ROGER`S SCIENCE OF UNITARY HUMAN BEINGS NURSING
CONCEPTUAL MODEL
INTRODUCTION
 MARTHA ROGERS` theory is known as the SCIENCE
OF UNITARY HUMAN BEINGS (SUHB).
 The theory views nursing as both as science and an
art as it provides a way to view the unitary human
being who is integral with the universe.
 The unitary human being & his or her environment
are one. Nursing focuses on people and the
manifestation that emerge from the mutual
human-environment field process.
 Her model addresses the importance of the
environment as an integral part of the patient, &
uses that knowledge to help nurses blend the
science & art of nursing to ensure patients have a
smooth recovery & that can get back to the best
health possible.
HISTORY & BACKGROUND
 Born on May 12, 1914 in Dallas Texas
 Earned a diploma in nursing from Knoxville General
Hospital in 1936
 Bachelor`s degree from George Peabody College in
Nashville, Tennessee in 1937
 After graduation in 1937, she worked for the
Children`s Fund of Michigan for 2 years as Public
Health Nurse
 In 1940, she accepted a position in Hartford, CT at
the Visiting Nurse Association for 5 years; 1 st as an
Assistant Supervisor then as an Assistant Education
Director & lastly as the Acting Director of
Education. At the same time, she was completing
her course work at Teacher`s College & completed
her degree requirements (Master`s degree)
 Master`s degree in Public Health Nursing from
Teacher`s College, Columbia University in New York
in 1945
 Master`s degree in Public Health & Doctor of
Science from The John Hopkins University in
Baltimore, Maryland in 1954
 She completed her studies in 1954
 Became the Head of the Division of Nursing of
New York University (NYU) in 1954, where she
focused her teaching & elaborating her theory
 She was a teacher & mentor to an impressive list
of nursing scholars & theorist including Newman &
Page
 Martha Rogers wrote 3 books that enriched the
learning experience & influenced the direction of
nursing research for countless students:
Educational Revolution in Nursing (1961), Reveille
in Nursing (1964)
 (1963), edited a journal called Nursing science &
also the time she formulated ideas about the
publication of her 3rd book “An Introduction to the
Theoretical Basis of Nursing (1970) and the last
introduced the 4 Rogerian Principles of
Homeodynamics.
 Martha Rogers was honored with numerous
awards and citations for her sustained
contributions to nursing & science.
 In 1996, she was posthumously inducted into the
American Nurses Association`s Hall of Fame
 Died on March 13, 1994 at the age of 80 years old
& was buried at Knoxville, Tennessee.
 She had a memorial place in the sidewalk hear her
childhood home in Knoxville
PUBLICATIONS OF MARTHA ROGERS
 Theoretical Basis of Nursing (Rogers, 1970)
 Nursing Science & Art: A Prospective (Rogers,
1988)
 Nursing Science of Unitary, Irreducible, Human
Beings Update (Rogers, 1990)
 Vision of Space Based Nursing (Rogers, 1990)
INFLUENCES ON HER THEORY
 The belief of the coexistence of the human & the
environment has greatly influenced the process of
change towards better health.
 In short, a patient can`t be separated from his/her
environment when addressing health & treatment
 This view lead & opened Martha Roger`s theory
known as “Science of Unitary Human Beings” that
allow nursing to be considered one of the scientific
disciplines
MAJOR CONCEPTS & METAPARADIGM OF MARTHA
ROGERS NURSING THEORY
HUMAN-UNITARY HUMAN BEINGS
 A person is defined as an irreducible, indivisible,
multidimensional energy fields identified by a
pattern & manifesting characteristic that are
specific to the whole & & which cannot be
predicted from knowledge of the parts.
 A person is also a unified whole, having its own
distinct characteristics that can`t be viewed by
looking at, describing or summarizing the parts
HEALTH
 She define health as an expression of the life
process.
 Unitary-human health signifies an irreducible
human field manifestation. It cannot be measured
by the parameters of biology or physics or of the
social sciences
ENVIRONMENT FIELD
 An irreducible, indivisible, pan dimensional energy
field identified by pattern & integral with the
human field.
NURSING
 The study of Unitary, irreducible, indivisible human
& environmental fields: people & their world.
 Nursing is a learned profession that is both a
science & an art
 Focus is the care of people & the life process of
human beings
 Its purpose is to identify & examine the
phenomenon that is central to its concern, the
unitary human being.
KEY CONCEPTS OF ROGERS THEORY
NURSING
The concept of nursing encompasses 2 dimensions:
1. Independent Science of Nursing
 An organized body of knowledge which is
specific to nursing is arrived by scientific
research & logical analysis
 2. 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
 Is a learned profession: it is a science & art
 The study of unitary, irreducible, indivisible human
& environment energy fields
 The art of nursing involves the imaginative &
creative use of nursing knowledge
 The purpose of nurses is to promote health and
well-being for all persons & groups wherever they
are using the science & art of nursing
 The areas of nursing services extend into all areas:
at home, at school, at work, at play, in hospital,
nursing home, clinics, in this planet & now moving
into outer space (space nursing)
ENERGY FIELD
 The fundamental unit of the living & the non-living
 Field is the unified concept
 Energy signifies the dynamic nature of the field; a
field is in continuous motion & is infinite
 The energy field continuously varies in intensity,
density & extent
OPENNESS
 Refers to qualities exhibited by open systems;
human beings & their environment are the open
systems.
 The human field & the environment field are
constantly exchanging energy. There are no
boundaries or barriers to inhibit energy flow
between fields (Rogers, 1970)
 The human beings openly participate in energy
transformation with the environment creating
mutual change (Leddy, 2004 p. 15)
PATTERN
 The distinguishing characteristics of an energy field
perceived as a single wave. Rogers call it “an
abstraction” that gives identity to the field.
 Patterning “is the dynamic or active process of the
life of the human being” that is “accessible to the
senses” (Alligood & Fawcett, 2004 p. 11)
 Pattern manifestations include “a person`s
experiences, expressions, perceptions and
physical, mental, social & spiritual data (Davidson,
2001 p. 103)
 PANDIMENSIONAL
 A nonlinear domain without spatial or temporal
attributes (Rogers, 1990 p. 7)
 The parameters in language that humans use to
describe events are arbitrary
 The present is relative, there is no temporal
ordering of lives
SYNERGY
 The unique behavior of hole systems, unpredicted
by any behaviors of their component functions
taken separately.
 Human behavior is synergistic
PRINCIPLES OF HOMEODYNAMICS
 Homeodynamics should be understood as a
dynamic version of HOMEOSTASIS (a relatively
steady state of internal operation in the living
system)
 The principles of Homeodynamics postulate the
way of perceiving unitary human beings
 The 3 principles of Homeodynamics as proposed
by Rogers are:
 Resonancy
 Helicy
 Integrality
PRINCIPLES OF HOMEODYNAMICS AS PROPOSED BY
MARTHA ROGERS
RESONANCY
 Speaks to the nature of the change occurring
between human & environmental fields that
undergoes continuous dynamic metamorphosis in
the human-environment process.
 The life process of human beings is a symphony of
rhythmical vibrations oscillating at various
frequencies.
 Is continuous change from lower to higher
frequency wave patterns in human and
environmental fields
HELICY
 Describes the unpredictable but continuous,
nonlinear evolution of energy fields as evidenced
by nonrepeating rhythmicities due to constant
interchange between human & the environment
 This change is also innovative; because of constant
interchange, an open system is never exactly the
same at any two moments; rather, the system is
continually new or different
 The life process evolves in sequential stages along
a curve that has the same general shape
 Is continuous innovative, unpredictable, increasing
diversity of human & environmental field patterns
INTEGRALITY
 Is a continuous mutual human & environment field
process
 Change occurs by continuous repatterning of the
of the human & environmental fields by resonance
waves
 The fields are one and integrated but unique to
each other
ASSUMPTIONS
 Man is a unified whole possessing his own integrity
& manifesting characteristics that are more than &
different from the sum of his parts
 Man & environment are continuously exchanging
matter & energy with one another
 The life process evolves irreversibly &
unidirectional along the space-time continuum
 Pattern & organization identify the man & reflect
his innovative wholeness
 Man is characterized by the capacity for
abstraction and imagery, language & thought
sensation & emotion
STRENGTHS
 Martha Rogers concepts provide a worldview from
which nurses may derive theories & hypotheses &
propose relationships specific to different
situations
  Rogers` theory is not directly testable due to lack
of concrete hypotheses but it is testable in
principle
LIMITATIONS
 Rogers` model does not define particular
hypotheses or theories for it is an abstract, unified
& highly derived framework
 Testing the concepts` validity is questionable
because its concepts are not directly measurable
 The theory was believed to be profound & was too
ambitious because the concepts are extremely
abstract
 Rogers claimed that nursing exists to serve people,
however, nurses roles are not clearly defined
 The purpose of nurses is to promote health & well-
being for all persons. However, Rogers` model has
no concrete definition of a health state.
APPLICATIONS TO NURSING
 Though not describing specifics, the framework set
by Rogers` theory allows nurses to operate from a
place of scientific assurance in the work they do,
all the while maintaining focus on the patients they
work with
 Rogers` theory is a useful model for addressing the
growing issue of nursing burnout, which is known
to cause increase rates of morbidity & mortality in
the clinical setting.
 Rogers` theory had a strong impact on health &
nursing. But not clearly, it is important to note that
by emphasizing both an individual`s inherent
worth as well as how that individual relates to the
environment, Rogers helped improve patient
centered nursing practice.
OREM`S SELF-CARE DEFICIT NURSING THEORY
INTRODUCTION
 DOROTHEA ELIZABETH OREM developed the SELF-
CARE DEFICIT theory. She is working towards her
goal of improving the quality of nursing in General
Hospitals in her state.
 The model interrelates concepts in such a way as
to create a different way of looking at a particular
phenomenon.
 The theory is relatively simple but generalizable to
apply to a wide variety of patients.
 This can be used by nurses to guide & improve
practice but it must be consistent with other
validated theories, laws & principles.
 DOROTHEA ELIZABETH OREM`s theory focuses on
each “individual`s ability to perform self0care,
defined as the “practice of activities that
individuals initiate & perform on their own behalf
in maintaining life, health & well-being”.
 The Self-Care Deficit theory is composed of 3
interrelated theories: (1)The theory of self-care,
(2)The self-care deficit theory, (3) The theory of
nursing systems which is further classified into
wholly compensatory, partial compensatory and
supportive educative.
HISTORY & BACKGROUND
 Born on July 15, 1914 in Baltimore, Maryland to a
father who was a construction worker & a mother
who was a homemaker. She was the youngest
among two daughters.
 She earned her nursing diploma from the
Providence Hospital School of Nursing in
Washington D.C. in 1939 & her Master of Science
in Nursing in 1945
 During her professional career, she worked as a
staff nurse, private duty nurse, nurse educator &
administrator & nurse consultant. She had a
distinguished career in nursing
 She earned several Honorary Doctorate degrees.
Among these were:
 Honorary Doctorates of Science from both
Georgetown University in 1976 and
Incarnate Word College in 1980
 Honorary Doctorate of Humane Letters
from Illinois Wesleyan University in 1988
 Doctorate Honoris Causae from the
University of Missouri in Columbia in 1998
 Dorothea Orem occupied important nursing
positions like Directorship of both the nursing
school and the department of nursing at
Providence Hospital, Detroit from 1940 to 1949
where she also teach Biological Sciences & Nursing
from 1939 to 1941
 At the Catholic University of America, Orem served
as the Assistant Professor from 1959 to 1964,
Associate Professor from 1964 to 1970, and Dean
of the School of Nursing from 1965 to 1966.
 She also served as curriculum consultant to the
Office of Education, United States Department of
Health, Education and Welfare, Practical Nurse
Section in 1958, 1959 and 1960 to the Division of
Hospital and Institutional Services, the Indiana
State Board of Health from 1949 to 1957, and to
the Center for Experimentation and Development
in Nursing, the John Hopkins Hospital 1969-1971,
and to the Director of Nursing Wilmer Clinic, the
John Hopkins Hospital, 1975-1976.
 She was a member of the group of nurse theorists
who presented Patterns of Unitary Man (Humans),
the initial framework for nursing diagnosis to the
North American Nursing Diagnosis Association in
1982.
 Orem retired in 1984 but she continued to work on
the 3rd edition which was published in 1985; 4 th
edition which was completed in 1991. She
continued to work on the conceptual development
of Self-Care Deficit Nursing Theory.
 Orem completed the 6th edition of Nursing:
Concepts of Practice, published by Mosby in
January 2001.
 Orem was given many awards during her career.
Among these were:
 The Catholic University of America Alumni
Achievement Award for Nursing Theory in
1980
 The Linda Richards Award from the
National League for Nursing in 1991
  Named an Honorary Fellow of the
American Academy of Nursing in 1992
 She also received accolades for her contributions
to the field of nursing including honorary degrees
from:
 Georgetown University
 Incarnate Word College
 Illinois Wesleyan University
 University of Missouri-Columbia
 She was inducted into the American Academy of
Nursing & received awards from the National
League for Nursing and the Sigma Theta Tau
Nursing Honor Society
 Orem died on June 22, 2007 at the age of 92 in
Savannah Georgia where she had spent her last 25
years of her life as a consultant and author.
INFLUENCES ON THEORY DEVELOPMENT
 OREM`S association with many nurses over the
years provided learning experiences. Her
collaborative work with graduate students &
colleagues were valuable contributions to her
theory
 There are instances wherein patients are
encouraged to bring out the best in them despite
being ill for a period of time.
 This is very particular in rehabilitation settings, in
which patients are entitled to be more
independent after being cared for by the
physicians and nurses
 Through these, the Self-Care Nursing Theory or the
Orem Model of Nursing was developed by
Dorothea Orem between 1959 and 2001
 OREM also cited other nurses who had valuable
contributions to nursing such as Nightingale,
Henderson, Abdellah & to name a few.
 She also acknowledged the contributions of
authors from other disciplines such as Barnard,
Selye, Bertalanffy & others
MAJOR CONCEPTS
HUMAN BEING/PERSON
 Defined as “men, women and children cared for
either singly or as social units”, and are the
“material object” of nurses & others who provide
direct care.
 Human being has the capacity to reflect, symbolize
& use symbols
 Are conceptualized as a total being with universal,
developmental needs & capable of continuous self-
care.
 Man is an integrated whole that can function
biologically, symbolically & socially
 A patient is an individual who is in need of
assistance in meeting specific health-care demands
because of lack of knowledge, skills, motivation or
orientation.
 For a human being to be considered as a patient,
the following conditions must be met:
 There must be some self-care demand to
be met for another person
 The individual must be motivated that
after medical or nursing interventions, the
person will be able to adapt some self-
caring behaviors
 The individual is currently unable to meet
self-care requisites
 Simply put an individual to constantly strive &
maintain a balance between his ability to achieve
self-car abilities and the self-care demands
HEALTH
 Is “being structurally and functionally whole or
sound”
 Is a state that encompasses both the health of
individuals and of groups.
 Human health is the ability to reflect on one`s self,
to symbolize experience and to communicate with
others.
 The essence of health is the capacity to live as a
human being within one`s physical, biological &
social environment, achieving some measures of
human life potential that contribute to the
maintenance & promotion of structural integrity,
functioning & development.
 Is the responsibility of total society and all its
members
ENVIRONMENT
 Has physical, chemical and biological features. It
includes the family, culture and community
 Encompasses elements external to man. Men &
environment are considered an integrated system.
 These are environmental conditions conducive to
development.
 Opportunities to be helped by being with
other persons or groups where care is
offered
 Available opportunities for solitude &
companionship
 Provision of help for personal & group
concerns without limiting individual
decisions & personal pursuits
 Shared respects, belief & trust
 Recognition & fostering of developmental
potential
NURSING
 Is an art with the practitioner of nursing gives
specialized assistance to persons with disabilities
that makes more than ordinary assistance
necessary to meet needs for self-care.
 The nurse also intelligently participates in the
medical care, the individual receives from the
physician
 Orem defined nursing as a service, art and a
technology
 Nursing is a SERVICE of deliberately selected &
performed actions to assist individuals or groups to
maintain self-care including structural integrity,
functioning & development. It is the grieving
assistance to a person when he is unable to meet
his own self-care needs
 The ART of nursing is the ability to assist others in
the design, provision & management of systems of
self-care to improve or maintain human
functioning at some level of effectiveness.
  As an ART nursing has an intellectual aspect– the
discernment of obstacle to care & planning for
what can be done to overcome them
 The ART of nursing according to OREM needs to
include:
 The art of helping
 The method of helping
 Helping techniques appropriate to
situations
 Nursing systems
 OREM identified 5 Methods of helping or assisting
that nurses must be aware of:
 Acting for or doing for another
 Guiding another
 Supporting another
 Providing an environment that promotes
personal development in relation to
becoming able to meet present or future
demands for action
 Teaching another
 Orem also described nursing as a TECHNOLOGY.
She stated “nursing has formalized methods or
techniques of practice, clearly described ways of
performing specific actions so that some particular
result will be achieved.
 Techniques of nursing must be learned; skills &
expertness in their use must be developed by
persons who pursue nursing as a career
 These techniques include those concerned with:
1. Communicating with persons in states of health
or disease
2. Bringing about & maintaining interpersonal,
intragroup &
intergroup relations for cooperative efforts
3. Giving human assistance adapted to specific
human needs
& limitations
4. Bringing about maintaining & controlling the
position and
movements of persons in a physical
environment for
therapeutic purposes.
5. Sustaining & maintain life processes
6. Promoting processes of human growth &
development
7. Appraising, changing & controlling psychological
modes of
human functioning in health and disease
8. Bringing about & maintaining therapeutic
relations based
on psychosocial mode of human functioning in
health &
disease.
 Orem stated that although nurses use this
technique, they are confined to nursing as nurses
works directly with the needs of the patient, in
close relation to his total living situation, provides
direct need fulfillment, functions on the basis of
holistic philosophy in assessing the areas of need,
identifying and utilizing resources for needs
fulfillment.
KEY CONCEPTS
THEORIES
 The Self-Care of Self-Care Deficit Theory of nursing
is composed of 3 interrelated theories:
 The Theory of Self- Care
 The Self-Care Deficit Theory
 The Theory of Nursing Systems
 These theories are further classified into wholly
compensatory, partial compensatory & supportive-
educative.
THEORY OF SELF-CARE
 THEORY OF SELF-CARE
 This theory is basic to the understanding of the
Self-Care deficit & the Theory of the Nursing
System
 This theory focuses on the performance or practice
of activities that individuals initiate & perform on
their own behalf to maintain life, health & well-
being.
 This includes:
 Self-Care
 Self-Care Agency
 Therapeutic Self-Care Demand
 Self-Care Requisites
 SELF-CARE
 According to Orem, SELF-CARE means the
practice of activities that individuals
personally initiate & perform on their own
behalf in maintaining life, health & well-being.
 It is a behavior that exists in concrete life
situations focused on the self, group or the
environment to regulate factors that affect
their development & functioning in the
interest of life, health & well-being.
 SELF-CARE AGENCY
 Is defined as the complex acquired ability to
meet one`s continuing requirements for care
that regulates life processes; maintains or
promotes integrity of human structure,
functioning & development and promotes
well-being.
 An AGENT is a person taking action
 A SELF-CARE AGENT is the provider of self-care
 A DEPENDENT SELF- CARE is the provider of
infant care or dependent adult care.
