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CEBU TECHNOLOGICAL UNIVERSITY

In consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Ave. cor Panganiban St., 6000 Cebu City, Cebu, Philippines
Tel. Nos. (032)316-5128/(032) 4186105
Email address: [email protected]

THEORETICAL FOUNDATIONS IN NURSING

Module 3. NURSING THEORIES

LEARNING OUTCOMES:

At the end of the module, the level I student should be able to:

1. Discuss the importance of nursing theories.

2. Explain the significance of different nursing theories in the nursing practice.

3. Describe the nursing theories and how it applies in the clinical practice setting.

OVERVIEW:

Theory is significant because it helps us to settle on what we know and what we need to know in the future. It
helps to differentiate what should form the basis of practice by clearly describing what nursing does and what
nursing is all about.
In addition, because the main exponent of nursing – caring – cannot be measured, it is vital to have the theory
to analyse and explain what nurses do. Ideally, nursing theory should provide the principles that support
nursing practice.
In history, many nurses disputed that most theories were not related to what really happens in the clinical
practice. However, due to various studies and researches, there was a modern transfer towards evidenced-
based practice in which nursing theories were proven and tested to be helpful in nursing care. Therefore,
knowledge is not static rather it continues to grow in relation to the goal of nursing for the human and social
welfare of the society.
Time Allotment : 9 hours

LESSON CONTENT:

NURSING THEORISTS:

1. Myra Estrine Levine

Background of the theorist

Myra E. Levine – (1920 – 1996) was born in Chicago.

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Her experiences during her father‘s frequent illnesses contributed to her interest in and dedication to
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Charter fellow in the American Academy of Nursing.

First recipient of Sigma Theta Tau‘s Elizabeth Russell Belford award for teaching excellence.

Levine’s theory

Levine’s Conservation Model – focused in promoting adaptation and maintaining wholeness using
the principles of conservation.
The nurse accomplishes the goals of the model through the conservation of energy, structure,
and personal and social integrity.
Levine discussed two other important concepts critical to the use of her model – adaptation
and wholeness.

Adaptation is the process of change, and conservation is the outcome of adaptation.

Adaptation is the process whereby the patient maintains integrity within the realities of the
environment. It is achieved through the ―frugal, economic, contained, and controlled use
of environmental resources by the individual in his or her best interest‖.

Three Concepts of Adaptation

(a) Historicity – refers to the notion that adaptive responses are partially based on personal
and genetic past history.

(b) Specificity – refers that each system that makes up a human being has unique stimulus-
response pathways. Responses are stimulated by specific stressors and are task
oriented. Responses that are stimulated in multiple pathways tend to be synchronized
and occur in a cascade of complimentary reactions.

(c) Redundancy – describes that if one system or pathway, is unable to ensure adaptation,
then another pathway may be able to take over and complete the job. This may be
helpful when the response is corrective. However, redundancy may be detrimental,
such as when previously failed responses are re-established.

“Wholeness – emphasizes a sound, organic, progressive mutuality between diversified functions and
parts within an entirety, the boundaries of which are open and fluid.‖
She stated that ―the unceasing interaction of the individual organism with its environment
does represent an ‗open and fluid‘ system, and a condition of health, wholeness, exists
when the interaction or constant adaptations to the environment, permit ease — the
assurance of integrity…in all the dimensions of life.‖

Conservation – is the product of adaptation.

―Conservation describes the way complex systems are able to continue to function even
when severely challenged.‖
―The goal of conservation is health and the strength to confront disability‖ as the rules of
conservation and integrity hold in all situation in which nursing is requires.
The primary focus of conservation is keeping together of the wholeness of the individual.

Integrity – being in control of one‘s life, having the freedom to choose: to move without
constraint, to exercise decision in all matters.

 Personal integrity – is the person‘s sense of identity and self-definition. It focuses on

a sense of self – ―that intensely private, always unique and secret knowledge that we
use to define ourselves‖.

