THEORETICAL FOUNDATION OF NURSING – MIDTERM

LLESSON 1. programs opened in colleges

-------------
and universities.
NURSING THEORY
THEORY
1950 – 1970’s
• Are mental patterns or constructs created to
help understand and find meaning from our Nursing became one of the
experience, organize and articulate our increasingly sought degrees in
knowing, and ask questions leading to new RESEARCH higher education so nurses
insight. began to participate in
EMPHASIS
research.
• An organized, coherent set of concepts and ERA
Nursing leaders arrived at an
their relationships to each other that offers
understanding of the scientific
descriptions, explanations, and predictions
age and that research was the
about phenomena.
path to the new nursing
NURSING THEORY knowledge.

• A set of concepts, definitions, and 1950 – 1970’s

propositions that projects a systematic view of
This era is tandem with the
phenomena by designating specific GRADUATE research era.
interrelationships among concepts for
purposes of describing, explaining, predicting, EDUCATION Master’s degree programs in
and/or controlling phenomena. ERA nursing emerged to meet the
public need for nurses for
• A conceptualization of some aspect of reality specialized clinical nursing
(invented or discovered) that pertains to practice.
nursing. The conceptualization is articulated
1980 – 1990’s
for the purpose of describing, explaining,
predicting, or prescribing nursing care Emphasis shifted from
(Meleis, 1997, p.12) THEORY learning about the theorists to
ERA how to use theoretical works
• FLORENCE NIGHTINGALE – The history of to generate research
professional nursing began with. questions, guide practice, and
• She envisioned nurses as a body of an organize curricula.
educated woman at a time when
21ST CENTURY
women were neither educated nor
employed in The development and use of
public service. THEORY theory led to what is
recognized today as the
HISTORICAL ERAS UTILIZATION
“nursing theory era”
1900 – 1940’s ERA
It gives emphasis to theory
A standardized curriculum had application in nursing
been published and adopted practice, education, research,
CURRICULUM by many diploma nursing and administration.
programs.
ERA
On the second half of 20th
century, diploma programs
began closing and significant
numbers of nursing education

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 3. EMERGENT VIEWS
• In the view of epistemology, science is
viewed as an ongoing process.

• Much importance is given to the idea

of consensus among scientists.

SIGNIFICANCE DISCIPLINE OF NURSING

• STANDARDIZATION OF CURRICULUM
University baccalaureate programs
proliferated, master’s programs in nursing
were developed, and the curricula began to
be standardized through the accreditation
process.
HISTORICAL VIEWS OF NURSING AS A SCIENCE

1. RATIONALISM • PUBLICATION OF CONCEPTUAL

• Rationalist epistemology (scope of FRAMEWORK IN RESEARCH
knowledge) emphasizes the Attention to the importance of nursing
importance of priori reasoning as the conceptualizations for the research process
appropriate method for advancing and the role of a conceptual framework in
knowledge. the purpose and design of research
production of science and nursing
• A priori reasoning uses deductive logic theoretical works also began to publish.
by reasoning from the cause to an
effect or form a generalization to a • RECOGNITION OF THEORIST
particular instance. CONTRIBUTION TO BODY OF KNOWLEDGE
works began to be recognized for their
• An example in nursing is to reason that theoretical nature, such as Henderson,
a lack of social support (cause) results Nightingale, and others.
in hospital admission (effect)
• MAJOR SIGNIFICANCE IS THE DISCIPLINE
2. EMPIRICISM IS DEPENDENT UPON THEORY
• The empiricist view is based on the theoretical works have taken nursing to a
central idea that scientific knowledge higher level
can be derived only from sensory
the emphasis has shifted from a focus on
experience (i.e. seeing, feeling, knowledge about how nurses function,
hearing facts). which concentrated on the nursing process,
to focus on what nurses know and how they
• One of the best examples that can be use knowledge to guide their thinking and
decision making while concentrating on the
used to demonstrate this form of logic
patient
in nursing has to do with formulating a
differential diagnosis. NURSING PROFESSION
➢ Nursing theory is a useful tool for reasoning ,
• Formulating a differential diagnosis critical thinking, and decision making in
requires collecting facts, then devising nursing practice.
a list of possible theories to explain the ➢ Nursing theoretical works provide a
facts. perspective of the patient.

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 ➢ Nursing theory provides more direction for 2 A profession has a theoretical body of
nursing practice. knowledge leading to a defined skill, abilities,
and norms.
SIGNIFICANCE TO THE PROFESSION 3 A profession provides a specific service.
• RECOGNITION OF THE PRACTICE OF 4 Members of a profession have autonomy in
decision making and practices.
NURSING
Nursing theorists help recognize what
should set the foundation of practice by NURSING AS A PROFESSION
explicitly describing nursing. 1 The profession as a whole has a code of ethics
to practice.
• RECOGNITION OR NURSES’ 2 Nurses have traditionally placed a high value
on the worth and DIGNITY OF OTHERS
CONTRIBUTION
requires INTEGRITY of it’s members, and
It helps nurses understand their purpose RESPECTFUL.
and role in the healthcare setting. 3 A profession serves all society and not the
specific interest of a group.
• SCIENTIFIC BASIS OF NURSING 4 The aims of the profession are humane rather
than materialistic.
INTERVENTIONS
It serve as a rationale or scientific reasons
for nursing interventions and give nurses CARING
the knowledge base necessary for acting
• The most unique characteristics of nursing as
and responding appropriately in nursing a profession is that it is a caring profession.
care situations.
• It involves five process:
• IMPROVING NURSING KNOWLEDGE BASE o Knowing
It prepares the nurses to reflect on the o Being with
assumptions and question the nursing o Doing for
values, thus further defining nursing and o Enabling
increasing the knowledge base. o Maintaining belief

• EMPHASIS ON SCOPE OF NURSING • Involves providing presence, comforting,

It attempts to maintain and preserve its listening, knowing the client, spiritual caring,
professional limits and boundaries.
and family care.

• SETS DIRECTION
It guides knowledge development and ROLE OF THE PROFESSIONAL NURSE
directs education, research, and practice, Caring, comforting involves
although each influences the others. CARE PROVIDER knowledge and sensitivity to
(Fitzpatrick and Whall, 2005). what members and what is
important to the client.
NURSE Effective communication is an
essential element of all
• a person who tends to the needs of the sick; a COMMUNICATOR helping professions, including
professional who “put the patient in the best
condition for nature to act upon him.” /HELPER nursing. It helps the clients to
(Nightingale, 1954) explain the internal feeling
she is going through.
PRIMARY CHARACTERISTIC OF A PROFESSION The patient just like the
1 A profession requires an extended education TEACHER/ student, also needs education
of its members as well as a basic liberal EDUCATOR based on the case or condition
foundation. she has.

