Introduction To Nursing Theories

Introduction to Nursing Theories
This page was last updated on February 21, 2011

INTRODUCTION
Each discipline has a unique focus for knowledge

development that directs its inquiry and distinguishes it from
other fields of study.(Smith & Liehr, 2008).
Nursing knowledge is the inclusive total of the philosophies,
theories, research, and practice wisdom of the discipline.As a
professional discipline this knowledge is important for
guiding practice.(Smith & Liehr, 2008).
Theory-guided, evidence-based practice is the hallmark

of any professional discipline.
Nursing is a professional discipline (Donaldson & Crowley,

1978).
Nursing theory is the term given to the body of knowledge

that is used to support nursing practice
Almost 90% of all Nursing theories are generated in the last

20 years.
Nursing models are conceptual models, constructed of

theories and concepts
METAPARADIGMS IN NURSING
1. Person
Recipient of care, including physical, spiritual, psychological,

and sociocultural components.
Individual, family, or community
2. Environment
All internal and external conditions, circumstances, and

influences affecting the person
3. Health
Degree of wellness or illness experienced by the person
4. Nursing
Actions, characteristics and attributes of person giving care
COMPONENTS OF A THEORY
A theory is a group of related concepts that propose action that guide

practice. A nursing theory is a set of concepts, definitions,
relationships, and assumptions or propositions derived from nursing
models or from other disciplines and project a purposive, systematic
view of phenomena by designing specific inter-relationships among
concepts for the purposes of describing, explaining, predicting,
and /or prescribing..
Based on the knowledge structure levels the theoretical works in
nursing can be studied under the following headings:
Metaparadigm (Person, Environment, Health & Nursing)

(Most abstract)
Nursing philosophies.
Conceptual models and Grand theories.
Nursing theories and Middle range theories (Least abstract)
DEFINITIONS
Definitions
Theory
o a set of related statements that describes or explains
phenomena in a systematic way
Concept
a mental idea of a phenomenon
Concepts are the building blocksthe primary

elementsof a theory.
Constructo
a phenomena that cannot be observed and must be

inferred
Constructs are concepts developed or adopted for use

in a particular theory. The key concepts of a given
theory are its constructs.
Proposition
o
a statement of relationship between concepts
Conceptual modelo
made up of concepts and propositions
They epresent ways of thinking about a problem or

ways of representing how complex things work the
way that they do.
Different Frameworks will emphasize different

variables and outcomes and their interrelatedness.
( Bordage, 2009)
Models may draw on a number of theories to help

understand a particular problem in a certain setting or
context. They are not always as specified as theory.
Variables
o
Variables are the operational forms of constructs. They

define the way a construct is to be measured in a
specific situation.
Match variables to constructs when identifying what

needs to be assessed during evaluation of a theorydriven program.
NURSING PHILOSOPHIES
Theory
Florence Nightingales
Legacy of caring
Key emphasis
Focuses on nursing and the patient
environment relationship.
Helping process meets needs through the

art of individualizing care.
Nurses should identify patients need-for
help by:
Ernestine Wiedenbach:
The helping art of clinical
nursing
Observation
Understanding client behaviour
Identifying cause of discomfort
Determining if clients can resolve

problems or have a need for help
Patients require help towards achieving
independence.
Derived a definition of nursing
Virginia Hendersons
Definition of Nursing
Identified 14 basic human needs on which

nursing care is based.
Patients problems determine nursing care
Faye
G.Abedellahs Typology
of twenty one Nursing
problems
Lydia E. Hall :Care, Cure, Nursing care is person directed towards
Core model
self love.
Jean Watsons Philosophy Caring is moral ideal: mind -body soul
and Science of caring
engagement with one and other.
Caring is a universal, social phenomenon

that is only effective when practiced
interpersonally considering humanistic
aspects and caring.
Patricia Benners Primacy Caring is central to the essence of nursing.
of caring
It sets up what matters, enabling
connection and concern. It creates
possibility for mutual helpfulness.
Caring creates - possibilities of coping
possibilities for connecting with and
concern for others, possibilities for giving
and receiving help
Described systematically five stages of
skill acquisition in nursing practice
novice, advanced beginner, competent,
proficient and expert.
CONCEPTUAL MODELS AND

GRAND THEORIES
Dorothea E. Orems Self Selfcare maintains wholeness.
care deficit theory in
nursing
Three Theories:
Theory of Self-Care
Theory of Self-Care Deficit
Theory of Nursing Systems
Wholly compensatory (doing for the
patient)
Partly compensatory (helping the patient
do for himself or herself)
Supportive- educative (Helping patient to
learn self care and emphasizing on the
importance of nurses role
Myra Estrin Levines: The Holism is maintained by conserving
conservation model
integrity
Proposed that the nurses use the principles
of conservation of:
Client Energy
Personal integrity
Structural integrity
Social integrity
A conceptual model with three

nursing theories
Conservation
Redundancy
Therapeutic intention
Person environment are energy fields that
Martha E.Rogers:
Science of unitary human
beings
evolve negentropically
Martha proposed that nursing was a basic
scientific discipline
Nursing is using knowledge for human
betterment.
Dorothy E.Johnsons
Behavioural system
model
The unique focus of nursing is on the

unitary or irreducible human being and
the environment (both are energy fields)
rather than health and illness
Individuals maintain stability and balance
through adjustments and adaptation to the
forces that impinges them.
Individual as a behavioural system is
composed of seven subsystems.
Attachment, or the affiliative subsystems
is the corner stone of social
organisations.
Behavioural system also includes the
subsystems of dependency, achievement,
aggressive, ingestive-eliminative and
sexual.
Sister Callista: Roys

Adaptation model
Disturbances in these causes nursing

problems.
Stimuli disrupt an adaptive system
The individual is a biopsychosocial
adaptive system within an environment.
The individual and the environment
provide three classes of stimuli-the focal,
residual and
contextual.
Through two adaptive mechanisms,
regulator and cognator, an individual
demonstrates adaptive responses or
ineffective responses requiring nursing
interventions
Betty Neumans : Health Reconstitution is a status of adaptation to

care systems model
stressors
A conceptual model with two theories
Optimal patient stability and prevention
as intervention
Neumans model includes intrapersonal,
interpersonal and extrapersonal stressors.
Nursing is concerned with the whole
person.
Imogene Kings Goal

attainment theory
Nursing actions (Primary, Secondary, and

Tertiary levels of prevention) focuses on
the variables affecting the clients response
to stressors.
Transactions provide a frame of reference
toward goal setting.
A conceptual model of nursing from which
theory of goal attainment is derived.
From her major concepts (interaction,
perception, communication, transaction,
role, stress, growth and development)
derived goal attainment theory.
Perceptions, Judgments and actions of

the patient and the nurse lead to reaction,
interaction, and transaction (Process of
nursing).
Nancy Roper, WW.Logan Individuality in living.
and A.J.Tierney A
model for nursing based A conceptual model of nursing from which
on a model of living
theory of goal attainment is derived.
Living is an amalgam of activities of
living (ALs).
Most individuals experience significant
life events which can affect ALs causing
actual and potential problems.
This affects dependence independence
continuum which is bi-directional.

Nursing helps to maintain the individuality
of person by preventing potential
problems, solving actual problems and
helping to cope.
Hildegard E. Peplau:
Interpersonal process is maturing force for
Psychodynamic Nursing personality.
Theory
Stressed the importance of nurses ability
to understand own behaviour to help
others identify perceived difficulties.
The four phases of nurse-patient

relationships are:
1. Orientation
2. Identification
3. Exploitations
4. Resolution
The six nursing roles are:
1. Stranger
2. Resource person
3. Teacher
4. Leader
5. Surrogate
6. Counselor
Interpersonal process alleviates distress.
Ida Jean Orlandos

Nursing Process Theory
Nurses must stay connected to patients and

assure that patients get what they need,
focused on patients verbal and non verbal
expressions of need and nurses reactions
to patients behaviour to alleviate distress.
Elements of nursing situation:
1. Patient
2. Nurse reactions
3. Nursing actions
Joyce Travelbees Human Therapeutic human relationships.
To Human Relationship
Model
Nursing is accomplished through human
to human relationships that began with:
The original encounter and then
progressed through stages of
Emerging identities
Kathryn E. Barnards
Parent Child Interaction
Model
Ramona T.Mercers
:Maternal Role
Attainment
Katharine Kolcabas
Theory of comfort
Developing feelings of empathy and

sympathy, until the nurse and patient
attained rapport in the final stage.
Growth and development of children and
motherinfant relationships
Individual characteristics of each member
influence the parentinfant system and
adaptive behaviour modifies those
characteristics to meet the needs of the
system.
Parenting and maternal role attainment in
diverse populations
A complex theory to explain the factors
impacting the development of maternal
role over time.
Comfort is desirable holistic outcome of
care.
Health care needs are needs for comfort,
arising from stressful health care situations
that cannot be met by recipients
traditional support system.
These needs include physical, psycho
spiritual, social and environmental
needs.
Comfort measures include those nursing
interventions designed to address the
Madeleine Leiningers
Transcultural nursing,
culture-care theory
specific comfort needs.

Caring is universal and varies
transculturally.
Major concepts include care, caring,
culture, cultural values and cultural
variations
Caring serves to ameliorate or improve
human conditions and life base.
Care is the essence and the dominant,

distinctive and unifying feature of nursing
Rosemarie Rizzo
Indivisible beings and environment coParses :Theory of human create health.
becoming
A theory of nursing derived from Rogers
conceptual model.
Clients are open, mutual and in constant
interaction with environment.
The nurse assists the client in interaction
with the environment and co creating
health
Nola J.Penders :The
Promoting optimum health supersedes
Health promotion; model disease prevention.
Identifies cognitive, perceptual factors in
clients which are modified by
demographical and biological
characteristics, interpersonal influences,
situational and behavioural factors that
help predict in health promoting behaviour
CONCLUSION
The conceptual and theoretical nursing models help to provide
knowledge to improve practice, guide research and curriculum and
identify the goals of nursing practice. The state of art and science of
nursing theory is one of continuing growth. Using the internet the
nurses of the world can share ideas and knowledge, carrying on the
work begun by nursing theorists and continue the growth and
development of new nursing knowledge. It is important the nursing
knowledge is learnt, used, and applied in the theory based practice
for the profession and the continued development of nursing and
academic discipline
REFERENCES
1. Donaldson, S. K., & Crowley, D. M. (1978). The discipline of
nursing. Nursing Outlook, 26, 113120.
2. Smith, M. J., & Liehr, P. R. (2008). Middle range theory for
nursing. New York: Springer Publishing.
3. George B. Julia , Nursing Theories- The base for professional
Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.
4. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis
for Nursing Philadelphia. Lippincott Williams& wilkins.
5. Meleis Ibrahim Afaf (1997) , Theoretical Nursing :
Development & Progress 3rd ed. Philadelphia, Lippincott.
6. Taylor Carol,Lillis Carol (2001)The Art & Science Of
Nursing Care 4th ed. Philadelphia, Lippincott.
7. Potter A Patricia, Perry G Anne (1992) Fundamentals Of
Nursing Concepts Process & Practice 3rd ed. London Mosby
Year Book.
8.
Tomey AM, Alligood. MR. Nursing theorists and their work.

(5th ed.). Mosby, Philadelphia, 2002
9.
Alligood M.R, Tomey. A.M. Nursing theory utilization and

application. 2nd Ed. Mosby, Philadelphia, 2002.
Development of Nursing Theories
This page was last updated on November 4, 2010
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Introduction
Theories are a set of interrelated concepts that give a systematic view of a phenomenon
(an observable fact or event) that is explanatory & predictive in nature.
Theories are composed of concepts, definitions, models, propositions & are based on
assumptions.
Theory gives planners tools for moving beyond intuition to design and evaluate health
behavior and health promotion interventions based on understanding of behavior.[Robert
T. Croyle (2005)].
They are derived through two principal methods; deductive reasoning and inductive
reasoning.
Nursing theorists use both of these methods.
Theory is a creative and rigorous structuring of ideas that projects a tentative,

purposeful, and systematic view of phenomena.
A theory makes it possible to organize the relationship among the concepts to describe,
explain, predict, and control practice
Definition
Concepts are basically vehicles of thought that involve images. Concepts are words that describe
objects, properties, or events & are basic components of theory.
Types:
1. Empirical concepts
2. Inferential concepts
3. Abstract concepts
Definitions
Models are representations of the interaction among and between the concepts showing
patterns.
Propositions are statements that explain the relationship between the concepts.
Process it is a series of actions, changes or functions intended to bring about a desired

result. During a process one takes systemic & continuous steps to meet a goal & uses
both assessments & feedback to direct actions to the goal.
A particular theory or conceptual frame work directs how these actions are carried
out. The delivery of nursing care within the nursing process is directed by the way
specific conceptual frameworks & theories define the person (patient), the environment,
health & nursing.
The terms model and theory are often wrongly used interchangeably, which further
confounds matters.
In nursing, models are often designed by theory authors to depict the beliefs in their
theory (Lancaster and Lancaster 1981).
They provide an overview of the thinking behind the theory and may demonstrate how
theory can be introduced into practice, for example, through specific methods of
assessment.
Models are useful as they allow the concepts in nursing theory to be successfully applied
to nursing practice (Lancaster and Lancaster 1981). Their main limitation is that they are
only as accurate or useful as the underlying theory.
Importance of nursing theories
Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn
and Jacobs1978).
It should provide the foundations of nursing practice, help to generate further knowledge
and indicate in which direction nursing should develop in the future (Brown 1964).
Theory is important because it helps us to decide what we know and what we need to
know (Parsons1949).
It helps to distinguish what should form the basis of practice by explicitly describing
nursing.
The benefits of having a defined body of theory in nursing include better patient care,
enhanced professional status for nurses, improved communication between nurses, and
guidance for research and education (Nolan 1996).
The main exponent of nursing caring cannot be measured, it is vital to have the theory
to analyze and explain what nurses do.
As medicine tries to make a move towards adopting a more multidisciplinary approach to

health care, nursing continues to strive to establish a unique body of knowledge.
This can be seen as an attempt by the nursing profession to maintain its professional
boundaries.
The characteristics of theories

Theories are:
interrelating concepts in such a way as to create a different way of looking at a particular

phenomenon.
logical in nature.
generalizable.
bases for hypotheses that can be tested.
increasing the general body of knowledge within the discipline through the research
implemented to validate them.
used by the practitioners to guide and improve their practice.
consistent with other validated theories, laws, and principles but will leave open
unanswered questions that need to be investigated.
Basic processes in the development of nursing theories

Nursing theories are often based on & influenced by broadly applicable processes & theories.
Following theories are basic to many nursing concepts.
General System Theory
It describes how to break whole things into parts & then to learn how the parts work together in
systems. These concepts may be applied to different kinds of systems, e.g. Molecules in
chemistry, cultures in sociology, and organs in Anatomy & Health in Nursing.
Adaptation Theory
It defines adaptation as the adjustment of living matter to other living things & to environmental
conditions.
Adaptation is a continuously occurring process that effects change & involves interaction &
response.
Human adaptation occurs on three levels :
1. The internal (self)

2. The social (others) &
3. the physical (biochemical reactions)
Developmental Theory
It outlines the process of growth & development of humans as orderly & predictable,
beginning with conception & ending with death.
The progress & behaviors of an individual within each stage are unique.
The growth & development of an individual are influenced by heredity, temperament,
emotional, & physical environment, life experiences & health status.
Common concepts in nursing theories

Four concepts common in nursing theory that influence & determine nursing practice are:
The person (patient).

The environment
Health
Nursing (goals, roles, functions)
Each of these concepts is usually defined & described by a nursing theorist, often uniquely;
although these concepts are common to all nursing theories. Of the four concepts, the most
important is that of the person. The focus of nursing, regardless of definition or theory, is the
person.
Historical perspectives and key concepts
1. Nightingale (1860): To facilitate the bodys reparative processes by manipulating
clients environment
2. Peplau 1952: Nursing is; therapeutic interpersonal process.
3. Henderson 1955: The needs often called Hendersons 14 basic needs
4. Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes
delivering nursing care for the whole person to meet the physical, emotional, intellectual,
social, and spiritual needs of the client and family.
5. Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when
met, diminishes distress, increases adequacy, or enhances well-being.
6. Johnsons Theory 1968: Dorothy Johnsons theory of nursing 1968 focuses on how the
client adapts to illness and how actual or potential stress can affect the ability to adapt.
The goal of nursing to reduce stress so that; the client can move more easily through
recovery.
7. Rogers 1970: to maintain and promote health, prevent illness, and care for and
rehabilitate ill and disabled client through humanistic science of nursing
8. Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client
is unable to fulfill biological, psychological, developmental, or social needs.
9. King 1971: To use communication to help client reestablish positive adaptation to
environment.
10. Neuman 1972: Stress reduction is goal of system model of nursing practice.
11. Roy 1979: This adaptation model is based on the physiological, psychological,
sociological and dependence-independence adaptive modes.
12. Watsons Theory 1979: Watsons philosophy of caring 1979 attempts to define the
outcome of nursing activity in regard to the; humanistic aspects of life.
Classification of nursing theories
A. Depending On Function (Polit et al 2001)
1. Descriptive-to identify the properties and workings of a discipline
2. Explanatory-to examine how properties relate and thus affect the discipline
3. Predictive-to calculate relationships between properties and how they occur

4. Prescriptive -to identify under which conditions relationships occur
B. Depending on the Generalisability of their principles
1. Metatheory: the theory of theory. Identifies specific phenomena through abstract
concepts.
2. Grand theory: provides a conceptual framework under which the key concepts and
C. Principles of the discipline can be identified.
1. Middle range theory: is more precise and only analyses a particular situation with a
limited number of variables.
2. Practice theory: explores one particular situation found in nursing. It identifies explicit
goals and details how these goals will be achieved.
D. Based on the philosophical underpinnings of the theories
1. Needs theories.
2. Interaction theories.
3. Outcome theories.
4. Humanistic theories.
1. Needs theories
These theories are based around helping individuals to fulfill their physical and mental needs.
Needs theories have been criticized for relying too much on the medical model of health and
placing the patient in an overtly dependent position.
2.Interaction theories
As described by Peplau (1988), these theories revolve around the relationships nurses form with
patients.
Such theories have been criticized for largely ignoring the medical model of health and
not attending to basic physical needs.
3. Outcome theories"
Oucome theories portray the nurse as the changing force, who enables individuals to
adapt to or cope with ill health.
Outcome theories have been criticized as too abstract and difficult to implement in
practice.
4. Humanistic Theories
Humanistic theories developed in response to the psychoanalytic thought that a persons destiny
was determined early in life.
Humanistic theories emphasize a persons capacity for self-actualization.

Humanists believe that the person contains within himself the potential for healthy &
creative growth.
Carl Rogers developed a person centered model of psychotherapy that emphasizes the
uniqueness of the individual.
The major contribution that Rogers added to nursing practice is the understandings that
each client is a unique individual, so, person-centered approach now practice in nursing.
Models of nursing
A model, as an abstraction of reality, provides a way to visualize reality to simplify thinking.
A conceptual model shows how various concepts are interrelated and applies theories to
predict or evaluate consequences of alternative actions.
According to Fawcett (2000),

A conceptual model gives direction to the search for relevant questions about the phenomena of
central interest to a discipline and suggests solutions to practical problems
Four concepts are generally considered central to the discipline of nursing: the person who
receives nursing care (the patient or client); the environment (society); nursing (goals, roles,
functions); and health. These four concepts form a metaparadigm of nursing.
The term metaparadigm comes from the Greek prefix meta, which means more comprehensive
or transcending, and the word Greek word paradigm, which means a philosophical or
theoretical framework of a discipline upon which all theories, laws, and generalizations are
formulated (Merriam-Websters Collegiate Dictionary, 1994).
Categories of Conceptual Models
Ten conceptual models of nursing have been classified according to two criteria:
the world view of change reflected by the model (growth or stability); and
the major theoretical conceptual classification with which the model seems most
consistent (systems, stress/adaptation, caring, or growth/development).
1.Systems Theory as a Framework
Systems theory is concerned with changes caused by interactions among all the factors
(variables)
General systems theory states
A system is defined as a whole with interrelated parts, in which the parts have a function
and the system as a totality has a function.
A general systems approach allows for consideration of the subsystems levels of the
human being, as a total human being, and as a social creature who networks himself with
others in hierarchically arranged human systems of increasing complexity. Thus the
human being, from the level of the individual to the level of society, can be
conceptualized as the client and becomes the target system for nursing intervention (Sills
& Hall, 1977).
An example of systems interaction
Input (Diet teaching)

Throughput (Assimilation of information)
Output (Food intake)
Feedback (Weight record, Hb estimation etc.)
Two nursing models based on systems theory:

1. Imogene Kings systems interaction model, and
2. Betty Neumans health care systems model.
Major Concepts as Defined in Kings Model
Person (Human
A personal system that interacts with interpersonal and social systems
Being)
A context within which human beings grow, develop, and perform daily
Environment
activities
dynamic life experiences of a human being, which implies continuous
Health
adjustment to stressors in the internal and external environment through
optimum use of ones resources to achieve maximum potential for daily living
Nursing
A process of human interaction
Imogene Kings Systems Interaction Model
In interaction model, the purpose of nursing is to help people attain, maintain, or restore health.
Kings model conceptualizes three levels of dynamic interacting systems.
1. Individuals are called personal systems.
2. Groups (two or more persons) form interpersonal systems.

