MODULE III: THEORETICAL FOUNDATIONS OF NURSING • Accepts & tries to understand people of all sorts,

regardless of race, religion and color

“NURSING AS A PROFESSION” • Knows nursing so thoroughly that every client will receive
What is a Profession? excellent care
-A profession is a calling that requires special knowledge and skilled Roles & Functions of Professional Nurses
preparation. 1. Care Provider
-A profession is generally distinguished from other kinds of • Support the client by attitudes & actions that show
occupation by: concern for client welfare and acceptance of the
a) Its requirement of prolonged specialized training client as a person.
acquiring a body of knowledge pertinent to the role to be
• The nurse is primarily concerned with the client’s
performed.
needs.
b) An orientation of the individual toward service, either to
2. Communicator / Helper
community or organization.
• The nurse communicates with clients, support
persons and colleagues to facilitate all nursing
What are the Criteria for a Profession?
actions.
1. A profession applies its body of knowledge in practical
3. Teacher / Educator
services that are vital to human welfare, and especially
suited to the tradition of seasoned practitioners shaping the • Provision of health teaching to effect behavior
skills of newcomers to the role. change.
2. It constantly enlarges the body of knowledge it uses and 4. Counselor
subsequently imposes on its members a lifelong obligation • Helping the client to recognize & cope with stressful
to remain current in order to “DO NO HARM”. psychologic or social problems, to improve personal
3. It functions autonomously (with authority) in formulation relationship and to promote personal growth.
of professional policy and in monitoring its practice and • Includes providing emotional, intellectual &
practitioners. psychological support.
4. It utilizes in its practice a well-defines and well- organized 5. Client Advocate
body of knowledge that is intellectual in nature and • Promoting what is best for the client.
describes its phenomenon and practitioners. • Ensuring that client’s needs are met.
5. A profession has a clear standard of educational • Protecting the client’s rights.
preparation for entry into practice. 6. Change Agent
6. A profession is distinguished by the presence of specific • Initiating changes & assisting the client in making
culture, norms and other values that are common among modification in the lifestyle to promoting health.
its members. 7. Leader
• Influencing the client to make decisions in
What are the Characteristics of a Profession? establishing and achieving goals to improve his
• A defined body of knowledge well-being.
• Power & authority over training and education 8. Researcher
• Registration • Participating in scientific investigation & uses
• Altruistic service research findings in practice.
• A code of ethics • Helps in developing knowledge about health & the
• Lengthy socialization promotion of health over the full life span.
• Autonomy 9. Manager
• Involves planning, giving direction, developing
Characteristics & Attributes of a Professional Person staff, monitoring operations, giving rewards fairly,
• Concerned with quality and representing both staff and administration.
• Self-directed, responsible and accountable for his actions Coordinating the activities of other members of the
• Able to make independent & sound judgement including healthcare team (ex. nutritionist & physical
high moral judgement therapist), when managing group of client’s care.
• Dedicated to the improvement of human life 10. Collaborator
• Committed to the spirit of inquiry • Working in combined effort with all those involved
in care delivery, for mutually acceptable plan to be
Professional Nurse obtained that will achieve common goals.
-One who has acquired the art and science of nursing through her
basic education, who interprets her role in nursing in terms of the EXPANDED ROLES OF NURSES
social ends for which it exists, the health & welfare of society and 1. Nurse Practitioner (NP)
who continues to add to her knowledge, skills and attitudes through • Has advance education (at least Master’s Degree in
continuing education and scientific inquiry or the use of the results Nursing) and is a graduate of nurse practitioner
of such inquiry. program.
• Functions more independence & autonomy than
Qualifications & Abilities of a Professional Nurse other nurses.
• Faith in the fundamental values • Highly skilled in performing nursing assessments,
• Sense of responsibility physical ex aminations, counselling, teaching and
• Faith in the reality of spiritual & aesthetic values and treating minor health problems.
awareness of the value & the pleasure of self-development • Have specialties (ex. Obstetrics, pediatrics or family
through the pursuit of some aesthetic interest care).
