NURSING

ADDITIONAL:

CONCEPTUAL MODELS
Imogene King
General System Framework/
Goal Attainment Theory
▣ Imogene Martina King (January 30, 1923 –
December 24, 2007) was one of the
pioneers and most sought nursing
theorists for her Theory of Goal
Attainment, which she developed in
the early 1960s.

▣she received a nursing diploma from

St. John’s Hospital School of
Nursing in St. Louis, Missouri.
▣The Theory of Goal
Attainment states
that “Nursing is a process of
action, reaction, and
interaction whereby nurse
and client share information
about their perception in the
nursing situation.”
▣the model focuses on the
attainment of certain life
goals. It explains that the
nurse and patient go hand-
in-hand in communicating
information, set goals
together, and then take
actions to achieve those goals
▣ The factors that affect the attainment of
goals are roles, stress, space, and time.

▣ Nurses goal: to help patients maintain

health so they can function in their
individual roles.
▣ The nurse’s function is to interpret

information in the nursing process-

plan, implement and evaluate nursing
care
▣ she defined several terms which include the :

Patient🡪 defined as a social being who has

three fundamental needs:
-the need for health information
- the need for care that seeks to prevent illness
- the need for care when the patient is unable
to help him or herself.
▣Health as involving the patient’s life
experiences, including adjusting to
stressors in the internal and external
environment by using resources
available

▣ Environment defined as the

background for human interaction. It
involves the internal environment and
the external
Three interacting systems
of personal,
interpersonal, and social
systems comprise the
human beings concept of
the metaparadigm.
These are used to
establish the nurse-
patient-relationship and
utilized by the nurse to
form a strong foundation
for a dynamic and
interactive environment
 Three interrelated system
1. Personal System -are composed of body
image, growth and development, perception,
self, space and time.
*these concepts relate to an individual

2. Interpersonal System – is composed of

concepts of communication, interaction
role, stress and transaction.
*these concepts highlighted the
interactions between two or more persons.
3. Social System –composed of the
concepts of authority, decision-
making, organization power and
status.
*these concepts provide
knowledge for nurses so that they
can be able to function in larger
system.
 King viewed nursing as an
interaction process between
the client and nurse during
perceiving, setting goals and
acting on them, transactions
occur and goals are
achieved.
Betty Neuman

System Model / Health

Care Theory
• General systems theory can be
applied to nursing in how
nurses care for their
patients.
• Nurses look at the whole picture
with their patients, not just
the one issue at hand.
• They help patients in all aspects
of their life and health,
anyway they can.
• FOCUSES ON🡪 INDIVIDUAL
RESPONSE TO STRESSORS

AND THE IMPACT OF THESE

STRESSORS TO THE OVERALL
WELLBEING OF THE
INDIVIDUAL
IDENTIFY THE STRESSORS AND IMPLEMENT
APPROPRIATE INTERVENTIONS
According to her theory that health is
a condition in which all parts and
subparts are in harmony with the
whole of the client.

The model is based on the person’s

relationship to stress
classified as :
-intrapersonal (within the individual),
-interpersonal(between
one or more people)
-extrapersonal (outside the individual)
constantly changing in response to
single multiple variables and
stressors .

person’s dynamic state of

adaptation which has evolved
and been maintained over a
period of time

function is to stabilize and

return the client to that
person’s personal line of
defense when stressor break
through.
The concern of nursing is to prevent stress
invasion

The nurse helps the client through primary,

secondary and tertiary prevention modes

adjust to environment
stressors and to maintain client system
stability PREVENTIVE
INTERVENTIONS
Preventive interventions are
purposeful actions to help
client retain, attain or
maintain the stability of the
client system and carried out
when a stressor is either
suspected or identified.
PREVENTIVE INTERVENTIONS
1.Primary Prevention-
-is carried out when stressor is suspected or identified.
-The degree of risk is already known but the reaction of the client may not yet
be visible.

ex. teaching weight reduction to decrease chance of developing diabetes

2. Secondary Prevention
-is carried out when symptoms from stress have already occurred that involves
interventions that “treat “the symptoms

ex. parents that have disabled child

3. Tertiary Prevention
-occurs after the active treatment.
- It readjusts the client system toward optimum levels of stability. The goal is to
strengthen resistance to stressors in order to prevent recurrence.

- ex. newly diagnosed diabetic is referred to the Diabetic

• Resource Nurse to prevent complications.
Sister Callista Roy

Adaptation Model
ROY’S MAJOR CONCEPTS:

1. PERSON

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.
2. ENVIRONMENT

-defined as conditions, circumstances,

and influences that affect humans’
development and behavior as an
adaptive system.

The environment is a stimulus or input

that requires a person to adapt.
These stimuli can be positive or negative.
Categories of environmental stimuli:
1. Focal stimuli - are that confront the
human system and require the most
attention.
-are those that immediately confront
the individual in a particular situation.

Example: Focal stimuli for a family include individual

needs; the level of family adaptation; and changes
within the family members, among the members and
in the family environment
2. Contextual stimuli -are characterized as
the rest of the stimuli present with the
focal stimuli and contribute to its effect.

