TFN REVIEWER

MARTHA ROGERS: SCIENCE OF

UNITARY HUMAN BEINGS

Martha Elizabeth Rogers (May 12, 1914 – In 1970, Rogers’ conceptual model of
March 13, 1994) was an American nurse, nursing rested on a set of basic assumptions
researcher, that described the life process in human
theorist, and author widely known for beings. Wholeness, openness,
developing the Science of Unitary Human unidirectionality, pattern and organization,
Beings and for her landmark book, An sentience, and thought characterized the life
Introduction to the Theoretical Basis of process (Rogers, 1970). Rogers
Nursing. consistently updated the conceptual model
She believes that a patient can never be through revision of the homeodynamic
separated from his or her environment when principles.
addressing health and treatment. Her
knowledge about the coexistence of the 5 ASSUMPTIONS
human and his or her environment
contributed a lot in the process of change WHOLENESS — Man is a unified whole
toward better health. possessing his own integrity and manifesting
Her model addresses the importance of the characteristics more than and different from
environment as an integral part of the the sum of his parts”
patient, and uses that knowledge to help
nurses blend the science and art of nursing OPENNESS — The concept of the universe
to ensure patients have a smooth of open systems holds that energy fields are
recovery and can get back to the best health infinite, open, and integral with one another
possible. (Rogers, 1983). The human and
environmental fields are in continuous
THE SCIENCE OF UNITARY HUMAN process and are open systems.
BEINGS
UNIDIRECTIONAL — The life process
Martha Rogers’ theory is known as the evolves irreversibly and unidirectionally
Science of Unitary Human Beings (SUHB). along the space-time continuum.
The theory views nursing as both a science
and an art as it provides a way to view the PATTERN AND ORGANIZATION — identify
unitary human being, who is integral with man and reflect his innovative wholeness.
the universe. The unitary human being and
his or her environment are one. Nursing SENTINENT AND THINKING BEING — Man
focuses on people and the manifestations is characterized by the capacity for
that emerge from the mutual human abstraction and imagery, language and
environmental field process. SUHB contains thought, sensation, and emotion.
two dimensions:

THE SCIENCE OF NURSING, which is the

knowledge specific to the field of nursing that
comes from scientific research

ART OF NURSING, which involves using the

science of nursing creatively to help better
the life of the patient
HOMEODYNAMIC PRINCIPLES MAJOR ASSUMPTIONS
POSTULATE A WAY OF VIEWING Unitary Human Being A unitary human being is
UNITARY HUMAN BEINGS. “an irreducible, indivisible, pandimensional
energy field identified by pattern and manifesting
RESONANCY is an ordered arrangement of characteristics that are specific to the whole
rhythm characterizing both the human and and which cannot be predicted from knowledge
environmental fields that undergo of the parts”. The life process of the unitary
continuous dynamic metamorphosis in the human being is one of wholeness and continuity
human environmental process as well as dynamic and creative change.

HELICY describes the unpredictable, NURSING is a learned profession and is both a

nonlinear evolution of energy fields as seen science and an art. It is an empirical science
in non-repeating rhythmicities, and and, like other sciences, it lies in the
postulates an ordering of the human phenomenon central to its focus. Rogerian
evolutionary emergency. nursing focuses on concern with people and the
world in which they live a natural fit for nursing
INTEGRALITY means a changes occur by care, as it encompasses people and their
the continuous repatterning of the human environments. The integrality of people and their
and environmental fields by resonance environments, operating from a
waves. The fields are integrated into each pandimensional universe of open systems,
other, but are also unique. points to a new paradigm and initiates the
identity of nursing as a science
4 CONCEPTS
HEALTH. She uses the term passive health to
ENERGY FIELD it is an inevitable part of symbolize wellness and the absence of disease
life. Human and environment both have and major illness (Rogers, 1970). Her promotion
energy filed which is open. i.e energy can of positive health connotes direction in helping
freely flow between human and people with opportunities for rhythmic
environment. consistency. She uses health as a value term
defined by the culture or the individual. Health
OPEN SYSTEMS hold that there is no and illness are manifestations of pattern and are
boundaries or barrier that can inhibit the considered “to denote behaviors that are of high
flow of energy between human and value and low value.”
environment which leads to continuous
movement or matter of energy. ENVIRONMENT is “an irreducible,
pandimensional energy field identified by pattern
PATTERN is the distinguishing and manifesting characteristics different from
characteristic of an energy field and is those of the parts. Each environmental field is
perceived as a single wave. The nature of specific to its given human field.” Environmental
the pattern changes continuously and fields are infinite, and change is continuously
innovatively, and these changes give innovative, unpredictable, and characterized by
identity to the energy field. increasing diversity. Environmental and human
fields are identified by wave patterns manifesting
PANDIMENSIONALITY provides for an continuous mutual change.
infinite domain without limit. It best
expresses the idea of a unitary whole
THEORY IMPLICATION TO NURSING DOROTHEA OREM (SELF
PRACTICE, EDUCATION and RESEARCH
CARE DEFICIT THEORY)
NURSING PRACTICE was defined by
Martha Rogers as “the process by which the Dorothea Elizabeth Orem, one of America’s
body of scientific knowledge (nursing foremost nursing theorists, was born in
science) is used for the purpose of assisting Baltimore, Maryland, in 1914. She began
human beings to move in the direction of her nursing career at Providence Hospital
maximum well- being” (George, 2011, p. School of Nursing in Washington, DC,
272). Rogers also separated the nursing where she received a diploma of nursing in
practice process into two different groups: the early1930s.
Evaluative and diagnostic phase includes
determining the patients’ and their family’s The Self-Care Deficit Theory developed as a
well-being status at the time result of working toward her goal of
Interventive how the nurse will go about improving the quality of nursing in general
implementing nursing interventions for the hospitals in her state. The model interrelates
patient. concepts in such a way as to create a
different way of looking at a particular
EDUCATORS, that teach either in class or phenomenon. The theory is relatively
online, that use Rogers’ model recognize simple, but generalizable to apply to a wide
that their students have individual variety of patients. It can be used by nurses
personalities and patterns to their work. They to guide and improve practice, but it must be
are all unitary human beings and should be consistent with other validated theories,
interacted with differently. Culture, family, laws and principles.
and experiences affect their reasons and
motives to become a nurse. Rogers Orem (1997) identified “five broad views of
worldwide view of Science of Unitary Human human beings that are necessary for
Beings focuses on “the integrality of person developing understanding of the conceptual
and environment, the individual’s active constructs of the SCDNT and for
participation in change, and each person’s understanding the interpersonal and
individual pattern” societal aspects of nursing systems”. These
are the view of PERSON, AGENT, USER
THE RESEARCH done on Martha Rogers’ OF SYMBOLS, ORGANISM, and OBJECT.
theory is based off of many questions
regarding the concepts and specifics of her The view of human beings as person
theory. It was found that the theory applies reflects the philosophical position of
to any environment that contains human moderate realism; it is this position
beings. Her theory focuses nursing regarding the nature of human beings that is
interventions on the patient well -being foundational to Orem’s work. position that
overall and not just their disease state. It human beings are unitary beings
encourages the use of guided imagery,
relaxation, therapeutic touch, and
meditation
Self-care, which refers to those actions in Self care agency is the ability of a person to
which a person engages for the purpose of perform their self-care activities. Self-care
promoting and maintaining life, health, and agency consists of two agents, self-care
well-being, is conceptualized as a form of agent and dependent care agent. Self-care
deliberate action agent is a person who provides the self-care
and dependent care agent is a person other
DELIBERATE ACTION refers to actions than the individual who provides the care, for
performed by individual human beings who example, the patient
have intentions and are conscious of their
intentions to bring about, through their THERAPEUTIC SELF-CARE DEMAND is
actions, conditions or states of affairs that do the totality of self-care actions to be
not at present exist. When engaging in performed for some duration in order to meet
deliberate action, the person acts as an self-care requisites by using valid methods
agent. and related sets of operations and actions.

