Module 3
Nursing Conceptual Models
Student Learning Outcomes: At the end of the lesson the student should be able to:
1. Identify the concepts that serve as foundation of a conceptual model.
2. Integrate the significance of conceptual models in the practice of nursing.
Topics:
1. Science of Unitary Human Beings Theory
2. Self-Care Deficit Theory
3. Goal Attainment Theory
4. Systems Model Theory
5. Adaptation Model Theory
Nursing Conceptual Models
- broad formulations of philosophy that are based on an attempt to include the
whole of nursing reality as the scholar understands it
- concepts and their relationships that specify a perspective and produce evidence
among phenomenon specific to the discipline
- address broad metaparadigm concepts that are central to their meaning in the
context of a particular framework and the nursing discipline
Lesson 1
Martha Rogers’ Science of Unitary Human Being
Background of the Theorist
born on May 12, 1914 (the
anniversary of Florence Nightingale’s
birth) (Dossey, 2000) in Dallas, Texas.
earned a diploma in nursing from
Knoxville General Hospital in 1936 and
a bachelor’s degree from George
Peabody College in Nashville,
Tennessee in 1937
received a master’s degree in
public health nursing from Teachers
College, Columbia University in New
York, and a master’s degree in public
health and a doctor of science from The Johns Hopkins University in Baltimore,
Maryland (Gunther, 2010)
became the head of the Division of Nursing of New York University (NYU) in
1954, where she focused on teaching and formulating and elaborating her theory
(Hektor, 1989)
teacher and mentor to an impressive list of nursing scholars and theorists,
including Newman and Parse
continued her work and writing until her death in March, 1994
Major Concepts and Definitions
Nursing is both an art and science
Emphasis: essentials, possibilities and potentials that exist within the wholeness
of life
Human being and environment are energy fields that are irreducible and equal to
more than the sum of their parts
The unitary human being and the environment are integral and therefore viewed
as a whole. This holistic perspective differentiates nursing from other sciences
and identifies nursing focus.
Life processes in human are characterized by:
o Energy field
o Openness
o Pattern
o Pandimensionality
a. Energy field
- Potential for process, movement and change
- Fundamental unit of both living and non-living
- Provides a way to perceive people and their environment as irreducible whole
b. Openness
-human field and the environment are constantly exchanging energy
- no boundaries or barriers to inhibit energy between fields
c. Pattern
-distinguishing characteristic of an energy field perceived as a single wave
- abstraction that gives field identity
- dynamic or active life process of human being which consists of his
expressions, perceptions, mental, social and spiritual data
d. Pandimensionality
- Nonlinear domain without spatial or temporal attributes
- Present is relative, there is no temporal ordering of lives
e. Homeodynamic principles
-postulate the way of perceiving unitary human beings
-the fundamental unit of the living system is an energy field
Principles of Homeodynamics Applied in Rogers’ Theory
1. Resonancy is continuous change from lower to higher frequency wave
patterns in human and environmental fields.
-intensity of change; ordered arrangement of rhythm of human and
environmental field
2. Helicy is continuous innovative, unpredictable, non-linear, increasing diversity
of human and environmental field patterns.
-life processes or nature of change
3. Integrality is continuous mutual human and environmental field processes/
relationship
-process where change occurs by repatterning of human and environmental
fields
The fields
are one
and
integrated
but
unique to
each
other.
Central Concepts of Rogers’ Science of Unitary Human Beings
Concept Definition
Human–unitary human beings “Irreducible, indivisible, multidimensional energy fields
identified by pattern and manifesting characteristics
that are specific to the whole and which cannot be
predicted from the knowledge of the parts”.
A unified whole having its own distinctive
characteristics which cannot be perceived by looking
at, describing or summarizing the parts
Health “Unitary human health signifies an irreducible human
field manifestation. It cannot be measured by the
parameters of biology or physics or of the social
sciences”.
An expression of the life process; characteristic and
behavior which emerged from the mutual,
simultaneous interaction of the human and
environment fields.
Environment irreducible, pan-dimensional energy field identified by
pattern and integral with human field
Environmental fields are infinite, with innovative and
unpredictable changes characterized by increasing
diversity
Nursing “The study of unitary, irreducible, indivisible human
and environmental fields: people and their world”.
A learned profession that is both a science and an art
Five Assumptions/ Theoretical Assertions
1. Man is a unified whole possessing his own integrity and manifesting
characteristics more than and different from the sum of his parts. (energy field)
More than his physiologic aspect, man is endowed with intellect, will, decision-
making abilities and values that comprise his social, psychological, spiritual
dimension.
2. Man and environment are continuously exchanging matter and energy with one
another. (openness)
Man is an open system because as long as he is alive, he continuously
exchanges matter and energy with the environment. He consumes food, air
water, temperature in a favorable manner and consequently affected if those
necessities are contaminated or in an unfavorable manner.
Man is affected by good news and by bad news as well; and reacts on it too
accordingly.
3. The life process evolves irreversibly and unidirectionally along the space-time
continuum.(helicy)
“That it will never come again is what makes life so sweet. “
4. Pattern and organization identify man and reflect his innovative wholeness.
(pattern and organization)
Man has different characteristics or energy field. He has a sense of self, degree
of wellbeing, time perception, which are unique to individual energy field.
5. Man is characterized by the capacity for abstraction and imagery, language and
thought, sensation and continuum. (sentient keeping being)
Representation of Martha Rogers’ Theory
The “Slinky”
Imagine the life process moving along the “Slinky” spirals with the human field
occupying space along the spiral and extending out in all directions from any given
location along a spiral. Each turn of the spiral exemplifies the rhythmical nature of life,
while distortions of the spiral portray deviations from nature’s regularities. Variations in
the speed of change through time may be perceived by narrowing or widening the
distance between spirals.
