse
Human Has the capacity to reflect, symbolize and use symbols. Environment environnent components are environmental factors ,environmental elements, conditions ,and developmental environment
Theory of Self Care Self care practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being Self care agency is a human ability which is "the ability for engaging in self care"
Therapeutic self care demand "totality of self care actions to be performed for some duration in order to Health meet self care requisites by using health and healthy valid methods and are terms used to related sets of describe living operations and things it is actions" when they are structurally and Self care requisitesfunctionally whole action directed towards or sound provision of self care wholeness or 3 categories of self integrity. .includes care requisites are:-that which makes Universal a person human,operatin Developmental g in conjunction Health deviation with physiological
Human beings require continuous, deliberate inputs to themselves and their environments to remain alive and function in accordance with natural human endowments. 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. 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 functioning regulating inputs. Human agency is exercised in
Strengths Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of nursing practice nursing curricula ,nursing education administration ,and nursing research Specifies when nursing is needed Also includes continuing education as part of the professional component of nursing education Weaknesses
The theory of Orem is quite hard to understand because she uses many concepts and her definitions are unique but in some books it stated that the terms Orems uses are precisely defined and congruent with other discipline. I guess what it makes it difficult to understand is that the readers like me lack familiarity with practical science and the filed of action of science just as stated by Alligood p.200
The theory is limited only for adult, who are capable of performing self In general system care. theory a system is viewed as a Lastly, The theory single whole is illness oriented
consultant Received honorary Doctor of Science degree in 1976 Dorothea Orem as a member of a curriculum subcommit tee at Catholic University, recognized the need to continue in developing a conceptual ization of nursing.
and psychophysiologic al mechanisms and a material structure and in relation to and interacting with other human beings Nursing is art, a helping service, and a technology
Theory of self care deficit Specifies when nursing is needed Nursing is required when an adult (or in the case of a dependent ,the parent) is incapable or limited in the provision of continuous effective self care Theory of Nursing Systems
Describes how the patients self care needs will be met by the nurse , the patient, or both Identifies 3 classifications of nursing system to meet the self care requisites of the patient: Wholly compensatory system Partly compensatory system Supportive educative system
discovering, developing, and transmitting ways and means to identify needs and make inputs to self and others. 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.
thing while Orem defines a system as a single whole thing Health is often viewed as dynamic and ever changing .Orems visual presentation of the boxed nursing systems implies three static conditions of health Appears that the theory is illness oriented rather with no indication of its use in wellness settings
rather than health.
CONCEPTUAL MODEL
Self Care
R Self Care Agency
R R
Self Care Demand
Deficit
R R
Nursing Agency
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NOLA J. PENDER
The Health Promotion Model
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Nola J. Pender was born in 1941 in Lansing, Michigan She studied and took her masters degree at Michigan State University, East Lansing, Michigan, from 19621964.
Individual Characteristics and Experience It affect subsequent health action Behavior Specific Cognition and Affect These are considered major motivational significance and modifiable through nursing actions.
Prior related behavior: Frequency of the similar behaviour in the past. Direct and indirect effects on the likelihood of engaging in health promoting behaviors. Personal factors: Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behavior being considered. Personal biological factors Personal psychological factors Personal socio-
Persons seek to create conditions of living through which they can express their unique human health potential. Persons have the capacity for reflective selfawareness, including assessment of their own competencies. Persons value growth in directions viewed as positive and attempts to achieve a personally acceptable balance between change and stability. Individuals seek to actively regulate their own behavior. Individuals in all their
STRENGTHS Gave sense or good logic to health professionals nature of work, it encouraged nurses to become actively involved Reduced the increasing number of morbidity /mortality rates Helped people restructure their cognitive world and their health behaviors in developing skills and confidence in caring for themselves
She had her PhD at Northwestern Behavioral University, Outcome Evanston, Illinois, 1969. At present Dr. These are Pender is the immediate Professor antecedents of Emeritus in behavior or the School of behavioral Nursing at outcomes. A the University behavioral event of Michigan. is initiated by a
The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have important motivational significance. These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the end point in the HPM. Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development. The final
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commitment to action unless there is demand that cannot be avoided or a competing preference that cannot be resisted.
cultural factors Perceived benefits of action: Anticipated positive out comes that will occur from health behavior. Perceived barriers to action: Anticipated, imagined or real blocks and personal costs of understanding a given behavior. Perceived self efficacy: Judgment of personal capability to organize and execute a health-promoting behavior. Activity related affect: Subjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behavior itself. Interpersonal influences: Cognition concerning behaviours, beliefs, or attitudes of
biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time. Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan. Self-initiated reconfiguration of personenvironment interactive patterns is essential to behavior change.
WEAKNESS
behavioral demand is also influenced This theory is by the immediate limited to competing demand individual and preferences, where in we which can derail an can use it to a intended health set promoting actions. community and Globally Some biological and psychological factors are now modifiable.
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the others. Interpersonal influences Situational influences: Personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. Commitment to plan of action: The concept of intention and identification of a planned strategy leads to implementation of health behavior Immediate competing demands and preferences: Competing demands are those alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Health promoting
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behavior: Endpoint or action outcome directed toward attaining positive health outcome such as optimal well-being, personal fulfillment, and productive living.
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CONCEPTUAL MODEL
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MYRA ESTRIN LEVINE

The Conservation Model
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Born in Chicago in 1920, raised with a sister and a brother with whom she shared a close loving relationship Also very fond of her father who was often ill and frequently hospitalized with GI problem. This was the reason why she choose nursing as her lifelong career. Also called as renaissance women. Fearless, highly principled woman. Committed to patients quality of
Wholeness
Exist when the interaction or constant adaptations to the environment permits the assurance of integrity Promoted by use of conservation principle Every individual has a unique range of adaptive responses The responses will vary by heredity, age, gender or challenges of illness experiences Example: The response to weakness of cardiac muscle is an increased
Environment: Completes the wholeness of person. Internal Environment
Adaptation
Homeostasis: A state of energy sparing that also provide the necessary baselines for a multitude of synchronized physiological and psychological factors

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
A state of conservation Homeorrhesis: A stabilized flow rather than a static state

Strengths The concept of illness adaptation, using interventions, and the evaluation of nursing interventions are interrelated .they are combined to look at nursing care in a different way (more comprehensiv e view incorporating total patient care) form previous time.
Emphasis the fluidity of change within a spacetime continuum
Describe the pattern of adaptation, which permit the individuals body
Levines idea about nursing care are organized in such a way as to b sequential and logical. they can be
Levines model possesses clarity; it is consistent internally and externally. Levine uses numerous terms but she was able to define it adequately. The model provides nursing with a logically congruent and holistic view of the person. Conservational model has been used for nursing practice in different settings. Example of this is, conservation model for guiding the nursing care of homeless at a clinic, shelters or streets. (http://currentnursi ng.com/nursing_th eory/Levin_four_co nservation_principl es.htm)
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care Remarkable, articulate with no hesitations. Died on 1996 at 73 years.
heart rate, dilation of ventricle and thickening of myocardial muscle While the responses are same, the timing and manifestation of organismic responses will be unique for each individual pulse rate) An ongoing process of change in which patient maintains his integrity within the realities of environment Achieved through the "frugal, economic, contained and controlled use of environmental resources by individual in his or her best interest"
to sustain its well being with the vast changes which encroach upon it from the environment External Environment
through such strategists raising questions
Preconceptual: Aspect of the world that individual are able to intercept
Operational: Elements that may physically affects individuals but not perceived by hem: radiation, micro-organism and pollution
Conceptual: Part of person's environment including cultural patterns characterized by spiritual existence, ideas, values, beliefs and tradition Organismic response: A change in behavior of an
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 ones life experience which creates a
used to explain the consequences of nursing action Its major elements are easily comprehensib le and the relation ship have the potential for being complex but are easily manageable The principle of conservation are specific enough to be testable Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them.
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Conservation

