Florence Nightingale’s Environmental Theory
(May 12, 1820 – August 13, 1910)
“Were there non who were discontented with what
they have, the world would never reach anything
better.”
• Her family belonged to elite social circle as her
father provided her with reputable education
(which is at that time uncommon for a Victorian
woman because they are not often educated as
well as men)
• Linguist – had a vast knowledge in Science,
Mathematics, Literature, Arts
• Unitarian Christian – believed she had a
religious calling
Lady with the lamp (Crimean War)
• With her lamp, she traversed the night with her
lamp during the Crimean War – the battle of
English vs. Turkish – to look for wounded
soldiers and aid them.
• Lead the team of nurses at the request of her
friend, Sidney Herbert – war minister during
that time – to gather a team of nurses to
oversee the military hospital.
• Arrived in Scutari on November 5, 1854 with 38
nurses
METAPARADIGM
“The act of utilizing the environment of the patient
to assist him in his recovery.”
“It involves the nurse’s initiative to configure
environmental settings appropriate for the gradual
restoration of the patient’s health and that external
factors associated with the patient’s surroundings
affect the life or biologic and physiologic processes
and his development.”
Major concepts:
• Person: Nightingale viewed the essence of
person as a client. “The recipient of care” She
believed that nurses should perform tasks to
and for the client as well as control the clients
environment to facilitate recovery easily.
• Health: According to Nightingale, health is
“being well and using every power that the
person has to the fullest extent.”
• Environment: External factors, such as
temperature, bedding and ventilation, and
internal factors such as food, water, and
medications.
• Nursing: According to Nightingale, nursing is
very essential for everybody’s well-being. It is
to modify or manage the environment to
implement the natural laws of health.
CONCEPTUAL FRAMEWORK OF NIGHTINGALE’S
ENVIRONMENTAL THEORY:
• Note that the client, the nurse, and the major
environment concepts are in balance; that is; the
nurse can manipulate the environment to
compensate for the client’s response to it. The goal
of the nurse is to assist the patient in staying in
balance. If the environment of a client is out of
balance, the client expends unnecessary energy.
NIGHTINGALE’S ENVIRONMENTAL MODEL
NIGHTINGALE’S NURSING PROCESS AND THOUGHT
CANON
(Nightingale,
1969)
Ventilation & • Client’s body temperature, room
warmth temperature, ventilation and foul
odors
• Create a plan to keep the room
well-ventilated and free of odor
while maintaining the client’s body
temp.
Light • Check room for adequate light,
sunlight is essential
 • Create and implement adequate
light in the room without placing
the client in direct light
Cleanliness of • Check room for and keep it free
rooms and from dust, dampness and dirt
walls
Health of • Check for fresh air, pure water,
houses drainage, cleanliness and light
• Remove garbage, stagnant water,
and ensure clean water and fresh
air
Noise • Check noise level in the room and
surroundings
• Attempt to keep noise level in
minimum
Bed and • Check bed and bedding for
bedding dampness, wrinkles and soiling
• Keep the bed dry, wrinkle-free and
at its lowest height to ensure
comfort
Personal • Attempt to keep the client dry and
cleanliness clean at all times
• Frequent assessment of the client’s
skin is essential to maintain good
skin integrity
Chattering • Avoid talking without giving advice
hopes and that is without a fact
advices • Respect the client as a person and
avoid personal talk
Variety • Attempt to accomplish variety in
the room and with the client
• Done with cards, flowers, pictures,
and books
• Encourage friends and relatives to
engage in stimulating activities
Food intake • Check the diet of the client. Note
the amount of food and fluid
ingested by the client at every meal
Petty • Ensures continuity of care
management • Document the plan of care and
evaluate the outcomes that ensure
continuity
Observation of • Observe and record anything about
the sick the client
• Continue observation in the client’s
environment and make changes in
the plan of care if needed
ENVIRONMENTAL FACTORS
• In Florence Nightingale’s Environmental Theory,
she identified five (5) environmental factors: fresh
air, pure water, efficient drainage, cleanliness or
sanitation, and light or direct sunlight.
o Pure fresh air – “to keep the air he breathes
as pure as the external air without chilling
him.”
o Pure water – “well water of a very impure