3. Society is composed of social systems.
As the person interacts with the environment, he or she must continuously adjust to
stressors in the internal and external environment (King, 1981).
Health assumes achievement of maximum potential for daily living and an ability to
function in social roles. It is the dynamic life experiences of a human being, which
implies continuous adjustment to stressors in the internal and external environment
through optimum use of ones resources to achieve maximum potential for daily living
(King, 1981,).
Illness is a deviation from normal, that is, an imbalance in a persons biological structure
or in his psychological makeup, or a conflict in a persons social relationships (King,
1989).
The goal of nursing is to help individuals and groups attain, maintain, and restore
health
Stress: a dynamic state whereby a human being interacts with the environment to
maintain balance for growth, development, and performance
Betty Neumans Health Care Systems Model

Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability.
Normal line of defense: an adaptational level of health considered normal for an

individual
Lines of resistance: protection factors activated when stressors have penetrated the
normal line of defense
Neumans model, organized around stress reduction, is concerned primarily with how stress and
the reactions to stress affect the development and maintenance of health.
The person is a composite of physiologic, psychological, sociocultural, developmental, and
spiritual variables considered simultaneously.
Ideally the five variables function harmoniously or are stable in relation to internal and external
environmental stressor influences (Neuman, 2002).
A person is constantly affected by stressors from the internal, external, or created

environment.
Stressors are tension-producing stimuli that have the potential to disturb a persons
equilibrium or normal line of defense.
This normal line of defense is the persons usual steady state.
It is the way in which an individual usually deals with stressors.
Stressors may be of three types:

1. Intrapersonal: forces arising from within the person
2. Interpersonal: forces arising between persons
3. Extrapersonal: forces arising from outside the person
Resistance to stressors is provided by a flexible line of defense, a dynamic protective buffer
made up of all variables affecting a person at any given moment the persons resistance to any
given stressor or stressors.
If the flexible line of defense is no longer able to protect the person against a stressor, the stressor
breaks through, disturbs the persons equilibrium, and triggers a reaction. The reaction may lead
toward restoration of balance or toward death.
Neuman intends for the nurse to assist clients to retain, attain, or maintain optimal system
stability (Neuman, 1996).
Thus, health (wellness) seems to be related to dynamic equilibrium of the normal line of defense,
where stressors are successfully overcome or avoided by the flexible line of defense.
Neuman defines illness as a state of insufficiency with disrupting needs unsatisfied (Neuman,
2002).
Illness appears to be a separate state when a stressor breaks through the normal line of defense
and causes a reaction with the persons lines of resistance.
Stress/Adaptation Theory as a Framework
In contrast to systems theory, stress and adaptation theories view change caused by person
environment interaction in terms of cause and effect.
The person must adjust to environmental changes to avoid disturbing a balanced existence.
Adaptation theory provides a way to understand both how the balance is maintained and the
possible effects of disturbed equilibrium.
This theory has been widely applied to explain, predict, and control biologic (physiologic and
psychological) phenomenon.
Criticisms of nursing theories
To understand why nursing theory is generally neglected on the wards it is necessary to take a
closer look at the main criticisms of nursing theory and the role that nurses play in contributing
to its lack of prevalence in practice.
Summarization
Definition
Importance of Nursing Theories
The characteristics of theories:
Basic Processes in the Development Of Nursing Theories:
Nursing theories are often based on & influenced
ANA definition of Nursing Practice
Common concepts in Nursing Theories:
Historical Perspectives & Key Concepts
Clasification of Nursing Theories
Models Of Nursing
Growth and Stability Models of Change
A unique body of knowledge
Conclusion
Theory and practice are related. A theory presents a systematic way of understanding events or
situations.It is a set of concepts, definitions, and propositions that explain or predict these events
or situations by illustrating the relationships between variables.Theories must be applicable to a
broad variety of situations. They are, by nature, abstract, and dont have a specified content or
topic area. Like empty coffee cups, theories have shapes and boundaries, but nothing inside.
They become useful when filled with practical topics, goals, and problems. [Robert T. Croyle
(2005)]
Reference
1. Robert T. Croyle (2005). Theory at a Glance: Application to Health Promotion and Health
Behavior (Second Edition). U.S. Department of Health and Human Services, National
Institutes of Health. Available at www.thecommunityguide.org.
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed.
Norwalk, Appleton & Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed.
Philadelphia, Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process &
Practice 3rd ed. London Mosby Year Book.
7. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories
to prepare nurse therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):22
Virginia Henderson's Need Theory
This page was last updated on March 1, 2011
Nursing theories mirror different realities, throughout their development; they reflected the
interests of nurses of that time.
Introduction
The Nightingale of Modern Nursing

Modern-Day Mother of Nursing.
"The 20th century Florence Nightingale."
Born in Kansas City, Missouri, in 1897.
Received a Diploma in Nursing from the Army School of Nursing at Walter Reed
Hospital, Washington, D.C. in 1921.
Worked at the Henry Street Visiting Nurse Service for 2 years after graduation.
In 1923, started teaching nursing at the Norfolk Protestant Hospital in Virginia
In 1929, entered Teachers College at Columbia University for Bachelors Degree in

1932, Masters Degree in 1934.
Joined Columbia as a member of the faculty, remained until 1948.
Since 1953, a research associate at Yale University School of Nursing.
recipient of numerous recognitions.
Her work influenced the nursing profession throughout the world.
a well known nursing educator and a prolific author.
honorary doctoral degrees from the Catholic University of America, Pace University,
University of Rochester, University of Western Ontario, Yale University
In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section of the
Medical Library Association.
Died: March 19, 1996.
In 1939, she revised: Harmers classic textbook of nursing for its 4th edition, and later
wrote the 5th; edition, incorporating her personal definition of nursing (Henderson,1991)
School of thoughts in Nursing Theories-1950-1970

Need theorists
Interaction Theorists
Outcome theorists
King
Abdellah
Henderson
Orem
Orlando
Johnson
Peterson and Zderad
Levine
Paplau
Rogers
Travelbee
Roy
Wiedenbach
Analysis of nursing theories according to 1st School
Focus
Human being
Problems
A set of needs or problems.
A developmental being.
Patient
Need Deficit
Orientation
Illness, disease
Dependent on medical practice.
Role of nurse
Beginnings of independent functions

Fulfill needs requisites
Decision making
Primarily health care professional
Hendersons Theory Background
Hendersons concept of nursing was derived form her practice and education therefore,
her work is inductive..
She called her definition of nursing her concept (Henderson1991)
She emphasized the importance of increasing the patients independence so that progress
after hospitalization would not be delayed (Henderson,1991)
Virginia Henderson defined nursing as "assisting individuals to gain independence in

relation to the performance of activities contributing to health or its
recovery" (Henderson, 1966).
She categorized nursing activities into 14 components, based on human needs.
She described the nurse's role as substitutive (doing for the person), supplementary
(helping the person), complementary (working with the person), with the goal of helping
the person become as independent as possible.
Her definition of nursing was one of the first statements clearly delineating nursing from
medicine:
"The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful death)
that he would perform unaided if he had the necessary strength, will or knowledge. And to
do this in such a way as to help him gain independence as rapidly as possible" (Henderson,
1966).
The 14 components
Breathe normally. Eat and drink adequately.

Eliminate body wastes.
Move and maintain desirable postures.
Sleep and rest.
Select suitable clothes-dress and undress.
Maintain body temperature within normal range by adjusting clothing and modifying
environment
Keep the body clean and well groomed and protect the integument
Avoid dangers in the environment and avoid injuring others.
Communicate with others in expressing emotions, needs, fears, or opinions.
Worship according to ones faith.
Work in such a way that there is a sense of accomplishment.
Play or participate in various forms of recreation.
Learn, discover, or satisfy the curiosity that leads to normal development and health and
use the available health facilities.
The first 9 components are physiological. The tenth and fourteenth are psychological aspects of
communicating and learning The eleventh component is spiritual and moral The twelfth and
thirteenth components are sociologically oriented to occupation and recreation
Assumption
The major assumptions of the theory are:
"Nurses care for patients until patient can care for themselves once again. Patients desire
to return to health, but this assumption is not explicitly stated.
Nurses are willing to serve and that nurses will devote themselves to the patient day and
night A final assumption is that nurses should be educated at the university level in both
arts and sciences.
Hendersons theory and the four major concepts

1. Individual
Have basic needs that are component of health.

Requiring assistance to achieve health and independence or a peaceful death.
Mind and body are inseparable and interrelated.
Considers the biological, psychological, sociological, and spiritual components.
The theory presents the patient as a sum of parts with biopsychosocial needs, and the
patient is neither client nor consumer.
2. Environment
Settings in which an individual learns unique pattern for living.

All external conditions and influences that affect life and development.
Individuals in relation to families
Minimally discusses the impact of the community on the individual and family.
Supports tasks of private and public agencies Society wants and expects nurses to act for
individuals who are unable to function independently. In return she expects society to
contribute to nursing education.
Basic nursing care involves providing conditions under which the patient can perform the
14 activities unaided
3. Health
Definition based on individuals ability to function independently as outlined in the 14

components.
Nurses need to stress promotion of health and prevention and cure of disease.
Good health is a challenge. Affected by age, cultural background, physical, and
intellectual capacities, and emotional balance Is the individuals ability to meet these
needs independently?
4. Nursing
Temporarily assisting an individual who lacks the necessary strength, will and knowledge
to satisfy 1 or more of 14 basic needs.
Assists and supports the individual in life activities and the attainment of independence.
Nurse serves to make patient complete whole", or "independent."
Henderson's classic definition of nursing:

"I say that the nurse does for others what they would do for themselves if they had the
strength, the will, and the knowledge. But I go on to say that the nurse makes the patient
independent of him or her as soon as possible."
The nurse is expected to carry out physicians therapeutic plan Individualized care is the
result of the nurses creativity in planning for care.
Use nursing research
Categorized Nursing : nursing care
Non nursing: ordering supplies, cleanliness and serving food.
In the Nature of Nursing that the nurse is and should be legally, an independent
practitioner and able to make independent judgments as long as s/he is not diagnosing,
prescribing treatment for disease, or making a prognosis, for these are the physicians
function.
Nurse should have knowledge to practice individualized and human care and should be
a scientific problem solver.
In the Nature of Nursing Nurse role is, to get inside the patients skin and supplement
his strength will or knowledge according to his needs.
And nurse has responsibility to assess the needs of the individual patient, help individual
meet their health need, and or provide an environment in which the individual can
perform activity unaided
Henderson's classic definition of nursing "I say that the nurse does for others what they
would do for themselves if they had the strength, the will, and the knowledge.
But I go on to say that the nurse makes the patient independent of him or her as soon as
possible."
Hendersons and Nursing Process

Summarization of the stages of the nursing process as applied to Hendersons definition of
nursing and to the 14 components of basic nursing care.
Nursing Process
Nursing
Assessment
Hendersons 14 components and definition of nursing

Hendersons 14 components
Nursing Diagnosis Analysis: Compare data to knowledge base of health and disease.
Nursing plan
Identify individuals ability to meet own needs with or without

assistance, taking into consideration strength, will or knowledge.
Nursing
implementation
Document how the nurse can assist the individual, sick or well.
Nursing
implementation
Assist the sick or well individual in to performance of activities in

meeting human needs to maintain health, recover from illness, or to aid
in peaceful death.
Nursing process
Implementation based on the physiological principles, age, cultural

background, emotional balance, and physical and intellectual capacities.
Carry out treatment prescribed by the physician.
Nursing
evaluation
Hendersons 14 components and definition of nursing

Use the acceptable definition of ;nursing and appropriate laws
related to the practice of nursing.
The quality of care is drastically affected by the preparation and
native ability of the nursing personnel rather that the amount of
hours of care.
Successful outcomes of nursing care are based on the speed with
which or degree to which the patient performs independently the
activities of daily living
Comparison with Maslow's Hierarchy of Need

Maslow's
Henderson
Physiological
needs
Breathe normally
Eat and drink adequately Eliminate by all avenues of elimination Move
and maintain desirable posture Sleep and rest Select suitable clothing
Maintain body temperature Keep body clean and well groomed and
protect the integument
Safety Needs
Avoid environmental dangers and avoid injuring other
Belongingness and Communicate with others

love needs
worship according to one's faith
Work at something providing a sense of accomplishment
Esteem needs
Play or participate in various forms of recreation

Learn, discover, or satisfy curiosity
Characteristic of Hendersons theory
There is interrelation of concepts in such a way as to create a different way of looking at

a particular phenomenon.
Concepts of fundamental human needs, biophysiology, culture, and interaction,
communication are borrowed from other discipline.Eg.. Maslows Hierarchy of human
needs; concept of interaction-communication i.e. nurse-patient relationship
Her definition and components are logical and the 14 components are a guide for the
individual and nurse in reaching the chosen goal.
Theories should be relatively simple yet generalizable.
Her work can be applied to the health of individuals of all ages.
Theories can be the bases for hypotheses that can be tested. Her definition of nursing
cannot be viewed as theory; therefore, it is impossible to generate testable hypotheses.
However some questions to investigate the definition of nursing and the 14 components
may be useful.
Theories contribute to and assist in increasing the general body of knowledge within the
discipline through the research implemented to validate them.
Her ideas of nursing practice are well accepted throughout the world as a basis for
nursing care.
However, the impact of the definition and components has not been established through
research.
Theories can be utilized by practitioners to guide and improve their practice.
Ideally the nurse would improve nursing practice by using her definition and 14
components to improve the health of individuals and thus reduce illness.
Usefulness
Nursing education has been deeply affected by Hendersons clear vision of the functions
of nurses.
The principles of Hendersons theory were published in the major nursing textbooks used
from the 1930s through the 1960s, and the principles embodied by the 14 activities are
still important in evaluating nursing care in thee21st centaury.
Others concepts that Henderson (1966) proposed have been used in nursing education
from the 1930s until the present O'Malley, 1996)
Limitations
Lack of conceptual linkage between physiological and other human characteristics.

No concept of the holistic nature of human being.
If the assumption is made that the 14 components prioritized, the relationship among the
components is unclear.
Lacks inter-relate of factors and the influence of nursing care.
Assisting the individual in the dying process she contends that the nurse helps, but there
is little explanation of what the nurse does.
Peaceful death is curious and significant nursing role.
PURPOSES OF NURSING THEORIES

In Practice:
Assist nurses to describe, explain, and predict everyday experiences.

Serve to guide assessment, interventions, and evaluation of nursing care.
Provide a rationale for collecting reliable and valid data about the health status of clients,
which are essential for effective decision making and implementation.
Help to describe criteria to measure the quality of nursing care.
Help build a common nursing terminology to use in communicating with other health
professionals.
Ideas are developed and words are defined.
Enhance autonomy (independence and self-governance) of nursing through defining its

own independent functions.
In Education:
Provide a general focus for curriculum design

Guide curricular decision making.
In Research:
Offer a framework for generating knowledge and new ideas.

Assist in discovering knowledge gaps in the specific field of study.
Offer a systematic approach to identify questions for study; select variables,

interpret findings, and validate nursing interventions.
Approaches to developing nursing theory
Borrowing conceptual frameworks from other disciplines.
Inductively looking at nursing practice to discover theories/concepts to

explain phenomena.
Deductively looking for the compatibility of a general nursing theory with

nursing practice.
Questions from practicing Nurse about using Nursing theory
Practice
Does this theory reflect nursing practice as I know it?

Will it support what I believe to be excellent nursing practice?
Can this theory be considered in relation to a wide range of nursing situation?
Personal Interests, Abilities and Experiences
What will it be like to think about nursing theory in nursing practice?
Will my work with nursing theory be worth the effort?
Conclusion
Henderson provides the essence of what she believes is a definition of nursing.

She didnt intend to develop a theory of nursing but rather she attempted to define the
unique focus of nursing.
Her emphasis on basic human needs as the central focus of nursing practice has led to
further theory development regarding the needs of the person and how nursing can assist
in meeting those needs.
Her definition of nursing and the 14 components of basic nursing care are uncomplicated
and self-explanatory.
References
1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N
9. Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition,
Thomson, NY, 2002
Faye Glenn Abdellah's Theory
Twenty-One Nursing Problems
INTRODUCTION
Faye Glenn Abdellah, pioneer nursing researcher, helped transform nursing theory,
nursing care and nursing education
Birth:1919
Dr Abdellah worked as Deputy Surgeon General in US and Chief Nurse Officer for the
US Public Health Service , Department of Health and human services, Washington, D.C.
She was a leader in nursing research and has over one hundred publications related to
nursing care, education for advanced practice in nursing and nursing research.
According to her, nursing is based on an art and science that mould the attitudes,
intellectual competencies, and technical skills of the individual nurse into the desire and
ability to help people , sick or well, cope with their health needs.
As per Abdellah, nursing as a comprehensive service includes:
1. Recognizing the nursing problems of the patient

2. Deciding the appropriate course of action to take in terms of relevant nursing principles
3. Providing continuous care of the individuals total needs
4. Providing continuous care to relieve pain and discomfort and provide immediate security
for the individual
5. Adjusting the total nursing care plan to meet the patients individual needs
6. Helping the individual to become more self directing in attaining or maintaining a healthy
state of mind & body
7. Instructing nursing personnel and family to help the individual do for himself that which
he can within his limitations
8. Helping the individual to adjust to his limitations and emotional problems
9. Working with allied health professions in planning for optimum health on local, state,
national and international levels
10. Carrying out continuous evaluation and research to improve nursing techniques and to
develop new techniques to meet the health needs of people
(In 1973, the item 3, - providing continuous care of the individuals total health needs was
eliminated.)
PHILOSOPHICAL UNDERPINNINGS OF THE THEORY
Abdellahs patient-centred approach to nursing was developed inductively from her

practice and is considered a human needs theory.
The theory was created to assist with nursing education and is most applicable to the
education of nurses.
Although it was intended to guide care of those in the hospital, it also has relevance for
nursing care in community settings.
MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS
The language of Abdellahs framework is readable and clear.

