NURSING CONCEPTUAL MODEL

1. Roger’s Science of Unitary Human Beings Nursing Conceptual Model

2. Orem’s Self-Care Deficit Model
3. King’s General Systems Framework Nursing Conceptual Model
4. Neuman’s Systems Model
5. Roy’s Adaptation Model
6. Johnson’s Behavioral System Model

OBJECTIVES:
• To explain the conceptual model in nursing.
• To identify the major concepts in nursing practice
• To apply the metaparadigm in nursing.

MARTHA E. ROGERS: UNITARY HUMAN BEING

• Eldest of four children of Bruce Taylor Rogers and Lucy Mulholland Keener Rogers
• Was born May 12, 1914, in Dallas, Texas.
• BSN at Knoxville General Hospital School of Nursing (1936)
• M.A. in public health nursing supervision from Teachers College, Columbia University
New York
• MA of Public Arts Degree & Doctor of Science Degree, John Hopkins University in
Baltimore
• Died –March 13, 1994, at the age of 79.

MAJOR CONCEPTS
Roger’s Conceptual Model of Nursing - the basic assumption that described the life process
in human being includes:
1. Wholeness
2. Openness
3. Unidirectionality
4. Pattern & Organization
5. Sentience & Thought

4 Building Blocks for the Model

1. Energy Field
a) unitary human being (human field)- is an irreducible, indivisible, pandimensional
energy field identified by pattern and manifesting characteristics that are specific to the whole
and that cannot be predicted from knowledge parts
b) environmental field – irreducible, pandimensional energy field identified by pattern
and integral with the human field

2. Universe of open system

- Holds that energy fields are infinite, open, and integral with one another.
- The human and the environmental field are in continuous process and are open system
 3. Pattern
- It is the distinguishing characteristic of an energy field and is perceived as a single wave
- is continually changing and may manifest disease, illness, feelings, or pain
- pattern change is continuous, innovative, and relative.

4. Pandimensionality
- defines as a nonlinear domain without spatial or temporal attributes.
- provides for an infinite domain without limit. It best expresses the idea of a unitary
whole.

Metaparadigm in Nursing

Nursing
It is learned profession and is both a science and an art. It is empirical science, and, like
other sciences, it lies in the phenomenon central to its focus. Nursing exists for the care of
people and the life process of human.
Person
As an open process as an open system in continuous process with the open system that
is environment
Health
She uses the term passive health to symbolize wellness and the absence of disease and
major illness.
Environment
Each environmental field are infinite, and change is continuously innovative, unpredictable,
and characterized by increasing diversity.

DOROTHEA OREM: SELF-CARE DEFICIT THEORY OF NURSING

• Born 1914 in Baltimore.
• 1930 Earned her diploma at Providence Hospital – Washington, DC
• 1939 – BSN Ed., Catholic University of America
• 1946 – MSN Ed., Catholic University of America
• Involved in nursing practice, nursing service, and nursing education
• During her professional career, she worked as a staff nurse, private duty nurse, nurse
educator and administrator and nurse consultant
• Received honorary Doctor of Science degree in 1976

MAJOR ASSUMPTIONS
• People should be self-reliant and responsible for their own care and others in their
family needing care
• People are distinct individuals
• Nursing is a form of action – interaction between two or more persons.
• Successfully meeting universal and development self-care requisites is an important
component of primary care prevention and ill health
• A person’s knowledge of potential health problems is necessary for promoting self-care
behaviors
• Self-care and dependent care are behaviors learned within a socio-cultural

MAJOR CONCEPTS
• The self-care deficit nursing theory is a general theory composed of the following FOUR
related theories:
1. theory of dependent-care - which explains how family member and/or friend
provide dependent care for a person who is socially dependent.
2. theory of self-care deficit- which describes and explains why people can be helped
through nursing.
3. theory of nursing systems - which describes and explains relationships that must be
brought about and maintained for nursing to be produced. theory of self-care -
which describes why and how people care for themselves

THEORY OF SELF CARE

• Self-care – practice of activities that individual initiates and perform on their own behalf
in maintaining life health and well being
• Dependent-Care - refers to the care that is provided to a person who, because of age or
related factors, is unable to perform the self-care needed to maintain life, healthful
functioning continuing personal development, and well- being.

Self-care requisites-action directed towards provision of self-care.