The self-care deficit nursing theory is a THEORY OF SELF-CARE DEFICIT is how

general theory composed of the following an adult learns to care on one self and how
four related theories: thus person can be helped through the
nursing process. Nurses use five methods to
THE THEORY OF SELF-CARE, which meet the self-care needs of patients.
describes why and how people care for Including:
themselves. • acting for or doing for another,
• guiding and directing,
THE THEORY OF DEPENDENT-CARE, • providing physical and psychological
which explains how family members and/or support,
friends provide dependent-care for a person • providing and maintaining an environment
who is socially dependent that supports personal development and
teaching.
THE THEORY OF SELF-CARE DEFICIT,
which describes and explains why people THEORY OF SELF-CARE is the basic needs
can be helped through Nursing of every individual. Such needs would
include breathing, intake of water and food,
THE THEORY OF NURSING SYSTEMS, elimination of waste etc. These are the basic
which describes and explains relationships needs of life. Developmental self-care
that must be brought about and maintained requisites are the major life changes in one
for nursing to be produced life that leads to one’s development of self-
care activities. A health-deviation self-care
THEORY ASSERTION requisite is when people obtain the help that
Presented as a general theory of nursing, they need when they need it to maintain and
one that represents a complete picture of gain the health they need.
nursing, the SCDNT is expressed in the
following three theories:
• Nursing systems theory is the relationships
that a nurse must have to promote the end
product of a patient as defined by the nurse
and patient in the development of the plan of
care. There are three different systems that
a nurse can use to obtain this goal.
METAPARADIGM OF SELF CAREFUL IMOGENE KING (THEORY
DEFICIT THEORY
OF GOAL ATTAINMENT)
PERSON as described by Orem is the
individual under nursing care. The person is Imogene M. King was born on January 30,
viewed biologically, symbolically and 1923, in West Point, Iowa. She died
socially but still as a whole person. This December 24, 2007, in St. Petersburg,
person is considered to be able to provide Florida,
self-care She was one of the pioneers and most
sought nursing theorists for her Theory of
ENVIRONMENT is the physical, chemical, Goal Attainment which was developed in
biologic and social factors that make up who the early 1960s. Her work is being taught to
a person is. Also, included would be thousands of nursing students from all
environmental factors, elements, conditions over the world and is implemented in a
and development. This influences a patient variety of service settings as well.
needs as related to healthcare. Imogene King contributed to the
advancement of nursing knowledge through
HEALTH as defined by Orem as “a state the development of her conceptual
characterized by soundness or wholeness of system and middle-range Theory of Goal
developed human structures and of bodily Attainment. By focusing on the attainment
and mental functioning. of goals, or outcomes, by nurse-patient
partnerships, King provided a conceptual
NURSING is how a healthcare professional system and middle-range theory that has
develops a plan of care to meet the patient’s demonstrated its usefulness to nurses.
self-care needs as described in Orem’s Nurses working in a variety of settings
definitions of the wholly compensatory, with patients from around the world continue
partly compensatory and supportive- to use King’s work to improve the quality of
educative system patient care
According to King, the patient is a social
Orem’s approach to the nursing process being who has three fundamental needs: the
provides a method to determine the self- need for health information, the need for
care deficits and then to define the roles care that seeks to prevent illness, and the
of patient or nurse to meet the self-care need for care when the patient is unable to
demands. The steps in the approach are help him or herself. She explains health as
thought of as the technical component of the involving life experiences of the patient,
nursing process. The nursing process in this which includes adjusting to stressors in the
model has three parts. internal and external environment by using
ASSESSMENT, which collects data to resources available. The environment is the
determine the problem or concern that background for human interaction. It
needs to be addressed. involves the internal environment, which
DIAGNOSIS AND CREATION of a nursing transforms energy to enable people to
care plan. adjust to external environmental changes,
IMPLEMENTATION AND EVALUATION. and it involves the external environment,
The nurse sets the health care plan into which I s formal and informal organizations.
motion to meet the goals set by the patient A nurse is considered part of the patient’s
and his or her health care team, and, when environment.
finished, evaluate the nursing care by
interpreting the results of the implementation
of the plan.
There are three interacting systems in the • Health is a dynamic state in the life cycle,
Theory of Goal Attainment according to King. while illness interferes with that process.
Health “implies continuous adjustment to
PERSONAL SYSTEM as a patient or a nurse. stress in the internal and external
specified the concepts of body image, growth environment through the optimum use of
and development, perception, self, space, one’s resources to achieve the maximum
and time in order to comprehend human potential for daily living.
beings as persons.
• Environment is “an understanding of the
INTERPERSONAL SYSTEM form when two ways that human beings interact with their
or more individuals interact, forming dyads environment to maintain health was essential
(two people) or triads (three people). The for nurses”. Open systems imply that
dyad of a nurse and a patient is one type of interactions occur constantly between the
interpersonal system. Families, when acting system and the system’s environment.,
as small groups, also can be considered “adjustments to life and health are influenced
interpersonal systems. Understanding the by an individual’s interaction with
interpersonal system requires the concepts of environment. Each human being perceives
communication, interaction, role, stress, and the world as a total person in making
transaction. transactions with individuals and things in the
environment”
SOCIAL SYSTEM is a more comprehensive
King’s middle-range Theory of Goal
interacting system consists of groups that
Attainment focused on all aspects of the
make up society, Religious, educational, and
nursing process: assessment, planning,
health care systems are examples of social
implementation, and evaluation. The body of
systems Within a social system, the concepts
literature clearly establishes King’s work as
of authority, decision making, organization,
important for knowledge building in the
power, and status guide system
discipline of nursing. Individuals are unique
understanding.
and holistic, of intrinsic worth, and capable of
MAJOR ASSUMPTIONS OF IMOGENE rational thinking and decision making in
KING most situations. Individuals differ in their
needs, wants, and goals.
• Nursing is an observable behavior found in
the health care systems in society”. The goal ASSESSMENT is when the nurse collects
of nursing “is to help individuals maintain data regarding the patient including his or her
their health so they can function in their roles” growth and development, the perception of
self, and current health status.
• Individuals are spiritual beings and have the PERCEPTION is the base for the collection
ability through their language and other and interpretation of data.
symbols to record their history and preserve COMMUNICATION is required to verify the
their culture. . Individuals are unique and accuracy of the perception, as well as for
holistic, of intrinsic worth, and capable of interaction and translation.
rational thinking and decision making in most NURSING DIAGNOSIS is developed using
situations. Individuals differ in their needs, the data collected in the assessment. In the
wants, and goals process of attaining goals, the nurse identifies
problems, concerns, and disturbances about
which the patient is seeking help
CREATE A CARE PLAN OF Dorothy Johnson’s theory defined
INTERVENTIONS to solve the problems Nursing as “an external regulatory force
identified. The planning is represented by which acts to preserve the organization
setting goals and making decisions about the and integration of the patient’s behaviors
means to achieve those goals. at an optimum level under those
IMPLEMENTATION PHASE of the nursing conditions in which the behavior
process is the actual activities done to constitutes a threat to the physical or
achieve the goals. In this model of nursing, it social health, or in which illness is found.”
is the continuation of transaction.
EVALUATION involves determining whether It also states that “each individual has
or not goals were achieved. The explanation patterned, purposeful, repetitive ways of
of evaluation in King’s theory addresses acting that comprises a behavioral system
meeting goals and the effectiveness of specific to that individual.”
nursing care.
ASSUMPTIONS:

DOROTHY JOHNSON'S: (1) There is “organization, interaction,

interdependency and integration of the
BEHAVIORAL
parts and elements of behaviors that go
SYSTEM MODEL to make up the system.”

Dorothy Johnson is known for her (2) A system

“Behavioral System Model of Nursing,” "tends to achieve a balance among the
which was first various forces operating within and upon
proposed in 1968. Her nursing model it, and that man strive continually to
states that “each individual has patterned, maintain a behavioral system balance
purposeful, repetitive ways of acting that and steady state by more or less
comprises a behavioral system specific automatic adjustments and adaptations to
to that individual.” It advocates the the natural forces occurring on him.”
fostering of efficient and effective
behavioral functioning in the patient to (3) A behavioral system, which requires
prevent illness. The patient is defined as and results in some degree of regularity
a behavioral system composed of seven and constancy in behavior, is essential to
behavior subsystems: AFFILIATE, man. It is functionally significant because
DEPENDENCY, INGESTIVE, ELIMINATIVE, it serves a useful purpose in social life
SEXUAL, AGGRESSIVE, and as well as for the individual.
ACHIEVEMENT.
(4) “System balance reflects adjustments
Each subsystem also has three and adaptations that are successful in some
functional requirements which include way and to some degree.”
(1) protection from noxious influences,
(2) provision for a nurturing environment
(3) stimulation for growth.
An imbalance in each system results in
disequilibrium. The nurse’s role is to help
the patient maintain
his or her equilibrium.
 MAJOR CONCEPTS

FOUR ASSUMPTIONS ABOUT HUMAN BEINGS

STRUCTURE AND FUNCTION Johnson views human beings as having two
major systems: the biological system and the
(1) “From the form the behavior behavioral system. It is the role of medicine to
takes and the consequences it focus on the biological system, whereas
achieves can be inferred what nursing’s focus is the behavioral system. The
‘drive’ has been stimulated or what concept of human being was defined as a
"goal" is being sought.” behavioral system that strives to make continual
adjustments to achieve, maintain, or regain
(2) Each individual person has a balance to the steady-state that is adaptation.
“predisposition to act with reference to
the ENVIRONMENT
goal, in certain ways rather than the Environment is not directly defined, but it is
other ways.” This predisposition is implied to include all elements of the
called a “set.” surroundings of the human system and includes
interior stressors.
(3) Each subsystem has a repertoire of
choices called a “scope of action." HEALTH
Health is seen as the opposite of illness, and
(4) The individual patient’s Johnson defines it as “some degree of
behavior produces an outcome that regularity and constancy in behavior, the
can be observed. behavioral system reflects adjustments and
adaptations that are successful in some way and
THREE FUNCTIONAL to some degree… adaptation is functionally
REQUIREMENTS FOR THE efficient and effective.”
SUBSYSTEMS
NURSING
1) The system must be protected from Nursing is seen as “an external regulatory
toxic influences with which the system force which acts to preserve the organization
cannot cope. and integration of the patient’s behavior at an
optimal level under those conditions in which
(2) Each system has to be nurtured the behavior constitutes a threat to physical or
through the input of appropriate social health, or in which illness is found.”
supplies from the environment.
BEHAVIORAL SYSTEM
(3) The system must be stimulated Man is a system that indicates the state of the
for use to enhance growth and system through behaviors.
prevent stagnation.
SYSTEM
That which functions as a whole by virtue of
organized independent interaction of its
parts.

SUBSYSTEM
A mini system maintained in relationship to the
entire system when it or the environment is
not disturbed.
SUBCONCEPTS 7 SUBSYSTEMS:

STRUCTURE ATTACHMENT OR AFFILIATE SUBSYSTEM

The parts of the system that make up Attachment or affiliative subsystem is the
the whole. “social inclusion intimacy and the formation and
attachment of a strong social bond.” It is
VARIABLES probably the most critical because it forms
Factors outside the system that the basis for all social organization. On a
influence the system’s behavior, but general level, it provides survival and
which the system lacks power security. Its consequences are social inclusion,
to change. intimacy, and the formation and maintenance
of a strong social bond
BOUNDARIES DEPENDENCY SUBSYSTEM
The point that differentiates the Dependency subsystem is the “approval,
interior of the system from the exterior. attention or recognition and physical
assistance.” In the broadest sense, it promotes
HOMEOSTASIS helping behavior that calls for a nurturing
Process of maintaining stability. response. Its consequences are approval,
attention or recognition, and physical assistance.
STABILITY Developmentally, dependency behavior evolves
Balance or steady-state in maintaining from almost total dependence on others to a
balance of behavior within an greater degree of dependence on self. A
acceptable range. certain amount of interdependence is essential
for the survival of social groups.
STRESSOR INGESTIVE SUBSYSTEM
A stimulus from the internal or external Ingestive subsystem is the “emphasis on the
world that results in stress or instability. meaning and structures of the social events
surrounding the occasion when the food is
TENSION eaten.” It should not be seen as the input
The system’s adjustment to demands, and outputmechanisms of the system. All
change or growth, or to actual subsystems are distinct subsystems with their
disruptions. own input and output mechanisms. The
INSTABILITY ingestive subsystem “has to do with when,
State in which the system output of how, what, how much, and under what
energy depletes the energy needed to conditions we eat.”
maintain stability. ELIMINATIVE SUBSYSTEM
Eliminative subsystem states that “human
SET cultures have defined different socially
The predisposition to act. It implies that acceptable behaviors for excretion of waste,
despite having only a few alternatives but the existence of such a pattern remains
from which to different from culture to culture.” It addresses
select a behavioral response, the “when, how, and under what conditions we
individual will rank those options and eliminate.” As with the ingestive subsystem,
choose the option considered most the social and psychological factors are
desirable. viewed as influencing the biological
aspects of this subsystem and may be, at
FUNCTION times, in conflict with the eliminative subsystem.
Consequences or purposes of action.
SEXUAL SUBSYSTEM
Sexual subsystem is both a biological and
social factor that affects behavior. It has the CALLISTO ROY'S
dual
ADAPTATION MODEL OF
functions of procreation and gratification.
Including, but not limited to, courting and NURSING
mating, this response system begins with the
development of gender role identity and The Adaptation Model of Nursing is a
includes the broad range of sex-role prominent nursing theory aiming to
behaviors. explain or define the provision of nursing
AGGRESSIVE SUBSYSTEM science. In her theory, Sister Callista
Aggressive subsystem relates to the Roy’s model sees the individual as a
behaviors concerning protection and self- set of interrelated systems who strives to
preservation, generating a defense response maintain a balance between various
when there is a threat to life or territory. stimuli.
Its function is protectionand preservation.
Society demands that limits be placed on The Roy Adaptation Model was first
modes of self-protection and that people and presented in the literature in an article
their property be respected and protected. published in Nursing Outlook in 1970 entitled
ACHIEVEMENT SUBSYSTEM “Adaptation: A Conceptual Framework for
Achievement subsystem provokes behavior Nursing.” In the same year, Roy’s
that tries to control the environment. It Adaptation Model of Nursing was
attempts to adapted in Mount St. Mary’s School in
manipulate the environment. Its function Los Angeles, California.
is control or mastery of an aspect of self or Roy’s model was conceived when
environment to some standard of nursing theorist Dorothy Johnson
excellence. Areas of achievement behavior challenged her students during a
include intellectual, physical, creative, seminar to develop conceptual models
mechanical, and social skills. of nursing. Johnson’s nursing model was
the impetus for the development of
BEHAVIORAL SYSTEM MODEL AND THE Roy’s Adaptation Model.
NURSING PROCESS
Roy’s model incorporated concepts from
The nursing process of the Behavior Adaptation-level Theory of Perception from
System Model of Nursing begins with an renown American physiological
assessment and diagnosis of the patient. psychologist Harry Helson, Ludwig von
Once a diagnosis is made, the nurse and Bertalanffy’s System Model, and Anatol
other healthcare professionals develop a Rapoport’s system definition. First,
nursing care plan of interventions and consider the concept of a system as
setting them in motion. The process ends applied to an individual. Roy
with an evaluation, which is based on the conceptualizes the person in a holistic
balance of the subsystems. perspective. Individual aspects of parts
act together to form a unified being.
Johnson’s Behavioral System Model is Additionally, as living systems, persons
best applied in the evaluation phase, are in constant interaction with their
during which time the nurse can determine environments. Between the system and
whether or not there is balance in the the environment occurs an exchange
subsystems of the patient. If a nurse helps of information, matter, and energy.
a patient maintain an equilibrium of the Characteristics of a system include inputs,
behavioral system through an illness in the outputs, controls, and feedback.
biological system, he or she has been
successful in the role.
ASSUMPTIONS MAJOR CONCEPTS OF THE ADAPTATION
SCIENTIFIC ASSUMPTIONS MODEL
• Systems of matter and energy progress to
higher levels of complex self-organization. PERSON
• Consciousness and meaning are “Human systems have thinking and
constructive of person and environment feeling capacities, rooted in consciousness
integration. and meaning, by which
• Awareness of self and environment is they adjust effectively to changes in the
rooted in thinking and feeling. environment and, in turn, affect the
• Humans by their decisions are accountable environment.” Based on Roy, humans are
for the integration of creative processes. holistic beings that are in constant interaction
• Thinking and feeling mediate human action. with their environment. Humans use a
• System relationships include acceptance, system of adaptation, both innate and
protection, and fostering of interdependence. acquired, to respond to the environmental
• Persons and the earth have common stimuli they experience. Human systems can
patterns and integral relationships. be individuals or groups, such as
• Persons and environment transformations families, organizations, and the whole global
are created in human consciousness. community.
• Integration of human and environment ENVIRONMENT
meanings results in adaptation. “The conditions, circumstances and influences
surrounding and affecting the development
PHILOSOPHICAL ASSUMPTIONS and behavior of persons or groups, with
• Persons have mutual relationships with the particular consideration of the mutuality of
world and God. person and health resources that includes
• Human meaning is rooted in the omega focal, contextual and residual stimuli.” The
point convergence of the universe. environment is defined as conditions,
• God is intimately revealed in the diversity of circumstances, and influences that affect
creation and is the common destiny of the development and behavior of humans
creation. as an adaptive system. The environment
• Persons use human creative abilities of is a stimulus or
awareness, enlightenment, and faith. input that requires a person to adapt.
• Persons are accountable for the processes These stimuli can be positive or negative.
of deriving, sustaining, and transforming the Roy categorized these stimuli as focal,
universe. contextual, and residual. Focal stimuli are
that which confronts the human system and
requires the most attention. Contextual
stimuli are characterized as the rest of the
stimuli that present with the focal stimuli
and contribute to its
effect. Residual stimuli are the additional
environmental factors present within the
situation, but whose effect is unclear. This
can include previous experience with certain
stimuli.
HEALTH FOUR ADAPTIVE MODES
“Health is not freedom from the
inevitability of death, disease, unhappiness, PHYSIOLOGICAL-PHYSICAL MODE
and stress, but the ability to cope with Physical and chemical processes involved
them in a competent way.” Health is in the function and activities of living
defined as the state where humans organisms. These are the actual processes
can continually adapt to stimuli. Because put in motion by the regulator subsystem.
illness is a part of life, health is the result The basic need of this mode is composed
of a process where health and illness can of the needs associated with oxygenation,
coexist. If a human can continue to adapt nutrition,
holistically, they will be able to maintain elimination, activity and rest, and protection.
health to reach completeness and The complex processes of this mode are
unitywithin themselves. If they cannot adapt associated with the senses, fluid and
accordingly, the integrity of the person can electrolytes, neurologic function, and
be affected negatively. endocrine function.
NURSING
“[The goal of nursing is] the promotion SELF-CONCEPT GROUP IDENTITY MODE
of adaptation for individuals and groups In this mode, the goal of coping is to have
in each of the four adaptive modes, a sense of unity, meaning the
thus contributing to health, quality of life, purposefulness in the universe, as well as
and dying with dignity.” In Adaptation a sense of identity integrity. This includes
Model, nurses are facilitators of adaptation. body image and self-ideals.
They assess the patient’s behaviors for
adaptation, promote positive adaptation ROLE FUNCTION MODE
by enhancing environment interactions This mode focuses on the primary,
and helping patients react positively to secondary and tertiary roles that a person
stimuli. Nurses eliminate ineffective coping occupies in society, and knowing where he
mechanisms and eventually lead to better or she stands as a member of society.
outcomes.
ADAPTATION INTERDEPENDENCE MODE
Adaptation is the “process and outcome This mode focuses on attaining relational
whereby thinking and feeling persons as integrity through the giving and receiving
individuals or in groups use conscious of love, respect and value. This is
awareness and choice to create human achieved with effective communication and
and environmental integration.” relations.

INTERNAL PROCESSES LEVELS OF ADAPTATION

REGULATOR INTEGRATED PROCESS
The regulator subsystem is a person’s The various modes and subsystems meet
physiological coping mechanism. It’s the the needs of the environment. These are
body’s attempt to adapt via regulation usually stable processes (e.g., breathing,
of our bodily processes, including spiritual realization, successful relationship).
neurochemical, and endocrine systems. COMPENSATORY PROCESS
COGNATOR The cognator and regulator are challenged
The cognator subsystem is a person’s by the needs of the environment, but are
mental coping mechanism. A person uses working to meet the needs (e.g., grief,
his brain to cope via self-concept, starting with a new job, compensatory
interdependence, and role function breathing).
adaptive modes.
COMPROMISED PROCESS WHAT IS THE NEUMAN SYSTEMS
The modes and subsystems are not MODEL?
adequately meeting the environmental
challenge (e.g.,hypoxia, unresolved loss, Betty Neuman describes the Neuman
abusive relationships). Systems Model as “a unique, open-
SIX-STEP Nursing Process system-based perspective that provides a
A nurse’s role in the Adaptation Model unifying focus for approaching a wide
is to manipulate stimuli by removing, range of concerns. A system acts
decreasing, increasing or altering stimuli as a boundary for a single client, a
so that the patient: group, or even a number of groups; it
1. Assess the behaviors manifested can also be defined as a
from the four adaptive modes. social issue. A client system in interaction
2. Assess the stimuli, categorize them with the environment delineates the
as focal, contextual, or residual. domain of nursing concerns.”
3. Make a statement or nursing The Neuman Systems Model views the
diagnosis of the person’s adaptive state. client as an open system that
4. Set a goal to promote adaptation. responds to stressors in the environment.
5. Implement interventions aimed at The client variables are physiological,
managing the stimuli. psychological, sociocultural, developmental,
6. Evaluate whether the adaptive goal and spiritual. The client system consists
has been met. of a basic or core structure that is
protected by lines of
resistance. The usual level of health is
BETTY NEUMAN: NEUMAN identified as the normal line of defense
that is protected by a flexible line of
SYSTEMS MODEL
defense. Stressors are intra-, inter-, and
extrapersonal in nature and arise from the
Three words frequently used in relation
internal, external, and created
to stress are inevitable, painful and
environments. When stressors break
intensifying. It is generally subjective, and
through the flexible line of
can be interpreted as the
defense, the system is invaded and the
circumstances one regards as
lines of resistance are activated and the
conceivably threatening and out of their
system is described as moving into
control. A nursing theory developed by
illness on a wellness-illness continuum.
Betty Neuman is based on the
If adequate energy is available, the system
person’s relationship to stress, the
will be reconstituted with the normal
response to it, and reconstitution factors
line of defense restored at, below, or
that are progressive in nature. The
above its previous level.
Neuman Systems Model presents a
broad, holistic and system-based method
Nursing interventions occur through
to nursing that maintains a factor of
three prevention modalities. Primary
flexibility. It focuses on the response of
prevention occurs before the stressor
the patient system to actual or potential
invades the system; secondary prevention
environmental stressors and the
occurs after the system has reacted to an
maintenance of the client system’s
invading stressor; tertiary preventionoccurs
stability through primary, secondary, and
after secondary prevention as
tertiary nursing prevention intervention to
reconstitution is being established.
reduce stressors.
ASSUMPTIONS

• Each client system is unique, a composite of factors and characteristics within a

givenrange of responses.

• Many known, unknown, and universal stressors exist. Each differs in its potential for
disturbing a client’s usual stability level or normal line of defense. The particular
interrelationships of client variables at any point in time can affect the degree to which a
client is protected by the flexible line of defense 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 line of defense. The normal line of defense can be used
as a standard from which to measure health deviation.