• Has the basic knowledge, skills & attitudes necessary to 2. Clinical Nurse Specialist (CNS)
address present-day social problems • Has Master’s Degree in Nursing & may have
• Has skill in using written and spoken language advanced experience & expertise in specialized area
• Appreciate & understand the importance of good health of practice (ex. Gerontology, Pediatrics, Critical
• Has emotional balance Care, Oncology).
• Likes hard work & possesses a capacity for it • Works in different setting depending on their
• Appreciates high standards of workmanship specialty.
 • Roles of CNS includes clinician, educator, manager, must have as few concepts as possible having
consultant & researcher. simple relations to assist clarity.
3. Nurse Midwife • According to Raynold, the most useful theories are
• Educated in nursing and midwifery and is a licensed those that offers greatest sense of understanding.
to provide independent care for women during Question to be asked:
normal pregnancy, labor and delivery. ✓ How simple is the theory?
4. Nurse Anesthetist 3. Generality
• Have an advanced education in anesthesiology. • It is important to examine the scope of concepts and
• Provides general anesthesia for clients undergoing goals within the theory for this analysis criterion.
surgery under the supervision of physician prepared • As a rule of thumb, “The more limited the concept
in anesthesiology. and goals is, the less general the theory becomes”.
5. Nurse Researcher • Consequently, The broader the scope of the theory,
• Responsible for continued development & the greater its significance.
refinement of nursing knowledge & practice Questions to be asked:
through the investigation of nursing problems. ✓ How general is the theory?
• Has advance education, usually doctorate level. ✓ How broad is the scope of the theory?
• They work in large teaching hospitals, research 4. Empirical Precision
centers or academic settings. • The degree in which the defined concepts are
6. Nurse Administrators observable in actual setting.
• Responsible for specific nursing units and serve as • Empirical adequacy can be measured by the
liaisons between staff members and director of evidences that supports the theory.
nursing. • According to Walker & Avant, a theory must
• Requires advance education. generate a hypothesis and must add to the body of
• Manages and controls client care. knowledge.
7. Nurse Educators Questions to be asked:
• Has advance education in nursing (at least Master’s ✓ Is the theory accessible?
Degree). ✓ How accessible is the theory?
• For teaching Master’s Degree or Doctorate degree 5. Derivable Consequences
in Nursing must have doctorate degree. • According to Chinn & Kramer, a nursing theory
• Must continue to maintain expertise in the practice should lead itself to research testing which would
setting, develop expert knowledge of theory, perfect result to additional knowledge that would guide
classroom presentation style, have in-depth practice.
knowledge of curriculum development & higher • Furthermore, nursing theory should give direction
education. to research and practice, create new ideas and seek
to distinguish the focus of nursing to other
MODULE IV: NURSING THEORIES & CONCEPTUAL professions.
FRAMEWORKS Questions to be asked:
✓ How important is the theory?
“ANALYSIS & EVALUATION OF THEORY” ✓ Does the theory have a significant contribution
to nursing knowledge?
Things to consider in evaluating a theory:
1. The degree of usefulness to guide practice, research, MODULE IV: THEORETICAL FOUNDAITONS OF NURSING
education and administration.
2. Providing a description of a theory through reviewing the FLORENCE NIGHTINGALE
entire work while focusing in its historical aspect.
3. Critical reflection should be done by ascertaining how • Born on May 12, 1820 in Florence Italy.
well a theory serves the profession’s progress. • A beautiful Victorian Lady, whose parents were wealthy &
well-travelled.
5 Criteria in evaluating a theoretical work (Chinn & Kramer, • She took her nursing program from Fleidener School of
1991) Nursing in Kaiserswerth Germany (July 6, 1851 – October 7,
1. Clarity 1851).
• In evaluating this, semantics (study of meaning of • Then went back to England and used knowledge from
the language, symbols and logic) and structure Kaiserswerth to prove her cause as a reformer for the
should be considered important. wellbeing of the citizens.
