THEORETICAL FOUNDATIONS OF NURSING

CONCEPT
 Often called the “building blocks of theories”
 Abstract & concrete concepts
 Mental formulation of an object or event that come from individual perceptual experience.
 Is a generalized idea of some group of objects; or an abstract idea generalized from several
specific instances
 It is an image or mental picture of some phenomenon
 Major components of a theory

 ABSTRACT
 Indirectly observable and are independent of time or place
 Not easily understood

 CONCRETE
 are specific to time, place and are observable.
 real, perceptible by the senses, experience

THEORY
 A group of related concepts that propose actions that guide practice
 A set of concepts, definitions, relationships, assumptions that project a systematic view of a
phenomena
 An organized system of accepted knowledge that is composed of concepts, proposition,
assumption and definition intended to explain a set of fact, event or phenomena

PHENOMENON
 is an aspect of reality that can be consciously sensed or influenced
 Observable event
 An empirical data that can be observed

PROPOSITION
 a statement that proposes a relationship between concepts

DEFINITION
 is composed of various descriptions which convey a general meaning and reduces the vagueness
in understanding a set of concepts

ASSUMPTION
 is a proposition that is taken for granted, as if it were true based upon presupposition without
preponderance of the facts
 A statement that specifies the relationship or connection of factual concepts or phenomena
 Statement that the theorist hold as factual

PRINCIPLE
 A basic law, truth or assumption
 a fundamental, primary, or general law or truth from which others are derived
CONCEPTUAL FRAMEWORK
 Group of related ideas, statements, or concepts
 Often used interchangeably with the terms “conceptual model” and “grand theories”
Examples: Freud’s structure of the mind (id, ego, and superego)

PARADIGM
 A paradigm is an organizing framework that contains concepts, theories, assumptions, beliefs,
values, and principles that form the way a discipline interprets the subject matter with which it is
concerned.

METAPARADIGM
 specifies the main concepts that encompass the subject matter and the scope of a discipline.
 the metaparadigm concepts provide the boundaries and limitations of a discipline

FOUR MAJOR CONCEPTS IN NURSING

1. PERSON
 refers to the individual, family, or group who are the interest of nursing
 the recipient of care central to the care being provided
 individual clients
 families
 communities
2. HEALTH
 the goal of nursing care; state of well-being; defined in different ways by the client, the
clinical setting and health care profession; it is a state that is dynamic and continuously
changing.

3. ENVIRONMENT
 the internal and external surrounding that affect the client; includes all possible conditions
affecting the client and the setting in which health care needs occur (community, home,
school or workplace).
 Is the place or community where care is provided
 It also describes the world a person lives in and interacts with

4. NURSING
 the discipline from which client care interventions are provided; the diagnosis and treatment
of human responses to actual or potential health problems; attributes, characteristics and
actions of the nurse providing care on behalf of, or in conjunction with the client.
 the actions and interactions of the nurse with the person.

COMPONENTS OF A THEORY
1. Purpose
2. Concepts
3. Models
4. Theoretical statements
5. Structure
6. Assumptions
 1. PURPOSE
 the purpose of a theory explains why the theory was formulated and specifies the context and
situation in which it should be applied
 Describe
 Explain
 Predict
 Prescribe

PURPOSES OF NURSING THEORY

EDUCATION
 Prepare students for practice as members of the professional community.
 Helps nursing students understand how roles and actions of nurses fit together in nursing
 Theories provide general focus for curriculum design
 Theories also guide curricular decision making

RESEARCH
 Offer a framework for generating knowledge and new ideas
 Assist in discovering knowledge gaps in the specific field of study
 Systematic approach to identify questions

CLINICAL PRACTICE
 Guide critical thinking of nurses
 Represent status of nursing as a discipline
 Used as a framework for structuring nursing practice
 Development of nursing knowledge/ nursing science
 Assist nurses to describe, explain and predict everyday experiences
 Serve to guide assessment, intervention and evaluation of nursing care
 Provide a rationale for collecting reliable and valid data
 Help to establish criteria to measure the quality of nursing care
 Help build a common nursing terminology
 Enhance autonomy of nursing

2. CONCEPTS AND CONCEPTUAL DEFINITIONS

 concepts are linguistic labels that are assigned to objects or events and are considered to be the
building blocks of theories
 the theoretical definition defines the concept in relation to other concepts and permits description
and classification of phenomena
 Operationally defined concepts link concept to the real world and identify empirical referents
(indicators) of the concept that will permit observation and measurement.