 THERAPEUTIC SELF-CARE DEMAND
 Is the humanly constructed entity with an
objective basis in information that describes
an individual structurally, functionally &
developmentally.
 It is based on the theory that self-care is a
human regulatory function which is derived
from facts & theories from the social &
environmental sciences.
 It is essentially a prescription for continuous
self-care action that effectively meets
identified self-care requisites.
 SELF-CARE REQUISITES
 Are expressions of purpose to be attained, or
results directed from deliberate engagement
in self-care.
 They are actions directed toward the provision
of self-care. It is presented in 3 categories:
 o Universal self-care requisites
o Developmental self-care requisites
o Health-deviation self-care requisites
1. UNIVERSAL SELF-CARE REQUISITES
 Common to all ADLs (Activities of Daily Living) of
the human beings associated with life processes &
the maintenance of integrity of human structure &
functioning
 Identify these requisites as:
o The maintenance of sufficient intake of air
o The maintenance of sufficient intake of water
o The maintenance of sufficient intake of food
o The provision of care associated with
elimination process & excrements
o The maintenance of a balance between
activity & rest
o The maintenance of a balance between
solitude & social
o interaction
o The prevention of hazards to human life,
human
o functioning & human well-being
o The promotion of human functioning &
development within social groups in accord
with human potential, known human
limitations, & the human desire to be normal
 These 8 requisites represent the essential physical,
social & spiritual elements of life. These are
important to human structure & functioning.
2. DEVELOPMENTAL SELF-CARE REQUISITES
 Are either specialized expressions of universal self-
care requisites that have been particularized for
developmental processes
 They are associated with developmental processes
derived from a condition or associated with an
event such as adjusting to a new job, adjusting to
body changes.
 2 Categories of Developmental Self-Care Requisites
o Conditions that support life processes and
promote specific developmental stages that
include:
 Intra-uterine life & death
 Neonatal life, whether born term or
premature, with normal or low birth
weight
 Infancy
 Childhood, adolescence & early
adulthood
 Pregnancy either childhood or adulthood
o Conditions affecting human development
consisting of 2 sub-types:
 a. The provision of care to prevent
occurrence of deleterious effects of these
adverse conditions
 E.g. provision of adequate nutrition &
care during infancy
 b. The provision of care to prevent or
overcome existing
 deleterious effects of particular conditions
or life events such as parenting, change in
socio-economic status which may include:
a) Educational deprivation
b) Problem in social adaptation
c) Loss of relatives, friends or associates
d) Loss of possessions or one`s job
e) A sudden change in living conditions
f) A change in status, either social or
economic
g) Poor health, poor living conditions or
disability
h) Terminal illness or expected death
i) Environmental hazards
3. HEALTH-DEVIATION SELF-CARE REQUISITES
 Are required in conditions of illness, injury or
disease or may result from medical measures
required to diagnose and correct the condition
like:
o Seeking & securing appropriate medical
assistance
o Being aware of and attending to the effects &
results of pathologic conditions & states
o Effectively carrying out medically prescribed
diagnostic, therapeutic & rehabilitative
measures
o Being aware of & attending to or regulating
the discomfort or deleterious effects of
prescribed medical measures
o Modifying the self-concept(self-image) in
accepting oneself as being in a particular state
of health and in need of specific forms of
health care
o Learning to live with the effects of pathologic
conditions & states and the effects of medical
diagnostic & treatment measures in a lifestyle
that promotes continued personal
development
THEORY OF SELF-CARE DEFICIT
 Is the critical constituent of Orem`s theory.
 It has its origin in the proper object of nursing:
human beings who are subject to health-deprived
or health-related limitations for engagement in
self-care or dependent care
 Orem identified 5 methods of helping:
o Acting for & doing for others
o Guiding others
o Supporting another
o Providing an environment to promote
patient`s ability
o Teaching another
 The central idea of this theory states that all
limitations or persons engaging in practical nursing
endeavors are associated with subjectivity of
mature & maturing individuals to health-related or
health-derived action limitations.
 These limitations render them completely or
partially unable to know existent & emerging
requisites for regulatory care for themselves or
their dependents.
 These limitations also prevent them from engaging
in the continuing performance of care measures to
control or in some way manage factors that are
regulatory of their own or their dependent`s
functioning and development
  Self-Care Deficit is the qualitative or quantitative
inadequacy of the self-care agency as related to
therapeutic self-care demand.
 It exists when therapeutic self-care demand cannot
be met entirely by the self-care agent. This can be
actual or potential.
 E.g. In case of a teenage pregnancy-the actual
infant-care deficit is the parent`s lack of knowledge
on how to provide physical care for the newborn
while the potential infant-care deficit could result
in increased risk of newborn neglect.
THEORY OF NURSING SYSTEMS
 This theory is a product of a series of relations
between the persons: legitimate nurse &
legitimate client.
 This system is activated when the client`s
therapeutic self-care demand exceeds available
self-care agency leading to the need for nursing.
 Nursing systems are the approaches nurses used to
assists patients with deficits in self-care due to a
condition of health.
 OREM identified the 3 classifications of nursing
systems to meet the self-care requisites of the
patient:
o Wholly Compensatory Nursing System
o Partially Compensatory Nursing System
o Supportive-educative System
CLASSIFICATIONS OF NURSING SYSTEMS
WHOLLY COMPENSATORY SYSTEM
 The patient is independent
 The nurse is expected to accomplish all the
patients therapeutic self-care or to compensate for
the patient`s inability to engage in self-care or
when the patient needs continuous guidance in
self-care
 E.g. The patient is unconscious because he had
stroke (cerebrovascular accident). The nurse
provides a total care for the patient like feeding,
hygiene, turning, elimination, suctioning of
secretions to maintain effective respiration,
promoting safety, providing exercises of joints &
body parts
PARTIALLY COMPENSATORY SYSTEM
 The patient can meet some needs. Needs nursing
assistance.
 Both the nurse & the patient engage in meeting
self-care needs
 E.g. the patient fell from the stairs in his school and
had fracture on his right leg. His leg is now on cast.
The patient do self-care activities like eating,
drinking but needs assistance with bathing,
toileting, transfer & mobility until he learns how to
use crutches properly
SUPPORTIVE-EDUCATIVE SYSTEM
 The patient can meet self-care requisites but needs
assistance with decision-making or knowledge and
skills to learn self-care
 E.g. The patient is pregnant for the 1st time. The
physician told her that her pregnancy is normal.
The patient is capable of self-care but she needs to
learn self-care for pregnancy like nutrition,
activity/rest/exercise, relief of common discomfort
of pregnancy, schedule of pre-natal check-up, labor
& delivery, post-partum care & baby`s care.
STRENGTHS
 A major strength of Orem`s theory is that it is
applicable for nursing by the beginning practitioner
as well as the advanced clinicians
 Orem`s theory provides a comprehensive basis for
nursing practice. It has utility for professional
nursing in the areas of nursing practice, nursing
education & administration.
 The terms self-care, self-deficit & nursing systems
are easily understood by the beginning student
nurses and can be explored in greater depth as the
nurse gains more knowledge & experience.
 STRENGTHS
 Orem specifically defines when nursing is needed:
Nursing is needed when the individual cannot
maintain continuously that amount & quality of
self-care necessary to sustain life & health, recover
from disease or injury, or cope with their effects
 Her self-care approach is contemporary with the
concepts of health promotion and health
maintenance.
 The 3 identifiable nursing systems were clearly
delineated and are easily understood.
LIMITATIONS
 Orem`s theory in general, is viewed as a single
whole thing while Orem defines system as a single
whole thing.
 Orem`s theory is simple yet complex. The use of
self-care in multitudes of terms, such as self-care
agency, self-care demand, self-care deficit, self-
care requisites and universal self-care can be very
confusing to the reader
 Orem`s definition of health was confined in 3 static
conditions which she refers to “concrete nursing
system” that connotes rigidity
 Throughout her work, there is limited
acknowledgement of the individual`s emotional
needs
 Health is often viewed as dynamic and ever-
changing
APPLICATIONS TO NURSING PRACTICE,
EDUCATION & RESEARCH
 Orem`s theory was used as a basis for clinical
practice in varied settings.
 It motivated the establishment of independent
nurse practice, in several outpatient clinics, nursing
homes and within the acute care settings
 Orem included skilled observation, delineated the
professional and technical levels of nursing
practice and put emphasis on the intellectual
aspects of the nursing practice
 Orem`s theory has been the focus of the
curriculum in many schools of nursing in the
United States
 It provides considerable direction to nursing
education and delineates many of the skills,
techniques & methods which must be learned to
become a nurse practitioner.
 It also defines the basic system within which the
nurse practices, and the group of nursing diagnosis
 which are used to select and design appropriate
self-care actions within the appropriate nursing
system
 Orem`s theory has also provided the conceptual
framework for researchers done by several
authors.
 It served as a basis for the outcome criteria of
researches and as a Likert scale questionnaire for
clinical assessment
 It is used for the development of criteria to
measure nursing practice in various situations.
SISTER CALLISTA ROY ADAPTATION MODEL
HISTORY & BACKGROUND
 Sister Callista Roy, a member of the Sisters of Saint
Joseph of Carondelet, was born on October 14,
1939, in Los Angeles, California.
 She received a bachelor’s degree in nursing in 1963
from Mount Saint Mary’s College in Los Angeles
and a master’s degree in nursing from the
University of California, Los Angeles, in 1966.
 After earning her nursing degrees, Roy began her
education in sociology, receiving both a master’s
degree in sociology in 1973 and a doctorate degree
in sociology in 1977 from the University of
California.
 While working toward her master’s degree, Roy
was challenged in a seminar with Dorothy E.
Johnson to develop a conceptual model for
nursing.
 While working as a pediatric staff nurse, Roy had
noticed the great resiliency of children and their
ability to adapt in response to major physical and
psychological changes.
 Roy was impressed by adaptation as an
appropriate conceptual framework for nursing.
 Roy developed the basic concepts of the model
while she was a graduate student at the University
of California, Los Angeles, from 1964 to 1966.
 Roy began operationalizing her model in 1968
when Mount Saint Mary’s College adopted the
adaptation framework as the philosophical
foundation of the nursing curriculum.
CAREER MILESTONES
 Roy was an associate professor and chairperson of
the Department of Nursing at Mount Saint Mary’s
College until 1982.
 She was promoted to the rank of professor in 1983
at both Mount Saint Mary’s College and the
University of Portland. She helped initiate and
taught in a summer master’s program at the
University of Portland.
 From 1983 to 1985, she was a Robert Wood
Johnson postdoctoral fellow at the University of
California, San Francisco, as a clinical nurse scholar
in neuroscience.
 She conducted research on nursing interventions
for cognitive recovery in head injuries and on the
influence of nursing models on clinical decision
making.
 In 1987, Roy began the newly created position of
nurse theorist at Boston College School of Nursing
BOOKS & WORKS PUBLISHED
 Roy has published many books, chapters, and
periodical articles and has presented numerous
lectures and workshops focusing on her nursing
adaptation theory (Roy & Andrews, 1991).
 The refinement and restatement of the Roy
Adaptation Model is published in her 1999 book,
The Roy Adaptation Model (Roy & Andrews, 1999).
ACHIEVEMENTS & AWARDS
 Received the National Founder’s Award for
Excellence in Fostering Professional Nursing
Standards in 1981.
 Received an Honorary Doctorate of Humane
Letters from Alverno College (1984), honorary
doctorates from Eastern Michigan University
(1985) and St. Joseph’s College in Maine (1999)
 Received American Journal of Nursing Book of the
Year Award for Essentials of the Roy Adaptation
Model (Andrews & Roy, 1986).
 Roy has been recognized as:
o The World Who’s Who of Women (1979);
o Personalities of America (1978);
o Fellow of the American Academy of Nursing
(1978);
o Recipient of a Fulbright Senior Scholar Award
from the Australian American Educational
Foundation (1989), )
 Received the Martha Rogers Award for Advancing
Nursing Science from the National League for
Nursing (1991).
 Received the Outstanding Alumna award and the
prestigious Carondelet Medal from her alma
mater, Mount Saint Mary’s.
 The American Academy of Nursing honored Roy for
her extraordinary life achievements by recognizing
her as a Living Legend (2007), named a Living
Legend by the American Academy of Nursing and
the Massachusetts Registered Nurses Association.
 2010 – Inductee, Sigma Theta Tau International
Nurse Researcher Hall of Fame
 2010 – “Sixty Who have Made a Difference”, UCLA
School of Nursing, 6th Anniversary
 2010 – Inducted to Nurse Researcher Hall of Fame,
Inaugural Class, Sigma Theta Tau International,
Honor Society of Nursing
 2010 – University of Southern Alabama Picture
Gallery of Theorist, University of Alabama
 2011 – The Sigma Mentor Award, Sigma Theta Tau
International Alpha Chi Chapter
 2011 – Faculty Senior Scientist Poster Exemplar
Award, Yvonne L. Munn Center for Nursing
Research and the Nursing Research Expo
Committee, Massachusetts General Hospital
 2011 – Nursing Science Quarterly Special Issue
Honoring the work of Callista Roy, Vol. 24, Num. 4,
Oct. 2011
 2013 – Excellence in Nursing, The University of
Antioquia, Medellin Colombia
 2013 – Alumni Award for Professional
Achievement, UCLA
 2013 – Honorary Doctoral Degree, Holy Family
University
  2013 – Distinguished Graduate Award, Bishop
Conaty/Our Lady of Loretto High School
INFLUENCES ON HER THEORY
 Roy’s model was conceived when nursing theorist
Dorothy Johnson challenged her students during a
seminar to develop conceptual models of nursing.
Johnson’s nursing model was the impetus for the
development of Roy’s Adaptation Model.
 Roy’s model incorporated concepts from
Adaptation-level Theory of Perception from
renown American physiological psychologist Harry
Helson, Ludwig von Bertalanffy’s System Model,
and Anatol Rapoport’s system definition.
THEORETICAL SOURCES
 Roy combined Helson’s work with Rapoport’s
definition of system
 to view the person as an adaptive system.
 With Helson’s adaptation theory as a foundation,
Roy (1970) developed and further refined the
model with concepts and theory from
Dohrenwend, Lazarus, Mechanic, and Selye.
 Roy gave special credit to co-authors Driever, for
outlining subdivisions of self-integrity, and
Martinez and Sato, for identifying common and
primary stimuli affecting the modes.
MAJOR CONCEPTS OF THE THEORY
PERSON
 “Human systems have thinking and feeling
capacities, rooted in consciousness and meaning,
by which they adjust effectively to changes in the
environment and, in turn, affect the environment.”
 Based on Roy, humans are holistic beings that are
in constant interaction with their environment.
Humans use a system of adaptation, both innate
and acquired, to respond to the environmental
stimuli they experience. Human systems can be
individuals or groups, such as families,
organizations, and the whole global community.
HEALTH
 “Health is not freedom from the inevitability of
death, disease, unhappiness, and stress, but the
ability to cope with them in a competent way.”
 Health is defined as the state where humans can
continually adapt to stimuli. Because illness is a
part of life, health is the result of a process where
health and illness can coexist. If a human can
continue to adapt holistically, they will be able to
maintain health to reach completeness and unity
within themselves. If they cannot adapt
accordingly, the integrity of the person can be
affected negatively.
ENVIRONMENT
 “The conditions, circumstances and influences
surrounding and affecting the development and
behavior of persons or groups, with particular
consideration of the mutuality of person and
health resources that includes focal, contextual
and residual stimuli.”
 The environment is defined as conditions,
circumstances, and influences that affect the
development and behavior of humans as an
adaptive system. The environment is a stimulus or
input that requires a person to adapt. These
stimuli can be positive or negative.
 Roy categorized these stimuli as focal, contextual,
and residual. Focal stimuli are that which
confronts the human system and requires the most
attention. Contextual stimuli are characterized as
the rest of the stimuli that present with the focal
stimuli and contribute to its effect. Residual
stimuli are the additional environmental factors
present within the situation, but whose effect is
unclear. This can include previous experience with
certain stimuli.
NURSING
 “[The goal of nursing is] the promotion of
adaptation for individuals and groups in each of
the four adaptive modes, thus contributing to
health, quality of life, and dying with dignity.”
 In Adaptation Model, nurses are facilitators of
adaptation. They assess the patient’s behaviors for
adaptation, promote positive adaptation by
enhancing environment interactions and helping
patients react positively to stimuli. Nurses
eliminate ineffective coping mechanisms and
eventually lead to better outcomes.
KEY CONCEPTS OF THE THEORY
ADAPTATION
 Adaptation is the “process and outcome whereby
thinking and feeling persons as individuals or in
groups use conscious awareness and choice to
create human and environmental integration.”
 The person is able to adapt if he is able to cope
with the constantly changing environment through
two types of system:
1. Regulator
o The regulator subsystem is a person’s
physiological coping mechanism. It’s the
body’s attempt to adapt via regulation of
our bodily processes, including
neurochemical, and endocrine systems.
2. Cognator
o The cognator subsystem is a person’s
mental coping mechanism.
o A person uses his brain to cope via self-
concept, interdependence, and role
function adaptive modes.
 The level of adaptation of a person is determined
by the combined effect of stimuli which could
either be:
o Focal stimuli are those that immediately
confront the person e.g. Pricking of the skin
during injection
o Contextual stimuli are all other stimuli present
or contributing factors in the situation, e.g.
inability to explain the procedure and the
need for the drug
o Residual stimuli are unknown factors such as
beliefs, attitudes, or traits that have an
intermediate effect or influence on the
present situation, e.g. the false belief that a
patient cannot take a bath after undergoing a
procedure such as x - ray
FOUR ADAPTIVE MODES
  The four adaptive modes of the subsystem are how
the regulator and cognator mechanisms are
manifested; in other words, they are the external
expressions of the above and internal processes.
1. Physiologic-Physical Mode
 Physical and chemical processes involved in the
function and activities of living organisms. These
are the actual processes put in motion by the
regulator subsystem.
 The basic need of this mode is composed of the
needs associated with oxygenation, nutrition,
elimination, activity and rest, and protection.
The complex processes of this mode are associated
with the senses, fluid and electrolytes, neurologic
function, and endocrine function.
2. Self-Concept Group Identity Mode
 In this mode, the goal of coping is to have a sense
of unity, meaning, the purposefulness in the
universe, as well as a sense of identity integrity.
This includes body image and self-ideals.
3. Role Function Mode
 This mode focuses on the primary, secondary and
tertiary roles that a person occupies in society, and
knowing where he or she stands as a member of
society, e.g. role of a mother, father…
4. Interdependence Mode
 This mode focuses on attaining relational integrity
through the giving and receiving of love, respect
and value. This is achieved with effective
communication and relations.
LEVELS OF ADPATATION
1. Integrated Process
2. The various modes and subsystems meet the needs of
the environment. These are usually stable processes (e.g.,
breathing, spiritual realization, successful relationship).
3. Compensatory Process
 The cognator and regulator are challenged by the
needs of the environment, but are working to
meet the needs (e.g., grief, starting with a new job,
compensatory breathing).
4. Compromised Process
 The modes and subsystems are not adequately
meeting the environmental challenge (e.g.,
hypoxia, unresolved loss, abusive relationships).
ASSUMPTIONS OF THE THEORY
SCIENTIFIC ASSUMPTIONS
 Systems of matter and energy progress to higher
levels of complex self-organization.
 Consciousness and meaning are constructive of
person and environment integration.
 Awareness of self and environment is rooted in
thinking and feeling.