 Social integrity - is life‘s meaning gained through interactions with others. Nurses
intervene to maintain relationships.
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 Structural integrity – Healing is the process of restoring structural integrity through

nursing interventions that promote healing and maintain structural integrity.

Organismic response is a change in behavior of an individual during an attempt to adapt to

the environment. It helps individual to protect and maintain their integrity.

There are four types:

(1) Flight or fight: An instantaneous response to real or imagined threat, most primitive
response;
(2) Inflammatory: response intended to provide for structural integrity and the promotion
of healing;
(3) Stress: Response developed over time and influenced by each stressful experience
encountered by person;
(3) Perceptual: Involves gathering information from the environment and converting it in
to a meaning experience.

Conservational principle

When a person is in a state of conservation, it means that individual adaptive responses conform
change productively, and with the least expenditure of effort, while preserving optimal function
and identity. Conservation is achieved through successful activation of adaptive pathways
and behaviors that are appropriate for the wide range of responses required by functioning
human beings.

Four Conservation Principles

a. Conservation of energy – refers to balancing energy input and output to avoid excessive
fatigue. It includes adequate rest, nutrition and exercise.

b. Conservation of structural integrity – refers to maintaining or restoring the structure of

body preventing physical breakdown and promoting healing.

c. Conservation of personal integrity – recognizes the individual as one who strives for
recognition, respect, self-awareness, selfhood and self-determination.

d. Conservation of social integrity – an individual is recognized as someone who resides

within a family, a community, a religious group, an ethnic group, a political system and a
nation.

Nursing Metaparadigm

ENVIRONMENT – completes the wholeness of the individual. It includes both the internal and
external environment.
a. The internal environment – the physiological and pathophysiological aspects of the
individual and is constantly challenged by the external environment. The internal
environment is the integration of bodily functions that resembles homeorrhesis rather
than homeostasis and is subject to challenges of the external environment, which always
are a form of energy.

Homeostasis – a state of energy sparing that also provides the necessary baselines
for a multitude of synchronized physiological and psychological factors.
Homeorrhesis – a stabilized flow rather than a static state.

b. The external environment is divided into:

 The perceptual environment – consists of information that is recorded by the
sensory organs and includes light, sound, touch, temperature, chemical change
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that is smelled or tasted, and position sense and balance.

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 The operational environment – that portion of the external environment which

interacts with living tissue even though the individual does not possess sensory
organs that can record the presence of these factors and includes all forms of
radiation, microorganisms, and pollutants.

 The conceptual environment – consists of language, ideas, symbols, and

concepts and inventions and encompasses the exchange of language, the ability
to think and experience emotion, value systems, religious beliefs, ethnic and
cultural traditions, and individual psychological patterns that come from life
experiences.

PERSON – is the unique individual in unity and integrity, feeling, believing, thinking, and whole
system of a system. Is a holistic being who constantly strives to preserve wholeness and
integrity and one ―who is sentient, thinking, future-oriented, and past-aware.‖

HEALTH – is the pattern of adaptive change of the whole being. It is implied to mean unity and
integrity and ―is a wholeness and successful adaptation‖. The goal of nursing is to promote
health. Disease is ―unregulated and undisciplined change and must be stopped or death will
ensue‖.

NURSING – is the human interaction relying on communication, rooted in the organic dependency of
the individual human being in his relationships with other human beings. It involves engaging
in ―human interactions‖. ―The nurse enters into a partnership of human experience where
sharing moments in time—some trivial, some dramatic—leaves its mark forever on each
patient‖.

The goal of nursing:

 To promote wholeness, realizing that every individual requires a unique and
separate cluster of activities. The individual‘s integrity is his/her abiding concern
and it is the nurse‘s responsibility to assist the patient to defend and to seek its
realization.
 It is accomplished through the use of the conservation principles: energy,
structure, personal, and social integrity.