She uses the term she for nurses, he for doctors and patients, and refers to the object of
nursing as patient rather than client or consumer.
She referred to Nursing diagnosis during a time when nurses were taught that diagnosis
was not a nurses prerogative.
Assumptions were related to
change and anticipated changes that affect nursing;
the need to appreciate the interconnectedness of social enterprises and social problems;
the impact of problems such as poverty, racism, pollution, education, and so forth on
health care delivery;
changing nursing education
continuing education for professional nurses
development of nursing leaders from under reserved groups
Abdellah and colleagues developed a list of 21 nursing problems.They also identified 10 steps to
identify the clients problems. 11 nursing skills to be used in developing a treatment typology
10 steps to identify the clients problems
Learn to know the patient

Sort out relevant and significant data
Make generalizations about available data in relation to similar nursing problems

presented by other patients
Identify the therapeutic plan
Test generalizations with the patient and make additional generalizations
Validate the patients conclusions about his nursing problems
Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting his behavior
Explore the patients and familys reaction to the therapeutic plan and involve them in the
plan
Identify how the nurses feels about the patients nursing problems
Discuss and develop a comprehensive nursing care plan
11 nursing skills
Observation of health status

Skills of communication
Application of knowledge
Teaching of patients and families
Planning and organization of work
Use of resource materials
Use of personnel resources
Problem-solving
Direction of work of others
Therapeutic use of the self
Nursing procedure
21 NURSING PROBLEMS
Three major categories
Physical, sociological, and emotional needs of clients

Types of interpersonal relationships between the nurse and patient
Common elements of client care
BASIC TO ALL PATIENTS
To maintain good hygiene and physical comfort

To promote optimal activity: exercise, rest and sleep
To promote safety through the prevention of accidents, injury, or other trauma and
through the prevention of the spread of infection
To maintain good body mechanics and prevent and correct deformity
SUSTENAL CARE NEEDS
To facilitate the maintenance of a supply of oxygen to all body cells

To facilitate the maintenance of nutrition of all body cells
To facilitate the maintenance of elimination
To facilitate the maintenance of fluid and electrolyte balance
To recognize the physiological responses of the body to disease conditions
To facilitate the maintenance of regulatory mechanisms and functions
To facilitate the maintenance of sensory function.
REMEDIAL CARE NEEDS
To identify and accept positive and negative expressions, feelings, and reactions
To identify and accept the interrelatedness of emotions and organic illness
To facilitate the maintenance of effective verbal and non verbal communication
To promote the development of productive interpersonal relationships
To facilitate progress toward achievement of personal spiritual goals
To create and / or maintain a therapeutic environment
To facilitate awareness of self as an individual with varying physical , emotional, and

developmental needs
RESTORATIVE CARE NEEDS
To accept the optimum possible goals in the light of limitations, physical and emotional
To use community resources as an aid in resolving problems arising from illness
To understand the role of social problems as influencing factors in the case of illness
ABDELLAHS THEORY AND THE FOUR MAJOR CONCEPTS

NURSING
Nursing is a helping profession.

In Abdellahs model, nursing care is doing something to or for the person or providing
information to the person with the goals of meeting needs, increasing or restoring selfhelp ability, or alleviating impairment.
Nursing is broadly grouped into the 21 problem areas to guide care and promote use of
nursing judgment.
She considers nursing to be comprehensive service that is based on art and science and
aims to help people, sick or well, cope with their health needs.
PERSON
Abdellah describes people as having physical, emotional, and sociological needs. These
needs may overt, consisting of largely physical needs, or covert, such as emotional and
social needs.
Patient is described as the only justification for the existence of nursing.
Individuals (and families) are the recipients of nursing
Health, or achieving of it, is the purpose of nursing services.
HEALTH
In PatientCentered Approaches to Nursing, Abdellah describes health as a state mutually

exclusive of illness.
Although Abdellah does not give a definition of health, she speaks to total health needs
and a healthy state of mind and body in her description of nursing as a comprehensive
service.
SOCIETY AND ENVIRONMENT
Society is included in planning for optimum health on local, state, national, and
international levels. However, as she further delineated her ideas, the focus of nursing
service is clearly the individual.
The environment is the home or community from which patient comes.
ABDELLAHS WORK AND CHARACTERISTICS OF A THEORY

Characteristic 1
Abdellahs theory has interrelated the concepts of health, nursing problems, and problem
solving as she attempts to create a different way of viewing nursing phenomenon
Nursing is the use of problem solving approach with key nursing problems related to
health needs of people.
Characteristic 2
Problem solving is an activity that is inherently logical in nature.
Characteristic 3
Framework focus on nursing practice and individuals.
Characteristic 4
The role of client within the framework.
Characteristic 5
The results of testing such hypothesis would contribute to the general body of nursing
knowledge
Characteristic 6
Abdellahs problem solving approach can easily be used by practitioners to guide various
activities within their practice that deals with clients who have specific needs and specific
nursing problems.
Characteristic 7
Although consistency with other theories exist, many questions remain unanswered
USE OF 21 PROBLEMS IN THE NURSING PROCESS

ASSESSMENT PHASE
Nursing problems provide guidelines for the collection of data.

A principle underlying the problem solving approach is that for each identified problem,
pertinent data are collected.
The overt or covert nature of the problems necessitates a direct or indirect approach,
respectively.
NURSING DIAGNOSIS
The results of data collection would determine the clients specific overt or covert
problems.
These specific problems would be grouped under one or more of the broader nursing
problems.
This step is consistent with that involved in nursing diagnosis
PLANNING PHASE
The statements of nursing problems most closely resemble goal statements. Once the
problem has been diagnosed, the nursing goals have been established.
IMPLEMENTATION
Using the goals as the framework, a plan is developed and appropriate nursing
interventions are determined.
EVALUATION
The most appropriate evaluation would be the nurse progress or lack of progress toward
the achievement of the stated goals
CONCEPT OF PROGRESSIVE PATIENT CARE
PPC is defined as better patient care through the organization of hospital facilities,
services and staff around the changing medical and nursing needs of the patient
PPC is tailoring of hospital services to meet patients needs
PPC is caring for the right patient in the right bed with the right services at the right time
PPC is systematic classification of patients based on their medical needs
ELEMENTS OF PPC
INTENSIVE CARE
Critically and seriously ill patients requiring highly skilled nursing care, close and
frequent if not constant, nursing observation are assigned to the ICU. One patient in an
ICU requires at least three nurses to observe him in 24 hrs
Intermediate care Patients assigned to this unit are both the moderately ill and those for
whom the treatment can only be palliative
Self care Ambulatory patients who are convalescencing or require diagnosis or therapy
may be cared for in this unit
Long term care unit This unit will provide services to certain patients now cared for in the
general hospital, in nursing homes, or in their own homes and who would benefit by care
in a hospital environment to achieve its maximum potential
Home care This programme makes it possible to extend needed services to the patient
after he leaves the hospital and returns to his home in the community
BENEFITS OF PPC
PATIENT
better attention
better adjustment
minimized problems
life saving care
constant medical and nursing care
PHYSICIAN
assuring best nursing care

drugs and equipments at hand
orders carried out effectively
better clinical an team service
HOSPITAL
effective and efficient use of staff

improved public image
NURSING PERSONNEL
individual skills can be used

more time with patient
helping pt. and family to solve problems
job satisfaction
in-service education
COMMUNITY
continuity with hospital services

minimize the need of hospitalization
IMPLICATIONS OF PPC FOR NURSING EDUCATION
Many nurse educators feel that the PPC hospital where all five phases of care are
available can provide clinical experience in which the nurse can learn to solve basic
nursing problems in meeting patients needs.
The three month assignment of professional nurses may no longer be realistic in such a
setting.
Organization of hospital and community services based on patients needs
In the intensive care unit, the critically ill patients are concentrated regardless of
diagnosis.
These patients are under the constant audio-visual observation of the nurse, with life
saving techniques and equipment immediately available
In the intermediate care unit are concentrated patients requiring a moderate amount of
nursing care, not of an emergency nature, who are ambulatory for short periods, and who
are beginning to participate in he planning of their own care
The self-care unit provides for patients who are physically self-sufficient and require
diagnostic and convalescent care in hotel-type accommodations. This unit serves as a link
between the hospital and the home.
In the long-term care unit are concentrated patients requiring prolonged care. The
grouping of such patients will permit staffing patterns that are less costly
Home care, the fifth element of progressive patient care, extends hospital services into
the home to assist the physician in the care of his patients
USEFULNESS
The patient centered approach was constructed to be useful to nursing practice, with
impetus for it being nursing education.
Abdellahs publications on nursing education began with her dissertation; her interest in
education for nurses continues into the present.
Abdellah has also published on nursing, nursing research, and public policy related to
nursing in several international publications. She has been a strong advocate for
improving nursing practice through nursing research
VALUE IN EXTENDING NURSING SCIENCE
It helped to bring structure and organization to what was often a disorganized collection
of lectures and experiences.
She categorized nursing problems based on the individuals needs and developed
developed a typology of nursing treatment and nursing skills..
NURSING RESEARCH
She has been a leader in nursing research and has over one hundred publications related
to nursing care, education for advanced practice in nursing and nursing research.
LIMITATIONS
Very strong nursing centered orientation

Little emphasis on what the client is to achieve
Her framework is inconsistent with the concept of holism

Potential problems might be overlooked
CONCLUSIONS
Using Abdellahs concepts of health, nursing problems, and problem solving, the
theoretical statement of nursing that can be derived is the use of the problem solving
approach with key nursing problems related to health needs of people.
From this framework, 21 nursing problems were developed
Abdellahs theory provides a basis for determining and organizing nursing care. The
problems also provide a basis for organizing appropriate nursing strategies.
It is anticipated that by solving the nursing problems, the client would be moved toward
health. The nurses philosophical frame of reference would determine whether this theory
and the 21 nursing problems could be implemented in practice.
REFERENCES
1. George Julia B. Nursing theories: The base of professional nursing practice 3rd edition.
Norwalk, CN: Appleton and Lange; 1990.
2. Abdellah, F.G. The federal role in nursing education. Nursing outlook. 1987, 35(5),224225.
3. Abdellah, F.G. Public policy impacting on nursing care of older adults .In E.M. Baines
(Ed.), perspectives on gerontological nursing. Newbury, CA: Sage publications. 1991.
4. Abdellah, F.G., & Levine, E. Preparing nursing research for the 21st century. New York:
Springer. 1994.
5. Abdellah, F.G., Beland, I.L., Martin, A., & Matheney, R.V. Patient-centered approaches
to nursing (2nd ed.). New York: Mac Millan. 1968.
6. Abdellah, F.G. Evolution of nursing as a profession: perspective on manpower
development. International Nursing Review, 1972); 19, 3..
7. Abdellah, F.G.). The nature of nursing science. In L.H. Nicholl (Ed.), perspectives on
nursing theory. Boston: Little, Brown, 1986.
Jean Watson's Philosophy of Nursing

Introduction
Born: West Virginia

Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD,
University of Colorado, 1973
Distinguished Professor of Nursing and endowed Chair in Caring Science at the

University of Colorado Health Sciences Center.
Fellow of the American Academy of Nursing.
Previously, Dean of Nursing at the University Health Sciences Center and President of
the National League for Nursing
Dr. Watson has earned undergraduate and graduate degrees in nursing and psychiatricmental health nursing and PhD in educational psychology and counseling.
widely published author and recipient of several awards and honors, -international
Kellogg Fellowship in Australia, Fulbright Research Award in Sweden and six (6)
Honorary Doctoral Degrees, including 3 International Honorary Doctorates (Sweden,
United Kingdom, Quebec, Canada).
Her research has been in the area of human caring and loss.
The foundation of Jean Watsons theory of nursing was published in 1979 in nursing:
The philosophy and science of caring
In 1988, her theory was published in nursing: human science and human care.
Major Concepts
-main focus in nursing is on carative factors.

-for nurses to develop humanistic philosophies and value system, a strong liberal arts
background is necessary.
the caring stance that nursing has always held is being threatened by the tasks and
technology demands of the curative factors
The seven assumptions
Caring can be effectively demonstrated and practiced only interpersonally.

Caring consists of carative factors that result in the satisfaction of certain human needs.
Effective caring promotes health and individual or family growth.
Caring responses accept person not only as he or she is now but as what he or she may
become.
A caring environment is one that offers the development of potential while allowing the
person to choose the best action for himself or herself at a given point in time.
Caring is more healthogenic than is curing. A science of caring is complementary to

the science of curing.
The practice of caring is central to nursing.
The ten primary carative factors

1. The formation of a humanistic- altruistic system of values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to ones self and to others.
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive and negative feelings.
6. The systematic use of the scientific problem-solving method for decision making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental, physical, sociocultural and spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces.
The first three carative factors form the philosophical foundation for the science of caring. The
remaining seven carative factors spring from the foundation laid by these first three.
1. The formation of a humanistic- altruistic

system of values
Begins developmentally at an early age with values shared with the parents.
Mediated through ones own life experiences, the learning one gains and exposure to the
humanities.
Is perceived as necessary to the nurses own maturation which then promotes altruistic
behavior towards others.
2. Faith-hope
Is essential to both the carative and the curative processes.

When modern science has nothing further to offer the person, the nurse can continue to
use faith-hope to provide a sense of well-being through beliefs which are meaningful to
the individual.
3. Cultivation of sensitivity to ones self and

to others
Explores the need of the nurse to begin to feel an emotion as it presents itself.
Development of ones own feeling is needed to interact genuinely and sensitively with
others.
Striving to become sensitive, makes the nurse more authentic, which encourages selfgrowth and self-actualization, in both the nurse and those with whom the nurse interacts.
The nurses promote health and higher level functioning only when they form person to
person relationship.
4. Establishing a helping-trust relationship
Strongest tool is the mode of communication, which establishes rapport and caring.
She has defined the characteristics needed to in the helping-trust relationship. These are:
o
Congruence
Empathy
Warmth
Communication includes verbal, nonverbal and listening in a manner which connotes

empathetic understanding.
5. The expression of feelings, both positive

and negative
feelings alter thoughts and behavior, and they need to be considered and allowed for in a
caring relationship.
Awareness of the feelings helps to understand the behavior it engenders.
6. The systematic use of the scientific

problem-solving method for decision making
According to Watson, the scientific problem- solving method is the only method that
allows for control and prediction, and that permits self-correction.
She also values the relative nature of nursing and supports the need to examine and
develop the other methods of knowing to provide an holistic perspective.
The science of caring should not be always neutral and objective.
7. Promotion of interpersonal teachinglearning
The caring nurse must focus on the learning process as much as the teaching process.
Understanding the persons perception of the situation assist the nurse to prepare a
cognitive plan.
8. Provision for a supportive, protective

and /or corrective mental, physical, sociocultural and spiritual environment
Watson divides these into eternal and internal variables, which the nurse manipulates in
order to provide support and protection for the persons mental and physical well-being.
The external and internal environments are interdependent.
Watson suggests that the nurse also must provide comfort, privacy and safety as a part of
this carative factor.
9. Assistance with the gratification of human

needs
It is grounded in a hierarchy of need similar to that of the Maslows.

She has created a hierarchy which she believes is relevant to the science of caring in
nursing.
According to her each need is equally important for quality nursing care and the
promotion of optimal health.
All the needs deserve to be attended to and valued.
Watsons ordering of needs
Lower order needs (biophysical needs)

o The need for food and fluid
o
The need for elimination
The need for ventilation
Lower order needs (psychophysical needs)

o
The need for activity-inactivity
The need for sexuality
Watsons ordering of needs

o
Higher order needs (psychosocial needs)
The need for achievement
The need for affiliation
Higher order need (intrapersonal-interpersonal need)
The need for self-actualization
Research findings have established a correlation between emotional distress and illness.
According to Watson, the current thinking of holistic care emphasizes that:
o
Factors of the etiological component interact and produce change through

complex neuro-physiological and neuro-chemical pathways
Each psychological function has a physiological correlate
Each physiological component has a psychological correlate
10. Allowance for existentialphenomenological forces
Phenomenology is a way of understanding people from the way things appear to them,
from their frame of reference.
Existential psychology is the study of human existence using phenomenological analysis.
This factor helps the nurse to reconcile and mediate the incongruity of viewing the person
holistically while at the same time attending to the hierarchical ordering of needs.
Thus the nurse assists the person to find the strength or courage to confront life or death.
Watsons theory and the four major concepts
1.
Human being
2.
She adopts a view of the human being as: .. a valued person in and of him or herself
to be cared for, respected, nurtured, understood and assisted; in general a philosophical
view of a person as a fully functional integrated self. He, human is viewed as greater than
and different from, the sum of his or her parts.
Health
Watson believes that there are other factors that are needed to be included in the WHO
definition of health. She adds the following three elements:
A high level of overall physical, mental and social functioning
A general adaptive-maintenance level of daily functioning
The absence of illness (or the presence of efforts that leads its absence)
3.
Environment/society
According to Watson caring (and nursing) has existed in every society. A caring attitude
is not transmitted from generation to generation. It is transmitted by the culture of the
profession as a unique way of coping with its environment.
4.
Nursing
According to Watson nursing is concerned with promoting health, preventing illness,

caring for the sick and restoring health.
It focuses on health promotion and treatment of disease. She believes that holistic health
care is central to the practice of caring in nursing.
She defines nursing as..
A human science of persons and human health-illness experiences that are mediated by
professional, personal, scientific, esthetic and ethical human transactions.
Watsons theory and nursing process
1.
Watson points out that nursing process contains the same steps as the scientific research
process. They both try to solve a problem. Both provide a framework for decision
making. Watson elaborates the two processes as:
Assessment
2.
Involves observation, identification and review of the problem; use of applicable

knowledge in literature.
Also includes conceptual knowledge for the formulation and conceptualization of
framework.
Includes the formulation of hypothesis; defining variables that will be examined in
solving the problem.
Plan
3.
It helps to determine how variables would be examined or measured; includes a

conceptual approach or design for problem solving. It determines what data would be
collected and how on whom.
Intervention
4.
It is the direct action and implementation of the plan.

It includes the collection of the data.
Evaluation
Analysis of the data as well as the examination of the effects of interventions based on
the data.
Includes the interpretation of the results, the degree to which positive outcome has
occurred and whether the result can be generalized.
It may also generate additional hypothesis or may even lead to the generation of a nursing
theory.
Watsons work and the characteristic of a theory
According to Watson, a theory is an imaginative grouping of knowledge, ideas and

experiences that are represented symbolically and seek to illuminate a given
phenomenon
She views nursing as,
.both a human science and an art and as such it cannot be considered qualitatively
continuous with traditional, reductionistic, scientific methodology.
She suggests that nursing might want to develop its own science that would not be related
to the traditional sciences but rather would develop its own concepts, relationships and
methodology.
Theories can interrelate concepts in such a way as to create a different way of looking at a
particular phenomenon
The basic assumptions for the science of caring in nursing and the ten carative factors
that form the structure for that concept is unique in Watsons theory.
She describes caring in both philosophical and scientific terms.
Watson also indicates that needs are interrelated.
The science of caring suggests that the nurse recognize and assist with each of the
interrelated needs in order to reach the highest order need of self-actualization.
Theories must be logical in nature
Watsons work is logical in that the factors are based on broad assumptions which
provide a supportive framework.
With these carative factors she delineates nursing from other professions
These carative factors are logically derived from the assumptions and related to he
hierarchy of needs.
Theories should be relatively simple yet

generalizable
The theory is relatively simple as it does not use theories from other disciplines that are
familiar to nursing.
The theory is simple relatively but the fact that it de-emphasizes the pathophysiological
for the psychosocial diminishes its ability to be generalizable.
She discusses this in the preface of her book when she speaks of the trim and the
core of nursing.
She defines trim as the clinical focus, the procedure and the techniques.
The core of the nursing is that which is intrinsic to the nurse-client interaction that
produces a therapeutic result. Core mechanisms are the carative factors.
Theories can be the basis for hypotheses that

can be tested
Watsons theory is based on phenomenological studies that generally ask questions rather
than state hypotheses. Its purpose is to describe the phenomena, to analyze and to gain an
understanding.
Theories contribute to and assist in increasing the general body within the discipline
through research implemented to validate them
According to Watson the best method to test this theory is through field study.
An example is her work in the area of loss and caring that took place in Cundeelee,
Western Australia and involved a tribe of aborigines.
Theories can be utilized by practitioners to

guide and improve their practice
Watsons work can be used to guide and improve practice.