3. MODEL
 are schematic representation of some aspect of reality.
 help illustrates the processes through which outcomes occur by specifying the relationships
among the variables in graphic form where they can be examined for inconsistency,
incompleteness or errors.
 4. THEORETICAL STATEMENTS
 theoretical statements, or propositions, are statements about the relationship between two or
more concepts and are used to connect concepts to devise the theory

5. STRUCTURE AND LINKAGES

 theoretical linkages offer a reasoned explanation of why the variables in the theory maybe
connected in some manner, which brings plausibility to the theory.
 theory structuring includes determination of the order of appearance of relationships, identification
of central relationships and delineation of direction, strength, and quality of relationships

6. ASSUMPTIONS
 are notations that are taken to be true without proof

WHAT IS A NURSING THEORY?

 a group of related concepts that derive from the nursing models/other discipline
 a conceptualization of some aspect of nursing communicated for the purpose of describing,
explaining, predicting and or prescribing nursing care.
 is an organized framework of concepts and purposes designed to guide the practice of nursing

“Systematic set of interrelated concepts, definitions and deductions that describe, explore, explain or
predict interrelationships. “ – Pinnel and Menesis

“Internally consistent group of relational statements (concepts, definitions and propositions) that
presents a systematic view about phenomenon and which is useful for description, explanation,
exploration and prediction.” – Walker and Avant

“Creative and vigorous structuring of ideas that project a tentative, purposeful and systematic view of
phenomena”. –Chinn and Krammer

CHARACTERISTICS OF A THEORY
 Creative in structure
 Articulate, systematic and logical
 Tentative in nature

USES OF A THEORY
 Guides research
 Improves nursing practice
 Facilitates communication
 To develop body of knowledge

CATEGORIES OF NURSING THEORY

 Grand Theories
 Middle Range Nursing Theories
 Practice Theories
CHARACTERISTICS
Complexity/ abstractness,
scope
Generalizability/specificity
Characteristics of
concepts
Characteristics of
propositions
Testability
Source of Development
Different views of person, health, environment and nursing by various nursing theorists
GRAND MIDDLE RANGE
Comprehensive, global Less comprehensive
viewpoint (all aspect of than grand theories,
human experience) middle view of reality
Nonspecific, general Some generalizability
application to the across settings and
discipline irrespective of specialties, but more
setting or specialty area specific than grand
theories
Concepts are abstract Limited number of
and not operationally concepts that are fairly
defined concrete and may be
operationnally defined
Proposositions not Propositions are clearly
alwayys explicit stated
Not generally testable May generate testable
hypothesis
Developed through Evolve from grand
thoughtful appraisal theories,clinical practice,
and careful literature review,
considerations over practice guidelines
many years
PRACTICE
Focused on a narrow
view of reality, simple
and straightforward
Linked to special
population or an
identified field of
practice
Single, concrete
concepts that is
operationalized
Propositions defined
Goals or outcome
defined and testable
Derived from practice
or deduced from
middle range or grand
range
  FLORENCE NIGHTINGALE

 Environmental Theory, Modern Nursing

Who is Florence Nightingale?

Nightingale became a heroine in Great Britain as a result of her work in the Crimean War. Her
depiction of the very poor sanitary conditions in the hospital wards at Scutari is overwhelming. She fought
the bureaucracy for food, bandages, fresh bedding, and cleaning supplies for the soldiers. At times she
bought supplies with her finances.