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Please click the link: http://nursingtheories.blogspot.com/2009/07/myra-levines-conservation-theory.html

2. Martha Elizabeth Rogers

Background of the theorist:

Born on May 12, 1914 in Dallas, Texas

Fellow for the American Academy of Nursing.
She officially retired as Professor and Head of the Division of Nursing in 1975, but continued as
Professor Emerita, Division of Nursing, New York University.
Died on March 13, 1994

Assumptions

(1) Man is a unified whole possessing his own integrity and manifesting characteristics that are more
than and different from the sum of his parts.
(2) Man and environment are continuously exchanging matter and energy with one another.
(3) The life process evolves irreversibly and unidirectionally along the space-time continuum.
(4) Pattern and organization identify the man and reflect his innovative wholeness.
(5) Man is characterized by the capacity for abstraction and imagery, language and thought sensation
and emotion.

Nursing Metaparadigms

PERSON (Unitary Human Being)

Unitary persons, being irreducible, indivisible, pan-dimensional energy field identified by
pattern and integral with the environment.

HEALTH
An expression of the life process; they are ―characteristics and behavior emerging out of the
mutual, simultaneous interaction of the human and environmental fields.‖

NURSING
The study of unitary, irreducible, indivisible human and environmental fields: people and their
world. Nursing exists to serve people, and the safe practice of nursing depends on the nature
and amount of scientific nursing knowledge the nurse brings to his or her practice. The goal of
nurses is to participate in the process of change.‖

Two dimensions in the concept Nursing:

a. Independent science of nursing – an organized body of knowledge which is specific to
nursing is arrived at by scientific research and logical analysis.
b. Art of nursing practice
- the creative use of science for the betterment of the human.
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- the creative use of its knowledge is the art of its practice.

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Theory

Martha Rogers‘ theory is known as the Science of Unitary Human Beings (SUHB). The theory views
nursing as both a science and an art as it provides a way to view the unitary human being, who is
integral with the universe. The unitary human being and his or her environment are one. Nursing
focuses on people and the manifestations that emerge from the mutual human-environmental field
process.

The belief of the coexistence of the human and the environment has greatly influenced the process of
change toward better health. In short, a patient can‘t be separated from his or her environment when
addressing health and treatment.

Concepts in Rogers‘ nursing theory:

a. Energy Field – it is the fundamental unit of both the living & the non-living. It provides a way to
view people and the environment as irreducible wholes. The energy fields continuously vary in
intensity, density, and extent.

b. Pattern – the distinguishing characteristics of an energy field perceived by a single wave. It is an

abstraction and gives identity to the field.

c. Unitary human being – ―an irreducible, indivisible, pandimensional energy field identified by
pattern and manifesting characteristics that are specific to the whole and which cannot be
predicted from knowledge of the parts.‖

d. Environmental Field – ―an irreducible, pandimensional energy field identified by pattern and integral with
the human field.‖

e. Openness – there are no boundaries that stop energy flow between the human and environmental
fields. It refers to qualities exhibited by open systems; human beings and their environment.

f. Pan-dimensionality – defined as ―non-linear domain without spatial or temporal attributes.‖ The

parameters that humans use in language to describe events are arbitrary, and the present is
relative; there is no temporal ordering of lives.

g. Synergy – defined as the unique behavior of whole systems, unpredicted by any behaviors of their
component functions taken separately. Human behavior is synergistic.
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Principles of Homeodynamics

Homeodynamic principles postulate a way of viewing unitary human beings.

Three Principles of Homeodynamics:

a. Principle of Resonancy

 It speaks to the nature of the change occurring between human and environmental fields.
The life process in human beings is a symphony of rhythmical vibrations oscillating at
various frequencies.
 It is the identification of the human field and the environmental field by wave patterns
manifesting continuous change from longer waves of lower frequency to shorter waves of
higher frequency.

b. Principle of Helicy

 The human-environment field is a dynamic, open system in which change is continuous

due to the constant interchange between the human and environment.
 This change is innovative. Because of constant interchange, an open system is never
exactly the same at any two moments; rather, the system is continually new or different.
c. Principle of Integrality

 Because of the inseparability of human beings and their environment, sequential changes
in the life processes are continuous revisions occurring from the interactions between
human beings and their environment.
 Between the two entities, there is a constant mutual interaction and mutual change
whereby simultaneous molding is taking place in both at the same time.