It can provide the nurse with the most satisfying aspects of practice and can provide the
client with the holistic care so necessary for human growth and development.
Theories must be consistent with other validated theories, laws and principles but will
leave open unanswered questions that need to be investigated
Watsons work is supported by the theoretical work of numerous humanists, philosophers,

developmentalists and psychologists.
She clearly designates the theories of stress, development, communication, teachinglearning, humanistic psychology and existential phenomenology which provide the
foundation for the science of caring.
Strengths
Besides assisting in providing the quality of care that client ought to receive, it also
provides the soul satisfying care for which many nurses enter the profession.
As the science of caring ranges from the biophysical through the intrapersonal, each
nurse becomes an active coparticipant in the clients struggle towards self-actualization.
The client is placed in the context of the family, the community and the culture.
It places the client as the focus of practice rather than the technology.
Limitations
Given the acuity of illness that leads to hospitalization, the short length stay , and the
increasing complex technology, such quality of care may be deemed impossible to give in
the hospital.
While Watson acknowledges the need for biophysical base to nursing, this area receives
little attention in her writings.
The ten caratiive factors primarily delineate the psychosocial needs of the person.
While the carative factors have a sound foundation based on other disciplines, they need
further research in nursing to demonstrate their application to practice.
Research related to Watsons theory
Saint Joseph Hospital in Orange, California has selected Jean Watsons theory of human
caring as the framework base for nursing practice.
The effectiveness of Watson's Caring Model on the quality of life and blood pressure of
patients with hypertension. J Adv Nurs. 2003 Jan;41(2):130-9.
This study demonstrated a relationship between care given according to Watson's Caring
model and increased quality of life of the patients with hypertension. Further, in those
patients for whom the caring model was practised, there was a relationship between the
Caring model and a decrease in patient's blood pressure. The Watson Caring Model is
recommended as a guide to nursing patients with hypertension, as one means of
decreasing blood pressure and increase in quality of life.
Martin, L. S. (1991). Using Watsons theory to explore the dimensions of adult polycystic
kidney disease . ANNA Journal, 18, 403-406 .
Mullaney, J. A. B. (2000). The lived experience of using Watsons actual caring

occasions to treat depressed women . Journal of Holistic Nursing, 18(2), 129-142
Martin, L. S. (1991). Using Watsons theory to explore the dimensions of adult polycystic
kidney disease . ANNA Journal, 18, 403-406
Conclusion
Watson provides many useful concepts for the practice of nursing.

She ties together many theories commonly used in nursing education and does so in a
manner helpful to practioners of the art and science of nursing.
The detailed descriptions of the carative factors can give guidance to those who wish to
employ them in practice or research.
Using her theory can add a dimension to practice that is both satisfying and challenging.
References
1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N
9. Cheng MY. Using King's Goal Attainment Theory to facilitate drug compliance in a
psychiatric patient. Hu Li Za Zhi. 2006 Jun;53(3):90-7.
Thomson, NY, 2002.
Johnson's Behaviour System Model
This page was last updated on January 6, 2011
Introduction
Dorothy E. Johnson was born August 21,

1919, in Savannah, Georgia.
B. S. N. from Vanderbilt University in
Nashville, Tennessee, in 1942; and her M.P.H.
from Harvard University in Boston in 1948.
From 1949 until her retirement in 1978 she

was an assistant professor of pediatric nursing,
an associate professor of nursing, and a
professor of nursing at the University of
California in Los Angeles.
Dorothy Johnson has had an influence on

nursing through her publications since the
1950s.
Johnson stressed the importance of researchbased knowledge about the effect of nursing
care on clients.
Johnsons behavior system model
In 1968 Dorothy first proposed her model of

nursing care as fostering of the efficient and
effective behavioral functioning in the patient
to prevent illness".
She also stated that nursing was concerned
with man as an integrated whole and this is the
specific knowledge of order we require.
In 1980 Johnson published her
conceptualization of behavioral system of
model for nursing this is the first work of
Dorothy that explicates her definitions of the
behavioral system model.
Definition of nursing
She defined nursing as an external regulatory force
which acts to preserve the organization and
integration of the patients behaviors at an optimum
level under those conditions in which the behaviors
constitutes a threat to the physical or social health, or
in which illness is found
Based on this definition there are four goals of
nursing are to assist the patient:
Whose behavior commensurate with social

demands.
Who is able to modify his behavior in ways
that it supports biological imperatives
Who is able to benefit to the fullest extent

during illness from the physicians knowledge
and skill.
Whose behavior does not give evidence of

unnecessary trauma as a consequence of
illness
Assumptions of behavioral system model

There are several layers of assumptions that Johnson
makes in the development of conceptualization of the
behavioral system model
There are 4 assumptions of system:
1. First assumption states that there is
organization, interaction, interdependency
and integration of the parts and elements
of behaviors that go to make up The system
2. A system tends to achieve a balance among
the various forces operating within and upon
it', and that man strive continually to maintain
a behavioral system balance and steady state
by more or less automatic adjustments and
adaptations to the natural forces impinging
upon him.
3. A behavioral system, which both requires and
results in some degree of regularity and
constancy in behavior, is essential to man that
is to say, it is functionally significant in that it
serves a useful purpose, both in social life and
for the individual.
4. The final assumption states system balance
reflects adjustments and adaptations that are
successful in some way and to some degree.
The integration of these assumptions provides the
behavioral system with the pattern of action to form
an organized and integrated functional unit that
determines and limits the interaction between the
person and his environment and establishes the
relation of the person to the objects, events and
situations in his environment.

Assumptions about structure and function of each
subsystem
from the form the behavior takes and the

consequences it achieves can be inferred what
drive has been stimulated or what goal is
being sought
Each individual has a predisposition to act
with reference to the goal, in certain ways
rather than the other ways. This
predisposition is called as set.
Each subsystem has a repertoire of choices or

scope of action
The fourth assumption is that it produce

observable outcome that is the individuals
behavior.
Each subsystem has three functional requirements
System must be protected" from noxious

influences with which system cannot cope.
Each subsystem must be nurtured through
the input of appropriate supplies from the
environment.
Each subsystem must be stimulated for use

to enhance growth and prevent stagnation.
Johnson believes each individual has

patterned, purposeful, repetitive ways of acting
that comprise a behavioral system specific to
that individual.
These actions and behaviors form an organized

and integrated functional unit that determines
and limits the interaction between the person
and his environment and establishes the
relationship of the person to the objects event
situations in the environment.
These behaviors are orderly, purposeful and

predictable and sufficiently stable and
recurrent to be amenable to description and
explanation
Johnsons Behavioral Subsystem
Attachment or affiliative subsystem: social

inclusion intimacy and the formation and
attachment of a strong social bond.
Dependency subsystem: approval, attention
or recognition and physical assistance
Ingestive subsystem: the emphasis is on the

meaning and structures of the social
events surrounding the occasion when the food
is eaten
Eliminative subsystem: human cultures

have defined different socially acceptable
behaviors for excretion of waste ,but the
existence of such a pattern remains different
from culture to Culture.
Sexual subsystem:" both biological and

social factor affect the behavior in the sexual
subsystem
Aggressive subsystem: " it relates to the

behaviors concerned with protection and self
preservation Johnson views aggressive
subsystem as one that generates defensive
response from the individual when life or
territory is being threatened
Achievement subsystem: " provokes

behavior that attempt to control the
environment intellectual, physical, creative,
mechanical and social skills achievement are
some of the areas that Johnson recognizes".
Representation of Johnson's Model

Goal ----- Set --- Choice of Behavior --- Behavior
Affiliation
Dependency
Sexuality
Aggression
Elimination
Ingestion
Achievement
The four major concepts

Johnson views human being as having two major
systems, the biological system and the behavioral
system. It is role of the medicine to focus on
biological system where as Nursling's focus is the
behavioral system.
Society relates to the environment on which

the individual exists. According to Johnson an
individuals behavior is influenced by the
events in the environment
Health is a purposeful adaptive response,
physically mentally, emotionally, and socially
to internal and external stimuli in order to
maintain stability and comfort.
Nursing has a primary goal that is to foster
equilibrium within the individual. She stated
that nursing is concerned with the organized
and integrated whole, but that the major focus
is on maintaining a balance in the Behavior
system when illness occurs in an individual.
Nursing process
Assessment
Grubbs developed an assessment tool based on
Johnsons seven subsystems plus a subsystem she
labeled as restorative which focused on activities of
daily living. .An assessment based on behavioral
model does not easily permit the nurse to gather
detailed information about the biological systems:
Affiliation
Dependency
Sexuality
Aggression
Elimination
Ingestion
Achievement
Restorative
Diagnosis
Diagnosis tends to be general to the system than
specific to the problem. Grubb has proposed 4
categories of nursing diagnosis derived from
Johnson's behavioral system model:
Insufficiency
Discrepancy
Incompatibility
Dominance
Planning and implementation

Implementation of the nursing care related to the
diagnosis may be difficult because of lack of clients
input in to the plan. the plan will focus on nurses
actions to modify clients behavior, these plan than
have a goal ,to bring about homeostasis in a
subsystem, based on nursing assessment of the
individuals drive, set behavior, repertoire, and
observable behavior. The plan may include protection,
nurturance or stimulation of the identified subsystem.
Evaluation
Evaluation is based on the attainment of a goal of
balance in the identified subsystems. If the baseline
data are available for an individual, the nurse may
have goal for the individual to return to the baseline
behavior. If the alterations in the behavior that are
planned do occur, the nurse should be able to observe
the return to the previous behavior patterns. Johnson's
behavioral model with the nursing process is a nurse
centered activity, with the nurse determining the
clients needs and state behavior appropriate for that
need.
Assessment
Affiliative subsystem between mother and

John.
Dependency subsystem between mother and
John
Affiliative subsystem between Mrs.Kim and

her mother.
Insufficiency ingestion subsystem.
Diagnosis
Insufficient development of the affiliative

subsystem.
Insufficient development of the dependency
subsystem
Planning and implementation
Increasing mothers awareness of the babys

clues.
Assisting her to talk with the baby.
Teach her to bring a bond between her and the
baby by touch, pat and cuddles etc.
Evaluation
Johnny's weight gain or weight loss will be

carefully assessed.
The infant interaction could be reassessed,
using the nursing child assessment feeding
scale.
The interaction of Mrs. Kim with her mother.
Johnsons and Characteristics of a theory
Interrelate concepts to create a different way

of viewing a phenomenon.
Theories must be logical in nature.
Theories must be simple yet generalizable
Theories can be bases of hypothesis that can

be tested.
Theories contribute to and assist in increasing

the body of knowledge within the discipline
through the research implemented to validate
them
Theories can be utilized by practitioners to

guide and improve their practice.
Theories must be consistent with other

validated theories, laws and principles but will
leave unanswered questions that need to be
investigated.
Limitation
Johnson does not clearly interrelate her

concepts of subsystems comprising the
behavioral system model.
The definition of concept is so abstract that
they are difficult to use.
It is difficult to test Johnson's model by

development of hypothesis.
The focus on the behavioral system makes it

difficult for nurses to work with physically
impaired individual to use this theory.
The model is very individual oriented so the

nurses working with the group have difficulty
in its implementation.
The model is very individual oriented so the

family of the client is only considered as an
environment.
Johnson does not define the expected

outcomes when one of the system is affected
by the nursing implementation an implicit
expectation is made that all human in all
cultures will attain same outcome
homeostasis.
Johnsons behavioral system model is not
flexible.
Summary
Johnsons Behavioral system model is a model of
nursing care that advocates the fostering of efficient
and effective behavioral functioning in the patient to
prevent illness. The patient is defined as behavioral
system composed of 7 behavioral subsystems. Each
subsystem composed of four structural characteristics
i.e. drives, set, choices and observable behavior.
Three functional requirement of each subsystem
includes
(1) Protection from noxious influences,

(2) Provision for the nurturing environment,
and
(3) stimulation for growth.
Any imbalance in each system results in

disequilibrium .it is nursing role to assist the client to
return to the state of equilibrium.
Reference
1. George B. Julia , Nursing Theories- The base
for professional Nursing Practice , 3rd ed.
Norwalk, Appleton and Lange.
2. Polit DF, Hungler BP. Nursing Research:
Principles and Methods. Philadelphia: JB
Lippincott Company; 1998.
3. Burns N, Grove SK. The practice of Nursing
Research. 4th Ed. Philadelphia: WB Saunders
Publications; 2001.
4. Treece JW, Treece EW. Elements of Research
in Nursing (3rded.). St. Louis: Mosby; 1982.
Imogene King's Theory of Goal Attainment
================================================
Introduction
Imogene King was born in 1923.

Completed her Bachelor in science of nursing from St. Louis University in 1948
Completed her Master of science in nursing from St. Louis University in 1957
Completed her Doctorate from Teachers college, Columbia University
Kings Conceptual Framework

It includes:
Several basic assumptions

Three interacting systems
Several concepts relevant for each system
Basic assumptions
Nursing focus is the care of human being

Nursing goal is the health care of individuals & groups
Human beings: are open systems interacting constantly with their environment
Interacting systems:
personal system
Interpersonal system
Social system
Concepts are given for each system
Concepts for Personal System
Perception
Self
Growth & development
Body image
Space
Time
Concepts for Interpersonal System
Interaction
Communication
Transaction
Role
Stress
Concepts for Social System
Organization
Authority
Power
Status
Decision making
Major Theses of Kings conceptual framework
Each human being perceives the world as a total person in making transactions with
individuals and things in environment
Transaction represents a life situation in which perceiver & thing perceived are
encountered and in which person enters the situation as an active participant and each is
changed in the process of these experiences
Kings Theory of Goal Attainment
Theory of goal attainment was first introduced by Imogene King in the early 1960s.
Theory describes a dynamic, interpersonal relationship in which a person grows and
develops to attain certain life goals.
Factors which affects the attainment of goal are: roles, stress, space & time
Propositions of Kings Theory

From the theory of goal attainment king developed predictive propositions, which includes:
If perceptual interaction accuracy is present in nurse-client interactions, transaction will

occur
If nurse and client make transaction, goal will be attained
If goal are attained, satisfaction will occur
If transactions are made in nurse-client interactions, growth & development will be

enhanced
If role expectations and role performance as perceived by nurse & client are congruent,
transaction will occur
If role conflict is experienced by nurse or client or both, stress in nurse-client interaction

will occur
If nurse with special knowledge skill communicate appropriate information to client,

mutual goal setting and goal attainment will occur.
Major concepts of kings theory

1. Human being /person: is social being who are rational and sentient. Person has ability to :
perceive
think
feel
choose
set goals
select means to achieve goals and
to make decision
According to King, human being has three fundamental needs:
(a) The need for the health information that is unable at the time when it is needed and
can be used
(b) The need for care that seek to prevent illness, and
(c) The need for care when human beings are unable to help themselves.
2.
Health
According to King, health involves dynamic life experiences of a human being, which implies
continuous adjustment to stressors in the internal and external environment through optimum use
of ones resources to achieve maximum potential for daily living.
3.
Environment
Environment is the background for human interactions. It involves:
(a) Internal environment: transforms energy to enable person to adjust to continuous

external environmental changes.
(b) External environment: involves formal and informal organizations. Nurse is a part of
the patients environment.
4.
Nursing
Definition: A process of action, reaction and interaction by which nurse and client share
information about their perception in nursing situation. and a process of human interactions
between nurse and client whereby each perceives the other and the situation, and through
communication, they set goals, explore means, and agree on means to achieve goals.
Action: is defined as a sequence of behaviors involving mental and physical action.

Reaction: not specified, but might be considered as included in the sequence of
behaviors described in action.
In addition, king discussed:

(a) goal
(b) domain and
(c) functions of professional nurse
Goal of nurse: To help individuals to maintain their health so they can function in their
roles.
Domain of nurse: includes promoting, maintaining, and restoring health, and caring for
the sick, injured and dying.
Function of professional nurse: To interpret information in nursing process to plan,
implement and evaluate nursing care.
King said in her theory, A professional nurse, with special knowledge and skills, and a
client in need of nursing, with knowledge of self and perception of personal problems,
meet as strangers in natural environment. They interact mutually, identify problems,
establish and achieve goals.
Theory of Goal Attainment and Nursing Process

Assumptions
Basic assumption of goal attainment theory is that nurse and client communicate
information, set goal mutually and then act to attain those goals, is also the basic
assumption of nursing process
Assessment
King indicates that assessment occur during interaction.

The nurse brings special knowledge and skills whereas client brings knowledge of self
and perception of problems of concern, to this interaction.
During assessment nurse collects data regarding client (his/her growth & development,
perception of self and current health status, roles etc.)
Perception is the base for collection and interpretation of data.
Communication is required to verify accuracy of perception, for interaction and

transaction.
Nursing diagnosis
The data collected by assessment are used to make nursing diagnosis in nursing process.
Acc. to king in process of attaining goaI the nurse identifies the problems, concerns and
disturbances about which person seek help.
Planning
After diagnosis, planning for interventions to solve those problems is done.

In goal attainment planning is represented by setting goals and making decisions about
and being agreed on the means to achieve goals.
This part of transaction and clients participation is encouraged in making decision on the
means to achieve the goals.
Implementations
In nursing process implementation involves the actual activities to achieve the goals.
In goal attainment it is the continuation of transaction.
Evaluation
It involves to finding out weather goals are achieved or not.

In king description evaluation speaks about attainment of goal and effectiveness of
nursing care.
Nursing Process and Theory of Goal Attainment

Nursing process method
Nursing process theory
A system of oriented actions
A system of oriented concepts
Assessment
Perception, communication and interaction of

nurse and client
Planning
Decision making about the goals

Be agree on the means to attain the goals
Implementation
Transaction made
Evaluation
Goal attained
References
1. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby,
Philadelphia, 2002.
7.
Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby,
Philadelphia, 2002.
Betty Neuman's System Model
INTRODUCTION
Betty Neumans system model provides a comprehensive flexible holistic and system
based perspective for nursing.
It focuses on the response of the client system to actual or potential environmental
stressors and the use of primary, secondary and tertiary nursing prevention intervention
for retention, attainment, and maintenance of optimal client system wellness.
HISTORY AND BACKGROUND OF THE THEORIST
Betty Neuman was born in 1924, in Lowel, Ohio.

BS in nursing in 1957
MS in Mental Health Public health consultation, from UCLA in 1966.
Ph.D. in clinical psychology
a pioneer in the community mental health movement in the late 1960s.
developed the model while working as a lecturer in community health nursing at

University of California, Los Angeles.
The models was initially developed in response to graduate nursing students expression
of a need for course content that would expose them to breadth of nursing problems prior
to focusing on specific nursing problem areas.
The model was published in 1972 as A Model for Teaching Total Person Approach to
Patient Problems in Nursing Research.
It was refined and subsequently published in the first edition of Conceptual Models for
Nursing Practice, 1974, and in the second edition in 1980.
DEVELOPMENT OF THE MODEL
Neumans model was influenced by a variety of sources.

The philosophy writers deChardin and cornu (on wholeness in system).
Von Bertalanfy, and Lazlo on general system theory.
Selye on stress theory.
Lararus on stress and coping.
BASIC ASSUMPTIONS
Each client system is unique, a composite of factors and characteristics within a given
range of responses contained within a basic structure.
Many known, unknown, and universal stressors exist. Each differ in its potential for
disturbing a clients usual stability level or normal LOD
The particular inter-relationships of client variables at any point in time can affect the
degree to which a client is protected by the flexible LOD against possible reaction to
stressors.
Each client/ client system has evolved a normal range of responses to the environment
that is referred to as a normal LOD. The normal LOD can be used as a standard from
which to measure health deviation.
When the flexible LOD is no longer capable of protecting the client/ client system against
an environmental stressor, the stressor breaks through the normal LOD
The client whether in a state of wellness or illness, is a dynamic composite of the interrelationships of the variables. Wellness is on a continuum of available energy to support
the system in an optimal state of system stability.
Implicit within each client system are internal resistance factors known as LOR, which
function to stabilize and realign the client to the usual wellness state.
Primary prevention relates to G.K. that is applied in client assessment and intervention, in
identification and reduction of possible or actual risk factors.
Secondary prevention relates to symptomatology following a reaction to stressor,

appropriate ranking of intervention priorities and treatment to reduce their noxious
effects.
Tertiary prevention relates to adjustive processes taking place as reconstitution begins

and maintenance factors move the back in circular manner toward primary prevention.
The client as a system is in dynamic, constant energy exchange with the environment.
MAJOR CONCEPTS
Content
the variables of the person in interaction with the internal and external environment
comprise the whole client system
Basic structure/Central core
common client survival factors in unique individual characteristics representing basic

system energy resources.
The basis structure, or central core, is made up of the basic survival factors that are
common to the species (Neuman,2002).
These factors include:- - Normal temp. range, Genetic structure.- Response pattern.
Organ strength or weakness, Ego structure
Stability, or homeostasis, occurs when the amount of energy that is available exceeds that
being used by the system.
A homeostatic body system is constantly in a dynamic process of input, output, feedback,

and compensation, which leads to a state of balance.
Degree to reaction
the amount of system instability resulting from stressor invasion of the normal LOD.
Entropy
a process of energy depletion and disorganization moving the system toward illness or
possible death.
Flexible LOD
a protective, accordion like mechanism that surrounds and protects the normal LOD from
invasion by stressors.
Normal LOD
It represents what the client has become over time, or the usual state of wellness. It is
considered dynamic because it can expand or contract over time.
Line of Resistance-LOR
The series of concentric circles that surrounds the basic structure.