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 Counseling is a process of LESSON 2.
helping a client to recognize
COUNSELOR and cope with stressful
KNOWLEDGE IN NURSING
psychological or social • The knowledge embodied in nursing is a
problems, to develop improved collection of the different observations of
interpersonal relationships reality accumulated through the years.
and promote personal growth. • Each observation is collected, organized and
CLIENT / An advocate pleads the cause systematically arranged to explain, describe,
ADVOCATE of others or argues for a cause or define the phenomenon of interest.
or proposal. • These phenomena are the clustered to
A change agent is a person or become a body of knowledge.
CHANGE AGENT group who initiates changes or
• Knowledge therefore is composed of ideas
who assist others in making
based on person's frame of mind of what is
modifications in themselves or
real and what is not, it is important to realize
in the system.
Leaders is defined as a mutual how knowledge is studied or analyzed for its
process of interpersonal truth.
LEADER influence through which the
nurses helps a client make NURSING KNOWLEDGE
decisions in establishing and • The development of knowledge in nursing also
achieving goals to improve the brings with it new terms. Including “theory”
client’s well-being. “paradigm” and “construct”.
Management defines a
manager as who plans, gives • CHINN & KRAMER (2004) – “Theory is a
direction, develops staff,
creative and rigorous structuring of ideas that
MANAGER monitoring operations, giving
projects a tentative, purposeful, and
rewards fairly and representing
systematic view of phenomena.”
both staff members and
administration as needed.
Majority of researchers in • Nursing theory is the conceptualization of
nursing are prepared at some aspect of reality (invented or
doctoral and post-doctoral discovered) that pertains to nursing.
RESEARCHER level. Although an increasing
number of clinicians and • MELEIS (1997)- “The conceptualization is
nurses with master’s degree articulated for the purpose of describing,
are beginning to practice it. explaining, predicting, or prescribing nursing
The nurses coordinates the care. “
activities of other members of
CASE MANAGER the healthcare, such as
nutritionist, physical PARADIGM
therapists, when managing a
group of clients care PARADIGM- Derives from the Greek word
The nurses works is combined “PARADEIGMA,” meaning PATTERN.
effort with all those involved in
care delivery for all mutually • SYNONYMOUS TO TERM “MODEL”
COLLABORATIVE acceptable plans to be • FAWCETT (1992)- “It represents global ideas
obtained that will achieve about the individuals, groups, situations, and
common goals. The nurses events of interest to a discipline.
initiates nursing actions wuthin • STEVENS – BARNUM (1994)- “It is much
the health team. broader than models, representing a world
view.

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 MAIN PARADIGMS TO CLASSIFY NURSING METAPARADIGM IN NURSING
THEORIES
• FAWCETT (1992) – “The most global
SYSTEMS PARADIGM perspective of a discipline acting as an
encapsulating unit or framework within which
• Theories within this paradigm are largely the more restricted structure develop”
based upon the ‘general systems’ paradigm • It identifies certain phenomena which are of
as put forward by VON BERTALANFFY (1951) interest to a discipline and explains how that
• A SYSTEM is a collection of parts that function discipline deals with those phenomena in a
as a whole entity for a particular purpose. unique manner.
• The parts within a particular system are • This is an expression which represent a very
interrelated. broad view of issues that are relevant to
• These interrelationships may form nursing.
‘subsystems’ within the parent system.
Similarly, the system itself may form part of an NEED FOR METAPARADIGM
overall ‘supra system’.
• If a conceptualization does not include
DEVELOPMENTAL PARADIGM assumptions about nursing, health, person,
and environment, it could not be considered
• Originated from the work of FREUD (1949) & to be a theory (FITZPATRICK & WALL, 1995).
SULLIVAN (1953). The central themes are • Most authors subscribe to a four-component
growth, development, maturation, and metaparadigm. These four components are:
change. nursing, health, person, and environment
• Development is seen as an ongoing process in (YURA & TORRES, 1975; FAWCETT,1995).
which the person must pass through various • These are also referred to as the ‘essential
stages. elements’ of any theory (Pearson and
• The nurse’s goal is to encourage positive Vaugn,1986)
development and to break down and
discourage the formation of barriers to natural
development. PERSON / MAN
1. HENDERSON (1996)- Biological human
INTERACTIONAL PARADIGM beings with inseparable mind and body who
share certain fundamental human needs.
• Interactional theories have their origin in the
symbolic interactionist paradigm (BLUMER, 2. ROPER, LOHAN, & TIERNEY (1990)- An
1996). This paradigm emphasizes the unfragmented whole who carries out or is
relationship between people and the roles assisted in carrying out those activities that
they play in society. contribute to the process of living.
• Nursing activities are perceived as
interactional process between practitioners 3. OREM (1980)- A functional integrated whole
and clients. Supporters of the interaction with a motivational to achieve self-care.
paradigm can reasonably explain all human
activities as interactions. 4. ROY (1971)- A bio-psycho-social being who
• EX. A nurse assesses a client. There is an presents as an integrated whole.
interaction taking place leading to a
transaction of new information. NURSING
1. ROPER, LOGAN, AND TIERNEY (1990)- A
profession whose focus is to help the clients
to prevent, solve, alleviate or cope with

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 problems associated with the activities he or 3. OREM (1980)- A sub-component of man and
she carries out in order to live. with integrated system related to self-care.

2. HENDERSON (1966)- A profession that 4. ROY (1971)- Both internal and external. From
assists the person sick or well performance of the environment people are subject to
those activities contributing to health or its stresses.
recovery (or to a peaceful death) that he or she
would perform unaided, given the necessary
PHILOSOPHY
strength, will or knowledge.
1. SILVA (1986)- A philosophy is concerned with
the nature of being, the nature of reality and
3. OREM (1980)- A human service related to the
the limits of knowledge.
clients need and ability to undertake self-care
and to help then sustain health, recover from
2. FAWCETT (1992:68)- A philosophy is also
disease and injury or cope with their effects.
perceived as a statement of beliefs and values
about the world, a perspective on human
4. ROY (1971) – A social valued service whose
beings and their world, and an approach to the
goal is to promote a positive adaptation to the
development of knowledge.
stimuli and stress encounteres by the client.

3. SALSBERRY (1994)- A philosophy identifies

HEALTH
what is believed to be the basic central issues
1. HENDERSON (1966)- The ability to function
of discipline. This latter definition illustrates
independently regarding fourteen activities pf
that philosophy can have a similar meaning to
daily living.
metaparadigm or domain.
2. ROPER, LOGAN, & TIERNEY (1990)- The
optimum level of independence in each PHENOMENON
activity of living which enables the individual
to function at his/her maximum potential. ➢ It is a thing, event, or activity that we perceive
through our senses.
3. OREM (1980)- A state of wholeness or integrity ➢ Phenomena represent the subject-matter of a
of the individual, his parts and his modes of discipline,
functioning. ➢ MELEIS (1991)- When experience and sensory
and intuitive data become coherent as a
4. ROY (1971)- The adaptation of the person to whole, and prior to any attachment of
stimuli on a continuous line between wellness meaning, we have a phenomenon.
and illness.
CONCEPT

ENVIRONMENT ➢ MELEIS (1991)- Defines a concept as a label

1. HENDERSON (1966)- That which may act in a used to describe a phenomenon or a group of
positive or negative way upon the clients. phenomena.
➢ Therefore, when we put a name to a
2. ROPER, LOGAB, AND TIERNEY (1990)- phenomenon, we are identifying concepts.
Circumstances that may impinge upon the ➢ As a mental image, a concept is a view of
individual as he or she travels along the reality tinted with the observer’s perception,
lifespan and cause movement towards experience, and philosophical bent.
maximum dependence or maximum
independence. \

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 CONSTRUCT and in the transfer of their thinking into
practice for the benefit of the client and the
➢ When a phenomenon is very abstract, and the profession’. Models, therefore, are conceptual
resultant concept is not directly observable or tools or devices that can be use by an
measurable. individual to understand and place complex.