The product of adaptation "Keeping together "of the life systems or the wholeness of the individual Achieving a balance of energy supply and demand that is with in the unique biological realities of the individual A holistic being who constantly strives to preserve wholeness and integrity A unique individual in unity and integrity, feeling, believing, thinking and whole system of system Health is a wholeness and
individual during an attempt to adapt to the environment Help individual to protect and maintain their integrity They co-exist They are four types 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 4. Perceptual: Involves gathering information from the environment and converting it in to a
unique message
Person
Health
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
Theories can be utilized by the practitioner to guide and improve their practice. Levines ideas seem to be consistent with other theories, laws and principles particularly those from the humanities and sciences Weaknesses
Certain isolated aspect of the theory are the generalizable i.e. those related to the conservational principles Since Levines idea have not yet been widely researched ,it is hard o determine the contribution to
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successful adaptation It is not merely healing of an afflicted part ,it is return to daily activities, selfhood and the ability of the individual to pursue once more his or her own interest without constraints Disease: It is unregulated and undisciplined change and must be stopped or death will ensue "nursing is a profession as well as an academic discipline, always practiced and studied in concert with all of the disciplines that together from the health sciences"
meaning experience Conservation principles: The goals of the conservation model are achieved through interventions that attend to the conservation principles. Conservation of energy: Refers to balancing energy input and output to avoid excessive fatigue Conservation of structural integrity: Refers to maintaining or restoring the structure of body preventing physical breakdown And promoting healing Conservation of personal integrity: Recognizes the individual as one who strives for recognition,
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
Nursing
the general body of knowledge with Limited attention can be focused on health promotion and illness prevention. 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 dont match, this mismatch will be an area of conflict. The major limitation is the focus on individual in an illness
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The human interaction relying on communication ,rooted in the organic dependency of the individual human being in his relationships with other human beings Nursing involves engaging in "human interactions"
respect, self awareness, selfhood and self determination Conservation of social integrity: An 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
state and on the dependency of patient.
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CONCEPTUAL MODEL
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SISTER CALLISTA ROY

Adaptation Model
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Sr.Callista Roy, a prominent nurse theorist, writer, lecturer, researcher and teacher Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los Angeles in
Adaptation
Responding positively to environmental changes The process and outcome of individuals and groups who use conscious awareness, self reflection and choice to create human and environmental integration Bio-psycho-social being in constant interaction with a changing environment Uses innate and acquired mechanisms to adapt An adaptive system described as a whole comprised of parts
Cognator subsystem : A major coping process involving 4 cognitiveemotive channels: perceptual and information processing, learning, judgment and emotion. Regulator subsystem: a basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels Physiological Physical Mode: it is associated with the physical ad chemical processes involved in the function and activities of living organism.
Explicit assumptions
Strengths
The person is a bio-psycho-social being. The person is in constant interaction with a changing environment. To cope with a changing world, person uses both innate and acquired mechanisms which are biological, psychological and social in origin. Health and illness are inevitable dimensions of the persons life. To respond positively to environmental changes ,the person must adapt. The persons
Scientific knowledge for practice Clinical assessment and intervention Research variables To guide nursing practice To organize nursing education Curricular frame work for various nursing colleges BBARNS (1999) reported that 163 studies have been conducted using this model. RAM is complete and comprehensive It explains the reality of client, so nursing
Sis. Callista Roy Adaptation model provides a well articulated conception of man as a nursing client and of nursing as an external regulatory mechanism. Her conception of person and of nursing process contributes to the science and art of nursing.
Person
Self Concept group Identity Mode: it is one of the three psychosocial modes and it focuses specially on the psychological and
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1963.
a master's degree Includes people program in as individuals or pediatric in groups-families, nursing at the organizations, University of communities, and California society as a whole ,Los Angeles in 1966. Environment She also earned a masters and PhD in Sociology in 1973 and 1977 ,respectively.
Functions as a unity for some purpose
spiritual aspects of the human system. Role Function Mode: is one of two social modes and focuses on the roles the person occupies in society. Interdependence Mode: focuses on close relationship of people and their purpose, structure and development.
adaptation is a function of the stimulus he is exposed to and his adaptation level
Sr. Callista had the significant opportunity of working with Dorothy E. Johnson
Focal - internal or external and immediately confronting the person Contextual- all stimuli present in the situation that contribute to effect of focal stimulus Residual-a factor whose effects in the current situation are unclear All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with
The persons adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response. The person has 4 modes of adaptation: physiologic needs, selfconcept, role function and interdependence. "Nursing accepts the humanistic approach of valuing other persons opinions, and view points" Interpersonal relations are an integral part of nursing There is a dynamic objective
interventions can be specifically targeted. Middle range theories have been derived from RAM
Weaknesses The model has several major concepts and sub concepts; therefore it has numerous relational statements and is complex. Development of definitions is inadequate related to her original format
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particular consideration of mutuality of person and earth resources, including focal, contextual and residual stimuli Health
for existence with ultimate goal of achieving dignity and integrity Implicit assumptions
Inevitable dimension of person's life Represented by a health-illness continuum A state and a process of being and becoming integrated and whole To promote adaptation in the four adaptive modes To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by
A person can be reduced to parts for study and care. Nursing is based on causality. Patients values and opinions are to be considered and respected. A state of adaptation frees an individuals energy to respond to other stimuli.
Nursing
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assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions
CONCEPTUAL MODEL
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INPUT
Control Processes
Effectors
OUTPUT
Stimuli Adaptation Level
Coping Mechanism Regulator Cognator
Physiological function Self Concept Role function
Adaptive and Ineffective Response
Feedback
Person as an adaptive system
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HILDEGARD E. PEPLAU
Psychodynamic Nursing
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Born in Reading, Pennsylvania [1909] Graduated from a diploma program in Pottstown, Pennsylvania in 1931. Done BA in interpersonal psychology from Bennington College in 1943. MA in psychiatric nursing from Colombia University New York in 1947. EdD in curriculum development in 1953.
MAN an organism that lives in an unstable equilibrium. HEALTH a word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living. ENVIRONMENT existing forces outside the organism and in the context of culture.
1. The kind of person that the nurse becomes make a Understanding of substantial ones own behavior difference in what To help others identify each patient will felt difficulties learn as he or she receives nursing To apply principles of care. human relations to the problems that arise at all levels of experience Psychodynamic nursing
STRENGTHS Interpersonal relations between patient and nurse , is easily understood.
In her book she discussed the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process. According to Peplau, nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care. Nursing is an interpersonal process because it involves interaction between
2. Fostering personality development toward maturity is a function of nursing and nursing education. Nursing uses principles and methods that guide the process toward resolution of interpersonal problems
Peplau believed that her theory of interpersonal relationship met the criteria of generality. She felt that nurses can apply this principles in any area of their lives
With the help of the theory of interpersonal relations, the client's needs could be assessed. It helped her to achieve them within her limits. This theory application helped in providing comprehensive care to the client
WEAKNESS
Professor emeritus from NURSING
Intra family dynamics, personal space considerations and community social service
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Rutgers university
Started first post baccalaureat e program in nursing Published Interpersonal Relations in Nursing in 1952 1968 :interpersonal techniquesthe crux of psychiatric nursing Worked as executive director and president of ANA. Worked with W.H.O, NIMH and nurse corps. Died in 1999.
a significant, therapeutic, interpersonal process. It functions comparatively with other human processes that make health possible for individuals in communities. an educative instrument, a maturing force that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal, and community living.
two or more individuals with a common goal.
The attainment of goal is achieved through the use of a series of steps following a series of pattern. The nurse and patient work together so both become mature and knowledgeable in the process.
ROLES OF NURSE
Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. Teacher: who imparts knowledge in reference to a need or interest Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation
resources are considered less Health promotion and maintenance were less emphasized Cannot be used in a patient who doesnt have a felt need eg. With drawn patients, unconscious patients some areas are not specific enough to generate hypothesis
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Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way
Additional Roles include: 1. Technical expert 2. Consultant 3. Health teacher 4. Tutor 5. Socializing agent 6. Safety agent
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7. Manager of environment 8. Mediator 9. Administrator 10. Recorder observer 11. Researcher
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CONCEPTUAL MODEL
On admission
IDENTIFICATION
During intensive treatment period
ORIENTATION
Discharge
RESOLUTION
Convalescence and rehabilitation
EXPLOITTAION
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IDA JEAN ORLANDO PELLETIER