A. Universal self-care requisites
1. Maintenance of sufficient intake of air.
2. Maintenance of sufficient intake of food.
3. Maintenance of sufficient intake of water
4. Provision of care associated with elimination process and excrements.
5. Maintenance of balance between activity and rest.
6. Maintenance of balance between solitude and social interaction.
7. Prevention of hazards to human life, human functioning, and human well-being.
8. Promotion of human functioning and development within social group in
accordance with human potential, known as limitations.
B. Developmental self-care requisites
• Associated with developmental processes/ derived from a condition…. Or
associated with an event
• E.g. adjusting to a new job; adjusting to body changes
C. Health deviation self-care
• Required in conditions of illness, injury, or disease these include:
1. Seeking and securing appropriate medical assistance
2. Being aware of and attending to the effects and results of pathologic conditions
3. Effectively carrying out medically prescribed measures
4. Modifying self-concepts in accepting oneself as being in a particular state of
health and in specific forms of health care
 5. Learning to live with effects of pathologic conditions
D. Self-care agency – is a human ability which is "the ability for engaging in self-care" -
conditioned by age developmental state, life experience sociocultural orientation
health and available resources
E. Therapeutic self-care demand – "totality of self-care actions to be performed for
some duration in order to meet self-care requisites by using valid methods and
related sets of operations and actions”
F. Self-care deficit- specifies when nursing is needed
• Is the relationship between an individual therapeutic self-care demand and his or
her power of selfcare agency in which self-care agency are inoperable.
• Nursing is required when an adult (or in the case of a dependent, the parent) is
incapable or limited in the provision of continuous effective self-care

METHODS OF HELPING
1. Acting for or doing for another
2. Guiding or directing another
3. Providing physical support or psychological support
4. Providing and maintaining an environment that supports personal development
5. Teaching another

THEORY OF NURSING SYSTEMS

• Wholly compensatory system
• Agency is so limited that s/he depends on others for well-being.
• Partly compensatory system
• A patient can meet some self-care requisites but needs a nurse to help others.
• Supportive – educative system
• Patient can meet self-care requisites but needs help in decision making behavior
control or knowledge acquisition.
APPLICATION THEORY OF NURSING SYSTEMS
Supportive – educative system
Newly diagnosed diabetic patient received diabetic care teaching while in the hospital.
Now patient visits module reports highly variable chemstrip readings. Nurse suspects patient
maybe doing the procedure incorrectly. Upon assessment she found out that the patient has
been cutting the strips in half to save money. Nurse instructs patient that cutting chemicals
may expose strips and result to inaccurate reading. She also noted that the wife who does the
cooking did not receive any nutritional education while patient was hospitalized. Nurse gave
counseling and provided wife referral to nutritional services.

Partly compensatory system

Preterm labor patient regularly visits clinic for BP monitoring. Patient is on bed rest at
home except for weekly visits to the clinic. Nurse assist patient out of the wheelchair into
bathroom, assists with urine sample collection and to the exam table. Nurse administers
injection of terbutaline sulfate and educates patient about it.
Wholly compensatory
Bedridden oncology patient arrives at clinic for chemotherapy. The relatives leave
patient alone with nurse for chemo treatment. Patients require 02 at 2L/min, continuous tube
feeding at 90 cc/hour, foley catheter, bedpan. Nurse administers chemo pre-meds, O2,
changed dressing of G-tube due to leakage, empties foley at the end of treatment and places
patient on bed pan for elimination.

Metaparadigm in Nursing

PERSON
• has the capacity to reflect, symbolize and use symbols
• Conceptualized as a total being with universal, developmental needs and capable
of continuous self-care
• can function biologically, symbolically, and socially
HEALTH
health and healthy are terms used to describe living things
•
It is when they are structurally and functionally whole or sound wholeness or
•
integrity. Includes that which makes a person human. Operating in conjunction
with physiological and psychophysiological mechanisms and a material structure
and in relation to and interacting with other human beings
ENVIRONMENT
• environment components are enthronement factors, enthronement elements,
conditions, and developed environment.
NURSING
• Is an art, a helping service, and a technology
• Actions deliberately selected and performed by nurses to help individuals or
groups under their care to maintain or change conditions in themselves or their
environments
• Encompasses the patient’s perspective of health condition, the physician’s
perspective, and the nursing perspective
• Goal of nursing – to render the patient or members of his family capable of
meeting the patient’s self-care needs
• To maintain a state of health
• To regain normal or near normal state of health in the event of disease or injury
• To stabilize, control, or minimize the effects of chronic poor health or disability

IMOGENE KING: THEORY OF GOAL ATTAINMENT

• Born on January 30, 1923, in West Point Iowa.
• Died December 24, 2007
• Bachelor’s in Science of Nursing from St. Louis University in 1948
• Master of Science in Nursing from St. Louis University in 1957
• Doctorate from Teacher’s College, Columbia University
• Worked as instructor in Medical Surgical in Nursing
BASIC ASSUMPTIONS
• Nursing focus is the care of human being
• Nursing goal is the health care of individuals & groups
• Human beings: are open systems interacting constantly with their environment, leading
to a state of health of individual, which is an ability to function in social roles.