• It involves identifying the major concepts & • During Crimean War (battle between English and Turkish),
subconcepts used in the theory. she was requested by her friend, Sir Sidney Herbert (secretary
• Words commonly used with multiple meanings at Great Britain) to help for the wounded soldiers.
within & across disciplines should be defined • With her lamp, she traversed the night to look for the wounded
operationally or how it is used in the framework soldiers and heal them with her consoling hands.
from which it is derived. • Called as “Lady with the Lamp”.
• Diagrams should also be clear and consistent all • Environmental Model (Notes on Nursing: What It Is, What It
throughout. Is Not).
• It should also follow a logical sequence which is • Nursing and Patient Environment Relationship.
understandable. • Provided the nursing profession the “Legacy of Caring”.
• Assumptions should be consistent with the defined • Founder of the Modern Nursing.
goals of the theory.
Questions to be asked: METAPARADIGM OF NURSING
✓ Is the theory clearly stated? PERSON
✓ How clear is the theory? • Viewed the essence of a person as a patient and envisioned as
✓ Is it easily understood? comprising physical, intellectual, emotional, social & spiritual
2. Simplicity components.
• A theory must be adequately comprehensive at a • The one who is receiving the care; dynamic & complex being.
level of abstraction to offer direction. However, it
HEALTH • Hospital safety and cleanliness standards
• According to her, “Healthy is not only to be well, but to be • Documentation
able to use well every power we have”. • Health promotion (sleep, nutrition and exercise)
• She believed in the prevention & health promotion in addition
to nursing patients from illness to health. VIRGINIA HENDERSON
ENVIRONMENT • 1955.
• Anything that can be manipulated to place a patient in the best • Introduced “The Nature of Nursing Model”.
possible condition for nature to act. • Identified & conceptualized the “14 Basic Human Needs” on
• Those elements external to and which affect the health of the which nursing care is based.
sick and healthy person. • According to her, nurses as direct provider of care helps
NURSING patients to become independent.
• Considered nursing as very essential for everybody’s well- • Called the “First Lady of Nursing” and the “First Truly
being. International Nurse”.
• She believed nursing to be a spiritual calling and nurses were • She began her career in Public Health Nursing in the Henry
to assist nature to repair the patient. Street Settlement and in the visiting nurse service in
Washington D.C.
• She also worked as a Full-time instructor in nursing in
NIGHTINGALE’S CANONS (1969) Virginia.
▪ Keeping the air as pure as the external
air, without chilling him. • She was an early advocate for the introduction of Psychiatric
▪ Believed that “noxious air” or Nursing in the curriculum.
VENTILATION & • The Nightingale of Modern Nursing.
“effluvia” or foul odors affects the
WARMTH client’s health. • The 20th century Florence Nightingale.
▪ Emphasized the importance of room
temperature (not too warm or too cold). METAPARADIGM OF NURSING
▪ Need for both fresh air and light – PERSON
LIGHT sunlight is beneficial to patients.
▪ Check room for dust, dampness and • Referred to a person as a patient.
dirt. • According to her, a person is an individual who requires
CLEANLINESS ▪ Keep room free from dust, dirt and assistance to achieve health and independence or in some
dampness. cases peaceful death.
▪ Check surrounding environment for
fresh air, pure water, drainage, HEALTH
HEALTH OF HOUSES cleanliness and light.
▪ Remove garbage, stagnant water, and • She viewed health as a quality of life and is very basic for a
ensure clean water and fresh air. person to function fully.
▪ Check noise level in the room and • As a vital need, health requires independence and
surroundings. interdependence.
NOISE ▪ Attempt to keep noise level in
minimum. ENVIRONMENT
▪ Check bed and bedding for dampness,
wrinkles and soiling.
• It is important for a healthy individual to control the
BED & BEDDINGS ▪ Keep the bed dry, wrinkle-free, and environment, but as illness occur this ability is diminished or
lowest height to ensure comfort. affected.
▪ Attempt to keep the patient dry and • In caring for the sick it is the responsibility of the nurse to help
PERSONAL clean at all times. the patient manage his surroundings to protect him from harm
▪ Frequent assessment of the patient’s or any mechanical injury.