She showed concern for the comfort of the English soldier - well, injured, or sick, including supporting
the establishment of a laundry, library, assistance with letter writing, a banking system so the soldiers
could save their pay, and a hospital for the families who go with the soldiers to war. Also, she provided
comfort and security to the seriously sick and dying. Her skills in decision-making were often better than
those of many officers in the army. She spent the years after the Crimea establishing schools of nursing
and influencing public policy by lobbying her acquaintances about several of her concerns.

 Lady with the Lamp

 Mother of Modern Nursing
 First Nurse Researcher
 First Nurse Theorist

NIGHTINGALE’S ENVIRONMENTAL THEORY

NIGHTINGALE’S CANONS

 VENTILATION AND WARMTH

 Check the patient’s body temperature, room temperature, ventilation and foul odors.
 Create a plan to keep the room well-ventilated and free of odor while maintaining the patient’s
body temperature.

 LIGHT
 Check room for adequate light. Sunlight is beneficial to the patient.
 Create and implement adequate light in the room without placing the patient in direct light

 CLEANLINESS
 Check room for dust, dampness and dirt
 Keep room free from dust, dirt and dampness

 HEALTH OF HOUSES
 Check surrounding environment for fresh air, pure water, drainage, cleanliness and light.
 Remove garbage, stagnant water and ensure clean water and fresh air.

 NOISE
 Check noise level in the room and surroundings
 Attempt to keep noise level in minimum
  BED AND BEDDING
 Check bed and bedding for dampness, wrinkles and soiling.
 Keep the bed dry, wrinkle-free and lowest height to ensure comfort

 PERSONAL CLEANLINESS
 Attempt to keep the patient dry and clean at all times
 Frequent assessment of the patient’s skin is essential to maintain good skin integrity

 VARIETY
 Attempt to accomplish variety in the room and with the client.
 This is done with cards, flowers, pictures and books. Also encourage friends or relatives to
engage in stimulating activities

 CHATTERING HOPES AND ADVICES

 Avoid talking without giving advice that is without a fact.
 Respect the patient as a person and avoid personal talk.

 TAKING FOOD
 Check the diet of the patient. Note the amount of food and fluid ingested by the patient at every
meal.

 PETTY MANAGEMENT
 This ensures continuity of care
 Document the plan of care and evaluate the outcomes to ensure continuity

 OBSERVATION OF THE SICK

 Observe and record anything about the patient.
 Continue observation in the patient’s environment and make changes in the plan of care if
needed.

 Emphasis on surroundings
 Disease was a reparative process
 Manipulation of the patient’s surroundings
 Essential Components of Environment
 Two of her Major contributions were Notes in Nursing and Notes on Hospitals

METAPARADIGM

PERSON - referred to the person as a patient; a person with vital reparative powers to dealk with the
disease and is responsive to the environment

HEALTH - being well and using every power that the person has to the fullest extent; focus is on the
reparative process of getting well

ENVIRONMENT - those elements external to and which affect the health of the sick and healthy person;
all external conditions that affect the life and development of the individual
NURSING - every woman, at one time in her life, would be a nurse ; goal is to place the individual in the
best condition for nature to act by basically affecting the environment; nurse performs the task to and for
the patient

 VIRGINIA HENDERSON

 Definition of Nursing & 14 Fundamental Human Needs

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 a 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.
 American Florence Nightingale
 First Lady of Nursing
 First Truly International Nurse
 Modern Day Nightingale

14 BASIC NEEDS

Physiologic
1. Breathe normally
2. Eat & drink adequately
3. Eliminate body waste
4. Move and maintain desirable posture
5. Sleep & rest
6. Select suitable clothing, dress and undress
7. Maintain body temperature
8. Keep the body clean & well groomed & protect the integument
9. Avoid dangers in the environment & avoid injuring others
10. Communicate with others in expressing emotions, needs, fears, or opinions

Spiritual
11. Worship according to one’s faith

Sociological
12. Work in such a way that there is a sense of accomplishment
13. Play, or participate in various forms recreation
14. Learn, discover or satisfy the curiosity that leads to “normal” development and health, and use
available health facilities.

