Naga College Foundation, Inc.

College of Health Sciences

NURSING CONCEPTUAL MODELS

MODULE 3

JOHANNA MARIA DJ. CASTILLO, RN, MN

Clinical Instructor
Course Code: NCM 100

Course Title: Theoretical Foundations in Nursing

Credit Units: 3 units lecture (54 hours)

Prerequisite: NONE

Duration: 1st Semester S/Y 2020-2021

Delivery Mode: Blended

Course Description:

This course deals with the meta- concepts of person, health, environment, and
nursing as viewed by the different theorists. Likewise, it includes non-nursing theories sub
systems, developmental and change theories. It presents how these concepts and theories
serve as guide in nursing practice. It further deals with health as multi factorial phenomenon
and necessary core competencies that the nurse need to develop.

Learning Objectives:

By the end of the lecture, students will be able to:

 Describe the various non-nursing theories as applied to nursing.

 Utilize selected nursing theories and non-nursing theories in the care of clients.

Learning Plan:

Schedule Description Time Frame

Invitation to join the Google Classroom

A. Write your expectation in Nursing Conceptual

Models.
4 hrs/meeting
Week 3 B. Nursing Conceptual Models
1. Roger’s Science of unitary human Total: 8 hrs
beings conceptual model
2. Orem’ Self care deficit model
3. King’s General Systems framework nursing
conceptual model
4. Neuman’s systems model
 5. Roy’s adaptation model
6. Johnson’s Behavioral system model

Pre Test:

TRUE or FALSE

___1. Human beings is considered as a whole which cannot be viewed as subparts.

___2. Dorotea Orem is the theorist who developed self care deficit nursing theory.

___3. Imogene King developed goal attainment theory.

___4. Adaptation model is developed by Calista Roy.

___5. The theory of Betty Neuman is all about system model in nursing practice.

Lesson Proper:

Martha E Rogers - Science of Unitary Human Beings

 Born :May 12, 1914, Dallas, Texas, USA

 Diploma : Knoxville General Hospital School of Nursing(1936)
 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 nursing :Johns Hopkins University, Baltimore, 1954
 Fellowship: American academy of nursing
 Position: Professor Emerita, Division of Nursing, New York University, Consultant,
Speaker
 Died : March 13 , 1994
Publications of Martha Rogers
 Theoretical basis of nursing (Rogers 1970)
 Nursing science and art :a prospective (Rogers 1988)
 Nursing :science of unitary, irreducible, human beings update (Rogers 1990)
 Vision of space based nursing (Rogers 1990)
Overview of Rogerian model
 Rogers conceptual system provides a body of knowledge in nursing.
 Rogers model provides the way of viewing the unitary human being.
 Humans are viewed as integral with the universe.
 The unitary human being and the environment are one, not dichotomous
 Nursing focus on people and the manifestations that emerge from the mutual
human /environmental field process
  Change of pattern and organization of the human field and the environmental field
is propagated by waves
 The manifestations of the field patterning that emerge are observable events
 The identification of the pattern provide knowledge and understanding of human
experience
 Basic characteristics which describes the life process of human: energy field,
openness, pattern, and pan dimensionality
 Basic concepts include unitary human being, environment, and homeodynamic
principles