➢ CHIN & KRAMER (1995)- A construct is a type 1. According to FAWCETT (1995) models are
of highly complex concept whose reality base more abstract than their theoretical
can only be inferred. counterparts.

➢ Constructs may be made measurable by 2. They present a more generalized and broader
identifying variables. Powers and Knapp view of phenomena under study.
(1995) define a variable as an
operationalization of a construct. USE OF MODEL

➢ For example, if ‘civil status’ is perceived as a ➢ They seek ti clarify and elucidate a
construct, it could be made measurable by phenomenon.
breaking it into the variables ‘single’ and
‘widowed,’ ‘divorced’, ‘married’ etc. LEVELS OF THEORY

PROPOSITION ➢ Metatheory incorporates the examination of

how theory affects and is a affected by
➢ When different concepts, constructs, and research and practice within nursing, and
variables can be linked by statements pf philosophy and politics outside nursing.
relationships. FORMS OF METATHEORY
➢ Are tentative statement about reality and
its nature. 1. FACTORS OF ISOLATING THEORY- theories
➢ They describe relationships between at this level are sometimes referred to as
events, situations, or actions’ (MELEIS, ‘naming theories’ because they name,
1991) describe and classify concepts. The product js
DESCRIPTIVE THEORY.
MODELS
2. FACTOR- RELATING THEORY- Theories at this
➢ McFARLANE (1986)- “Representation of level seek to explain phenomena by relating
reality’. named concepts to one another. The product
is EXPLANATORY THEORY.
➢ STOCKWELL (1985)- ‘A simplified way of
organizing a complex phenomenon. 3. SITUATION-RELATING THEORY- Theories at
this level seek to anticipate relationships
➢ FAWCETT (1992)- States that a model is a set among concepts or propositions. The result of
of concepts and the assumptions that the theorizing at this level is PREDICTIVE
integrate them into a meaningful THEORY.
configuration.
4. SITUATION- PRODUCING THEORY- Theories
➢ McKENNA (1994)- A model has also been at this level seek to assign actions which lead
described as ‘a mental or diagrammatic to specific outcomes. The end result of such
representation of care which is systematically theorizing is PERSPECTIVE THEORY.
constructed, and which assist practitioners in
organizing their thinking about what the do,

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 LEVELS OF THEORY ➢ GRAY & FROSSRTROM (1991)- “The process
includes quiet reflection on practice,
➢ Grand theories have the broadest scope and remembering and noting features of nursing
present general concepts and propositions. situations, attending to one’s own feelings,
reevaluating the experience, and integrating
➢ Theories at this level may both reflect and new knowing with others.
provide insight useful for practice but are nit
designed for empirical testing.
LESSON 3
➢ Development of grand theories resulted from
the deliberate effort of committed scholars
NURSING PHILOSOPHIES
who have engaged in thoughtful reflection on
nursing practice and knowledge and on the PHILOSOPHIES
many contexts of nursing over time. • Philosophies are theoretical works that
address one or more of the metaparadigm
concepts (person, environment, health, and
LEVELS OF METATHEORY nursing) in a broad philosophical way.

MIDDLE - RANGE THEORY- Was proposed by ROBERT

• Philosophies are broad statements of values
MERTON (1968) in the field of sociology to provide
and beliefs that propose general ideas about
theories that are both broad enough to be useful in
what nursing is, what nursing’s concerns are,
complex situations and appropriate for empirical
and how the profession addresses it’s moral
testing.
obligation to society.
• Middle-range theories are more-narrow in
scope than grand theories and offer and • Philosophies provide us with broad general
effective bridge between grand theories and views of nursing that clarify nursing values to
nursing practice. answer broad disciplinary questions.
• They present concepts and propositions at a
lower of abstraction and hold great promise
for increasing theory-based research and
FLORENCE NIGHTINGALE PHILOSOPHY OF
nursing practice theory. NURSING
Nursing practice theory has the most limited scope • Nurses are different from the household
and level of abstraction and is developed for use servants of her day.
within a specific range of nursing situations. • Contrast the differences between nursing and
medicine. L
Theories developed at this level have a more direct • Specific concerns of nursing to be involved
impact on nursing practice than do theories that are with health as well as illness.
more abstract. • Provides directives for her unique perspective
that is focused on the relationship between
Nursing practice theories provide frameworks for patients and their surrounding (often referred
nursing interventions and predict outcomes and the to as environment).
impact of nursing practice • She addresses the categories of pure air, pure
water, efficient drainage, cleanliness, and light
➢ JOHN & FRESHWATER (1998)- “Nursing
and provides directives on diet, noise, rest,
practice theory has been articulated using
and nurse’s responsibility for protection and
multiple ways of knowing through reflective
management of the care of patient.
practice”

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 Nightingale isolated five environmental components
essential to an individual’s health: clean air, pure
OF NIGHTINGALE’S PHILOSOPHY water, efficient drainage, cleanliness, and light.
PERSON- Although most of Nightingale’s writing COMPONENTS OF THE PHILOSOPHY
refers to the person as the one who is receiving care, NURSING- Nightingale believed nursing to be a
she did believe that the person is a dynamic and spiritual calling. Nurses were to assist nature that was
complex being. healing the patient.

READ & ZURAKOWSKI (1996)- “Nightingale ➢ She defined different types of nursing as
envisioned the person as comprising physical, nursing proper (nursing the sick), general
intellectual, emotional, social, and spiritual nursing (health promotion), and midwifery
components” nursing.
➢ Nightingale saw nursing as the “Science of
HOLISTIC VIEW OF PERSON environmental management”

➢ The patient is at the center of the Nightingale GOAL OF NURSING

model, which incorporates a holistic view of
the person as someone with psychological, ➢ Assisting the patient in his or her retention of
intellectual, and spiritual components. “vital powers” by meeting his or her needs,
and thus, putting the patient in the best
➢ This is evidenced in her acknowledgment of condition for nature to act upon.
the importance of “variety”. For example, she
wrote of “the degree… to which the nerves ➢ This must not be interpreted as a “passive
are sick suffer from seeing the same walls, state” but rather one that reflects the patient's
the same ceiling, the same surroundings”. capacity for self-healing facilitated by nurses’
ability to create an environment conducive to
COMPONENTS OF THE PHILOSOPHY health.

HEALTH: “Health is not only to be well, but to be able

➢ The focus of this nursing activity was the
to use well every power we have”… From this
proper use of fresh air, light, warmth,
statement, we can infer that she believed in
cleanliness, quiet, proper selection and
prevention and health promotion in addition to
administration of diet, monitoring the patient’s
nursing patients from illness to health.
expenditure of energy, and observing.
➢ Health was viewed as an additive process, the
ASSUMPTION:
result of environmental, physical, and
1. Nursing is separate from medicine.
psychological factors, not just the absence of
2. Nurses should be trained.
disease.
3. The environment is important to the health of
the patient.
➢ Disease was repetitive process to correct a
4. The disease process is not important to
problem and could provide an opportunity for
nursing.
spiritual growth.
5. Nursing should support the environment to
assist the patient in healing.
➢ The laws of health, as defined by Nightingale,
6. Research should be utilized through
were those to do with keeping the person, and
observation and empirics to define the nursing
the population, healthy.
discipline.
7. Nursing is both an empirical science and an
art.
FIVE ENVIRONMENTAL COMPONENTS
8. Nursing’s concern is with the person in the
environment.