METAPARADIGM

PERSON - The individual who requires assistance to achieve health and independence or peaceful death

HEALTH - The patient’s ability to perform the 14 components of nursing care unaided or independently

ENVIRONMENT - The aggregate of all the external conditions and influences affecting the life and
development of an organism.
NURSING - “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 a 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.”

MAJOR ASSUMPTIONS

 PERSON
- The person must maintain physiological and emotional balance.
- The mind and body of the person are inseparable.
- The Patient requires help toward independence.
- The patient and his or her family is a unit.
- The Patient’s needs are encompassed by the 14 components of nursing.

 HEALTH
- Health is a quality of life
- Health is basic to human functioning
- Health requires independence and interdependence.
- Promotion of health is more important than care of the sick.
- Individuals will achieve or maintain health if they have the necessary strength, will or knowledge.

 ENVIRONMENT
- Healthy individuals may be able to control their environment, but illness may interfere with that
ability.
- Nurses should have safety education.
- Nurses should protect patients from mechanical injury.
- Nurses should minimize chances of injury through recommendation regarding construction of
buildings, purchase of equipment, and maintenance.
- Doctors use nurse’s observations and judgments as the base of their prescriptions for protection
devices.
- Nurses must know about social customs and religious practices to assess dangers.

 NURSING
- The nurse has a unique function to help sick or well individuals.
- The nurse functions as a member of a medical team.
- The nurse functions independently of the physician in attendance.
- The nurse is knowledgeable in both biological and social sciences.
- The nurse can assess basic human needs.
- The 14 components of nursing care encompass all possible functions of nursing.

GOAL OF NURSING: Assisting individuals to achieve health and independence or peaceful death
Nurse assumes the ff role:
 As a substitute for the patient (substitutive)
 As a helper for the patient (supplementary)
 As a partner with the patient (complimentary)
  FAYE GLENN ABDELLAH

 Twenty One Nursing Problems

The nurse formulates an individualized view of the client’s needs, which may occur in the following four
areas:
 Comfort, hygiene and safety.
 Physiological balance
 Psychological & social factors.
 Sociological and community factors

Abdellah’s 21 Nursing Problems

1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, sleep.
3. To promote safety through prevention of accident, injury, or other trauma and through the
prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body to disease conditions -pathological,
physiological, and compensatory.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory function.
12. To identify and accept positive and negative expressions, feelings and reactions.
13. To identify and accept interrelatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement and personal spiritual goals.
17. To create or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs.
19. To accept the optimum possible goals in the light of limitations, physical and emotional.
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors in the cause of illness.

METAPARADIGM
PERSON - The recipient of care having physical, emotional, and sociologic needs that may be overt and
covert.

HEALTH - A state that is mutually exclusive of illness.

ENVIRONMENT - Suggests that patients interact with and respond to their environment and the nurse is
part of that environment; also refers to the home or community where the patient come from

NURSING - Nursing is a helping profession.

GOAL OF NURSING
To provide service to individuals, families, and society. To be kind and caring but also intelligent,
competent, and technically well prepared to provide its service.

FRAMEWORK

Typology of 21 nursing problems

 JEAN WATSON

 Philosophy and Science of Caring, Theory of Transpersonal Caring

Ten Carative Factors

1. Formation of a humanistic-altruistic system of values.
2. Installation of faith-hope.
3. Cultivation of sensitivity to self and to others.
4. Development of a helping-trust relationship.
5. Promotion and acceptance of the expression of positive and negative feelings.
6. Systematic use of the scientific problem-solving method for decision making.
7. Promotion of transpersonal teaching-learning.
8. Provision for supportive, protective, and corrective mental, physical, sociocultural, and spiritual
environment.
9. Assistance with gratification of basic human needs.
10. Allowance for existential-phenomenological forces.