• When the flexible line of defense is no longer capable of protecting the client/client
system against an environmental stressor, the stressor breaks through the normal line
of defense.

• The client, whether in a state of wellness or illness, is a 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 lines of
resistance, which function to stabilize and realign the client to the usual wellness
state.

• Primary prevention relates to general knowledge that is applied in client assessment

and intervention, in identification and reduction or mitigation of possible or actual risk
factors associated with environmental stressors to prevent possible reaction.

• Secondary prevention relates to symptomatology following a reaction to stressors,

appropriate ranking of intervention priorities, and treatment to reduce their noxious
effects.

• Tertiary prevention relates to the adjustive processes taking place as reconstitution

begins and maintenance factors move the client back in a circular manner toward
primary prevention.

• The client as a system is in dynamic, constant energy exchange with the

environment. (Neuman, 1995)
MAJOR CONCEPT OF NEUMAN SYSTEMS MODEL

HUMAN BEING
Human being is viewed as an open system that interacts with both internal and
external environment forces or stressors. The human is in constant change, moving
toward a dynamic state of system stability or toward illness of varying degrees.
ENVIRONMENT
The environment is a vital arena that is germane to the system and its function. The
environment may be viewed as all factors that affect and are affected by the
system. In Neuman Systems Model identifies three relevant environments: (1) internal,
(2) external, and (3) created.
• The internal environment exists within the client system. All forces and interactive
influences that are solely within boundaries of the client system make up this
environment.
• The external environment exists outside the client system.
• The created environment is unconsciously developed and is used by the client to
support protective coping.

HEALTH
In Neuman’s nursing theory, Health is defined as the condition or degree of system
stability and is
viewed as a continuum from wellness to illness. When system needs are met, optimal
wellness exists. When needs are not satisfied, illness exists. When the energy needed
to support life is not
available, death occurs.

NURSING
The primary concern of nursing is to define the appropriate action in situations that are
stress-
related or in relation to possible reactions of the client or client system to stressors.
Nursing interventions are aimed at helping the system adapt or adjust and to retain,
restore, or maintain some degree of stability between and among the client system
variables and environmental stressors with a focus on conserving energy.

OPEN SYSTEM
A system in which there is a continuous flow of input and process, output and feedback.
It is a system of organized complexity, where all elements are in interaction.

BASICALLY STRUCTURE AND ENERGY RESOURCES .

The basic structure, or central core, is made up of those basic survival factors
common to the species. These factors include the system variables, genetic features, and
strengths and weaknesses of the system parts. system stability or toward illness of varying
degrees.
CLIENT VARIABLES SUBCONCEPTS OF NEUMAN SYSTEMS MODEL
Neuman views the individual client
holistically and considers the variables STRESSORS
simultaneously and stressor is any phenomenon that might penetrate both
comprehensively. the flexible and normal lines of defense, resulting in
either a positive or negative outcome.
• The physiological variable refers to the
structure and functions of the body. • INTRAPERSONAL STRESSORS are those that occur
• The psychological variable refers to mental within the client system boundary and correlate
processes and relationships. with the internal environment.
• The sociocultural variable refers to system • INTERPERSONAL STRESSORS occur outside the client
functions that relate to social and system boundary, are proximal to the
culturalexpectations and activities. system, and have an impact on the system.
• The developmental variable refers to those • EXTRAPERSONAL STRESSORS also occur outside the
processes related to development over the client system boundaries but are at a greater distance from
lifespan. the system that are interpersonal stressors. An example is
• The spiritual variable refers to the influence social policy.
of spiritual beliefs.
STABILITY
FLEXIBLE LINE OF DEFENSE A state of balance or harmony requiring energy
A protective accordion-like mechanism exchanges as the client adequately copes with
that surrounds and protects the normal stressors to retain, attain, or maintain an optimal
line of defense from invasion by level of health thus preserving system integrity.
stressors. DEGREE OF REACTION
The amount of system instability resulting from stressor
NORMAL LINE OF DEFENSE invasion of the normal line of defense.
An adaptational level of health ENTROPY
developed over time and considered A process of energy depletion and disorganization
normal for a particular individual client or moving the system toward illness or possible death.
system; it becomes a standard for NEGENTROPY
wellness-deviance determination. A process of energy conservation that increases
organization and complexity, moving the system
LINES OF RESISTANCE toward stability or a higher degree of wellness.
Protection factors activated when INPUT / OUTPUT
stressors have penetrated the normal The matter, energy, and information exchanged
line of defense, causing a reaction between the client and environment that is
synptomatology. entering or leaving the system at any point in time.
RECONSTITUTION
The return and maintenance of system stability,
following treatment of stressor reaction, which
may result in a higher or lower level of wellness.
PREVENTION AS INTERVENTION
Intervention modes for nursing action and
determinants for entry of both client and nurse into
the health care system.
 HILDEGARD PEPLAU THEORY
OF INTERPERSONAL
RELATIONS
• PRIMARY PREVENTION occurs before the Hildegard E. Peplau has been described as
system reacts to a stressor; it includes the mother of psychiatric nursing because her
health promotion and maintenance of theoretical and clinical work led to the
wellness. Primary prevention focuses on development of the distinct specialty field of
strengthening the flexible line of defense psychiatric nursing. Her scope of influence in
through preventing stress and reducing risk nursing includes her contributions as a
factors. This intervention occurs when the psychiatric nursing expert, educator, author,
risk or hazard is identified but before a and nursing leader and theorist.
reaction occurs. Strategies that might
be used include immunization, health According to Peplau (1952/1988), nursing is
education, exercise, and lifestyle therapeutic because it is a healing art,
changes. assisting an individual who is sick or in need
of health care. Nursing can be viewed as an
• SECONDARY PREVENTION occurs after interpersonal process because it involves
the system reacts to a stressor and is interaction between two or more individuals
provided in terms of existing symptoms. with a common goal. In nursing, this
Secondary prevention focuses on common goal provides the incentive for the
strengthening the internal lines of resistance therapeutic process in which the nurse and
and, thus, protects the basic structure patient respect each other as individuals, both
through appropriate treatment of symptoms. of them learning and growing as a result of
The intent is to regain optimal system the interaction. An individual learns when
stability and to conserve energy in doing she or he selects stimuli in the environment
so. If secondary prevention is and then reacts to these stimuli.
unsuccessful and reconstitution does not
occur, the basic structure will be Hildegard Peplau’s Interpersonal Relations
unable to support the system and its Theory emphasized the nurse-client
interventions, and death will occur. relationship as the foundation of nursing
practice. It gave emphasis on the give-and-
• TERTIARY PREVENTION occurs after the take of nurse-client relationships that was
system has been treated through seen by many as revolutionary. Peplau went
secondary prevention strategies. Its on to form an interpersonal model
purpose is to maintain wellness or protect emphasizing the need for a partnership
the client system reconstitution through between nurse and client as opposed to the
supporting existing strengths and client passively receiving treatment and the
continuing to preserve energy. Tertiary nurse passively acting out doctor’s orders.
prevention may begin at any point after
system stability has begun to be
reestablished (reconstitution has begun).
Tertiary prevention tends to lead back
to primary prevention. (Neuman, 1995)
 IDA JEAN (ORLANDO)
PELLETIER : NURSING
PROCESS THEORY
PHASES IN THE NURSE PATIENT Orlando’s nursing theory stresses the
RELATIONSHIP reciprocal relationship between patient and
nurse. What the nurse and the patient say
ORIENTATION PHASE. The orientation and do affects them both. Orlando’s theory
phase is directed by the nurse and involves focuses on how to produce improvement in
engaging the client in treatment, providing the patient’s behavior. Evidence of relieving
explanations and information, and the patient’s distress is seen as positive
answering questions. changes in the patient’s observable
behavior. Orlando may have facilitated the
IDENTIFICATION PHASE. The identification development of nurses as logical thinkers
phase begins when the client works
interdependently with the nurse, expresses The Deliberative Nursing Process has five
feelings, and begins to feel stronger. stages:
[Link],
EXPLOITATION PHASE. In the exploitation 2. diagnosis,
phase, the client makes full use of the 3. planning,
services offered. 4. implementation, and
5. evaluation.
RESOLUTION PHASE. In the resolution
phase, the client no longer needs Nurses use the standard nursing process in
professional services and gives up Orlando’s Nursing Process Discipline
dependent behavior. The relationship ends. Theory to produce positive outcomes or
patient improvement. Orlando’s key focus
THE 4 COMPONENTS OF THE THEORY was the definition of the function of nursing.
The model provides a framework for
PERSON, which is a developing organism nursing, but the use of her theory does not
that tries to reduce anxiety caused by needs exclude nurses from using other nursing
theories while caring for patients.
ENVIRONMENT, which consists of existing
forces outside of the person, and put in the The goal of this model is for a nurse to act
context of culture deliberately rather than automatically. The
nurse will have a meaning behind the action.
HEALTH, which is a word symbol that This nursing process is use to different
implies forward movement of personality patients with different problems, and can be
stopped at any time, depending on the
NURSING, which is a significant therapeutic patient’s progress or health. This makes
interpersonal process that functions Orlando’s theory universal for the nursing
cooperatively with other human process field.
that make health possible for individuals in
communities.
STEPS IN NURSING PROCESS ASSUMPTIONS

• ASSESSMENT, the nurse completes a 1. When client is unable to cope with their
holistic assessment of the patient’s needs. needs on their own, they become distressed
by feelings of helplessness.
• Diagnosis, the nurse’s clinical judgment 2. In its professional character, nursing adds
about health problems. The diagnosis can to the distress of the patient.
then be confirmed using links to defining 3. Clients are unique and individual in their
characteristics, related factors, and risk responses.
factors found in the patient’s assessment. 4. Nursing deals with people, health and
environment
• PLANNING, each of the problems identified 5. Clients’ needs help in communicating
in the diagnosis is given a specific goal or needs
outcome, and each goal or outcome is given 6. Human beings are able to be explicit about
nursing interventions to help achieve the goal. their needs, perceptions, thoughts and
By the end of this stage, the nurse will have a feelings
nursing care plan. 7. The nurse situation is dynamic, actions and
reactions are are influenced both by nurse
• IMPLEMENTATION stage, the nurse begins and client
using the nursing care plan 8. Human being attached meaning to
situations and actions that are not apparent to
• EVALUATION stage, the nurse looks at the others
progress of the patient toward the goals set in [Link] are concerned with the needs that
the nursing care plan. patient cannot meet on their own

CONCEPTS : DOMAIN CONCEPTS

FUNCTION OF PROFESSIONAL NURSING NURSING is responsive to individuals who

– ORGANIZING PRINCIPLES. The nurse is suffer or anticipate a sense of helplessness
responsive of the clients needs and anticipate
sense of helpessness GOAL OF NURSING increase sense of well-
being, increase in ability, adequacy in better
PRESENTING BEHAVIOR – PROBLEMATIC care of self or improvement in patient’s
SITUATION. The nurse seeks for immediate behavior.
need and recognize that situation is
problematic HEALTH is sense of adequacy or well-being.
Fulfilled needs. Sense of comfort.
IMMEDIATE REACTION – INTERNAL
RESPONSE. The person perceives his ENVIRONMENT not defined directly but
perception, thoughts and action is defined as implicitly in the immediate context
the persons immediate reaction for a patient

NURSING PROCESS DISCIPLINE —

INVESTIGATION. An observation is explored
with the patient to ensure that needs are met.