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 9. The person is interacting with the NOISE to keep noise level to a
environment. minimum, and refrain from
10. Sick and well are governed by the same laws whispering outside the
of health. door.
11. The nurses should be observant and Assess the bed and
confidential. bedding for dampness,
wrinkles, and spoiling, and
NIGHTINGALE’S BED AND BEDDING check the bed for height to
CANONS NURSING PROCESS AND ensure the client’s
(NIGHTINGALE,1969; THOUGHTS comfort.
SELANDERS, 1998)
Assess the client's body Attempt to keep the clients
temperature, room dry and clean at all times.
temperature, and room PERSONAL Frequent assessment of
fresh air (or adequate CLEANLINESS the clients skin is needed
VENTILATION AND ventilation) and foul odors to maintain adequate skin
WARMTH develop a plan to keep the moisture.
room airy and free of odor
while maintaining the Attempt to stimulate
client’s body temperature. variety in the room and
with the client. This is
Asses the room for accomplished with cards,
adequate light. Sunlight VARIETY flowers, pictures, books, or
works best. Develop and puzzles. Encourage friends
LIGHT implement adequate light and relatives to engage the
in the client’s room without clients in some sort of
placing the clients in direct stimulating conversation.
light.
Avoid talking without
Assess the room reason or giving advice that
dampness, darkness, and is without fact. Continue to
CLEANLINESS OF dust or mildew. Keep the CHATTERING HOPES talk to the client as a
ROOMS AND WALLS room free from dust, AND ADVICES person, and continue to
mildew, and dampness. stimulate the client's
mind. Avoid personal talk.
Assess the surrounding
environment for pure air, Assess the diet of the
pure water, drainage, client. Take note of the
cleanliness, and light. TAKING FOOD amount of food and drink
Examples include ingested by the clients at
removing garbage or every meal or snack.
garments from the area,
HEALTH OF HOUSES removing any standing Continue with the
water (ensuring that water assessment of the diet to
drains away from the area), include type of food and
and ensuring that air and drink the client likes or
water are clean and free WHAT FOOD dislikes. Attempts to
from odor and that there is ensure that the client
plenty of light. always has some foor or
drinks available that he or
Assess the noise level in she enjoys.
the client’s room and
surrounding area. Attempt

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 Petty management • An individual achieves wholeness by
PETTY ensures continuity of care. maintaining physiological and emotional
MANAGEMENT Documentation of the plan balance.
of care and all evaluation • A sum of parts with biopsychosocial needs,
will ensure others give the and the mind and body are inseparable and
--------------------------- same care to the client in
interrelated.
your absence.
METAPARADIGM
Observe everything about
your client. Record all NURSING: The art of nursing is based on her proposal
observations. of 14 basic human needs on which nursing care is
Observations should be premised.
OBSERVATION OF factual and not merely
• Her contributions include defining nursing,
THE SICK opinions. Continue to
observe the client’s delineating autonomous, nursing functions,
surrounding environment, stressing goals of interdependence for
and make alterations in the patient, and creating self-help concept.
plan of care when needed. • She clarified the practice of nursing as
independent from the practice of physicians
and acknowledged her interpretation of the
nurse’s role as a synthesis of many influences.
LESSON 4 NURSING
VIRGINIA HENDERSON NEED THEORY “The unique of the nurse is to assist the individual,
NEED THEORY sick or well, in the performance of those activities
contributing to health or its recovery (or to peaceful
It emphasizes the importance of increasing the death) that he would perform unaided if he had the
patient’s independence and focusing on the basic necessary strength, will, or knowledge; and to do this
human needs so that progress after hospitalization in such a way as to help him gain independence as
would not be delayed. rapidly as possible” (HENDERSON, 1964)
ASSUMPTIONS

1. Nurses care for patients until they cam care LEVELS OF NURSE-PATIENT RELATIONSHIP
for themselves once again. Although not
precisely explained. HENDERSON identified three levels of nurse-patient
2. Patients desire to return to health relationship in which the nurses acts as:
3. Nurses are willing to serve, and “nurses will
• (1) a substitute for the patient,
devote themselves to the patient day and
• (2) a helper to the patient, and
night”
4. Henderson also believes that the “mind and • (3) a partner with the patient.
body are inseparable and are interrelated”. Through the interpersonal process, the nurse must get
“inside the skin” of each of her patients in order to
METAPARADIGM know what help is needed.

MAN / PERSON Henderson asserted that the nurse works in

interdependence with other health care professionals
• Viewed the patient as an individual who
and with patients.
requires help toward achieving independence
and completeness or wholeness of mind and
body.
PERSON 14 ACTIVITIES FOR CLIENT ASSISTANCE / BASIC
NEEDS

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1. Worship according to one’s faith ➢ Meeting the goal of achieving the 14 needs of
2. Work in such a way that there is a sense of the client can be a basis to further improve
accomplishment + one’s performance towards nursing care.
3. Eat and drink adequately
4. Eliminate body wastes
5. Sleep and rest FAYE ABDELLAH’S 21 NURSING PROBLEMS
6. Select suitable clothes dress and undress
7. Maintain body temperature within normal ➢ A set of problems formulated in terms of
range by adjusting clothing and modifying the nursing-centerd services, which are used
environment. to determine that patient’s needs.
8. Avoid dangers in the environment and avoid ➢ It is a guide for comprehensive nursing
injuring others. care.
9. Communicate with others in expressing ➢ It is a problem-centered approach or
emotions, needs, fears, or opinions philosophy of nursing.
10. Keep the body clean and well groomed and ➢ The 21 nursing problems progressed to a
protect the integument second-generation development referred
11. Learn, discover, or satisfy the curiosity that to as patient problems and patient
leads to normal development and health and outcomes.
use the available health facilities.
12. Breathe normally
13. Move and maintain desirable postures ➢ Assumptions
14. Play or participate in various forms of ➢ There are change and anticipated changes
recreation. that affect nursing.
➢ The need to appreciate the
interconnectedness of social enterprises and
METAPARADIGM social problems.
➢ The impact of problem such as poverty,
• Environment emphasized that maintaining
racism, pollution, education, and so-forth on
supportive environment conducive to health is
health and health care delivery.
one of her 14 activities for client assistance.
➢ Changing nursing education; continuing
education for professional nurses; and
• Health was taken to mean balance in all
development of nursing leader from
realms of human life.
undeserved group.

• It is equated with the independence or ability

to perform activities without aid in the 14 10 STEPS IN CLIENT PROBLEM IDENTIFICATION |
components or basic human needs. 10 STEPS NURSING SKILL TO BE USED

• Good health is a challenge because it is 1) Learn to know the patient

affected by numerous factors such as age, 2) Sort out relevant and significant data
cultural background, emotional balance, and 3) Make generalizations about available data in
others. relation to similar nursing problem presented
by other patients.
4) Identify the therapeutic plan.
APPLICATION OF THE THEORY 5) Test generalizations with the patient and make
additional generalizations.
➢ A way of nurses to set goals based on
Henderson’s 14 components.