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 a 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. The practice of caring integrates biophysical
knowledge with knowledge of human behavior to generate or promote health and to provide
ministrations to those who are ill. A science of caring is therefore complementary to the science of
curing.
- The practice of caring is central to nursing. (Watson, 1979)

METAPARADIGM

PERSON - Possesses three spears; mind, body and soul

HEALTH - Unity and harmony within the mind, body and soul

ENVIRONMENT - Internal and External Environment

NURSING - To assist persons to attain a higher degree of harmony by offering caring relationships that
clients can use for personal growth and development
  DOROTHEA OREM

 Self-Care Deficit Theory of Nursing

 THEORY OF SELF CARE

To understand this theory one must first understand the concepts of:

Self-Care Is the performance or practice of activities that individual initiate and perform on their own
behalf to maintain life, health and well being

Self-Care Agency - Is the human’s acquired ability or power to engage in self-care. This ability to engage
self care is affected by: basic conditioning factors

Therapeutic Self-Care Demand - Is the TOTALITY of “care measures necessary at specific times or over
a duration of time meeting an individual’s self-care requisites by appropriate methods and related sets of
operations and actions”.

BASIC CONDITIONING FACTORS

- Age
- Gender
- Developmental state
- Health state
- Sociocultural factors
- Health care system factors
- Diagnostic & Treatment modalities
- Family system factors
- Patterns of living
- Activities regularly engaged in
- Environmental factors
- Resource adequacy and availability

SELF-CARE REQUISITES - The reason for which self-care is undertaken; they express the intended or
desired results.

THREE CATEGORIES OF SELF-CARE REQUISITES:

1. Universal
2. Developmental
3. Health Deviation

SELF-CARE REQUISITES: UNIVERSAL

- Associated with life processes
- The maintenance of the integrity of Human structure and Functioning, and with General well-
being
- Common to all human beings during all stages of the life cycle.
- Should viewed as interrelated factors, each affecting the others.
- Common term for these requisites is the: Activities of Daily Living
EIGHT ELEMENTS:
- Maintenance of a sufficient intake of air
- Intake of food
- Intake of water
- Provision of care associated with elimination
- Balance between activity & rest
- Balance between solitude and social interaction
- Prevention of hazards to human life, human functioning and human well being
- Promotion of human functioning and development

SELF-CARE REQUISITES: DEVELOPMENTAL

- Associated with human growth and developmental process and with condition and events
occurring during various stages of the life cycle.
Examples:
- Adjusting to a new job
- Adjusting to body changes such as hair loss or facial lines

SELF-CARE REQUISITES: HEALTH DEVIATION

Result from illness, injury, or disease or its treatment. Includes actions such as:seeking health care
assistance’ Carrying out prescribed therapies, Learning to live with effects of illness or treatment

In the theory of self-care: Orem explains WHAT it means by self-care and list the various factors that
affect its provision.

 THEORY OF SELF CARE DEFICIT

 Theory of Self-Care Deficit - Results when self-care agency is not adequate to meet the known
self-care demand. Delineates WHEN nursing is needed.

FIVE METHODS OF HELPING THAT NURSES MAY USE:

 Acting or doing for
 Guiding and directing
 Providing physical or psychological support
 Providing and maintaining an environment that supports personal development
 Teaching

NURSING AGENCY
 Is a complex property or attribute of people educated and trained as nurses that enables them: to
act, to know, and to help others meet their therapeutic self-care demands by exercising or
developing their own self-care agency.

THREE CLASSIFICATIONS OF NURSING SYSTEM

1. WHOLLY COMPENSATORY
 When the nurse is expected to accomplish all the patient’s therapeutic self-care or to compensate
for the patient’s inability to engage self-care or when the patient needs continuous guidance in
self-care

2. PARTLY COMPENSATORY
 When both the nurse and patient engage in meeting self-care needs.
 3. SUPPORTIVE-EDUCATIVE
 Requires assistance in decision making, behavior control and acquisition of knowledge and skills.
The patient is doing all of the self-care

METAPARADIGM

PERSON - Biopsychosocial being capable of self-care.