Principle of Reciprocy

Postulates the inseparability of man and environment and predicts that sequential changes in life
process are continuous, probabilistic revisions occurring out of the interactions between man and
environment

Principle of Synchrony

This principle predicts that change in human behavior will be determined by the simultaneous
interaction of the actual state of the human field and the actual state of the environmental field at any
given point in space-time.

Strengths

It provide a worldview from which nurses may derive theories and hypotheses and propose
relationships specific to different situations.
Rogers‘ theory is not directly testable due to lack of concrete hypotheses, but it is testable in principle.

Weaknesses
1. Does not define particular hypotheses or theories for it is an abstract, unified and highly derived
framework.
2. Testing the concepts‘ validity is questionable because its concepts are not directly measurable.
3. The theory was believed to be profound and was too ambitious because the concepts are
extremely abstract.
4. Nurses‘ roles were not clearly defined.
5. The purpose of nurses is to promote health and well-being for all persons wherever they are.
6. Rogers‘ model has no concrete definition of health state.
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Please click this link: https://nurseslabs.com/martha-e-rogers-theory-unitary-human-beings/

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3. Dorothy Johnson
Background of the Theorist

Aug. 21, 1919 – born in Savannah, Georgia

1938 - finished her Associate degree, Armstrong Junior College, Savannah Georgia
1942 - BSN, Vanderbilt University,
1948 - Masters in Public Health, Harvard University, Boston
1949 – 1978 – assistant professor, associate professor and professor of nursing, UCLA
Feb. 1999 – Johnson died.

In 1980 Johnson published her conceptualization of ―behavioral system of model for nursing‖ where
she explains her definitions of the behavioral system model.

Nursing Metaparadigm

HUMAN BEING – having two major systems;

a. biological system – medicine‘s focus

b. behavioural system – nursing‘s focus

It is viewed as an open system with organized, interrelated and interdependent subsystems.

The whole of the human organism (system) is greater than the sum of its parts (subsystems).

HEALTH – it is an elusive state that is affected by social, psychological, biological, and physiological
factors in order to retain some balance or equilibrium or to maintain stability and comfort.
It is demonstrated by observed behavior that is purposeful, orderly and predictable.
Balance and stability of the subsystems;
Lack of balance = poor health
Balance = health

SOCIETY/ENVIRONMENT – relates to the environment on which the individual exists. According to

Johnson an individual‘s behavior is influenced by the events in the environment

NURSING – ―an external regulatory force which acts to preserve the organization and integration of
the patients behaviors at an optimum level under those conditions in which the behaviors
constitutes a threat to the physical or social health, or in which illness is found‖.
The primary goal of nursing is to cultivate equilibrium within the individual, which allows
for the practice of nursing with individuals at any point in the health-illness continuum.

Assumptions

1. Assumptions about system

 There is ―organization, interaction, interdependency and integration of the parts and
elements of behaviors that go to make up the system ‖
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 It ―tends to achieve a balance among the various forces operating within and upon it', and
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that man strive continually to maintain a behavioral system balance and steady state by

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more or less automatic adjustments and adaptations to the natural forces impinging upon
him.‖
 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.
 A ―system balance reflects adjustments and adaptations that are successful in some way
and to some degree.‖

2. Assumptions about structure and function of each subsystem

 ―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‖
 Each individual 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 produce ―observable outcome‖ that is the individual‘s behavior

BEHAVIOURAL SYSTEM MODEL

Behavioural system
Man is a system that indicates the state of the system through behaviors.
System
That which functions as a whole by virtue of organized independent interaction of its
parts.
Subsystem
A mini system maintained in relationship to the entire system when it or the
environment is not disturbed.