12 | D G C
STEPS 3) To promote safety through prevention of
accidents, injury, or other trauma and through
❖ VALIDATE- the patient’s conclusions bout his the prevention of the spread of infection.
nursing problems. 4) To maintain good body mechanics and prevent
❖ CONTINUE- to observe and evaluate the and deformities.
patient over a period of time to identify any 5) To facilitate maintenance of a supply of oxygen
attitudes and clues affecting his or her to all body cells.
behavior. 6) To facilitate the maintenance of nutrition of all
❖ EXPLORE- the patient’s and family’s reaction body cells.
to the therapeutic plan and involve them in 7) To facilitate the maintenance elimination.
plan. 8) To facilitate the maintenance of fluid and
❖ IDENTIFY- how the nurses feel about the electrolyte balance.
patient’s nursing problem. 9) To recognize the physiologic responses of the
❖ DISCUSS AND DEVELOP- a comprehensive body to disease conditions.
nursing plan. 10) To facilitate the maintenance of regulatory
mechanisms and functions.
CONCEPT 11) To facilitate the maintenance of sensory
➢ Nursing diagnoses were a determination of the function.
nature and extent of nursing problems 12) To identify and accept positive and negative
presented by individuals receiving nursing expressions, feelings, and reactions.
care. 13) To identify and accept the interrelatedness of
➢ Nursing functions were nursing activities that emotions and organic illness.
contributed to the solution for the same 14) To facilitate the maintenance of effective
nursing problem. verbal and nonverbal communications
15) To promote the development of productive
OTHER CONCEPTS interpersonal relationships.
1) HEALTH CARE TEAM- a group of health 16) To facilitate progress toward achievement of
professionals trained at various levels, and personal spiritual goals.
often at different institutions, working together 17) To create and maintain therapeutic
to provide health care. environment.
2) PROFESSIONALIZATION OF NURSES- 18) To facilitate awareness of self as an individual
requires that nurses identify those nursing with varying physical, emotional, and
problem that depend on the nurse’s use of his developmental needs.
or her capacities to conceptualize events and 19) To accept the optimum possible goals in light
make judgement about them. of physical and emotional limitations.
3) PATIENT- individual who needs nursing care 20) To use community resources as an aid in
who is dependent on the heath care provider. resolving problems arising from illness.
4) NURSING- a service to individuals and 21) To understand the role of social problems as
families and t society which helps people to an influencing factor in the cause of illness.
cope with their health needs.
METAPARADIGM
ABDELLAH’S 21 NURSING PROBLEM NURSING: an art and a science that mold the attitude,
1) To maintain good hygiene and physical intellectual competencies, and technical skills of the
comfort. individual nurse into the desire and ability to help
2) To promote optimal activity, exercise, rest, and individuals cope with their health needs, whether they
sleep. are ill or well.

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 HUMAN LIFE
JEAN WATSON’S PHILOSOPHY OF HUMAN
CARING ➢ “Human life is defined as being in the world
which is continuous in time and spaced.”
➢ A framework, theory, model, worldview, or a ➢ The locus of human existence is experience,
paradigm that is transdisciplinary. broadly defined as sensorimotor experience,
➢ Expanded the original 10 carative factor to a mental/emotional experience, and spiritual
science. Philosophy, and ethic of human caring experience.
useful for all health professionals and healing ➢ Experience is translated through multiple
practitioners, particularly those practicing layers of awareness.
mind-body medicine. ➢ Consciousness has the capacity to construct
and create.
HUMAN BEINGS (PERSONHOOD) ➢ The world as experienced is not merely
reflected and interpreted by consciousness; it
• Person is viewed holistically where in the body,
is co-created.
mind, and soul, are interrelated, each part a
➢ Collective and individual worldviews are
reflection of the whole is greater than and
dynamic and co-created.
different from the sum of parts.
NURSING (TRANSPERSONAL CARING-HEALING)
• The person is a living, growing, gestalt that
• Nursing as transpersonal that “conveys a
possesses three spheres of being-body, mind,
human-to-human connection in which both
and soul- influenced by the concept of self.
persons are influenced through the
relationship and being together in the
• The mind and emotions are the starting point
moment.
and the access to the subjective world.
• This human connection has a spiritual
dimension that can tap into healing.
• The self, the seat of identity is the subjective
• “transpersonal includes the unique
center that lives within the whole of the body,
individuality of each human, while extending
thoughts, sensations, desires, memories, and
beyond goal-ego”
life history.

GOAL OF NURSING
PERSONHOOD
➢ The goal of nursing in the caring-healing
➢ Personhood and life are based on the concept
process is to help persons gain a higher degree
of human being as embodied spirit.
of harmony within the mind-body-spirit, which
➢ Within this transpersonal framework, the body
generates self-knowledge, self-reverence,
is a living spirit that manifest one’s being in the
self-healing, self-healing, and self care
world and one’s way of standing and reflects
process allowing for diverse possibility.
how one holds oneself with respect to one’s
➢ Watson suggest the greater the “degree of
relation to self and one’s consciousness or
genuineness and sincerity” of the nurse within
unconsciousness.
the context of the caring act, the greater the
SPIRIT efficacy of caring.

➢ The soul fully participates in healing CARING AS A SCIENCE

➢ As nurses and future nurses, we continue to
➢ Caring science allow nurses to approach the
explore the spiritual, nonphysical, inner, and
sacred in caring-healing work.
extrasensory (beyond the five senses) realms
➢ In caring sciences, compassionate human
to learn the dynamics and creative energy
service and caring are motivated by love.
currents of the soul’s existence and to learn of
the inner healing journey toward wholeness.

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 ➢ The general goal is biophysical-mental- modes of expression and meditation,
spiritual evolution for self and others as well comment healing and illness experiences,
as discovery of inner power and self-control and provide psychoarchitecture for healing
through caring. spaces integrates and embraces visual arts
➢ Shifting the focus from illness, diagnosis, and and poetry to illustrate and enhance her
treatment to human caring, healing and concepts.
promoting spiritual health potentiates health, ➢ Examples are her use of sylvia piath’s poem
healing, and transcendence. “Tulips” to illustrate the importance is not
separating science and human values and use
TRANSPERSONAL CARING
of a painting to the necessity for adequate
➢ Caring, as a moral ideal, encourages the nurse ventilation for mine workers in the workplace.
to attempt to hold the conscious intent to ➢ Advanced caring-healing arts, or modalities,
preserve wholeness, to potentiate healing, are integral to transpersonal practice.
and to preserve dignity, integrity, and life
These advanced caring-healing modalities include the
generating process.
intentional conscious use of imagery and auditory,
➢ Transpersonal describes an intersubjective,
visual, olfactory, tactile, gustatory, mental-cognitive,
human to human relationships that
kinesthetic, and caring consciousness, which
encompasses two unique individuals, both
includes psychological and therapeutic presence
the nurse and the patient, in given moment.
modalities.
➢ Simultaneously the relationship transcends
the two subjectivities, connecting to other
higher dimensions of being and a
HEALTH
higher/deeper consciousness that access the
universal field and planes of inner wisdom; the ➢ Health is redefined in this philosophy as unity
human spirit realm. and harmony within the body, mind, and soul
and harmony between self and others and
CARING MOMENT
between self and others and between self and
➢ Human caring is actualized in the moment nature and openness to increased possibility.
based on the actions and choices made by ➢ A subjective experience and a process of
both the one-caring and the one-being-cared- adapting, coping, and growing throughout life
for. that is associated with the degree of
➢ The nurse and patient both determine the congruence between self as perceived and
relationship and the use of that moment in self as experienced.
time and space.
CHARACTERISTICS OF HEALTH
➢ In the moment, how the nurse choses to be
and to act will have significant effect on the 1. Health focuses on physical, social, esthetic,
opportunities of the moment and the eventual and moral realms and is viewed as
outcomes. consciousness and a human-environmental
energy field.
CARING HEALING INTENT
2. Health reflects a person’s basic striving to
Caring -healing consciousness is an intentionality of actualized and develop the spiritual essence
love and wholeness that is a source and form of life of self (Watson, 1998a)
energy, life spirit, and vital energy that can be 3. It is a search to connect with deeper meanings
communicated by one-caring to the one-being-cared- and truths and “embrace the near and far in
for, which potentiates healing. the instant and to seize the tangible manifestly
real, and the divine”
APPLICATION
CONCEPT OF ILLNESS
➢ The healing arts activate specific response to
promote wellness and centering, act as