Nursing Process Theory
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a firstgeneration American of Italian descent was born in 1926. She received her nursing diploma from New York Medical College, her BS in public health nursing from St. John's University, NY, and her MA in mental health nursing from Columbia University, New York.
Nursing
Nursing process
Is responsive to individuals who suffer or anticipate a sense of helplessness Process of care in an immediate experience for avoiding, relieving, diminishing or curing the individuals sense of helplessness Finding out meeting the patients immediate need for help Professional nursing is conceptualized as finding out and meeting the clients immediate need for help.
The behavior of the patient, the reaction of the nurse and the nursing actions which are assigned for the patients benefit
Goal of nursing
Increased sense of well being, increase in ability, and adequacy in better care of self and improvement in patients behavior.
Need

Health
Sense of adequacy or well being. Fulfilled needs.
Defined as a requirement of the patient which, if supplied, relieves or diminishes his immediate distresses and improves his immediate sense of adequacy or well being.
When patients cannot cope with their needs without help, they become distressed with feelings of helplessness Nursing , in its professional character , does add to the distress of the patient Patients are unique and individual in their responses Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child Nursing deals with people, environment and health Patient need help in communicating needs, they are uncomfortable and ambivalent about dependency needs. Human beings are
STRENGTHS
Use of her theory assures that patient will be treated as individuals and that they will have active and constant input into their own care Prevents inaccurate diagnosis or ineffective plans because the nurse has to constantly explore her reactions with the patient Assertion of nursings independence as a profession and her belief that this independence must be based on a sound theoretical
Orlando's theory remains one the of the most effective practice theories available. The use of her theory keeps the nurse's focus on the patient. While providing the overall framework for nursing, the use of her theory does not exclude nurses from using other theories while caring for the patient.
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Sense of comfort. Nursing client
Man/ Human being

Developmental beings with needs, individuals have their own subjective perceptions and feelings that may not be observable directly. Environment
Patients who are under medical care and who cannot deal with their needs or who cannot carry out medical treatment alone.
Nursing problem
Not defined directly but implicitly in the immediate context for a patient
Distress due to unmet needs due to physical limitations, adverse reactions to the setting or experiences which prevent the patient from communicating his needs.
Nurse patient relations Central in theory and not differentiated from nursing therapeutics or nursing process.
able to be secretive or explicit about their needs, perceptions, thoughts and feelings The nurse patient situation is dynamic, actions and reactions are influenced by both nurse and patient. Human beings attach meanings to situations and actions that are not apparent to others Patients entry into nursing care is through medicine The patient cannot state the nature and meaning of his distress for his need without the nurses help or without her first having established a helpful relationship with him Any observation shared and observed with the patient is immediately useful
frame work
Guides the nurse to evaluate her care in terms of objectively observable patient outcomes Make evaluation a less time consuming and more deliberate function, the results of which would be documented in patients charts Nursing can pursue Orlando's work for retesting and further developing her work
WEAKNESS
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Nursing therapeutics
Disciplined and professional activities automatic activities plus matching of verbal and nonverbal responses, validation of perceptions, matching of thoughts and feelings with action. Direct function initiates a process of helping the patient express the specific meaning of his behavior in order to ascertain his distress and helps the patient explore the distress in order to ascertain the help he requires so that his distress may be relieved. Indirect function calling for help of others, whatever help the patient may require for his need to be met. Automatic activities perception by five senses, automatic
in ascertaining and meeting his need or finding out that he is not in need at that time Nurses are concerned with needs that patients cannot meet on their own.
Lack of operational definitions for concepts and limits the development of research hypothesis. Focus on short term care, particularly aware and conscious individuals and on the virtual absence of reference group or family members. Highly interactive nature of Orlando's theory makes it hard to include the highly technical and physical care that nurses give in certain settings. Her theory struggles with the authority derived from the function of profession and that of the employing
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thoughts, automatic feeling, and action.
institutions commitment to the public.
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CONCEPTUAL MODEL
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IMOGENE KING
Interacting System Framework and Theory of Goal Attainment
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Born in 1923 Completed her Bachelor in science of nursing from St. Louis University in 1948 Completed her Master of science in nursing from St. Louis University in 1957 Completed her Doctorate from Teachers college, Columbia University Imogene King completed her diploma nursing education in 1945, at St. John's
Person: is social being who are rational and sentient. Person has ability to :