Concepts of Rogers model

Energy field
 The energy field is the fundamental unit of both the living and nonliving
 This energy field "provide a way to perceive people and environment as irreducible
wholes"
 The energy fields continuously varies in intensity, density, and extent.
Openness
 The human field and the environmental field are constantly exchanging their energy
 There are no boundaries or barrier that inhibit energy flow between fields
Pattern
 Pattern is defined as the distinguishing characteristic of an energy field perceived as
a single waves
 "pattern is an abstraction and it gives identity to the field"
Pan dimensionality
 Pan dimensionality is defined as "non linear domain without spatial or temporal
attributes"
 The parameters that human use in language to describe events are arbitrary.
 The present is relative, there is no temporal ordering of lives.
Homeodynamic principles
 The principles of homeodynamic postulates the way of perceiving unitary human
beings
 The fundamental unit of the living system is an energy field
 Three principle of homeodynamics
o Resonancy
o Helicy
o integrality
Resonance
 Resonance is an ordered arrangement of rhythm characterizing both human field
and environmental field that undergoes continuous dynamic metamorphosis in the
human environmental process
Helicy
 Helicy describes the unpredictable, but continuous, nonlinear evolution of energy
fields as evidenced by non repeating rhythmicties
 The principle of Helicy postulates an ordering of the humans evolutionary
emergence
Integrality
 The mutual, continuous relationship of the human energy field and the
environmental field .
 Changes occur by by the continuous repatterning of the human and environmental
fields by resonance waves
 The fields are one and integrated but unique to each other
Nursing Paradigms
Unitary Human Being (person)
 A unitary human being is an "irreducible, indivisible, pan dimensional (four-
dimensional) energy field identified by pattern and manifesting characteristics that
are specific to the whole and which cannot be predicted from knowledge of the
parts" and "a unified whole having its own distinctive characteristics which cannot
be perceived by looking at, describing, or summarizing the parts"
Environment
  The environment is an "irreducible, pan dimensional energy field identified by
pattern and integral with the human field"
 The field coexist and are integral.
 Manifestation emerge from this field and are perceived.
Health
 "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"
 Health and illness are the part of the 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
Nursing
 Two dimensions Independent science of nursing
1. An organized body of knowledge which is specific to nursing is arrived at by
scientific research and logical analysis
2. Art of nursing practice:
 The creative use of science for the betterment of the human
 The creative use of its knowledge is the art of its practice
 Nursing exists to serve people.
 It is the direct and overriding responsibility to the society
 The safe practice of nursing depends on the nature and amount of scientific nursing
knowledge the individual brings to practice…….the imaginative, intellectual
judgment with which such knowledge is made in service to the man kind.
Rogerian theories-Grand theories
 The theory of paranormal phenomena
 The theory of rhythmicities
 The theory of accelerating evolution

Theory of paranormal phenomena

 This theory explains precognition, déjàvu, clairvoyance, telepathy, and therapeutic
touch
 Clairvoyance is rational in a four dimensional human field in continuous mutual,
simultaneous interaction with a four dimensional world; there is no linear time nor
any separation of human and the environmental fields
The theory of accelerating evolution
 Theory postulates that evolutionary change is speeding up and that the range of
diversity of life process is widening.
 Higher wave frequencies are associated with accelerating human development
Theory of Rhythmicity
 Focus on the human field rhythms (these rhythms are different from the biological,
psychological rhythm)
 Theory deals with the manifestations of the whole unitary man as changes in
human sleep wake patterns, indices of human field motion, perception of time
passing, and other rhythmic development
Theories derived from the science of unitary human beings
 The perspective rhythm model (Patrick 1983)
 Theory of health as expanding consciousness (Neuman, 1986)
 Theory of creativity, actualization and empathy (Alligood 1991)
 Theory of self transcendence (Reed1997)
 Power as knowing participation in change (Barrett 1998)

Dorothea Orem's Self-Care Theory

 Born 1914 in Baltimore, US

 Earned her diploma at Providence Hospital – Washington, DC
 1939 – BSN Ed., Catholic University of America
 1945 – MSN Ed., Catholic University of America
  She worked as a staff nurse, private duty nurse, nurse educator and administrator
and nurse consultant.
 Received honorary Doctor of Science degree in 1976.
 Theory was first published in Nursing: Concepts of Practice in 1971, second in
1980, in 1995, and 2001.
MAJOR ASSUMPTIONS
 People should be self-reliant and responsible for their own care and others in their
family needing care
 People are distinct individuals
 Nursing is a form of action – interaction between two or more persons
 Successfully meeting universal and development self-care requisites is an important
component of primary care prevention and ill health
 A person’s knowledge of potential health problems is necessary for promoting self-
care behaviors
 Self care and dependent care are behaviors learned within a socio-cultural context
DEFINITIONS OF DOMAIN CONCEPTS
Nursing – is art, a helping service, and a technology
 Actions deliberately selected and performed by nurses to help individuals or groups
under their care to maintain or change conditions in themselves or their
environments
 Encompasses the patient’s perspective of health condition ,the physician’s
perspective , and the nursing perspective
 Goal of nursing – to render the patient or members of his family capable of meeting
the patient’s self care needs
 To maintain a state of health
 To regain normal or near normal state of health in the event of disease or injury
 To stabilize ,control ,or minimize the effects of chronic poor health or disability