HEALTH - “A state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity”.

ENVIRONMENT - Requisites for self-care have their origins in human beings and the environment.

NURSING
- A creative effort of one human being to help another human being.
Consists of three nursing systems:
- Wholly compensatory,
- Partially compensatory, and
- Supportive/educative.

 MARTHA ROGERS

 Unitary Human Being

4 BUILDING BLOCKS OF CONCEPTUAL MODEL

 Energy Field - Constitute the fundamental unit of both the living and the non-living.
 Universe of Open System - Holds that energy fields are infinite, open, and integral with one
another.
 Pattern - The nature of the pattern changes continuously, innovatively, and these changes give
identity to the energy field.
 Pandimensionality - A nonlinear domain without spatial or temporal attributes.

Principles of Homeodynamics

 Principle of Resonancy: - Patterning changes with development from lower to higher frequency,
that is, with varying degrees of intensity.
 Principle of Helicy: - Spiral development in continuous, nonrepeating, and innovative patterning.
 Principle of Integrality: - The continuous mutual process of person and environment.

Includes – Principles of Reciprocy

Principles of Synchony
METAPARADIGM

PERSON - An open system in continuous process with the open system that is the environment.

HEALTH - She uses the term passive health to symbolize wellness and the absence of disease and
major illness.

ENVIRONMENT - Irreducible, pandimensional energy field identified by pattern and manifesting

characteristics different from those of the parts.

NURSING - Nursing is a learned profession, both a science and an art.

 DOROTHY JOHNSON

 Behavioral System Model

Major Concepts and Definitions

 Behavior - Output of intraorganismic structures and processes as they are coordinated and
articulated by and responsive to changes in sessory stimulation

 System - Is a whole that functions as a whole by virtue of interdependence of its parts.

 Behavioral System - Encompasses the patterned, repetitive and purposeful ways of behaving.

 Equilibrium - Stabilized but more or less transitory resting state in which the individual is in
harmony with himself and his environment.

 Tension - State of being stretched or strained and can be viewed as an end product of a
disturbance in equilibrium

 Stressor - Internal or external stimuli that produce tension and result in a degree of instability

7 SUBSYSTEMS

 ATTACHMENT/AFFILIATIVE - It forms the basis for social organization. In general provides

survival and security.

 DEPENDENCY - Promotes helping behavior that calls for a nurturing response.

 INGESTIVE- Has to do with when, how, what, how much, and under what conditions we eat.

 ELIMINATIVE - Addresses when, how and under what conditions we eliminate.

 SEXUAL - Has a dual function of procreation and gratification. Including but not limited to
courting and mating.

 ACHIEVEMENT - Attempts to manipulate the environment. Its function is control or mastery of

an aspect of self or environment to some standard of excellence.
  AGGRESSIVE/PROTECTIVE - Function is protection and preservation

FOUR STRUCTURAL ELEMENTS

 DRIVE -what goal is being sought

 SET - predisposition to act
 CHOICE - alternatives for action
 BEHAVIOR /ACTION - observable outcomes

METAPARADIGM

Person - A behavior system with patterned, repetitive, and purposeful ways of behaving that link the
person to the environment.

Health - An elusive dynamic state influenced by biological, psychological and social factors.

Environment - Consists of all factors that are not part of the individual’s behavioral system, but influence
the system.

Nursing - An external force acting to preserve the organization of the patient’s behavior.

 SISTER CALLISTA ROY

 Adaptation Model
Roy based her work on Helson’s Adaptation Theory
Is an excellent example of how borrowed knowledge becomes unique to nursing.
Roy synthesizes different (borrowed) theories, such as systems, stress, and adaptation, into a collective
view for explication of a person interacting with the environment.

Major Concepts

System - This is a set of parts connected to function as a whole for some purpose and that does so by
virtue of the interdependence of its parts.