Protection factors activated when stressors have penetrated the normal LOD, causing a
reaction symptomatology. E.g. mobilization of WBC and activation of immune system
mechanism
Input- output
The matter, energy, and information exchanged between client and environment that is
entering or leaving the system at any point in time.
Negentropy
A process of energy conservation that increase organization and complexity, moving the
system toward stability or a higher degree of wellness.
Open system
A system in which there is continuous flow of input and process, output and feedback. It
is a system of organized complexity where all elements are in interaction.
Prevention as intervention
Interventions modes for nursing action and determinants for entry of both client and
nurse in to health care system.
Reconstitution
The return and maintenance of system stability, following treatment for stressor reaction,
which may result in a higher or lower level of wellness.
Stability
A state of balance of harmony requiring energy exchanges as the client adequately copes
with stressors to retain, attain, or maintain an optimal level of health thus preserving
system integrity.
Stressors
environmental factors, intra (emotion, feeling), inter (role expectation), and extra
personal (job or finance pressure) in nature, that have potential for disrupting system
stability.
A stressor is any phenomenon that might penetrate both the F and N LOD, resulting
either a positive or negative outcome.
Wellness/Illness
Wellness is the condition in which all system parts and subparts are in harmony with the
whole system of the client.
o Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman,
2002).
o
Illness is an excessive expenditure of energy when more energy is used by the

system in its state of disorganization than is built and stored; the outcome may be
death (Neuman, 2002).
Prevention
the primary nursing intervention. Prevention focuses on keeping stressors and the stress
response from having a detrimental effect on the body.
PRIMARY PREVENTION
Primary prevention occurs before the system reacts to a stressor. On the one hand, it
strengthens the person (primary the flexible LOD) to enable him to better deal with
stressors
On the other hand manipulates the environment to reduce or weaken stressors.
Primary prevention includes health promotion and maintenance of wellness.
SECONDARY PREVENTION
Secondary prevention occurs after the system reacts to a stressor and is provided in terms
of existing system.
Secondary prevention focuses on preventing damage to the central core by strengthening
the internal lines of resistance and/or removing the stressor.
TERTIARY PREVENTION
Tertiary prevention occurs after the system has been treated through secondary prevention
strategies.
Tertiary prevention offers support to the client and attempts to add energy to the system
or reduce energy needed in order to facilitate reconstitution.
FOUR NURSING PARADIGMS

PERSON
human being is a total person as a client system and the person is a layered
multidimensional being.
Each layer consists of five person variable or subsystems:
Physiological- Refer of the physicochemical structure and function of the body.
Psychological- Refers to mental processes and emotions.
Socio-cultural- Refers to relationships; and social/cultural expectations and

activities.
Spiritual- Refers to the influence of spiritual beliefs.
Developmental- Refers to those processes related to development over the

lifespan.
ENVIRONMENT
The environment is seen to be the totality of the internal and external forces which
surround a person and with which they interact at any given time.
These forces include the intrapersonal, interpersonal and extra-personal stressors which
can affect the persons normal line of defense and so can affect the stability of the system.
o
The internal environment exists within the client system.
The external environment exists outside the client system.
Neuman also identified a created environment which is an environment that is

created and developed unconsciously by the client and is symbolic of system
wholeness.
HEALTH
Neuman sees health as being equated with wellness. She defines health/wellness as the
condition in which all parts and subparts (variables) are in harmony with the whole of the
client (Neuman, 1995).
The client system moves toward illness and death when more energy is needed than is
available. The client system moved toward wellness when more energy is available than
is needed
NURSING
Neuman sees nursing as a unique profession that is concerned with all of the variables
which influence the response a person might have to a stressor.
The person is seen as a whole, and it is the task of nursing to address the whole person.
Neuman defines nursing as action which assist individuals, families and groups to
maintain a maximum level of wellness, and the primary aim is stability of the
patient/client system, through nursing interventions to reduce stressors.
Neuman states that, because the nurses perception will influence the care given, then not
only must the patient/clients perception be assessed, but so must those of the caregiver
(nurse).
The role of the nurse is seen in terms of degree of reaction to stressors, and the use of
primary, secondary and tertiary interventions
STAGES OF NURSING PROCESS (BY NEUMAN)

NURSING DIAGNOSIS
It depends on acquisition of appropriate database; the diagnosis identifies, assesses,

classifies, and evaluates the dynamic interaction of the five variables.
Variances from wellness (needs and problems) are determined by correlations and
constraints through synthesis of theory and data base.
Broad hypothetical interventions are determined, i.e. maintain flexible line of defense.
NURSING GOALS
These must be negotiated with the patient, and take account of patients and nurses
perceptions of variance from wellness.
NURSING OUTCOMES
Nursing intervention using one or more preventive modes.

Confirmation of prescriptive change or reformulation of nursing goals.
Short term goal outcomes influence determination of intermediate and long term goals.
A client outcome validates nursing process.
NeumanS SYSTEM MODEL FORMAT

Neumans nursing process format designates the following categories of data about the client
system as the major areas of assessment.
ASSESSMENT
Potential and actual stressors.

Condition and strength of basic structure factors and energy sources.
Characteristics of flexible and normal line of defenses, lines of resistance, degree of

reaction and potential for reconstitution.
Interaction between client and environment.
Life process and coping factors (past, present and future) actual and potential stressors
(internal and external) for optimal wellness external.
Perceptual difference between care giver and the client.
NURSING DIAGNOSIS
The data collected are then interpreted to condition and formulate the Nursing diagnosis.
Health seeking behaviors.
Activity intolerance.
Ineffective coping.
Ineffective thermoregulation.
GOAL
In Neumans systems model the goal is to keep the client system stable.
PLANNING
Planning is focused on strengthening the lines of defense and resistance.
IMPLEMENTATION
The goal of stabilizing the client system is achieved through three modes of prevention
Primary prevention : actions taken to retain stability

Secondary prevention : actions taken to attain stability
Tertiary prevention : actions taken to maintain stability
EVALUATION
The nursing process is evaluated to determine whether equilibrium is restored and a

steady state maintained.
ACCEPTANCE BY THE NURSING COMMUNITY
Neumans model has been described as a grand nursing theory by walker and Avant.
Grand theories can provide a comprehensive perspective for nursing practice, education,
and research and Neumans model does.
PRACTICE
The Neuman systems model has been applied and adapted to various specialties include
family therapy, public health, rehabilitation, and hospital nursing.
The sub specialties include pulmonary, renal, critical care, and hospital medical units.
One of the models strengths is that it can be used in a variety of settings
Using this conceptual model permits comparison of a nurses interpretation of a problem

with that of the patient, so the patient and nurse do not work on two separate problems.
The role of the nurse in the model is to work with the patient to move him as far as
possible along a continuum toward wellness.
Because this model requires individual interaction with the total health care system, it is
indicative of the futuristic direction the nursing profession is taking.
The patient is being relabeled as a consumer with individual needs and wants.
EDUCATION
The model has also been widely accepted in academic circles.

curriculum guide for a conceptual framework at Indiana University, Northwestern State
University in Shreveport, Louisiana.
RESEARCH
A study was published by Riehl and Roy to test the usefulness of the Neuman model in
nursing practice.
Acceptance by the nursing community for research applying this model is in the
beginning stages and positive.
NEUMAN'S SYSTEM MODEL AND THE CHARACTERISTICS OF A THEORY
Neuman's model connects the interrelated concepts in such a way as to create a different
way of looking at a particular phenomenon.
Neumans model in general presents itself as logically consistent.
There is a logical sequence in the process of nursing wherein emphasis on the importance
of accurate data assessment is basic to the sequential steps of the nursing process.
Neumans model is fairly simple and straightforward in approach.
The terms used are easily identifiable and for the most part have definitions that are
broadly accepted.
Neumans model, due to its high level and breadth of abstraction, lends itself to theory
development.
The model has provided clear, comprehensive guidelines for nursing education and
practice in a variety of settings; this is its primary contribution to nursing knowledge.
Neuman's model is applicable in the practice as assessment/intervention instrument

together with comprehensive guidelines for its use with the nursing process.
Research Articles
Using the Neuman Systems Model for Best Practices--Sharon A. DeWan, Pearl N.
Ume-Nwagbo, Nursing Science Quarterly, Vol. 19, No. 1, 31-35 (2006).
o The purpose of this study was to present two case studies based upon Neuman
systems model; one case is directed toward family care, and the other
demonstrates care with an individual. Theory-based exemplars serve as teaching
tools for students and practicing nurses.
o
These case studies illustrate how nurses' actions, directed by Neuman's wholistic
principles, integrate evidence-based practice and generate high quality care
Melton L, Secrest J, Chien A, Andersen B. A community needs assessment for a

SANE program using Neuman's model J Am Acad Nurse Pract. 2001 Apr;13(4):17886.
o
The purpose of the study was to present guidelines for a community needs
assessment for a Sexual Assault Nurse Examiner (SANE) program using
Neuman's Systems Model.
Sexual assault is a problem faced by almost every community. A thorough

community assessment is an important first step in establishing programs that
adequately meet a community's needs.
Guidelines for conducting such an assessment related to implementation of a

SANE program are rare, and guidelines using a nursing model were not found in
the literature
REFERENCES
1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, NY.
Thomson, NY, 2002
Martha Roger's Science of Unitary Human Beings
Introduction
Born :May 12, 1914, Dallas, Texas

Diploma :Knoxville General Hospital School of Nursing(1936)
Graduation in Public Health Nursing, George Peabody College, TN, 1937
MA :Teachers college, Columbia university, New York, 1945
MPH :Johns Hopkins University, Baltimore, MD, 1952
Doctorate in nursing :Johns Hopkins University, Baltimore, 1954
Fellowship: American academy of nursing
Position: Professor Emerita, Division of Nursing, New York University,

Consultant, Speaker
Died : March 13 , 1994
Publications of Martha Rogers

Theoretical basis of nursing (Rogers 1970)
Nursing science and art :a prospective (Rogers 1988)
Nursing :science of unitary, irreducible, human beings update (Rogers 1990)
Vision of space based nursing (Rogers 1990)
Rogers nursing theory

Nursing is both a science and art. the uniqueness of nursing, like that of any
other science, lies in the phenomenon central to its focus.
Nurses long established concern with the people and the world they live is in
a natural forerunner of an organized abstract system encompassing people
and the environments.
The irreducible nature of individuals is different from the sum of the parts.
The integral ness of people and the environment that coordinate with a
multidimensional universe of open systems points to a new paradigm :the
identity of nursing as a science.
The purpose of nurses is to promote health and well-being for all persons
wherever they are.
Evolution of abstract system

The development of the abstract system was strongly influenced by an early
grounding in arts and background of science and her keen interest in space
The science of unitary human beings originated as a synthesis of facts and
ideas from multiple sources of knowledge
The uniqueness is in the central phenomena : people and environment
The Rogerian view of a causality emerges from an infinite universe of open

system.
Overview of Rogerian model

Rogers model provides the way of viewing the unitary human being
Humans are viewed as integral with the universe
The unitary human being and the environment are one ,not dichotomous
Nursing focus on people and the manifestations that emerge from the mutual
human /environmental field process
Change of pattern and organization of the human field and the environmental
field is propagated by waves
The manifestations of the field patterning that emerge are observable events
The identification of the pattern provide knowledge and understanding of

human experience
Basic characteristics which describes the life process of human: energy field,
openness, pattern, and pan dimensionality
Basic concepts include unitary human being, environment, and

homeodynamic principles
Concepts of Rogers model
Energy field
The energy field is the fundamental unit of both the living and nonliving
This energy field "provide a way to perceive people and environment as
irreducible wholes"
The energy fields continuously varies in intensity, density, and extent
Openness
The human field and the environmental field are constantly exchanging their
energy
There are no boundaries or barrier that inhibit energy flow between fields
Pattern
Pattern is defined as the distinguishing characteristic of an energy field

perceived as a single waves
"pattern is an abstraction and it gives identity to the field"
Pan dimensionality
Pan dimensionality is defined as "non linear domain without spatial or

temporal attributes"
The parameters that human use in language to describe events are arbitrary.
The present is relative ;there is no temporal ordering of lives.
Unitary Human Being (person)
A unitary human being is an "irreducible, indivisible, pan dimensional (fourdimensional) energy field identified by pattern and manifesting
characteristics that are specific to the whole and which cannot be predicted
from knowledge of the parts" and "a unified whole having its own distinctive
characteristics which cannot be perceived by looking at, describing, or
summarizing the parts"
The people has the capacity to participate knowingly and probabilistically in
the process of change
Environment
The environment is an "irreducible ,pan dimensional energy field identified by

pattern and integral with the human field"
The field coexist and are integral. Manifestation emerge from this field and
are perceived.
Health
Rogers defined health as an expression of the life process; they are the
"characteristics and behavior emerging out of the mutual, simultaneous
interaction of the human and environmental fields"
Health and illness are the part of the sane continuum.
The multiple events taking place along life's axis denote the extent to which
man is achieving his maximum health potential and very in their expressions
from greatest health to those conditions which are incompatible with the
maintaining life process
Nursing
The concept Nursing encompasses two dimensions

Independent science of nursing
An organized body of knowledge which is specific to nursing is arrived at by

scientific research and logical analysis
Art of nursing practice
The creative use of science for the betterment of the human

The creative use of its knowledge is the art of its practice
Assumptions about people and nursing

Nursing exists to serve people..it is the direct and overriding
responsibility to the society
The safe practice of nursing depends on the nature and amount of scientific
nursing knowledge the individual brings to practice.the imaginative,
intellectual judgment with which such knowledge is made in service to the
man kind
People needs knowledgeable nursing
Homeodynamic principles
The principles of homeodynamic postulates the way of perceiving unitary
human beings
The fundamental unit of the living system is an energy field
Three principle of homeodynamics

o
Resonancy
Helicy
integrality
Resonance
Resonance is an ordered arrangement of rhythm characterizing both human
field and environmental field that undergoes continuous dynamic
metamorphosis in the human environmental process
Helicy
Helicy describes the unpredictable, but continuous, nonlinear evolution of

energy fields as evidenced by non repeating rhythmicties
The principle of Helicy postulates an ordering of the humans evolutionary
emergence
Integrality
Integrality cover the mutual, continuous relationship of the human energy
field and the environmental field .
Changes occur by by the continuous repatterning of the human and
environmental fields by resonance waves
The fields are one and integrated but unique to each other
Rogerian theories-Grand theories

The theory of accelerating evolution
The theory of paranormal phenomena
The theory of rhythmicities
Theory of paranormal phenomena

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

Nursing is the study of unitary. Irreducible, indivisible human and
environmental energy fields
The art of nursing involves the imaginative and creative use of nursing
knowledge
The purpose of nurses is to promote health and well-being for all person and
groups wherever they are using the art and science of nursing
The health services should be community based
Rogers challenges nurses to consider nursing needs of all people, including

future generation of space kind ;as life continuous to evolve from earth to
space and beyond.
Her view provides a different world view that encompasses a practice of

nursing for the present time and for the imagined and for the yet to be
imagined future
Rogers proposes a nursing practice of noninvasive modalities, such as

therapeutic touch, humor, guided imagery, use of color, light, music,
meditation focusing on health potential of the person.
Professional practice in nursing seeks to promote symphonic interaction

between man and environment, to strengthen the coherence and integrity of
the human field, and to direct and redirect patterning of the human and
environmental fields for realization of maximum health potential
Nursing intervention seeks to coordinate environmental field and human field

rhythmicities, participates in the process of change , to help people move
toward better health
Nursing aims to assist people in achieving their maximum potential.
Nursing practice should be emphasized on pain management, supportive

psychotherapy motivation for rehabilitation.
Maintenance and promotion of health, prevention of disease, nursing

diagnosis, intervention, and rehabilitation encompasses the scope of nursing
Rogers contribution to nursing knowledge

Rogers was one of the first nurse scholars to identify the person (unitary
man) as the central phenomena of nursing concern
Nursing abstract system is a matrix of concepts relevant to the life process in
man
Rogers conceptual system provides a body of knowledge in nursing that will

have relevance for all workers concerned with people, but with special
relevance for nurses; because it matters to human beings; consequently to
nurses
In the evolution it is properly subjected to reformulation and change as the

knowledge grows, the the conceptual data will be more clearer and it will take
new dimensions
The utilization of Rogerian model is used as a guide for theory development,

research, nursing education, and in the direct patient care practice
Rules for nursing research guided by the Rogerian theory
Rules for research
The Rogerian research require both basic and applied research

The phenomena to be studied are unitary human beings and their
environmental interaction
Study participants may be any person or group, with the provision that both
person and environment are taken into account
Research methodology
Qualitative and quantitative methods can be applied

Experimental researches are questionable because she rejects the notion of
causality
Case study and longitudinal research are better than cross sectional study
Research instruments that are directly derived from science of unitary human
beings should be used
Data analysis multivariate analysis (canonical correlation studies)
Research tools derived from science of unitary human beings
Perceived field motion scale

Human field rhythm scale
Temporal experience scale
Assessment of dream experience scale
Person environment participation scale
Leddy healthiness scale
Mutual exploration of the healing human-environment field scale
Garon assessment of pain scale
Family assessment tool
Community health assessment tool
Rules for nursing education guided by Rogerian theory
Focus of the curriculum
Nursing education can be for professional nursing , technical nursing

The focus is the transmission of the body of knowledge
Teaching and practicing therapeutic touch
Conducting regular in-service education
Nursing programs
Baccalaureate degree program

Masters program
Doctoral program
The major concepts are principal of Resonancy, Helicy, Integrality
The faculty in the nursing education must be prepared at doctoral level
Teaching- learning strategies
Emphasis should be on developing self awareness as an aspect of the clients

environmental energy field and the dynamic role of nurse pattern
manifestation on the client
Emphasis on laboratory study- the lab setting include homes, schools,
industry, clinics, hospitals, other places where people lives
Importance of use of media in education
Rules for nursing administration guided by Rogerian theory

Purpose of nursing services
Nursing services is the center of any health care system

The purpose of nursing services is health promotion
Characteristics of nursing personnel
The administrators should hold higher degrees in nursing and licensed

Leaders must be visionary and willing to embrace innovative and creative
change
Leaders should be able to identify the patterning to ensure the integrated

behaviors for client and employees
Management strategies and administrative policies
Administrative policies foster an open and supportive administrative climate

that enhances staff members self esteem , actualization, and freedom of
choice and provide opportunity for staff development and continuing
education
The ultimate goal is the clients well-being
Rules for independent practitioner guided by Rogerian model

Nursing is an independent science
Nurse assumes the role of potentiater of care
She proposes the independent role in various setting like school, industry,
community, space (by 2050AD)
Independent practitioner is an advanced practice registered registered nurse

who focus on well-being or mutual patterning of individual, family, community
across the life span ,at risk for developing dissonance/illness
Rules for nursing practice guided by Rogerian theory

Areas of Rogerian model application
SETTINGS
All spheres of life

School
Industry
Family
Community
Space
SPECIALITIES
Pediatrics
Psychiatry
Oncology
Burns
Geriatrics
Neurology
Cardiology
Rehabilitative medicine
SPECIALIZED AREAS OF PRACTICE
Neonatal ICU
Pediatric ICU
Post operative unit
Pre operative unit
Palliative care unit
Rehabilitation center
Burns unit
Adult ICUs
Old age homes
Neuropsychiatric units
AREA WHERE ROGERIAN MODEL IS NOT APPLICABLE

o
Operation theaters
Purpose of nursing practice
To promote well-being for all persons, wherever they are

To assist both the client and nurse to increase their awareness of their own
rhythm
Setting for practice
From community to hospital to outer space
Legitimate participants
People of all ages both as individual human energy fields and group energy
fields
Nursing process- Health patterning practice method

