lOMoARcPSD|24670182

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Nursing (De La Salle Medical and Health Sciences Institute)

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FLORENCE NIGHTINGALE (1820-
1910) -ENVIRONMENTAL THEORY
● Famous for her work in the military
hospitals of the Crimeans.
Nightingale established nursing as
respectable profession for women
● Known as lady in lamp
● Mother of modern nursing
● Studied nursing at institute of
Protestant Deaconesses in
Kaiserswerth, Germany
1853: Crimean war - Turkey - Epidemic of
Cholera
● Nightingale with 38 nurses went in
turkey
● 6 wounded army: 9 death
● Disease (typhoid, cholera,
dysentery)
● Requested 200 scrub brushes for
cleaning the building at daytime
● Carries the lamp at night to visit
patients thus called “The Lady of
the Lamp”
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1857: Sanitary Commission formed Army necessary chilling the
Medical College patient
● Inadequate ventilation may
1859: Rehearse the books she wrote be the source of disease
● Without proper ventilation
● Notes on hospital
it may cause respiratory
tract of infection
● Notes on nursing
2. ADEQUATE LIGHT
● Suggestion for thoughts to searches ● Direct sunlight has quite as
of the Religion truths real & tangible effects on
the human body
1860: Established Nightingale School & 3. CLEANLINESS
Home for nurses at St. Thomas Hospital in ● Presence of organic matter
London contribute on the
Focus of the Theory: development of diseases
● Nurse & patient should take
both daily
● Environment plays a great role in
taking care of the patient ● Nurses keep their uniforms
● Environment are external clean
conditions & influences affecting ● Nurses hands must be
the life & development of an washed to keep it clean
organism & capable of preventing, 4. WARMTH
suppressing/contributing to disease, ● Check body temperature
accidents &/or death. through palpation
● Nurse’s role to manipulate
ENVIRONMENT’S IMPORTANT environment through:
COMPONENTS ● Health balance of
ventilation & normal body
1. PROPER VENTILATION
warmth
● More responsible to keep
● Positioning the patient
air that patient breathes pure
● Opening windows
as the external air without
● Regulate room temperature
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5. QUITE (NOISE)
● Unnecessary noise is
harmful to patient
6. DIET
● Nurse’s role to access:
● Meal schedule
● Food effects to patient
● Patient’s dietary intake
7. HEALTH OF HOUSES
● Pure air, water, drainage,
cleanliness and light
8. BED AND BEDDING
● Keep the bed dry - wrinkle -
free at the lowest height to
ensure comfort of the client
9. PERSONAL CLEANLINESS
● Keep the client dry and
clean at all time
10. VARIETY
● Stimulate variety in the
room
11. CHATTERING HOPES AND
ADVICES
● Avoid talking without
reason or giving advice
without fact, avoid personal
talk
12. PETTY MANAGEMENT
● Ensure continuity of care;
documentation of plan of
core and evaluation
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13. OBSERVATION OF THE SICK
● Observe everything about
your client’s, record all
factual observations,
continue to observe client’s
surrounding and make
alteration in plan of care
when needed
CONCEPT
ENVIRONMENT
● Anything that can be manipulated
to place a patient in the best
possible condition for nature to act
PERSON
● The one who is receiving care; a
dynamic being comprising
physical, intellectual, emotional,
social and spiritual components
(communicate with your client)
HEALTH
● Health is not only to be well but to
be able to use every power we have
NURSING
● A spiritual calling nurses were to
assist nature to repair the patient
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● Nursing proper General nursing,
Midwifery nursing
ERNEISTIEN WIEDENBACH -
HELPING ART OF CLINICAL
NURSING MODEL
● Born in 1900 in Germany
● Graduated in Wellesley College in
1922 (Liberated arts)
● Graduated in 1925 in John Hopkins
Hospital (BSN)
● Worked at John Hopkins Hospital
and Bellevue Hospital
● Master’s degree and certificate in
Public Health Nursing in 1934
(Teacher’s College, Columbia
University)
● Worked as a professional writer
with the Nursing information
Bureau (NIB) for american Journal
of Nursing, worked to prepare
nurses to enter World War I
● Practiced as nurse-midwife at the
Maternity Center Association and
taught evening courses at Teachers
College in Advanced Maternity
Nursing
● Retired in 1966: Never married and
died at the age of 97 on March 8,
1998

● Nursing is an art of nurturing or
caring for someone on motherly
fashion (due to her experience in
the field of maternity nursing)
4 MAIN ELEMENTS TO CLINICAL
NURSING
1. PHILOSOPHY
● Nurse’s attitude & belief
about life & how that
affected reality for them
● Motivates the nurse to act in
a certain way
● 3 ESSENTIAL
COMPONENTS OF
PHILOSOPHY
● Reverence for life
● Respect for dignity, worth,
autonomy & individuality
of human being
● Resolution to act an
personally & professionally
held beliefs
2. PURPOSE
● Nurse wants to accomplish
through what she does
3. PRACTICE
● Observable nursing actions
what are affected by beliefs
& feeling about the meeting
the patient’s need for help
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4. ART
● Understanding of patient’s
need & concerns
● Developing goals & actions
to enhance patient’s ability
& direct the activities
related to the medical plan
to improve the patient’s
condition
● Focus on prevention of
complications
CONCEPTS AND SUBCONCEPTS
PATIENT
● Any person who has entered the
health care system & is receiving
help of some kind (care, teaching &
advice)
NURSE
● The purpose, philosophy,
practice/knowledge, judgement,
skills)
● Ministration, validation,
coordination (reporting, consulting,
conferring)
● Art (stimulus, preconception,
interpretation actions)
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Should identify patient’s need for help
through:
1. Observation (patient’s behavior-
consistent or inconsistent)
2. Explore (meaning of their
behavior)
3. Determine (cause of their
discomfort/incapability) (if they
can resolve their problem/ have
need for help)
NEED FOR HELP
● Measure desired by the patient that
has the potential to restore/extend
the ability to cope with various life
situations that affect health &
wellness)
CLINICAL JUDGEMENT
● Nurse’s likeness to make sound
decisions
SOUND DECISIONS
● Differentiating fact from
assumption & relating them to
cause & effect
SOUND JUDGEMENT
● Resulting & disciplined functioning
of mind & emotions and improves