kind is used for domestic purposes. And
when the epidemic disease shows itself,
persons using such water are almost sure to
suffer.”
o Effective drainage – “all the while the sewer
may be nothing but a laboratory from which
epidemic disease and ill health are being
installed into the house.”
o Cleanliness – “the greater part of nursing
consists in preserving cleanliness.”
o Light (especially direct sunlight) – “the
usefulness of light in treating disease is very
important.”
• The factors posed great significance during
Nightingale’s time when health institutions had
poor sanitation, and health workers had little
education and training and were frequently
incompetent and unreliable in attending to the
patients’ needs.
• Also emphasized in her environmental theory is
providing a quiet or noise-free and warm
environment, attending to patient’s dietary needs
by assessment, documentation of time of food
intake, and evaluating its effects on the patient.
ANALYSIS OF NIGHTINGALE’S THEORY
• In the era that we are in today, we are faced
with environmental conditions beyond what
ought to be natural and nurturing. Some of the
global environmental issues we have now are
global warming, nuclear radiation threats,
human-made environmental calamities, and
pollution. From these occurrences, Nightingale’s
model seemed to be ideal. Her concept of
providing fresh air to patients is in question with
today’s industrialization effects.
• In addition to the analysis of the concept of
ventilation, it is not always beneficial for all
clients to have fresh air. Natural air has its
impurities which in turn may infect open wounds
and drainages such as in burns.
 APPLICATION OF ENVIRONMENTAL THEORY
Margaret Jean Watson’s Philosophy and Theory of
Transpersonal Caring
(June 10, 1940 – present)
“Caring in nursing conveys physical acts, but embraces
the mind-body-spirit as it reclaims the embodied spirit
as its focus of attention.”
• Born in Southern West Virginia and grew up
during the 1940s and 1950s in the small town of
Welch, West Virginia in the Appalachian
Mountains
• is an American nurse theorist and nursing
professor known for her “Philosophy and
Theory of Transpersonal Caring.”
• Watson attended high school in West Virginia
and then the Lewis Gale School of Nursing in
Roanoke, Virginia, where she graduated in
1961.
METAPARADIGM
“Transpersonal caring relationship is the foundation
of Watson’s theory. It is a special kind of human
care relationship – a union with another person –
high regard for the whole person and their being in
the world.”
• Person: Human being is a valued person in and
of him to be cared for, respected, nurtured,
understood, and assisted. In general, it is a
philosophical view of a person as a fully
functional integrated self. Watson viewed
human as greater than, and different from, the
sum of his parts.
• Health: It is the unity of the mind, body, and
soul. It is also associated with the degree of
congruence between self as perceived and as
experienced.
Three elements
1. A high level of over-all physical,
mental, and social functioning;
2. A general adaptive-maintenance level
of daily functioning;
3. The absence of illness or the presence
of efforts that lead to its absence
• Environment: It provides the values that
determine how one should behave and what
goals one should strive toward. “Caring (and
nursing) has existed in every society. Every
society has had some people who have cared
for others. A caring attitude is not transmitted
from generation to generation by genes. It is
transmitted by the culture of the profession as
a unique way of coping with its environment.”
• Nursing: “A human science of people and
human health-illness experiences that are
mediated by professional, personal, scientific,
aesthetic, and ethical human care
transactions.” A nursing’s social, moral and
scientific contributions to humankind and
society lie in its commitment to human care
ideals in theory, practice, and research.
ASSUMPTIONS
1. Caring can be effectively demonstrated and
practiced only interpersonally.
2. Caring consists of carative factors that result in
the satisfaction of certain human needs.
 3. Caring consists of carative factors that result in solving method for process; to engage in the artistry of
the satisfaction of certain human needs. decision making” caring-healing practices.”
became
4. Caring responses accept the patient as he or she
“systematic use of
is now, as well as what he or she may become. a creative problem
5. A caring environment offers the development of solving caring
potential while allowing the patient to choose process” (in 2004