The slinky represents that life process is
continuous and it moves unidirectional from
conception to birth in a non -linear plane.
(spiral)
When the spirals are moulded, they do not go
back to its original state. Similarly, the nature of
human change is spiral like, continuously
progressing towards diversity.
Like a human life process, kaleidoscope
illustrates the changing patterns that are
infinitely different.
Lesson 2
Dorothea Orem’s Self Care Deficit Theory
Background of the Theorist
Dorothea Orem was born
in Baltimore, Maryland.
She received her diploma
in nursing from Providence Hospital
School of Nursing in Washington, DC,
and her baccalaureate degree in
nursing from Catholic University in
1939.
In 1945, she also earned
her master’s degree from Catholic
University (Taylor, 2006).
Orem held a number of
positions as private duty nurse, hospital staff nurse, and educator.
She was the director of both the School of Nursing and Nursing Service at
Detroit’s Providence Hospital until 1949, moving from there to Indiana
where she served on the Board of Health until 1957.
She assumed a role as a faculty member of Catholic University in 1959,
later becoming acting dean (Taylor, 2006)
Concepts in Orem’s Self-Care Deficit Theory
What condition exists in a person when judgements are made that a nurse
should be brought into the situation? That condition which needs nursing assistance is
the inability of the persons to provide for themselves the amount and quality of required
self- care.
The self-care deficit nursing theory is a general theory composed of the following
four related theories:
1. The theory of self-care, which describes why and how people care for
themselves.
1. Self-care - is a human regulatory function that is a deliberate action to
supply or ensure the supply of necessary materials needed for continued
life, growth, and development and maintenance of human integrity.
-practice of activities that mature and maturing persons perform for
functional and developmental regulations
2. Self-care agency- ability for engaging in self-care activities conditioned
by age, developmental state, life experience and available resources.
3. Therapeutic self-care demand – totality of self- care actions or nursing
care measures to be performed for some duration in order to meet all
individuals’ self-care requisites by using valid methods
4. Self-care requisites - actions directed toward provision of care. There
are three types: universal, developmental, and health deviation self-care
requisites.
Universal self-care requisites- associated with life processes which
are common to all humans to maintain their integrity and
functioning. (Activities of Daily Living/ ADL)
Developmental self-care - requisites necessary for growth and
development, derived from a condition or associated with an event
-overcoming effects of human conditions and life situations
that can adversely affect human development-
- Examples: adjusting to new job, adjusting to body changes
in adolescent years, pregnancy or old age
Health deviation self-care - requisites associated with health deficits
such as illness, injury or disease.
- seeking appropriate medical assistance, carrying out
medically prescribed measures, learning to live and accept
with the effects of pathologic conditions
2. The theory of dependent-care, which explains how family members and/or
friends provide dependent-care for a person who is socially dependent
Dependent care- patient care provided when he is unable to perform self- care
measures needed to maintain life because of age or related factors
Dependent-care agency- acquired ability of a person to know and meet the
therapeutic self-care demand of the dependent person
Dependent-care deficit- occurs when the dependent care provider’s agency is not
adequate to meet the therapeutic self-care demand of the patient
Dependent- care demand- care measures to meet the dependent’s therapeutic
self-care demand when his self- care agency is inadequate or operational
3. The theory of self-care deficit, which describes and explains why people can
be helped through nursing
Self-care deficit- relationship between an individual’s therapeutic self-care
demand and his powers of self-care agency when it is inadequate or inoperable
4. The theory of nursing systems, which describes and explains relationships that
must be brought about and maintained for nursing to be produced.
Nursing systems are series of practical nursing actions coordinated with patient’s
actions to meet the therapeutic self-care demands of the patient
3 classifications of nursing systems to meet the self-care requisites of the patient
1. Wholly compensatory system- patient is dependent; and the nurse is
expected to accomplish all the patient’s therapeutic self-care
a. Unconscious patient from a CVA (stroke; cerebrovascular
accident) and the nurse provides total patient care like feeding,
hygiene, suctioning
b. Quadriplegia patient from SCI (spinal cord injury) because of a
fall and the nurse provides all nursing care to meet his needs
(all aspects of needs aside from physiological)
2. Partially compensatory system- patient can meet some needs; both
nurse and patient engage in meeting self-care needs
a. Post- operative patient from a leg fracture has cast and needs
assistance on self-care activities (bathing, feeding, transfer and
mobility) until he get used to crutches
3. Supportive education system- patient can meet self- care requisites but
needs assistance with decision making on skills to meet self-care
a. Primigravida patient (first time pregnancy)- the pregnancy is
normal and the patient is capable but she needs to learn self-
care for pregnancy- nutrition, activity, relief of pregnancy
discomfort, pre-natal check up until post partum
Metaparadigm of Nursing in Orem’s Theory
a. Person- a total being with universal, developmental needs and capable of
continuous self-care.
o A nursing client who has health derived limitations that render him
incapable of continuous self- care that
A human being is the focus of nursing only when self-care requisites
exceeds self-care capabilities.
b. Environment- components are environmental factors, environmental elements,
conditions and developmental environment.
c. Health- when human beings are structurally and functionally whole or sound.(if a
person operates in conjunction with physiological and psychological mechanisms
while interacting with other human beings
d. Nursing- an art, helping service and a technology
- Actions deliberately performed by nurses to help individuals or groups to
maintain or change the environment