Health – health and healthy are terms used to describe living things …
 It is when they are structurally and functionally whole or sound … wholeness or
integrity. .includes that which makes a person human,…operating in conjunction
with physiological and psychophysiological mechanisms and a material structure
and in relation to and interacting with other human beings
Environment
 environment components are enthronement factors, enthronement elements,
conditions, and developed environment
Human being – has the capacity to reflect, symbolize and use symbols
 Conceptualized as a total being with universal, developmental needs and capable of
continuous self care
 A unity that can function biologically, symbolically and socially
Nursing client
 A human being who has "health related /health derived limitations that render him
incapable of continuous self care or dependent care or limitations that result in
ineffective / incomplete care.
 A human being is the focus of nursing only when a self –care requisites exceeds self
care capabilities
Nursing problem
 deficits in universal, developmental, and health derived or health related conditions
Nursing process
 a system to determine (1)why a person is under care (2)a plan for care ,(3)the
implementation of care
Nursing therapeutics
 deliberate, systematic and purposeful action,
OREM’S GENERAL THEORY OF NURSING
Orem’s general theory of nursing in three related parts:-
 Theory of self care
 Theory of self care deficit
 Theory of nursing system
A. Theory of Self Care
This theory Includes:
  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" -conditioned by age developmental state, life experience sociocultural
orientation health and available resources
 Therapeutic self care demand – "totality of self care actions to be performed for
some duration in order to meet self care requisites by using valid methods and
related sets of operations and actions"
 Self care requisites - action directed towards provision of self care. 3 categories
of self care requisites are-
o Universal self care requisites
o Developmental self care requisites
o Health deviation self care requisites

1. Universal self care requisites

 Associated with life processes and the maintenance of the integrity of human
structure and functioning
 Common to all , ADL
 Identifies these requisites as:
o Maintenance of sufficient intake of air ,water, food
o Provision of care assoc with elimination process
o Balance between activity and rest, between solitude and social interaction
o Prevention of hazards to human life well being and
o Promotion of human functioning
2. Developmental self care requisites
 Associated with developmental processes/ derived from a condition…. Or associated
with an event
o E.g. adjusting to a new job
o adjusting to body changes
3. Health deviation self care
 Required in conditions of illness, injury, or disease .these include:--
 Seeking and securing appropriate medical assistance
 Being aware of and attending to the effects and results of pathologic conditions
 Effectively carrying out medically prescribed measures
 Modifying self concepts in accepting oneself as being in a particular state of health
and in specific forms of health care
 Learning to live with effects of pathologic conditions
B. 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. Orem
identifies 5 methods of helping:
o Acting for and doing for others
o Guiding others
o Supporting another
o Providing an environment promoting personal development in relation to
meet future demands
o Teaching another
C. Theory of Nursing Systems
 Describes how the patient’s 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
 Design and elements of nursing system define
 Scope of nursing responsibility in health care situations
 General and specific roles of nurses and patients
 Reasons for nurses’ relationship with patients and
  Orem recognized that specialized technologies are usually developed by members
of the health profession
 A technology is systematized information about a process or a method for affecting
some desired result through deliberate practical endeavor, with or without use of
materials or instruments.
Categories of technologies
1. Social or interpersonal
 Communication adjusted to age, health status
 Maintaining interpersonal, intra group or inter group relations for coordination of
efforts
 Maintaining therapeutic relationship in light of psychosocial modes of functioning in
health and disease
 Giving human assistance adapted to human needs ,action abilities and limitations
2. Regulatory technologies
 Maintaining and promoting life processes
 Regulating psycho physiological modes of functioning in health and disease
 Promoting human growth and development
 Regulating position and movement in space
OREM’S THEORY AND NURSING PROCESS
 Nursing process presents a method to determine the self care deficits and then to
define the roles of person or nurse to meet the self care demands.
 The steps within the approach are considered to be the technical component of the
nursing process.
 Orem emphasizes that the technological component "must be coordinated with
interpersonal and social processes within nursing situations.

Nursing Process Orem’s Nursing Process

 Assessment  Diagnosis and prescription;
determine why nursing is
needed. analyze and interpret
–make judgment regarding
care
 Design of a nursing system
and plan for delivery of care
 Production and management
of nursing systems

Step 1-collect data in six areas:-

 The person’s health status

 The physician’s perspective of
the person’s health status
 The person’s perspective of his
or her health
 The health goals within the
context of life history ,life
style, and health status
 The person’s requirements for
self care
 The person’s capacity to
perform self care

 Nursing Step 2
diagnosis
  Plans with  Nurse designs a system that is
scientific wholly or partly compensatory
rationale or supportive-educative.
 The 2 actions are:-
 Bringing out a good
organization of the
components of patients’
therapeutic self care demands
 Selection of combination of
ways of helping that will be
effective and efficient in
compensating for/ overcoming
patient’s self care deficits

 Implementation Step 3
 evaluation
 Nurse assists the patient or
family in self care matters to
achieve identified and
described health and health
related results. collecting
evidence in evaluating results
achieved against results
specified in the nursing
system design
 Actions are directed by
etiology component of nursing
diagnosis
 evaluation