with the expanded knowledge &
increased clarity of professional
purpose
NURSING SKILLS
● Actions characterized by harmony
of movements, precision &
effective use of self
APPLICATION TO NURSING
THEORY CONCEPTS
NURSING
● The nurse is functioning human
being who acts, thinks and feel all
actions, thoughts and feeling
underline what the nurse does
VIRGINIA HENDERSON - THE
NATURE OF NURSING MODEL
● Nightingale of Modern Nursing
● Modern day mother of nursing
● The 20th Century Florence
Nightingale
● Died in March 19, 1996 at the age
of 98
THE UNIQUE FUNCTION OF THE
NURSE IS:
● To assist the individual, sick or
well, in the performance of those
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activities contributing to health on
its recovery (or to a peaceful
death); and that
● He would perform unaided if he
had the necessary strength will or
knowledge & to do this in such a
way to help him gain independence
as rapidly as possible
3 LEVELS OF NURSE-PATIENT
RELATIONSHIP
1. Substitute for the patient - Doing
for the patient - Substitutive
2. A helper to a patient - Helping the
patient - Supplementary
3. A partner with the patient -
Working with the patient -
Complementary
Henderson believe in “Getting inside the
skin” of her patient in order to know what
he or she needs
HENDERSON’S FOURTEEN NEEDS
1. Breathe normally
2. Eat and drink adequately (to avoid
malnutrition & obesity)
3. Eliminate body waste (to avoid
getting constipated)
4. Move and maintain desirable
postures (don’t let the patient stick
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to one position for a long period of
time)
5. Sleep and rest (it is very important)
6. Select suitable clothes: dress and
undress (depends on the climate)
7. Maintain body temperature within a
normal range by adjusting clothing
and modifying the environment
8. Keep the body clean and well-
groomed and protect the
integument (it is more important to
elderly)
9. Avoid dangers in the environment
and avoid injuring others
10. Communicate with others in
expressing emotions needs, fears or
opinions (encourage the patient
from being unconscious)
11. Worship according to one’s faith
(allow them to express their
beliefs)
12. Work in such a way that there is a
sense of accomplishment
13. Play or participate in various form
of recreation
14. Learn, discover, or satisfy the
curiosity that leads to normal
development and health and use the
available health facilities (most
applicable to children’s)
COMPONENTS
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● Physical ● A holistic being that is compared FAYE GLENN ABDELLAH -

● Social
● Emotional
● Psychological
● Spiritual
MAJOR ASSUMPTIONS
1. Nurses care for patients can care
for themselves once again. Patients
desire to return to health
2. Nurses are willing to serve and the
nurse’s will devote themselves to
the patient day and night
3. Nurses should be educated at the
university level in both arts and
sciences
CONCEPTS
PATIENT
● Individual who requires help
toward independence
NURSE
● Assists the individual, ill or not, to
perform activities that will
contribute to health, recovery or
peaceful death
PERSON
by physical, psychological
HEALTH
● Individual’s ability to function
independently as outlined in the 14
components
ENVIRONMENT
● All external conditions and
influences that affect life and
development
NURSING PRACTICE AT PRESENT
● Nursing interventions are
implemented according to the 14
basic human needs of the patient
● Degree of performance
involvement of the patient & level
of nurse activity will be
independent on the specific role of
the nurse will be playing
TWENTY-ONE NURSING PROBLEM
● Born in March 1919, New York
City
● Earned a nursing diploma from
Fitkin Memorial Hospital School of
Nursing
● BSN degree (1945): M.A in
Physiology (1947); Doctor of
Education (1955)
● Served an active duty in the korean
wars - the first nurse to achieve the
rank of two-star rear admiral
● Proponent of “Patient-Centered
Approach” to nursing through her
articles and journals
● “Abdellah and colleagues
developed a list of 21 nursing
problems, identified 10 steps to
identify the client’s problems and
11 nursing skills to be used in
developing a treatment typology.”
10 STEPS TO IDENTIFY TO
CLIENT’S PROBLEMS
1. Learn to know the patient
2. Sort out relevant and significant
data
3. Make generalizations about
available data in relation to similar

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nursing problems prevented by
other patients
4. Identify therapeutic plan
5. Tell generalizations with the
patient and make additional
generalizations
6. Validate the patient’s conditions
about his nursing problems
7. Continue to observe and evaluate
the patient over a period of time to
identify any attitudes and clues
affecting his behaviour
8. Explore the patient’s and family’s
therapeutic plan
9. Identify how the nurse feel about
the patient’s nursing problems
10. Discuss and develop a
comprehensive nursing care plan
11 NURSING PROBLEMS
1. Observation of health status
2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel resources
8. Problem-solving (scientific
method)
9. Directions of work of others (know
how to delegate)
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10. Therapeutic use of self (techniques
helps the patient to recover)
11. Nursing procedures (knowledge,
skills, medical procedure)
Nursing problems presented by a client is a
condition faced by the client or client’s
family that the nurse through the
performance of professional functions can
assist them to meet
● OVERT NURSING PROBLEM-
Apparent condition faced by the
client of family, which the nurse
can assist him or them to meet
through the performance of
professional function
➢ Been observed
● COVERT NURSING
PROBLEM- Concealed or hidden
condition faced by the client or
family, which the nurse can assist
him
➢ Physiological & emotional
➢ Can’t be seen by naked eye
21 NURSING PROBLEMS
BASIC TO ALL PATIENT
● To maintain good hygiene and
physical comfort
● To promote optimal activity,
exercise, rest and sleep
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● To promote safety through
prevention of accidents, injuries or
other trauma and through
prevention of the spread of
infection
● To maintain good body mechanics
and prevent and correct deformity
SUSTENAL CARE NEEDS (to
sustain/maintain)
● To facilitate the maintenance
supply of oxygen to all body cells
● To facilitate the maintenance of
nutrition for all body cells
● To facilitate the maintenance of
elimination
● To facilitate the maintenance of
fluid and electrolyte balance
● To recognize the physiological
responses of the body to disease
conditions - pathological,
physiological, and compensatory
● To facilitate the maintenance of
regulatory mechanisms and
functions
● To facilitate the maintenance of
sensory function
REMEDIAL CARE NEEDS (remedy)