Example: the current bronchoconstriction in

the lungs of the patient currently has
and is influencing and potentiating the
shortness of breath.
3. Residual stimuli- are the additional
environmental factors present within
the situation but whose effect is
unclear.
-include the individual's beliefs or
attitudes that may influence the situation
Example: nurturance, socialization, and
support
3. Health
-is defined as the state where humans can
continually adapt to stimuli

4. Nursing
-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
Adaptation
-is the “process and outcome whereby
thinking and feeling persons as
individuals or in groups use conscious
awareness and choice to create human
and environmental integration.”
Internal Processes
1. Regulator
The regulator subsystem is a person’s
physiological coping mechanism.
• The body attempts to adapt via regulation of our bodily processes,
including neurochemical and endocrine systems.

2. Cognator
The cognator subsystem is a person’s
mental coping mechanism.
• A person uses his brain to cope via self-concept,
interdependence, and role function adaptive modes.
Four Adaptive Modes

1. Physiological-Physical Mode
• Physical and chemical processes are
involved in the function and activities of
living organisms.
• mode’s basic need is composed of the
needs associated with oxygenation,
nutrition, elimination, activity and rest,
and protection.
2.Self-Concept Group Identity Mode

• In this mode, the goal of coping is to have

a sense of unity, meaning the
purposefulness in the universe, and a
sense of identity integrity.

• This includes body image and self-ideals.

3. Role Function Mode
• This mode focuses on the primary,
secondary, and tertiary roles that a
person occupies in society and
knowing where they stand as a member
of society.
4. Interdependence Mode

• This mode focuses on attaining relational

integrity through the giving and
receiving of love, respect and value.

• This is achieved with effective

communication and relations.
Levels of Adaptation

1. Integrated Process

The various modes and subsystems meet

the needs of the environment.
These are usually stable processes (e.g.,
breathing, spiritual realization,
successful relationship).
2. Compensatory Process

• The cognator and regulator are challenged

by the environment’s needs but are
working to meet the needs (e.g., grief,
starting with a new job, compensatory
breathing).
3. Compromised Process

• The modes and subsystems are not

adequately meeting the environmental
challenge (e.g., hypoxia, unresolved
loss, abusive relationships).
Dorothy Johnson

Behavioral System
Theory
• Dorothy E. Johnson is well-known for her
“Behavioral System Model,” which was
first proposed in 1968.
• Her model was greatly influenced by
Florence Nightingale’s book, Notes on
Nursing.
• It advocates fostering efficient and
effective behavioral functioning in the
patient to prevent illness and stresses
the importance of research-based
knowledge about the effect of nursing
care on patients.
• The patient is identified as a behavioral
system composed of seven behavioral
subsystems:
1. affiliative An imbalance in any of
2. dependency the behavioral
subsystems results in
3. ingestive disequilibrium.
4. eliminative It is nursing’s role: to
5. sexual assist the client in
returning to a state of
6. aggressive equilibrium.
7. achievement.
• Dorothy Johnson’s theory defined
Nursing as :

“an external regulatory force which acts

to preserve the organization and
integration of the patient’s behaviors at
an optimum level under those conditions
in which the behavior constitutes a threat
to the physical or social health, or in
which illness is found.”
According to the Behavior System Model, the goals of
nursing are fourfold:

1) To assist the patient whose behavior is

proportional to social demands.
2) To assist the patient who can modify his
behavior in ways that supports biological
imperatives.
3) To assist the patient who can benefit to the
fullest extent during illness from the
physician’s knowledge and skill.
4) To assist the patient whose behavior
does not give evidence of unnecessary
trauma as a consequence of illness.
Concepts in the theory
Behavioral system
• Man is a system that indicates the state of the
system through behaviors.

System
• That which functions as a whole under organized
independent interaction of its parts.

Subsystem
• A mini system is maintained concerning the entire
system when it or the environment is not disturbed.
 SEVEN
SUBSYSTEMS
1. Attachment or affiliative subsystem
is the “social inclusion intimacy and
the formation and attachment of a
strong social bond.”

most critical because it forms the

basis for all social organizations

it provides survival and security.

2. Dependency subsystem

is the “approval, attention or recognition

and physical assistance.”

In the broadest sense, it promotes

helping behavior that calls for a nurturing
response

approval, attention or recognition, and

physical assistance
3. Eliminative subsystem

states that “human cultures have

defined different socially
acceptable behaviors for
excretion of waste
4. sexual subsystem

is both a biological and social factor

that affects behavior.
It has the dual functions of
procreation and gratification.
Including, but not limited to, courting
and mating

begins with the development of gender role identity

and includes a broad range of sex-role behaviors.
5. aggressive subsystem

relates to protection and self-

preservation, generating a defense
response when there is a threat to
life or territory.

Its function is protection and

preservation
6. Achievement subsystem

provokes behavior that tries to

control the environment.

It attempts to manipulate the

environment.

Its function is to control or mastery

an aspect of self or environment to
some standard of excellence.
7. Ingestive subsystem

• the social and psychological factors

influence the biological aspects of
this subsystem and may conflict
with the eliminative subsystem.