SEVEN SUBSYSTEMS OF BEHAVIOUR:

1. THE ATTACHMENT OR AFFILIATIVE SUBSYSTEM

Establish a sense of relatedness & belonging with others including attachment behavior,
interpersonal relationships & communication skills serves the need for security through social
inclusion or intimacy, the formation and attachment of a strong social bond.

2. THE DEPENDENCY SUBSYSTEM

Behavior associated with obtaining assistance from others in the environment for completing
tasks &/or emotional support. Includes seeking of attention, approval, recognition, basic self
care skills and emotional security.

3. THE INGESTIVE SUBSYSTEM

Behaviours associated with the intake of needed resources from the external environment
including food, fluid, information, knowledge and objects for the purpose of establishing an
effective relationship with the environment.

4. THE ELIMINATIVE SUBSYSTEM

Relate to behaviours surrounding the excretion of waste products from the body.

5. THE SEXUAL SUBSYSTEM

Behavior associated with a specific gender based identity for the purpose of ensuring
pleasure, procreation, and knowledge and behavior being congruent with biological sex.

6. THE AGGRESSIVE SUBSYSTEM

Behavior associated with real or partial threat in the environment for the purpose of ensuring
survival. Protection of self through direct or indirect acts and identification of potential danger

7. THE ACHIEVEMENT SUBSYSTEM

Behavior associated with mastery of oneself and one‘s environment for the purpose of
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producing a desired effect. It includes problem solving activity

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8. THE RESTORATIVE SUBSYSTEM

Behavior associated with maintaining and restoring energy equilibrium, e.g. relief from fatigue,
recovery from illness, sleep behavior, leisure/recreational interests and sick role behavior.

Purposes of the Systems Theory

a. Nurse creates a balance between client and environment to achieve and optimal level of
functioning.
b. An imbalance in any of the behavioural subsystems results in disequilibrium.
c. It is nursing‘s role to assist the client to return to a state of equilibrium.

Each subsystem comprises four structural characteristics:

a. Universal drive – the existence of which is supported by existing theory or research.

b. Set – tendency to act in a certain way in a given situation. It plays a major role in determining the
choices a person makes and actions eventually taken.
c. Choice – the alternate behaviors the person considers in any given situation.
d. Action – observable behaviour of the person.

Limitation
1. Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral
system model.
2. The definition of concept is so abstract that they are difficult to use.
3. It is difficult to test Johnson's model by development of hypothesis.
4. The focus on the behavioral system makes it difficult for nurses to work with physically impaired
individual to use this theory.
5. The model is very individual oriented so the nurses working with the group have difficulty in its
implementation.
6. The model is very individual oriented so the family of the client is only considered as an
environment.
7. Johnson does not define the expected outcomes when one of the system is affected by the
nursing implementation an implicit expectation is made that all human in all cultures will attain
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same outcome –homeostasis.

8. Johnson‘s behavioral system model is not flexible.
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Please click the link: http://currentnursing.com/nursing_theory/behavioural_system_model.html

4. Sister Callista Roy

Background of the theorist

OCT 14, 1939 - BORN IN Los Angeles

She entered the Sisters of Saint Joseph Carondelet
She introduced her ideas about ―Adaptation Nursing‖ as the basis for an integral nursing curriculum.
Goal of nursing is to direct nursing education, practice and research.
Best known for her work on the Roy Adaptation Model of Nursing.

Nursing Metaparadigm

HUMAN as ADAPTIVE SYSTEM

It is the bio-psycho-social being in constant interaction with a changing environment – system
openness.
The focus of nursing relationships and interactions can be at the level of the individual,
groups, organizations, communities and society as a whole.
Conceptualizes the human system in a holistic perspective as holism stem from the
underlying philosophic assumption of the model.

Holism – the aspect of unified meaningfulness of human behaviour in which the

human system is greater than the sum of individual parts.

Combination of concepts;

 Adaptation – 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.