● To identify and accept positive and
negative expressions, feelings, and
reactions
● To identify and accept
interrelatedness of emotions and
organic illness
● To facilitate the maintenance of
effective verbal and nonverbal
communication
● To promote the development of
productive interpersonal
relationships
● To facilitate progress toward
achievement and personal spiritual
goals
● To create or maintain a therapeutic
environment
● To facilitate awareness of self as an
individual with varying physical,
emotional, and development needs
RESTORATIVE CARE NEEDS
● To accept the optimum possible
goals in the light of limitations,
physical and emotional
● To use community resources as an
aid in resolving problems that arise
from illness
● To understand the role of social
problems as influencing factors in
the cause of illness
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DOROTHEA OREM
 Born 1914 in Baltimore Mary Land
 Received Diploma of nursing at
Providence Hospital School of
Nursing in Washington D. C.
 Received BS Nursing 1939
 MS in Nursing Education, 1945
Early nursing experiences:
1. Operating room nurse
2. Private duty nurse
Orem’s general theory nursing (2001)
Requirement for nursing in adult is the
health associated absence of the ability that
amount and quality of self-care
*nurses took care because of their disease
With children, the condition is the ability
of the parent of guardian associated with
the child’s health state
*nurses and family took care
3 interrelated theories of self-care deficit
theory (general theory)
1. Theory of Self Care
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2. There of Self Care Deficit
3. Theory of Nursing System
6 central concepts
1. Self-Care (Performance)- is the
performance or practice of activities
that individuals initiate and perform on
their own behalf to maintain, health
and well-being
When self-care is effectively performed, it
helps maintain structural integrity
*took care of our selves
2. Self-care agency (ability)- humans
acquired ability or power to engaged in
self-care affected by basic conditioning
factors & ability to take care
*factors on how effect on yourselves
Consist of 2 agencies:
1. Self-care agent- persons who
provides the self-care (me)
2. Dependent care agent- person
other than the individual who provides
the care (such a parent, nursing) (the
one who took care of you)

3. Therapeutic (Therapy) Self
Care demand- the totality of care
measures necessary of specific times or
over a duration of time for meeting an
individual’s self-care requisites by
using appropriate methods and related
self of operations of actions
*all needs of the patients, to
cure, recovery (TOTALITY)
4. Self-Care Deficit- when
therapeutic self-care demand exceeds
self-care agency
*kakayanan ng nurse in therapeutic, hindi
natin kaya that’s why (self-care deficit)
may kulang
5. Nursing Agency- is a set of established
capabilities of a nurse who can legitimately
performs activity of care for a client. It
helps a person achieve their care demand
*kakayanan ng mga person
6. Nursing Systems- there are professional
functions that must be performed by the
nurse order to meet client’s needed and
foreseen results
PROFESSIONAL FUNCTIONS
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Assessment, documentation, moral and
ethical of care, injection
1. Theory of Self-care- additional
self-care theory
Self-care theory- self-care requisites
(pangangailangan) the reason for which
self-care is undertaken, they express the
intended or desired results
3 Categories of requisites
A. Universal Self Care
requisites- he maintenance of
the integrity of human
structure
*all people had universal self-care
requisites *NEEDED IN WORLD
NEEDS
1. Maintenance of sufficient intake
of air
2. “ water
3. “food intake
4. The provision of care associated
with elimination process and
excrement’s
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5. The maintenance of a balance
between activity and rest
6. “ solitude and social interaction
7. The prevention of hazards to
human life, human functioning
8. Promotion of human functioning
and development
*past the stages of development
B. Developmental Self-care
requisites- developmental
processes that occur during
various stages of life cycle
C. Health deviation of self-
care requisites- genetic and
constitutional defects of
human structural and
functional deviations
*took care different to normal &
abnormal
*genetically problem
2. Theory of Self Care deficit-
when nursing is needed to assist
individuals in the provision of self-care

METHODS OF ASSISTANCE
1. Acting for/doing for another
e.g. feeding
2. Guiding and directing
e.g. guiding while walking
3. Providing physical
e.g. changing bed, food
Psychological support
e.g. encouragement
4. Providing and maintain an environment
that supports personal development
5. Teaching- promotion of health life-style
3 THEORY OF NURSING SYSTEM
There are professional functions that must
be performed by the nurse in order to meet
clients need
3 types
1. Wholly compensatory nursing
system- Patient is dependent
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2. Partially compensatory- patient
can meet some needs but needs nursing
assistance
3. Supportive Educative- Patient
can meet self-care requisite but needs
assistance with decision making or
knowledge
e.g. teaching, procedure, position
Purpose of Theory
Practice | Education Preventive of
Complication| Research
JEAN WATSON: THEORY OF
TRANSPERSONAL CARING
 Born and raised in Welch, West
Virginia
 Graduated high school from West
Virginia and Lewis Gale School of
Nursing in Roanoke, Virginia
 Baccalaureate degree in nursing
1964
 Master’s degree-1966
 Doctorate in Educational
Psychology
 Established the Center of Human
Caring at University of Colorado
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CONTENTS OF THE THEORY
Major conceptual elements of her theory
are: transpersonal caring relationship; ten
carative factors and caring
occasion/caring moment.
 Embodied spirit
 Expanded views of self and person
 Importance of caring-healing
consciousness
 Positing of consciousness as energy
CARATIVE FACTORS
 Forming a humanistic-altruistic
system of values
 Enabling a sustaining faith-hope
 Being sensitive to self and others
 Developing a helping-trusting,
caring relationship (seeking
transpersonal connections).
 Promoting and accepting the
expression of positive and negative
feelings and emotions
 Engaging in creative individualized
problem-solving caring processes
 Promoting transpersonal teaching-
learning
 Attending to supportive, protective
and/or corrective mental, physical-
societal and spiritual environment