the best action for themselves at a given point in Watson website)
time. 7. “The promotion of “Engaging in genuine teaching-
transpersonal learning experience that attends to
6. The science of caring is complementary to the
teaching- the unity of being and meaning,
science of curing. learning.” attempting to stay within others’
7. The practice of caring is central to nursing. frame of reference.”
8. “The provision of “Creating healing environment at all
TRANSPERSONAL the supportive, levels (physical as well as the
protective, and nonphysical, subtle environment of
The transpersonal concept is an intersubjective human-
(or) corrective energy and consciousness, whereby
to-human relationship in which the nurse affects and is mental, physical, wholeness, beauty, comfort, dignity,
affected by the other person. Both are fully present in societal, and and peace are potentiated)”
the moment and feel a union with the other; they share spiritual
a phenomenal field that becomes part of both’s a life environment.”
story. 9. “The assistance “Assisting with basic needs, with an
with the intentional caring consciousness,
10 CARATIVE FACTORS gratification of administering ‘human care
human needs.” essentials,’ which potentiate
“caritas” a Latin word meaning “to cherish” , “to alignment of mind-body-spirit,
appreciate” or to give “special attention” wholeness, and unity of being in all
aspects of care.”
CARATIVE FACTORS CARITAS PROCESS 10. “The allowance for “Opening and attending to spiritual-
1. “The formation of “Practice of loving-kindness and existential- mysterious and existential
a humanistic- equanimity within the context of phenomenological dimensions of one’s own life-death;
altruistic system of caring consciousness.” forces” became soul care for self and the one-being-
values.” “allowance for cared for”
2. “The instillation of “Being authentically present and existential-
faith-hope.” enabling and sustaining the deep phenomenological
belief system and subjective life- spiritual forces” (in
world of self and one being cared 2004 Watson
for.” website)
3. “The cultivation of “Cultivation of one’s own spiritual WATSON’S HIERARCHY OF NEEDS
sensitivity to one’s practices and transpersonal self-
self and others.” going beyond the ego-self.” • With the gratification of human needs,
4. “Development of a “Developing and sustaining a helping Watson’s hierarchy of needs begins with lower-
helping-trust trusting, authentic caring order biophysical needs or survival needs, the
relationship” relationship.” lower-order psychophysical needs or functional
became needs, the higher-order psychosocial needs or
“development of a
helping-trusting,
integrative needs, and finally, the higher-order
human caring intrapersonal-interpersonal need or growth-
relation” (in 2004 seeking need.
Watson website) o Lower Order Biophysical Needs or Survival Needs
5. “The promotion “Being present to, and supportive of, ▪ Watson’s hierarchy of needs begins with
and acceptance of the expression of positive and
lower-order biophysical needs or survival
the expression of negative feelings as a connection
positive and with deeper spirit and self and the needs. These include the need for food
negative feelings.” one-being-cared for.” and fluid, elimination, and ventilation.
6. “The systematic “Creative use of self and all ways of o Lower Order Psychophysical Needs or Functional
use of the knowing as part of the caring Needs
scientific problem-
 ▪Next in line are the lower-order
psychophysical needs or functional needs.
These include the need for activity,
inactivity, and sexuality.
o Higher-Order Psychosocial Needs or Integrative
Needs
▪ The higher-order psychosocial needs or
integrative needs include the need for
achievement and affiliation.
o Higher-Order Intrapersonal-Interpersonal Need or
Growth-seeking Needs
▪ The higher-order intrapersonal-
interpersonal need or growth-seeking
need is the need for self-actualization
APPLICATION OF WATSON’S THEORY
Patricia Benner’s Novice to Expert Theory
(August 1942 – present)
“Nursing is concerned with the social sentient body
that dwells in finite human worlds; that gets sick and
recovers; that is altered during illness, pain and
suffering; and that it engages with the world
differently upon recovery.”
• Born in Hampton, Virginia and spent her
childhood in California (where she had early
and professional education)
• Received Bachelor’s Degree in Nursing from
Pasadena College in 1964 and Master’s
Degree in Medical Surgical Nursing in 1970
• She is an internationally noted researcher
and lecturer on health, stress and coping,
skill acquisition and ethics.
METAPARADIGM
“As nursing skills and knowledge build, the care