Coping mechanisms - describe the control processes of the person as an adaptive

system.
Some coping mechanisms are inherited or genetic, other mechanisms are learned.

Two subsystem coping mechanisms;

1) regulator subsystem – subsystem coping mechanism which responds

automatically through neural, chemical, and endocrine coping channels.
2) cognator subsystem – subsystem coping mechanisms which responds to
complex processes of perceptual and information processing, learning,
judgment, and emotion.‖
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 System – a set of units so related or connected as to form a unity or whole and

characterized by inputs, outputs, and control and feedback processes.
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System openness – the qualities held by the person is that the person is in
constant interaction with the environment wherein exchange of
information, matters and energy occurs.

Two control processes are:

a) stabilizers subsystem – the established structures, values, and daily activities

whereby participants accomplish the primary purpose of the group and
contribute to common purpose of society.
b) innovator subsystem – the cognitive and emotional strategies that allow a
person to change to higher level of potential.

ENVIRONMENT
Conditions, circumstances and influences that surround and affect the development and
behaviour of the person.

Classification of environmental stimuli:

a. residual stimuli – those stressors whose influence on the person are not clear.
b. focal stimuli – those most immediately present or confronting the person, objects or events
that attracts the most attention.
c. contexual stimuli – All other stimuli in the internal or external environment, which may or
may not affect the situation.
Stimuli are constantly changing.

HEALTH
It is represented by a health illness continuum.
It is a state and process of being and becoming and integrated & whole person.

NURSING
The science and practice that expand adaptive abilities and enhances person & environment
transformation.
Goal of nursing: The ―promotion of adaptation in each of the four modes.‖

The Four Adaptive modes

a) Physiological adaptive mode – way a person responds as a physical being to stimuli from the
environment.

The basic need of this mode is composed of the needs associated with oxygenation,
nutrition, elimination, activity and rest, and protection.

The complex processes of this mode are associated with the senses, fluid and electrolytes,
neurologic function, and endocrine function.

b) Self-concept adaptive mode – the composite of beliefs and feelings that one holds about oneself
at a given time.

2 components of self-concepts:
1) physical self – incorporates body sensation and body image.
2) personal self – incorporates self-consistency, self-ideal, and moral-ethical-spiritual self.

c) Role function of adaptive mode – the performance of duties based on given position with in
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society.
Social integrity is the goal of role function.
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d) Interdependence adaptive mode – involves one‘s relations with significant others and support
systems. It is a close relationship that result in the giving and receiving of love, respect and
value.
Affectional adequacy is the goal of the interdependence adaptive mode.

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.‖

 Adaptive responses – are those responses that promote the integrity of the person in terms of
goals survival, growth, reproduction and mastery.
 Ineffective responses – responses that do not contribute to adaptive goals, that is survival,
growth, reproduction and mastery.

It is very important for the nurse to identify the stimuli and person‘s adaptation level – to determine
whether positive response to internal/external stimuli will be elicited.

Conceptual Framework of Sister Callista Roy‘s Adaptation Theory

Please click this link: http://currentnursing.com/nursing_theory/Roy_adaptation_model.html

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5. Betty Neuman
Background of the theorist

1924 - born in Lowell, Ohio

Her model was originally developed in 1970 at the University of California, LA as a way tote ach an
introductory nursing course to nursing students.

The Neuman Systems Model

Neuman Systems Model is described as ―a unique, open-system-based perspective that provides a

unifying focus for approaching a wide range of concerns. A system acts as a boundary for a single
client, a group, or even a number of groups; it can also be defined as a social issue.
The Neuman Systems Model views the client as an open system that responds to stressors in the
environment.

Two major components of this model:

a. Stressors – stressors are intra-, inter-, and extra-personal in nature and arise from the
internal, external, and created environments.
When the client seeks or maintains a balance among the various factors, both within and
outside the system that seek to disrupt it.

b. Reaction to the stressors – may be possible (not yet occurring) or actual, with identifiable
responses and symptoms.