 Assisting with gratification of basic
human needs while preserving
human dignity and wholeness
 Allowing for existential-
phenomenological and spiritual
dimensions of caring and healing
TRANSPERSONAL CARING
RELATIONSHIP
 Originally defined as a human-to-
human connectedness in a nurse-
patient encounter wherein “each is
touched by the human center of the
other”.
 The transpersonal caring
relationship has taken on a
multidimensional meaning not
bounded by time and space.
CARING OCCASION/CARING
MOMENTS
 Watson defines caring occasion
and caring moment and adds
descriptions of caring (healing)
consciousness and the connections
implicit in caring-healing
consciousness and energy.
 It occurs whenever nurse and
other(s) come together with their
unique life histories and
phenomenal field in human-to-
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human transaction and is “a focal  Caring occasions involve action
point in space and time has a and choice by nurse and client if
greater field of its own that is the caring occasion is
greater than the occasion itself transpersonal, the limits of
arise[s] from aspects of itself that openness expand, as do human
become part of the life history each capacities.
person, as well as part of some  The most abstract characteristic of
larger, deeper, complex pattern in a caring person is that the person is
life”. somehow responsive to another
person as a unique individually,
MAJOR ASSUMPTIONS perceives the others feelings, and
sets one person apart from another.
 Human caring in nursing is not just
 Human caring involves values, a
an emotion, concern, attitude, or
will and a commitment to care,
benevolent desire caring connotes a
knowledge, caring actions, and
personal response.
consequences.
 Caring is an intersubjective human
 The ideal and value of caring is a
process and is the moral ideal of
starting point, a stone, and an
nursing.
attitude that has to become a will,
 Caring can be effectively
an intention, a commitment, and a
demonstrated only interpersonally.
conscious judgement that manifests
 Effective caring promotes health
itself in concrete acts.
and individual or family growth.
 Caring promotes health more than
does curing.
 Caring responses accept a person
not only as they are now, but also
for what the person may become.
 A caring environment offers the
development of potential while
allowing the person to choose the METAPARADIGM
best action for the self at a given
point in time. NURSING
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◦ As providing caring,
professional
◦ Focuses on health promotion
and treatment of disease
◦ A human science of person
and human health
PERSON
◦ To be valued, cared for,
respected, nurtured, understood
and assisted
◦ Recipient of care
◦ Human being complex needs
including physical,
psychological and psychosocial
HEALTH
◦ Unity and harmony within
the mind, body and soul
◦ Absence of illness
◦ High level of overall
physical, mental, spiritual,
social and well-being
functioning
ENVIRONMENT
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◦ Usually designed as a home-
like environment
◦ All internal and external
factors
◦ Not only affects patients and
their ability to heal but can also
affect nurses as well
SISTER CALLISTA LORRAINE ROY
- ADAPTATION MODEL
● Born on October 13, 1939 at Los
Angeles, California
● Sister of Saint Joseph of Carondelet
● Worked with Dorothy E. Johnson
ADAPTATION THEORY
● Adaptive responses are a function
of the incoming stimulus and
adaptive level
● A stimulus is any factor that
provokes a response. Stimuli may
arise from the internal or external
environment
● The condition of the life processes
described on three levels:
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➢ Integrated
➢ Compensatory
➢ Comprised
ADAPTATION LEVEL
● CONTEXTUAL STIMULUS -
other stimuli present in the
situation that contribute to the
effect of the focal stimulus
● FOCAL STIMULUS - Internal or
external stimulus most immediately
confronting the human system
● RESIDUAL STIMULUS -
Environmental factors within or
without the human system with
effects in the current situation that
are unclear
ADAPTATION PROBLEMS
● Broad areas of concern related to
adaptation. These describe the
difficulties related to the indicators
of positive adaptations
COPING PROCESS