Assessment
Voluntary mutual patterning
Evaluation
For the nurse
Pattern appraisal
Mutual patterning of human and environmental fields
Evaluation
For the patient
Self reflection
Patterning activities
Personal appraisal
Nursing process
Assessment
Areas of assessment
Simultaneous states of the individual and the environment
Total pattern of events at any given point in space time
Rhythms of life process
Supplementary data
Categorical disease entities
Subsystem pathology
Pattern appraisal
It is a comprehensive assessment of:
Human field patterns of communication, exchange, rhythms, dissonance

Environmental fields pattern of communication, rhythms, dissonance,
harmony
Intuitive reflection of self
Validation of the appraisal
Validate with self
Validate with the client
Mutual patterning of human and environmental field
Sharing knowledge
Offering choices
Empowering the client
Fostering patterning
Evaluation
Repeat pattern appraisal
Identify dissonance and harmony
Validate appraisal with the client
Self reflection for the client
Pattern appraisal include appraisal of multiple lifestyle rhythms such as:
Nutrition
Work/leisure activities
Exercise
Sleep / wake cycles
Relationships
Discomfort or pain
Fear /hopes
Patterning activities for the client

Meditation
Imagery
Journaling
Modifying the surroundings
References
1. George B. Julia , Nursing Theories- The base for professional Nursing Practice ,
3rd ed. Norwalk, Appleton & Lange.
2. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing
Philadelphia. Lippincott Williams& wilkins.
3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress
3rd ed. Philadelphia, Lippincott.
5. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts
Process & Practice 3rd ed. London Mosby Year Book.
Theories Based on Interactive Process

I. IMOGENE KING: THEORY OF GOAL ATTAINMENT

Major Concepts and Definitions
1. Interaction
A process of perception and communication

Between person and environment
Between person and person
Represented by verbal and nonverbal behaviors
Goal-directed
Each individual brings different knowledge , needs, goals, past experiences and
perceptions, which influence interaction
2. Communication
Information from person to person

Directly or indirectly
Information component of interaction
3. Perception
Each persons representation of reality
4. Transaction
Purposeful interaction leading to goal attainment
5. Role
A set of behaviours expected of persons occupying a position in a social system

Rules that define rights and obligations in a position
6. Stress
Dynamic state
Human being interacts with the environment
7. Growth and development
Continuous changes in individuals
At cellular, molecular and behavioural levels of activities
Helps individuals move towards maturity
8.Time
Sequence of events
Moving onwards to the future
9. Space
Existing in all directions
Same everywhere
Immediate environment (nurse and client interaction
MAJOR ASSUMPTIONS
Nursing
Observable behaviour
In health care system in society
Goal to help individuals maintain health
Interpersonal process of action; reaction, interaction and transaction
Person
Social beings
Sentient beings
Rational beings
Perceiving beings
Controlling beings
Purposeful beings
Action oriented beings
Time oriented beings
Health
Dynamic state in the life cycle

Continuous adaptation to stress
To achieve maximum potential for daily living
Function of nurse, patient, physicians, family and other interactions
Environment
Open system
Constantly changing
Influences adjustment to life and health
Personal system
Concepts
Perception
Self
Body image
Growth and development
Time
Space
Interpersonal system
Concepts
Interaction
Transaction
Communication
Role
Stress
Social system
Concepts
Organization
Authority
Power
Status
Decision making
ASSUMPTIONS
Perceptions, goals, needs and values of the nurses and client influence interaction process
Individuals have the right to knowledge about themselves and to participate in decisions
that influence their life, health and community services
Health professionals have the responsibility that helps individuals to make informed
decisions about their health care
Individuals have the right to accept or reject health care
Goals of health professionals and recipients of health care may not be congruent
II. SISTER CALLISTA ROY: ADAPTATION MODEL

Introduction
Begins with man
Man as a biopsychosocial being
In constant interaction with his environment
Focus of nursing
Mans position on the health illness continuum
Influenced by ability to adapt to confronted stimuli
MAJOR CONCEPTS AND DEFINITIONS
System
a set of units so related or connected as to form a unit characterised by inputs, out puts,
control and feedback process.
Adaptational level
a constantly changing point, made up of focal, contextual and residual stimuli

represent the persons own standard of the range of stimuli, to which one can respond with
the ordinary adaptive response
Adaptation problems:
the occurrence of situations of inadequate responses to need deficits or excesses
Focal stimulus:
stimulus most immediately confronting the person

must make an adaptive response
factor that precipitates behaviour
Contextual stimuli
all other stimuli present

contribute to behaviour caused by the focal stimuli
Residual stimuli
factors that may be affecting behaviour

effect not validated
Regulator
subsystem coping mechanism

responds automatically through neural-chemical-endocrine processes
Cognator
subsystem coping mechanism

cognitive emotive process
responds through
perception, information
processing, learning
judgment and emotion
Adaptive (effector) modes
classification of ways of coping

manifests regulator and cognator activity
physiologic, self concept, role function and interdependence
Adaptive responses
Promote integrity of the person in terms of the goals of survival, growth, reproduction
and mastery.
Ineffective responses:
Does not contribute to adaptive goals
Physiological mode
-involves bodys basic needs and ways of dealing with adaptation in relation to
Fluid and electrolytes

Exercise and rest
Elimination
Nutrition
Circulation
Oxygen
-regulation includes:
The senses
Temperature
Endocrine regulation
Self concept mode:
composite of belief and feeling

formed from perceptions
directs ones behaviour
components are :
the physical self
the personal self
Role performance mode:
performance of duties
based on given positions in society
Interdependence mode:
ones relation with significant others

support system
maintains psychic integrity
meets needs for nurturance and affection
MAJOR ASSUMPTIONS
from system theory
from Helsons theory
from humanism
Assumptions from systems theory

a system is a set of units so related or connected as to form a unit or whole
a system is a whole that functions as a whole by virtue of the interdependence of its parts
systems have inputs, outputs and control and feedback processes
input, in the form of a standard or feedback (information)
living systems are more complex than mechanical systems and have standards and
feedback to direct their functioning as a whole.
Assumptions from helsons theory

human behaviour represents adaptation to environmental and organismic forces
adaptive behaviour is a function of the stimulus and adaptation level, that is, the pooled
effect of the focal, contextual and residual stimuli
adaptation is a process of responding positively to environmental changes
responses reflect the state of the organism as well as the properties of stimuli and hence
are regarded as active processes.
Assumptions from humanism

Persons have their own creative power
A persons behaviour is purposeful and not merely a chain of cause and effect
Person is holistic
A persons opinions and view points are of value
The interpersonal relationship is significant.
Elements
Nursing
A science and practice discipline

A theoretical system of knowledge
Prescribes a process of analysis and action
Related to the care of the ill or potentially ill person
Person
A biopsychosocial being
A living, complex, adaptive system
With internal processes (the cognator and regulator)
Acting to maintain adaptation to the four modes
Health
A state and a process of being and becoming an integrated and whole person
Environment
All the conditions, circumstances and influences surrounding and affecting the
development and behaviour of persons or groups
References
1. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby,
Philadelphia, 2002.
2. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby,
Philadelphia, 2002.
Lippincott Williamsand wilkins.
5. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development and Progress 3rd ed.
6. Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed.
7. Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing Concepts Process and
Dorothea Orem's Self-Care Theory

Dorothea Orem (1914-2007)
==========================================
INTRODUCTION
One of foremost nursing theorists.

Born 1914 in Baltimore.
Earned her diploma at Providence Hospital Washington, DC
1939 BSN Ed., Catholic University of America
1945 MSN Ed., Catholic University of America
Involved in nursing practice, nursing service, and nursing education
During her professional career, she worked as a staff nurse, private duty nurse, nurse
educator and administrator and nurse consultant
Received honorary Doctor of Science degree in 1976
Published first formal articulation of her ideas in Nursing: Concepts of Practice in 197,
second in 1980, and in 1995.
DEVELOPMENT OF THEORY
1949-1957 Orem worked for the Division of Hospital and Institutional Services of the
Indiana State Board of Health.
Her goal was to upgrade the quality of nursing in general hospitals throughout the state.
During this time she developed her definition of nursing practice.
1959 Orem subsequently served as acting dean of the school of Nursing and as an
assistant professor of nursing education at CUA. She continued to develop her concept of
nursing and self care during this time.
Orems Nursing: Concept of Practice was first published in 1971 and subsequently in
1980, 1985, 1991, 1995, and 2001.
MAJOR ASSUMPTIONS
People should be self-reliant and responsible for their own care and others in their family
needing care
People are distinct individuals
Nursing is a form of action interaction between two or more persons
Successfully meeting universal and development self-care requisites is an important

component of primary care prevention and ill health
A persons knowledge of potential health problems is necessary for promoting self-care

behaviors
Self care and dependent care are behaviors learned within a socio-cultural context
DEFINITIONS OF DOMAIN CONCEPTS

Nursing is art, a helping service, and a technology
Actions deliberately selected and performed by nurses to help individuals or groups under
their care to maintain or change conditions in themselves or their environments
Encompasses the patients perspective of health condition ,the physicians perspective ,
and the nursing perspective
Goal of nursing to render the patient or members of his family capable of meeting the
patients self care needs
To maintain a state of health
To regain normal or near normal state of health in the event of disease or injury
To stabilize ,control ,or minimize the effects of chronic poor health or disability
Health health and healthy are terms used to describe living things
It is when they are structurally and functionally whole or sound wholeness or integrity.
.includes that which makes a person human,operating in conjunction with
physiological and psychophysiological mechanisms and a material structure and in
relation to and interacting with other human beings
Environment
environment components are enthronement factors, enthronement elements, conditions,

and developed environment
Human being has the capacity to reflect, symbolize and use symbols
Conceptualized as a total being with universal, developmental needs and capable of

continuous self care
A unity that can function biologically, symbolically and socially
Nursing client
A human being who has "health related /health derived limitations that render him
incapable of continuous self care or dependent care or limitations that result in ineffective
/ incomplete care.
A human being is the focus of nursing only when a self care requisites exceeds self care
capabilities
Nursing problem
deficits in universal, developmental, and health derived or health related conditions
Nursing process
a system to determine (1)why a person is under care (2)a plan for care ,(3)the
implementation of care
Nursing therapeutics
deliberate, systematic and purposeful action
OREMS GENERAL THEORY OF NURSING

Orems general theory of nursing in three related parts:
Theory of self care
Theory of self care deficit
Theory of nursing system
A. Theory of Self Care

This theory Includes:
Self care practice of activities that individual initiates and perform on their own behalf
in maintaining life ,health and well being
Self care agency is a human ability which is "the ability for engaging in self care"
-conditioned by age developmental state, life experience sociocultural orientation health
and available resources
Therapeutic self care demand "totality of self care actions to be performed for some
duration in order to meet self care requisites by using valid methods and related sets of
operations and actions"
Self care requisites-action directed towards provision of self care. 3 categories of self
care requisites are-
1. Universal
Developmental
Health deviation
2. Universal self care requisites
Associated with life processes and the maintenance of the integrity of human structure
and functioning
Common to all , ADL
Identifies these requisites as:
Maintenance of sufficient intake of air ,water, food
Provision of care assoc with elimination process
Balance between activity and rest, between solitude and social interaction
Prevention of hazards to human life well being and
Promotion of human functioning
3. Developmental self care requisites
Associated with developmental processes/ derived from a condition. Or associated

with an event
E.g. adjusting to a new job
adjusting to body changes
Health deviation self care

o
Required in conditions of illness, injury, or disease .these include:--
Seeking and securing appropriate medical assistance
Being aware of and attending to the effects and results of pathologic conditions
Effectively carrying out medically prescribed measures
Modifying self concepts in accepting oneself as being in a particular state of

health and in specific forms of health care
Learning to live with effects of pathologic conditions
B. Theory of self care deficit
Specifies when nursing is needed

Nursing is required when an adult (or in the case of a dependent, the parent) is incapable
or limited in the provision of continuous effective self care. Orem identifies 5 methods of
helping:
o
Acting for and doing for others
Guiding others
Supporting another
Providing an environment promoting personal development in relation to meet

future demands
Teaching another
C. Theory of Nursing Systems
Describes how the patients self care needs will be met by the nurse , the patient, or both
Identifies 3 classifications of nursing system to meet the self care requisites of the
patient:-
Wholly compensatory system
Partly compensatory system
Supportive educative system
Design and elements of nursing system define
Scope of nursing responsibility in health care situations
General and specific roles of nurses and patients
Reasons for nurses relationship with patients and
The kinds of actions to be performed and the performance patterns and nurses and
patients actions in regulating patients self care agency and in meeting their self care
demand
Orem recognized that specialized technologies are usually developed by members of the
health profession
A technology is systematized information about a process or a method for affecting some

desired result through deliberate practical endeavor ,with or without use of materials or
instruments
Categories of technologies
1. Social or interpersonal
Communication adjusted to age, health status

Maintaining interpersonal, intra group or inter group relations for coordination of efforts
Maintaining therapeutic relationship in light of psychosocial modes of functioning in

health and disease
Giving human assistance adapted to human needs ,action abilities and limitations
2. Regulatory technologies
Maintaining and promoting life processes

Regulating psycho physiological modes of functioning in health and disease
Promoting human growth and development
Regulating position and movement in space
OREMS THEORY AND NURSING PROCESS
Orems approach to the nursing process presents a method to determine the self care
deficits and then to define the roles of person or nurse to meet the self care demands.
The steps within the approach are considered to be the technical component of the
nursing process.
Orem emphasizes that the technological component "must be coordinated with
interpersonal and social processes within nursing situations.
Comparison of Orems Nursing Process and the Nursing Process
Nursing Process
Assessment
Orems Nursing. Process

Diagnosis and prescription;
determine why nursing is needed.
analyze and interpret make
judgment regarding care
Design of a nursing system and

plan for delivery of care
Production and management of

nursing systems
Step 1-collect data in six areas:
The persons health status

The physicians perspective of the
persons health status
The persons perspective of his or

her health
The health goals within the context

of life history ,life style, and health
status
The persons requirements for self

care
The persons capacity to perform

self care
Nursing diagnosis Step 2
Plans with
scientific rationale
Implementation
Nurse designs a system that is

wholly or partly compensatory or
supportive-educative.
The 2 actions are:-
Bringing out a good organization

of the components of patients
therapeutic self care demands
Selection of combination of ways

of helping that will be effective
and efficient in compensating for/
overcoming patients self care
deficits
Step 3
evaluation
Nurse assists the patient or family

in self care matters to achieve
identified and described health and
health related results. collecting
evidence in evaluating results
achieved against results specified
in the nursing system design
Actions are directed by etiology
component of nursing diagnosis
evaluation
Application of Orems theory to nursing process

Personal
factors
Universal self Developmental Health Medical

Self care
care
self care
deviation problem & deficits
plan
29 yr.
32pack /yr
Teenage
Seeks
Female
Water-no
pregnancy-2
medical
Early
restrictions
OC-10 yrs
attention
adulthood Food nil
Husband
for overt
transition
Wt89lb
emotionally
s/s
Wt loss-19% away
Aware of
nauseated
disease
No
evidence
8th grade
Urinary
No BSE
ability to Surgery on
Difference
Teenage
retention
Infrequent
manage reproductive between
pregnancy Intermittent physical
effects organs
knowledge
No work
self
examination
base &
Married
catheterization No HRT
lifestyle
Child-2
Pain
Poor health
Lives at
Tearful
EDU
Will receive
mothers
Husband
deprivation
RT ,perform
home.
abusive
Oppressive
intermittent
Environment Dissatisfied living
catheterization
unclean
with home
conditions
Limited
RT
resources
Therapeutic
self care
demand
Air
Maintain
effective
respiration
Water
No problem
Food maintain
sufficient
intake
Adequacy of
self care
agency
Inadequate
Adequate
Inadequate
Hazards
Inadequate
Prevent spouse
abuse
Promotion of
normalcy
Inadequate
Maintain
Inadequate
developmental
environment
Support ed
normalcy in
Inadequate
environment
Prevent
/manage dev
threat
Maintenance Inadequate
of health status
Management Inadequate
of disease
process
Adherence to Inadequate
med regimen
Awareness of Inadequate
potential
problems
Nursing
diagnosis
Methods of
helping
Potential for
impaired
respiratory
status
P F fluid
imbalance
Actual
nutritional
deficit r/t
nausea
Guiding &
directing
Teaching
Providing physical
support
Personal
development
P/F injury
Guiding &
directing
Guiding &
A/d in
environment directing
Shared housing
Actual delay in Guiding &
normal dev. directing
R/T early
Providing psy
parenthood
support
Level of
Providing
education
physical, psy
Dev deficit r/t support
loss of
reproductive
organs
P/F contd.
Guiding &
alterations in directing,
health status teaching
P/F UTI
Guiding &
directing,
teaching
P/F
teaching
adherence in
self
catheterization teaching
& OPD RT
Actual deficit
Adjust to loss Inadequate

of
reproductive
ability & dev
healthy view Inadequate
of illness
Adjust life
style to cope
with change
in awareness of
advisability of
HRT & RT
effects
Actual threat toProviding psy
self image
support
Actual self
deficit in
planning for
future needs
Guiding &
directing
OREMS WORK AND THE CHARACTERISTICS OF A THEORY
Theories can interrelate concepts in such a way as to create a different way of looking at a
particular phenomenon
Theories must be relatively simple yet generalizable
Theories are the basis for hypothesis that can be tested
Theories contribute to and assist in increasing the general body of knowledge within the
discipline through the research implemented to validate them
Theories can be used by the practitioners to guide and improve their practice
Theories must be consistent with other validated theories ,laws and principles
Theory Testing
Orems theory has been used as the basis for the development of research instruments to
assist researchers in using the theory
A self care questionnaire was developed and tested by Moore(1995) for the special
purpose of measuring the self care practice of children and adolescents
The theory has been used as a conceptual framework in assoc. degree programs also in
many nursing schools
Strengths
Provides a comprehensive base to nursing practice

It has utility for professional nursing in the areas of nursing practice nursing curricula
,nursing education administration ,and nursing research
Specifies when nursing is needed
Also includes continuing education as part of the professional component of nursing

education
Her self care approach is contemporary with the concepts of health promotion and health
maintenance
Expanded her focus of individual self care to include multi person units
Limitations
In general system theory a system is viewed as a single whole thing while Orem defines a
system as a single whole ,thing
Health is often viewed as dynamic and ever changing .Orems visual presentation of the
boxed nursing systems implies three static conditions of health
Appears that the theory is illness oriented rather with no indication of its use in wellness
settings
Summary
Orems general theory of nursing is composed of three constructs .Throughout her

work ,she interprets the concepts of human beings, health, nursing and society .and has
defined 3 steps of nursing process. It has a broad scope in clinical practice and to lesser
extent in research ,education and administration
RESEARCH ON OREM'S THEORY

1. Self-care requirements for activity and rest: an Orem nursing focus
2. Nursing diagnoses in patients after heart catheterization--contribution of Orem
3. Self-care--the contribution of nursing sciences to health care
4. Self-care: a foundational science
5. Orem's self-care deficit nursing theory: its philosophic foundation and the state of the
science
6. Dorothea E. Orem: thoughts on her theory
7. Orem's theory in practice. Hospice nursing care
8. Solving the Orem mystery: an educational strategy
9. Orem's family evaluation
REFERENCES
Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year
Book Inc.
Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M.
Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline and
profession. Nursing Theorists and their work. Mosby, St. Louis, Missouri, United States
of America.
Whelan, E. G. (1984). Analysis and application of Dorothea Orems Self-care Practuce

Model. Retrieved October 31, 2006.
George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed.
Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process &
Nursing Theories: An Overview

====
INTRODUCTION
A theory is a group of related concepts that propose action that guide practice.
A nursing theory is a set of concepts, definitions, relationships, and assumptions or
propositions derived from nursing models or from other disciplines and project a
purposive, systematic view of phenomena by designing specific inter-relationships
among concepts for the purposes of describing, explaining, predicting, and /or
prescribing.
Kerlinger ---views theories as a set of interrelated concepts that give a systematic view of
a phenomenon (an observable fact or event) that is explanatory and predictive in nature.
Theories are composed of concepts, definitions, models , propositions and are based on
assumptions.
They are derived through two principal methods:
1) Deductive reasoning
2) Inductive reasoning.
Nursing theorists use both of these methods.