Application of Orem’s theory to nursing process

Therapeutic Adequacy Nursing Methods of

self care of self care diagnosis helping
demand agency
Air Inadequate Potential for Guiding &
Maintain impaired directing
effective respiratory
respiration status
Water Adequate P F fluid
No problem imbalance Teaching
Food maintain Inadequate Actual
sufficient nutritional Providing
intake deficit r/t physical
nausea support
Personal
development
Hazards Inadequate P/F injury
Prevent Guiding &
spouse abuse directing
Promotion of
normalcy Inadequate A/d in Guiding &
environment directing
Shared
housing
Maintain Inadequate Actual delay in Guiding &
developmental normal dev. directing
environment R/T early
 Support ed parenthood Providing psy
normalcy in Level of support
environment Inadequate education
Prevent Providing
/manage dev Dev deficit r/t physical, psy
threat loss of support
reproductive
organs
Maintenance Inadequate P/F contd. Guiding &
of health alterations in directing,
status Inadequate health status teaching
Management P/F UTI Guiding &
of disease directing,
process teaching
Adherence to Inadequate P/F ¯ teaching
med regimen adherence in
self
Awareness of Inadequate catheterization teaching
potential & OPD RT
problems Actual deficit
in awareness
of advisability
of HRT & RT
effects
Adjust to loss Inadequate Actual threat Providing psy
of to self image support
reproductive
ability & dev Actual self Guiding & dir
healthy view Inadequate deficit in
of illness planning for
Adjust life future needs
style to cope
with change

OREM’S WORK AND THE CHARACTERISTICS OF A THEORY

 Orem's theory
o interrelate concepts in such a way as to create a different way of looking at a
particular phenomenon
o is logical in nature.
o is relatively simple yet generalizable
o is basis for hypothesis that can be tested
o contribute to and assist in increasing the general body of knowledge within
the discipline through the research implemented to validate them
o can be used by the practitioners to guide and improve their practice
o must be consistent with other validated theories ,laws and principles
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
 Her self-care approach is contemporary with the concepts of health promotion and
health maintenance
Limitations
 In general system theory a system is viewed as a single whole thing while Orem
defines a system as a single whole, thing.
 Health is often viewed as dynamic and ever changing.
 The theory is illness oriented.
King’s Conceptual Framework and Theory of Goal Attainment

King’s Conceptual System

Imogene King’s Conceptual System scrutinizes the interrelationship between human
beings and their environment, which then defines the physical and social conditions for
them to function (Sieloff, Frey, & King, 2007, p. 5). Human beings are seen as interacting
open systems (Butts & Rich, 2018, p. 466). The environments in which they constantly
interact are both internal and external (Sielfoff et al., 2007, p. 5). Understanding these
interactions enable the nurse to organize his/her knowledge, skills, and values in
adequately assessing the patient and their needs (Butts & Rich, 2018, p. 466). Every
patient-nurse interaction is considered a transaction, facilitating the patient’s goal(s) to be
met (Butts & Rich, 2018, p. 466). King’s model reflects the general systems theory of
nursing by encompassing the metaparadigm concepts of human beings, environment,
health, and nursing.

Metaparadigms

Human Beings (Persons)

Three interacting systems of personal, interpersonal, and social systems comprise the
human beings concept of the metaparadigm. “Personal system is defined as ‘a unified,
complex whole self who perceives, thinks, desires, imagines, decides, identifies goals, and
selects means to achieve them’” (Fawcett, 2017, p. 63). The personal system embodies
the individual that interacts and reacts to stimuli from others and the environment, and
influencing said individual’s function (Butts & Rich, 2018, p. 467).
The interpersonal system occurs between the individual and groups of people and may
include the nurse (Butts & Rich, 2018, p. 467). Paramount to the patient-nurse
transaction is communication. The nurse must believe in the patient’s speech, have the
willingness to listen, and be self-conscious of both his/her verbal and non-verbal
language. Borges, Moreira, da Silva, Loureiro, & de Meneses (2017) exclaimed,
“communication is the means by which learning happens and, to be effective, it has to
happen in an atmosphere of mutual respect and one has to want to be understood” (p.
1774).
The social system is the broader interactions that occur within and between groups, in
which boundaries, social roles, behaviors, and practices are set (Shanta & Connolly, 2013,
p. 175). These groups share commonalities in terms of interests, goals, and values, and
include concepts of organization, power, status, authority, and decision-making (Butts &
Rich, 2018, p. 467).

Environment
Environment consists of both internal and external elements. The internal environment is
found within the individual, whereas the external occurs outside of the individual’s control.
This is transformative as one is able to continuously adjust to changes based on his/her
environment. Silefoff et al. (2007) “is an essential factor in one’s adaptation to life and
health” (p. 5).