 Humans by their 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 relationships.
 Persons 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 the 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.
STRENGTHS OF THE THEORY
 The Adaptation Model of Callista Roy suggests the
influence of multiple causes in a situation, which is
a strength when dealing with multi-faceted human
beings.
 The sequence of concepts in Roy’s model follows
logically. In the presentation of each of the key
concepts, there is the recurring idea of adaptation
to maintain integrity. Every concept was
operationally defined.
 The concepts of Roy’s model are stated in relatively
simple terms.
 A major strength of the model is that it guides
nurses to use observation and interviewing skills in
doing an individualized assessment of each person.
The concepts of Roy’s model are applicable within
many practice settings of nursing.
LIMITATIONS OF THE THEORY
 Strengths of the Roy’s Adaptation Model
 Painstaking application of the model requires
significant input of time and effort.
 Roy’s model has many elements, systems,
structures and multiple concepts.
 As one of the weaknesses of the theory that
application of it is time-consuming, application of
the model to emergency situations requiring quick
action is difficult to complete. The individual might
have completed the whole adaptation process
without the benefit of having a complete
assessment for thorough nursing interventions.
 Adaptive responses may vary in every individual
and may take a longer time compared to others.
Thus, the span of control of nurses may be
impeded by the time of the discharge of the
patient.
APPLICATION TO NURSING PRACTICE,
EDUCATION & RESEARCH
 Roy’s model is a valuable theory for nursing
practice because it includes a goal that is specified
as the aim for activity and prescription of activities
to attain the goal. The goal of the model is the
person’s adaptation in four adaptive modes in the
situations of health and illness. The prescriptions
or interventions are the management of stimuli by
removing, increasing, decreasing or altering them.
These prescriptions can be obtained by listing
practice related hypothesis generated by the
model
  Roy’s model can serve as a basis for student nurses
who render care for clients to promote adaptation
with regard to their adaptive modes. Through this
model, clarification of objective, identification
technique and specification of patterns for
teaching and learning can be achieved.
 Roy’s model was used extensively to guide
knowledge development through nursing research.
Roy together with her colleagues obtained a
typology of adaptation problems or nursing
diagnosis in which research and testing is
considered necessary.
DOROTHY JOHNSON`S BEHAVIORAL SYSTEMS MODEL
HISTORY & BACKGROUND
 Dorothy Johnson was born on August 21, 1919 in
Savannah, Georgia.
 She was the youngest of seven children.
 Her father was the superintendent of a shrimp and
oyster factory and her mother was very involved
and enjoyed reading.
 In 1938, she finished her associate degree in
Armstrong Junior College in Savannah, Georgia.
 Due to the Great Depression, she took a year off
from school to be a governess, or teacher, for two
children in Miami, Florida. This is when she began
to realized her love for children, nursing and
education.
 Dorothy Johnson’s professional nursing career
began in 1942 when she graduated from
Vanderbilt University School of Nursing in in
Nashville, Tennessee. She was the top student in
her class and received the prestigious Vanderbilt
Founder’s Medal.
 In 1948, she received her Master in public health
from Harvard University in Boston, Massachusetts.
 After graduation, Dorothy Johnson’s professional
experiences involved mostly teaching, although
she was a staff nurse at the Chatham-Savannah
Health Council from 1943 to 1944.
 She was an instructor and an assistant professor in
pediatric nursing at Vanderbilt University School of
Nursing.
 From 1949 until her retirement in 1978 and her
subsequent move to Key Largo, Florida, Johnson
was an assistant professor of pediatric nursing, an
associate professor of nursing, and a professor of
nursing at the University of California, Los Angeles.
 In 1955 and 1956, Johnson was a pediatric nursing
advisor assigned to the Christian Medical College
School of Nursing in Vellore, South India. From
1965 to 1967, she served as chairperson on the
committee of the California Nurses Association
that developed a position statement on
specifications for the clinical specialist.
 Dorothy Johnson was a prolific writer on the
subject of nursing theory.
 Her many publications on this subject profoundly
influenced theoretical thinking in nursing during
the second half of the twentieth century.
 Johnson’s publications include four books, more
than 30 articles in periodicals, and many papers,
reports, proceedings, and monographs.
 She held a strong conviction that continuing
improvement of care was the ultimate goal of
nursing.
 Her 1968 paper, entitled, One Conceptual Model of
Nursing, is a classic contribution to Nursing
literature.
 Two of the many works written by Johnson
include: Theory Development: What, Why,
How? and Barriers and Hazards in Counseling.
 Of the many honors she received, Dorothy Johnson
was proudest of the 1975 Faculty Award from
graduate students, the 1977 Lulu Hassenplug
Distinguished Achievement Award from the
California Nurses Association, and the 1981
Vanderbilt University School of Nursing Award for
Excellence in Nursing.
 Dorothy Johnson died in February 1999 at the age
of 80. Before she died, she was pleased that her
theory had been found useful in furthering the
development of a theoretical basis for nursing and
was being used as a model for nursing practice on
an institution-wide basis, but she reported that her
greatest source of satisfaction came from following
the productive careers of her students.
INFLUENCES ON HER THEORY
 Johnson’s model was greatly influenced
by Florence Nightingale’s book, Notes on Nursing.
 It advocates the fostering of efficient and effective
behavioral functioning in the patient to prevent
illness and stresses the importance of research-
based knowledge about the effect of nursing care
on patients.
 Her model was also influenced by observational
studies and on child and adult behavioral patterns
that were available during the time.
 The General Systems Theory also influenced the
development of her model.
MAJOR CONCEPTS OF THE THEORY
HUMAN BEINGS
 Johnson views human beings as having two major
systems: the biological system and the behavioral
system. It is the role of medicine to focus on the
biological system, whereas nursing’s focus is the
behavioral system.
 The concept of human being was defined as a
behavioral system that strives to make continual
adjustments to achieve, maintain, or regain
balance to the steady-state that is adaptation.
HEALTH
 Health is seen as the opposite of illness, and
Johnson defines it as “some degree of regularity
and constancy in behavior, the behavioral system
reflects adjustments and adaptations that are
successful in some way and to some degree…
adaptation is functionally efficient and effective.”
ENVIRONMENT
 Environment is not directly defined, but it is
implied to include all elements of the surroundings
 of the human system and includes interior
stressors.
NURSING
 Nursing is seen as “an external regulatory force
which acts to preserve the organization and
integration of the patient’s behavior at an optimal
level under those conditions in which the behavior
constitutes a threat to physical or social health, or
in which illness is found.”
KEY CONCEPTS OF THE THEORY
BEHAVIORAL SYSTEM
 Man is a system that indicates the state of the
system through behaviors.
SYSTEM
 That which functions as a whole by virtue of
organized independent interaction of its parts.
SUBSYSTEM
 A mini system maintained in relationship to the
entire system when it or the environment is not
disturbed.
STRUCTURE
 The parts of the system that make up the whole.
VARIABLES
 Factors outside the system that influence the
system’s behavior, but which the system lacks
power to change.
BOUNDARIES
 The point that differentiates the interior of the
system from the exterior.
HOMEOSTASIS
 Process of maintaining stability.
STABILITY
 Balance or steady-state in maintaining balance of
behavior within an acceptable range.
STRESSOR
 A stimulus from the internal or external world that
results in stress or instability.
TENSION
 The system’s adjustment to demands, change or
growth, or to actual disruptions.
INSTABILITY
 State in which the system output of energy
depletes the energy needed to maintain stability.
SET
 The predisposition to act. It implies that despite
having only a few alternatives from which to select
a behavioral response, the individual will rank
those options and choose the option considered
most desirable.
FUNCTION
 Consequences or purposes of action.
7 SUBSYSTEMS IN JOHNSON`S BEHAVIORAL SYSTEM
MODEL
1) ATTACHMENT OR AFFILIATIVE SUBSYSTEM
 Attachment or affiliative subsystem is the “social
inclusion, intimacy and the formation and
attachment of a strong social bond.”
 It is probably the most critical because it forms the
basis for all social organization.
 On a general level, it provides survival and security.
 Its consequences are social inclusion, intimacy, and
the formation and maintenance of a strong social
bond
2) DEPENDENCY SUBSYSTEM
 Dependency subsystem is the “approval, attention
or recognition and physical assistance.”
 In the broadest sense, it promotes helping
behavior that calls for a nurturing response.
 Its consequences are approval, attention
or recognition, and physical assistance.
 Developmentally, dependency behavior evolves
from almost total dependence on others to a
greater degree of dependence on self.
 A certain amount of interdependence is essential
for the survival of social groups.
3) INGESTIVE SUSBSYSTEM
 Is the “emphasis on the meaning and structures of
the social events surrounding the occasion when
the food is eaten.”
 It should not be seen as the input and
output mechanisms of the system.
 All subsystems are distinct subsystems with their
own input and output mechanisms.
 The ingestive subsystem “has to do with when,
how, what, how much, and under what conditions
we eat.”
4) ELIMINATIVE SUBSYSTEM
 Eliminative subsystem states that “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.”
 It addresses “when, how, and under what
conditions we eliminate.”
 As with the ingestive subsystem, the social and
psychological factors are viewed as influencing the
biological aspects of this subsystem and may be, at
times, in conflict with the eliminative subsystem.
5) SEXUAL SUBSYSTEM
 Sexual subsystem is both a biological and social
factor that affects behavior.
 It has the dual functions of procreation and
gratification.
 Including, but not limited to, courting and mating,
this response system begins with the development
of gender role identity and includes the broad
range of sex-role behaviors.
6) AGGRESSIVE SUBSYSTEM
 Aggressive subsystem relates to the behaviors
concerning protection and self-preservation,
generating a defense response when there is a
threat to life or territory.
 Its function is protection and preservation.
 Society demands that limits be placed on modes of
self-protection and that people and their property
be respected and protected.
7) ACHIEVEMENT SUBSYSTEM
 Achievement subsystem provokes behavior that
tries to control the environment.
 It attempts to manipulate the environment.
  Its function is control or mastery of an aspect of
self or environment to some standard of
excellence.
 Areas of achievement behavior include intellectual,
physical, creative, mechanical, and social skills.
 NOTE: an eight subsystem, restorative is added.
The restorative subsystem is concerned with rest,
sleep, comfort/freedom from pain
o Each subsystem has three functional requirements
namely:
o The system must be protected from toxic
influences with which the system cannot
cope.
o Each system has to be nurtured through
the input of appropriate supplies from the
environment.
o The system must be stimulated for use to
enhance growth and prevent stagnation.
o Each subsystem comprises four structural
characteristics:
o 1). Goal – based on universal drive
o 2). Set – a tendency to act in a certain way
in a given
o situation
o 3) Choice – refers to the alternate
behaviors the person
o considers in any given situation.
o 4) Action – the observable behavior of the
person
ASSUMPTIONS OF THE THEORY
 There is “organization, interaction,
interdependency and integration of the parts and
elements of behaviors that go to make up the
system.”
 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 occurring on
him.”
 A behavioral system, which requires and results in
some degree of regularity and constancy in
behavior, is essential to man. It is functionally
significant because it serves a useful purpose in
social life as well as for the individual.
 “System balance reflects adjustments and
adaptations that are successful in some way and to
some degree.”
STRENGTHS OF THE THEORY
 Dorothy Johnson’s theory guides nursing practice,
education, and research; generates new ideas
about nursing; and differentiates nursing from
other health professions.
 It has been used in inpatient, outpatient, and
community settings as well as in nursing
administration. It has always been useful to
nursing education and has been used in practice in
educational institutions in different parts of the
world.
 Another advantage of the theory is that Johnson
provided a frame of reference for nurses
concerned with specific client behaviors. It can also
be generalized across the lifespan and across
cultures.
LIMITATIONS OF THE THEORY
 The theory is potentially complex because there
are a number of possible interrelationships among
the behavioral system, its subsystems, and the
environment. Potential relationships have been
explored, but more empirical work is needed.
 Johnson’s work has been used extensively with
people who are ill or face the threat of illness.
However, its use with families, groups, and
communities is limited.
 Though the seven subsystems identified by
Johnson are said to be open, linked, and
interrelated, there is a lack of clear definitions for
the interrelationships among them which makes it
difficult to view the entire behavioral system as an
entity.
 The problem involving the interrelationships
among the concepts also creates difficulty in
following the logic of Johnson’s work.
APPLICATIONS TO NURSING PRACTICE,
EDUCATION & RESEARCH
 The Johnson Behavioral System Model was used to
develop a self – report and observational
instrument to be carried out with the nursing
process. The implementation of the instrument
provided a more comprehensive and organized
step to assessment and intervention, thereby
increasing patient and nurse satisfaction with care
 A core curriculum based on a person as a
behavioral system would have definite goals and
clear course of planning.
 Nursing research according to Johnson is vital to
explain and identify the behavioral system
disorders which arise in relation with illness, and
develop good reasoning for the means of
management.
KING`S CONCEPTUAL SYSTEMS FRAMEWORK & GOAL
ATTAINMENT THEORY & TRANSACTIONAL PROCESS
HISTRORY & BACKGROUND
 Was born on January 30, 1923, in West Point Iowa
 During her early high school years, she decided to
pursue her career in teaching, however, her uncle,
the town surgeon, offered to pay her tuition pay to
nursing school
 She accepted the offer and seeing nursing school
as a way to escape life in a small town. Thus, began
her remarkable career in nursing.
 She received her diploma in nursing from St. John`s
Hospital School of Nursing in St. Louis, Missouri, in
1945
 After receiving her diploma in 1945, she worked in
a variety of staff nurse roles
 In 1947 to 1958, she worked as an instructor in
Medical-Surgical nursing and was an Assistant
Director at St/ John`s Hospital School of Nursing.
 She develop a master` degree program in nursing
based on a nursing conceptual framework from
1961 to 1966 at Loyola University in Chicago
 Her 1st theory appeared in 1964, in the journal
“Nursing Science”, which nurse Theorist Martha
Rogers edited
 From 1968 to 1972, King served as the Director of
the School of Nursing at Ohio State University in
Columbus.
 She returned to Chicago in 1972 as a professor in
the Loyola University graduate program
 From 1972 to 1975, King was a member of the
Defense Advisory Committee on Women in the
service for the U.S. Department of Defense.
 From 1978 to 1980, she served as the Coordinator
of Research in Clinical Nursing at Loyola Medical
Center Department of Nursing.
 She was also elected as “alderman” for a 4-year
term (1975 to 1979) in Ward 2 at Wood Dale,
Illinois.
 In 1980, King was appointed as a professor at the
University of South Florida College of Nursing, in
Tampa. She continued to provide a community
service to help plan care through her conceptual
system and theory at various health care
organizations.
 King earned recognition as a “nurse theorist”
through the publication of Toward a Theory for
Nursing: General Concepts of Human Behavior” in
1971 and “A Theory for Nursing: Systems,
Concepts, Process” in 1981, as well as numerous
articles related to her conceptual system and a
theory of goal attainment.
 In 1981, the manuscript of her 2 nd book, “A Theory
for Nursing: Systems, Concepts, Process” was
published.
 In addition to her first 2 books, she authored
multiple book chapters & articles in professional
journals.
 In 1986, her 3rd book, “Curriculum & Instruction in
Nursing: Concepts & Process” was published.
 In 1994, King was inducted into the American
Academy of Nursing (AAN) & served as AAN
Theory of Expert Panel.
 In 1996, she received a Jessie M. Scott Award
 In 1997, King received a Gold Medallion from Gov.
Chiles for advancing the nursing profession in the
state of Florida.
 In May 1998, she received an honorary doctorate
from Loyola University, where her “Nursing
Collection” was housed.
 In 1999, King was inducted into the Teachers
College, Columbia University Hall of Fame.
 In 2004, she was inducted into the FNA Hall of
Fame and the ANA Hall of Fame and as a Living
Legend in 2005.
 Despite of her many awards & honors, she
considered teaching students to be her important
accomplishment. Over the years she enjoyed
watching her nursing students become expert
practitioners, teachers & researchers.
 Imogene King died on December 24, 2007, 2 days
after suffering from stroke (84 years old)
OVERVIEW OF IMOGENE KING`S “CONCEPTUAL MODEL &
THEORY OF GOAL ATTAINMENT
 King`s concepts focus on the methods of a nurse-
client communication and working together
toward mutually selected goals to help nurses in
the nurse-patient relationship.
 She used a “systems approach” in the
development of her systems framework & her
subsequent Goal Attainment Theory.
 The “Goal Attainment Theory refers to the 3
interacting systems:
o Individual or personal
o Group or interpersonal
o Society or social
 This theory pertains to the importance of
interaction, perception, communication,
transaction, self, role, stress, growth &
development, time & personal space.
 King emphasizes that both the nurse & the client
bring important knowledge & information to the
relationship & that they work together to achieve
goals.
 The relationship of the 3 interacting systems that
leads to King`s Theory of Goal Attainment are:
o Personal system (individual)
o Interpersonal system (nurse-patient
dialogue)
o Social system (the family, the school & the
church)
 Each system was given a different concept.
KING`S THEORY OF GOAL ATTAINMENT
PERSONAL SYSTEM (INDIVIDUAL)
 The concepts of personal systems are: perception,
self, growth & development, body image, space &
time.
 These concepts are fundamentals in understanding
human being because these refers to how the
nurse views & integrates self from personal goals &
beliefs.
 Among the listed concepts, the most important is
“perception” because it influences behavior.
 King summarized the connections among these
concepts as “An individual perception of self, of
body image, of time, of space that influences the
way a person responds to object & events in one`s
life.
 As an individual person grow & develop the
lifespan experiences with changes in structure &
function of their bodies overtime, this influences
the perception of their self.
 Personal systems are individuals, who are regarded
as rational, sentient, social beings.
 Concepts related to the personal systems are:
o Perception: a process of organizing,
interpreting & transforming information from
sense data & memory that gives meaning to
one`s experiences, represents one`s image of
reality & influences one`s behavior.
 o Self: a composite of thoughts & feelings that
constitute a person`s awareness of individual
existence, of who they are & what they are.
o Growth & Development: cellular, molecular &
behavioral changes in human beings that are a
function of genetic endowment, meaningful &
satisfying experiences & an environment
conducive to helping individuals move toward
maturity.
o Body Image: a person`s perception of their
body
o Time: the duration between the occurrence of
one event & the occurrence of another event.
o Space: the physical area called territory that
exist in all directions.
o Learning: gaining knowledge
INTERPERSONAL SYSTEM (NURSE-PATIENT DIALOGUE)
 Concepts associated for the interpersonal system
are: interaction, communication, transaction, role
& stress.
 King refers to the “2 individuals as dyads, 3 as
triads & 4 or more individuals as small group or
large group.
 This shows how the nurse interrelates with co-
worker or patient, particularly in a nurse-patient
relationship.
 Communication between the nurse & the patient
can be verbal or non-verbal.
 Collaboration between dyads (nurse-patient) is
very important for the attainment of the goal
 The concepts associated with this system are:
o Interactions: the acts of 2 or more persons in
mutual presence; a sequence of verbal & non-
verbal behaviors that are goal directed.
o Communication: the vehicle by which human
relations are developed & maintained;
encompasses intrapersonal, interpersonal,
verbal & non-verbal communication.
o Transaction: a process of interaction in which
human beings communicate with the
environment to achieve goals that are valued;
goal-directed human behaviors
o Role: a set of behaviors expected of a person
occupying a position in a social system.
o Stress: a dynamic state whereby a human
being interacts with the environment to
maintain balance for growth, development &
performance, involving an exchange of energy
& information between the person & the
environment for regulation and control of
stressors.
o Coping: a way of dealing with stress
SOCIAL SYSTEM (THE FAMILY, THE SCHOOL & THE CHURCH)
 This shows how the nurse interacts with co-
workers, superiors, subordinates and the client`s
environment in general
 These are groups of people within the community
or society that shares a common goals, values &
interest
 It provides a framework for social interaction &
relationships & establishes rules of behavior &
courses of action
 Are organized boundary systems of social roles,
behaviors, & practices developed to maintain
values & the mechanism to regulate the practices
& roles.