Nursing Theory: Barnum(1998)---- "attempts to describe or explain the phenomenon
(process, occurrence and event) called nursing"
Theories are for professional nursing
Theory is "a creative and rigorous structuring of ideas that projects a tentative,
purposeful, and systematic view of phenomena"
A theory makes it possible to "organize the relationship among the concepts to describe,
explain, predict, and control practice"
DEFINITIONS
Concepts--- are basically vehicles of thought that involve images.
Concepts are words that describe objects , properties, or events and are basic components
of theory.
Types of Concepts:
Empirical concepts
Inferential concepts
Abstract concepts.
Models ----- are representations of the interaction among and between the concepts showing
patterns.
Propositions---- are statements that explain the relationship between the concepts.
Process ---- it is a series of actions , changes or functions intended to bring about a desired result
. During a process one takes systemic and continuous steps to meet a goal and uses both
assessments and feedback to direct actions to the goal.
A particular theory or conceptual frame work directs how these actions are carried out .
The delivery of nursing care within the nursing process is directed by the way specific
conceptual frameworks and theories define the person (patient), the environment, health
and nursing.
The terms model and theory are often wrongly used interchangeably, which further
confounds matters.
In nursing, models are often designed by theory authors to depict the beliefs in their
theory (Lancaster and Lancaster 1981).
They provide an overview of the thinking behind the theory and may demonstrate how
theory can be introduced into practice, for example, through specific methods of
assessment.
Models are useful as they allow the concepts in nursing theory to be successfully applied
to nursing practice (Lancaster and Lancaster 1981).
Their main limitation is that they are only as accurate or useful as the underlying theory.
IMPORTANCE OF NURSING THEORIES
Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn
and Jacobs1978).
It should provide the foundations of nursing practice, help to generate further knowledge
and indicate in which direction nursing should develop in the future (Brown 1964).
Theory is important because it helps us to decide what we know and what we need to
know (Parsons1949).
It helps to distinguish what should form the basis of practice by explicitly describing
nursing.
The benefits of having a defined body of theory in nursing include better patient care,
enhanced professional status for nurses, improved communication between nurses, and
guidance for research and education (Nolan 1996). In addition, because the main
exponent of nursing caring cannot be measured, it is vital to have the theory to
analyze and explain what nurses do.
As medicine tries to make a move towards adopting a more multidisciplinary approach to

health care, nursing continues to strive to establish a unique body of knowledge.
This can be seen as an attempt by the nursing profession to maintain its professional
boundaries.
THE CHARACTERISTICS OF THEORIES

Theories:
interrelate concepts in such a way as to create a different way of looking at a particular

phenomenon.
are logical in nature.
are generalizable.
are the bases for hypotheses that can be tested.
increase the general body of knowledge within the discipline through the research
implemented to validate them.
are used by the practitioners to guide and improve their practice.
are consistent with other validated theories, laws, and principles but will leave open
unanswered questions that need to be investigated
BASIC PROCESSES IN THE DEVELOPMENT OF NURSING THEORIES

Nursing theories are often based on and influenced by broadly applicable processes and theories.
Following theories are basic to many nursing concepts.
A. General System Theory:
It describes how to break whole things into parts and then to learn how the parts work
together in " systems".
These concepts may be applied to different kinds of systems, e.g.. Molecules in chemistry
, cultures in sociology, organs in Anatomy and health in Nursing.
B. Adaptation Theory
It defines adaptation as the adjustment of living matter to other living things and to
environmental conditions.
Adaptation is a continuously occurring process that effects change and involves
interaction and response.
Human adaptation occurs on three levels:
--- the internal ( self )
--- the social (others)
--- and the physical ( biochemical reactions )
C. Developmental Theory
It outlines the process of growth and development of humans as orderly and predictable,
beginning with conception and ending with death.
The progress and behaviors of an individual within each stage are unique.
The growth and development of an individual are influenced by heredity , temperament,
emotional, and physical environment, life experiences and health status.
COMMON CONCEPTS IN NURSING THEORIES

Four concepts common in nursing theory that influence and determine nursing practice are
-- The person( patient)

--- The environment
-- Health
--- Nursing (goals, roles, functions)
Each of these concepts is usually defined and described by a nursing theorist , Often
uniquely; although these concepts are common to all nursing theories.
Of the four concepts , the most important is that of the person. The focus of nursing ,
regardless of definition or theory , is the person.
HISTORICAL PERSPECTIVES AND KEY CONCEPTS

1. Nightingale (1860): To facilitate "the bodys reparative processes" by manipulating
clients environment
2. Paplau 1952: Nursing is; therapeutic interpersonal process.
3. Henderson 1955: The needs often called Hendersons 14 basic needs
4. Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes
delivering nursing care for the whole person to meet the physical, emotional, intellectual,
social, and spiritual needs of the client and family.
5. Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when
met, diminishes distress, increases adequacy, or enhances well-being.
6. Johnsons Theory 1968: Dorothy Johnsons theory of nursing 1968 focuses on how the
client adapts to illness and how actual or potential stress can affect the ability to adapt.
The goal of nursing to reduce stress so that; the client can move more easily through
recovery.
7. Rogers 1970: to maintain and promote health, prevent illness, and care for and
rehabilitate ill and disabled client through "humanistic science of nursing"
8. Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client
is unable to fulfill biological, psychological, developmental, or social needs.
9. King 1971: To use communication to help client reestablish positive adaptation to
environment.
10. Neuman 1972: Stress reduction is goal of system model of nursing practice.
11. Roy 1979: This adaptation model is based on the physiological, psychological,
sociological and dependence-independence adaptive modes.
12. Watsons Theory 1979: Watsons philosophy of caring 1979 attempts to define the
outcome of nursing activity in regard to the; humanistic aspects of life.
CLASSIFICATION OF NURSING THEORIES

Depending on the generalisability of their principles
Metatheory: the theory of theory. Identifies specific phenomena through abstract

concepts.
Grand theory: provides a conceptual framework under which the key concepts and
principles of the discipline can be identified.
Middle range theory: is more precise and only analyses a particular situation with a
limited number of variables.
Practice theory: explores one particular situation found in nursing. It identifies explicit
goals and details how these goals will be achieved.
Theories can also be categorised as:
"Needs "theories.
"Interaction" theories.
"Outcome "theories.
"Humanistic theories"
These categories indicate the basic philosophical underpinnings of the theories

"Needs" theories
These theories are based around helping individuals to fulfill their physical and mental
needs. The basis of these theories is well-illustrated in Roper, Logan and Tierneys Model
of Nursing (1980).
Needs theories have been criticized for relying too much on the medical model of health
and placing the patient in an overtly dependent position.
"Interaction" theories
As described by Peplau (1988), these theories revolve around the relationships nurses
form with patients.
Such theories have been criticized for largely ignoring the medical model of health and
not attending to basic physical needs.
"Outcome" theories
These portray the nurse as the changing force, who enables individuals to adapt to or
cope with ill health (Roy 1980).
Outcome theories have been criticized as too abstract and difficult to implement in
practice (Aggleton and Chalmers 1988).
"Humanistic" Theories:
Humanistic theories developed in response to the psychoanalytic thought that a persons

destiny was determined early in life.
Humanistic theories emphasize a persons capacity for self actualization .
Humanists believes that the person contains within himself the potential for healthy and
creative growth.
Carl Rogers developed a person centered model of psychotherapy that emphasizes the
uniqueness of the individual.
The major contribution that Rogers added to nursing practice is the understanding that
each client is a unique individual, so person-centered approach now practice in Nursing.
MODELS OF NURSING
Until fairly recently, nursing science was derived principally from social, biologic, and
medical science theories.
However, from the 1950s to the present, an increasing number of nursing theorists have
developed models of nursing that provide bases for the development of nursing theories
and nursing knowledge.
A model, as an abstraction of reality, provides a way to visualize reality to simplify

thinking.
A conceptual model shows how various concepts are interrelated and applies theories to
predict or evaluate consequences of alternative actions.
According to Fawcett (2000),
A conceptual model "gives direction to the search for relevant questions about the
phenomena of central interest to a discipline and suggests solutions to practical
problems"
Four concepts are generally considered central to the discipline of nursing: the person
who receives nursing care (the patient or client); the environment (society); nursing
(goals, roles, functions); and health.
These four concepts form a metaparadigm of nursing.
The term metaparadigm comes from the Greek prefix "meta," which means more
comprehensive or transcending, and the word Greek word "paradigm," which means a
philosophical or theoretical framework of a discipline upon which all theories, laws, and
generalizations are formulated (Merriam-Websters Collegiate Dictionary, 1994).
There are two major differences in philosophical beliefs, or world views, about the nature
of change.
"The world view of change uses the growth metaphor, and the persistence view focuses
on stability" (Fawcett, 1989,).
Within the change world view, change and growth are continual and desirable, "progress
is valued, and realization of ones potential is emphasized" (Fawcett).
Persistence is endurance in time
persistence world view emphasizes equilibrium and balance.
CATEGORIES OF CONCEPTUAL MODELS
Ten conceptual models of nursing have been classified according to two criteria:
1. the world view of change reflected by the model (growth or stability); and
2. the major theoretical conceptual classification with which the model seems most
consistent (systems, stress/adaptation, caring, or growth/development).
Systems Theory as a Framework
Systems theory is concerned with changes caused by interactions among all the factors
(variables)
General systems theory is emphasized
A system is defined as "a whole with interrelated parts, in which the parts have a function
and the system as a totality has a function" (Auger, 1976)
A general systems approach allows for consideration of the subsystems levels of the
human being, as a total human being, and as a social creature who networks himself with
others in hierarchically arranged human systems of increasing complexity. Thus the
human being, from the level of the individual to the level of society, can be
conceptualized as the client and becomes the target system for nursing intervention. (Sills
and Hall, 1977).
An example of systems interaction
Input (Diet teaching)

Throughput (Assimilation of information)
Output (Food intake)
Feedback (Weight record ,Hb estimation etc.)
Two nursing models based on systems theory:

1. Imogene Kings systems interaction model, and
2. Betty Neumans health care systems model.

Imogene Kings Systems Interaction Model
interaction model, the purpose of nursing is to help people attain, maintain, or restore
health
Kings model conceptualizes three levels of dynamic interacting systems.
1. Individuals are called "personal systems."

2. Groups (two or more persons) form "interpersonal systems."
3. Society is composed of "social systems."
As the person interacts with the environment, he or she must continuously adjust to
stressors in the internal and external environment (King, 1981).
Health assumes achievement of maximum potential for daily living and an ability to
function
in social roles. It is the "dynamic life experiences of a human being, which implies
continuous
adjustment to stressors in the internal and external environment through optimum use of
ones resources to achieve maximum potential for daily living" (King, 1981,).
"Illness is a deviation from normal, that is, an imbalance in a persons biological structure
or in his psychological makeup, or a conflict in a persons social relationships" (King,
1989).
"The goal of nursing is to help individuals and groups attain, maintain, and restore
health"
Stress: "a dynamic state whereby a human being interacts with the environment to
maintain balance for growth, development, and performance"
Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system
stability.
Normal line of defense: an adaptational level of health considered normal for an
individual
Lines of resistance: protection factors activated when stressors have penetrated the
normalline of defense
Neumans model, organized around stress reduction, is concerned primarily with how
stress and the reactions to stress affect the development and maintenance of health.
The person is a composite of physiologic, psychological, sociocultural, developmental,

and spiritual variables considered simultaneously.
"Ideally the five variables function harmoniously or are stable in relation to internal and
external environmental stressor influences" (Neuman, 2002).
A person is constantly affected by stressors from the internal, external, or created

environment.
Stressors are tension-producing stimuli that have the potential to disturb a persons
equilibrium or normal line of defense.
This normal line of defense is the persons "usual steady state."
It is the way in which an individual usually deals with stressors.
Stressors may be of three types:
Intrapersonal: forces arising from within the person
Interpersonal: forces arising between persons
Extrapersonal: forces arising from outside the person
Resistance to stressors is provided by a flexible line of defense, a dynamic protective

buffer made up of all variables affecting a person at any given moment the persons
resistance to any given stressor or stressors.
If the flexible line of defense is no longer able to protect the person against a stressor, the
stressor
breaks through, disturbs the persons equilibrium, and triggers a reaction. The reaction
may lead
toward restoration of balance or toward death.
Neuman intends for the nurse to "assist clients to retain, attain, or maintain optimal
system stability" (Neuman, 1996).
Thus, health (wellness) seems to be related to dynamic equilibrium of the normal line of
defense, where stressors are successfully overcome or avoided by the flexible line of
defense.
Neuman defines illness as "a state of insufficiency with disrupting needs unsatisfied"
(Neuman, 2002).
Illness appears to be a separate state when a stressor breaks through the normal line of
defense and causes a reaction with the persons lines of resistance.
In contrast to systems theory, stress and adaptation theories view change caused by
personenvironment interaction in terms of cause and effect.
The person must adjust to environmental changes to avoid disturbing a balanced
existence. Adaptation theory provides a way to understand
both how the balance is maintained and the possible effects of disturbed equilibrium.
This theory has been widely applied to explain, predict, and control biologic (physiologic
and psychological)
The drive for a unique body of knowledge is based

on the assumption that borrowed knowledge is
less worthy.
However, nurse education is based on theory borrowed from other disciplines, such as
sociology and psychology.
It has been argued that applying knowledge from different disciplines only serves to
dilute nursing practice.
Nevertheless, as the occupation is focused on
humans, perhaps it is inevitable that nursing uses
knowledge from other social sciences.
It has been argued that no knowledge is exclusive, and because of nursings diverse
nature it is impossible for it to have a unique body of knowledge and one unified body of
theory (Castledine 1994, Levine 1995).
To understand why nursing theory is generally neglected on the wards it is necessary to

take a closer look at the main criticisms of nursing theory and the role that nurses play in
contributing to its lack of prevalence in practice.
Use of language Scott (1994) states that the crucial ingredients of nursing theory should
be accessibility and clarity. However, one of the main criticisms of nursing theory is its
use of overtly complex language (Kenny 1993).
It is important that the language used in the
development of nursing theory be used consistently.
Not part of everyday practice Despite theory and practice being viewed as inseparable
concepts, a theory-practice gap still exists in nursing (Upton 1999).
Yet despite the availability of a vast amount of literature on the subject, nursing theory
still means very little to most practicing nurses. Perhaps this is because the majority of
nursing theory is developed by and for nursing academics (Lathlean 1994).
It has been recognised that traditionally nurses are used to speaking with their hands
(Levine 1995).
Therefore, many nurses have not had the training or experience to deal with the abstract
concepts presented by nursing theory.
This makes it difficult for the majority of nurses to understand and apply theory to
practice (Miller 1985).
Summary
Definition
Importance of Nursing Theories
The characteristics of theories:
Basic Processes in the Development Of Nursing Theories:
Nursing theories are often based on and influenced
ANA definition of Nursing Practice
Common concepts in Nursing Theories:
Historical Perspectives and Key Concepts
Classification of Nursing Theories
Models Of Nursing
Conclusion:
Littlejohn (2002) comments that irrespective of nursing theories, nurses will continue to exhibit a
caring response to the sick and troubled. If this is true, perhaps nurses are nursing without the
knowledge of theories and theory is irrelevant. However, theory and practice are related, and if
nursing is to continue to develop, the concept of theory must be addressed. If nursing theory does
not drive the development of nursing, it will continue to develop in the footsteps of other
disciplines such as medicine
Reference:
Lippincott Williamsand wilkins.
3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development and Progress 3rd ed.
4. Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed.
5. Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing Concepts Process and
Roy's Adaptation Model
=
Introduction
Sr.Callista Roy, a prominent nurse theorist, writer, lecturer, researcher and teacher
Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill
Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy
she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College,
Los Angeles in 1963.
a master's degree program in pediatric nursing at the University of California ,Los

Angeles in 1966.
She also earned a masters and PhD in Sociology in 1973 and 1977 ,respectively.
Sr. Callista had the significant opportunity of working with Dorothy E. Johnson
Johnson's work with focusing knowledge for the discipline of nursing convinced Sr.
Callista of the importance of describing the nature of nursing as a service to society and
prompted her to begin developing her model with the goal of nursing being to promote
adaptation.
She joined the faculty of Mount St. Mary's College in 1966, teaching both pediatric and
maternity nursing.
She organized course content according to a view of person and family as adaptive
systems.
She introduced her ideas about Adaptation Nursing as the basis for an integrated nursing
curriculum.
Goal of nursing to direct nursing education, practice and research
Model as a basis of curriculum impetus for growth--Mount St. Marys College
1970-The model was implemented in Mount St. Marys school
1971- she was made chair of the nursing department at the college.
Influencing Factors
Family
Education
Religious Background
Mentors
Clinical Experience
THEORY DESCRIPTION
The central questions of Roys theory are:
o Who is the focus of nursing care?
o
What is the target of nursing care?
When is nursing care indicated?
Roys first ideas appeared in a graduate paper written at UCLA in 1964.
Published these ideas in "Nursing outlook" in 1970
Subsequently different components of her framework crystallized during 1970s, 80s, and
90s
Over the years she identified assumptions on which her theory is based.
Explicit assumptions (Roy 1989; Roy and Andrews 1991)

The person is a bio-psycho-social being.
The person is in constant interaction with a changing environment.
To cope with a changing world, person uses both innate and acquired mechanisms which
are biological, psychological and social in origin.
Health and illness are inevitable dimensions of the persons life.
To respond positively to environmental changes, the person must adapt.
The persons adaptation is a function of the stimulus he is exposed to and his adaptation
level
The persons adaptation level is such that it comprises a zone indicating the range of
stimulation that will lead to a positive response.
The person has 4 modes of adaptation: physiologic needs, self- concept, role function and
inter-dependence.
"Nursing accepts the humanistic approach of valuing other persons opinions, and view
points" Interpersonal relations are an integral part of nursing
There is a dynamic objective for existence with ultimate goal of achieving dignity and
integrity.
Implicit assumptions
A person can be reduced to parts for study and care.
Nursing is based on causality.
Patients values and opinions are to be considered and respected.
A state of adaptation frees an individuals energy to respond to other stimuli.
ROY ADAPTATION MODEL CONCEPTS: EARLY AND REVISED

Adaptation -- goal of nursing
Person -- adaptive system
Environment -- stimuli
Health -- outcome of adaptation
Nursing -- promoting adaptation and health
Concepts-Adaptation
Responding positively to environmental changes.
The process and outcome of individuals and groups who use conscious awareness, self
reflection and choice to create human and environmental integration
Concepts-Person
Bio-psycho-social being in constant interaction with a changing environment
Uses innate and acquired mechanisms to adapt
An adaptive system described as a whole comprised of parts
Functions as a unity for some purpose
Includes people as individuals or in groups-families, organizations, communities, and

society as a whole.
Concepts-Environment
Focal - internal or external and immediately confronting the person
Contextual- all stimuli present in the situation that contribute to effect of focal stimulus
Residual-a factor whose effects in the current situation are unclear
All conditions, circumstances, and influences surrounding and affecting the development
and behavior of persons and groups with particular consideration of mutuality of person
and earth resources, including focal, contextual and residual stimuli
Concepts-Health
Inevitable dimension of person's life
Represented by a health-illness continuum
A state and a process of being and becoming integrated and whole
Concepts-Nursing
To promote adaptation in the four adaptive modes
To promote adaptation for individuals and groups in the four adaptive modes, thus
contributing to health, quality of life, and dying with dignity by assessing behaviors and
factors that influence adaptive abilities and by intervening to enhance environmental
interactions
Concepts-Subsystems
Cognator subsystem A major coping process involving 4 cognitive-emotive channels:
perceptual and information processing, learning, judgment and emotion.
Regulator subsystem a basic type of adaptive process that responds automatically
through neural, chemical, and endocrine coping channels
Relationships
Derived Four Adaptive Modes
500 Samples of Patient Behavior
What was the patient doing?
What did the patient look like when needing nursing care?
Four Adaptive Modes

Physiologic Needs
Self Concept
Role Function
Interdependence
Four Adaptive Mode Categories

Tested in practice for 10 years
Criteria of significance, usefulness, and completeness were met
Sample Proposition and Hypothesis for Practice

Self Concept Mode: Increased quality of social experience leads to increased feelings of
adequacy
Providing support for new mothers can lead to positive parenting
THEORY DEVELOPMENT
Derived Theory
91 Propositions
Described relationships between and among regulator and cognator and four adaptive
modes
12 Generic propositions
Questions Raised by 21st Century Changes