Health
Health is defined as the process of growth and development, and the way in which
individuals cope with their stressors and function in their environment (Butts & Rich,
2018, p. 467). It is dynamic and constantly changing, requiring continuous adjustments to
maintain physiological and psychological soundness (Butts & Rich, 2018, p. 468). It can
be optimized through obtaining appropriate resources in dealing with such stressors as
identified in the patient-nurse interpersonal transactions.

Nursing
Nursing is the helping of individuals to maintain their health in order for them to function
within their roles, regardless of age and socioeconomic backgrounds. They help persons
maintain their daily lives and satisfy basic needs. Sielfoff et al. (2007) elaborate, “The
domain of nursing includes promotion of health, maintenance and restoration of health,
care of the sick and injured, and care of the dying” (p. 7).
Value
The value of King’s Conceptual System is its ability to guide nursing practice. Derived
from her conceptual framework, King developed the Theory of Goal Attainment. This
middle-range theory focuses on the interactional process that is the nature of nursing,
guiding individuals in goal attainment of their health. These goals can then be used as
criteria in measuring the effectiveness of nursing (Butts & Rich, 2018, p. 469). Moreover,
“King’s theory exemplifies respect for patients and places importance on information
exchange, goal setting, and patient-centered care” (de Leon-Demara, MacDonald,
Gregory, Katz, & Halas, 2015, p. 632)
In conclusion, King’s Conceptual System provides a unique perspective of the nursing
discipline as abstracted from the metaparadigm concepts. King’s model focuses on the
individual and emphasizes the patient-nurse relationship in identifying and overcoming
barriers to health, with an underlying holistic theme. Based on her conceptual system,
King was able to derive the Theory of Goal Attainment to further advance nursing
research and practice.
Betty Neuman's System Model

 Theorist - Betty Neuman - born in 1924, in Lowel, Ohio.

 BS in nursing in 1957; MS in Mental Health Public health consultation, from UCLA in
1966; Ph.D. in clinical psychology
 Theory was publlished in:
o “A Model for Teaching Total Person Approach to Patient Problems” in Nursing
Research - 1972.
o "Conceptual Models for Nursing Practice", first edition in 1974, and second
edition in 1980.
 Betty Neuman’s system model provides a comprehensive flexible holistic and
system based perspective for nursing.

DEVELOPMENT OF THE MODEL

Neuman’s model was influenced by:

 The philosophy writers deChardin and Cornu (on wholeness in system).
 Von Bertalanfy, and Lazlo on general system theory.
 Selye on stress theory.
 Lararus on stress and coping.
BASIC ASSUMPTIONS
 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 it’s potential for
disturbing a client’s usual stability level or normal LOD (Line of Defence).
 The particular inter-relationships of client variables at any point in time can affect
the degree to which a client is protected by the flexible LOD against possible
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 dynamic composite of the
inter-relationships 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 possible or actual risk factors.
 Secondary prevention relates to symptomatology 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 exchange with the
environment.
MAJOR CONCEPTS (Neuman, 2002)
Content
 the variables of the person in interaction with the internal and external environment
comprise the whole client system
Basic structure/Central core
 The 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 which
include: normal temp. range, genetic structure.- 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 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.
Line of Resistance-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 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 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 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.
 Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002).
Prevention
 the primary nursing intervention.
 focuses on keeping stressors and the stress response from having a detrimental
effect on the body.
 Primary Prevention
o occurs before the system reacts to a stressor.
o strengthens the person (primary the flexible LOD) to enable him to better
deal with stressors
o includes health promotion and maintenance of wellness.
 Secondary Prevention
o occurs after the system reacts to a stressor and is provided in terms of
existing system.
o focuses on preventing damage to the central core by strengthening the
internal lines of resistance and/or removing the stressor.
 Tertiary Prevention
o occurs after the system has been treated through secondary prevention
strategies.
o offers support to the client and attempts to add energy to the system or
reduce energy needed in order to facilitate reconstitution.
FOUR NURSING PARADIGMS
PERSON
 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 Physiological - Refers of the physicochemical structure and function of the
body.
o Psychological - Refers to mental processes and emotions.
o Socio-cultural - Refers to relationships and social/cultural expectations and
activities.
o Spiritual - Refers to the influence of spiritual beliefs.
o Developmental - Refers to those processes related to development over the
lifespan.
ENVIRONMENT
 "the totality of the internal and external forces (intrapersonal, interpersonal and
extra-personal stressors) which surround a person and with which they interact at
any given time."
 The internal environment exists within the client system.
 The external environment exists outside the client system.
 The created environment is an environment that is created and developed
unconsciously by the client and is symbolic of system wholeness.
HEALTH
 Health is equated with wellness.
 “the condition in which all parts and subparts (variables) are in harmony with the
whole of the client (Neuman, 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
 a unique profession that is concerned with all of the variables which influence the
response a person might have to a stressor.
 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.’’
 The role of the nurse is seen in terms of degree of reaction to stressors, and the
use of primary, secondary and tertiary interventions.
NEUMAN'S MODEL & CHRACTERISTICS
 interrelated concepts
 logically consistent.
 logical sequence
 fairly simple and straightforward in approach.
 easily identifiable definitions
 provided guidelines for nursing education and practice
 applicable in the practice