 The concepts related to social systems are:
o Organization: composed of human beings
with prescribed roles & positions who use
resources to accomplish personal &
organizational goals
o Authority: a transactional process
characterized by active, reciprocal relations in
which member`s values, backgrounds &
perceptions play a role in defining, validating
& accepting the authority of individuals within
an organization.
o Power: the process whereby one or more
persons influence other persons in a situation.
o Status: the position of an individual in a group
or a group in relation to other groups in an
organization.
o Decision Making: a dynamic & systematic
process by which goal-directed choice of
perceived alternatives is made & acted upon
by individuals or groups to answer a question
& attain a goal.
o Control: being in-charge
 Among the 3 systems, the conceptual framework of
interpersonal system had the greatest influence on the
development of her theory.
 King stated that “although personal systems & social
systems influence quality of care, the major elements
in a theory of goal attainment are discovered in the
interpersonal systems in which 2 people, who are
usually strangers to each other, come together in a
health care organization to help & to be helped to
maintain a state of health that permits functioning in
roles.
THE GOAL ATTAINMENT THEORY
 Originated from the elements or concepts in her
Interacting Systems Framework but it focuses on
the Interpersonal Systems & the interactions,
communications & transactions between 2
individuals (the nurse & the patient)
 The essence of her theory is that the nurse & the
patient come together, communicate & make
transactions – they set goals & work to achieve the
goals set.
 Each of them have purpose, they perceive, judge,
act & react upon each other. At the end of their
communication, a goal will be set & with this
transactions will be made.
 King believed that the goal of nursing is to “help
individuals maintain their health so they can
function in their roles (King, 1981), transactions
occur to set goals related to the health of the
patient.
 She proposed that through mutual goal setting &
goal attainment, transactions result in enhanced
growth and development for the client.
  King used 10 major concepts from the personal
and interpersonal systems to support the Theory
of Goal Attainment.
 These concepts include: human interactions,
perception, communication, role, stress, time,
space, growth & development and transactions.
MAJOR CONCEPTS OF IMOGENE KING`S THEORY OF GOAL
ATTAINMENT
HUMAN BEING
 Individuals are social beings who are rational &
sentient.
 Humans communicate their thoughts, actions,
customs & beliefs through language
 Persons exhibit common characteristics such as the
ability to perceive, to think, to feel, to choose
between alternative courses of action, to set goals,
to select the means to achieve goals & to make
decisions.
HEALTH
 Is a dynamic life experience of a human being,
which implies continuous adjustment to stressors
in the internal & external environment through
optimum use of one`s resources to achieve
maximum potential for daily living.
ENVIRONMENT
 Is the background for human interactions
 It is both external to and internal to the individual
NURSING
 Is a process of action, reaction and interaction
whereby nurse & client share information about
their perceptions in the nursing situation.
 The nurse & client share specific goals, problems,
concerns & explore means to achieve a goal.
ASSUMPTIONS OF THE THEORY
 The focus of nursing is the care of the human being
(patient).
 The goal of nursing is the health care of both
individuals and groups.
 Human beings are open systems interacting with
their environments constantly.
 The nurse and patient communicate information,
set goals mutually, and then act to achieve those
goals. This is also the basic assumption of the
nursing process.
 Patients perceive the world as a complete person
making transactions with individuals and things in
the environment.
 Transaction represents a life situation in which the
perceiver and the thing being perceived are
encountered. It also represents a life situation in
which a person enters the situation as an active
participant. Each is changed in the process of these
experiences.
STRENGTHS OF THE THEORY
 A major strong point of King’s conceptual system
and Theory of Goal Attainment is the ease with
which it can be understood by nurses.
 The theory of goal attainment also does describe a
logical sequence of events.
 For most parts, concepts are concretely defined
and illustrated.
 King’s definitions are clear and are conceptually
derived from research literature. Her Theory of
Goal Attainment presents ten major concepts, and
the concepts are easily understood and derived
from research literature, which clearly establishes
King’s work as important for knowledge building in
the discipline of nursing.
LIMITATIONS OF THE THEORY
 Theory of Goal Attainment has been criticized for
having limited application in areas of nursing in
which patients are unable to interact competently
with the nurse. King maintained the broad use of
the theory in most nursing situations.
 Another limitation relates to the lack of
development of application of the theory in
providing nursing care to groups, families, or
communities.
 King’s theory also contains some inconsistencies:
(1) She indicates that nurses are concerned about
the health care of groups but concentrates her
discussion on nursing as occurring in a dyadic
relationship. (2) King says that the nurse and client
are strangers, yet she speaks of their working
together for goal attainment and of the
importance of health maintenance.
APPLICATION TO NURSING PRACTICE,
EDUCATION & RESEARCH
 Professionals have used King’s theory in different
specialized area with the use of dynamic,
interactive communication between the nurse and
the client as proof.
 The Goal Oriented Nursing Records (GNOR) that
King developed have been useful in documenting
the outcomes of care that was performed by
nurses.
 It helps nurses to easily facilitate the present
problem from careful assessment of the client
gathered through the interactive communication
process between the nurse and the client. Her
record management facilitates proper and correct
range for the use of education system.
 The significance of King’s theory has been applied
to different professional practice setting such as in
nursing administration, theory – based practice in
the emergency department, in tertiary hospitals
and in the community.
 King’s interacting system has been used to design
the nursing curriculum in different schools and
universities and framework for nursing education.
 It provides a systematic means of viewing the
nursing profession, organizing nursing knowledge
and clarifying the nursing discipline
 King’s theory has been one of the theoretical bases
of some researches that helped in formulating a
system view of the application of the nursing
practice.
 Some researches have formulated a middle range
theory out of King’s theory out of King’s theory
such as patient’s satisfaction from nursing care,
clients with chronic illness and family health.
  The theory can also help set a framework for
nursing studies which can further prove the use
and advantages of the nursing practice.
NEUMAN`S SYSTEMS MODEL
BETTY NEUMAN SYSTEMS MODEL
 Describes the Neuman Systems Model as “a
unique, open-system-based perspective that
provides a unifying focus for approaching a wide
range of concerns.
 A system acts as a boundary for a single client, a
group, or even a number of groups; it can also be
defined as a social issue.
 A client system in interaction with the environment
that delineates the domain of nursing concerns.”
 The Neuman Systems Model views the client as an
open system that responds to stressors in the
environment.
 The client variables are physiological,
psychological, sociocultural, developmental, and
spiritual.
 The client system consists of a basic or core
structure that is protected by lines of resistance.
The usual level of health is identified as the normal
line of defense that is protected by a flexible line of
defense.
 Stressors are intrapersonal, interpersonal and extra
personal in nature and arise from the internal,
external, and created environments. When
stressors break through the flexible line of defense,
the system is invaded and the lines of resistance
are activated and the system is described as
moving into illness on a wellness-illness
continuum.
 If adequate energy is available, the system will be
reconstituted with the normal line of defense
restored at, below, or above its previous level.
 Nursing interventions occur through three
prevention modalities. Primary, secondary and
tertiary.
THE NEUMAN SYSTEMS MODEL
 Since 1960, Betty has been recognized as a pioneer
in the field of nursing, particularly in the area of
community mental health
 She developed her model while lecturing in
community mental health at UCLA & 1 st published
in 1972 under the title “A Model for Teaching the
Total Person Approach to patient Problems”
(Neuman & Fawcett, 2011).
 Since that time she has been the prolific writer&
her model has been used extensively in colleges of
nursing, beginning with Neumann College`s
baccalaureate nursing program in Aston,
Pennsylvania.
 Neuman`s model uses a systems approach that is
focused on the human needs of protection or relief
from stress (Neuman & Fawcett, 2011)
 Neuman believed that the causes of stress can be
identified & remedied through nursing
interventions
 She emphasized the need of humans for dynamic
balance that the nurse can provide through
identification of problems, mutually agreeing on
goals, & using the concept of prevention as
intervention.
 Neuman`s model is one of only a few considered
prescriptive in nature. The model is universal,
abstract & applicable for individuals from many
cultures (Neuman & Fawcett, 2011).
HISTORY & BACKGROUND
 Betty Neuman was born on September 11, 1924
near Lowell, Ohio. She grew up on a farm which
later encouraged her to help people who are in
need.
 Her father was a farmer who became sick and died
at the age of 36. Her mother was a self-educated
midwife, that led the young Neuman to be always
influenced by the commitment that took her away
from home from time to time.
 She had one older brother and a brother who was
younger which makes her the middle child among
her siblings.
 Her love for nursing started when she took the
responsibility of taking care of her father which
later created her compassion in her chosen career
path.
 During World War II, she had her first job as an
aircraft instrument technician.
 In 1947, she received her RN Diploma from
Peoples Hospital School of Nursing, Akron, Ohio.
 Betty Neuman moved to California and worked in a
variety of capacities as a hospital nurse and head
nurse at Los Angeles County General
Hospital, school nurse, industrial nurse, and clinical
instructor at the University of Southern California
Medical Center, Los Angeles.
 In 1957, she received a baccalaureate degree in
public health and psychology with honors.
 Amidst her hectic life as a nurse, she also managed
to work as a fashion model and learned to fly a
plane.
 She got married, supported her husband’s medical
practice, and had their daughter in 1959.
 She earned a master’s degree in mental health,
public health consultation in 1966 from the
University of California, Los Angeles (UCLA).
 After her graduation, she was hired as a
department chair in the UCLA School of Nursing
graduate program.
 Neuman developed the first community mental
health program for graduate students in the LA
area from 1967 to 1973.
 In 1985, Betty Neuman concluded a doctoral
degree in clinical psychology at Pacific Western
University.
 She was a pioneer of nursing involvement in
mental health.
 She and Donna Aquilina were the first two nurses
to develop the nurse counselor role within
community crisis centers in Los Angeles.
 Neuman persisted to start a private practice as a
marriage and family therapist, specializing in
Christian counseling.
 She is a Fellow of the American Association of
Marriage and Family Therapy and of the American
Academy of Nursing.
 Until 2009, she was the director of the Neuman
Systems Model Trustees Group, Inc. that she
established in 1988, and still attends as a
consultant.
 The Trustees Group was created to preserve and
maintain the message of her nursing theory for the
health care community.
 In 1970, Betty Neuman designed a nursing
conceptual model to expand students’
understanding of client variables beyond the
medical model.
 Her teaching programs at UCLA paved the way for
developing her nursing model. During those times,
she did not write a book but made her concepts
known to Joan Riehl-Sisca and Sr. Callista Roy and
incorporated them in their 1971 book, Conceptual
Models for Nursing Practice.
 In 1972, Neuman published a draft of her model.
She developed and improved the concepts and
published her book, The Neuman System Model:
Application to Nursing Education and Practice, in
1982. Further revisions were made in later
editions.
 As a speaker and author, she spent countless hours
teaching and explaining the many concepts and
aspects of the model to students and professors.
 Neuman has also been involved in numerous
publications, paper presentations, consultations,
lectures, and conferences on application and use
of the model.
 She worked as a consultant nationally and
internationally concerning the implementation of
the model for nursing education programs and for
clinical practice facilities.
 Betty Neuman has done many things including a
nurse, educator, health counselor, therapist,
author, speaker, and researcher.
 Throughout the years, she earned many awards
and honors including several honorary doctorates
and was an honorary member of the American
Academy of Nursing.
 The profound effect of her work on the nursing
profession is well known throughout the world.
 Honorary Doctorate of Letters, Neumann College,
Aston, PA (1992), Honorary Member of the
Fellowship of the American Academy of Nursing
(1993), Honorary Doctorate of Science, Grand
Valley State University, Michigan (1998)
 She was honored by President Richard Jusseaume
and Provost Dr. Laurence Bove with the Walsh
University Distinguished Service Medal, which is
awarded to those who have contributed
outstanding professional or voluntary service to
others within the national, regional or local
community.
 In an annual Nursing Research Day sponsored by
Walsh’s Phi Eta Chapter of Sigma Theta Tau, Byers
School of Nursing Dean Dr. Linda Linc granted
Neuman with the first annual Neuman Award,
named in her honor, for outstanding service in the
nursing profession.
INFLUENCES ON HER THEORY
 A nursing theory developed by Betty Neuman is
based on the person’s relationship to stress, the
response to it, and reconstitution factors that are
progressive in nature.
 She explained that her conceptual model was the
result of her observations during her clinical
experiences in mental health nursing as well as
from synthesis of knowledge from several
theoretical sources.
 The foundations of Neuman’s model are primarily
Selye’s stress theory, Von Bertalanffy’s General
Systems Theory, and De Chardin’s philosophy of
Life.
 These perspectives support the idea that a holistic
viewpoint of humans is crucial.
MAJOR CONCEPTS OF THE THEORY
HUMAN BEING 
 Human being is viewed as an open system that
interacts with both internal and external
environment forces or stressors.
 The human is in constant change, moving toward a
dynamic state of system stability or toward illness
of varying degrees.
HEALTH
 In Neuman’s nursing theory, Health is defined as
the condition or degree of system stability and is
viewed as a continuum from wellness to illness.
 When system needs are met, optimal wellness
exists. When needs are not satisfied, illness exists.
When the energy needed to support life is not
available, death occurs.
ENVIRONMENT 
 The environment is a vital arena that is germane to
the system and its function.
 The environment may be viewed as all factors that
affect and are affected by the system.
 In Neuman Systems Model identifies three
relevant environments: (1) internal, (2) external,
and (3) created.
o The internal environment exists within
the client system. All forces and
interactive influences that are solely
within boundaries of the client system
make up this environment.
o The external environment exists outside
the client system.
o The created environment is unconsciously
developed and is used by the client to
support protective coping.
NURSING
 The primary concern of nursing is to define the
appropriate action in situations that are stress-
related or in relation to possible reactions of the
client or client system to stressors.
 Nursing interventions are aimed at helping the
system adapt or adjust and to retain, restore, or
maintain some degree of stability between and
among the client system variables and
 environmental stressors with a focus on conserving
energy.
KEY CONCEPTS OF THE THEORY
OPEN SYSTEM
 A system in which there is a continuous flow of
input and process, output and feedback.
 It is a system of organized complexity, where all
elements are in interaction.
BASIC STRUCTURE & ENERGY RESOURCES
 The basic structure, or central core, is made up of
those basic survival factors common to the species
and represent basic client system energy resources
 These factors include the system variables, genetic
features, and strengths and weaknesses of the
system parts.
CLIENT VARIABLES
 Neuman views the individual client holistically and
considers the variables simultaneously and
comprehensively.
o The physiological variable refers to the
structure and functions of the body.
o The psychological variable refers to
mental processes and relationships.
o The sociocultural variable refers to
system functions that relate to social and
cultural expectations and activities.
o The developmental variable refers to
those processes related to development
over the lifespan.
o The spiritual variable refers to the
influence of spiritual beliefs.
FLEXIBLE LINE OF DEFENSE
 A protective accordion-like mechanism that
surrounds and protects the normal line of defense
from invasion by stressors.
NORMAL LINE OF DEFENSE
 An adaptational level of health developed over
time and considered normal for a particular
individual client or system; it becomes a standard
for wellness-deviance determination.
LINES OF RESISTANCE
 Protection factors activated when stressors have
penetrated the normal line of defense, causing a
reaction symptomatology.
STRESSORS
 A stressor is any phenomenon that might
penetrate both the flexible and normal lines of
defense, resulting in either a positive or negative
outcome.
o Intrapersonal stressors are those that
occur within the client system boundary
and correlate with the internal
environment.
o Interpersonal stressors occur outside the
client system boundary, are proximal to
the system, and have an impact on the
system.
o Extra personal stressors also occur
outside the client system boundaries but
are at a greater distance from the system
that are interpersonal stressors. An
example is social policy.
STABILITY
 A state of balance or 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.
DEGREE OF REACTION
 The amount of system instability resulting from
stressor invasion of the normal line of defense.
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.
INPUT/OUTPUT
 The matter, energy, and information exchanged
between the client and environment that is
entering or leaving the system at any point in time.
RECONSTITUTION
 The return and maintenance of system stability,
following treatment of stressor reaction, which
may result in a higher or lower level of wellness.
PREVENTION AS INTERVENTION
 Intervention modes for nursing action and
determinants for entry of both client and nurse
into the health care system.
o Primary prevention occurs before the
system reacts to a stressor; it
includes health promotion and
maintenance of wellness. Primary
prevention focuses on strengthening the
flexible line of defense through
preventing stress and reducing risk
factors. This intervention occurs when the
risk or hazard is identified but before a
reaction occurs. Strategies that might be
used include immunization, health
education, exercise, and lifestyle changes.
o Secondary prevention occurs after the
system reacts to a stressor and is provided
in terms of existing symptoms. Secondary
prevention focuses on strengthening the
internal lines of resistance and, thus,
protects the basic structure through
appropriate treatment of symptoms. The
intent is to regain optimal system stability
and to conserve energy in doing so. If
secondary prevention is unsuccessful and
reconstitution does not occur, the basic
structure will be unable to support the
system and its interventions, and death
will occur.
o Tertiary prevention occurs after the
system has been treated through
secondary prevention strategies. Its
purpose is to maintain wellness or protect
the client system reconstitution through
supporting existing strengths and
continuing to preserve energy. Tertiary
prevention may begin at any point after
 system stability has begun to be
reestablished (reconstitution has begun).
Tertiary prevention tends to lead back to
primary prevention. (Neuman, 1995)
STRENGTHS OF THE THEORY
 The major strength of the Neuman Systems Model
is its flexibility for use in all areas of nursing –
administration, education, and practice.
 Neuman has presented a view of the client that is
equally applicable to an individual, a family, a
group, a community, or any other aggregate.
 The Neuman Systems Model, particularly
presented in the model diagram, is logically
consistent.
 The emphasis on primary prevention, including
health promotion, is specific to this model.
 Once understood, the Neuman Systems Model is
relatively simple, and has readily acceptable
definitions of its components.
LIMITATIONS OF THE THEORY
 The major weakness of the model is the need for
further clarification of terms used.
 Interpersonal and extra personal stressors need to
be more clearly differentiated.
APPLICATION TO NURSING PRACTICE, EDUCATION &
RESEARCH
 With Neuman’s System Model, nursing practice
became unified and holistic in approach.
 The model can be applicable in addressing the
problem of an individual, family, community or the
society in different settings.
 This model can help nurses to formulate an
approach that can prevent and alleviate the client’s
condition. It is also applicable in organizing a
framework to plan care at primary, secondary, and
tertiary levels of prevention of health care
facilities.
 With its holistic approach, it has been applicable in
the academe used both by nursing students and
educators.
 As the model demonstrated effectiveness in
conceptual transition among levels of nursing
education, it has formed a basis for continuing
study after graduation thus facilitating growth of
nursing knowledge and practice as it is integrated
in the nursing curriculum
 Neuman’s model has been one of the widely used
framework used in nursing research as it guides
the enhancement of nursing care. Nursing research
expanded the use of the model in hospital, health
clinics, community and school.