● Are innate or acquired ways of
interacting with the changing
environment
● INNATE COPING
MECHANISM- Are genetically
determined or common to the
species and generally viewed as
automatic processes; human do not
have to think about them
● ACQUIRED COPING
MECHANISM- Are developed
through strategies such as learning.
The experiences encountered
throughout life contribute to
customary responses to particular
stimuli
● REGULATOR SUBSYSTEM-
Major coping process involving the
neural, chemical, and endocrine
system
● COGNITIVE SUBSYSTEM-
Major coping process involving
four cognitive-emotion channels
➢ Perceptual and information
processing
➢ Learning
➢ Judgement
➢ Emotion
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BEHAVIOR- Viewed as an output of FOUR PROCESS INVOLVED IN
human system and takes the form of either PHYSIOLOGICAL ADAPTATION:
adaptive response or ineffective systems 1. The senses
● ADAPTIVE RESPONSE- 2. Fluid, Electrolyte and acid-base
Promotes integrity in terms of the balance
goals of human systems 3. Neurologic Function
● INEFFECTIVE RESPONSE- Do 4. Endocrine function.
not contribute to integrity in terms
of the goals of human systems
SELF-CONCEPT GROUP IDENTITY
INTEGRATED LIFE PROCESS MODE
● The adaption level at which the
structures and functions of a life  It focuses specifically on the
● process are working as a whole to psychological and spiritual aspects
meet human needs of the human aspects. The basic
● PHYSIOLOGICAL-PHYSICAL need underlying the self-concept
MODE- Associated with the mode for the individual is psychic
physical and chemical processes and spiritual integrity.
involved in the function and Its components include:
activities of living organism.
1. The Physical Self
FIVE BASIC NEEDS:
➢ Sensation and body image
1. Oxygenation
2. The Personal Self
2. Nutrition
3. Elimination ➢ Self–Consistency
4. Activity and Rest ➢ Self-Ideal or expectancy
5. Protection ➢ Moral-Ethical-Spiritual Self
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● SELF-CONCEPT GROUP
IDENTITY MODE-The Group
Identity reflects how people in
groups perceive themselves based
on environmental feedback.
Composed of :
1. Interpersonal Relationships
2. Group Self-Image
3. Social Milieu
4. Culture
● ROLE FUNCTION MODE-
Focuses on the roles the person
occupies in society. A role as a
functioning unit of society. Person
performs primary, secondary and
tertiary roles. Which then carried
out by the:
➢ Instrumental Behavior -
actual physical performance
of behavior
➢ Expressive Behavior – are
the feelings, attitudes, like
or dislikes, that the person
has towards role or about
the performance of a role.
PRIMARY
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➢ Majority of the behavior
engaged by the person
during a particular period of
life.
SECONDARY
➢ Person assumes to complete
a task associated with
developmental stage and a
primary role.
TERTIARY
➢ Interrelated, represent ways
in which individuals meet
their role obligations.
Normally temporary in
nature and freely chosen by
an individual.
● INTERDEPENDENCE ROLE-
Focuses on the close relationship of
people (individually or
collectively) and their purpose,
structure, and development. This
mode also involves the willingness
and ability to give other and accept
what one has to offer.
➢ Two Specific
Relationships in
Interdependence Role:
➢ Significant Others
➢ Support Systems
● PERCEPTION- The interpretation
of a stimulus and the conscious
application of it where it links the
regulator with the cognator and
connects the appropriate adaptive
modes.
MAJOR ASSUMPTIONS
● HUMAN ADAPTIVE
SYSTEMS- Viewed as interactive
parts that act in unity for some
purpose. Complex and multifaceted
and respond to myriad
environmental stimuli to achieve
adaptation.
● HUMANISM- Asserts that the
person and human experiences are
essential to knowing and valuing,
and that they share in creative
power.
● VERITIVITY- Affirms the belief
in the purpose, value,and meaning
of all human life.
● ADAPTATION- 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.
METAPARADIGM
PERSON
● Holistic, adaptive system.
● As an adaptive system, the human
system is described as a whole with
parts that function as unity for
some purpose.
ENVIRONMENT
● All the conditions , circumstances,
and influences surrounding and
affecting the development and
behavior of a person or group.
HEALTH
● A state and a process of being and
becoming integrated and a whole
person.
NURSING
● A health care profession that
focuses on human life process and
patterns and emphasizes promotion
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of health for individuals, families,
groups, and society as a whole.
MYRA ESTRIN LEVINE - THE
CONSERVATION MODEL
• Was born in Chicago in 1920,
the first child in a family of
three siblings. Her experiences
during her father’s frequent
illnesses contributed to her
interest in and dedication in
nursing. She died in 1996 at the
age of 75.
• Clinically, she held positions
as a private duty nurse, a
civilian nurse for the U.S.
Army, surgical supervisor, and
director for nursing. She held
faculty positions at Cook
County School of Nursing,
Loyola University, Rush
University, and the University
of Illinois, Chicago.
• Was a charter fellow in the
American Academy of Nursing
and was honored by the Illinois
Nurses Association. She
authored 77 published articles.
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• She was the first recipient of
Sigma Theta Tau’s Elizabeth
Russell Belford Award for
teaching excellence.
SIGNIFICANT DATES TO
REMEMBER
Ø 1944 — received a diploma
from Cook County School of
Nursing.
Ø 1949 — received a B.S. from
the University of Chicago.
Ø 1962 — received an M.S. in
Nursing from Wayne State
University.
Ø 1992— received a granted
honorary doctorate by Loyola
University
DEVELOPMENT OF THE THEORY
• She had no intention of
developing a theory. (Only
ideas)
• After the initial publication
of “INTRODUCTION TO
CLINICAL NURSING”, she
referred to the work as a
THEORY but to identify it as a

CONCEPTUAL MODEL (20
years ago)
• She was interested in helping
nurses
• Relation to nursing care that
needs to be solved in an
individualized manner.
• She was also careful to credit
the scientist
• Works of DUBOS (1965),
COHEN (1968), and
GOLDSTEIN (1963) =
Levine’s concept of adaptation.
ADAPTATION
• Conserving wholeness in the
midst of constant
environmental change
• Process by which individual
fit the environment in which
they live
• Method of change
• Basic To Survival
• 3 Characteristics of
Adaptation
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• HISTORICITY,
SPECIFICITY,
REDUNDANCY
CONSERVATION
A universal concept, natural law,
that deals with defense of wholeness and
system integrity. • According to
Levine(1990),“Conservation defends the
wholeness of living systems by ensuring
their ability to confront change
appropriately and retain their unique
identity”. • Levine used the thermostat as
an example to illustrate the theory of
conservation. • She stated that
physiological and behavioral responses are
essential components of her theory. And it
is not parallel or simultaneous but part of
the same whole.
4 LEVELS OF BEHAVIOR
1.Cannon’s (1939) “fight or flight”
response -adrenocortical-sympathetic
reactions that provide both physiological
and behavioral readiness in the face of
sudden and unexplained challenges in the
environment
2. Inflammatory-immune response - rely
on for restoration of physical wholeness
and healing.
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3. Selye’s (1956) stress response -an
integrated defense that occurs over time
and is “influenced by the accumulated
experience of the individual”.
4. Gibson’s (1966) perceptual response
-the senses are not only provide access to
environmental energy sources but also
convert these sources into meaningful
experiences; people not only see, they
look; they not only hear, they listen.
4 PRINCIPLES OF CONSERVATION
1. The conservation of energy of the
individual
•clearly evident in the very sick, whose
lethargy, withdrawal, and self-concern are
manifested while, in its wisdom, the body
is spending its energy resources on the
process of healing.
• protects functional integrity.
2. The conservation of the structural
integrity of individual
• focuses on the healing process.
• structural integrity is more than a
physiological need.
3. The conservation of the personal
integrity of the individual