Open Systems Framework Open system is the absence of boundary existense, where a dynamic interaction between the internal and external environment can exchange information without barriers or hindrances.
Explicit Assumptions : The central focus of nursing is the interaction of human beings and environment, with the goal being health for human beings. Individuals are social, sentient, rational, reacting, perceiving, controlling, purposeful, action-oriented, and timeoriented beings. The interaction process is influenced by perceptions, goals, needs, and values of both the client and the nurse. Human beings
STRENGTHS Maintains her definitions clear and conceptually derived from research Promotion of health, prevention of illness and restoration of health are emphasized The right of the patient to self determination is addressed. Nurse-Patient relationship is improved. Kings theory is amenable to utilization in nursing education as a basis for earning, on significant phase and component of
perceive think feel choose set goals select means to achieve goals and to make decision
According to King, human being has three fundamental needs: (a) The need for the health information that is unable at the time when it is needed and
PERSONAL SYSTEMS are individuals, who are regarded as rational, sentient, social beings. The personal system processes selective inputs from the environment through the senses. Concepts related to the personal system are perception, self, growth and development, body image, time, and space.
Kings theory offers insight into nurses interactions with individuals and groups within the environment. It highlights the importance of clients participation in decision that influences care and focuses on both the process of nurse-client interaction and the outcomes of care.
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Hospital in St. Louis, Missouri 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 Chicago
can be used (b) The need for care that seek to prevent illness, and (c) The need for care when human beings are unable to help themselves. Health: According to King, health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living
PERCEPTION is a process or organizing, interpreting, and transforming information from sense data and memory that gives meaning to one's experience, represents one's image of reality, and influences one's behavior. SELF is a composite of thoughts and feelings which constitute a person's awareness of individual existence, of who and what he or she is. GROWTH AND DEVELOPMENT include cellular, molecular, and behavioral changes in human beings and are a function of genetic endowment, meaningful and satisfying experiences, and an environment conducive to helping individuals move
as patients have rights to obtain information, to participate in decisions that may influence their life, health, and community services, and to accept or reject care. It is the responsibility of health care members to inform the individuals of all aspects of health care to help them in making informed decisions. Incongruities may exist between the goals of health care givers and recipients. Persons have the right to either accept or reject any aspect of health care.
the nursing process.
WEAKNESSES
Limited application in areas of nursing in which patients are unable to competently interact with the nurse. It is not clear how the theory could be utilized with groups. Utilizing transactions with groups of individuals who had different goals is not addressed by King.
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Environment Environment is the background for human interactions. It involves: (a) Internal environment: transforms energy to enable person to adjust to continuous external environmental changes. (b) External environment: involves formal and informal organizations. Nurse is a part of the patients environment. Nursing Nursing: is defined as A process of action, reaction and interaction by which nurse and client share
toward maturity. BODY IMAGE is a person's perceptions of his or her own body.
Implicit Assumptions: Patients want to participate actively in the care process. Patients are conscious, active, and cognitively capable to participate in decision making.
TIME is the duration between the occurrence of one event and the occurrence of another event. SPACE exits in all directions and is the physical area called territory. INTERPERSONAL SYSTEMS are composed of two, three, or more individuals interacting in a given situation. The concepts associated with this system are interaction, communication, transaction, role, and stress. INTERACTIONS are the acts of two or more persons in mutual presence. The process of
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information about their perception in nursing situation. and a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals.
interactions between two or more individuals represents a sequence of verbal and nonverbal behaviors that are goal directed. COMMUNICATION is the vehicle by which human relations are developed and maintained. This concept encompasses intrapersonal and interpersonal communication, as well as verbal and nonverbal communication. TRANSACTION is a process of interaction in which human beings communicate with the environment to achieve goals that are valued. Transactions are goaldirected human behaviors. ROLE is a set of behaviors expected when occupying a position in a social system. STRESS is a dynamic
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state whereby a human being interacts with the environment to maintain balance for growth, development, and performance, which involves an exchange of energy and information between the person and the environment for regulation and control of stressors. SOCIAL SYSTEMS are organized boundary systems of social roles, behaviors, and practices developed to maintain values and the mechanisms to regulate the practices and rules. The concepts related to social systems are organization, authority, power, status, and decision-making. ORGANIZATION is composed of human beings with prescribed roles and positions who use resources to accomplish personal and organizational
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goals. AUTHORITY is a transactional process characterized by active, reciprocal relations in which members' values, backgrounds, and perceptions play a role in defining, validating, and accepting the authority of individuals within an organization. POWER is the process whereby one or more persons influence other persons in a situation. STATUS is the position of an individual in a group or a group in relation to other groups in an organization. DECISION-MAKING is a dynamic and systematic process by which goal-directed choice of perceived alternatives is made and acted upon by individuals or groups to answer a question
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and attain a goal.
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CONCEPTUAL MODEL
Perception Nurse Judgment Action Reaction Perception Patient Judgment Action
Feedback
Interaction
Transaction
Feedback
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JEAN WATSON Philosophy and Science of Caring
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Born: West Virginia Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD, University of Colorado, 1973 Dr. Jean Watson is Distinguished Professor of Nursing and holds an endowed Chair in Caring Science at the University of Colorado Health Sciences Center. She is founder of the original Center for
Human Being She adopts a view of the human being as: .. a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts. Health

The Ten Primary Watson proposes even assumptions Carative Factors The first three carative about the science of factors form the caring. The basic assumptions are: philosophical
STRENGTHS
foundation for the Caring can be effectively science of caring. The demonstrated and remaining seven practiced only carative factors spring interpersonally. from the foundation laid Caring consists of by these first three. carative factors that result in the 1. The formation of a satisfaction of humanistic- altruistic certain human system of values needs. Begins Effective caring developmentally promotes health at an early age and individual or with values family growth. shared with the Caring responses parents. accept person not Mediated through only as he or she ones own life is now but as what experiences, the he or she may learning one become. Watson gains and believes that exposure to the A caring environment is one there are other humanities. that offers the factors that Is perceived as development of are needed to necessary to the potential while be included in
Besides assisting in providing the quality of care that client ought to receive, it also provides the soul satisfying care for which many nurses enter the profession. As the science of caring ranges from the biophysical through the intrapersonal, each nurse becomes an active co participant in the clients struggle towards selfactualization. The client placed in context of family, community the culture. is the the the and
The theory provides a moral and philosophical basis for nursing. The scope of the framework encompasses all aspects of the health-illness continuum. In addition, the theory addresses aspects of preventing illness and experiencing a peaceful death. It also provides an important guideline for nurse-patient interaction however it focuses more on psychosocial aspect rather than physiological aspect.
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Human Caring in Colorado and is a Fellow of the American Academy of Nursing. She previously served as Dean of Nursing at the University Health Sciences Center and is a Past President of the National League for Nursing Dr. Watson has earned undergraduat e and graduate degrees in nursing and psychiatricmental health nursing and holds her PhD in educational psychology and counseling.
the WHO definition of health. She adds the following three elements: A high level of overall physical, mental and social functioning A general adaptivemaintenance level of daily functioning The absence of illness (or the presence of efforts that leads its absence) Environment/soc iety According to Watson caring (and nursing) has existed in every society. A caring attitude is not transmitted from generation to generation. It is transmitted
nurses own maturation which then promotes altruistic behavior towards others. 2. Faith-hope
WEAKNESSES Caring is more Is essential to healthogenic than Given the acuity both the carative of illness that is curing. A and the curative leads to science of caring is processes. hospitalization, complementary to the short length When modern the science of stay , and the science has curing. increasing nothing further to The practice of complex offer the person, caring is central to technology, such the nurse can nursing. quality of care continue to use may be deemed faith-hope to impossible to provide a sense give in the of well-being hospital. through beliefs which are While Watson meaningful to the acknowledges individual. the need for biophysical base 3. Cultivation of to nursing, this sensitivity to ones self area receives and to others little attention in her writings. Explores the need of the nurse The ten carative to begin to feel an factors primarily emotion as it delineate the presents itself. psychosocial needs of the Development of person. ones own feeling is needed to
allowing the person to choose the best action for himself or herself at a given point in time.
It places the client as the focus of practice rather than the technology.
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by the culture of the profession as a unique way of coping with its environment. Nursing
interact genuinely and sensitively with others.
According to Watson nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health. It focuses on health promotion and treatment of disease. She believes that holistic health care is central to the practice of caring in nursing. She defines nursing as.. A human science of persons and human healthillness
Striving to become sensitive, makes the nurse more authentic, which encourages selfgrowth and selfactualization, in both the nurse and those with whom the nurse interacts. The nurses promote health and higher level functioning only when they form person to person relationship. a
While the carative factors have a sound foundation based on other disciplines, they need further research in nursing to demonstrate their application to practice.
4. Establishing helping-trust relationship
Strongest tool is the mode of communication, which establishes rapport and caring. She has defined the characteristics
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experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions.
needed to in the helping-trust relationship. These are: 1) Congruence, 2) Empathy 3) Warmth Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding.
5. Expression of feelings, both positive and negative
According to Watson, feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship. According to her such expression improves ones level of awareness. Awareness of the
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feelings helps to understand the behavior it engenders. 6. The systematic use of the scientific problem-solving method for decision making
According to Watson, the scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction. She also values the relative nature of nursing and supports the need to examine and develop the other methods of knowing to provide a holistic perspective. The science of caring should not be always neutral and objective. Promotion of
7.
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interpersonal teaching-learning
The caring nurse must focus on the learning process as much as the teaching process. Understanding the persons perception of the situation assist the nurse to prepare a cognitive plan.
8. Provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment
Watson divides these into eternal and internal variables, which the nurse manipulates in order to provide support and protection for the persons mental and physical wellbeing. The external and
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internal environments are interdependent.
Watson suggests that the nurse also must provide comfort, privacy and safety as a part of this carative factor.
9. Assistance with the gratification of human needs
It is grounded in a hierarchy of need similar to that of the Maslows. She has created a hierarchy which she believes is relevant to the science of caring in nursing. According to her each need is equally important for quality nursing care and the promotion of optimal health. All the needs deserve to be attended to and valued.
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Watsons of needs
ordering
Lower order needs (biophysical needs) o The need for food and fluid o The need for elimination o The need for ventilation Lower order needs (psychophysical needs) o The need for activity-inactivity o The need for sexuality Watsons ordering of needs o Higher order needs (psychosocial needs) o The need for achievement o The need for affiliation o Higher order need (intrapersonalinterpersonal need)
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The need for selfactualization 10. Allowance for existentialphenomenological forces