Roy's Adaptation Model

 [Link] Roy- 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.
 Bachelor of Arts with a major in nursing - Mount St. Mary's College, Los Angeles in
1963.
 Master's degree program in pediatric nursing - University of California ,Los Angeles
in 1966.
 Master’s and PhD in Sociology in 1973 and 1977.
 Worked with Dorothy E. Johnson
 Worked as f faculty of Mount St. Mary's College in 1966.
 Organized course content according to a view of person and family as adaptive
systems.
 RAM as a basis of curriculum i at Mount St. Mary’s College
 1970-The model was implemented in Mount St. Mary’s school
 1971- she was made chair of the nursing department at the college.
Assumptions (Roy 1989; Roy and Andrews 1991)
Explicit assumptions
 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 person’s life.
 To respond positively to environmental changes, the person must adapt.
 The person’s adaptation is a function of the stimulus he is exposed to and his
adaptation level
 The person’s 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, self- concept, role
function and inter-dependence.
 "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 for existence with ultimate goal of achieving dignity
and integrity.
Implicit assumptions
 A person can be reduced to parts for study and care.
 Nursing is based on causality.
 Patient’s values and opinions are to be considered and respected.
 A state of adaptation frees an individual’s energy to respond to other stimuli.
Major Concepts
 Adaptation -- goal of nursing
  Person -- adaptive system
 Environment -- stimuli
 Health -- outcome of adaptation
 Nursing- promoting adaptation and health
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
Person
 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
 Functions as a unity for some purpose
 Includes people as individuals or in groups-families, organizations, communities,
and society as a whole.
Environment
 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 particular consideration of
mutuality of person and earth resources, including focal, contextual and residual
stimuli
Health
 Inevitable dimension of person's life
 Represented by a health-illness continuum
 A state and a process of being and becoming integrated and whole
Nursing
 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 assessing behaviors
and factors that influence adaptive abilities and by intervening to enhance
environmental interactions
Subsystems
 Cognator subsystem — A major coping process involving 4 cognitive-emotive
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
Relationships
 Derived Four Adaptive Modes
 500 Samples of Patient Behavior
 What was the patient doing?
 What did the patient look like when needing nursing care?
Four Adaptive Modes
 Physiologic Needs
 Self Concept
 Role Function
 Interdependence
THEORY DEVELOPMENT
Philosophical Assumptions
 Persons have mutual relationships with the world and God
 Human meaning is rooted in an omega point convergence of the universe
 God is intimately revealed in the diversity of creation and is the common destiny of
creation
 Persons use human creative abilities of awareness, enlightenment, and faith
 Persons are accountable for the processes of deriving, sustaining, and transforming
the universe
Adaptation and Groups
  Includes relating persons, partners, families, organizations, communities, nations,
and society as a whole
Adaptive Modes
A. Persons
 Physiologic
 Self Concept
 Role Function
 Interdependence
B. Groups
 Physical
 Group Identity
 Role Function
 Interdependence
Role Function Mode
 Underlying Need of Social integrity
 The need to know who one is in relation to others so that one can act
 The need for role clarity of all participants in group
Adaptation Level
 A zone within which stimulation will lead to a positive or adaptive response
 Adaptive mode processes described on three levels:
 Integrated
 Compensatory
 Compromised
Integrated Life Processes
 Adaptation level where the structures and functions of the life processes work to
meet needs
 Examples of Integrated Adaptation
 Stable process of breathing and ventilation
 Effective processes for moral-ethical-spiritual growth
Compensatory Processes
 Adaptation level where the cognator and regulator are activated by a challenge to
the life processes
 Compensatory Adaptation Examples:
 Grieving as a growth process, higher levels of adaptation and transcendence
 Role transition, growth in a new role
Compromised Processes
 Adaptation level resulting from inadequate integrated and compensatory life
processes
 Adaptation problem
 Compromised Adaptation Examples
 Hypoxia
 Unresolved Loss
 Stigma
 Abusive Relationships
THE NURSING PROCESS
 RAM offers guidelines to nurse in developing the nursing process.
 The elements :
 First level assessment
 Second level assessment
 Diagnosis
 Goal setting
 Intervention
 evaluation
Usefulness of Adaptation Model
 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
Characteristics of the theory
 interrelated
 logical in nature
 relatively simple yet generalizable
 can be the basis for the hypotheses that can be tested
 contribute to and assist in increasing the general body of knowledge of a discipline
 can be utilized by the practitioners to guide and improve their practice
 consistent with other validated theories, laws and principles
 Testable