Metaparadigm in Nursing
Nursing
• Nursing is an observable found in the health care system in society.
• The goal of nursing is to help individuals maintain their health so they can function in
their roles
• Nursing is an interpersonal process of action, reaction, interaction, and transaction.
Perception of a nurse and a patient influence the interpersonal process.

Person
• Individuals are spiritual beings.
• Individuals have the ability through their language and other symbols to record their
history and preserve their culture.
• 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.

Health
• involves dynamic life experiences of a human being, which implies continuous
adjustment to stress in the internal and external environment through optimum use of
one’s resources to achieve maximum potential for daily living.

Environment
• Background for human interactions
(a) Internal environment: transforms energy to enable person to adjust to continuous
external environmental changes.
(b) External environment: involves formal and informal organizations. Nurse is a part of
the patient’s environment.

KING’S THEORY OF GOAL ATTAINMENT

• Theory describes a dynamic, interpersonal relationship in which a person grows and
develops to attain certain life goals.
• Factors which affect the attainment of goal are roles, stress, space & time

PROPOSITIONS OF KING’S THEORY

1. If perceptual interaction accuracy is present in nurse-client interactions, transaction will
occur
2. If nurse and client make transaction, goal will be attained
3. If goals are attained, satisfaction will occur
 4. If goals are attained, effective nursing care will occur.
5. If transactions are made in nurse-client interactions, growth & development will be
enhanced
6. If role expectations and role performance as perceived by nurse & client are congruent,
transaction will occur
7. If role conflict is experienced by nurse or client or both, stress in nurse-client interaction
will occur
8. If nurse with special knowledge skill communicate appropriate information to client,
mutual goal setting and goal attainment will occur.

THEORY OF GOAL ATTAINMENT AND NURSING PROCESS

BETTY NEUMAN: SYSTEM MODEL

• “Health is a condition in which all parts and subparts are in harmony with the whole of
the client.”
• Born in 1924 at Lowell, Ohio.
• Her father was a farmer, and her mother was a homemaker
• Her initial nursing education was completed with double honors at People’s Hospital
School of Nursing, Akron, Ohio in 1947
• She completed her Baccalaureate degree with honors in nursing in 1957.
• She received her master’s degree in Mental Health, Public Health Consultation from
UCLA.
• She received a Doctoral Degree in Clinical Psychology from Pacific Western University in
1985
• She moved to Los Angeles, California and worked in variety of nursing roles that include
hospital staff and head nurse, school nurse, and industrial nurse.
• She was also involved in clinical teaching in the University of Southern California Medical
Center in the areas of medical-surgical, communicable disease, and critical care.
• She had always been interested in human behavior; therefore, she attended the UCLA
with a double major in Public Health and Psychology.
• Health Care System Model- based on individual relationship to stress, the reaction to it,
and reconstitution factors that are dynamic in future.
• Reconstitution is the state of adaptation to stressors
• Claims that the incorporation of nursing actions in the primary, secondary, and tertiary
level of prevention reduces stress
• The body is more than the sum of its parts.
• This holds as a granite truth more than ever, as knowledge about the origins, nature and
purpose of human being expand, discovered and rediscovered.
• Human beings can also be considered as a concrete example of an Open system. An
Open system reacts and adjust itself to the environment.
• The human body for example relies on a delicate chemical and environmental balance
to secure its survival.
• it is constantly at part with both internal and external forces from moment to moment.
Without such intricate and sensitive balance, the entire system crashes, and the result is
death.
• Nursing, being a profession that seeks to restore total balance in the individual, utilizes
the nursing process to give specific and precise care.
• The parts of a system comprise of input, output, and feedback. Input is the data that go
through and are integrated in the system. The output is the product of the input that is
processed in the system. The feedback is the re-evaluated and changed output that goes
as input back into the system.
• Applying this to nursing, it can now be considered the interventions and healing
practices that are done and endeavors to obtain a positive healing output and feedback
on the patient

Metaparadigm in Nursing
Neuman’s theory incorporated the concept of a whole person and an open
system approach. The concept is aimed towards the development of a person in a state
of wellness having the capacity to function optimally. The main role of the nurse in her
theory is to help a person to adapt with environmental stimuli causing illnesses back to a
state of wellness.
Nursing
• She believes that nursing is concerned with the whole person.
• She views nursing as a “unique profession in that it is concerned with all the
variables affecting an individual’s response to stress.
• The nurse’s perception influences the care given; therefore, the states that the
perceptual field of the caregiver and the client must be assessed.