IMPROVEMENT – RESOLUTION. The

outcome is evaluated not the nurse activity
VIRGINIA HENDERSON – 14
BASIC NEEDS THEORY
META PARADIGM MODEL OF THE THEORY
PERSON she defined person as someone
who is in need of basic health component, Henderson's was more of a result of an
and someone that requires assistance and individual coming from hospital, because the
also known as someone who does not have nurses expected task is to nurse the individual
autonomy. In person she stated that mind and get back to his healthy state, healthy meaning
body are connected in any aspect of a human performing task independently in the 14 basic
being, this include components like biological, human needs component:
psychological, sociological, spiritual and etc.
The 14 Basic Human Needs:
ENVIRONMENT she defined environment as [Link] normally.
a setting that would contribute to the person [Link] and drink adequately.
discovering different pattern for living, in short 3..Eliminate body wastes.
an influence. It also affect the life and growth 4. Move and maintain desirable postures.
development of the person. The environment 5. Sleep and rest.
does not only apply to the literal environment, 6. Select suitable clothes-dress and undress.
it also includes the relationship between [Link] body temperature within normal
person and families. Of course this has a big range by adjusting clothing and modifying
impact on her theory because almost all of the environment
14 human needs are affected by environment. [Link] the body clean and well groomed and
protect the integument
HEALTH she defined health as the ability of a [Link] dangers in the environment and avoid
person to perform task independently relating injuring others.
to her theory "14 Basic Human Needs". She [Link] with others in expressing
also stated that we should stress out on emotions, needs, fears, or opinions.
disease prevention and health promotion of [Link] according to one’s faith.
our client. Lastly, achieving good health is a [Link] in such a way that there is a sense of
challenge, why? Because there are tons of accomplishment.
factors that hinders us from reaching it, these [Link] or participate in various forms of
are age, cultural background, lifestyle, recreation.
gender, emotional balance etc. [Link], discover, or satisfy the curiosity that
leads to normal development and health and
NURSING Nursing for Henderson is the use the available health facilities.
assistance to an individual to achieve the 14
basic human needs if they are not able to do it These 14 human needs are actually holistic
independently. Primary goal would be to cause not only does it include the biological
nurse them to autonomy or to basically make health it also includes spiritual, social, mental,
them independent. emotional and etc. If we try to look at a bigger
picture this model is actually quite identical
with Maslow's Hierarchy of Needs Theory.
GENERAL ASSUMPTION ASSUMPTIONS

The Assumptions for this Theory are: The assumptions Abdellah’s “21 Nursing
Problems Theory” relate to change and
Nurses care for patients until they can care anticipated changes that affect nursing;
for themselves once again. Although not •the need to appreciate the
precisely explained, patients desire to return interconnectedness of social enterprises and
to health. social problems;
• the impact of problems such as poverty,
Nurses are willing to serve and that “nurses racism, pollution, education, and so forth on
will devote themselves to the patient day health and health care delivery;
and night.” Henderson also believes that the • changing nursing education; continuing
“mind and body are inseparable and are education for professional nurses; and
interrelated.” ([Link]) • development of nursing leaders from
underserved groups.
Nurses are willing to serve and that “nurses
will devote themselves to thpatient day and [Link] to know the patient.
night.” (Henderson, 1991). 2. Sort out relevant and significant data.
3. Make generalizations about available data
Nurses should be educated at the university concerning similar nursing problems
level in both arts and [Link] presented by other patients.
also believes that mind and body are 4. Identify the therapeutic plan.
inseparable. It is implied that the mind and [Link] generalizations with the patient and
body are interrelated. (Henderson, 1966, make additional generalizations.
1991)([Link]) [Link] the patient’s conclusions about
his nursing problems.
[Link] to observe and evaluate the
ABDELLAH 21 NURSING patient over a period of time to identify any
PROBLEMS THEORY attitudes and clues affecting this behavior.
[Link] the patient’s and family’s reaction
to the therapeutic plan and involve them in
According to Faye Glenn Abdellah’s theory,
the plan.
“Nursing is based on an art and science that
[Link] how the nurse feels about the
molds the attitudes, intellectual
patient’s nursing problems.
competencies, and technical skills of the
[Link] and develop a comprehensive
individual nurse into the desire and ability to
nursing care plan.
help people, sick or well, cope with their
health needs.”

The patient-centered approach to nursing

was developed from Abdellah’s practice,
and the theory is considered a human needs
theory. It was formulated to be an instrument
for nursing education, so it most suitable
and useful in that field. The nursing model is
intended to guide care in hospital institutions
but can also be applied to community health
nursing, as well.
MAJOR CONCEPTS OF 21 NURSING ABDELLAH TYPOLOGY OF 21 NURSING
PROBLEMS THEORY PROBLEMS

INDIVIDUAL 1. To maintain good hygiene and physical

She describes nursing recipients as comfort.
individuals (and families), although she does 2. To promote optimal activity: exercise, rest,
not delineate her beliefs or assumptions about sleep
the nature of human beings. 3. To promote safety by preventing accidents,
injuries, or other trauma and preventing the
HEALTH spread of infection.
Health, or the achieving of it, is the purpose of 4. To maintain good body mechanics and
nursing services. Although Abdellah does not prevent and correct the deform
define health, she speaks to “total health 5. To facilitate the maintenance of a supply of
needs” and “a healthy state of mind and oxygen to all body cells.
body.” Health may be defined as the dynamic 6. To facilitate the maintenance of nutrition for
pattern of functioning whereby there is a all body cells.
continued interaction with internal and 7. To facilitate the maintenance of elimination.
external forces that results in the optimal use 8. To facilitate the maintenance of fluid and
of necessary resources to minimize vulnerabili electrolyte balance.
9. To recognize the physiologic responses of
SOCIETY the body to disease conditions—pathologic,
Society is included in “planning for optimum physiologic, and compensatory.
health on local, state, and international levels.” 10. To facilitate the maintenance of regulatory
However, as Abdellah further delineates her mechanisms and functions.
ideas, the focus of nursing service is clearly 11. To facilitate the maintenance of sensory
the individual. function.
12. To identify and accept positive and
NURSING PROBLEMS negative expressions, feelings, and reactions.
The client’s health needs can be viewed as 13. To identify and accept interrelatedness of
problems, overt as an apparent condition, or emotions and organic illness.
covert as a hidden or concealed one. Because 14. To facilitate the maintenance of effective
covert problems can be emotional, verbal and nonverbal communication.
sociological, and interpersonal in nature, they 15. To promote the development of productive
are often missed or misunderstood. Yet, in interpersonal relationships.
many instances, solving the covert problems 16. To facilitate progress toward achievement
may solve the overt problems as well. and personal spiritual goals.
17. To create or maintain a therapeutic
PROBLEM SOLVING environment.
Quality professional nursing care requires that 18. To facilitate awareness of self as an
nurses be able to identify and solve overt and individual with varying physical, emotional,
covert nursing problems. The problem-solving and developmental needs.
process can meet these requirements by 19. To accept the optimum possible goals in
identifying the problem, selecting pertinent the light of limitations, physical and emotional.
data, formulating hypotheses, testing 20. To use community resources as an aid in
hypotheses through collecting data, and resolving problems that arise from an illness.
revising hypotheses when necessary based 21. To understand the role of social problems
on conclusions obtained from the data. as influencing factors in the cause of illness.
BASIC NEEDS THE TEN STEPS ARE:
The basic needs of an individual patient are to
maintain good hygiene and physical comfort; promote [Link] to know the patient.
optimal health through healthy activities, such as [Link] out relevant and significant data.
exercise, rest, and sleep; promote safety through the [Link] generalizations about available data
prevention of health hazards like accidents, injury, or concerning similar nursing problems presented
other trauma and the prevention of the spread of by other patients.
infection; and maintain good body mechanics and [Link] the therapeutic plan.
prevent or correct deformity. [Link] generalizations with the patient and
make additional generalizations.
SUSTENAL CARENEEDS [Link] the patient’s conclusions about his
Sustenal care needs to facilitate the maintenance of nursing problems.
a supply of oxygen to all body cells; facilitate the [Link] to observe and evaluate the patient
maintenance of nutrition of all body cells; facilitate the over a period of time to identify any attitudes
maintenance of elimination; facilitate the and clues affecting his or her behavior.
maintenance of fluid and electrolyte balance; [Link] the patient and their family’s reactions
recognize the physiological responses of the body to to the therapeutic plan and involve them in the
disease conditions; facilitate the maintenance of plan.
regulatory mechanisms and functions, and facilitate [Link] how the nurses feel about the
the maintenance of sensory function patient’s nursing problems.
[Link] and develop a comprehensive
REMEDIAL CARE NEEDS nursing
Remedial care needs to identify and accept positive
and negative expressions, feelings, and reactions; THE 11 NURSING SKILLS ARE:
identify and accept the interrelatedness of emotions • observation of health status
and organic illness; facilitate the maintenance of • skills of communication
effective verbal and non-verbal communication; • application of knowledge
promote the development of productive interpersonal • the teaching of patients and families
relationships; facilitate progress toward achievement • planning and organization of work
of personal spiritual goals; create and maintain a • use of resource materials
therapeutic environment; and facilitate awareness of • use of personnel resources
the self as an individual with varying physical, • problem-solving
emotional, and developmental needs. • the direction of work of others
• therapeutic uses of the self
RESTORATIVE CARE NEEDS • nursing procedure
Restorative care needs include the acceptance of the
optimum possible goals in light of limitations, both
physical and emotional; the use of community
resources as an aid to resolving problems that arise
from an illness; and the understanding of the role of
social problems as influential factors in the case of
illness.