Systems also have inputs, outputs and control and feedback processes

Adaptation Level - This represents the condition of the life processes described on the three levels as in
integrated, compensatory and compromised.

This is a constantly changing point, made up of focal, contextual and residual stimuli which represent the
person’s own standard of the range of stimuli to which one can respond with the ordinary adaptive
responses.

THIS IS MADE UP OF THE POOLED EFFECT OF THREE CLASSES OF STIMULI.

Stimulus - is any factor that provokes a response. Stimuli may arise from either the internal or external
environment.

 Focal Stimuli - The internal and external stimulus which confront the individual
 Contextual Stimuli - Other stimuli present that contribute to the effect of the focal stimulus
 Residual Stimuli - Environmental factors whose effects are unclear in a given situation.
Adaptation Problems - These are broad areas of concern related to adaptation. These describe the
difficulties related to the indicators of positive adaptation. These are seen not as nursing diagnoses, but
as areas of concern for the nurse related to adapting person or group.

Coping Processes - These are innate or acquired ways of interacting with the changing environment

Regulator Subsystem - Involves the neural, chemical, and endocrine system.

Cognator Subsystem - Involves 4 cognitive-emotive channels; perceptual, and information processing,

learning, judgment , and emotion.

Innate Coping Mechanism - These are genetically determined to the species and are generally viewed
as automatic processes; human do not have to think about them.

Acquired Coping Mechanism - These are developed through strategies such as learning.

Adaptive Responses - These promote integrity in terms of the goals of the human system.

Ineffective Responses - These do not contribute to integrity in terms of the goals of the human system.

Integrated Life Processes - This refers to the adaptation level at which the structures and functions of a
life process are working as a whole to meet human needs.

Perception - The interpretation of a stimulus and the conscious appreciation of it. Links the regulator with
the cognator and connects the adaptive modes.

Four Adaptive Modes

 Physiological-Physical Mode
 Self-Concept-Group Identity Mode
 Role Function Mode
 Interdependence Mode
METAPARADIGM

Person - adaptive system

Health - outcome of adaptation

Environment - stimuli

Nursing - promoting adaptation and health

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  BETTY NEUMAN

 SYSTEM MODEL

Major Concepts

 Lines of Resistance - Series of broken rings surrounding the basic core structure. Represent the
resource factors that help the client defend against a stressor such as the body’s immune system

 Normal Line of Defense - The model’s outer solid circle. Represents a stability state for the
individual or system

 Flexible Line of Defense - Model’s outer broken ring; Dynamic and can be rapidly altered over a
short time

 Wellness - Exists when the parts of the client system interact in harmony with the whole system.
System needs are met.

 Illness - Occurs when needs are not satisfied, resulting in a state of instability and energy
depletion.

Stressors - Tension-producing stimuli that have the potential to disrupt system stability.
 Intrapersonal forces occurring within the individual, such as conditional responses
 Interpersonal forces occurring between one or more individuals, such as role expectations.
 Extrapersonal forces occurring outside the individual, such as financial circumstances.

PREVENTION AS INTERVENTION
INTERVENTIONS ARE PURPOSEFUL ACTIONS TO HELP THE CLIENT RETAIN, ATTAIN, AND
MAINTAIN SYSTEM STABILITY

 PRIMARY PREVENTION – Health Promotion and Disease Prevention

 SECONDARY PREVENTION – Early detection and prompt treatment
 TERTIARY PREVENTION – Rehabilitation

Entropy - A process of energy depletion and disorganization moving the system toward illness or
possible death.

Negentropy - A process of energy conservation that increases organization and complexity, moving the
system toward stability or a higher degree of wellness

Reconstitution - Occurs following treatment of stressor reactions. Represent return of system to stability,
which may be at a higher or lower level of wellness than prior to stressor invasion.

Metaparadigm

Person - A client as a system that may be an individual, family, group, community, or social issue

Health - A continuum of wellness to illness that is dynamic in nature and constantly subject to change

Environment - Internal and external factors that surround or interact with the person/client

Nursing- Concerned with the whole person