CLEANLINESS skin is essential to maintain good skin
integrity
▪ Rearrange room
NURSING
VARIETY ▪ Offer variety of colors • Henderson asserted that nurses function independently from
▪ Avoid talking without reason or giving physician but they must promote the treatment plan prescribed
advices that is without fact. by the physician.
CHATTERING ▪ Continue to talk to the client as a • Another special role of the nurse is to help both the sick and
HOPES & ADVICES person, and continue to stimulate well individual.
patient’s mind.
• The care given by the nurse must empower the patient to gain
▪ Avoid personal talk.
▪ Continue with the assessment of the
independence as rapidly as possible.
diet to include type of food and drink the • In the role of the nurse as a healthcare provider, the nurse must
client likes or dislikes. be knowledgeable in both biological and social sciences and
TAKING FOOD ▪ Attempt to ensure that the client always must have the ability to assess basic human needs.
has some food or drink available that he
or she enjoys. 14 FUNDAMENTAL NEEDS OF HUMANS
▪ Ensures continuity of care.
1. Breathing normally
PETTY ▪ Documents the plan of care and
2. Eating and drinking adequately
MANAGEMENT evaluate the outcomes to ensure
continuity. 3. Eliminating body wastes
▪ Observe and record anything about the 4. Moving and maintaining a desirable position.
patient. ▪ Observations should be factual 5. Sleeping and resting
OBSERVATION OF and not merely opinions. 6. Selecting suitable clothes
THE SICK ▪ Continue observation in the patient’s 7. Maintaining a normal body temperature by adjusting
environment and make changes in the clothing & modifying the environment.
plan of care if needed. 8. Keeping the body clean & well-groomed to promote
integument (skin).
NIGHTINGALE’S CONTRIBUTIONS TO NURSING 9. Avoiding dangers in the environment & avoiding injuries to
• Nursing Education others.
• Infection control 10. Communicating with others in expressing emotions, needs,
• Reforms health care fears or opinions.
 11. Worshiping according to one’s faith. PURPOSE OF KNOWING THE PATIENT’S CULTURE &
12. Working in such a way that one feels a sense of RELIGION FOR HEALTHCARE PERSONNEL
accomplishment. 1. To heighten awareness of ways in which their own faith
13. Playing or participating in various forms of recreation. system provides resources for encounters with illness,
14. Learning, discovering of satisfying the curiosity that leads to suffering and death.
normal development and health & using available health 2. To foster understanding, respect and appreciation for the
facilities. individuality and diversity of patients’ beliefs, values,
spirituality and culture regarding illness, its meaning,
NURSE-PATIENT RELATIONSHIP cause, treatment, and outcome.
1. The Nurse as a substitute for the patient 3. To strengthen their commitment to relationship-centered
-the nurse serves as the substitute as to what the patient lacks medicine that emphasizes care of the suffering person
such as knowledge, will and strength in order to make him rather than attention simply more to the pathophysiology
complete, whole and independent. of disease, and recognizes the physician as a dynamic
2. The Nurse as a helper for the patient component of the relationship.
-In times when the patient cannot meet their basic needs, the 4. To facilitate in recognizing the role of the hospital
nurse serves as the helper to accomplish them. chaplain and the patient’s clergy as partners in the health
-The nurse focuses her attention in assisting the patient to care team in providing care for the patient.
meet his needs so as to regain independence as quickly as
possible. METAPARADIGM OF NURSING
3. The Nurse as a partner with the patient PERSON
-As a partner, the nurse and the patient formulate the care • Humans are thus believed to be caring and capable of being
plan together. concerned about the desires, welfare, and continued existence
-The nurse serves as an advocate & resource person by of others. Human care is collective, that is, seen in all cultures.
empowering the patient to make effective decisions
regarding his care plans. HEALTH
4. Nurse as a member of the healthcare team • Is viewed as a state of well-being.
-For a team to work together harmoniously, every member • Is culturally defined, valued, and practiced.
must work interdependently. • Seen as universal across all cultures but distinct within each
-However, it does not include taking other member’s roles culture in a way that represents the beliefs, values, and
and responsibilities. practices of the particular culture.