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP
INTRODUCTION
 Hildegard Peplau’s Interpersonal Relationship
Theory emphasized the nurse-client relationship as
the foundation of nursing practice.
 It gave emphasis on the give-and-take of nurse-
client relationships that was seen by many as
revolutionary.
 Peplau went on to form an interpersonal model
emphasizing the need for a partnership between
nurse and client as opposed to the client passively
receiving treatment and the nurse passively acting
out doctor’s orders.
HISTORY & BACKGROUND
 Hildegard Peplau’s was an American nurse who is
the only one to serve the American Nurses
Association (ANA) as Executive Director and later
as President.
 She became the first published nursing theorist 
since Florence Nightingale.
 Peplau was well-known for her Theory of
Interpersonal Relations, which helped to
revolutionize the scholarly work of nurses.
 Her achievements are valued by nurses all over the
world and became known to many as the “Mother
of Psychiatric Nursing” and the “Nurse of the
Century.” 
 She was born on September 1, 1909 & was raised
in Reading, Pennsylvania by her parents of German
descent, Gustav and Otyllie Peplau.
 She was the second daughter, having two sisters
and three brothers.
 Though illiterate, her father was persevering while
her mother was a perfectionist and oppressive.
 With her young age, Peplau’s eagerness to grow
beyond traditional women’s roles was precise.
 She considers nursing was one of few career
choices for women during her time.
 In 1918, she witnessed the
devastating flu epidemic that greatly influenced
her understanding on the impact of illness and
death on families.
 In 1931, she graduated in Pottstown, Pennsylvania
School of Nursing.
 After graduation, she worked as a staff nurse in her
place and in New York City.
 A summer position as a nurse for the New York
University summer camp led to a recommendation
for Peplau to become the school nurse at
Bennington College in Vermont, where she earned
a Bachelor’s degree in interpersonal psychology in
1943.
 Peplau’s lifelong work was largely focused on
extending Sullivan’s interpersonal theory for use in
nursing practice.
 She studied psychological issues together with
Erich Fromm, Frieda Fromm-Reichmann, and Harry
Stack Sullivan at Chestnut Lodge, a private
psychiatric hospital in Maryland.
 In 1947, Peplau held her master’s and doctoral
degrees from Teachers College, Columbia
University.
 She served in the Army Nurse Corps and was
assigned to the 312th Field Station Hospital from
1943-1945 in England, where the American School
of Military Psychiatry was located.
 She met and worked with all the leading figures in
British and American psychiatry.
 After the war, Peplau was at the table with many of
these same men as they worked to reshape the
 health system in the United States through the
passage of the National Mental Health Act of 1946.
 She was certified in psychoanalysis by the William
Alanson White Institute of New York City.
 In the early 1950s, she developed and taught the
first batch of graduates in psychiatric nursing
students at Teachers College.
 Peplau was a member of the faculty of the College
of Nursing at Rutgers University from 1954 until
her retirement in 1974. She was a professor
emerita at the said university.
 At Rutgers University, she created the first
graduate level program for the preparation of
clinical specialists in psychiatric nursing.
 She was a prolific writer and was equally well
known for her presentations, speeches, and clinical
training workshops.
 Peplau vigorously advocated that nurses should
become further educated so they could provide
truly therapeutic care to patients rather than the
custodial care that was prevalent in the mental
hospitals of that era.
 During the 1950s and 1960s, she supervised
summer workshops for nurses throughout the
United States, mostly in state psychiatric hospitals.
 In these seminars, she taught interpersonal
concepts and interviewing techniques, as well as
individual, family, and group therapy.
 Peplau was an advisor to the World Health
Organization and was a visiting professor at
universities in Africa, Latin America, Belgium, and
throughout the United States.
 A strong advocate for graduate education and
research in nursing, Peplau served as a consultant
to the U.S. Surgeon General, the U.S. Air Force, and
the National Institute of Mental Health.
 She participated in many government policy
making groups.
 Peplau was devoted to nursing education at full
length of her career.
 After her retirement from Rutgers, she served as a
visiting professor at the University of Leuven in
Belgium in 1975 and 1976. There she helped
establish the first graduate nursing program in
Europe.
 She was the only nurse who served the ANA as
executive director and later as president, she
served two terms on the Board of the International
Council of Nurses (ICN).
 And as a member of the New Jersey State Nurses
Association, she actively contributed to the ANA by
serving on various committees and task forces.
 Her fifty-year career in nursing left an
unforgettable mark on the field and on the lives of
the mentally challenged in the United States.
 During the peak of her career, she became the
founder of modern psychiatric nursing, an
innovative educator, advocate for the mentally ill,
proponent of advanced education for nurses,
Executive Director and then President of the ANA
and prolific author.
 And just like any other famous personalities, her
life was often marked with controversy, which she
faced with boldness, prowess and conviction.
PUBLISHED BOOKS & WORKS
 Some of Hildegard Peplau’s works include: 
o Interpersonal Relations In Nursing: A
Conceptual Frame of Reference for
Psychodynamic Nursing
o Interpersonal Theory in Nursing Practice:
Selected Works of Hildegard E. Peplau
o Basic principles of patient counseling: Extracts
from two clinical nursing workshops in
psychiatric hospitals
o A Glance Back in Time:
 An article from Nursing Forum, On
Semantics (psychiatric nursing):
 An article from: Perspectives in Psychiatric
Care, The Psychiatric Nurse–Accountable?
To Whom? For What?
 An article from: Perspectives in Psychiatric
Care, and Psychotherapeutic Strategies
 An article from: Perspectives in Psychiatric
Care.
 Her book on her conceptual framework,
Interpersonal Relations in Nursing, was completed
in 1948.
 Publication took four additional years because it
was groundbreaking for a nurse to contribute this
scholarly work without a co-authoring physician.
 Peplau’s original book from 1952 has been
translated into nine languages and in 1989 was
reissued in Great Britain by Macmillan of London.
 In 1989, Springer published a volume of selected
works of Peplau from previously unpublished
papers.
 Her ideas have, indeed, stood the test of time.
 The archives of her work and life are housed at the
Schlesinger Library at Harvard University.
AWARDS & HONORS
 Peplau was acknowledged with numerous awards
and honors for her contributions to nursing and
held 11 honorary degrees.
 She was awarded honorary doctoral degrees from
universities including: Alfred, Duke, Indiana, Ohio
State, Rutgers, and the University of Ulster in
Ireland.
 She was named one of “50 Great
Americans” in Who’s Who in 1995 by Marquis.
 She was also elected fellow of the American
Academy of Nurse and Sigma Theta Tau, the
national nursing honorary society.
 In 1996, the American Academy of Nursing
honored Peplau as a “Living Legend.” 
 She received nursing’s highest honor,
the “Christiane Reimann Prize,” at the ICN
Quadrennial Congress in 1997. This award is given
once every four years for outstanding national and
international contributions to nursing and
healthcare.
 And, in 1998, the ANA inducted her into its Hall of
Fame.
  On March 17, 1999, Peplau died peacefully in
her sleep at her home in Sherman Oaks,
California.  providing explanations and information, and
INFLUENCES OF THE THEORY
 Peplau’s theory was the first nursing theory to
borrow concepts from other disciplines.
 The theory was influenced by the Psychoanalytic
theory of Freud, Maslow’s Hierarchy of Needs and
Sullivan’s theory of Interpersonal Relationship
MAJOR CONCEPTS OF PEPLAU`S THEORY
PERSON
 A developing organism that tries to reduce anxiety
caused by needs
 An individual is made of physiological,
psychological and social spheres striving towards
equilibrium in life
HEALTH
 Peplau didn't include an exact definition of health
within her model.
 Peplau viewed health as "a word symbol that
implied forward movement of personality and
other ongoing human processes in the direction of
creative, constructive, productive, personal, and
community living”.
ENVIRONMENT
 Being and occurring in the context of the nurse
client relationship
 Existing forces outside of the individual
NURSING
 “An interpersonal process of therapeutic
interactions between an individual who is sick or in
need of health services and a nurse especially
educated to recognize, respond to the need for
help.”  
 It is a “maturing force and an educative
instrument” involving an interaction between two
or more individuals with a common goal
 This common goal provides the incentive for the
therapeutic process in which the nurse and patient
respect each other as individuals, both of them
learning and growing as a result of the interaction.
 An individual learns when she or he selects stimuli
in the environment and then reacts to these
stimuli.
 An educative and therapeutic relationship in which
the nurse makes the client a partner in their health
care and promotion
 A significant therapeutic interpersonal process
KEY CONCEPT OF PEPLAU`S THEORY
THERAPEUTIC NURSE-CLIENT RELATIONSHIP
 A professional and planned relationship between
client and nurse that focuses on the client’s needs,
feelings, problems, and ideas.
 It involves interaction between two or more
individuals with a common goal.
 The attainment of this goal, or any goal, is
achieved through a series of steps following a
sequential pattern.
4 PHASES OF THE THERAPEUTIC NURSE-CLIENT
RELATIONSHIP
1. ORIENTATION PHASE
 The orientation phase is directed by the nurse and
involves engaging the client in treatment,
answering questions.
o Problem defining phase
o Starts when the client meets nurse as a
stranger
o Defining problem and deciding the type of
service needed
o Client seeks assistance, conveys needs, asks
questions, shares preconceptions and
expectations of past experiences
o Nurse responds, explains roles to the client,
helps to identify problems and to use available
resources and services
2. IDENTIFICATION PHASE
 The identification phase begins when the client
works interdependently with the nurse, expresses
feelings, and begins to feel stronger.
 Selection of appropriate professional assistance
 Patient begins to have a feeling of belonging and a
capability of dealing with the problem which
decreases the feeling of helplessness and
hopelessness
3. EXPLOITATION PHASE
 In this phase, the client makes full use of the
services offered.
 Use of professional assistance for problem-solving
alternatives
 Advantages of services are used is based on the
needs and interests of the patients
 The individual feels like an integral part of the
helping environment
They may make minor requests or attention-
getting techniques
 The principles of interview techniques must be
used in order to explore, understand and
adequately deal with the underlying problem
 Patient may fluctuate on independence
 Nurse must be aware of the various phases of
communication
 Nurse aids the patient in exploiting all avenues of
help and progress is made towards the final step
4. RESOLUTION PHASE
 In the resolution phase, the client no longer needs
professional services and gives up dependent
behavior. The relationship ends.
 Termination of professional relationship
 The patient’s needs have already been met by the
collaborative effect of patient and nurse
 Now they need to terminate their therapeutic
relationship and dissolve the links between them.
 Sometimes may be difficult for both as
psychological dependence persists
 Patient drifts away and breaks the bond with the
nurse and healthier emotional balance is
demonstrated and both becomes mature
individuals.
 Peplau’s model has proved of great use to later
nurse theorists and clinicians in developing more
sophisticated and therapeutic nursing
interventions.
ROLES OF THE NURSE IN THE THERAPEUTIC RELATIONSHIP  Can involve loss of rational thought, delusions,
IDENTIFIED BY PEPLAU: hallucinations, and complete physical immobility
STRANGER and muteness.
 Offering the client the same acceptance and  The person may bolt and run aimlessly, often
courtesy that the nurse would to any stranger exposing himself or herself to injury.
RESOURCE PERSON ASSUMPTIONS OF THE THEORY
 Providing specific answers to questions within a 1) Nurse and the patient can interact.
larger context 2) Peplau emphasized that both the patient and nurse
TEACHER mature as the result of the therapeutic interaction.
 Helping the client to learn formally or informally 3) Communication and interviewing skills remain
LEADER fundamental nursing tools.
 Offering direction to the client or group 4) Peplau believed that nurses must clearly understand
SURROGATE themselves to promote their client’s growth and to avoid
 Serving as a substitute for another such as a parent limiting the client’s choices to those that nurses value.
or a sibling STRENGTHS OF THE THEORY
COUNSELOR  Peplau’s theory helped later nursing theorists and
 Promoting experiences leading to health for the clinicians develop more therapeutic interventions
client such as expression of feelings regarding the roles that show the dynamic
TECHNICAL EXPERT character typical in clinical nursing.
 Providing physical care for the patient and  Its phases provide simplicity regarding the natural
operates equipment progression of the nurse-patient relationship,
 Peplau also believed that the nurse could take on which leads to adaptability in any nurse-patient
many other roles but these were not defined in interaction, thus providing generalizability.
detail. However, they were “left to the intelligence LIMITATIONS OF THE THEORY
and imagination of the readers.” (Peplau, 1952)  Though Peplau stressed the nurse-client
ADDITIONAL ROLES INCLUDE: relationship as the foundation of nursing practice,
 Consultant health promotion, and maintenance were less
 Health teacher emphasized.
 Tutor  Also, the theory cannot be used in a patient who
 Socializing agent doesn’t have a felt need such as with withdrawn
 Safety agent patients.
 Manager of environment APPLICATION TO NURSING PRACTICE,
 Mediator EDUCATION & RESEARCH
 Administrator  Peplau’s ideas paved way for integrating other
 Recorder observer scientific disciplines into nursing especially in
 Researcher formulating the paradigm of psychiatric nursing in
ANXIETY early days.
 Another concept of Peplau and is defined as the  As it became apparent that nursing practice is its
initial response to a psychic threat. true value could only be accomplished through
 There are four levels of anxiety described by starting and strengthening the nurse – patient
Peplau. relationship, many clinicians now believe that it’s
4 LEVELS OF ANXIETY in the interest of the profession and of the patient
MILD ANXIETY to utilize her Interpersonal Model extensively.
 Is a positive state of heightened awareness and  In Psychiatric Nursing, Peplau’s Interpersonal
sharpened senses, allowing the person to learn Model is used in counselling women undergoing
new behaviors and solve problems. depression.
 The person can take in all available stimuli  Because of the maintained and strengthened nurse
(perceptual field). – patient relationship, women were able to
MODERATE ANXIETY describe patterns that resulted form their negative
 Involves a decreased perceptual field (focus on thinking and independently found strategies to
immediate task only) manage them.
 The person can learn a new behavior or solve  Hildegard Peplau’s book, Interpersonal Relations in
problems only with assistance. Nursing is being used as a manual of instruction to
 Another person can redirect the person to the help graduate nurses and nursing students alike in
task. creating a significant nurse – patient relationship.
SEVERE ANXIETY  Her theoretical ideas, particularly her views of
 Involves feelings of dread and terror. nursing and nursing process, the psychodynamic
theory, and her prescribed methods, have been an
 The person cannot be redirected to a task; he or
essential part of the collective culture of the
she focuses only on scattered details and has
nursing profession
physiologic symptoms of tachycardia, diaphoresis,
and chest pain.  When Peplau’s model was slowly integrated into
PANIC ANXIETY research, research has shifted to perspectives
 within the social system as newer studies indicate
that broader relationships could also affect a
person in many ways.
ORLANDO`S THEORY OF DELIBERATIVE NURSING PROCESS
INTRODUCTION
 Ida Jean Orlando developed her Deliberative
Nursing Process that allow nurses to formulate an
effective nursing care plan that can also be easily
adapted when & if any complexity comes up with a
patient.
 Her theory stresses the reciprocal relationship
between patient & nurse.
 It emphasizes the critical importance of the
patient`s participation in the nursing process
INTRODUCTION
 Orlando also considered nursing as a distinct
profession & separated it from medicine when
nurses as determining nursing action rather than
being prompted by physician`s orders,
organizational needs & past personal experiences
 She believed that physician`s orders are for
patients and not for nurses
 She proposed that “patients have their own
meanings & interpretations of situations &
therefore nurses must validate their inferences &
analysis with patients before drawing
conclusions”
HISTORY & BACKGROUND
 Ida Jean Orlando was a first - generation Irish
American born on August 12, 1926.
 She dedicated her life studying nursing and
graduated in 1947 and received a Bachelor of
Science degree in public health nursing in 1951.
 In 1954, she completed her Master of Arts
in Mental Health consultation. While studying she
also worked intermittently and sometimes
concurrently as a staff nurse in OB, MS, ER; as a
supervisor in a general hospital, and as an assistant
director and a teacher of several courses.
 And in 1961, she was married to Robert Pelletier
and lived in the Boston area.
 As for being a respectable and credible role-model,
Orlando was well educated with many advanced
degrees in nursing.
 In 1947, she received a diploma in nursing from
the Flower Fifth Avenue Hospital School of Nursing
in New York.
 In 1951, she received a Bachelor of Science degree
in public health nursing from St. John’s University
in Brooklyn, New York.
 And in 1954, Orlando received her Master of Arts
degree in mental health consultation from
Teachers College, Columbia University
 Ida Jean Orlando had a diverse career, working as a
practitioner, consultant, researcher, and educator
in nursing.
 Orlando devoted her life to mental health and
psychiatric nursing, working as a clinical nurse and
researcher.
 After receiving her master’s degree in 1954,
Orlando went to the Yale University School of
Nursing in New Haven, Connecticut as an associate
professor of mental health and psychiatric nursing
for eight years. 
 She was awarded a federal grant and became a
research associate and the principal project
investigator of a National Institute of Mental
health Institute of the United States Public Health
Service’s grant entitled “Integration of Mental
Health Concepts in a Basic Curriculum.”
 The project sought to identify those factors
relevant to the integration of psychiatric-mental
health principles into the nursing curriculum.
 During 1958-1961, Orlando, as an associate
professor and the director of the graduate
program in mental health and psychiatric nursing
at Yale University, used her proposed conceptual
nursing model as the foundation for the curriculum
of the program.
 From 1962-1972, Orlando served as a clinical nurse
consultant at Mclean Hospital in Belmont,
Massachusetts.
 In this position, she studied the interactions of
nurses with clients, other nurses and other staff
members and how these interactions affected the
process of the nurse’s help to clients.
 Orlando convinced the administration that an
educational program for nurses was needed,
whereupon Mclean Hospital initiated an
educational program based on her nursing model.
 From 1972 to 1984, she also served on the board
of the Harvard Community Health Plan in Boston,
Massachusetts.
 In 1981, Orlando became an educator at Boston
University School of Nursing and held
administrative positions from 1984 to 1987 at
Metropolitan State Hospital in Waltham,
Massachusetts.
 In September 1987, she became the Assistant
director of Nursing for Education and Research at
the said institution.
 She was also a project consultant for the Mental
Health Project for Associate Degree Faculties
created by the New England Board of Higher
Education.
 Finally in 1992, Orlando retired and received the
Nursing Living Legend award by the Massachusetts
Registered Nurse Association.
PUBLISHED BOOKS & WORKS
 After working as a researcher, she wrote a book on
her findings from Yale, entitled “The Dynamic
Nurse-Patient Relationship: Function, Process, and
Principles.” Her book was published in 1961.
 A year later, she also continued her research
studies published her second book “The Discipline
and Teaching of Nursing Process” in 1972.
 Ida Jean Orlando retired from nursing in 1992.
 After becoming well-educated, researching over
2,000 nurse-patient interactions, and coming up
with a theory that changed nursing, she was
recognized as a “Nursing Living Legend” by the
Massachusetts Registered Nurse Association.
  Ida Jean Orlando died on November 28, 2007 at
the age of 81.
INFLUENCES OF THE THEORY
 Ida Jean Orlando developed her theory from a
study conducted at the Yale University School of
Nursing, integrating mental health concepts into a
basic nursing curriculum.
 She proposed that “patients have their own
meanings and interpretations of situations and
therefore nurses must validate their inferences and
analyses with patients before drawing
conclusions.”