Summary
 5 elements - person, goal of nursing, nursing activities, health and environment
 Persons are viewed as living adaptive systems whose behaviours may be classified
as adaptive responses or ineffective responses.
 These behaviors are derived from regulator and cognator mechanisms.
 These mechanisms work with in 4 adaptive modes.
 The goal of nursing is to promote adaptive responses in relation to 4 adaptive
modes, using information about person’s adaptation level, and various stimuli.
 Nursing activities involve manipulation of these stimuli to promote adaptive
responses.
 Health is a process of becoming integrated and able to meet goals of survival,
growth, reproduction, and mastery.
 The environment consists of person’s internal and external stimuli
 Johnson's Behaviour System Model

 Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia.

 B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H.
from Harvard University in Boston in 1948.
 From 1949 till retirement in 1978 she was an assistant professor of pediatric
nursing, an associate professor of nursing, and a professor of nursing at the
University of California in Los Angeles.
 Johnson stressed the importance of research-based knowledge about the effect of
nursing care on clients.
Behavior system model
 Dorothy first proposed her model of nursing care in 1968 as fostering of “the
efficient and effective behavioral functioning in the patient to prevent illness".
 She also stated that nursing was “concerned with man as an integrated whole and
this is the specific knowledge of order we require”.
 In 1980 Johnson published her conceptualization of “behavioral system of model for
nursing”where she explains her definitions of the behavioral system model.
Definition of nursing
She defined nursing as “an external regulatory force which acts to preserve the
organization and integration of the patients behaviors at an optimum level under those
conditions in which the behaviors constitutes a threat to the physical or social health, or in
which illness is found”
Four goals of nursing are to assist the patient:
1. Whose behavior commensurate with social demands.
2. Who is able to modify his behavior in ways that it supports biological imperatives
3. Who is able to benefit to the fullest extent during illness from the physicians
knowledge and skill.
4. Whose behavior does not give evidence of unnecessary trauma as a consequence of
illness
Assumptions
There are several layers of assumptions that Johnson makes in the development of
conceptualization of the behavioral system model viz.
 Assumptions about system
 Assumptions about structure
 Assumptions about functions
Assumptions about system
There are 4 assumptions of system:
 1. First, there is “organization, interaction, interdependency and integration of the
parts and elements of behaviors that go to make up the system ”
2. A system “tends to 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.”
3. 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 that it serves a useful purpose, both in social life and for the
individual.
4. Last, “system balance reflects adjustments and adaptations that are successful in
some way and to some degree.”.
Assumptions about structure and function of each subsystem
 “from the form the behavior takes and the consequences it achieves can be inferred
what “drive” has been stimulated or what “goal” is being sought”
 Each individual has a “predisposition to act with reference to the goal, in certain
ways rather than the other ways”. This predisposition is called as “set”.
 Each subsystem has a repertoire of choices or “scope of action”
 The fourth assumption is that it produce “observable outcome” that is the
individual’s behavior.
Each subsystem has three functional requirements
1. System must be “protected" from noxious influences with which system cannot
cope”.
2. Each subsystem must be “nurtured” through the input of appropriate supplies from
the environment.
3. Each subsystem must be “stimulated” for use to enhance growth and prevent
stagnation.
 These behaviors are “orderly, purposeful and predictable and sufficiently stable and
recurrent to be amenable to description and explanation”
Johnson’s Behavioral Subsystem
 Attachment or affiliative subsystem: “social inclusion intimacy and the
formation and attachment of a strong social bond.”
 Dependency subsystem: “approval, attention or recognition and physical
assistance”
 Ingestive subsystem: “the emphasis is on the meaning and structures of the
social events surrounding the occasion when the food is eaten”
 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.”
 Sexual subsystem:" both biological and social factor affect the behavior in the
sexual subsystem”
 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”
 Achievement subsystem: " provokes behavior that attempt to control the
environment intellectual, physical, creative, mechanical and social skills
achievement are some of the areas that Johnson recognizes".
Representation of Johnson's Model
Goal ----- Set --- Choice of Behavior --- Behavior
 Affiliation
 Dependency
 Sexuality
 Aggression
 Elimination
 Ingestion
 Achievement
The four major concepts
  “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.
 “Society” relates to the environment on which the individual exists. According to
Johnson an individual’s behavior is influenced by the events in the environment
 “Health” is a purposeful adaptive response, physically mentally, emotionally, and
socially to internal and external stimuli in order to maintain stability and comfort.
 “Nursing” has a primary goal that is to foster equilibrium within the individual.
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.
Nursing process
Assessment
Grubbs developed an assessment tool based on Johnson’s seven subsystems plus a
subsystem she labeled as restorative which focused on activities of daily living. An
assessment based on behavioral model does not easily permit the nurse to gather detailed
information about the biological systems:
 Affiliation
 Dependency
 Sexuality
 Aggression
 Elimination
 Ingestion
 Achievement
 Restorative
Diagnosis
Diagnosis tends to be general to the system than specific to the problem. Grubb has
proposed 4 categories of nursing diagnosis derived from Johnson's behavioral system
model:
 Insufficiency
 Discrepancy
 Incompatibility
 Dominance
Planning and implementation
Implementation of the nursing care related to the diagnosis may be difficult because of
lack of clients input in to the plan. the plan will focus on nurses actions to modify clients
behavior, these plan than have a goal ,to bring about homeostasis in a subsystem, based
on nursing assessment of the individuals drive, set behavior, repertoire, and observable
behavior. The plan may include protection, nurturance or stimulation of the identified
subsystem.
Evaluation
Evaluation is based on the attainment of a goal of balance in the identified subsystems. If
the baseline data are available for an individual, the nurse may have goal for the
individual to return to the baseline behavior. If the alterations in the behavior that are
planned do occur, the nurse should be able to observe the return to the previous behavior
patterns. Johnson's behavioral model with the nursing process is a nurse centered
activity, with the nurse determining the clients needs and state behavior appropriate for
that need.
Johnson’s and Characteristics of a theory
 Interrelate concepts to create a different way of viewing a phenomenon - Concepts
in Johnson's theory are interrelated.
 Theories must be logical in nature- Johnson's theory is logical in nature.
 Theories must be simple yet generalizable - The theory is simple.
 Theories can be bases of hypothesis that can be tested - Research studies are
conducted applying Jonhson's theory.
 Theories contribute to and assist in increasing the body of knowledge within the
discipline through the research implemented to validate them.
 Theories can be utilized by practitioners to guide and improve their practice.
 Theories must be consistent with other validated theories, laws and principles but
will leave unanswered questions that need to be investigated.
Limitation
 Johnson does not clearly interrelate her concepts of subsystems comprising the
behavioral system model.
 The definition of concept is so abstract that they are difficult to use.
 It is difficult to test Johnson's model by development of hypothesis.
 The focus on the behavioral system makes it difficult for nurses to work with
physically impaired individual to use this theory.
 The model is very individual oriented so the nurses working with the group have
difficulty in its implementation.
 The model is very individual oriented so the family of the client is only considered
as an environment.
 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
cultures will attain same outcome –homeostasis.
 Johnson’s behavioral system model is not flexible.