HILDEGARD PEPLAU ENVIRONMENT

• Defined culture as closely related with society/environment.
• Born on September 1, 1909. • According to her, culture centers on a particular group
• Introduced “Interpersonal Relations in Nursing Model (society) and the patterning of actions, thoughts, and decisions
(Psychodynamic Nursing Model)”. that occurs as the result of “learned, shared, and transmitted
• Provide the clear design for the practice of Psychiatric values, beliefs, norms, and lifeways”.
Nursing.
• Identified the Four Phases of the Nurse-Client Relationship. NURSING
• Called as “Psychiatric Nurse of the Century”. • Leininger identified three nursing decisions and action models
to achieve culturally congruent care.
4 PHASES OF NURSE-PATIENT RELATIONSHIP • These 3 modes of action can lead to the deliverance of nursing
1. ORIENTATION – the initial interaction between the nurse and care that best fits with the client’s culture and thus reduce
the patient wherein the clients attempt to identify difficulties and cultural stress and chance for conflict between client &
expresses the desire for professional help. caregiver.
1. Cultural Preservation or Maintenance – retain and or
2. IDENTIFICATION – the patient and the nurse explore the preserve relevant care values so that clients can maintain
experience and the needs of the patient and plan together an their wellbeing, recover from illness, or face handicaps
appropriate program to foster health. and/or death.
2. Cultural Care Accommodation or Negotiation – adapt or
3. EXPLOITATION – the patient derives the full value of the negotiate with the others for a beneficial or satisfying
relationship as he moves from dependent to independent one. health outcome.
3. Cultural Care Repatterning or Restructuring – change or
4. RESOLUTION – the patient earn independence over his care as greatly modify client’s life ways for a new, different and
he gradually put aside old goals and formulates new ones. beneficial health care patterns.

MADELEINE LEININGER PATRICIA BENNER

“Culture Care Diversity & University Theory” “Skills Acquisition in Nursing”

(Transcultural Nursing) (From Novice to Expert Model)

• Defined as a comparative study of cultures to understand • The model posits that changes in four aspects of
similarities (culture universal) & difference (culture - performance occur in movement through the levels of
specific) across human groups. skill acquisition:
• The central purpose of the theory is to discover and explain 1. Movement from a reliance on abstract principles and rules
diverse and universal culturally based care factors to the use of past, concrete experience.
influencing the health, well-being, illness, or death of 2. Shift from reliance on analytical, rule-based thinking to
individual or groups. intuition.
• The purpose and goal of the theory is to use research findings 3. Change in the learner’s perception of the situation from
to provide culturally congruent, safe, and meaningful care to viewing it as a compilation of equally relevant bits to viewing
clients of diverse or similar cultures it as an increasingly complex whole, in which certain parts
stand out as more or less relevant.
 4. Passage from a detached observer, standing outside the 6. Monitoring and ensuring quality of health care practices –
situation, to one of a position of involvement, fully engaged competencies with regard to maintenance of safety,
in the situation. continuous quality improvement, collaborative and
consultation with physicians, self-evaluation and
STAGES OF SKILLS ACQUISITION IN NURSING management of technology.
1. NOVICE - a person who has no background experience of the 7. Organizational and work-role competencies –
situation in which he or she is involved. competencies in priority setting, team building, coordinating,
• To guide performance, context free rules and objective and providing for continuity.
attributes must be given.
• Behavior is governed by established rules and is limited SISTER CALLISTA ROY
and inflexible.
• The novice has difficulty discriminating between “ADAPTATION MODEL”
relevant and irrelevant aspects of a situation.
• Nurses at higher levels can be classified as a novice if • Roy’s model focuses on the concept of adaptation of the
they are placed in an unfamiliar situation. person.
2. ADVANCE BEGINNER - has a sufficient experience to • According to her, a person is adapting in a stable interaction
easily understand aspects of the situation. with the environment, either internal or external.