delivered strengthens and the nurse makes their way
to the expert stage.”
• Person: “a self-interpreting being, that is,
the person does not come into the world
predefined but gets defined in the course of
living a life. A person also has an effortless
and non-reflective understanding of the self
in the world. The person is viewed as a
participant in common meanings.”
Major aspects of understanding that the
person must deal with as:
o The role of the situation
o The role of the body
o The role of personal concerns
o The role of temporality
• Health: “on the lived experience of being
healthy and ill.”
Defined health as what can be assessed;
absence of disease and illness while
well-being is the human-experience of
health or wholeness.
Illness is the human experience of loss or
dysfunction whereas;
disease is what can be assessed at the
physical level.
• Environment: Benner preferred the term
“situation” since it suggests a social
environment with a social definition and
meaning. She used the phenomenological
terms of being situated and situated
meaning, which are defined by the person’s
engaged interaction, interpretation and
understanding of the situation.
• Nursing: Benner described nursing as
“enabling condition of connection and
concern” which shows a high level of
 emotional involvement in the nurse-client
relationship. She viewed nursing practice as
• PROFICIENT
the care and the lived experience of health,
▪ The performer perceives the situation as a
illness, and disease and the relationships
whole rather than in terms of aspects and
among these three elements.
performance is guided by maxims.
FROM NOVICE TO EXPERT ▪ The performer identifies the most
significant aspects and has a better
• NOVICE
understanding of the situation based on
▪ The person has no background experience
background understanding.
of the situation in which he or she is
▪ In this stage, there is much more
involved. To guide performance, context
involvement with the patient and family
free rules and objective attributes must be
since this stage is the transition into
given.
expertise.
▪ Novice has difficulty discriminating relevant
• EXPERT
and irrelevant aspects of situation.
▪ It is accomplished when the expert
▪ In general, this is the level nursing students
performer no longer relies on analytical
belong but higher levels can be classified as
principle like rules, guidelines and maxims
novice if they are placed in an unfamiliar
to connect her understanding of the
situation.
situation to an appropriate action.
• ADVANCE BEGINNER
▪ Benner viewed an expert nurse as
▪ Has a sufficient experience to easily
possessing an intuitive grasp of the problem
understand aspects of the situation.
without losing time considering a range of
(Aspects, unlike attributes and features,
alternative diagnosis and solutions.
cannot be objectified completely because
▪ There is qualitative change as the expert
they require experience based on
performer “knows the patient” which
recognition in the background of the
means that knowing typical patterns of
situation)
responses and knowing the patient as a
▪ Clinical situations are viewed by nurses at
person.
the advance beginner stage as a challenge
KEY ASPECTS:
of their abilities and the demands of the
• Demonstrating a clinical grasp and
situation placed on them instead of the
resource-based practice.
patient’s need.
• Possessing embodied knowledge.
▪ Newly graduated nurses belong on this
• Seeing the big picture.
level.
• Seeing the unexpected.
• COMPETENT
▪ Competent performance considers SEVEN DOMAINS OF NURSING PRACTICE
consistency, predictability, and time
management as essential components. She 1. Helping role
believes that a sense of mastery is acquired 2. Teaching or coaching function
through planning and predictability. 3. Diagnostic client-monitoring function
▪ This stage is the most essential in clinical 4. Effective management of rapidly changing
learning because the learner must know situations
how to recognize patterns and identify 5. Administering and monitoring therapeutic
which element of the situation needs interventions and regimens
attention and which ones to ignore. 6. Monitoring and ensuring quality of health-care
▪ The competent nurse develops new rules practices
and reasoning procedures for a plan while 7. Organizational and work-role competencies
applying learned rules for action on the
basis of the relevant facts of the situation.
 APPLICATION OF NOVICE TO EXPERT THEORY
Martha Rogers’ Theory of Unitary Human Beings
(May 12, 1914 – March 13, 1994)
“Professional practice in nursing seeks to promote