• focuses on a sense of self • Goldstein
(1963) • Maslow (1968) and Rogers (1961)
• public and private self
4. The conservation of the social
integrity of the individual
• involves a definition of self that goes
beyond the individual and includes the
holiness of each person.
• Relationships, identity, function.
• the ultimate direction for social integrity
is derived from the ethical values of the
social system.
• The nurse creates an
environment in which healing
could occur.
• The person can be understood
only in the context of the
environment.
• Human’s beings respond in a
singular, yet integrated, fashion.
• Adaptive changes involve the
whole individual.
• Every self- sustaining system
monitors its own behavior by
conserving the use of the
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resources required to define its ● Relationship
unique identity.
● Sense of security formed
Six Nursing Role
HILDEGARD PEPLAU (Interpersonal
Relations) A. Stranger Role
Phases of Nurse-Patient Relationship ● Receives the client same way one
meets a stranger
A. Orientation Phase
B. Resource Role
● Aquitaine phase of the nurse-
patient ● Answer questions, gives
information
● Perceptions are worked through
C. Counseling Role
● Roles begin to understood
● Client understanding and integrates
B. Identification Phase the meaning of life
● Client begins to identify problems D. Surrogate Role
● Goal of the nurse: Help the patient ● Client clarity domains of
to recognize his/her dependence, interdependence and
independence
C. Exploitation Phase
● Full potential of client’s trust to
nurse
● Full use of nursing services E. Active Leader Role
D. Resolution Phase ● Client assume maximum
responsibility
● Client med needs
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F. Technical Expert Role
● Providing physical care
Additional Roles
1. Technical Expert
2. Consultant
3. Health Teacher
4. Tutor
5. Socializing Agent
6. Safety Agent
7. Manager of Environment
8. Mediator
MADELEINE LEININGER (Living
Legend, Founder of Transcultural
Nursing)
Transcultural Nursing
Purpose of Transcultural Nursing
● To discover a body of knowledge
and skills that focused on
transcultural care
Human Caring
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● A Universal Phenomenon, but the
expressions processes and patterns
vary among cultures
Transcultural Nursing
● A substantive area of study and
practice focused on comparative
human care
Transcultural Nursing Goal
● To provide culture specific and
Universal nursing care practices
Definitions
Culture – Set of values, beliefs .From
generation to Generation.
Religion – Set of belief in human. To be
obeyed and worshipped
Ethnic – a group of people share a culture
Ethnicity – consciousness of belonging to
a group
Cultural Identity – Sense of being on part
of an Ethnic Group
Cultural-Universal – Commonalities of
values
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Culture-Specific – Values, beliefs of
behavior tend unique to a designated
culture
Material Culture – Object (ex. Dress,
Artifacts)
Non-Material Culture – beliefs, language
Subculture – People who have distinct
identity but related to larger group
Bicultural – person with 2 cultures,
lifestyle
Diversity – fact of being different
Acculturation – adopting culture
Culture Shock – being disoriented or
unable to respond to a diff cultural
environment
Ethnic Groups – share a common social,
culture
Ethnic Identity – perspective of the
person, sense of belonging to a group
Race – people according to a shared
characteristic genetic.
Concepts
Care – to assist supporting behaviors that
eases or improves
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Culturally Congruent Care – care that fits 5 person variable corrective action to change,
the person based on their culture enhance or stabilize the system.
Physiological
Culturally Competent Care – ability of Negentropy
the practitioner to bridge cultural gaps Sociological
● As a process of energy
Three Nursing Decision and Actions Psychological conservation utilization assist
Developmental system profession toward stability
1. Culture Care Preservation – or wellness
Preserve the beliefs, culture
Spiritual
Stability
2. Culture Care Accommodation –
Major Concepts
help people to adapt or negotiate ● Dynamic and desired state of
with others Open System balance
3. Culture Care Restructuring – Function or Process ● Copes with stressors to maintain an
help people to change or modify optimal level of health and integrity
clients life ways ● Client as a system exchange energy
information and matter with the Environment
environment as it uses available
energy resources to more toward ● Created Environment
stability and wholeness Client System
● Basic Client Structure
Input or Output o Composed of a central core
BETTY NEUMAN – Neuman System
● Matter, Energy and information Lines of Resistance
Model
exchanged between client and
Wholistic approach environment Normal Lines of Defense

● Client viewed as a “whole” Feedback ● Represent stability for the

individual or system
● Person, Group, Community or social ● System output in the form of
issue matter, energy, and information for ● Maintained over time

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Flexible Lines of Defense
● Models outer broken ring
● Can be altered over time; protective
buffer for presenting stressors from
breaking through usual wellness
state
● According to "When it contracts, it
provide less protection”
Health
● Wellness- exists when all system
supports interact in harmony with
the whole system needs are being
met.
● Illness- opposite ends of the
continuum from wellness and
represents a state of instability and
energy depletion.
Stressor
● Tension producing stimuli that have
the potential to disrupt system
stability
Degree of Reaction
● System instability that occurs when
stressor invade normal line of
defense
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Prevention as Intervention
● Purposeful actions to help client
maintain system stability
Levels of Prevention:
● Primary – used when stressor is
suspected or identified; degree of
risk in known
● Secondary- involves intervention
or treatment initiated after
symptoms occured
● Tertiary – occurs after active
treatment; maintenance
Reconstitution
● Occurs after treatment for
stressor
NURSING
● Concerned with the whole person.
She views as a “unique profession
in that is concerned with all of the
variables affecting an individual’s
response to stress.”
DOROTHY JOHNSON -
BEHAVIORAL SYSTEM MODEL
THE THEORY
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● Defined as behavioral system
composed of seven behavioral
subsystems
● Each subsystems is comprised of
four structural characteristics
● An imbalance in each results in
disequilibrium
● The nurse’s role is to help the
patient maintain his or her
equilibrium
GOALS OF NSG ACCORDING TO
BSM
● To assist the patient whose
behavior is proportional to social
demands
● To assist the patient who is able to
modify his behavior in ways that its
supports biological imperatives
(more on physical well being and
alter the behavior, mentally ill)
● To assist the patient who is able to
benefit to the fullest extent during
illness from the physicians
knowledge and skill (decision
making, giving information,
treatment prescribed by doctors)
● To assist the patient whose
behavior does not give evidence of
unnecessary trauma as a
consequence of illness (safety)