• They can demonstrate marginally acceptable • The person continually experiences environmental stimulus.
performance. • The environment serves as the source of a range of stimuli that
• He or she had enough experience in actual situations to will either threaten or promote the person’s unique wholeness.
identify meaningful aspects or global characteristics that • These three types of stimuli act together and influence the
can be identified only through prior experience. adaptation level, which is a person’s ability to respond
• They feel more responsible for managing patient care yet positively in a situation.
they still rely on the help of those who have more • According to Roy, each of us has certain needs which we
experienced. endeavor to meet in order to maintain integrity.
3. COMPETENT - competence is reflected by the nurse who • These needs are divided into four modes: Physiological, self -
has been on the same job for 2 – 3 years and consciously and concept, role function, and interdependence.
deliberately plans nursing care in long term goals. • Goals of each adaptive modes includes:
• An increase level of efficiency is evident. 1. Physiological – PHYSIOLOGICAL INTEGRITY
• They display more responsibility for the patient, often 2. Self-concept – PSYCHOLOGICAL INTEGRITY
more than what is realistic and may exhibit critical view 3. Role Function – SOCIAL INTEGRITY
of the self. 4. Interdependence – AFFECTIONAL ADEQUACY
• They develop new rules for action and reasoning
procedures for a plan while applying learned rules for DOROTHEA OREM
action on the basis of the relevant facts of the situation.
4. PROFICIENT - the proficient nurse perceives the situation
“SELF-CARE & SELF-CARE DEFICIT THEORY”
as a whole rather than in terms of aspects and manages nursing
care rather than performing tasks.
• Proficient level is qualitative leap beyond the competent. 1. THEORY OF SELF-CARE
• The nurse identifies the most significant aspects and has • She defined self-care as “the practice of activities that
a better understanding of the situation based on individuals initiate and perform on their own behalf in
background understanding. maintaining life, health and well-being”.
• They no longer rely on pre-set goals for organization. • She identified the three self-care requisite categories:
1) Universal
• They show more confidence in their knowledge & skills.
2) Developmental
5. EXPERT - an individual no longer relies on rules or
3) Health Deviation
guidelines to connect understanding of a situation to an
2. THEORY OF SELF-CARE DEFICIT
appropriate action.
• Specific when nursing is needed because the person
• They have an intuitive grasp of the situation/problem
cannot carry out self-care.
without losing time considering a range of alternative
diagnosis and solutions (demonstrates a clinical grasp • According to OREM, Nursing is required when a person
and resource – based practice). is incapable or limited in the provision of continuous
effective self-care.
• Possessing embodied knowledge.
• Identified 5 methods of helping the person on self-care
• Seeing the big picture.
deficit:
• Seeing the unexpected.
1) Acting for and doing for others
2) Guiding others
7 DOMAINS OF NURSING PRACTICE 3) Supporting others
1. Helping role – competencies related to establishing a healing 4) Providing an environment to promote patient’s
relationship, providing comfort measures, and inviting active ability,
participation and control in care 5) Teaching another.
2. Teaching or coaching function – this includes timing, 3. THEORY OF NURSING SYSTEM
readying patients for learning, motivating change, assisting • It describes how the patient’s self-care needs will be met
with lifestyle alterations, and negotiating agreement on by the nurse, the patient or both.
goals.
• According to OREM, there are 3 classifications of
3. Diagnostic or client-monitoring function – competencies in
nursing systems to meet the self – care requisites of the
on-going assessment & anticipation of outcomes.
patient:
4. Effective management of rapidly changing situations –
1) Wholly Compensatory System - patient is
ability to contingently match demands with resources and to
dependent.
assess and manage care during crisis situations.
➢ The nurse is expected to accomplish all the patient’s
5. Administering and monitoring therapeutic interventions
therapeutic self-care or to compensate for the patient’s
and regimens – competencies related to preventing
inability to engaged in self-care or when the patient
complications during drug therapy, wound management and
needs continuous guidance in self-care
hospitalization.
 2) Partially Compensatory System - the patient can 3. Social – how the nurse interacts with co-workers,
meet some needs thus patient needs some nursing superiors, subordinates, and the client environment in
assistance. general.