MAJOR CONCEPTS OF ORLANDO`S THEORY
 The nursing metaparadigm consists of four
concepts: person, health, environment and
nursing.
 Of the four concepts, Ida Jean Orlando only
included three in her theory of Nursing Process
Discipline: person, health, and nursing.
HUMAN BEING
 Orlando uses the concept of human as she
emphasizes individuality and the dynamic nature
of the nurse-patient relationship.
 For her, humans in need are the focus of nursing
practice.
 HEALTH
 In Orlando’s theory, health is replaced by a sense
of helplessness as the initiator of a necessity for
nursing.
 She stated that nursing deals with individuals who
are in need of help.
ENVIRONMENT
 Orlando completely disregarded environment in
her theory, only focusing on the immediate need
of the patient, chiefly the relationship and actions
between the nurse and the patient (only an
individual in her theory; no families or groups were
mentioned).
 The effect that the environment could have on the
patient was never mentioned in Orlando’s theory.
NURSING
 Orlando speaks of nursing as unique and
independent in its concerns for an individual’s
need for help in an immediate situation.
 The efforts to meet the individual’s need for help
are carried out in an interactive situation and in a
disciplined manner that requires proper training.
KEY CONCEPTS OF ORLANDO`S THEORY
FUNCTION OF PROFESSIONAL NURSING
 The function of professional nursing is the
organizing principle. This means that finding out
and meeting the patient’s immediate needs for
help.
 According to Orlando, nursing is responsive to
individuals who suffer, or who anticipate a sense of
helplessness.
 It is focused on the process of care in an
immediate experience, and is concerned with
providing direct assistance to a patient in whatever
setting they are found in for the purpose of
avoiding, relieving, diminishing, or curing the sense
of helplessness in the patient.
 The Nursing Process Discipline Theory labels the
purpose of nursing to supply the help a patient
needs for his or her needs to be met.
 That is, if the patient has an immediate need for
help, and the nurse discovers and meets that need,
the purpose of nursing has been achieved.
PRESENTING BEHAVIOR
 Is the patient’s problematic situation.
 Through the presenting behavior, the nurse finds
the patient’s immediate need for help.
 To do this, the nurse must first recognize the
situation as problematic.
 Regardless of how the presenting behavior
appears, it may represent a cry for help from the
patient.
 The presenting behavior of the patient, which is
considered the stimulus, causes an automatic
internal response in the nurse, which in turn
causes a response in the patient.
DISTRESS
 The patient’s behavior reflects distress when the
patient experiences a need that he cannot resolve,
a sense of helplessness occurs.
IMMEDIATE REACTION
 The immediate reaction is the internal response.
 The patient perceives objects with his or her five
senses.
 These perceptions stimulate automatic thought,
and each thought stimulates an automatic feeling,
causing the patient to act.
 These three items are the patient’s immediate
response.
 The immediate response reflects how the nurse
experiences his or her participation in the nurse-
patient relationship.
NURSE REACTION
 The patient behavior stimulated a nurse reaction,
which marks the beginning of the nursing process
discipline.
NURSE`S ACTION
 When the nurse acts, an action process transpires.
 This action process by the nurse in a nurse-patient
contact is called nursing process.
 The nurse’s action may be automatic or
deliberative.
AUTOMATIC NURSING ACTIONS
 Are nursing actions decided upon for reasons other
than the patient’s immediate need.
DELIBERATIVE NURSING ACTIONS
 Are actions decided upon after ascertaining a need
and then meeting this need
THE FOLLOWING LISTS IDENTIFIES THE CRITERIA FOR
DELIBERATIVE ACTIONS:
 Deliberative actions result from the correct
identification of patient needs by validation of the
nurse’s reaction to patient behavior.
 The nurse explores the meaning of the action with
the patient and its relevance to meeting his need.
 The nurse validates the action’s effectiveness
immediately after completing it.
 The nurse is free of stimuli unrelated to the
patient’s need when she acts.
NURSING PROCESS DISCIPLINE
 Is the investigation into the patient’s needs.
 Any observation shared and explored with the
patient is immediately useful in ascertaining and
meeting his or her need, or finding out he or she
has no needs at that time.
 The nurse cannot assume that any aspect of his or
her reaction to the patient is correct, helpful, or
appropriate until he or she checks the validity of it
by exploring it with the patient.
 The nurse initiates this exploration to determine
how the patient is affected by what he or she says
and does.
 Automatic reactions are ineffective because the
nurse’s action is determined for reasons other than
the meaning of the patient’s behavior or the
patient’s immediate need for help.
 When the nurse doesn’t explore the patient’s
reaction with him or her, it is reasonably certain
that effective communication between nurse and
patient stops.
 The nurse decides on an appropriate action to
resolve the need in cooperation with the patient.
 This action is evaluated after it is carried out.
 If the patient behavior improves, the action was
successful and the process is completed. If there is
no change or the behavior gets worse, the process
recycles with new efforts to clarify the patient’s
behavior or the appropriate nursing action.
 The action process in a person-to-person contact
functioning in secret. The perceptions, thoughts,
and feelings of each individual are not directly
available to the perception of the other individual
through the observable action.
 The action process in a person-to-person contact
functioning by open disclosure. The perceptions,
thoughts, and feelings of each individual are
directly available to the perception of the other
individual through the observable action.
IMPROVEMENT
 Improvement is the resolution to the patient’s
situation.
 In the resolution, the nurse’s actions are not
evaluated.
 Instead, the result of his or her actions are
evaluated to determine whether his or her actions
served to help the patient communicate his or her
need for help and how it was met.
 In each contact, the nurse repeats a process of
learning how he or she can help the patient.
 The nurse’s own individuality, as well as that of the
patient, requires going through this each time the
nurse is called upon to render service to those who
need him or her.
5 STAGES OF DELIBERATIVE NURSING PROCESS
1) ASSESSMENT
 In the assessment stage, the nurse completes a
holistic assessment of the patient’s needs.
 This is done without taking the reason for the
encounter into consideration.
 The nurse uses a nursing framework to collect both
subjective and objective data about the patient.
2) DIAGNOSIS
 The diagnosis stage uses the nurse’s clinical
judgment about health problems.
 The diagnosis can then be confirmed using links to
defining characteristics, related factors, and risk
factors found in the patient’s assessment.
3) PLANNING
 The planning stage addresses each of the problems
identified in the diagnosis.
 Each problem is given a specific goal or outcome,
and each goal or outcome is given nursing
interventions to help achieve the goal.
 By the end of this stage, the nurse will have a
nursing care plan.
4) IMPLEMENTATION
 In the implementation stage, the nurse begins
using the nursing care plan.
5) EVALUATION
 In the evaluation stage, the nurse looks at the
progress of the patient toward the goals set in the
nursing care plan.
 Changes can be made to the nursing care plan
based on how well (or poorly) the patient is
progressing toward the goals.
 If any new problems are identified in the
evaluation stage, they can be addressed, and the
process starts over again for those specific
problems.
ASSUMPTIONS OF ORLANDO`S THEORY
 When patients are unable to cope with their needs
on their own, they become distressed by feelings
of helplessness.
 In its professional character, nursing adds to the
distress of the patient.
 Patients are unique and individual in how they
respond.
 Nursing offers mothering and nursing analogous to
an adult who mothers and nurtures a child.
 The practice of nursing deals with people,
environment, and health.
 Patients need help communicating their needs;
they are uncomfortable and ambivalent about
their dependency needs.
 People are able to be secretive or explicit about
their needs, perceptions, thoughts, and feelings.
 The nurse-patient situation is dynamic; actions and
reactions are influenced by both the nurse and the
patient.
 People attach meanings to situations and actions
that aren’t apparent to others.
 Patients enter into nursing care through medicine.
 The patient is unable to state the nature and
meaning of his or her distress without the help of
the nurse, or without him or her first having
established a helpful relationship with the patient.
 Any observation shared and observed with the
patient is immediately helpful in ascertaining and
meeting his or her need, or finding out that he or
she is not in need at that time.
 Nurses are concerned with the needs the patient is
unable to meet on his or her own.
STRENGTHS OF ORLANDO`S THEORY
  The guarantee that patients will be treated as
individuals is very much applied in Orlando’s
theory of Deliberative Nursing Process. Each
patient will have an active and constant input into
their own care.
 Assertion of nursing’s independence as a
profession and her belief that this independence
must be based on a sound theoretical framework.
 The model also guides the nurse to evaluate her
care in terms of objectively observable patient
outcomes.
LIMITATIONS OF ORLANDO`S THEORY
 The lack of the operational definitions of society or
environment was evident which limits the
development of research hypothesis.
 Orlando’s work focuses on short term care,
particularly aware and conscious individuals an
APPLICATION TO NURSING PRACTICE,
EDUCATION & RESEARCH
 Therapeutic effectiveness of nurses in rendering
care
 Nurses quick decision making & critical thinking
skills most especially in special areas
TRAVELBEE`S HUMAN TO HUMAN RELATIONSHIP
INTRODUCTION
 JOYCE TRAVELBEE developed the Human-to-
Human Relationship Model presented in her book
Interpersonal Aspects of Nursing (1966,1971)
 She dealt with interpersonal aspects of nursing
 She explains “human-to-human relationship is the
means through which the purpose of nursing is
fulfilled”
 Travelbee believed that nursing is accomplished
through human-to-human relationships that begin
with the original encounter & the progress through
stages of emerging identities, developing feelings
of empathy & later feelings of sympathy.
 Travelbee`s ideas have greatly influenced the
hospice movement in the west.
HISTORY & BACKGROUND
 Joyce Travelbee was born on December 14, 1926 in
Louisiana, USA.
 She is known for her work as a nursing theorist.
 In 1956, Travelbee earned her Bachelor of Science
in Nursing degree from Louisiana State University.
 She was given a Master of Science in Nursing
degree in 1959 from Yale University.
 Her career dealt predominantly with psychiatric
nursing and education.
 She worked as a psychiatric nursing instructor at
the DePaul Hospital Affiliate School in New
Orleans, Louisiana, and worked later in the Charity
Hospital School of Nursing in Louisiana State
University, New York University, and the University
of Mississippi.
 She died in 1973 at the age of 47.
INFLUENCES ON THE THEORY OF TRAVELBEE
 The assumptions of the model are based on Soren
Kierkegaard’s philosophy of existentialism and
Viktor Frankl’s logotherapy.
 Existentialism places the accountability for
people’s choices in life on the people who make
those choices.
 Logotherapy, which was first proposed in
Frankl’s Man’s Searching for Meaning (1963), is a
form of psychotherapy that makes the assumption
that fulfillment is the best protection against
emotional instability.
MAJOR CONCEPTS
PERSON
 Person is defined as a human being. 
 Both the nurse and the patient are human beings.
HEALTH
 Health is subjective and objective. 
 Subjective health is an individually defined state of
well - being in accord with self-appraisal of
physical-emotional-spiritual status while Objective
health is an absence of discernible disease,
disability of defect as measured by physical
examination, laboratory tests and assessment by
spiritual director or psychological counselor.
ENVIRONMENT
 Is not clearly defined. 
NURSING
 “An interpersonal process whereby the
professional nurse practitioner assists an
individual, family or community to prevent or cope
with experience or illness and suffering, and if
necessary, to find meaning in these experiences.”
KEY CONCEPTS
 Travelbee believed nursing is accomplished
through human-to-human relationships that begin
with the original encounter and then progress
through stages of emerging identities, developing
feelings of empathy, and later feelings of sympathy.
 The nurse and patient attain a rapport in the final
stage.
 For meeting the goals of nursing, it is a
prerequisite to achieving a genuine human-to-
human relationships.
 This relationship can only be established by an
interaction process.
 It has five phases:
o The inaugural meeting or original encounter
o Visibility of personal identities/ emerging
identities.
o Empathy
o Sympathy
o Establishing mutual understanding and
contact/ rapport
 Other concepts of the nursing theory are suffering,
meaning, nursing, hope, communications, self-
therapy, and a targeted intellectual approach.
 Each of these concepts is defined by Travelbee to
help nurses understand the model.
 Suffering ranges from a feeling of unease to
extreme torture, and varies in intensity, duration,
and depth.
 The role of nursing in Travelbee’s theory is to help
the patient find meaning in the experience of
suffering, as well as help the patient maintain
hope.
  Hope is defined as a faith that can and will bring  The name was officially changed to “The Human
change that will bring something better with it. Becoming Theory” in 1992 to remove the term
 It has six characteristics: “man”, after the change in the dictionary definition
o It is strongly associated with dependence on of the word from its former meaning of
other people. “humankind”.
o It is oriented with the future.
HISTORY AND BACKGROUND
o It is linked to elections from several
 Born in Pennsylvania in 1938.
alternatives or escape routes out of its
 She went on tograduate from St. Francis Academy
situation.
in 1956, before enrolling at Duquesne University.
o The desire to possess any object or condition,
 She went on to receive her Bachelor of Science in
to complete a task or have an experience.
Nursing from Duquesne in 1960 before moving on
o Confidence that others will be there for one
to the University of Pittsburgh and completing her
when you need them.
master’s in Nursing in 1961 and her doctorate in
o The hoping person is in possession of courage
Nursing and Higher Education in 1969.
to be able to acknowledge its shortcomings
 She began her teaching career at the University of
and fears and go forward toward its goal
Pittsburgh while finishing her Ph.D. before
STRENGTHS OF THE THEORY
accepting a position at Duquesne in 1966.
 Travelbee’s theory has a wide scope of application.
 She served as Dean of the School of Nursing at
 It seems to be working with
Duquesne from 1977-1979 and left the University
 Patients in distress and life changing events, and
in 1983 to serve as a professor and the coordinator
with those who are chronically ill, those
of the Center for Nursing Research at Hunter
undergoing rehabilitation and the dying and
College of the City University of New York.
terminally ill.
 She remained at Hunter College until she accepted
LIMITATIONS OF THE THEORY
a position as the Niehoff Chair at Loyola University
 The definition of Travelbee’s theory are not
Chicago Niehoff School of Nursing in 1993.
consistent in clarity and origin.
 In 2006, she left Loyola and has served as a
 She had more focus on adult individuals who are
consultant and visiting scholar at New York
sick and the nurse’s role in helping them find
University College of Nursing.
meaning in sickness and suffering.
 Dr. Parse made considerable contributions to the
APPLICATION TO NURSING PRACTICE
field of nursing, most significantly her theory of
 Travelbee's theory has significantly influenced
Man-Living Health which she renamed the Human
nursing and health care and the hospice
Becoming
movement in the west.
 Theory in 1990. Her theory is internationally
known through her nine books and over one
PARSE’S THEORY OF HUMAN BECOMING
hundred articles as well as the many other works
INTRODUCTION
based upon her theory published by other
 Rosemarie Rizzo Parse is an articulate, courageous,
scholars.
and vibrant leader with a strong vision and a
 She has presented her theory all over the world
deliberate determination to advance the discipline
and had her books translated into several different
of nursing.
languages. She also founded Nursing Science
 She is well-known internationally for her human
Quarterly, a journal dedicated to the study of
becoming school of thought - a nursing perspective
nursing theory and research.
that focuses on quality of life and human dignity
 She is also the founder of the Institute of Human
from the perspective of patients, families, and
Becoming and the president of Discovery
communities.
International, Inc., a nursing consultation firm.
 Dr. Parse is an inspirational mentor who has helped
PUBLISHED BOOKS AND WORKS
many seasoned and budding nurse scholars to
 Educated at Duquesne University, Pittsburgh
pursue their dreams.
 MSN and Ph.D. from University of Pittsburgh
 The Parse theory of Human Becoming guides
 Published her theory of nursing, Man-Living-
nurses in their practice to focus on quality of life as
Health in 1981
it is described and lived (Karen & Melnechenko,
 Name changed to Theory of Human Becoming in
1995)
1992
 The Human Becoming Theory of Nursing presents
 Editor and Founder, Nursing Science Quarterly
an alternative to both the conventional bio-
 Has published eight books ang hundreds of
medical approach and the bio-psycho-social-
articles about Human Becoming Theory
spiritual (but still normative) approarch of most
 Professor and Niehoff Chair at Loyola University,
other theories of nursing (ICPS).
Chicago
 The Human Becoming Theory posits quality of life
AWARDS AND HONORS
from each person's own perspective as the goal of
 Two Lifetime Achievement Awards (one from the
nursing practice.
Midwest Nursing Research Society and one from
 Rosemarie Rizzo Parse first published the theory in
1981 as the “Man-living-health” theory.
 the Asian American Pacific Islander Nurses'
Association)
 The Rosemarie Rizzo Parse Scholarship was
endowed in her name at the Henderson State
University School of Nursing.
 Her books were twice named to the best picks' list
of theory books by Sigma Theta Tau International
Honor Society in Bursing
 The Society of Rogerian Scholar honored her with
the Martha E. Rogers Golden Slinky Award.
 In 2008, she was the recipient of the New York
Times Nurse Educator of the Year Award.
INFLUENCES ON THE THEORY
 The Human Becoming Theory was developed as a
human science nursing theory in the tradition of
Dilthey, Heidegger, Sarte, Merleau-Ponty, and
Gadamer, and Science of Unitary Human Being by
Martha Rogers
 The assumptions underpinning the theory were
synthesized from works by the European
philosoophers, Heidegger, Sarte, and Merleau-
Ponty, along with worls by the pioneer American
nurse theorist, Martha Rogers.
 The theory is structured around three abiding
themes: meaning, rhythmicity, and transcendence.
MAJOR CONCEPTS
PERSON
 Open being who is more than and different from
the sum of the parts
ENVIRONMENT
 Everything in the person and his experiences
 Inseparable, complimentary to, and evolving with
HEALTH
 Open process of being and becoming. Involves
synthesis of values
NURSING
 A human science and art that uses an abstract
body of knowledge to serve people
KEY CONCEPTS
MEANING
 Meaning is “structuring meaning multi-
dimensionally” by analyzing and developing
“what was, is and will be.” (Kearney-Nunnery,
2012, p.56). With "meaning" the concept is valuing
images and language through speaking versus
being silent and movement versus stillness.
 Human Becoming is freely choosing personal
meaning in situations in the inter-subjective
process of living value priorities.
 Man's reality is given meaning through lived
experiences.
 Man and environment co-create.
RYTHMICITY
 Rhythmicity or rhythmical patterns is as the
connection between the human and universe
being a mutual process with a sense of cadent
rhythms. The rhythmical patterns as part of
revealing versus concealing, enabling versus
limiting and connecting versus separating and
consisting of all realms in between.
 Human Becoming is co-creating rhythmical
patterns of relating in mutual process with the
universe.
 Man and environment co-create (imaging, valuing,
languaging) in rhythmical patterns
TRANSCENDENCE
 The human transcending means with unlimited
possibilities of powering with pushing or resisting.
Originating is part of the transcendence with
certainty or uncertainty and conforming versus not
conforming. It is transforming with the familiar or
the unfamiliar.
 Human Becoming is co-transcending
multidimensionally with emerging possibilities.
 Refers to reaching out and beyond the limits that a
person sets
 One constantly transform.
FOUR POSTULATES:
1. ILLIMITABILITY
 is "the indivisible unbounded knowing extended to
infinity, the all-at-once remembering and
prospecting with the moment" (Parse, 2007, p.
308).
2. PARADOX
 "Paradox is an intricate rhythm expressed as a
pattern preference" (Parse, 2007, p. 309). Parse
refers to Paradoxes as "lived rhythms" in her book
(Parse, 2007, p. 309).