symphonic interaction between man and environment,
to strengthen the coherence and integrity of the human
field, and to direct and redirect patterning of the human
and environmental fields for realization of maximum
health potentials.”
• Mary Elizabeth Rogers was born in 1914 in
Dallas, Texas
• Earned her Public Health Nursing degree form
George Peabody College in Tennessee in 1937
• Rogers worked as a professor at New York
University’s School of Nursing
• She was also a fellow for the American Academy
of Nursing
METAPARADIGM
“The Science of Unitary Human Beings (SUHB) does not
directly identify testable empirical indicators. Instead,
the theory specifies a worldview and philosophy used to
identify the phenomena concerning nursing.”
• Person: A unitary human being is an open
system which continuously interact with the
environment. A person’s aspects cannot be
viewed individually, it should be considered
holistically.
• Health: Rogers defines health as an expression
of the life process. The characteristics and
behavior coming from the mutual, simultaneous
interaction of the human and environmental
fields and health and illness are part of the
same continuum. The multiple events occurring
during the life process show how a person is
achieving his or her maximum health potential.
The events vary in their expressions from
greatest health to those incompatible with the
maintaining life process.
• Environment: Rogers’ theory of Unitary Human
Beings includes the entire energy field other
than the person. These energy fields are not
limited are not limited by space and time,
rather identified by its organization and pattern.
• Nursing: Nursing is both a science and art. It
maintains the energy field which is conducive
for the patient, the recipient of care. Nursing
intervention guides the interaction of person
and environment’s energy field to maximize the
health potential of the patient.
THE SCIENCE OF UNITARY HUMAN BEINGS
The belief of the coexistence of the human and the
environment has greatly influenced the process of
change toward better health. In short, a patient can’t be
separated from his or her environment when
addressing health and treatment. This view leads and
opened Martha E. Rogers’ theory, known as the
“Science of Unitary Human Beings,” which allowed
nursing to be considered one of the scientific
disciplines.
Rogers’ theory defined Nursing as “an art and science
that is humanistic and humanitarian. It is directed
toward the unitary human and is concerned with the
nature and direction of human development. The goal of
nurses is to participate in the process of change.”
According to Rogers, the Science of Unitary Human
Beings contains two dimensions: the science of nursing,
which is the knowledge specific to the field of nursing
that comes from scientific research; and the art of
nursing, which involves using the science of nursing
creatively to help better the lives of the patient.
Assumptions of Rogers’ Science of Unitary Human iii. Rhythms of the life and process
Beings iv. Supplementary data
v. Categorical disease entities
1. WHOLENESS: Man is a unified whole possessing his
vi. Subsystem pathology
own integrity and manifesting characteristics that
vii. Pattern appraisal
are more than and different from the sum of his
parts. Mutual Patterning: patterning can be done by
2. OPENNESS: Men and the environment are suggesting the various alternatives such as empowering,
continuously exchanging matter and energy with encouraging, etc. depending on the client’s condition
one another. and needs.
3. UNDIRECTIONALITY: The life process evolves
Mutual patterning of human and
irreversibly and unidirectionally along the space-
environmental field:
time continuum.
4. PATTERN AND ORGANIZATION: Identifies the man i.Sharing knowledge
and reflect his innovative wholeness. ii.Offering choices
5. SENTENCE & THOUGHT: Man is characterized by iii. Empowering the patient
the capacity for abstraction and imagery, language iv. Fostering pattering
and thought sensation, and emotion. v. Evaluation
vi. Repeat pattern appraisal
PRINCIPLE OF HOMEODYNAMICS – dynamic version of
vii. Identify dissonance and harmony
homeostasis
viii. Validate appraisal with the
3 PRINCIPLES OF HOMEODYNAMICS: patients
ix. Self-reflection for the patients
Integrity – (synchrony + reciprocity) because of the
inseparability of human beings and environment, Evaluation: done by repeating the pattern appraisal
sequential changes in the life processes are continuous after the mutual patterning to determine the extents of
revisions occurring from the interactions between dissonance and harmony.
human beings and environment.