Abdellah’s work, based on the problem-solving

method, serves as a vehicle for delineating nursing
(patient) problems as the patient moves toward a
healthy outcome. The theory identifies ten steps to
identify the patient’s problem and 11 nursing skills to
develop a treatment typology.
ABDELLAH ALSO EXPLAINED NURSING Focus of Care Pendulum of Faye Abdellah’s
AS A COMPREHENSIVE SERVICE, Theory. The nursing-centered orientation to
WHICH INCLUDES: client care seems contrary to the client-centered
approach that Abdellah professes to uphold. The
1. Recognizing the nursing problems of the apparent contradiction can be explained by her
patient desire to move away from a disease-centered
2. Deciding the appropriate course of action orientation. In her attempt to bring the nursing
to take in terms of relevant nursing practice to its proper relationship with restorative
principles and preventive measures for meeting total client
3. Providing continuous care of the needs, she seems to swing the pendulum to the
individual’s total needs opposite pole, from the disease orientation to
4. Providing continuous care to relieve pain nursing orientation, while leaving the client
and discomfort and provide immediate somewhere in the middle.
security for the individual In her attempt to bring the nursing practice to its
5. Adjusting the total nursing care plan to proper relationship with restorative and
meet the patient’s individual needs preventive measures for meeting total client
6. Helping the individual to become more needs, she seems to swing the pendulum to the
self-directing in attaining or maintaining a opposite pole, from the disease orientation to
healthy state of body and mind nursing orientation, while leaving the client
7. Instructing nursing personnel and family somewhere in the middle.
to help the individual do for himself that
which he can within his limitations 21 NURSING PROBLEMS AND THE NURSING
8. Helping the individual to adjust to his PROCESS
limitations and emotional problems
9. Working with allied health professions in ASSESSMENT PHASE, the nursing problems
planning for optimum health on local, state, implement a standard procedure for data
national, and international levels collection. A principle underlying the problem-
10. Carrying out continuous evaluation and solving approach is that for each identified
research to improve nursing techniques problem, pertinent data is collected. The overt or
and to develop new techniques to meet covert nature of problems necessitates a direct
people’s health needs or indirect approach, respectively

PATIENT CENTERED APPROACHES TO NURSING DIAGNOSIS, the outcome of the

NURSING collection of data in the first phase concludes the
patient’s possible problems, which can be
Faye Abdellah’s work is a set of problems grouped under one or more of the broader
formulated in terms of nursing-centered nursing problems.
services used to determine the patient’s
needs. The nursing-centered orientation to NURSING CARE PLAN is developed, and
client care appears to be contradicting the appropriate nursing interventions are
client-centered approach that Abdellah determined. The nurse now sets those
professes to support. This can be observed interventions in action, which complete the
by her desire to move away from a disease- implementation phase of the nursing process.
centered orientation.
EVALUATION takes place after the interventions
have been carried out. The most convenient
evaluation would be the nurse’s progress or lack
of progress toward achieving the goals
established in the planning phase.
MADELEINE LEININGER
TRANSCULTURAL NURSING
THEORY
Through her observations, while working as The Transcultural Nursing Theory or Culture
a nurse, Madeleine Leininger identified a Care Theory by Madeleine Leininger involves
lack of cultural and care knowledge as the knowing and understanding different
missing component to a nurse’s cultures concerning nursing and health-
understanding of the many variations illness caring practices, beliefs, and values
required inpatient care to support to provide meaningful and efficacious
compliance, healing, and wellness, which led nursing care services to people’s cultural
her to develop the theory of Transcultural values health-illness context.
Nursing also known as Culture Care Theory. It focuses on the fact that different cultures
This theory attempts to provide culturally have different caring behaviors and different
congruent nursing care through “cognitively health and illness values, beliefs, and
based assistive, supportive, facilitative, or patterns of behaviors.
enabling acts or decisions that are mostly The cultural care worldview flows into
tailor-made to fit with the individual, group’s, knowledge about individuals, families,
or institution’s cultural values, beliefs, and groups, communities, and institutions in
lifeways.” diverse health care systems. This knowledge
Leininger’s theory’s main focus is for nursing provides culturally specific meanings and
care to fit with or have beneficial meaning expressions about care and health. The next
and health outcomes for people of different focus is on the generic or folk system,
or similar cultural backgrounds. With these, professional care system(s), and nursing
she has developed the Sunrise Model in a care. Information about these systems
logical order to demonstrate the includes the characteristics and the specific
interrelationships of the concepts in her care features of each. This information
theory of Culture Care Diversity and allows for the identification of similarities
Universality. and differences or cultural care universality
and cultural care diversity.
Next are nursing care decisions and actions
which involve cultural care
preservation/maintenance, cultural care
accommodation/negotiation, and cultural
care re-patterning or restructuring. It is here
that nursing care is delivered.
Major concepts:

TRANSCULTURAL NURSING
HUMAN BEINGS
Transcultural nursing is defined as a learned
Such are believed to be caring and capable
subfield or branch of nursing that focuses upon
of being concerned about others’ needs,
the comparative study and analysis of cultures
well-being, and survival. Leininger also
concerning nursing and health-illness caring
indicates that nursing as a caring science
practices, beliefs, and values to provide
should focus beyond traditional nurse-
meaningful and efficacious nursing care services
patient interactions and dyads to include
to their cultural values and health-illness context.
families, groups, communities, total
Ethnonursing
cultures, and institutions.
This is the study of nursing care beliefs, values,
and practices as cognitively perceived and known
SOCIETY AND ENVIRONMENT
by a designated culture through their direct
Leininger did not define these terms; she
experience, beliefs, and value system (Leininger,
speaks instead of worldview, social
1979).
structure, and environmental context.
NURSING
WORLDVIEW
Nursing is defined as a learned humanistic and
Worldview is how people look at the world,
scientific profession and discipline which is
or the universe, and form a “picture or value
focused on human care phenomena and activities
stance” about the world and their lives.
to assist, support, facilitate, or enable individuals
or groups to maintain or regain their well-being
CULTURAL AND SOCIAL STRUCTURE
(or health) in culturally meaningful and beneficial
DIMENSIONS
ways, or to help people face handicaps or death.
Cultural and social structure dimensions are
defined as involving the dynamic patterns
PROFESSIONAL NURSING CARE (CARING)
and features of interrelated structural and
Professional nursing care (caring) is defined as
organizational factors of a particular culture
formal and cognitively learned professional care
(subculture or society) which includes
knowledge and practice skills obtained through
religious, kinship (social), political (and
educational institutions that are used to provide
legal), economic, educational, technological,
assistive, supportive, enabling, or facilitative acts
and cultural values, ethnohistorical factors,
to or for another individual or group to improve a
and how these factors may be interrelated
human health condition (or well-being), disability,
and function to influence human behavior in
lifeway, or to work with dying clients.
different environmental contexts.
CULTURAL CONGRUENT (NURSING) CARE
ENVIRONMENTAL CONTEXT
Cultural congruent (nursing) care is defined as
Environmental context is the totality of an
those cognitively based assistive, supportive,
event, situation, or particular experience
facilitative, or enabling acts or decisions that are
that gives meaning to human expressions,
tailor-made to fit with the individual, group, or
interpretations, and social interactions in
institutional, cultural values, beliefs, and lifeways
particular physical, ecological,
to provide or support meaningful, beneficial, and
sociopolitical, and/or cultural settings.
satisfying health care, or well-being services.

CULTURE
HEALTH
Culture is learned, shared, and transmitted
It is a state of well-being that is culturally
values, beliefs, norms, and lifeways of a
defined, valued, and practiced. It reflects
particular group that guides their thinking,
individuals’ (or groups) ‘ ability to perform their
decisions, and actions in patterned ways.
daily role activities in culturally expressed,
beneficial, and patterned lifeways.
CULTURE CARE PROFESSIONAL CARE SYSTEMS
Culture care is defined as the subjectively Professional care systems are defined as
and objectively learned and transmitted formally taught, learned, and transmitted
values, beliefs, and patterned lifeways that professional care, health, illness, wellness, and
assist, support, facilitate, or enable another related knowledge and practice skills that
individual or group to maintain their well- prevail in professional institutions, usually with
being, health, improve their human multidisciplinary personnel to serve
condition lifeway, or deal with illness, consumers.
handicaps or death.
ETIC
CULTURE CARE DIVERSITY The knowledge that describes the professional
Culture care diversity indicates the perspective. It is professional care knowledge.
variabilities and/or differences in meanings,
patterns, values, lifeways, or symbols of care ETHNOHISTORY
within or between collectives related to Ethnohistory includes those past facts, events,
assistive, supportive, or enabling human instances, experiences of individuals, groups,
care expressions. cultures, and instructions that are primarily
people-centered (ethno) and describe, explain,
CULTURE CARE UNIVERSALITY and interpret human lifeways within particular
Culture care universality indicates the cultural contexts over short or long periods of
common, similar, or dominant uniform care time.
meanings, patterns, values, lifeways, or
symbols manifest among many cultures and CARE
reflect assistive, supportive, facilitative, or Care as a noun is defined as those abstract and
enabling ways to help people. (Leininger, concrete phenomena related to assisting,
1991) supporting, or enabling experiences or
behaviors toward or for others with evident or
Subconcepts : anticipated needs to ameliorate or improve a
human condition or lifeway.
GENERIC (FOLK OR LAY) CARE SYSTEMS
Generic (folk or lay) care systems are CARE
culturally learned and transmitted, Care as a verb is defined as actions and
indigenous (or traditional), folk (home- activities directed toward assisting, supporting,
based) knowledge and skills used to provide or enabling another individual or group with
assistive, supportive, enabling, or facilitative evident or anticipated needs to ameliorate or
acts toward or for another individual, group, improve a human condition or lifeway or face
or institution with evident or anticipated death.
needs to ameliorate or improve a human life
way, health condition (or well-being), or to CULTURE SHOCK
deal with handicaps and death situations. Culture shock may result when an outsider
attempts to comprehend or adapt effectively to
EMIC a different cultural group. The outsider is likely
Knowledge gained from direct experience or to experience feelings of discomfort and
directly from those who have experienced it. helplessness and some degree of disorientation
It is generic or folk knowledge. because of the differences in cultural values,
beliefs, and practices. Culture shock may lead
to anger and can be reduced by seeking
knowledge of the culture before encountering
that culture.
CULTURAL IMPOSITION
Cultural imposition refers to the outsider’s efforts,
ROSEMARIE RIZZO PARSE
both subtle and not so subtle, to impose their own
cultural values, beliefs, behaviors upon an THEORY OF HUMAN BECOMING
individual, family, or group from another culture.
(Leininger, 1978) Parse’s Human Becoming Theory guides the
practice of nurses to focus on quality of life as
it is described and lived. The human becoming
Sunrise Model of Madeleine Leininger’s Theory theory of nursing presents an alternative to
both the conventional bio-medical approach
The Sunrise Model is relevant because it enables as well as the bio-psycho-social-spiritual
nurses to develop critical and complex thoughts approach of most other theories and models
about nursing practice. These thoughts should of nursing. Parse’s model rates quality of life
consider and integrate cultural and social from each person’s own perspective as the
structure dimensions in each specific context, goal of the practice of nursing. Rosemarie
besides nursing care’s biological and Rizzo Parse first published the theory in 1981
psychological aspects. as the “Man-living-health” theory, and the
name was changed to the “human becoming
Three modes of nursing care decisions and actions theory” in 1992.