Person
• The concept of human beings as an open client system in reciprocal interaction with
the environment.
• The client may be an individual, family, group, community, or social issue.
• The client system is a dynamic composite of interrelationships among physiological,
sociological, development, and spiritual factors.

Health
• She considers her work a wellness model.
 • She views health as continuum of wellness to illness that is dynamic in nature
and is constantly changing.
• “Optimal wellness or stability indicates that total system needs are being met. A
reduced state of wellness is the result is the result of unmet needs.”
Environment
• The internal and external factors that surround and influence the client system.
• Stressors (intrapersonal, interpersonal, and extra personal) are significant to the
concept of environment and are described as environmental forces that interact
with and are potentially alter system stability.

The three relevant environments environment can be an (1) internal, (2) external and
(3) created force that interacts with a person’s state of health.

These stressors can be:

• Internal environment – is intrapersonal, with all the interaction contained within
the client.
• External environment - is interpersonal or extra personal with all factors arising
from outside the client.
• Created environment– is unconsciously develop and is used by the client to support
protective coping.

System Model in Nursing Practice.

Wholistic Approach
The Neuman system model is a dynamic, open system approach to client care
originally developed to provide a unifying focus for defining nursing problems and for
understanding the client interaction with the environment.

Open System
“There is a continuous flow of input and process, output, and feedback.”
“Stress and reaction to stress are basic components of an open system.”

Client variables
The client's variables can be one or combination of the following physiological,
sociocultural, developmental and spiritual. These variables function to achieve
stability in relation to the environmental stressors experienced by the client.

Stability
• Is a dynamic and “desirable state of balance in which energy exchanges can take
place without disruption of the character of the system,” which points toward
optimal health.

Environment
• Consists of both internal and external forces surrounding the client, influencing, and
being influenced by the client, at any point in time.

Client system
• A composite of 5 variables in interaction with the environment:
• Physiological Variables – refers to body structure and function.
• Psychological Variables - refers to mental process's interaction with the environment
• Sociocultural Variables – refers to the effects and influences of social and cultural
conditions
• Developmental Variables – refer to age-related processes and activities.
• Spiritual Variables - refers to spiritual beliefs and influences.

Lines of Resistance
• A series of broken rings surrounding the basic core structure
• These rings represent resource factors that help the client defend against a stressor.
• Serves as a protection factor that are activated by stressors penetrating the normal
line of defense.

Normal line of defense

• Is the model’s outer solid circle
• To achieve the stability of the system, the normal line of defense must act in
coordination with the normal wellness state. It must reflect the actual range of
responses that is normally acted by clients in response to any stressors. It is baseline
in determining the level of wellness of client within the continuum of health.

Flexible line of defense

• The model’s outer broken ring
• Serves as a boundary to the normal line of defense to adjust to situation that
threaten the imbalance within the client’s stability. It expanded the range of normal
defense from becoming invaded by the stressors thus increasing its protection.

Stressors
• Tension-producing stimuli “that have the potential to disrupt system stability,
leading to an outcome that may be positive or negative.”

Degree of Reaction
• Represents system instability that occurs when stressors invade the normal line of
defense.

Prevention as Intervention
• Intervention are purposeful actions to help the client retain, attain, or maintain
system stability. They can occur before and after protective lines of defense and
resistance are penetrated.
 • Interventions are based on possible or actual degree of reaction, resources, goals,
and anticipated outcomes,

There are three levels of prevention according to Neuman's Theory

Primary prevention
• Used when a stressor is suspected or identified.
• A reaction has not yet occurred, but the degree of risk is known.
• The purpose of this is to reduce the possibility of encounter with the stressor or
to decrease the possibility of a reaction.
Secondary Prevention
• Involves intervention or treatment initiated after symptoms from stress have
occurred.
• The client’s internal and external resources are used to strengthen internal lines
of resistance, reduce the reaction, increase resistance factors.
Tertiary Prevention
• Occurs after the active treatment or secondary prevention stage. It focuses on
readjustment toward optimal client system stability
• The goal is to maintain optimal wellness by preventing recurrence of reaction or
regression