Resonancy – speaks to the nature of the change

occurring between human and environmental fields.
The life process in human beings is a symphony of
rhythmical vibrations oscillating at various frequencies.

Helicy – The human-environment field is a dynamic,

open system, in which change is continuous due to the
constant interchange between human and
environment.

ROGERS’ SCIENCE OF UNITARY HUMAN BEINGS AND

NURSING PROCESS

Assessment: first stage of nursing process and enables

the nurse to undertake a holistic assessment of the
patient considering all of the individuals needs in order
to identify their problems.

Areas of assessment:

i. Total pattern of events at any given point

in space-time
ii. Simultaneous states of the patient and
his/her environment
APPLICATION OF THE THEORY
Dorothea Orem’s Self-Care Deficit Theory
(July 15, 1914 – June 22, 2007)
"Individuals, families, groups and communities need to
be taught self-care"
• One of America's foremost nursing theorist
• Born in Maryland, Baltimore in June 15, 1914
• Her father was a construction worker, and her
mother is a homemaker. She was the youngest
among two daughters.
METAPARADIGM
“Orem's theory addresses client's self-care needs. It is
defined as goal-oriented activities that are set towards
generating interest in the part of the client to maintain
life and health development. The theory is aimed
towards making the clients perform self-care activities in
order to live independently.”
• Person: According to Orem, human beings are
very much different from other living things in
terms of their capacity. Humans can reflect
upon events, themselves, and the environment.
• Health: Orem presents health based on
preventive healthcare. This model of health
care includes the promotion and maintenance
of health, the treatment of disease or injury,
and the prevention of complications.
• Environment: Orem's view of health as a
phenomenon affected by inseparable entities
shows her view of the surrounding environment
as an external source of influence in the internal
interaction of a person's different aspect.
• Nursing: Orem defines nursing as a human
service. It is a distinguished human service since
its focus is on persons with inabilities to
maintain continuous provision of healthcare.
She added that Nursing is based on values.
How are they related to each other? the person (or
patient) is the central focus of nursing care. According
to Orem, the person's health state is mediated by
his/her environment. A person, who is healthy, is
capable of self-care. When there is illness in the
person's health state, the person is not able to
complete all self-care requisites. When this occurs,
nursing care is needed to assist the person in
completing his/her self-care. Nurses must assess the
person's ability to provide his/her own self-care and the
environmental context of the person in order to
overcome health-associated limitations.
INTERRELATED THEORIES:
1. Theory of self-care
• Self-care & self-care agency
• Self-care requisites
• Therapeutic self-care demand
2. The self-care deficit theory
• 5 methods of helping
3. Theory of nursing systems
• Wholly compensatory
• Partially compensatory
• Supportive-educative
Theory of Self-care:
This theory focuses on the performance or practice of
activities that individuals initiate and perform on their
own behalf to maintain life, health, and well-being.
Self-care: Self-care is an activity that promotes a
person's well-being. It is performed by persons who are
aware of the time frames on behalf of maintaining life,
continuing personal development and a healthy
functional living.
o Learning to live with the effects of
pathologic conditions and states and the
effects of medical diagnostic and treatment
measures in a lifestyle that promotes
continued personal development