CULTURAL CARE PRESERVATION OR Major Assumptions :

MAINTENANCE
Cultural care preservation is also known as MEANING
maintenance. It includes those assistive, human becoming is freely choosing personal
supporting, facilitative, or enabling professional meaning in situations in the intersubjective
actions and decisions that help people of a process of living value priorities. Man’s reality
particular culture to retain and/or preserve is given meaning through lived experiences. In
relevant care values so that they can maintain addition, man and environment co-create.
their well-being, recover from illness, or face
handicaps and/or death. RHYTHMICITY
states that human becoming is co-creating
CULTURAL CARE ACCOMMODATION OR rhythmical patterns of relating in mutual
NEGOTIATION process with the universe. Man and
Cultural care accommodation, also known as environment co-create (imaging, valuing,
negotiation, includes those assistive, supportive, languaging) in rhythmical patterns.
facilitative, or enabling creative professional
actions and decisions that help people of a TRANSCENDENCE
designated culture to adapt to or negotiate with explains that human becoming is co-
others for a beneficial or satisfying health transcending multidimensionally with
outcome with professional care providers. emerging possibilities. It refers to reaching out
and beyond the limits a person sets, and that
CULTURE CARE REPARTTERNING OR one constantly transforms.
RESTRUCTURING
Culture care repatterning or restructuring includes
those assistive, supporting, facilitative, or enabling
professional actions and decisions that help
clients reorder, change, or greatly modify their
lifeways for new, different, and beneficial health
care pattern while respecting the clients’ cultural
values and beliefs and still providing a beneficial
or healthier lifeway than before the changes were
established with the clients. (Leininger, 1991)
These three themes are permeated by four Levine (1989) proposed the following four
postulates: illimitability, paradox, freedom, principles of conservation:
and mystery.
1. THE CONSERVATION OF ENERGY OF THE
ILLIMITABILITY is “the indivisible unbounded INDIVIDUAL.
knowing extended to infinity, the all-at-once recognizes the individual as one who strives
remembering and prospecting with the for recognition, respect, self-awareness,
moment.” selfhood, and self-determination.

PARADOX is “an intricate rhythm expressed as 2. THE CONSERVATION OF THE STRUCTURAL

a pattern preference.” Paradoxes are not INTEGRITY OF THE INDIVIDUAL.
“opposites to be reconciled or dilemmas to be refers to maintaining or restoring the body’s
overcome but, rather, lived rhythms.” structure, preventing physical breakdown, and
promoting healing.
FREEDOM is “contextually construed
liberation.” People are free to continuously 3. THE CONSERVATION OF THE PERSONAL
choose ways of being with their situations. INTEGRITY OF THE INDIVIDUAL.
recognizes the individual as one who strives
MYSTERY is “the unexplainable, that which for recognition, respect, self-awareness,
cannot be completely known.” selfhood, and self-determination.

Myra Estrin Levine: The 4. THE CONSERVATION OF THE SOCIAL

INTEGRITY OF THE INDIVIDUAL.
Conservation Model exists when a patient is recognized as someone
Levine’s conservation model believes nursing who resides within a family, a community, a
intervention is a conservation activity, with religious group, an ethnic group, a political
energy conservation as a fundamental system, and a nation.
concern, four conservation principles of
nursing. It guides nurses to concentrate on the Major Concepts
importance and responses at the level of the
person. Nurses fulfill the theory’s purpose by ENVIRONMENT
conserving energy, structure, and personal includes both the internal and external
and social integrity. environment. Three Aspects of Environment
Drawn upon Bates’ (1967) Classification:
Every patient has a different array of adaptive
responses, which vary based on personal • OPERATIONAL ENVIRONMENT consists of the
factors, including age, gender, and illness. The undetected natural forces and that impinge on
fundamental concept of Myra Estrin Levine’s the individual.
theory is conservation. When an individual is in • PERCEPTUAL ENVIRONMENT consists of
a phase of conservation, it means that the information that is recorded by the sensory
person can adapt to the health challenges with organs.
the slightest amount of effort. The core of
Levine’s Conservation Model is to improve a • CONCEPTUAL ENVIRONMENT is influenced
person’s physical and emotional well-being by by language, culture, ideas, and cognition.
considering the four domains of conservation
she set out. By proposing to address the
conservation of energy, structure, and
personal and social integrity, this nursing
theory helps guide nurses in providing care
that will help maintain and promote the health
of the patient.
PERSON
The person is a unique individual in unity, SPECIFICITY
integrity, feeling, belief, thinking, and whole. Adaptation is also specific. Each system has
particular responses. The physiologic
HEALTH responses that “defend oxygen supply to the
Health is the pattern of adaptive change of brain are distinct from those that maintain the
the whole being. appropriate blood glucose levels.” (Levine,
1989)
NURSING
Nursing is the human interaction relying on REDUNDANCY
communication, rooted in the individual Although the changes that occur are
human being’s organic dependency in his sequential, they should not be viewed as
relationships with other human beings. linear. Rather, Levine describes them as
occurring in “cascades” in which there is an
ADAPTATION interacting and evolving effect in which one
Adaptation is the process of change and sequence is not yet completed when the next
integration of the organism in which the begins.
individual retains integrity or wholeness. It is
possible to have degrees of adaptation.
ENERGY CONSERVATION
CONSERVATION
Nursing interventions are based on the
Conservation includes joining together and is
conservation of the patient’s energy.
the product of adaptation, including nursing
intervention and patient participation to
HOLISM
maintain a safe balance.
The singular yet integrated response of the
individual to forces in the environment.
PERSONAL INTEGRITY
Personal integrity is a person’s sense of
HOMEOSTASIS
identity and self-definition. Nursing
Stable state normal alterations in physiologic
intervention is based on the conservation of
parameters respond to environmental
the individual’s personal integrity.
changes; an energy sparing state, a state of
conservation.
SOCIAL INTEGRITY
Social integrity is life’s meaning gained
MODES OF COMMUNICATION
through interactions with others. Nurses
The many ways information, needs, and
intervene to maintain relationships.
feelings are transmitted among the patient,
family, nurses, and other health care workers.
STRUCTURAL INTEGRITY
Structural integrity: Healing is the process of THERAPEUTIC INTERVENTIONS
restoring structural integrity through nursing Interventions that influence adaptation
interventions that promote healing and favorably, enhancing the adaptive responses
maintain structural integrity. available to the person.

Subconcepts :

HISTORICITY
Adaptation is a historical process. Responses
are based on past experiences, both personal
and genetic.
ASSUMPTIONS ABOUT INDIVIDUALS Major Concepts

Each individual “is an active participant in • Focus of nursing

interactions with the environment… • Nursing Situation
constantly seeking information from it.” • Direct Invitation
(Levine, 1969) • Caring Between
• Calls for Caring
The individual “is a sentient being, and the • Nursing Responses of Caring
ability to interact with the environment • Dance of Caring Persons
seems ineluctably tied to his sensory • Dance of Living Caring
organs.”
Afaf Ibrahim Meleis: Transitions
“Change is the essence of life, and it is
unceasing as long as life goes on. Change is Framework/ Transitions Theory
characteristic of life.” (Levine, 1973)
The Transitions Framework/Transitions
ASSUMPTIONS ABOUT NURSING Theory focuses on “the human
experiences,the responses, [and] the
“Ultimately, the decisions for nursing consequences of transitions on the well-
intervention must be based on the unique being of people.”. . .
behavior of the individual patient.”
The goal of Transitions Framework nursing is
“Patient-centered nursing care means “to help people go through healthy
individualized nursing care. It is predicated transitions, [including] mastery of behaviors,
on the reality of common experience: every sentiments, cues, and symbols associated
man is a unique individual, and as such he with new roles and identities] and non-
requires a unique constellation of skills, problematic processes, to enhance healthy
techniques, and ideas designed specifically outcomes” (Meleis, A. I. (2010).
for him.” (Levine, 1973)
Transitions from practice to evidence-based
Anne Boykin and Savina O. models of care. In A. I. Meleis (Ed.),
Schoenhofer: The Theory of Transitions theory: Middle-range and
situation-specific theories in nursing
Nursing As Caring research and practice (p 5). New York, NY:
Springer.)
The focus of nursing is nurturing persons
living caring and growing in caring. As an
expression of nursing, caring is the
intentional and authentic presence of the
nurse with another person who is recognized
as living caring and growing in caring. A
nursing situation is a shared lived experience
in which the caring between nurse and
nursed enhances personhood. The nurse
intentionally enters a nursing situation with
the purpose of coming to know the person as
caring, offering a direct invitation to the
nursed to express what matters most in the
moment, hearing calls for caring, and
responding with caring nurturance created in
the context of the nursing situation.
Major Concepts

TRANSITION RESPONSE PATTERNS

• Anticipating • Process Indicators
• Experiencing — Feeling connected
• Completing — Interacting
— Location and being situated
TRANSITION TYPE — Developing confidence and coping
• Developmental transition
• Situational transition • Outcome Indicators
• Wellness/illness transition — Mastery
• Organizational transition — Fluid integrative identities
• Cultural transition — Health outcomes
— Separation — Developmental outcomes
— Liminality — Behavioral outcomes
— Iintegration
Nola Pender: The Health
TRANSITION PATTERNS
• Single transition
Promotion Model
• Multiple transitions The Health Promotion Model (HPM) by
• Sequential transitions Dr. Nola Pender focuses on helping
• Simultaneous transitions people achieve a higher level of well-
• Related transitions being and providing health
• Unrelated transitions professionals with positive resources
to help patients achieve behavior-
TRANSITION PROPERTIES specific changes.
• Awareness
• Engagement The goal of the HPM is not just about
• Change and difference helping patients prevent illness
• Transition time span through their beliefs and attitudes, but
• Critical points and events also seeking the means by which a
person can pursue better health or
TRANSITION CONDITIONS ideals.
• Personal Characteristics
— Perceptions of and meanings attached to four assumptions:
health
— Cultural beliefs 1. Individuals strive to control their
— Socioeconomic status own behavior.
— Preparation
— Knowledge 2. Individuals work to improve
themselves and their environment.
• Environmental Characteristics
— Community resources 3. Health professionals comprise the
— Societal conditions interpersonal environment, which
influences individual behaviors.
NURSING THERAPEUTICS
• Assessment of readiness 4. Self-initiated change of individual
• Risk assessment and environmental characteristics is
• Transition preparation essential to changing behavior.
• Role supplementation
• Creation of a healthy environment
• Monitoring
THE MODEL FOCUSES ON FOLLOWING THREE THEORETICAL PROPOSITIONS OF THE HEALTH
AREAS: PROMOTION MODEL