SR. CALLISTA ROY: ADAPTATION MODEL THEORY

• Born at Los Angeles on October 14, 1939, as the 2nd child of Mr. and Mrs. Fabien Roy
• she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College,
Los Angeles in 1963.
• She also earned a master’s and PhD in Sociology in 1973 and 1977, respectively.
• a master's degree program in pediatric nursing at the University of California, Los
Angeles in 1966.
• Sr. Callista Roy, a prominent nurse theorist, writer, lecturer, researcher and teacher
• Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill

EXPLICIT ASSUMPTION (Roy 1989)

• The person is a bio-psycho-social being.
• The person is in constant interaction with a changing environment.
• To cope with a changing world, person uses both innate and acquired mechanisms
which are biological, psychological, and social in origin.
• Health and illness are inevitable dimensions of the person’s life.
• To respond positively to environmental changes, the person must adapt.
• The person’s adaptation is a function of the stimulus he is exposed to and his adaptation
level
• The person’s adaptation level is such that it comprises a zone indicating the range of
stimulation that will lead to a positive response.
• The person has 4 modes of adaptation: physiologic needs, self- concept, role function
and inter-dependence.
 • "Nursing accepts the humanistic approach of valuing other persons’ opinions, and
viewpoints" Interpersonal relations are an integral part of nursing
• There is a dynamic objective for existence with goal of achieving dignity and integrity.

IMPLICIT ASSUMPTIONS
• A person can be reduced to parts for study and care.
• Nursing is based on causality.
• Patient’s values and opinions are to be considered and respected.
• A state of adaptation frees an individual’s energy to respond to other stimuli.

ROY’s ADAPTATION MODEL (RAM)

Key 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.
Major Assumption
• Represents the condition of the life processes described on three levels as integrated as
integrated, compensatory, and compromised.
• A person’s adaptation level is a “constantly changing point, made up of focal, contextual
and residual stimuli. Which represent the person’s own standard of the range of stimuli
to which one can respond with ordinary adaptive responses.

Types of Stimuli
Focal - The internal or external stimulus most immediately confronting the human system.
Contextual - The environmental factors within or without but which are not the center of
the person’s attention and/or energy
Residual - Are environmental factors with or without the human system with effects in the
current situation that are unclear.

Categories of Coping Mechanism

System
Is” a set of parts connected to function for some purpose and that does so by virtue of the
interdependence of its parts.”
It also has inputs, outputs, and control and feedback processes.

ADAPTIVE SYSTEM
 COGNATOR
o A major coping process involving 4 cognitive-emotive channels: perceptual and
information processing, learning, judgment, and emotion.
 REGULATOR
 o basic type of adaptive process that responds automatically through neural,
chemical, and endocrine coping channels

COPING PROCESSESS
• are innate or acquired ways of interacting the changing environment.

INNATE COPING MECHANISM

• Are genetically determined or common to the species and are generally viewed as
automatic processes; humans do not have to think about them.

ACQUIRED COPING MECHANISM

• Are develop through strategies such as learning. The experiences encountered
throughout life contribute to customary responses to particular stimuli.

REGULATOR SUBSYSTEM
• Is a major coping process involving the neural, chemical, and endocrine system.

COGNATOR SUBSYSTEM
• Is a major coping process involving four cognitive-emotive channels; perceptual and
information processing, learning, judgement, and emotions

ADAPTIVE RESPONSE
• Are those that promote integrity in terms of the goals of human system.

INEFFECTIE RESPONSE
• Are those do not contribute to integrity in terms of the goals of the human systems

INTEGRATED LIFE PROCESS

• Refers to the adaptation level at which the structures and functions of a life process are
working as a whole to meet human needs.