➢ Both the nurse and the patient engage in meeting self-
care needs. BETTY NEUMANN
3) Supportive-educative System - the patient can meet
selfcare requisites but needs assistance with “HEALTH CARE SYSTEM MODEL”
decision making or knowledge and skills to learn
self-care.
• Neuman’s model concentrates on explaining a person’s
reaction to stressors in the environment.
DOROTHY JOHNSON
• She asserted that nursing is a unique profession that concern
with all the variables affecting an individual’s response to
“BEHAVIORAL SYSTEM MODEL” stressors:
1) INTERAPERSONAL (within the individual),
• Johnson views each individuals/patient as having two major 2) INTERPERSONAL (between one or more other
systems, the biological system and the behavioral system. people),
• She believes that each individual has patterned, purposeful, 3) EXTRAPERSONAL (outside the individual).
repetitive ways of acting that comprise a behavioral system • She believes that nursing requires a holistic approach and th e
specific to that individual. nurse must be able to adjust to meet the individual and unique
• The primary goal of nursing is to cultivate/foster/improve needs of every client.
equilibrium within the individual. • The concern of nursing is to:
• According to Johnson, nursing is concern with the organized 1) To prevent stress invasion,
and integrated whole or holistic growth of the individual, but 2) To protect the client’s basic structures, and
the chief focus is to maintain a balance in the behavioral 3) To obtain or maintain a maximum level of wellness.
system when illness occurs in an individual/patient. • How do we achieve this one as nurses?
➢ Through PRIMARY, SECONDARY and TERTIARY
8 BEHAVIORAL SUBSYSTEM modes of preventions, to adjust to environmental
1. Ingestive subsystem – related to behaviors surrounding the stressors and maintain client stability.
ingestion of food that is socially and culturally acceptable
ways. PREVENTION – the primary nursing interventions focuses on
2. Eliminative subsystem – related to behaviors surrounding th keeping the stressors and the stress response from having a
e secretion of waste products from the body (i.e. time & place detrimental effect on the body.
for humans to excrete waste).
3. Attachment or affiliative subsystem – security seeking 1. Primary prevention – focuses on foreseeing threats or an
behaviors (social inclusion, intimacy, and the formation and act or situation and preventing its unnecessary effects as
attachment of a strong social bond). possible (i.e. health promotion and disease prevention). 2.
4. Aggressive subsystem – related to behaviors concerned with 2. Secondary prevention – focuses on helping alleviate the
self-protection and self-preservation. actual existing effects of an action that altered that balance
5. Dependency subsystem – these are actions that trigger of health of a person (i.e. early detection and prompt
nurturing behaviors from other individuals in the treatment).
environment. 3. Tertiary prevention – focuses on actual treatments or
6. Achievement subsystem – contains behaviors that attempt to adjustments to facilitate the strengthening of person after
control environment (intellectual, physical, imaginative, being exposed to a certain disease or illness.
mechanical, and social skills); efforts to gain mastery & ▪ The aim is to prevent the regression or reoccurrence
control. of the illness in the manner of rehabilitation, as in the
7. Sexual subsystem – imitates behaviors related to procreation case of disability avoidance and physical therapy.
or reproduction (i.e. role identity, courting and mating).
8. Restorative behaviors – concerned with rest, sleep, comfort
and freedom from pain.

IMOGENE KING

“GOAL ATTAINMENT THEORY”

• King describes nursing as a helping profession that assists

individuals and groups in society to attain, maintain, and
restore health. If not possible, nurses help individuals die with
dignity.
• Goal attainment theory focuses on creating a positive behavior
that can be adapted both by the nurse and the client to achieve
goals established by the client with the help of the nurse.
• Nursing for her is an interactive process between the client
and the nurse whereby during perceiving, setting goals, and
acting on them transactions occurs and goals are achieved.
• She identified the three interacting systems that needs to be
utilized by the nurse to form a strong foundation for a dyna
mic and interactive environment:
1. Personal – how the nurse views and integrates self-
based from personal goals and beliefs.
2. Interpersonal – how the nurse interrelates with a
coworker or patient particularly in a nurse-patient
relationship.