• Individual characteristics and experiences [Link] behavior and inherited and acquired
characteristics influence beliefs, affect, and
• Behavior-specific cognitions and affect enactment of health-promoting behavior.
[Link] commit to engaging in behaviors from
• Behavioral outcomes which they anticipate deriving personally valued
benefits.
[Link] barriers can constrain commitment
THE MAJOR CONCEPTS AND DEFINITIONS OF to action, a mediator of behavior as well as
THE HEALTH PROMOTION MODEL actual behavior.
[Link] competence or self-efficacy to
• Individual Characteristics and Experience execute a given behavior increases the
likelihood of commitment to action and actual
• Prior related behaviour performance of the behavior.
[Link] perceived self-efficacy results in
• Frequency of the similar behaviour in the fewer perceived barriers to a specific health
past. Direct and indirect effects on the behavior.
likelihood of engaging in health promoting [Link] affect toward a behavior results in
behaviors. greater perceived self-efficacy, which can in
turn, result in increased positive affect.
[Link] positive emotions or affect are
associated with a behavior, the probability of
commitment and action is increased.
[Link] are more likely to commit to and
engage in health-promoting behaviors when
significant others model the behavior, expect
the behavior to occur, and provide assistance
and support to enable the behavior.
[Link], peers, and health care providers are
important sources of interpersonal influence
that can increase or decrease commitment to
and engagement in health-promoting behavior.
[Link] influences in the external
environment can increase or decrease
commitment to or participation in health-
promoting behavior.
[Link] greater the commitments to a specific
plan of action, the more likely health-promoting
behaviors are to be maintained over time.
[Link] to a plan of action is less likely
to result in the desired behavior when
competing demands over which persons have
little control require immediate attention. 13.
Commitment to a plan of action is less likely to
result in the desired behavior when other
actions are more attractive and thus preferred
over the target behavior.
[Link] can modify cognitions, affect, and
the interpersonal and physical environment to
create incentives for health actions.
Margaret A. Newman: Health Helen Erickson, Evelyn Tomlin,
as Expanding Consciousness Mary Ann Swain: Modeling &
Role-Modeling
The theory of health as expanding
consciousness was stimulated by concern “Modeling” is gaining an understanding of
for those for whom health as the absence the client’s world from the client’s
of disease or disability is not possible. perspective. That is to build a “model” of
Nurses often relate to such people: people the client’s world view. “Role‑Modeling” is
facing the uncertainty, debilitation, loss based on the assumption that all humans
and eventual death associated with want to interact with others, they want to
chronic illness. The theory has progressed carry out selected roles in society. Role-
to include the health of all persons Modeling is using the client’s model of the
regardless of their health status. The world to plan interventions that meet his
theory asserts that every person in every or her perceived needs, grow, develop and
situation, no matter how disordered and heal. Role-Modeling requires that we aim
hopeless it may seem, is part of the to build trust, promote a positive
universal process of expanding orientation and a sense of control, affirm
consciousness—a process of becoming strengths and set specific mutual goals.
more of oneself, of finding greater Our nursing goal is to help people achieve
meaning in life, and of reaching new quality, holistic health.” (from Society for
dimensions of connectedness with other the Advancement of Modeling & Role
people and the world. Modeling)

Major Concepts Major Concepts

• Transforming presence • Health

• Mutual nurse-patient/family/community • Adaptation
relationship • Holism
• Uncovering meaning through pattern • Affiliated Individuation
recognition • Self-Care
• Gaining insight and discovering choices • Nurturance
• Unfolding awareness/expanding • Unconditional Acceptance
consciousness • Facilitation
• Undivided wholeness/boundarylessness
• Human-environment-health interaction
• Fluctuation of the life process
• Research-as-praxis
THEORETICAL COMPONENTS OF MODELING Concepts
AND ROLE-MODELING
• COMMITMENT, ATTACHMENT AND
1. Stress, effected by stressors, is a part of PREPARATION (formerly the Anticipatory
everyday life Stage) During this initial stage the mother-to-
2. Our ability to cope and adapt determines be begins to adjust to the anticipated realities
our ability to mobilize resources needed to of her new role.
work through epigenetic developmental tasks.
3. The resources needed to cope are created • ACQUAINTANCE, LEARNING AND PHYSICAL
by repeated needs satisfaction. RESTORATION STAGE (formerly the Formal
4. Attachment objects, those things that Stage) The stage immediately after childbirth,
repeatedly meet our needs, are associated adoption or bringing a new child into the
with developmental tasks. home, this is the stage during which the new
5. Loss of attachment objects is both normal mother adapts to her role by modeling learned
and situational and results in a grief process. behaviors and conforming closely to social and
6. Unresolved attachment-loss-attachment family norms.
results in morbid grieving and affects needs
status • MOVING TOWARDS A NEW NORMAL
7. As tasks are resolved, the residual that (formerly the Informal Stage) This is the period
remains affects future task resolution in which the mother begins to develop her own
maternal identity and becomes more
comfortable with her decision-making and
MERCER'S MATERNAL ROLE mothering skills.
ATTAINMENT THEORY
• ACHIEVEMENT OF MATERNAL IDENTITY
The Maternal Role Attainment Theory was (formerly the Personal Stage) This final stage,
developed to serve as a framework for nurses which typically occurs at about four months
to provide appropriate health care after birth, is the point at which the new
interventions for nontraditional mothers in mother has successfully integrated prior
order for them to develop a strong maternal learning with personal experience.
identity. This mid-range theory can be used
throughout pregnancy and postnatal care, but
is also beneficial for adoptive or foster
mothers, or others who find themselves in the
maternal role unexpectedly. The process used
in this nursing model helps the mother develop
an attachment to the infant, which in turn
helps the infant form a bond with the mother.
This helps develop the mother-child
relationship as the infant grows.
 Merle H. Mishel: Uncertainty in
Influences - Mercer describes multiple Illness Theory and
factors that influence women as they move Reconceptualized Uncertainty
through the process of attaining maternal
identity. These can be broken down into in Illness Theory
four primary areas: birth experience, social
Mishel’s original uncertainty in illness
stressors, self-concept and health status.
theory is an explanation of “how patients
cognitively structure a schema for the
• BIRTH EXPERIENCE - Although a positive
subjective interpretation of uncertainty
birth experience contributes to and
with treatments and outcomes. . . . The
strengthens the mother-child bond, many
desired outcome . . . is a return to the
new mothers feel disappointment, guilt or
previous level of adaptation or functioning”
inadequacy when the birth experience fails
(Clayton Dean, & MIshel, 2018, p. 49).
to live up to their expectations or what
they perceive to be the norm.
The reconceptualized uncertainty in illness
theory “addresses the process that occurs
• SOCIAL STRESSORS -Social support is an
when a person lives with unremitting
important factor in the development of
uncertainty found in chronic illness or in
maternal identity. New mothers who
illness with a potential for recurrence . . .
receive appropriate guidance and
The desired outcome . . . is a growth to a
information, emotional support and
new value system” (Clayton et al., 2018, p
appraisal of their parenting skills feel
49).
competent and confident.
When the theory was reconceptualized, the
• SELF-CONCEPT -This is a broad term that
concepts of self-organization, probabilistic
includes factors such as self-esteem, self-
thinking, and formation of a new life
worth and the mother’s perception of her
perspective were added, and appraisal of
abilities as a caretaker for her child.
uncertainty and coping with uncertainty
were eliminated.
• HEALTH STATUS - The health status of
both the mother and the infant are
essential components of developing Major Concepts
maternal identity. For the new mother, ORIGINAL THEORY – UNCERTAINTY
issues ranging from episiotomy pain to
postpartum depression can have an impact • Antecedents of uncertainty — stimuli
on her ability to care for and relate to her frame (symptom pattern, event familiarity,
child. event congruence), cognitive capacity, and
structure providers (education, social
support, credible authority)

• Appraisal of uncertainty — inference or

illusion, valuing of uncertainty as a danger
or opportunity

• Coping with uncertainty — danger,

opportunity, coping (mobilizing strategies
and control situation when uncertainty is
regarded as danger; building strategies
when uncertainty is regarded as
opportunity), adaptation
RECONCEPTUALIZED THEORY – Theory of Illness Trajectory
UNCERTAINTY
Carolyn L. Wiener
• Antecedents of uncertainty — stimuli &
frame (symptom pattern, event familiarity,
Marylin J. Dodd
event congruence), cognitive capacity, and
structure providers (education, social It provides framework for understanding
support, credible authority) how patients tolerate uncertainty
manifested as a loss of control
• Self-organization
Being ill creates a disruption in the normal
• Probabilistic thinking life. Such disruption affects all aspects of
life...
• Formation of a new life perspective —
prior life experience, physiological status, • Physiological Functioning
social resources, health care provider • Social Interactions
• Conceptions of Self
The Theory of Illness Trajectory helps the
Pamela G. Reed: Self- clinician interpret these behaviors and to
transcendence Theory intervene to help ease transitions across
this trajectory.
Self-transcendence is a human capacity to
expand personal boundaries in many ways, Major Concepts and Definitions
for example, intrapersonally, Illness Trajectory:
interpersonally, and transpersonally to States of Uncertainty
connect within self, with others and nature, “a course of illness over time plus the
and with purposes or dimensions regarded actions taken by patients, families and
as larger than or beyond the self. Self- health professionals to manage or shape
transcendence facilitates well-being, and the course
also mediates the relationship between
experiences of increased vulnerability and • Uncertain Temporality
well-being outcomes. Various personal and — taken-for-granted expectations regarding
contextual factors, including nursing the flow of life events are disrupted
interventions, influence self-transcendence — a temporal disjunction in the biography
as related to well-being. The theory was
created from a lifespan developmental • Uncertain Body
perspective of human-environment — changes r/t illness and treatment
processes of health and well-being. centered in one's ability to perform usual
activities

Major Concepts • Uncertain Identity

— interpretation of self is distorted as the
• Vulnerability body fails to perform in usual ways, and
• Self-Transcendence expectations r/t the flow of events
• Well-Being (temporality) are altered by disease and
• Personal and Contextual Factors treatment