METAPARADIGM IN NURSING
PERSON
• Bio-psycho-social being in constant interaction with a changing environment
• Uses innate and acquired mechanisms to adapt
• An adaptive system described comprised of parts (cognator and regular subsystems)
• Functions as a unity for some purpose
• Includes people as individuals or in groups-families, organizations, communities, and
society.
HEALTH
• Inevitable dimension of person's life
• Represented by a health-illness continuum
• A state and a process of being and becoming integrated and whole
NURSING
• promote adaptation for individuals and groups in the four adaptive modes, thus
contributing to health, quality of life, and dying with dignity

DOROTHY JOHNSON: BEHAVIORAL SYSTEM MODEL

• Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia.
• B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H. from
Harvard University in Boston in 1948.
• From 1949 till retirement in 1978 she was an assistant professor of pediatric nursing, an
associate professor of nursing, and a professor of nursing at the University of California
in Los Angeles.
• Died February 1999
BEHAVIORAL SYSTEM MODEL ASSUMPTIONS
• ASSUMPTIONS ABOUT SYSTEMS
1. There is “organization, interaction, interdependency and integration of the parts and
elements of behaviors that go to make up the system”
2. A system “tends to achieve a balance among the various forces operating within and
upon it', and that man strive continually to maintain a behavioral system balance and
steady state by more or less automatic adjustments and adaptations to the natural
forces impinging upon him.”
3. A behavioral system, which both requires and results in some degree of regularity and
constancy in behavior, is essential to man that is to say, it is functionally significant in
that it serves a useful purpose, both in social life and for the individual.
4. Last, “system balance reflects adjustments and adaptations that are successful in
some way and to some degree.”.

• ASSUMPTION ABOUT STRUCTURE AND FUNCTION

• “From the form the behavior takes and the consequences it achieves can be
inferred what “drive” has been stimulated or what “goal” is being sought”
• Everyone has a “predisposition to act with reference to the goal, in certain ways
rather than the other ways”. This predisposition is called as “set”.
• Each subsystem has a repertoire of choices or “scope of action”
• It produces “observable outcome” that is the individual’s behavior.

FUNCTIONAL REQUIREMENTS
1.System must be “protected" from noxious influences with which system cannot cope”.
2. Each subsystem must be “nurtured” through the input of appropriate supplies from
the environment.
3. Each subsystem must be “stimulated” for use to enhance growth and prevent
stagnation.

MAJOR CONCEPTS
BEHAVIOR
 • Output of intraorganismic structures and process as they are coordinated and
articulated by and responsive to changes in sensory stimulation.
SYSTEM
• “A system is a whole that functions as a whole by virtue of the interdependence
of its parts”.
• There is organization, interaction, interdependency and integration of the parts
and elements.
• Adjustments and adaptation
BEHAVIORAL SYSTEM
• Patterned, repetitive, and purposeful ways of behaving.
SUBSYTEM
• A mini-system with its own particular goal and function
• Motivational drives direct the activities of these subsystems.

SEVEN SUSBSYSTEMS
1. Attachment/Affiliative
ü Provides survival and security. Its consequences are social inclusion, intimacy,
and the formation and maintenance of a strong social bond.
2. Dependency subsystem
• Promotes helping behavior that calls for a nurturing response. Its consequences
are approval, attention or recognition, and physical assistance.
3. Ingestive subsystem
• Satisfies appetite. It is governed by social and psychologic considerations as well
as biologic.
4. Eliminative subsystem
• Excrete body wastes.
5. Sexual subsystem
• Dual functions of procreation and gratification; including but not limited to
courting and mating.
• Begins with the development of gender role identity.
6. Achievement subsystem
ü Attempts to manipulate the environment. It controls or masters an aspect of the
self or environment to some standard of excellence.
7. Aggressive/Protective subsystem
ü protects and preserves the self and society within the limits imposed by society

Each of the above subsystem has the same functional requirements: protection, nurturance,
and stimulation.
Responses are developed through motivation, experience, and learning and are influenced
by biopsychosocial factors.
Metaparadigm in Nursing
PERSON
ü A behavioral system composed of seven subsystems: affiliative, achievement,
dependence, aggressive, eliminative, ingestive, and sexual.
ENVIRONMENT
ü Consists of all factors that are not part of the individual’s behavioral system but
that influence the system and some of which can be manipulated by the nurse to
achieve the health goal of the client. The individual links to and interacts with
the environment.
HEALTH
ü An elusive, dynamic state of influenced by biologic, psychologic, and social
factors. Health is reflected by the organization, interdependence, and integration
of the subsystem. Human attempt to achieve a balance in this system; this
balance leads to functional behavior. A lack of balance in the structural or
functional requirements of the subsystem leads to a poor health.
NURSING
ü An external regulatory force that acts to preserve the organization and
integration of the client’s behavior at an optimal level under those conditions in
which the behavior constitutes a threat to physical or social health or in which
illness is found.