15 | D G C
 ➢ Health and illness functioning simultaneously ➢ Watson describes a caring/love that radiates
as a way to stabilize and balance one’s life. in concentric circles from self, to others, the
➢ Illness is subjective turmoil or disharmony community, and planet, and the universe,
within a person’s inner self or soul at some “nurses with informed Caritas Consciousness
level or disharmony within the spheres of could literally transform entire systems,
mind, body, and soul. contributing to worldwide changes through
➢ Illness connotes a felt incongruence within their own practices of being, thus ‘seeing’ and
the person such as incongruence between the doing things differently”.
self as perceived and the self as experienced
yet, it is also an “invitation to understand, gain
new meaning for one’s life pattern, to see CONCEPTUAL MODEL OF MARTHA ROGERS
health and illness as evolving consciousness
MODEL
and opportunities for healing.
➢ Representation of “reality” (McFarlane, 1986)
ENVIRONMENT
➢ A simplified way of organizing a complex
• Broadened the focus from the immediate phenomenon (Stockwell, 1985).
physical environment to a nonphysical ➢ Fawcett (1992) state that a model is a set of
energetic environment, a vibrational field concept and the assumption that integrate
integral to the person. them into a meaningful configuration.
• The nurse becomes the environment in which ➢ A model has also been described as ‘a mental
“sacred space” is created. She describes how or diagrammatic representation of care which
the “nurse is not only in the environment, able is systematically constructed, and which
to make significant changes in the way of assist practitioners in organizing their thinking
being/doing; knowing in the physical about what they do, and in the transfer of their
environment, but that the nurse is the thinking into practice for the benefit of the
environment” client and the profession’ (McKenna, 1994).

CHARACTERISTIC OF ENVIRONMENT
CONCEPTUAL MODELS
➢ This environment promotes the intentional
healing role of architecture (or surroundings) ❖ Models, therefore, are conceptual tools or
alongside conscious, intentional, caring, devices that can be used by an individual to
healing modalities. understand and place complex phenomena
➢ Conscious attention to healing spaces shifts into perspective.
the health care facility from being simply a ❖ According to Fawcett (1995), models are
place for bodies to be treated to a place in more abstract than their theoretical
which there is the conscious promotion of counterparts.
mind-body-spirits wholeness, attention to the ❖ They present a more generalized and broader
relationship between stress factors, and view of the phenomenon under study.
acknowledgment of the key role that emotions
and the senses play in healing.
MARTHA ROGER’S SCIENCES OF UNITARY HUMAN
APPLICATION BEING

➢ Through the intentional introduction of quiet, ➢ Human beings are conceptualized as

art, favorite music and colors, pleasant dynamic, constantly evolving energy fields,
smells, beautiful views of nature, mythology, rather than as homeostatic beings.
and the patient’s favorite rituals and symbols ➢ Variation is expected and embraced within
of expressions of humanity and culture, this homeodynamic perspective.
healing spaces can assist in transcending ➢ The human field and the environmental field
illness, pain, and suffering. are constantly exchanging energy.

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 ➢ There are no boundaries or barriers to inhibit MAJOR CONCEPTS OF THE FRAMEWORK
energy flow between fields
PATTERN
UNITARY HUMAN BEING
➢ Pattern identifies individuals and reflects their
➢ “The human being openly participates in wholeness. Pattern is defined as the
energy transformation with the environment distinguishing characteristics of an energy
creating mutual change” field that is perceived as a single wave.
➢ is “an irreducible, indivisible, pandimensional
➢ They present a more generalized and broader
energy field identified by pattern and
view of the phenomena under study.
manifesting characteristics that are specific
to the whole and which cannot be predicted ➢ Roger’s (1986) clarifies that pattern is “an
from knowledge of the parts abstraction” that “gives the identity to the
➢ The life process of the unitary human being is field”
one of wholeness and continuity as well as ➢ Patterning “is the dynamic or active process of
dynamic and creative change. the life of the human being”

ENVIRONMENT ENERGY FIELD

• The environment is “an irreducible,
pandimensional energy field identified by ➢ Energy is the “potential for process,
pattern and integral with the human field”. movement, and change”
• Manifestations emerge from this field and are ➢ The energy field is the conceptual boundary of
perceived. all that is, the living and the nonliving.
➢ The energy field “provides a way to perceive
NURSING people and their environment as irreducible
• The focus of nursing is the care of people wholes”.
within their life process and the lived
experience. PANDIMENSIONALITY
• “Professional practice in nursing seeks to
promote symphonic interaction between ➢ Defined as “a nonlinear domain without
human and environmental fields, to spatial; or temporal attributes”
strengthen the integrity of the human field, ➢ The universe encompasses infinite
and to direct and redirect patterning pf the dimension, providing an understanding of
human and environment fields for realization nonlocality, a causality, and unpredictability.
of maximum health potential”.
• The nurse participate knowingly with the OPENNESS
patient and the goal of nursing is human
betterment. ➢ The human field and the environmental field
are constantly in mutual process.
HEALTH
➢ There are no boundaries or barriers to inhibit
• The concept of health and illness are energy flow between fields.
understood as pattern manifestation.
➢ “The human being openly participates in
• The manifestation of health emerges from the
energy transformation with the environmental
mutual, simultaneous patterning process of
creating mutual change”
the human / environmental fields.
➢ The complexity, and yet simplicity, of these
• Pattern manifestation is an expression of the
paradigm-shifting ideas preceded current
process of life as defined by individuals and
their culture. scientific understanding by several decades.
➢ Rogers used her extensive knowledge and
• It is continuous expression or manifestation of
the life process in Roger’s framework. diverse educational background to articulate
a revolutionary way of viewing the human
experience.