How can ethics and public policy keep pace with developments in science?
How can nurses focus on human needs not machines?
How can nurses contribute to creating meaning and purpose in a global society?
Scientific Assumptions for the 21st Century

Systems of matter and energy progress to higher levels of complex self organization
Consciousness and meaning are constitutive of person and environment integration
Awareness of self and environment is rooted in thinking and feeling
Human decisions are accountable for the integration of creative processes.
Thinking and feeling mediate human action
System relationships include acceptance, protection, and fostering of interdependence
Persons and the earth have common patterns and integral relations
Person and environment transformations are created in human consciousness
Integration of human and environment meanings results in adaptation
Philosophical Assumptions
Persons have mutual relationships with the world and God
Human meaning is rooted in an omega point convergence of the universe
God is intimately revealed in the diversity of creation and is the common destiny of
creation
Persons use human creative abilities of awareness, enlightenment, and faith
Persons are accountable for the processes of deriving, sustaining, and transforming the
universe
Adaptation and Groups

Includes relating persons, partners, families, organizations, communities, nations, and
society as a whole
Adaptive Modes
A. Persons
Physiologic
Self Concept
Role Function
Interdependence
B. Groups
Physical
Group Identity
Role Function
Interdependence
Role Function Mode

Underlying Need of Social integrity
The need to know who one is in relation to others so that one can act
The need for role clarity of all participants in group
Adaptation Level
A zone within which stimulation will lead to a positive or adaptive response
Adaptive mode processes described on three levels:
Integrated
Compensatory
Compromised
Integrated Life Processes

Adaptation level where the structures and functions of the life processes work to meet
needs
Examples of Integrated Adaptation
Stable process of breathing and ventilation
Effective processes for moral-ethical-spiritual growth
Compensatory Processes
Adaptation level where the cognator and regulator are activated by a challenge to the life
processes
Compensatory Adaptation Examples:
Grieving as a growth process, higher levels of adaptation and transcendence
Role transition, growth in a new role
Compromised Processes
Adaptation level resulting from inadequate integrated and compensatory life processes
Adaptation problem
Compromised Adaptation Examples
Hypoxia
Unresolved Loss
Stigma
Abusive Relationships
THE NURSING PROCESS

RAM offers guidelines to nurse in developing the nursing process.
The elements :
First level assessment
Second level assessment
Diagnosis
Goal setting
Intervention
evaluation
Usefulness of Adaptation Model

Scientific knowledge for practice
Clinical assessment and intervention
Research variables
To guide nursing practice
To organize nursing education
Curricular frame work for various nursing colleges
Characteristics of the theory

Theories can interrelates concepts in such a way as to present a new view of looking at a
particular phenomenon.
Theories should be relatively simple yet generalizable
Theories can be the basis for the hypotheses that can be tested
Theories contribute to and assist in increasing the general body of knowledge of a

discipline through the research implemented to validate them
Theories can be utilized by the practitioners to guide and improve their practice
Theories must be consistent with other validated theories, laws and principles but will
leave open unanswered questions that need to be investigated
Testability
RAM is testable
BBARNS (1999) reported that 163 studies have been conducted using this model.
RAM is complete and comprehensive
It explains the reality of client, so nursing interventions can be specifically targeted.
Research studies using RAM

Middle range theories have been derived from RAM
1998-Ducharme et al described a longitudinal model of psychosocial determinants of
adaptation
1998-Levesque et al presented a MRT of psychological adaptation
1999-A MRNT , the urine control theory by Jirovec et al
Dunn, H.C. and Dunn, D. G. (1997). The Roy Adaptation Model and its application to
clinical nursing practice. Journal of Ophthalmic Nursing and Technology. 6(2), 74-78.
Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes, P.,
Kowitski, C., and Ziegler, E. (1998). Women's perception of group support and
adaptation to breast cancer. Journal of Advanced Nursing. 28(6), 1259-1268.
Chiou, C. (2000). A meta-analysis of the interrelationships between the modes in Roy's

adaptation model. Nursing Science Quarterly. 13(3), 252-258
Yeh, C. H. (2001). Adaptation in children with cancer: research with Roy's model.
Nursing Science Quarterly. 14, 141-148.
Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing-impaired older

persons: testing Roy's adaptation model. Nursing Science Quarterly. 13(2), 158-165.
Summary
5 elements -person, goal of nursing, nursing activities, health and environment
Persons are viewed as living adaptive systems whose behaviours may be classified as
adaptive responses or ineffective responses.
These behaviors are derived from regulator and cognator mechanisms.
These mechanisms work with in 4 adaptive modes.
The goal of nursing is to promote adaptive responses in relation to 4 adaptive modes,

using information about persons adaptation level, and various stimuli.
Nursing activities involve manipulation of these stimuli to promote adaptive responses.
Health is a process of becoming integrated and able to meet goals of survival, growth,
reproduction, and mastery.
The environment consists of persons internal and external stimuli.
References
George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed.
Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process &
Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories
Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225
Theory of Psychosocial Development
Erik H. Erikson
"Healthy children will not fear life if their elders have integrity enough not to fear death."Erikson
This page was last updated on 9/06/2010
INTRODUCTION
Erik Erikson was a psychoanalyst who developed the theory of psychosocial

development.
He was born on June 15, 1902 in Karlsruhe Germany.
His classic work "Childhood and Society" set forth his theory of the life cycle.
Young Man Luther, Identity: Youth and Crisis, and Gandhi's Truth are his other
influencial works.
He believed that the achievements and failures of earlier stages influence later stages,
whereas later stages modify and transform earlier ones.
Erikson's conceptualization of psychosocial development based its model the epigenetic

principle of organismic growth in utero.
Erikson views psychosocial growth occurs in phases.
EIGHT STAGES OF THE LIFE CYCLE
Erikson explains 8 developmental stages in which physical, cognitive, instinctual, and

sexual changes combine to trigger an internal crisis whose resolution results in either
psychosocial regression or growth and the development of specific virtues.
Erikson defined virtue as "inherent strength".
Related
Psychosocial Stage
Age
Virtue
Psychopathology
Trust vs. mistrust
Autonomy vs. shame

and doubt
Initiative vs. guilt
birth18 months
~18 months
~3 years
Hope
Will
Purpose
Psychosis
Addictions
Depression
Paranoia
Obsessions
Compulsions
Impulsivity
Conversion disorder
Phobia
Psychosomatic disorder
Industry vs. inferiority
Identity vs. role

confusion
Intimacy vs. isolation
Inhibition
Creative inhibition
Inertia
Delinquent behavior
Gender-related identity
disorders
Borderline psychotic
episodes
Schizoid personality
disorder
Distantiation
Midlife crisis
Premature invalidism
Extreme alienation
Competence
~13 years
~20s
Generativity
vs.stagnation
~40s
Integrity vs. despair
~60s
Fidelity
Love
Care
Wisdom
Trust Versus Mistrust (Birth to About 18 Months)
The infant is taking the world in through the mouth, eyes, ears, and sense of touch.
A baby whose mother is able to anticipate and respond to its needs in a consistent and
timely manner despite its oral aggression will learn to tolerate the inevitable moments of
frustration and deprivation
A person who, as a result of severe disturbances in the earliest dyadic relationships, fails
to develop a basic sense of trust or the virtue of hope may be predisposed as an adult to
the profound withdrawal and regression characteristic of schizophrenia (Newton DS,
Newton PM, 1998).
Autonomy Versus Shame and Doubt (About 18 Months to About 3 Years)
"This stage, therefore, becomes decisive for the ratio between loving good will and
hateful self-insistence, between cooperation and willfulness, and between self-expression
and compulsive self-restraint or meek compliance." - Erikson
This oral-sensory stage of infancy, marked by the potential development of basic trust
aiming toward the achievement of a sense of hope.
Here, the child will develop an appropriate sense of autonomy, otherwise doubt and
shame will undermine free will.
An individual who becomes fixated at the transition between the development of hope
and autonomous will, with its residue of mistrust and doubt, may develop paranoic fears
of persecution (Newton DS, Newton PM, 1998).
Other disturbances of improper transition of this stage results in perfectionism,

inflexibility, stinginess and ruminative and ritualistic behavior of obsessive-compulsive
personality disorder.
Initiative Versus Guilt (About 3 Years to About 5 Years)
Here, the childs task is to develop a sense of initiative as opposed to further shame or
guilt.
The lasting achievement of this stage is a sense of purpose.
The child's increasing mastery of locomotor and language skills expands its participation
in the outside world and stimulates omnipotent fantasies of wider exploration and
conquest
Industry Versus Inferiority (About 5 Years to About 13 Years)
Here the child is in school-age , so called stage of latency.

He tries to master the crisis of industry versus inferiority aiming toward the development
of a sense of competence.
Identity Versus Role Confusion (About 13 Years to About 21 Years)
At puberty, the fifth stage, the task of adolescence is to navigate ther identity crisis as
each individual struggles with a degree of identity confusion.
The lasting outcome of this stage can be a capacity for fidelity.
Intimacy Versus Isolation (About 21 Years to About 40 Years)
Young adulthood, at the stage of genitality or sixth stage, is marked by the crisis of
intimacy versus isolation, out of which may come the achievement of a capacity for love.
Generativity Versus Stagnation (About 40 Years to About 60 Years)
"Generativity is primarily the concern for establishing and guiding the next generation."Erikson
Care is the virtue that curresponding to this stage.
This failure of generativity can lead to profound personal stagnation, masked by a variety
of escapisms, such as alcohol and drug abuse, and sexual and other infidelities.Mid-life
crisis may occur.
Integrity Versus Despair (About 60 Years to Death)
"The acceptance of one's one and only life cycle and of the people who have become
significant to it as something that had to be and that, by necessity, permitted of no
substitutions."
The individual in possession of the virtue of wisdom and a sense of integrity has room to
tolerate the proximity of death and to achieve.
When the attempt to attain integrity has failed, the individual may become deeply
disgusted with the external world, and contemptuous of persons as well as institutions.
NURSING IMPLICATIONS
Application of Erikson's stages of psychosocial development helps in analysing patient's

symptomatic behavior in the context of truamatic past experineces and struggles with
current developmental tasks.
When patients' resolutions of previous psychosocial stages have been so faulty as to
seriously compromise their adult development, they have the opportunity to rework early
development through the relationship with the therapist. (Newton DS, Newton PM,
1998).
"The object of psychotherapy is not to head off future conflict but to assist the patient in
emerging from each crisis "with an increased sense of inner unity, with an increase of
good judgment, and an increase in the capacity `to do well' according to his own
standards and to the standards of those who are significant to him." (Erikson in Identity:
Youth and Crisis)
ERIKSON'S WORKS
Erikson E: Childhood and Society. Norton, New York, 1950.

Erikson E: The dream specimen of psychoanalysis. J Am Psychoanal Assoc 2:5, 1954.
Erikson E: The first psychoanalyst. Yale Rev 46:40, 1956.
Erikson E: Freud's "The Origins of Psychoanalysis." Int J Psychoanal 36:1, 1955.
Erikson E: Gandhi's Truth. Norton, New York, 1969.
Erikson E: Hitler's imagery and German youth. Psychiatry 5:475, 1942.
Erikson E: Identity and the Life Cycle. Norton, New York, 1980.
Erikson E: Identity: Youth and Crisis. Norton, New York, 1968.
Erikson E: Insight and Responsibility. Norton, New York, 1964.
Erikson E: Life History and the Historical Moment. Norton, New York, 1975.
Erikson E: Observations on Sioux education. J Psychol 7:101, 1939.
Erikson E: The problem of ego identity. Psychol Issues 1:379, 1959.
Erikson E: Young Man Luther. Norton, New York, 1962.
Erikson E, Erikson J, Kivnick H: Vital Involvement in Old Age. Norton, New York, 1986.
REFERENCES
1. Erikson E: Insight and Responsibility. Norton, New York, 1964.
2. Erikson E: Identity: Youth and Crisis. Norton, New York, 1968.
3. Newton DS, Newton PM in Kaplan HI & Sadok BJ's Synopsis of psychiatry-behavioural
science or clinical psychiatry.9th edn. Hong Kong.William and Wilkinsons publications.
1998.
Maslow's Theory of Needs
==================================
Introduction
Proposed by Abraham Maslow in his 1943

paper A Theory of Human Motivation.
Maslows Hierarchy of Needs is a motivational
theory that argues that while people aim to meet
basic needs, they seek to meet successively
higher needs in the form of a hierarchy.
Maslow's theoryhas been applied in nursing to

guide the prioritization of patient care needs
It is often represented as a pyramid with five

levels of needs.
Maslows hierarchy of needs

Maslows hierarchy of needs is a based on the theory that
one level of needs must be met before moving on to the
next step.
Self-actualization e.g. morality, creativity,

problem solving.
Esteem e.g. confidence, self-esteem,
achievement, respect.
Belongingness e.g. love, friendship, intimacy,

family.
Safety e.g. security of environment,
employment, resources, health, property.
Physiological e.g. air, food, water, sex, sleep,

other factors towards homeostasis.
Assumptions
Maslows theory maintains that a person does not

feel a higher need until the needs of the current
level have been satisfied.
B and D Needs
Deficiency or deprivation needs
The first four levels are
considered deficiency or deprivation needs (D-needs)
in that their lack of satisfaction causes a deficiency that
motivates people to meet these needs
Growth Needs or B-Needs or Being Needs
The needs Maslow believed to be higher,

healthier, and more likely to emerge in selfactualizing people were being needs, or B-needs.
Growth needs are the highest level, which is selfactualization, or the self-fulfillment.
Maslow suggested that only two percent of the

people in the world achieve self actualization.
E.g. Abraham Lincoln, Thomas Jefferson, Albert
Einstein, Eleanor Roosevelt.
Self actualized people were reality and problem

centered.
They enjoyed being by themselves, and having

deeper relationships with a few people instead of
more shallow relations with many people.
They tended to be spontaneous and simple.
Application in Nursing
Maslow's hierarchy of needs is a useful

organizational framework that can be applied to
the various nursing models for assessment of a
patients strengths, limitations, and need for

nursing interventions. (Smeltzer SC, Bare BG,
2004)
References
1. Health Care Delivery and Nursing Practice. In
Brunner & Suddarths Textbook of MedicalSurgical Nursing, (Edtrs. Smeltzer SC, Bare BG.)
10th Edition. Lippincott Williams and Wilkins.
Philadelphia. 2003.
2. Psychiatry, Third Edition. Edited by Allan
Tasman, Jerald Kay, Jeffrey A. Lieberman,
Michael B. First and Mario Maj. John Wiley &
Sons, Ltd, 2008.
3. Maslow, A. H.. A Theory of Human Motivation.
Psychological Review, 50, 1943. pp. 370.
Theory of Florence Nightingale
Date of last revision January 8, 2011
===============================
The goal of nursing is to put the patient in the best condition
for nature to act upon him. - Nightingale
Introduction
Born - 12 May 1820

Founder of mordern nursing.
The first nursing theorist.
Also known as "The Lady with the Lamp"
She explained her environmental theory in her famous book Notes on Nursing: What it
is, What it is not .
She was the first to propose nursing required specific education and training.
Her contribution during Crimean war is well-known.
She was a statistician, using bar and pie charts, highlighting key points.
International Nurses Day, May 12 is observed in respect to her contribution to Nursing.
Died - 13 August 1910
Assumpations of Nightingale's Theory
Natural laws
Mankind can achieve perfection
Nursing is a calling
Nursing is an art and a science
Nursing is achieved through environmental alteration
Nursing requires a specific educational base
Nursing is distinct and separate from medicine
Nightingales Canons: Major Concepts

1. Ventilation and warming
2. Light, Noise
3. Cleanliness of rooms/walls
4. Health of houses
5. Bed and bedding
6. Personal cleanliness
7. Variety
8. Chattering hopes and advices
9. Taking food. What food?
10. Petty management/observation
Nursing Paradigms
Nightingale's documents contain her philosophical assumptions and beliefs regarding all
elements found in the metaparadigm of nursing. These can be formed into a conceptual
model that has great utility in the practice setting and offers a framework for research
conceptualization. (Selanders LC, 2010)
Nursing
Person
Nursing is different from medicine and the goal of nursing is to place the patient in the
best possible condition for nature to act.
Nursing is the "activities that promote health (as outlined in canons) which occur in any
caregiving situation. They can be done by anyone."
People are multidimensional, composed of biological, psychological, social and spiritual

components.
Health
Health is not only to be well, but to be able to use well every power we have.
Disease is considered as dys-ease or the absence of comfort.
Environment
"Poor or difficult environments led to poor health and disease".

"Environment could be altered to improve conditions so that the natural laws would allow
healing to occur."
Nightingale's Theory and Nursing Practice

Application of Nightingale's theory in practice:
"Patients are to be put in the best condition for nature to act on them, it is the
responsibility of nurses to reduce noise, to relieve patients anxieties, and to help them
sleep."
As per most of the nursing theories, environmental adaptation remains the basis of
holistic nursing care.
Criticisms
She emphasized subservience to doctors.

She focused more on physical factors than on psychological needs of patient.
Applications of Nightingale's Theory
Nightingale theory and intentional comfort touch in management of tinea pedis in

vulnerable populations
Incorporating Florence Nightingale's theory of nursing into teaching a group of
preadolescent children about negative peer pressure.
Conclusion
Florence Nightingale provided a professional model for nursing organization.

She was the first to use a theoretical founation to nursing.
Her thoghts have influenced nursing significantly.
References
1. Nightingale, F. Notes on nursing: What it is and what it is not. 1860.
2. Works by Florence Nightingale at Project Gutenberg

3. Selanders LC. The power of environmental adaptation: Florence Nightingale's original
theory for nursing practice. .J Holist Nurs. 2010 Mar; 28(1):81-8.

Introduction To Nursing Theories

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Each discipline has a unique focus for knowledge

Theory-guided, evidence-based practice is the hallmark

Nursing is a professional discipline (Donaldson & Crowley,

Nursing theory is the term given to the body of knowledge

Almost 90% of all Nursing theories are generated in the last

Nursing models are conceptual models, constructed of

Recipient of care, including physical, spiritual, psychological,

All internal and external conditions, circumstances, and

Degree of wellness or illness experienced by the person

Actions, characteristics and attributes of person giving care

A theory is a group of related concepts that propose action that guide

Metaparadigm (Person, Environment, Health & Nursing)

Conceptual models and Grand theories.

Nursing theories and Middle range theories (Least abstract)

a mental idea of a phenomenon

Concepts are the building blocksthe primary

a phenomena that cannot be observed and must be

Constructs are concepts developed or adopted for use

a statement of relationship between concepts

made up of concepts and propositions

They epresent ways of thinking about a problem or

Different Frameworks will emphasize different

Models may draw on a number of theories to help

Variables are the operational forms of constructs. They

Match variables to constructs when identifying what

Helping process meets needs through the

Identifying cause of discomfort

Determining if clients can resolve

Identified 14 basic human needs on which

Caring is a universal, social phenomenon

CONCEPTUAL MODELS AND

A conceptual model with three

The unique focus of nursing is on the

Sister Callista: Roys

Disturbances in these causes nursing

Betty Neumans : Health Reconstitution is a status of adaptation to

Imogene Kings Goal

Nursing actions (Primary, Secondary, and

Perceptions, Judgments and actions of

continuum which is bi-directional.

The four phases of nurse-patient

The six nursing roles are:

Ida Jean Orlandos

Nurses must stay connected to patients and

Developing feelings of empathy and

specific comfort needs.

Care is the essence and the dominant,

Tomey AM, Alligood. MR. Nursing theorists and their work.

Alligood M.R, Tomey. A.M. Nursing theory utilization and

Nursing theorists use both of these methods.

Theory is a creative and rigorous structuring of ideas that projects a tentative,

Process it is a series of actions, changes or functions intended to bring about a desired

Importance of nursing theories

As medicine tries to make a move towards adopting a more multidisciplinary approach to

The characteristics of theories

interrelating concepts in such a way as to create a different way of looking at a particular

bases for hypotheses that can be tested.

used by the practitioners to guide and improve their practice.

Basic processes in the development of nursing theories

1. The internal (self)

3. the physical (biochemical reactions)