o
Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference. Existential psychology is the study of human existence using phenomenologica l analysis. This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs. Thus the nurse assists the
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person to find the strength or courage to confront life or death.
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CONCEPTUAL MODEL
Promotes Healing
NURSE
Healing Space and Environment
Increase Patient awareness and consciousness
Mind
Body
Spirit
High Degree of Health
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MADELEINE LEININGER
Culture care: Diversity and Universality Theory
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Madeleine M. Leininger is the creator of the Transcultural Subfield of Nursing. She obtained her basic nursing education at St. Anthony School of Nursing, Denver, Colorado, and graduated in 1948. She merited her Bachelor of Science degree from Benedictine College, Atchison, Kansas. In 1953, she obtained her degree of
Person Human beings are best explained in her assumptions. Human are thus believed to be caring and capable of being concerned about the desires, welfare, and continued existence of others. Human care is collective, that is, seen in all cultures. Human have endured within cultures and through place and time because they have been able to care for infants, children, and the elderly in a variety of ways in many different environments. Thus, humans are universally caring beings who survive in
Culture-Broadly defines set of values, beliefs and traditions, that are held by a specific group of people and handed down from generation to generation. Culture is also beliefs, habits, likes, dislikes, customs and rituals learn from ones family. (Specter 1991) Culture is the learned, shared and transmitted values, beliefs, norms and life way practices of a particular group that guide thinking, decisions, and actions in patterned ways. Religion: Is a set of belief in a divine or super human power (or powers) to be obeyed and
1. Care is the STRENGTHS essence and the central dominant, 1. The major strength of distinct, and Leiningers unifying focus of theory is the nursing. recognition of 2. Humanistic and the importance scientific care is of culture and essential for its influence on human growth, everything that well-being, health, involves the survival, and to recipients and face death and providers of disability. Nursing Care. 3. Culture care is the 2. Because synthesis of two everyone, as major constructs individuals or in that guide the groups, belongs researcher to to a culture discover, explain, and/or and account for subculture, this health, well-being, theory applies to care expressions, anyone in any and other human situation. For conditions. nurses, there is 4. Care is essential a special to curing or concern about healing for there being culturally could be no curing appropriate in without caring. approach and in 5. Culture Care responses. expression, Leininger meanings, particularly patterns,
Nurses need to be aware of and sensitive to the cultural needs of clients. The body of knowledge relevant to this sensitive area is growing, and it is imperative that nurses from all cultural backgrounds be aware of nursing implications in this area. The practice of nursing today demands that the nurse identify and meet the cultural needs of diverse groups, understand the social and cultural reality of the client, family, and community, develop expertise to implement culturally acceptable strategies to provide nursing care, and identify
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Master of Science (Doctor of Philosophy) in Anthropology from the University of Washington, Seattle.
a diversity of cultures through their ability to provide the universality of care in a variety of ways according to differing cultures, needs, and settings. Leininger (1991) also indicates that nursing as a caring science should focus ahead of traditional nursepatient interactions to include families, groups, communities, total cultures, institutions as well as worldwide health institutions and ways to expand international nursing care policies and practices.
worshipped as the creator and ruler of the universe? Ethical values and religion system of beliefs and practices, difference within the culture and across culture are found
Ethnic: refers to a group of people who share a common and distinctive culture and who are members of a specific group. Ethnicity:a consciousness belonging to group. of a
Cultural Identify: the sense of being part of an ethnic group or culture Cultureuniversals: commonalities of values, norms of behavior, and life patterns that are similar among different cultures.
Environment In term of Environment, Leininger speaks about worldview,
processes, and structural forms are diverse but some commonalities (universalities) exist among and between cultures. 6. Culture Care values, beliefs, and practices are influenced by embedded in the worldview, social factors and the ethnohistorical and environmental contexts. 7. Every culture has generic care to be discovered and used for culturally congruent care practices. 8. Culturally congruent and therapeutic care occurs when culture care values, beliefs, expressions, and patterns are explicitly known and used appropriately,
warns about and use resources cultural acceptable to the imposition and client culture shock. 3. The complexity of Sunrise Model can be viewed as both a strength and a limitation. The complexity is a strength in that it emphasizes the importance of the inclusion of anthropological and cultural concepts in nursing education d practice. WEAKNESSES 1. Limited number of graduates who are academically prepared to conduct investigations needed to provide transcultural nursing care. An associated
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social structure, and environmental context. However, environment, if viewed as being signified in culture, is a major principle of Leiningers theory. Environment framework is defined as being the totality of an event, situation, or experience. Her description of cultures centers on a particular group (society) and the patterning of actions, thoughts, and decisions that occurs as the result of learned, shared, and transmitted values, beliefs, norms, and lifeways. This learning, sharing, transmitting, and patterning take place within a group of people who function in an identifiable setting or
Culture-specifies ; values, beliefs, and patterns of behavior that tend to be unique to a designate culture. Material culture; refers to objects (dress, art, religious arti1acts) Non-material culture; refers to beliefs customs, languages, social institutions. Subculture: composed of people who have a distinct identity but are related to a larger cultural group. Bicultural : a person who crosses two cultures, lifestyles, and sets of values. Diversity: refers to the fact or state of being different. Diversity can occur between cultures and within a cultural group. Acculturation;
sensitively, and concern is that meaningfully with too few nursing people of diverse programs or similar cultures. include courses 9. Leiningers three and planned theoretical modes learning of care offer new, experiences that creative, and provide a different knowledge base therapeutic ways for transcultural to help people of nursing practice. diverse or similar There is also a cultures. need of research 10. Qualitative fund to support research continued study paradigmatic of caring methods offer practices-both important means those that are to discover largely universal and embedded, those that are covert, epistemic, particular o a and ontological culture. culture care 2. It is interesting knowledge and to note that, in practices. spite of 11. Transcultural Leiningers nursing is a emphasis on the discipline with a importance of body of avoiding cultural knowledge and imposition and practices to attain cultural shock, and maintain the Domenig (1999) goal of culturally expresses congruent care for concern that health and wellLeininger does being. not make
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environment. Therefore, although Leininger does not use the specific terms of society or environment, the concept of culture is closely related to society/environment, and is a central matter of her theory.
individuals who have taken on, usually observable, features of another culture. People of a minority group tend to assume the attitudes, values, beliefs, find practices of the dominant society resulting in a blended cultural pattern. Cultural shock:the state of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness, unfamiliarity, and incompatibility to the stranger's perceptions and expectations at is differentiated from others by symbolic markers (cultures, biology, territory, religion). Ethnic groups; share a common
Health She discussed about components of health, specifically: Health systems Health care practices Changing health patterns Health promotions Health maintenance Health is a key concept in transcultural nursing.
interaction the main object of her theory and that nurses need to be encouraged to analyze their own cultural backgrounds. It would be difficult to identify how Leininger could have put greater emphasis on the importance of these aspects. 3. The complexity of the Sunrise Model can lead to misinterpretation or rejection, both of which are limitation.
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Because of the weight on the need for nurses to have knowledge that is specific to the culture in which nursing is being practiced, it is acknowledged that health is seen as being universal across cultures but distinct within each culture in a way that represents the beliefs, values, and practices of the particular culture. Thus, health is both universal and diverse. Nursing
social and cultural heritage that is passed on to successive generations.,
Ethnic identity;refers to a subjective perspective of the person's heritage and to a sense of belonging to a group that is distinguishable from other groups. Race: the classification of people according to shared biologic characteristics, genetic markers, or features. Not all people of the same race have the same culture.
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Leininger showed her concern to nurses who do not have sufficient preparation for a transcultural perspective. For that reason, they will not be able to value nor practice such viewpoint to the fullest extent possible. She gave three types of nursing actions that are culturally-based and thus consistent with the needs and values of the clients. These are: Cultural care preservation/m aintenance Cultural care accommodatio n/negotiation Cultural care repatterning/re structuring These three