Summary
Johnson’s 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 composed of four structural characteristics i.e. drives, set, choices and
observable behavior.
Three functional requirement of each subsystem includes
 (1) Protection from noxious influences,
 (2) Provision for the nurturing environment, and
 (3) stimulation for growth.
Any imbalance in each system results in disequilibrium .it is nursing role to assist the
client to return to the state of equilibrium.

Activities

1. Identify 5 systems in your environment and how are you related to it?
Eg. Example of environmental systems are clean water, solid waste disposal,
environment sustainability, energy conservation. Example natural systems school
system, government system, public transportation.

Post Test

TRUE or FALSE

___1. Human beings is considered as a whole which cannot be viewed as subparts.

___2. Dorotea Orem is the theorist who developed self care deficit nursing theory.

___3. Imogene King developed goal attainment theory.

___4. Adaptation model is developed by Calista Roy.

___5. The theory of Betty Neuman is all about system model in nursing practice.

Answer

References:

1. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd
ed. Norwalk, Appleton & Lange.
2. Wills [Link], McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Lippincott Williams& wilkins.
3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed.
Philadelphia, Lippincott.
4. Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-
Year Book Inc.
5. Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M.
6. Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline
and profession. Nursing Theorists and their work. Mosby, St. Louis, Missouri, United
States of America.
7. Butts, J.B., & Rich, K.L. (2018). Philosophies and Theories for Advanced Nursing
Practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
8. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, NY.