Self-care agency: These are complex set of activities SUMMARY OF INTERRELATED THEORIES: The theory of
required to purposively regulate the actions needed for self-care delineates the demands of self-care requisites
planning a care plan for a client. that an individual needs to meet in order to stay healthy
or get better from illness. When a person cannot meet
Self-care Requisites or requirements can be defined as
these self-care demands, or when self-care requisites
actions directed toward the provision of self-care. It is
exceed self-care capabilities, nursing is needed. Nurses
presented in three categories.
can help patients meet their self-care needs by utilizing
• Universal Self-Care Requisites: Universal self- the 5 methods in the Theory of Self Care Deficit.
care requisites are associated with life However, the nurse must properly assess the level of
processes and the maintenance of the human self-care a patient requires so that the nurse can utilize
structure and functioning integrity. the nursing system (as stated in the Theory of Nursing
o The maintenance of a sufficient intake System) that best fits the patient's ability to perform
of air self-care. In the end, the nurse assists the patient in
o The maintenance of a sufficient intake meeting his/her self-care needs so that he/she is healthy
of water and free of illness.
o The maintenance of a sufficient intake
THERAPEUTIC SELF-CARE DEMAND
of food
o The provision of care associated with • Therapeutic Self-care Demand is the totality of
the elimination process and excrements “self-care actions to be performed for some
o The maintenance of a balance between duration to meet known self-care requisites by
activity and rest using valid methods and related sets of actions
o The maintenance of a balance between and operations.”
solitude and social interaction
• Developmental self-care requisites:
Developmental self-care requisites are “either
specialized expressions of universal self-care
requisites that have been particularized for
developmental processes or they are new
requisites derived from a condition or
associated with an event.”
o Provision of conditions that promote
development
o Engagement in self-development and;
o Prevention of the effects of human
conditions that threatens life
• Health deviation self-care requisites: Health
deviation self-care requisites are required in
Theory of self-care deficit:
conditions of illness, injury, or disease or may
result from medical measures required to This theory delineates when nursing is needed. Nursing
diagnose and correct the condition. is required when an adult (or in the case of a
o Modifying the self-concept (and self-image) dependent, the parent or guardian) is incapable of or
in accepting oneself as being in a particular limited in providing continuous effective self-care.
state of health
Orem identified 5 methods of helping:
 • Acting for and doing for others
• Guiding others
• Supporting another
• Providing an environment promoting personal
development about meet future demands
• Teaching another
Theory of nursing systems:
This theory is the product of a series of relations
between the persons: legitimate nurse and legitimate
client. This system is activated when the client’s
therapeutic self-care demand exceeds the available self-
care agency, leading to nursing.
Systems that compose the nursing systems:
• Wholly compensatory - A situation in which
the individual is unable “to engage in those
self-care actions requiring self-directed and
controlled ambulation and manipulative
movement or the medical prescription to
refrain from such activity… Persons with these
limitations are socially dependent on others for
their continued existence and well-being.”
• Partially compensatory - A situation in which
“both nurse and perform care measures or
other actions involving manipulative tasks or
ambulation [Either] the patient or the nurse
may have a major role in the performance of
care measures.”
Example: Nurse can assist the postoperative
client in ambulating, Nurse can bring a meal
tray for a client who can feed himself
• Supportive-educative - This is also known as a
supportive-developmental system. The person
“can perform or can and should learn to
perform required measures of externally or
internally oriented therapeutic self-care but
cannot do so without assistance.”
Example: Nurse guides a mother on how to
breastfeed her baby, Counseling a psychiatric
client on more adaptive coping strategies.
OREM’S SELF CARE THEORY AS A THEORITICAL
FRAMEWORK FOR NURSING PRACTICE:
Assessment
• Diagnosis and prescription; determine why
nursing is needed. Analyze and interpret by
making a judgment regarding care.
• Design of a nursing system and plan for
delivery of care.
• Production and management of nursing
systems.
Step 1 – Collect Data in Six Areas
• The person’s health status
• The physician’s perspective of the person’s
health status
• The person’s perspective of his or her health
• The health goals within the context of life
history, lifestyle, and health status.
• The person’s requirements for self-care
• The person’s capacity to perform self-care
Nursing diagnosis and care plans
• The nurse designs a system that is wholly or
partly compensatory or supportive-educative.
• Goals are to promote patient’s therapeutic
self-care demands and compensate or
overcome patient’s self-care deficits
• Plans with scientific rationale
Step 2
(1) Bringing out a good organization of the components
of patients’ therapeutic self-care demands.
(2) Selection of a combination of helping methods will
be effective and efficient in compensating
for/overcoming the patient’s self-care deficits.
Implementation and diagnosis
• It is the production and management of nursing
systems.
Step 3
• A nurse assists the patient or family in self-care
matters to identify and describe health and
health-related results.
• Actions are guided by the rationale of nursing
diagnosis.
• Evaluation of results achieved compared to
planned outcomes.
APPLICATION OF OREM’S SELF-CARE DEFICIT THEORY
patient from survival to transformation."
Sister Callista Roy’s Adaptation Model
(October 14, 1939 – present)
"The model provides a way of thinking about people and
their environment that is useful in any setting. It helps
one prioritize care and challenges the nurse to move the
• Sister Callista L. Roy was born on October 14,
1939 in Los Angeles, California.
• Sister Callista L. Roy is a nursing theorist,
professor, and author. She is known for her
groundbreaking work in creating the Adaptation
Model of Nursing.
• She is a fellow of American Academy of Nursing
and active in many nursing organizations which
include Sigma Theta Tau and the North
American Nursing Diagnosis Association
(NANDA).
METAPARADIGM
“The concepts of nursing, person, health and
environment are all interrelated in one central
concept.”
• 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 results from a process where
health and illness can coexist. If a human
can continue to adapt holistically, they will
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 Three types of stimuli:
consideration of the mutuality of person and
1. Focal stimuli are that confront the human system
health resources that includes focal,
and require the most attention.
contextual and residual stimuli.”
2. Contextual stimuli are characterized as the rest of
The environment is defined as conditions,
the stimuli present with the focal stimuli and
circumstances, and influences that affect
contribute to its effect.
humans’ development and behavior as an
3. Residual stimuli are the additional environmental
adaptive system. Roy categorized these
factors present within the situation but whose
stimuli as focal, contextual, and residual.
effect is unclear. This can include previous
• Nursing: “[The goal of nursing is] the
experience with certain stimuli.
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.