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modes of action can lead to the deliverance of nursing care that best fits with the clients culture and thus reduce cultural stress and chance for conflict between client and caregiver.
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CONCEPTUAL MODEL
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BETTY NEUMAN
Systems Model
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Betty Neumann was born in 1924, in Lowel, Ohio. She completed BS in nursing in 1957 and MS in Mental Health Public health consultation, from UCLA in 1966. She holds a Ph.D. in clinical psychology She was a pioneer in the community mental health movement in the late 1960s. Betty Neumann began
PERSON
The focus of the Neumann model is based on the philosophy that each human being is a total person as a client system and the person is a layered multidimensional being. Each layer consists of five person variable or subsystems: o PhysiologicalRefer of the physicochemical structure and function of the body. o PsychologicalRefers to mental processes and emotions. o Socio-culturalRefers to relationships; and social/cultural expectations and activities.
Content: - the variables of the person in interaction with the internal and external environment comprise the whole client system Basic structure/Centra l core: - common client survival factors in unique individual characteristics representing basic system energy resources. The basis structure, or central core, is made up of the basic survival factors that are common to the species (Neumann,2002). These factors include:- Normal temp. range, Genetic structure.-
Each client system is unique, a composite of factors and characteristics within a given range of responses contained within a basic structure. Many known, unknown, and universal stressors exist. Each differ in its potential for disturbing a clients usual stability level or normal LOD The particular interrelationships of client variables at any point in time can affect the degree to which a client is protected by the flexible LOD against possible
The Neumans system model 1. The system when applied in model moved nursing practice away from the helped in traditional identifying the illness model to interpersonal, one that intrapersonal and encompasses a extra personal total person stressors from approach to various aspects. patient care. This was helpful to 2. The model provide care in a is not restricted comprehensive to nursing alone manner. The but can be application of this shared by theory revealed anyone working how well the in the health primary, secondary care system. and tertiary 3. The model prevention lessens the interventions could fragment of be used for solving care and offers the problems in the an client interdisciplinary approach. 4. Lessens incongruities of nurses and clients in formulating goals. 5. Conceptualizati STRENGTHS
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developing her health system model while a lecturer in community health nursing at University of California, Los Angeles.
Spiritual- Refers to the influence of spiritual beliefs. o DevelopmentalRefers to those processes related to development over the lifespan. ENVIRONMENT
o
The environment is seen to be the totality of the internal and external forces which surround a person and with which they interact at any given time. These forces include the intrapersonal, interpersonal and extrapersonal stressors which can affect the persons normal line of
Response pattern. Organ strength or weakness, Ego structure 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. Degree to reaction: - the amount of system instability resulting from stressor invasion of the normal LOD. Entropy: - a process of energy depletion and disorganization moving the system toward
reaction to stressors. Each client/ client system has evolved a normal range of responses to the environment that is referred to as a normal LOD. The normal LOD can be used as a standard from which to measure health deviation. When the flexible LOD is no longer capable of protecting the client/ client system against an environmental stressor, the stressor breaks through the normal LOD The client whether in a state of wellness or illness, is a
on of nursing phenomena promotes efficacious critical thinking process such as application, analysis, synthesis and evaluation WEAKNESSES 1. The model lack of framework to identify, describe and explain the different response to stress. 2. Nurse education in some instances relies heavily upon relating knowledge from allied disciplines to nursing practice.
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defense and so can affect the stability of the system. o The internal environment exists within the client system. o The external environment exists outside the client system. o Neumann also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness. HEALTH
Neumann sees health as being equated with wellness. She defines health/wellnes s as the
illness or possible death. Flexible LOD: - a protective, accordion like mechanism that surrounds and protects the normal LOD from invasion by stressors. Normal LOD: - It represents what the client has become over time, or the usual state of wellness. It is considered dynamic because it can expand or contract over time. LOR: - The series of concentric circles that surrounds the basic structure. Protection factors activated when stressors have penetrated the normal LOD, causing a reaction symptomatology. E.g. mobilization
dynamic composite of the interrelationships of the variables. Wellness is on a continuum of available energy to support the system in an optimal state of system stability. Implicit within each client system are internal resistance factors known as LOR, which function to stabilize and realign the client to the usual wellness state. Primary prevention relates to G.K. that is applied in client assessment and intervention, in identification and reduction of
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condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neumann, 1995). The client system moves toward illness and death when more energy is needed than is available. The client system moved toward wellness when more energy is available than is needed NURSING
Neumann sees nursing as a unique profession that is concerned with all of the variables which influence the response a person might have to a
of WBC and activation of immune system mechanism Input- output: The matter, energy, and information exchanged between client and environment that is entering or leaving the system at any point in time. Negentropy: - A process of energy conservation that increase organization and complexity, moving the system toward stability or a higher degree of wellness. Open system:- A system in which there is continuous flow of input and process, output and feedback. It is a system of organized complexity where
possible or actual risk factors. Secondary prevention relates to symptomatolog y following a reaction to stressor, appropriate ranking of intervention priorities and treatment to reduce their noxious effects. Tertiary prevention relates to adjustive processes taking place as reconstitution begins and maintenance factors move the back in circular manner toward primary prevention. The client as a system is in dynamic, constant energy
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stressor. The person is seen as a whole, and it is the task of nursing to address the whole person. Neuman defines nursing as action which assist individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient/client system, through nursing interventions to reduce stressors. Neuman states that, because the nurses perception will influence the
all elements are in interaction. Prevention as intervention: Interventions modes for nursing action and determinants for entry of both client and nurse in to health care system. Reconstitution: The return and maintenance of system stability, following treatment for stressor reaction, which may result in a higher or lower level of wellness. Stability: - A state of balance of harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health thus preserving
exchange with the environment.
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care given, then not only must the patient/clients perception be assessed, but so must those of the caregiver (nurse). The role of the nurse is seen in terms of degree of reaction to stressors, and the use of primary, secondary and tertiary interventions
system integrity. Stressors: environmental factors, intra (emotion, feeling), inter (role expectation), and extra personal (job or finance pressure) in nature, that have potential for disrupting system stability. A stressor is any phenomenon that might penetrate both the F and N LOD, resulting either a positive or negative outcome. Wellness/Illness: - Wellness is the condition in which all system parts and subparts are in harmony with the whole system of the client. o Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002). o Illness is an
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excessive expenditure of energy when more energy is used by the system in its state of disorganization than is built and stored; the outcome may be death (Neuman, 2002). PREVENTION
According to Neumanns model, prevention is the primary nursing intervention. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body.
PRIMARY PREVENTION
Primary prevention occurs before the system reacts to a
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stressor. On the one hand, it strengthens the person (primary the flexible LOD) to enable him to better deal with stressors On the other hand manipulates the environment to reduce or weaken stressors. Primary prevention includes health promotion and maintenance of wellness. SECONDARY PREVENTION
Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing system. Secondary prevention focuses on preventing damage to the
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central core by strengthening the internal lines of resistance and/or removing the stressor. TERTIARY PREVENTION
Tertiary prevention 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.
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CONCEPTUAL MODEL
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FAYE GLENN ABDELLAH