17 | D G C
 • Roger’s principle of homeodynamics provide a ➢ Power as knowing participation in change,
way of describing explaining, and envisaging a emerges from the principle of helicy within the
wide range of perceivable person/ Rogerian model.
environment processes involving change and ➢ The theory proposes that as knowledge
growth. increases, so does the capacity to participate
• The principle are theoretical assertions that knowingly.
were first proposed by Roger’s (1970) as “an ➢ Furthermore, the theory proposes the
ordered arrangement of rhythms capacity of human beings to pattern their
characterizing both the human field and the human/environmental fields.
environmental field that undergoes ➢ Barrett (2010) explains, “following the testing
continuous dynamic metamorphosis in the and research of the theory and measurement
human-environment process.” instrument, a practice methodology was
developed, and the health patterning practice
PRINCIPLE OF HOMEODYNAMICS model was initiate” (p.47).
➢ Patterning manifests via the nurse and client
RESONANCY- is the continuous change from lower-to patterning process.
higher-frequency wave patterns in the ➢ Barrett (2000) describes power as being aware
human/environmental patterns. of what one being aware of what one is
choosing to do, feeling free to do it, and doing
HELICY- is the continuous, innovative, unpredictable,
it.
increasing diversity of human / environmental
➢ She identifies power as a relative state
patterns.
characterized by the momentary continuously
changing patterns.
INTEGRITY- is the continuous, mutual, continuous
➢ Power is a relative trait characterized by “the
human/environmental field process.
more consistent organization of the human
HUMAN FIELD- Conceptualization of and environmental field pattern”
human/environmental energy field. (from Bultemeier, ➢ She specific that as the person is
K. (1993). Photographic inquiry of the phenomenon of knowledgeable of his or her pattern
premenstrual syndrome within the Rogerian-derived manifestation, meaningful participation in the
theory of perceived dissonance. Unpublished patterning process occurs.
doctoral dissertation, University of Tennessee-
THEORY OF SELF TRANSCENDENCE
Knoxville).
• The theory of self-transcendence by Gulliver
(2007) describes the process occurring at the
end-of-life.
• Proposes continuously fluctuating imagery
boundaries over past, present, and future.
• With self-transcendence the boundaries
become more less distinct.
• The theory further articulates the infinite
possibilities for the transition.

THEORY OF POWER AS KNOWING PARTICIPATION

IN CHANGE

➢ The theory propose by Barrett (1986,2010)

18 | D G C
 place frames of reference (that is, their self-
DOROTHEA OREM’S SELF-CARE DEFICIT
care agency)
THEORY ❖ This need for nursing occurs when self-care
are not adequate because of health state or
➢ SELF CARE DEMAND health-care-related conditions.
➢ Individuals throughout their life cycles are
viewed as having a continuing demand for SELF-CARE DEFICIT THEORY
engagement in self-care in care of self.
➢ THERAPEUTIC SELF-CARE DEMAND - The ➢ Explains that both internal and external
constituent action components of the conditions arising from or associated with
demand together. health states of individuals can bring about
➢ It offers a theoretical explanation of the action limitation of individuals to engage in
continuing action demand. care of self (for example, lack of knowledge or
developed skills, or lack of energy)
SELF CARE AGENCY ➢ The presence and nature of such action
limitations can set up action-deficit
➢ Individuals also are viewed as having the relationship between individuals developed
human power (named “self-care agency”) and operational powers of self-care agency
➢ It developed and exercised capabilities and the kinds and frequencies of deliberate
necessary for them to know and meet the actions to be performed to know and meet
components of their therapeutic self-care individuals’ therapeutic self-care demands in
demands. time and place frames of reference.
SELF CARE DEFICIT NURSING AGENCY

• When health and healthcare-associated ➢ The power of nurses to design and produce
reasons exist, individuals’ self-care agency is nursing care for others is the critical power
unequal in its development or operability for that is operative in nursing.
meeting their existent and changing ➢ NURSING AGENCY- This human power with
therapeutic self-care demand, a self-care its constituent capabilities and disposition
deficit exist.

HUMAN BEING

• Individuals are mature human beings have

IMOGENE KING’S CONCEPTUAL SYSTEM AND
learned and continue to learn to meet some or THEORY OF GOAL ATTAINMENT.
all components of their own therapeutic self-
care demands, and the therapeutic self-care ➢ King’s conceptual system is based on the
demands of their dependents. assumption that human beings are the focus
of nursing
NEED FOR NURSING ➢ The goal of nursing is health promotion and
maintenance
❖ The real or potential existence of such a ➢ She emphasized “nursing’s domain involves
health-related deficit relationship between human beings, families, and communities as
the care demand and power of agency is the a framework within which nurses make
reason why individuals require nursing care. transactions in multiple environments with
❖ Nursing required when individuals developed health as a goal”
operational powers and capabilities to know ➢ Nurses must have the knowledge and skill to
and meet their own therapeutic self-care observe and interpret behavior and intervene
demands, in whole or in part- and in-time in the behavioral realm to assist individuals

19 | D G C
 and groups cope with health, illness, and COPING- Used the term coping in her discussion of
crisis. the concept of stress in the interpersonal system and
in later discussion of the Theory of Goal Attainments
PERSONAL SYSTEM without explicit definition.

❖ Individuals are personal systems INTERPERSONAL SYSTEM

❖ Each individual is an open, total, unique
system in constant interaction with the ❖ Interpersonal systems are formed by the
environment. interactions of two or more individuals.
❖ Interactions between and among personal ❖ The process of nursing occurs primarily within
systems are the focus of King’s conceptual the interpersonal systems between the nurse
system. and patients.

PERSONAL SYSTEM CONCEPTS COMMUNICATION- “Information processing, a

change of information from one state to another”
PERCEPTION- “A process of organizing, interpreting,
and transforming information from sense data and INTERACTION- “Acts of two or more persons in
memory” mutual presence”; “The process of interactions
between two or more individuals represents a
SELF- “knowledge of self is a key to understanding sequence of verbal and nonverbal behaviors that are
human behavior because self is the way I define me to goal-directed”
myself and to others.
ROLE- “Set of behaviors expected when occupying a
• Self is all that I am. I am a whole person position in a social system”
• Self is what I think of me and what I am
capable of being and doing. • STRESS- “Dynamic state whereby a human
• Self is subjective in that it is what I think I being interacts with the environment to
should be or would like to be (p.26). self is a maintain balance for growth, development,
dynamic, action-oriented open system. and performance which involves an exchange
of energy and information between the person
GROWTH AND DEVELOPMENT- “The processes that and the environment for regulation and
take place in an individual’s life that help the individual control of stressors”
move from potential capacity for achievement to self-
actualization” • STRESSORS- Events that produce stress

BODY IMAGE- “An individual’s perceptions of his/her • TRANSACTION- “Observable behaviors of

own body, others’ reactions to his/her appearance human beings interacting with their
which results from others’ reactions to self” environment”;

LEARNING- “A process of sensory perception, ❖ “In the interactive process, two

conceptualization, and critical thinking involving individuals mutually identify goals and
multiple experiences in which changes in concepts, the means to achieve them.
skills, symbols, habits, and values can be evaluated in ❖ When they agree to the means to
observable behaviors and inferred from behavioral implement the goals, they move
manifestation” toward transactions…. Transactions
are defined as goal attainment”
TIME- “Duration between the occurrence of one event
and occurrence of another event. SOCIAL SYSTEMS

PERSONAL SPACE- “Existing in all directions and is • Social systems are composed of large groups
the same everywhere” with common interests or goals.

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 • A social system is defined as “an organized Goal Attainment comprises the concepts of
boundary system of social roles, behaviors, perception, communication, interaction,
and practices developed to maintain values transaction, self, role, growth and
and the mechanisms to regulate the practice development, stress/stressors, coping, time,
and rules” and personal space.
• Examples of social systems include health
THE GOAL ATTAINMENT THEORY
care settings, workplaces, educational ➢ King identified that perception,
institutions, religious organizations, and communication, and interaction are essential
families. elements in transaction.
➢ When transactions are made, goals are
ORGANIZATION- A system whose continuous usually attained.
activities are conducted to achieve goals. ➢ The human interaction and conceptual focus
dimensions of the theory guide the nursing
AUTHORITY- Transactional process characterized by process dimension.
active, reciprocal relations in which members’ values,
backgrounds, and perceptions play a role in defining,
validating, and accepting the [directions] of ALIGNMENT OF GOAL ATTAINMENT AND NURSING
individuals within an organization. PROCESS

POWER- The capacity or ability of a group to achieve

goals.