(doesn’t give trauma and
complication)
GOAL: Restore or maintain behavioral
integrity, stability and efficient and
effective behavioral function
CLIENT: Biopsychosocial being with an
instability in one of the subsystems due to
stress
NURSING: External regulatory torch
which acts to preserve the organization and
integration
● ASSUMPTION ABOUT
SYSTEM
● ASSUMPTION ABOUT
STRUCTURE
● ASSUMPTION ABOUT
FUNCTION
ASSUMPTION ABOUT SYSTEM
● 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 mean strive continually to
maintain a behavioral system
balance and steady state by more or
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less automatic adjustment, and ● Each subsystem has a repertoire of
adaptations to the natural forces choices of “scope of actions
impinging upon him (system tends produces “observable outcome”
to maintain its equilibrium)
● A behavioral system which both FUNCTIONAL REQUIREMENTS OF
requires and results in some degree EACH SUBSYSTEM
of regularity and constantly in
● System must be “protected” from
behavior, is essential to man it is
noxious influences with which
functionally significant in that it
system cannot cope (avoiding
serve a useful purpose both in
influences)
social life and for individual
● Each subsystem must be “nurtured”
(regularity to the function of
through the input of appropriate
system)
supplies from the environment
● System balance reflects adjustment
● Each subsystem must be
and adaptations that are successful
“stimulated” for use to enhance
in some way and to some degree
growth and prevent stagnation
(stimulate the brain/mind)
SUBSYSTEM
ASSUMPTION ABOUT STRUCTURE
AND FUNCTION OF EACH
ATTACHMENT-AFFILIATIVE
SUBSYSTEM
SUBSYSTEM
● From the form of behavior takes
● Behavioral associated with the
the consequences it achieve can be
development and maintenance of
inferred what “drive” has been
interpersonal relationships with
stimulated or what “goal” is being
parents, peers, authority figures
sought (have a balance)
● Establish a sense of relatedness and
● Each individual has a
belonging with others including
“predisposition to act with
attachment behavior, interpersonal
reference to goal, in certain in ways
relationships and communication
rather than the other ways”. This
skills
predisposition is called as “set”.
● Goal attainment
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DEPENDENCY SUBSYSTEM (patients
who are ill)
● Behaviour associated with
obtaining assistance from others in
the environment for completing
task and/or emotional support
● Includes seeking of attention
approval, recognition, basic self
care skills and emotional security
INGESTIVE SUBSYSTEM (All focuses
on the acquiring knowledge)
● Behavior associated with the intake
of needed resources from the
external environments including
food, fluid information, knowledge
and objects for the propose of
establishing an effective
relationship with the environment
ELIMINATIVE SUBSYSTEM
● Behavior associated with the
release of physical waste products
from the body
● Express feelings
SEXUAL SUBSYSTEM
● Behavior associated with a specific
gender based identity for the
purpose of ensuring
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pleasure/procreation, and
knowledge and behavior being
congruent with biological sex
AGGRESSIVE-PROTECTIVE
SUBSYSTEM (Safety of patient/self)
● Behavior associated with mastery
of oneself and one’s environment
for the purpose of producing a
desired effect
● Knowledge of personal strengths
and weaknesses
● Includes problem solving activity
RESTORATIVE SUBSYSTEM (coping)
● Behavior associated with
maintaining and restoring energy
equilibrium e.g relief from fatigue,
recovery from illness, sleep
behavior, leisure/recreational
interests and sick role behaviour
PURPOSE OF THE SYSTEMS
THEORY
● Nurse creates a balance between
client and environment to achieve
an optimal level of functioning
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FIVE CORE PRINCIPLES
● Wholeness and order
● Stabilization
● Reorganization
● Hierarchic interaction
● Dialectical contradiction
WHOLENESS AND ORDER (organized
self)
● Development analogy of wholeness
and order is continuity and identity
● Continuity and change can exist
across the life span
● Continuity is the relationship of the
parts rather than in their
individuality
STABILIZATION (maintain)
● Dynamic system respond to
contextual changes set point
maintained by altering internal
conditions
REORGANIZATION (returning to its
balance)
● Encounters new experiences in the
environment that cannot be
balanced by existing system
mechanism

● Nurse acts to provide conditions or
resources essential to help the
accommodation process
HIERARCHIC INTERACTION
● Hierarchies, or a pattern of relying
on a particular subsystems, lead to
a degree of stability
DIALECTICAL CONTRADICTION
(maturity)
● Motivational force for behavioral
change
● Drives/responses developed and
modified over time through
maturation, experience and learning
● Environmental domains that the
person is responding to include the
biological, psychological, cultural,
familial, social, and physical
setting
MAJOR CONCEPTS
● Human being- biological system
and behavioral system. The role of
the medicine to focus on biological
system
MARTHA E. ROGERS
Unitary Human Beings
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Born: May 12, 1914, Dallas, Texas, USA - Humans are the only organisms
able to think, imagine, and have
She was the eldest of four children of language and emotions.
Bruce Taylor Rogers and Lucy Mulholland
Keener Rogers. Major Concepts
Died: March 13, 1994 Energy Field
Wholeness - It is inevitable part of life. Human
and environment both have energy
- Human being is considered as field which is open.
united whole.
- i.e. energy can freely flow between
Openness human and environment
- A person and his environment are Openness
continuously exchanging energy
with each other. - There is no boundary or barrier that
can inhibit the flow of energy
between human and environment
Unidirectionality which leads to the continuous
movement or matter of energy.
- The life process of human being
evolves irreversibly and
unidirectional (from birth to death). Pattern
Pattern & Organization - Pattern is defined as the
Pattern identifies individuals and distinguishing characteristic of an
-
reflects their innovative wholeness. energy field perceived as a single
waves
Sentience & Thought
- “pattern is an abstraction and it
gives identity to the field”
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Homeodynamics
- refers to the balance between the
dynamic life process and
environment.
- These principles help to view
human as unitary human being.
- Three principle of homeodynamics:
1. Resonancy
2. Helicy
3. Integrality
METAPARADIGM
ENVIRONMENT
• It includes the entire energy field
other than a person.
• These energy fields are irreducible,
not limited by space and time,
identified by its pattern and
organization.
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HEALTH
• Not clearly defined by Rogers. It is
determined by the interaction
between energy fields i.e. human
and environments.
• Bad interaction or misplacing of
energy leads to illness.
NURSING
• Nursing exists to serve people.
• Nursing is both science and art. It
is the direct and overriding
responsibility to the society.
IMOGENE KING - CONCEPTUAL
SYSTEM AND MIDDLE-RANGE
THEORY OR GOAL ATTAINMENT
• January 30, 1923: Born in West
Point, Iowa. Youngest of the 3
children
1945: Nursing Diploma from St.
• Structure- represented by the three open
John’s Hospital School, St. Louis,
Missouri
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• Continued to speak at conferences
around the world and consulted
with students who were using and
studying her theory
• December 24, 1997: She died, 2
days after suffering from stroke
Interacting System Framework
Personal System
- Include perception, self-growth,
development, body image, space,
learning and time.
Interpersonal System
- Includes interaction
communication, transaction, role,
stress.
Social System
- Concepts include organization,
authority, power, status and
decision making
system
Functions- demonstrated in reciprocal
relations of individual in interaction