21 Nursing Problems
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Faye Glenn Abdellah, pioneer nursing researcher, helped transform nursing theory, nursing care and nursing education Birth:1919 Dr Abdellah worked as Deputy Surgeon Ge neral Former Chief Nurse Officer for the US Public Health Servi ce , Department of Health and human services, Washington, D.C. She has been a leader in nursing research and
NURSING Nursing is a helping profession. It is based on an art and science that mould the attitudes, intellectual competencies, and technical skills of the individual to nurse into the desire and ability to help people, sick or well, cope with their health needs.
21 NURSING PROBLEMS Three major categories 1. Physical, sociological, and emotional needs of clients 2. Types of interpersonal relationships between the nurse and patient 3. Common elements of client care BASIC TO ALL
PATIENTS In Abdellahs model, nursing care is doing To maintain good something to or for hygiene and physical the person or comfort providing information To promote optimal activity: exercise, to the person with the rest and sleep goals of meeting To promote safety needs, increasing or through the restoring self-help prevention of ability, or alleviating accidents, injury, or impairment. other trauma and through the Nursing is broadly prevention of the
STRENGTHS She referred to nursing diagnosis during a time when The patient centered nurses were taught approach was that diagnosis was constructed to not a nurses be useful to prerogative. nursing practice, with impetus Assumptions were for it related to being nursing education. change and Abdellahs anticipated publications on changes that affect nursing nursing; education began with her changing nursing dissertation; her education interest in education for continuing nurses education for continues into professional the present. nurses Abdellah has also published development of on nursing, nursing leaders nursing from under research, and reserved groups public policy related to problem solving nursing in skills to be used in several developing a international treatment typology publications.
Abdellahs theory provides a basis for determining and organizing nursing care. The problems also provide a basis for organizing appropriate nursing strategies. It is anticipated that by solving the nursing problems, the client would be moved toward health. The nurses philosophical frame of reference would determine whether this theory and the 21 nursing problems could be implemented in practice.
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has over one hundred publications related to nursing care, education for advanced practice in nursing and nursing research. In 1960, influenced by the desire to promote client-centred comprehensi ve nursing care, Abdellah described nursing as a service to individuals, to families, and, therefore to, to society. According to her, nursing is based on an art and science that mould the attitudes, intellectual competencie
grouped into the 21 problem areas to guide care and promote use of nursing judgment. 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 and social needs. Patient is described as the only justification for the existence of nursing. Individuals (and families) are the recipients of nursing
spread of infection To maintain good body mechanics and prevent and correct deformities
She has been a strong advocate for improving nursing practice through nursing research WEAKNESSES Very strong nursing centeredorientation Little emphasis on what the client is to achieve
HEALTH Health is a dynamic pattern of functioning
SUSTENAL CARE To facilitate the maintenance of a supply of oxygen to all body cells To facilitate the maintenance of nutrition of all body cells To facilitate the maintenance of elimination To facilitate the maintenance of fluid and electrolyte balance To recognize the physiological responses of the body to disease conditions To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function
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s, and technical skills of the individual nurse into the desire and ability to help people , sick or well, cope with their health needs.
REMEDIAL CARE To identify and accept positive and negative expressions, feelings, and reactions To identify and accept the interrelatedness of emotions and organic illness To facilitate the maintenance of effective verbal and non verbal communication In Patient Centered To promote the development of Approaches to productive Nursing; Abdellah interpersonal describes health as a relationships state mutually To facilitate progress exclusive of illness. toward achievement of personal spiritual goals To create and / or Health, or achieving maintain a therapeutic of it, is the purpose of environment nursing services. To facilitate awareness of self as an individual with varying physical , Although Abdellah emotional, and does not give a developmental needs definition of health, she speaks to total RESTORATIVE CARE NEEDS health needs and a To accept the healthy state of mind optimum possible whereby there is a continued interaction with internal and external forces that results in the optimum use of necessary resources that serve to minimize vulnerabilities
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and body in her description of nursing as a comprehensive service.
SOCIETY/ ENVIRONMENT Society is included in planning for optimum health on local, state, national, and international levels. However, as she further delineated her ideas, the focus of nursing service is clearly the individual.
goals in the light of limitations, physical and emotional To use community resources as an aid in resolving problems arising from illness To understand the role of social problems as influencing factors in the case of illness Problem-Solving 1. Identifying the problem 2. Selecting the relevant data 3. Devising hypothesis 4. Testing hypothesis through assortment of data 5. Revising hypothesis when necessary on the basis of conclusion obtained from the data. 11 nursing skills 1. Observation of health status 2. Skills of communication 3. Application of knowledge
The environment is the home or community from which patient comes.
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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
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MARTHA E. ROGERS
Unitary Human Beings
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Born :May 12, 1914, Dallas, Texas Diploma :Knoxville General Hospital School of Nursing(193 6) Graduation in Public Health Nursing, George Peabody College, TN, 1937 MA :Teachers college, Columbia university, New York, 1945 MPH :Johns Hopkins University, Baltimore, MD, 1952 Doctorate in
Rogers conceptual system provides a The energy field is the With only three body of knowledge A unitary human fundamental unit of principles, a few in nursing that will being is an both the living and major concepts, have relevance for "irreducible, nonliving and five indivisible, pan all workers This energy field assumption, dimensional (fourconcerned with "provide a way to Rogers has dimensional) people, but with perceive people and energy field explained the environment as special relevance identified by nature of man and for nurses; irreducible wholes" pattern and the life process The energy fields because it matters manifesting 1. Man is a unified continuously varies in characteristics that Rogers conceptual to human beings; whole possessing intensity, density, and are specific to the consequently to his own integrity model is abstract extent whole and which nurses and manifesting and therefore cannot be Openness characteristics generalized and predicted from In the evolution it is more than and powerful. It is knowledge of the properly subjected different from the The human field and parts" and "a broad in scope, sum of his parts to reformulation the environmental unified whole providing a (energy field). and change as the field are constantly having its own 2. Man and framework for the knowledge grows, exchanging their distinctive environment are development of energy the the conceptual characteristics continuously nursing knowledge data will be more which cannot be There are no exchanging matter through the perceived by clearer and it will boundaries or barrier and energy with generation of looking at , that inhibit energy flow one another take new describing, or grand and middle- dimensions between fields (openness). summarizing the range theories 3. The life process Pattern parts" evolves irreversibly The utilization of Pattern is defined as Weaknesses The people has the and unidirectional Rogerian model is the distinguishing capacity to along the spacecharacteristic of an When the model is used as a guide for participate time continuum theory energy field perceived examined in total knowingly and (helicy). Human Being (person) Energy field
IN 1970, Rogers IDENTIFIED five assumptions that are also theoretical assertions supporting her model derived from literature on human beings, physics, mathematics, and behavioral science:
Strengths
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nursing :Johns Hopkins University, Baltimore, 1954
Fellowship: American academy of nursing Position: Professor Emerita, Division of Nursing, New York University, Consultant, Speaker
Died : March Rogers defined 13 , 1994 health as an expression of the life process; they are the "characteristics and behavior emerging out of the mutual, simultaneous interaction of the human and environmental fields"
4. Pattern and organization "pattern is an identify man and abstraction and it reflect his Environment gives identity to the innovative field" The environment is wholeness an "irreducible Pan dimensionality (pattern and ,pan dimensional organization). Pan dimensionality is energy field 5. Man is defined as "non linear identified by characterized by domain without spatial pattern and the capacity for or temporal attributes" integral with the abstraction and The parameters that human field" imagery, language human use in The field coexist and thought, language to describe and are integral. sensation, and events are arbitrary. Manifestation emotion (sentient, The present is emerge from this thinking being). relative ;there is no field and are temporal ordering of perceived. lives. Health
probabilistically in the process of change
as a single waves
perspective, some still classify it as complex. Understanding the concepts and principles of the Science of Unitary Human Being requires a foundation in general education, a willingness to let go of the traditional, and an ability to perceive the world in a new and creative way
development, research, nursing education, and in the direct patient care practice Nursing intervention seeks to coordinate environmental field and human field rhythmicities, participates in the process of change , to help people move toward better health
Health and illness are the part of the
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sane continuum.
The multiple events taking place along life's axis denote the extent to which man is achieving his maximum health potential and very in their expressions from greatest health to those conditions which are incompatible with the maintaining life process The concept Nursing encompasses two dimensions Independent science of nursing. An organized body of knowledge which is specific to nursing is arrived at by scientific research and logical analysis Art of nursing practice The creative use of science for the
Nursing
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betterment of the human
The creative use of its knowledge is the art of its practice
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CONCEPTUAL MODEL
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DOROTHY E. JOHNSON Behavioral System Model
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Dorothy E. Johnson was born August 21, 1919, in Savanna h, Georgia. B. S. N. from Vanderbil t University in Nashville, Tennesse e, in 1942; and her M.P.H. from Harvard University in Boston in 1948. From 1949 until her retiremen t in 1978 she was an
HUMAN BEING human being as having two major systems, the biological system and the behavioral system. It is role of the medicine to focus on biological system where as Nursling's focus is the behavioral system. ENVIRONMENT/ SOCIETY Society relates to the environment on which the individual exists. According to Johnson an individuals behavior is influenced by the events in the environment
HEALTH Health is a
1. Attachment or affiliative subsystem: social inclusion intimacy and the formation and attachment of a strong social bond. 2. Dependency subsystem: approval, attention or recognition and physical assistance 3. Ingestive subsystem: the emphasis is on the meaning and structures of the social events surrounding the occasion when the food is eaten 4. Eliminative subsystem: human cultures have defined different socially acceptable behaviors for excretion of waste ,but the existence of such a pattern remains different from culture to Culture. 5. Sexual subsystem:" both biological and
There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system model (Johnson was influenced by Buckley ,Chin and Rapport) there are 4 assumptions of system: First assumption states that there is organization, interaction, interdependen cy and integration of the parts and elements of behaviors that go to make up The system A system tends to
STRENGTHS 1. Interrelate concepts to create a different way of viewing a phenomenon. 2. Theories must be logical in nature. 3. Theories must be simple yet generalizable 4. Theories can be bases of hypothesis that can be tested. 5. Theories contribute to and assist in increasing the body of knowledge within the discipline through the research implemented to validate them 6. Theories can be utilized by practitioners to guide and
Johnsons Behavioral system model is a model of nursing care that advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. The patient is defined as behavioral system composed of 7 behavioral subsystems. Each subsystem. Any imbalance in each system results in disequilibrium .it is nursing role to assist the client to return to the state of equilibrium.
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assistant professor of pediatric nursing, an associate professor of nursing, and a professor of nursing at the University of California in Los Angeles. Dorothy Johnson has had an influence on nursing through her publicatio ns since the 1950s. Througho ut her career, Johnson
purposeful adaptive response, physically mentally, emotionally, and socially to internal and external stimuli in order to maintain stability and comfort. NURSING Nursing has a primary goal that is to foster equilibrium within the individual .she stated that nursing is concerned with the organized and integrated whole, but that the major focus is on maintaining a balance in the Behavior system when illness occurs in an individual.
social factor affect the behavior in the sexual subsystem 6. Aggressive subsystem:" it relates to the behaviors concerned with protection and self preservation Johnson views aggressive subsystem as one that generates defensive response from the individual when life or territory is being threatened 7. Achievement subsystem: provokes behavior that attempt to control the environment intellectual, physical, creative, mechanical and social skills achievement are some of the
achieve a balance among the various forces operating within and upon it', and that man strive continually to maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces impinging upon him. A behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man that is to say, it is functionally significant in
improve their practice. 7. Theories must be consistent with other validated theories, laws and principles but will leave unanswered questions that need to be investigated. WEAKNESSES 1. Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral system model. 2. The definition of concept is so abstract that they are difficult to use. 3. It is difficult to test Johnson's model by development of hypothesis. 4. The focus on the behavioral
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has stressed the importanc e of researchbased knowledg e about the effect of nursing care on clients.
that it serves a useful purpose, both in social life and for the individual. The final assumption states system balance reflects adjustments and adaptations that are successful in some way and to some degree.
system makes it difficult for nurses to work with physically impaired individual to use this theory. 5. The model is very individual oriented so the nurses working with the group have difficulty in its implementation. 6. The model is very individual oriented so the family of the client is only considered as an environment. 7. Johnson does not define the expected outcomes when one of the system is affected by the nursing implementation an implicit expectation is made that all human in all
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cultures will attain same outcome homeostasis. 8. Johnsons behavioral system model is not flexible.
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CONCEPTUAL MODEL
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Reference:

Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002 George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange. Polit DF, Hungler BP. Nursing Research: Principles and Methods. Philadelphia: JB Lippincott Company; 1998. Burns N, Grove SK. The practice of Nursing Research. 4th Ed. Philadelphia: WB Saunders Publications; 2001. http://currentnursing.com/nursing_theory/behavioural_system_model.htm
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Theoretical Foundations of Nursing

Compilation of Nursing Theorist and Their Work

Prepared by: Venice Joy T. Malonzo, RN

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Hospital, Washington, D.C. in 1921.

the holistic nature of human being.

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

rather than health.

Theoretical Foundations of Nursing

Self Care Demand

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

MYRA ESTRIN LEVINE

Environment: Completes the wholeness of person. Internal Environment

A state of conservation Homeorrhesis: A stabilized flow rather than a static state

Emphasis the fluidity of change within a spacetime continuum

Describe the pattern of adaptation, which permit the individuals body

Theoretical Foundations of Nursing

care Remarkable, articulate with no hesitations. Died on 1996 at 73 years.

through such strategists raising questions

Preconceptual: Aspect of the world that individual are able to intercept

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

state and on the dependency of patient.

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

SISTER CALLISTA ROY

Theoretical Foundations of Nursing

Functions as a unity for some purpose

adaptation is a function of the stimulus he is exposed to and his adaptation level

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

Stimuli Adaptation Level

Coping Mechanism Regulator Cognator

Physiological function Self Concept Role function

Adaptive and Ineffective Response

Person as an adaptive system

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

STRENGTHS Interpersonal relations between patient and nurse , is easily understood.

Professor emeritus from NURSING

Theoretical Foundations of Nursing

two or more individuals with a common goal.

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing

7. Manager of environment 8. Mediator 9. Administrator 10. Recorder observer 11. Researcher

Theoretical Foundations of Nursing

During intensive treatment period

Convalescence and rehabilitation

Theoretical Foundations of Nursing

IDA JEAN ORLANDO PELLETIER

Sense of adequacy or well being. Fulfilled needs.

Theoretical Foundations of Nursing

Sense of comfort. Nursing client

Man/ Human being

Theoretical Foundations of Nursing

Theoretical Foundations of Nursing