STATUS- The position of an individual in a group or a

group in relation to other groups in an organization.

DECISION MAKING- Dynamic and systematic

process by which a goal-directed choice of perceived
alternatives is made, and acted upon, by individuals or
groups to answer a question and attain a goal.
➢ King demonstrated linkages between the
THEORY OF GOAL ATTAINMENT theory of goal attainment and the traditional
nursing process.
❖ he Theory of Goal Attainment addresses
nursing as a process of human interaction. NURSING PROCESS AND GOAL ATTAINMENT
❖ Theory of Goal Attainment is a normative ❖ King viewed the traditional nursing process as
theory; that is, it should set the standard of a system of interrelated actions—the method
practice for all nurse-patient interactions. by which nursing is practiced.
❖ In contrast, knowledge of the interrelated
❖ “King’s law of nurse-patient interaction: concepts in the Theory of Goal Attainment
Nurses and patients in mutual presence, provides the theoretical basis for nursing
interacting purposefully, make transactions in practice.
nursing situations based on each individual’s ❖ King underscored the importance of nursing
perceptions, purposeful communication, and process as both method and theory when she
valued goals” stated, “Nurses are first, and foremost,
human beings who perform their functions in
❖ The nurse and patient form an interpersonal a professional role.
system in which each affects the other and in ❖ It is the way in which nurses, in their role, do
which both are affected by situational factors with and for individuals that differentiates
in the environment. nursing from other health professionals.
❖ Drawn from both the personal and
interpersonal system concepts, the Theory of

21 | D G C
 ❖ In this way, King illustrated how “nursing ❖ The focal stimulus is the phenomenon that
theory serves to connect philosophical attracts the most of one’s attention.
reflection with nursing practice” ❖ Contextual stimuli are all other stimuli existing
in a situation that strengthen the effect of the
focal stimulus.
❖ Residual stimuli are any other phenomena
arising from a person’s internal or external
environment that may affect the focal
stimulus but whose effects are unclear

ADAPTATION AS A CONCEPT

➢ The three types of stimuli act together and

influence the adaptation level, which is a
person’s “ability to respond positively in a
situation”

ADAPTATION

SISTER CALLIST ROY’S ADAPTATION MODEL ➢ A person’s adaptation level may be described
as integrated, compensatory, or compromised
(RAM) ➢ A person does not respond passively to
➢ It provides a useful framework for providing environmental stimuli; the adaptation level is
nursing care for persons in health and in modulated by a person’s coping mechanisms
acute, chronic, and terminal illness. and control processes.

PERSON COPING MECHANISM AS A CONCEPT

➢ The RAM views the person as an adaptive ➢ Roy categorizes the coping mechanisms into
system in constant interaction with an internal either the regulator or the cognator
and external environment. subsystem.
➢ The coping mechanisms of the regulator
ENVIRONMENT subsystem occur through neural, chemical,
and endocrine processes.
➢ The environment is the source of a variety of
➢ The coping mechanisms of the cognator
stimuli that either threaten or promote the
subsystem occur through cognitive-emotive
person’s unique wholeness.
processes.
➢ The person’s major task is to maintain integrity
in the face of these environmental stimuli. CONTROL PROCESS

CONCEPT OF INTEGRITY ➢ Roy has identified two control processes that

coincide with the regulator and cognator
➢ The degree of wholeness achieved by adapting
subsystems when a person responds to a
to changes in need.
stimulus.
➢ The control processes identified by Roy are the
STIMULI
stabilizer subsystem and the innovator
❖ The first type of stimulus, focal, is defined as subsystem.
the internal or external stimulus most ➢ The stabilizer subsystem refers to “the
immediately challenging the person’s established structures, values, and daily
adaptation. activities whereby participants accomplish

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 the primary purpose of the group and ➢ The self-concept is formed both from internal
contribute to common purposes of society”. perceptions and from the perceptions of
others.
➢ The innovator subsystem refers to cognitive
and emotional strategies that allow a person
➢ The self-concept changes over time and
to change to higher levels of potential. guides one’s actions.
➢ Although direct observation of the processes ➢ The self-concept incorporates two
of the regulator and cognator subsystems is components: the physical self and the
not possible, Roy proposes that the behavioral personal self. The physical self-incorporates
responses of these two subsystems can be body sensation and body image
observed in any of the four adaptive modes:
physiological, self-concept, role function, and ➢ The personal self-incorporates self-
interdependence adaptive modes. consistency, self-ideal, and moral-ethical-
spiritual self.
➢ Roy and her associates describe the function
of the adaptive modes in the Theory of the ➢ Psychic integrity is the goal of the self-concept
Person as an Adaptive System mode
PERSON AS ADAPTIVE SYSTEM INDEPENDENCE MODE

➢ Roy’s Theory of the Person as an Adaptive ➢ The interdependence adaptive mode refers to
System postulates that the four adaptive coping mechanisms arising from close
modes are interrelated through perception. relationships that result in “the giving and
➢ Either an adaptive response or an ineffective receiving of love, respect, and value”
response in one mode influences adaptation ➢ In general, these contributive and receptive
in the other modes. behaviors occur between the person and the
➢ The physiological adaptive mode refers to the most significant other or between the person
“way a person responds as a physical being to and his or her support system
stimuli from the environment” ➢ Affectional adequacy is the goal of the
interdependence adaptive mode
PHYSIOLOGICAL MODE
ROLE FUNCTION ADAPTIVE MODE
➢ The five physiological needs of this mode are
oxygenation, nutrition, elimination, activity ➢ The role function adaptive mode refers to the
and rest, and protection. primary, secondary, or tertiary roles the
➢ Four complex processes that mediate the person performs in society.
regulatory activity of this mode are senses, ➢ “A role, as the functioning unit of society, is
fluids and electrolytes, neurological function, defined as a set of expectations about how a
and endocrine function. person occupying one position behaves
➢ Physiological integrity is the adaptive toward a person occupying another position”
response of this adaptive mode. ➢ Social integrity is the goal of the role function
mode
SELF CONCEPT ADAPTIVE MODE
ADAPTIVE RESPONE
➢ The self-concept adaptive mode refers to
psychological and spiritual characteristics of ➢ Adaptive responses promote the integrity of
the person the person and the goals of adaptation.
➢ A person’s self-concept consists of all the ➢ The major task of a person is to adapt to
beliefs and feelings that one has formed about environmental stimuli to achieve survival,
oneself. growth, development, and mastery.

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➢ Adaptation is accomplished through two main
coping subsystems: regulator and cognator.
➢ The mechanisms of regulator and cognator
have not been explicated by Roy because
these mechanisms cannot be directly
observed and remain largely unknown

ADAPTOVE RESPONSE AND NURSING

➢ enables the person to find meaning and

purpose in life and to become an integrated
whole.
➢ Adaptation is by helping the person survive,
grow, reproduce, and master. Adaptation
leads to optimum health and well-being, to the
highest quality of life Adaptation possible, and
to death with dignity

HEALTH

1) as “a state and a process of being and

becoming an integrated and whole person”
2) Health is a reflection of how successfully an
individual has adapted to environmental
stimuli.

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