3. FREEDOM
 Freedom is "contextually construed liberation"
(Parse, 2007, p. 309).
4. MYSTERY
 Mystery "is the unexplainable, that which cannot
be completely known" (Parse, 2007, p. 309). It is
the evolving of humankind as unpredictable and
ever changing.
ASSUMPTIONS
ABOUT MAN
 The human is co-existing while co-constituting
rhythmical patterns with patterns
 The human is open, freely choosing meaning in
situation, bearing responsibility for decisions.
 The human is unitary, continuously co-constituting
patterns of relating.
 The human is transcending multidimensionally
with the possible.
ABOUT BECOMING:
 Becoming is unitary human-living-health.
 Becoming is a rhytmically co-constituting human-
universe process.
 Becoming is the human's patterns of relating value
priorities.
 Becoming is an inter-subjective process of
transcending with the possible.
 Becoming is unitary human's emerging.
STRENGTHS
 Differentiates nursing from other disciplines.
 Practice - provides guidelines of care and useful
administration.
  Provides research methodologies.
 Provides framework to guide inquiry of other
theories (grief, hope, laughter, etc.)
LIMITATIONS
 Lack of articulation with the body of knowledge
and psychomotor skills that most nurses and
society generally attribute to the practice of
professional nursing.
 Research considered to be in a”closed circle”.
 Rarely quantifiable results - difficult to compare to
other research studies, no control group,
standardized questions, etc.
 Does not utilize the nursing process/diagnoses.
 Degates the idea that each person engages in a
unique lived experience.
 Not accessible to the novice nurses.
 Not applicable to acute, emergent care.
APPLICATION TO NURSING PRACTICE, EDUCATION, AND
RESEARCH
NURSING PRACTICE:
 A transformative approach to all levels of nursing.
 Differs from the traditional nursing process,
particularly in that it does not seek to “fix”
problems.
 Ability to see patients perspective allows nurse to
“be with” patient and guide them toward desired
health outcomes.
 Nurse-person relationship co-creates changing
health patterns.
RESEARCH:
 Enhances understanding of human lived
experience, health, quality of life, and quality of
nursing practice.
 Expands the theory of human becoming.
 Builds new nursing knowledge about universal
lived experiences which may ultimately contribute
to health and quality of life.
Locsin’s Technological Competency as Caring in Nursing
Introduction
 Technological Competency as Caring in Nursing is a
middle range theory.
 It is illustrated in the practice of nursing grounded
in the harmonious coexistence between
technology and caring in nursing
 The harmonization of these concepts places the
practice of nursing within the context of modern
healthcare and acknowledges that these concepts
can co-exist.
 Technology brings the patient closer to the nurse.
Conversely, technology can also increase the gap
between the nurse and nursed.
 In this relationship of the “knower” and the
“known”, technology provides the efficiency and
the value that marks their mutual and momentary
reality.
 When technology is used to know persons
continuously in the moment, the process of
nursing is lived.
 Technological competency in nursing fosters the
recognition and realization of persons as
participants in their care rather than object of
care.
 The idea of “participation in their care” stems
from active engagement; the nurse enters rge
world of the one nursed, through available
appropriate technologies, attempting to know the
nursed more fully in the moment.
History and Background
 Locsin was born in 1954, he is a registered nurse, a
native of Dumaguete City, Philippines who resides
and practices his nursing profession at Tokushima
University, Tokushima, Japan as a Professor of
Nursing.
 Dr. Rozzano Locsin is recognized for his important
contributions in the field of earned his Doctor of
Philosophy in Nursing degree from the University
of the Philippines in 1988,
 Master of Arts in Nursing and Bachelor of Science
in Nursing from Silliman University in 1978 and
1976 in the Philippines.
 He joined Florida Atlantic University, Christine E.
Lynn College of Nursing in 1991 where he is a
tenured Professor of Nursing.
 Dr. Locsin's research and scholarly works
concerning technology and caring in nursing
converge on the theme "life transitions in human
health.“
 Known as The middle-range theory, “Technological
Competency as Caring in Nursing”
Published Books & Works
 Rozzano Locsin's Technological competency as
caring in nursing: Knowing as process and
technological knowing as practice
 A Contemporary Nursing Process: The (Un)
Bearable Weight of Knowing in Nursing
 Technological Competency as Caring in Nursing: A
Model for Practice
Advancing Technology, Caring, and Nursing
 The Evolution of the Theory of Technological
Competency as Caring in Nursing
 Nursing Robots: Robotic Technology and Human
Caring for the Elderly
Awards and Honors
 2000–2001 Fullbright Scholar Award Florida Center
for International Exchange of Scholars,
Washington D.C.
 2004–2006 - Fullbright Alumni Initiative Award to
Uganda Fullbright Senior Specialist in Global and
Public Health and International Development
 2003 Edith Moore Copeland for Excellence in
Creativity (Founder’s Award) Sigma Theta Tau
International Honor Society of Nursing –
Indianapolis (37th Biennial Convention) Award:
Sigma Theta International
 2003 Julita V. Sotejo Medallion of Honor: Lifetime
Achievement Award, University of the Philippines,
Nursing Alumni International Inc., Los Angeles,
California
 2003 University Research of the Year – Professor,
Scholarly & Creative Works, FAU
  2007 First recipient of the Lillian O.
Slemp Endowed Chair in Nursing at the University
of Texas-Pan American in Edinburg, Texas  moment (Locsin, 2005).
 2009 Ingural recipient of the John F. Wymer, Jr.   who is also the recipient of nursing care has
Distinguished Professor in Nursing at Florida
Atlantic University.
 2010 Academic Excellence Award, Philippine
American Society Outstanding Sillimanian Award
and the Outstanding Paulinian
Award in the field of Nursing Education
Influences of the Theory
 Locsin’s theory on technological competency as an
expression of caring is grounded as the Nursing as
Caring theory of Boykin and Schoenhofer. Nursing
as caring is a general nursing theory stating in the
primary concern of nursing is caring and it should
be uniquely and knowing expressed in nursing
(Boykin & Schoenhofer, 1990).
 He was enriched by the practical value of all of the
general theories of nursing that are grounded in
caring. ( Savina O. Schoenhofer, RN, PhD Professor,
Department of Graduate Nursing Alcorn State
University, Natchez Mississippi, USA, Technological
competency as caring in nursing is a critical
process of knowing persons wholeness.
 Locsin also found influence from Martin
Heidegger, a philosopher who spoke over 50 years
ago expressing concern over accepting technology
without critical evaluation ( Locsin & Purnell,
2007).
 Locsin’s theory development then became to
examine the challenges that nursing faces within
the technological environment.
Major Concepts
Nursing
 “ Nurses value technological competency as an
expression of caring in nursing”
 is described As a discipline and a specialized
practice that uses technologies to individualize
care to meet the unique needs of the person.
Health
 Humanity is preserved by technology.
 “An experience that is often expressed in terms of
wellness and illness, and may occur in the
presence or absence of disease”
 having the Patient participate in their own health.
And in using technologies to better understand the
hemodynamics of the patient to provide the best
care and meet their individual needs
Environment
 Environment is the technological world in which
we live.
 is in the surroundings that use technology. such as
a critical care unit to understand the persons as a
complete moment by moment. Increased
technological monitoring allows for greater insight
of whole state of health.
Person
 Patients seen as “participants in their care rather
than object of nurse care” (Locsin, 2013).
 Describes persons as human beings who are whole
and complete in any
desires, dreams, and ambitions are to live life
completely as caring persons. They also want to
feel acknowledged as a unique person with hopes
and dreams and not as an object
Key Concepts
Dynamic Process of Nursing
 Affirms the practice of nursing as a shared
engagement in response to the question, “how do
nurses practice nursing?”
 Nursing care practice sustains and
maintains,supports, and celebrates human health
and well-being.
 Dynamic process nursing care practice focus on
activities that human nurses and ARs engage in, to
service humankind.
 Functionalities direct the actions and interactions
between human persons-the nurse and the one
nursed
 The practice of nursing grounded in the science of
caring is expressed in the technological
competency of nurses.
 This process of knowing persons as nursing
embraces the futuristic visioning of nursing as
engagements between human persons who may
be endowed with technological enhancers.
3 Dynamic Nursing Processes serve to guide nurses in their
practice:
 Dynamic Nursing Process events of knowing
persons as caring are identified as:
o Technological knowing
o Mutual designing
o Participative engaging
Technological Knowing
 Is a way of understanding persons through the use
of technologies of health and human care and
provides nurses an “other way of knowing
persons”
Mutual Designing
 Is a multidimensional process of knowing persons
in which both the nurse and the one nursed co-
create a mutually fulfilling nursing care process
derived from both the nurse’s design and those of
the person being nursed, and together conjointly
practiced as nursing.
 The probability of Artificial Super Intelligence (ASI)
as Barrat (20) claims will occur much sooner than
expected . He described the development of the
AGI as the “ability to solve problems,learn,and
take effective, human-like action , in a variety of
environments”
Participative Engaging
 Promotes the opportunity for simultaneous
practice of shared activities which are crucial to
knowing persons.
  In this, engagement, the alternating rhythm of
implementation and evaluation occurs during
which the nurse enters the world of the other and
the engagement results in continous knowing.
 Participative engaging between human person and
ARs continously advance as AI progress to a level
that complements the emergence of super
intelligent machines and human persons.
Universal Technological Domain
 The technological encounter within the UTD is the
all encompassing unity of space and technology in
this domain is where all technological skills and
techniques of engagement occur between ARs and
human persons.
 Explications and utilizations of knowing persons as
caring is illuminated as the technological
encounter.
Assumptions
 Persons are caring by virtue of their humanness.
( Boykin and Schoenhofer,2001)
 Persons are whole or complete in the moment.
(Boykin and Schoenhofer, 2001)
 Knowing persons is a process of nursing that
allows for continuous appreciation of persons
moment to moment.( Locsin, 2005)
 Nursing is a discipline and a professional practice. (
Boykin and Schoenhofer, 2001)
 Technologies of health and nursing are aspects of
care that enable nurses to know human beings
more fully as persons who participate in their care,
rather than simply recipients of our care.
(Kongsuwan and Locsin)
Strengths of the Theory
 Locsin’s theory can serve as basic data for nursing
in Bangladesh.
 According to Locsin (2010), knowing persons is a
considerable process in order to understand the
persons as whole and participate in the care that
would prevent risk to life and enhance patients’
wellness.
 To examine Technological Competency as Caring in
Nursing (TCCN) as perceived by Intensive Care Unit
(ICU) nurses in Bangladesh, and to examine the
relationship between TCCN and selected factors
(nurses’ age, level of nursing education, length of
working experience, continuing education and
training, and self-awareness).
Limitations
 The demanding Practice of human caring in
nursing is not well served depending solely on
sentimental explanations of the harmonious
coexistence between technologies and caring in
nursing (Locsin, 1995)
 Technology brings the patient closer to the nurse.
Conversely, technology can also increase the gap
between the nurse and nursed.
 The amount of the invasive technologies used on a
patient can make it difficult to create mutual
relationships.
Application to Nursing Practice, Education & Research
 Locsin's Model in nursing promotes the awareness
and acknowledgment that people are not just
objects of care but rather “participants in their
care”.
 Model-based nursing practice is necessary in
nursing practice to provide quality human care
with the use of technologies.
 Locsin's theory can serve as a foundation for
nursing research studies.
 It suggests nurses to strive to become
technologically-competent professionals to be able
to deliver expert caring to their patients.
 Technology is essential for nursing students in
their training and preparation.
Leininger Theory of Culture, Care Diversity & Universality
INTODUCTION
 Madeleine Leininger is considered as the founder
of the theory of transcultural nursing.
 Born on July 13, 1925 (Sutton, Nebraska, US) Died
on August 10 2012 (Omaha, Nebraska, US)
 Her theory has now developed as a discipline in
nursing.
 Transcultural nursing theory is als o known as
Culture Care theory.
 Theoretical framework is depicted in her model
called the Sunrise Model (1997).
 The Transcultural Nursing Theory or Culture Care
Theory by Madeleine Leininger involves knowing
and understanding different cultures with respect
to nursing and health-illness caring practices.
 It focuses on the fact that different cultures have
different caring behaviors and different health and
illness values, beliefs, and patterns of behaviors.
 Madeleine Leininger defined transcultural nursing
as “a substantive area of study and practice
focused on comparative cultural care (caring)
values, beliefs, and practices of individuals or
groups of similar or different cultures with the goal
of providing culture-specific and universal nursing
care practices in promoting health or well-being or
to help people to face unfavorable human
conditions, illness, or death in
culturally meaningful ways.”
HISTORY AND BACKGROUND
 Dr. Madeleine Leininger’s earliest work in
developing the Theory of Culture Care Diversity
and Universality (also known as the Culture Care
Theory or CCT) occurred during her study with the
Gadsup People in the Eastern Highlands of
Papua New Guinea.
 The earliest conceptualizations of the theory were
introduced with the ethnonursing method in her
doctoral dissertation (Leininger, 1966).
 Her findings were explicated further in a later
review article about the Gadsup study published in
the Journal of Transcultural Nursing (Leininger,
1993).
  The evolution of the theory can be traced forward
from Leininger’s (1978) groundbreaking
dissertation through the 1970s, which saw
publication of her first transcultural nursing text,
Transcultural Nursing: Concepts, Theories, and
Practices
 She presented her earliest transcultural nursing
theory ideas including assumptions, definitions,
and propositions as well as other theories and
studies about cross-cultural nursing and caring
phenomena.
 Leininger also presented an early conceptual and
theory-generating model (Figure 1; Leininger,
1978, p. 39) that, along with 30 identified
ethnonursing care constructs, she asserted could
be used to conduct transcultural nursing studies
(Leininger, 1988a)
 In this depiction, early conceptualizations of both
the CCT and the Sunrise Model (which later
became the Sunrise Enabler) can be discerned
 For example, social structure features evolved into
cultural and social structure dimensions; care
constructs became care expressions, patterns, and
practices; and nursing interventions based on
research findings developed into the culture care
modes of decisions and actions
PUBLISHED BOOKS AND WORKS
 Lininger has written and edited 27 books and
founded the Journal of Transcultural Nursing to
support the research of the Transcultural Nursing
Society, which she started in 1974.
 She published over 200 articles and book chapters,
produced numerous audio and video recordings,
and developed a software program. She has also
given over 850 keynote and public lectures in US
and around the world. (Nurselabs, 2019)
 She also established the Journal of Transcultural
Nursing and served as editor from 1989 to 1995.
 She also initiated and promoted worldwide
certification of transcultural nurses (CTN) for client
safety and knowledgeable care for people of
diverse cultures. (Nurselabs, 2019)
 Evolution of her theory can be understood from
her books:
o Culture Care Diversity and Universality (1991)
o Transcultural Nursing (1995)
o Transcultural Nursing (2002)
 In 1960, Leininger was awarded a National League
of Nursing Fellowship for fieldwork in the Eastern
Highlands of New Guinea, where she studied the
convergence and divergence of human behavior in
two Gadsup villages.
 While at Wayne State, Leininger won numerous
awards, including the prestigious President’s
Award for Excellence in Teaching, the Board of
Governors Distinguished Faculty Award, and the
Gershenson’s Research Fellowship Award.
 In 1998, she was honored as a Living Legend
by the American Academy of Nursing and
Distinguished Fellow, Royal College of Nursing in
Australia.
 The Leininger Transcultural Nursing Award was
established in 1983 to recognize outstanding and
creative leaders in transcultural nursing. This
prestigious award will continue as the Leininger
Transcultural Nursing Award under the auspices of
the Transcultural Nursing Society in Madeleine
Leininger’s honor.
INFLUENCE OF THE THOERY
 The theory comes from all her experiences and
exposure in the field.
 Leininger worked as a clinical specialist on child
mental health on a child guidance center.
 Children were from culturally diverse backgrounds
due to immigration.
 Began to notice the behavioural and questioned
the cultural aspects of these difference in relation
to care.
 She continued her observations, question, and
linking the concepts of human care and culture led
her to establish the theory of culture care and
transcultural nursing
MAJOR CONCEPT
1. Human beings
 Such are believed to be caring and to be capable of
being concerned about the needs, well-being, and
survival of others. Leininger also indicates that
nursing as a caring science should focus beyond
traditional nurse-patient interactions and dyads to
include families, groups, communities, total
cultures, and institutions
2. Health
 It is a state of well-being that is culturally defined,
valued, and practiced, and which reflects the
ability of individuals (or groups) to perform their
daily role activities in culturally expressed,
beneficial, and patterned lifeways.
3. Society and Environment
 These terms are not defined by Leininger; she
speaks instead of worldview, social structure, and
environmental context.
4. Nursing
 Nursing is defined as a learned humanistic and
scientific profession and discipline which is focused
on human care phenomena and activities in order
to assist, support, facilitate, or enable individuals
or groups to maintain or regain their well-being (or
 health) in culturally meaningful and beneficial
ways, or to help people face handicaps or death.
KEY CONCEPTS
Transcultural Care Theory and Ethnonursing
 Developed the Transcultural Nursing Model. She
advocated that nursing is a humanistic and
scientific mode of helping a client through specific
cultural caring processes (cultural values, beliefs
and practices) to improve or maintain a health
condition.
 Nursing is a learned humanistic and scientific
profession and discipline which is focused on
human care phenomena and activities in order to
assist, support, facilitate, or enable individuals or
groups to maintain or regain their well being (or
health) in culturally meaningful and beneficial
ways, or to help people face handicaps or death.
Transcultural Nursing
 Transcultural nursing as a learned subfield or
branch of nursing which focuses upon the
comparative study and analysis of cultures with
respect to nursing and health-illness caring
practices, beliefs and values with the goal to
provide meaningful and efficacious nursing care
services to people according to their cultural
values and health-illness context.
 Awareness of the differences allows the nurse to
design culture-specific nursing interventions.
Ethnonursing
 This is the study of nursing care beliefs, values, and
practices as cognitively perceived and known by a
designated culture through their direct experience,
beliefs, and value system (Leininger, 1979).
Professional Nursing Care (Caring)
 Professional nursing care (caring) is defined as
formal and cognitively learned professional care
knowledge and practice skills obtained through
educational institutions that are used to provide
assistive, supportive, enabling, or facilitative acts
to or for another individual or group in order to
improve a human health condition (or well-being),
disability, lifeway, or to work with dying clients.
Cultural Congruent (Nursing) Care
 Cultural congruent (nursing) care is defined as
those cognitively based assistive, supportive,
facilitative, or enabling acts or decisions that are
tailor-made to fit with individual, group, or
institutional cultural values, beliefs, and lifeways in
order to provide or support meaningful, beneficial,
and satisfying health care, or well-being services.
Culture Care
 Culture care is defined as the subjectively and
objectively learned and transmitted values, beliefs,
and patterned lifeways that assist, support,
facilitate, or enable another individual or group to
maintain their well-being, health, improve their
human condition and lifeway, or to deal with
illness, handicaps or death.
Culture Care Diversity
 Culture care diversity indicates the variabilities
and/or differences in meanings, patterns, values,
lifeways, or symbols of care within or between
collectives that are related to assistive, supportive,
or enabling human care expressions.