ADAPTATION MODEL

Roy recognized the works of Von Bertalanffy’s (1968)

General System Theory and Helson’s (1964) Adaptation
Theory as a basis of scientific assumptions for her
model. The Roy’s adaptation model contains the
following concepts:

• The person is adapting in a stable

interaction with the environment, either
internal or external.
• The environment serves as the source of a
range of stimuli that will either threaten or
promote the person’s unique wholeness.
• The person’s major task is to maintain
integrity in face of these environmental
stimuli.
Roy and Andrews (1999) defined integrity as the degree
of wholeness achieved by adapting to changes in
needs.
The 3 types of stimuli act together and influence the
adaptation level which is defined as the ability to
respond positively in a situation. A person’s adaptation
level may be described as integrated, compensatory, or
compromised.
The subsystem’s four adaptive modes are how the
regulator and cognator mechanisms are manifested; in
other words, they are the external expressions of the
above and internal processes.
SIX-STEP NURSING PROCESS
A nurse’s role in the Adaptation Model is to manipulate
stimuli by removing, decreasing, increasing, or altering
stimuli so that the patient.
The Nursing Process is a problem-solving approach for
gathering data, identifying capacities and needs of the
human adaptive system, selecting and implementing
approaches for nursing care, and evaluation of the
outcome of care provided.
1. Assess the behaviors manifested from the four
adaptive modes.
 Observable behavior: vital signs (temperature,
pulse rate, respiratory rate, blood pressure)
Non-observable behavior: Feelings experienced
by the person. (e.g: anxiety, nervousness)
2. Assess the stimuli, categorize them as focal,
contextual, or residual. Andrews and Roy, 1999 – adaptive or ineffective
- Nurse analyzes the subjective and objective responses result from these coping mechanisms.
behaviors and look more deeply for possible Adaptive responses support the integrity of the person
causes of a particular set of behaviors. and the goals of adaptation. The major task of the
3. Make a statement or nursing diagnosis of the person is to become accustomed with environmental
person’s adaptive state. stimuli in order to achieve survival, growth,
4. Set a goal to promote adaptation. (Done together development, and mastery. Ineffective responses
with the client) neither promote integrity nor contribute to the goals of
5. Implement interventions aimed at managing the adaptation.
stimuli.
6. Evaluate whether the adaptive goal has been met.

APPLICATION OF ROY’S THEORY