Decision Making- occurs when choices
are made in resource allocation to support
attaining system goals
Perception-presented as major concept of
a personal system
Self- are the dynamic person who is an
open system
Growth and Development- changes in
behavior at the cellular and in molecular
level in individual
Interaction- characterized by values;
mechanism for establishing human
relationship.
Transaction- cognition and perception and
not from transactional analysis.
Basic Assumptions
● Nursing is focus care of Human
Beings.
● Nursing goal is the health care
of individuals & groups
● Human beings: are open system
interacting
Propositions are made in King’s Theory
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1. If perceptual interaction
accuracy is present in nurse-
client interaction transaction
will occur.
2. If Nurse and client make
transaction, goal will be
attained.
HEALTH
3. If Goals are attained,
satisfaction will occur.
4. If transactions are made in
nurse-client interactions,
growth & development be
enhanced
NURSING
METAPARADIGM
PERSON
THEORY
• Individuals are spiritual beings
• Individuals have the ability through
their language and other symbols to
record their history and preserve
their culture
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• Individuals are unique and holistic,
of intrinsic worth, and capable of
rational thinking and decision
making in most situations
• Individuals differ in their needs,
wants, and goals.
• Involves dynamic life experiences
of a human being, which implies
continuous adjustment to stressor in
the internal and external
environment through optimum use
of one’s resources to achieve
maximum potential for daily living.
• Is a process of action, reaction and
interaction by which nurse and
client share information about their
perception in nursing situation.
Imogene King define theory as a
set of concepts, that when defined
are interrelated and observable in
the world of nursing practice and
theory serves to build scientific
knowledge for nursing.

MARGARET NEWMAN– Health as
Expanding Consciousness
Ida Jean Orlando- Nursing Process
Theory
Nursing Process Theory- a deliberative
nursing process has elements of continuous
reflection as the nurse tries to understand
the meaning to the patient of the behavior
she observes and what she needs from her
in order to be helped.
Major Dimensions of the Theory
1. Professional Nursing Function-
organizing principle
➢ The nurse’s unique function
is patient’s immediate needs
for help”
➢ The product of meeting the
patient’s need for help is
improvement in the
immediate verbal and
nonverbal behavior of the
patient
2. The Patient’s Presenting
Behavior- problematic situation
➢ The presenting behaviour of
the patient regardless of the
form in which it appears,
maybe a plea for help
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➢ The patient and nurse
participate
3. Immediate Reaction- internal
response
➢ The problematic situation
triggers and automatic
reaction in the nurse that is
both cognitive and affective
➢ Distinct items that occur in
any person’s process of
action
➢ Perception of an object with
the use of senses
➢ Stimulation of automatic
thoughts
➢ Through stimulate feelings
➢ The person acts
➢ Interaction of these item is
called the nursing process
4. Deliberative Nursing Process-
reflective injury
➢ The deliberative process
requires that there is a
shared communication
process between the nurse
and the patient to determine
the following:
➢ The meaning of the
patient’s behavior
➢ The help required by the
patient whether the patient
was helped by the nurse’s
Immediate reactions of a person in
a person to person encounters
➢ The thought about this
perception
➢ The feelings associated with
the thoughts
5. Improvement- resolution
➢ When immediate need for
help have been determined
and met, there is
improvement
➢ This allows the nurse to
conclude that the patient’s
sense of helplessness has
been relieved, prevented, or
diminished
➢ If the patient’s behaviour
has not changed, the
function of the nursing has
not been met and the nurse
continues with the inquiry
process until there is
improvement
Major Concepts of the Theory
- Nursing is unique and independent

- Nursing resolves individual’s and
though interactive process
- Actions should be based on
rationale not on protocols
- Person in each situation is different
Health
Distress- experience of a patient whose
need has not been met
Nursing role- is to discover and meet the
patient’s immediate need for help
Nursing actions- directly or indirectly
provide for the patient's immediate need
Outcome- change in the behavior of the
patient indicating either a relief from
distress or an unmet need
Environment
JOYCE TRAVELBEE- HUMAN-TO-
HUMAN RELATIONSHIP MODEL
● A nurse does not only seek to
alleviate physical pain or render
physical core- she ministers to the
whole person. The existence of
suffering, whether physical, mental
or spiritual
Nursing
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● Interpersonal process whereby the
professional nurse practitioner
assist the individual or family to
preserve or cope with the
experience of illness and suffering
and if necessary.
● Includes perception of health and
the absence of disease
● Subjective Health - Are
individually defined state of well-
being in accord with self appraisal
of physical, emotional and spiritual
status.
● Objective Health - Absence of
decerrible disease of defect as
observed
● Conditions associated with the
environment are life experiences
encountered by all men
● She used the concepts of stages of
development of the nurse-patient
relationship stages of suffering,
tasked to be mastered, constant
changes and development
HUMAN-TO-HUMAN
RELATIONSHIP
PHASE OF THE ORIGINAL
ENCOUNTER
● Emotional, knowledge, colors
impressions and perceptions of
both nurse and the patient during
initial encounter
PHASE OF EMERGING IDENTITIES
● Both the nurse and patient begins to
transcend their respective role and
perceive uniqueness in other
PHASE OF EMPATHY
● This phase involves sharing
anothers psychological state but
standing apart and most sharing
feeling
PHASE OF SYMPATHY
● Sharing feeling and experiencing
what others are feeling and
experiencing accomplished
PHASE OF RAPPORT
● All previous phase culminate in the
rapport defined as these
experiences, thoughts and attitudes
 lOMoARcPSD|24670182

that both nurse and patient undergo

and are able to perceive share and
communicate

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