Culture Care Universality
 Culture care universality indicates the common,
similar, or dominant uniform care meanings,
pattern, values, lifeways or symbols that are
manifest among many cultures and reflect
assistive, supportive, facilitative, or enabling ways
to help people. (Leininger, 1991)
Generic (Folk or Lay) Care Systems
 Generic (folk or lay) care systems are culturally
learned and transmitted, indigenous (or
traditional), folk (home-based) knowledge and
skills used to provide assistive, supportive,
enabling, or facilitative acts toward or for another
individual, group, or institution with evident or
anticipated needs to ameliorate or improve a
human life way, health condition (or well-being),
or to deal with handicaps and death situations.
Emic
 Knowledge gained from direct experience or
directly from those who have experienced. It is
generic or folk knowledge.
Professional Care Systems
 Professional care systems are defined as formally
taught, learned, and transmitted professional care,
health, illness, wellness, and related knowledge
and practice skills that prevail in professional
institutions usually with multidisciplinary
personnel to serve consumers.
Etic
 Knowledge which describes the professional
perspective. It is professional care knowledge.
Ethnohistory
 Ethnohistory includes those past facts, events,
instances, experiences of individuals, groups,
cultures, and instructions that are primarily
people-centered (ethno) and which describe,
explain, and interpret human lifeways within
particular cultural contexts and over short or long
periods of time.
Culture Shock
 Culture shock may result when an outsider
attempts to comprehend or adapt effectively to a
 different cultural group. The outsider is likely to
experience feelings of discomfort and helplessness
and some degree of disorientation because e of
the differences in cultural values, beliefs, and
practices. Culture shock may lead to anger and can
be reduced by seeking knowledge of the culture
before encountering that culture.
Cultural Imposition
 Cultural imposition refers to efforts of the
outsider, both subtle and not so subtle, to impose
his or her own cultural values, beliefs, behaviors
upon an individual, family, or group from another
culture. (Leininger, 1978)
Sunrise Model of Madeleine Leininger’s Theory
 The Leininger Sunrise Model represents the
structure of culture care theory by describing the
relationship between anthropological and nursing
beliefs and principles. Nurses use this model when
making cultural evaluations of patients.
 Nurses use this model when making cultural
evaluations of patients. The model connects the
concepts of the theory with actual clinical
practices, while offering a systemic approach to
identifying values, beliefs, behaviors, and
community customs. The model encompasses
numerous aspects of culture: religious, financial,
social, technological, educational, legal, political,
and philosophical dimensions
 The Sunrise Model is relevant because it enables
nurses to develop critical and complex thoughts
towards nursing practice. These thoughts should
consider, and integrate, cultural and social
structure dimensions in each specific context,
besides the biological and psychological aspects
involved in nursing care.
 The cultural care worldview flows into knowledge
about individuals, families, groups, communities,
and institutions in diverse health care systems.
 This knowledge provides culturally specific
meanings and expressions in relation
Three modes of nursing care decisions and actions
1. Cultural care preservation or Maintenance
 Cultural care preservation is also known as
maintenance and includes those assistive,
supporting, facilitative, or enabling professional
actions and decisions that help people of a
particular culture to retain and/or preserve
relevant care values so that they can maintain
their well-being, recover from illness, or face
handicaps and/or death.
2. Cultural care accommodation or Negotiation
 Cultural care accommodation also known as
negotiation, includes those assistive, supportive,
facilitative, or enabling creative professional
actions and decisions that help people of a
designated culture to adapt to or negotiate with
others for a beneficial or satisfying health outcome
with professional care providers.
3. Culture care repatterning or Restructuring
 Culture care repatterning or restructuring includes
those assistive, supporting, facilitative, or enabling
professional actions and decisions that help a
clients reorder, change, or greatly modify their
lifeways for new, different, and beneficial health
care pattern while respecting the clients cultural
values and beliefs and still providing a beneficial or
healthier lifeway than before the changes were
coestablished with the clients. (Leininger, 1991)
ASSUMPTIONS
 Care is the essence and central dominant, and
unifying focus of nursing.
 Humanistic scientific care is essential for human
growth, well-being, health, survival and to face
dying, death, and disabilities.
 Care (caring) is essential to curing or healing, for
there can be no curing without caring (this
assumption had profound relevance worldwide).
 Culture care is the synthesis of two major
constructs (culture and care) that guide the
researcher to discover, explain, and account for
health, well-being, care expressions, and other
human conditions.
 Culture care expressions, meanings, patterns,
processes, and structural forms are diverse but
some commonalities (universalities) exist among
and between cultures.
 Culture care values, beliefs, and practices are
influenced by and embedded in the worldview. IN
social structure factors (e.g., spiritually, religion,
life philosophy, kinship, politics, economics,
technology, biological factors, and cultural values).
Nd in the ethnohistorical and environmental
contexts.
 Every Culture has generic (lay, folk, naturalistic,
mainly emic) and usually some professional (etic)
care to be discovered and used for culturally
congruent care practices.
  Culturally congruent and therapeutics care occurs
when culture care values, beliefs, expressions, and
patterns are explicitly known and used
appropriately, sensitively and meaningfully with
people of diverse or similar cultures.
 Leininger’s three theoretical modes of care
(culture care modes) offer new, creative, and
different therapeutic ways to help people of
diverse cultures.
 The ethnonursing research method and other
qualitative paradigmatic research methods offer
important means to discover largely embedded,
covert, epistemic, and ontological culture care
knowledge and practices.
 Transcultural nursing is a discipline that has a body
of knowledge an practices designed to help
caregivers attain and maintain the goal of
providing culturally congruent care for health and
well-being.
STRENGTHS
 Leininger’s Transcultural Nursing Theory or Culture
Care Diversity and Universality focused on the
concept of culture in providing nursing care to our
patients. It aids the nurse to be culture sensitive.
 Compare to other theories which primarily focus
on people, health, environment and nursing, for
Leininger she highlight on care as core of nursing.
 Leininger has developed the Sunrise Model in a
logical order to demonstrate the interrelationships
of the concepts in her theory of Culture Care
Diversity and Universality.
 Leininger’s theory is essentially parsimonious in
that the necessary concepts are incorporated in
such a manner that the theory and its model can
be applied in many different settings.
 It is highly generalizable. The concepts and
relationships that are presented are at a level of
abstraction which allows them to be applied in
many different situations.
 Though not simple in terms, it can be easily
understood upon the first contact.
LIMITATIONS
 It can be the primary cause of error in making
clinical decisions like misperception of the
outcomes and misperception of the values
patients place on to outcomes.
 If nursing practices fail to recognize culturological
aspects of human needs, there will be signs of less
efficacious nursing care practices and
dissatisfaction with nursing services.
 This theory doesn’t give any attention to the
disease, symptoms etc.
 There can be a problem in adapting or integrating
the culture of the other which can be the cause of
cultural shock on the part of the nurses.
 The limited applicability of a static culture
framework, lack of attention to the structural
context in which health care issues arise and must
be addressed, and the consequent
inappropriateness of many health care strategies
based on cultural framework.
APPLICATION TO NURSING PRACTICE, EDUCATION AND
RESEARCH
NURSING PRACTICE
 Madeleine Leininger, explains the role of the nurse
in providing culturally congruent health care to
those clients whose perceptions of care (emic)
may differ from those of the professionals' or
nurses' (etic; Leininger, 1995Leininger,
2002McFarland, Mixer, Wehbe-Alamah, & Burk,
2012;Sagar, 2012).
 It guides the nurses to have a very understanding
in practice when exposed to different cultural
backgrounds. This Not only facilitate the work of
the nurses, but it also beneficial to the client as
his/her medical and personal need are addressed.
 To develop understanding, respect and
appreciation for the individuality and diversity of
patients beliefs, values, spirituality and culture
regarding illness, its meaning, cause, treatment,
and outcome. To encourage in developing and
maintaining a program of physical, emotional and
spiritual self-care.
 Leininger’s theory helps to better define the
expectations of the nurse patient relationship
because ultimately the nurse is the one who
implements care and is at the patient’s side for
most his or her time receiving care (Betancourt, A,
& Leininger, 2016).
 Leininger developed her model to bring about the
practice of culturally congruent nursing.
 The purposed of this study was to gain knowledge
of the culture of a group of Guatemalan refugees
who fled to the United States due to political
unrest, extreme poverty, and persecution.
 This study also conveys another concept that is
unique to Leininger’s theory in which the focus of
caring may transcend the individual and focus on
families, society, or communities as a client (Cohen
1992).
 Madeleine Leininger’s culture care theory
suggested three modes in which to facilitate
nursing actions, judgments, and interventions to
meet the healthcare needs of their patients in a
culturally sensitive and congruent manner.
EDUCATION
  Although the CCT has been used extensively to
guide transculturally focused courses, it has been
proposed that expanded theory applications
would be beneficial as a guiding framework for
both undergraduate and graduate nursing
curricula and programs.
 The CCT core constructs cultural competence,
culturally congruent care, generic and professional
care, cultural diversity, and a view of health from
the perspective of patients and others could be
threaded through every nursing curriculum course
to enhance nursing competence in the provision of
culturally congruent care for diverse clients.
 In addition, DNP projects that include educational
programs about culturally congruent strategies for
implementing evidence-based guidelines for
health
 care providers have the potential to produce
measurable outcomes in provider/staff practice
changes as well as improved patient health
outcomes (White & Zaccagnini, 2017).
RESEARCH
 Application to Research & Practice Phase l-Develop
awareness/sensitivity to cultural core differences
and similarities
 Phase Il- Gain in-depth research-based knowledge
about target culture
 Phase III Development of culturally congruent care
practices
 Phase IV-implementation and iterative evaluation
of practice
THEORY OF HEALTH AS EXPANDING CONSIOUSNESS
MARGARET NEWMAN
INTRODUCTION
 Margaret Newman’s Theory of health as
expanding consciousness was stimulated by
concern for those for whom health as the absence
of disease or disability is not possible, (Newman,
2010). The concept of health is viewed as the
holistic pattern of an individual. (Newman, 2003)
The expression of illness is originated from the
interaction of individual between their
environment. The observable variable in the
environment stimulate individual's health.
 According to Newman, when nurse view illness in
individual like this, their focus is to treat symptoms
based on a pattern. This leads to Newman's theory
to focus on the pattern that refers to "information
of depicts the whole, understanding the
wholeness as one."
 One of the primary roles of a nurse according to
her is to help the client to recognize and positively
address their own patterns according to their
environment. Individual are less bound by linear
thought and a physical concept of health, they are
immersed more in the metaphysical aspect of
human existence according to Newman. The
theory of health as an expanding consciousness
claimed that every person is part of the universe
expanding consciousness no matter how distorted
health for an individual.
HISTORY AND BACKGROUND
 Was born on October 10, 1933, in Memphis,
Tennessee.
 Dr. Newman was raised in a Christian community
and It influenced her decision to join missionary
service later in life; there she realized for the first
time she could not address people’s spiritual
needs without attempting to take care of their
physical needs as well.
 Newman did not choose a nursing major after high
school. However, it appeared that one of her
roommates at the college was a nursing student
who once was asked to assist injured victims after
a huge tornado. It made Newman to think over a
nursing career for herself
 Later she had to come back home when she found
out that her mother was diagnosed with a chronic
irreversible health condition – amyotrophic lateral
sclerosis. She decided to become a primary
caregiver for her mother.
 She earned her Bachelor’s degree in nursing in
1962 from the University of Tennessee.
 She received her Master’s degree in medical-
surgical nursing in 1964 from the University of
California.
 While working towards her graduate degree,
Newman served as a joint director of nursing of a
clinical research center, as well as an assistant
professor of nursing at the University of Tennessee
in Memphis.
 She received doctorate degree from New York
University in 1971 and taught at New York
University until 1977.
 In the fall of 1977, she accepted the position of
professor-in-charge of graduate study in nursing at
Penn State University.
 In 1984, Newman began working as a nurse
theorist at the University of Minnesota, and she
retired from teaching in 1996.
PUBLISHED BOOKS AND AWARDS:
Newman has presented many papers on topics pertaining
to her theory of health as expanding consciousness. She
published:
o Theory Development in Nursing (1979)
o Health as Expanding Consciousness on (1986,
1994)
 o A Developing Discipline: Selected works of
Margaret Newman (1995)
o Transforming Presence: The Difference that
Nursing makes (2008)
 Newman first presented her ideas on a theory of
health in 1978 at a conference on nursing theory
in New York. During that time, she was also
pursuing research on the relationship of
movement, time, and consciousness and was
expanding development of the theory of health as
expanding consciousness.
 In 1985, as a traveling research fellow, Newman
conducted workshops in New Zealand. Further, at
the University of Tampere, Finland, in 1985,
Newman was the major speaker for a week-long
conference on the theory of consciousness as it
related to nursing (M. Newman, personal
correspondence, 1988).
 In 1986, Newman’s did a case study analysis of
practice at three sites within the Minneapolis-St.
Paul area and discussed conclusions concerning
changes necessary for hospital nursing practice
(Newman & Autio, 1986).
 From 1986 to 1997, Newman investigated
sequential patterns of persons with heart disease
and cancer in relation to the theory of health as
expanding consciousness
 Other publications reflect on Newman’s passion
for integration of nursing theory, practice, and
research, evolving viewpoints on trends in
philosophy of nursing and analysis of theoretical
models of nursing practice and nursing research
 During 1989 and 1990, Newman was the principal
investigator of a project that explored the theory
and structure of a professional model of nursing
practice at Carondelet St. Mary’s Community
Hospitals and Health Centers in Tucson, Arizona
 Newman has been sought for consultation
regarding the expansion of her theory of health in
more than 40 states and numerous foreign
countries.
 Newman’s served on several editorial review
panels, including those of Nursing Research,
Western Journal of Nursing Research, Nursing and
Health Care, Advances in Nursing
Science, and Nursing Science Quarterly, and on the
advisory board of Advances in Nursing Science (M.
Newman, personal correspondence, 2004).
 Newman was also a participating member of the
nurse theorist task force from 1978 to 1982 with
the North American Nursing Diagnosis Association
(NANDA).
AWARDS AND HONORS
 She was recognized for creating Theory of Health
as Expanding Human Consciousness in 1978; her
theory greatly influenced the nursing perspective
on health, illness and human consciousness
 She is a Fellow in the American Academy of
Nursing and also has won their “Living Legend
Award”.
 Both the University of Tennessee and New York
University have honored her as an outstanding
alumnus and the New York University presented
her with the Distinguished Scholar in Nursing
Award.
 The University of Minnesota honored her with the
E. Louise Grant Award for Nursing Excellence.
 In 1983, she received the Founders Award for
Nursing Excellence in Nursing Research from Sigma
Theta Tau International, and the Zeta Chapter of
the same organization created a Margaret
Newman Scholar Award to fund doctoral students
who research Newman's theory.
 Since 1983, she has been named in the Who's Who
in American Women and was included in the
Who's Who in America in 1996.
INFLUENCES OF THE THEORY
 The theory of health expanding consciousness
came from Martha Rogers’ theory of unitary
human beings. The assumption of Rogers
regarding the interaction of individuals with their
environment is used as a basis of consciousness
being a manifestation of patterns evolving from
the environment-person relationship.
 Her work was also influenced by Itzhak Bentov’s
elaboration of life as the expansion of
consciousness, David Bohm’s theory of the
implicate order, Ilya Prigogine’s theory of
dissipative structures, and Arthur Young’s theory
of the evolution of consciousness.
MAJOR CONCEPTS
1. Nursing
 Newman did not clearly define the nursing
paradigm
 Nursing is “caring in the human health
experience”.
 Nursing is seen as a partnership between the
nurse and client, with both grow in the “sense of
higher levels of consciousness”
2. Human
 “The human is unitary, that is cannot be divided
into parts, and is inseparable from the larger
unitary field”
 “Persons as individuals, and human beings as a
species are identified by their patterns of
consciousness”
  “The person does not possess consciousness-the
person is consciousness”.
 Persons are “centers of consciousness” within an
overall pattern of expanding consciousness
3. Environment
 Environment is described as a “universe of open
systems”
 manifested patterns; body temperature, diet,
blood pressure, rest, social, cognition, emotions-
anything observable.
4. Health
 “Health and illness are synthesized as health - the
fusion on one state of being (disease) with its
opposite (non-disease) results in what can be
regarded as health”
 focus not on treatment/disease but a higher level
of consciousness.
KEY CONCEPTS
1. HEALTH
 In Newman’s theory, health is an expansion of
consciousness defined as the informational
capacity of the system and seen as the ability of
the person to interact with the environment
(Newman, 1994).
 According to her, “Health is the pattern of the
whole, and wholeness is one cannot lose it or gain
it.”
2. PATTERN
 Pattern characterized by “movement, diversity,
and rhythm” and is describe as a “design, or
framework as is seen in person-environment
interactions”.
 Pattern recognition is the “insight or recognition of
a principle, realization of a truth, or reconciliation
of a duality” and is “key to the process of evolving
to a higher level of consciousness”. It emerges
from a process of uncovering meaning in a
person’s life. Meaning is inherent in pattern, and
vice versa
3. CONSCIOUSNESS
 Consciousness includes not only the cognitive and
affective awareness normally associated with
consciousness, but also the interconnectedness of
the entire living system, which includes
physiochemical maintenance and growth
processes as well as the immune system. This
patter of information, which is the consciousness
of the system, is part of a larger, undivided pattern
an expanding universe.
 Movement
 Time
 Space
 To see health as a pattern of the whole, one needs
to see disease not as a separate entity but as a
manifestation of the evolving pattern of person-
environment interaction. The paradigm shift is:
 From treatment of symptoms to a search for
pattern.
 From viewing disease and disruption as
negative to viewing them as part of the self-
organizing process of expanding
consciousness.
 From viewing the nursing role as addressing
the problems of disease to assisting people to
get in touch with their own pattern of
expanding consciousness.
ASSUMPTIONS
-For the foundation of her assumptions is her definition of
health (Brown 2017), and her theory embraces a unitary
and transformative paradigm of nursing as “caring in the
human health experience” (Endo, 2016), Newman
developed assumptions that support her theory:
1. Health encompasses conditions previously observed as
pathology.
2. The “pathological” conditions can be a manifestation of
the total pattern of an individual.
3. The individual’s pattern that eventually manifests itself
as pathology is primary and exists prior to structural and
functional changes.
4. Removing the pathology will not change the pattern of
the individual.
5. It is health for the person if becoming “ill” is the only way
the person’s pattern can manifest itself.
6. Health is an expansion of consciousness.
STRENGTHS
 One of the major strengths in Margaret Newman's
theory is that it can be applied in any setting or
surroundings.
 Her model can also "generate caring
interventions" as a nursing practice.
LIMITATIONS
 The major weakness of her model is that it has
only little discussion on environment
 Abstract
 Multidimensional
 Qualitative.
APPLICATION TO NURSING PRACTICE, EDUCATION, AND
RESEARCH
 Newman’s model of health is useful in the practice
of nursing because it contained concepts used by
the nursing profession. Movement and time are an
intrinsic part of nursing intervention, that is range-
of-motion, ambulation, turning, coughing, and
deep-breathing. These parameters are used each
day by the nurse in practice.
 Newman did not advocate one model as the sole
basis for curriculum. Rather students have the
opportunity to study various approaches to health
 and nursing to choose what is relevant to them in
their practice and research.
 Some researchers have attempted to test
Newman’s propositions of time, space and
movement.
- A negative correlation was found between
depression and subjective time – findings do not support an
increasing level of consciousness with age.
 Cooperative inquiry or interactive/ integrative
participation
- Newman stated that research should center
around “participatory investigations in which subjects
(clients)are our partners, our core-searchers, in our search
for health patterns.”