Nursing Metaparadigm

HUMAN BEING
It is viewed as an open system that interacts with both internal and external environment
forces or stressors. The human is in constant change, moving toward a dynamic state of
system stability or toward illness of varying degrees.

ENVIRONMENT
Is a vital arena that is germane to the system and its function. It includes internal, external
and created environment.
 The internal environment exists within the client system.
 The external environment exists outside the client system.
 The created environment exists that is created and developed unconsciously by the
client to support protective coping.

HEALTH
The condition or degree of system stability and is viewed as a continuum from wellness to
illness.
When system needs are met, optimal wellness exists. When needs are not satisfied, illness
exists. When the energy needed to support life is not available, death occurs.
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NURSING
Is the appropriate action in situations that are stress-related or in relation to possible reactions
of the client or client system to stressors.

Nursing interventions – are aimed at helping the system adapt or adjust and to retain, restore,
or maintain some degree of stability between and among the client system variables and
environmental stressors with a focus on conserving energy.

Open system – a system in which there is a continuous flow of input and process, output and
feedback. It is a system of organized complexity, where all elements are in interaction.

Basic Structure and Energy Resources

The basic structure, or central core, is made up of those basic survival factors common to the
species.

Client variable
She views the individual client holistically and considers the variables simultaneously and
comprehensively.
This variables function to achieve stability in relation to the environmental stressors
experienced by the client.

 The physiological variable refers to the structure and functions of the body.
 The psychological variable refers to mental processes and relationships.
 The developmental variable refers to those processes related to development over
the lifespan.
 The sociocultural variable refers to system functions that relate to social and cultural
expectations and activities.
 The spiritual variable refers to the influence of spiritual beliefs.

Line of resistance
Protect the basic structure and become activated when the normal line of defense is invade
by environmental stressors.

Normal line of defence

An adaptation level of health developed over time and considered normal for a particular
individual client or system; it becomes a standard for wellness-deviance determination.

Flexible line of defence

Serves as a cushion and is described as accordion-like mechanism that expands away from
or contracts closer to the normal line of defense.
It protects the normal line of defence and acts as a buffer for the client system‘s usual stable
state.

Stressors
A stressor is any phenomenon that might penetrate both the flexible and normal lines of
defence, resulting in either a positive or negative outcome.

Types of stressors: (environmental forces)

 Intrapersonal stressors – are those that occur within the client system boundary and
correlate with the internal environment.
 Interpersonal stressors – occur outside the client system boundary, are proximal to
the system, and have an impact to the system.
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 Extrapersonal stressors - occur outside the client system boundaries but are at a
greater distance from the system than are interpersonal stressors. An example is
social policy.

Stability
A state of balance or harmony requiring energy exchanges as the client adequately copes
with stressors to retain, attain, or maintain an optimal level of health thus preserving system
integrity.

Degree of Reaction
The amount of system instability resulting from stressor invasion of the normal line of
defence.

Negentropy
A process of energy conservation that increases organization and complexity, moving the
system toward stability or a higher degree of wellness.

Entropy
A process of energy depletion and disorganization moving the system toward illness
or possible death.

Intervention modes for nursing action and determinants for entry of both client and nurse into
the health care system.

Nursing interventions occur through three prevention modalities:

 Primary prevention - occurs before the system reacts to a stressor; it includes health
promotion and maintenance of wellness. It focuses on strengthening the flexible line
of defense through preventing stress and reducing risk factors. This intervention
occurs when the risk or hazard is identified but before a reaction occurs.

 Secondary prevention - occurs after the system reacts to a stressor and is provided in
terms of existing symptoms. It focuses on strengthening the internal lines of
resistance and, thus, protects the basic structure through appropriate treatment of
symptoms. The intent is to regain optimal system stability and to conserve energy in
doing so.

 Tertiary prevention - occurs after the system has been treated through secondary
prevention strategies. Its purpose is to maintain wellness or protect the client system
reconstitution through supporting existing strengths and continuing to preserve
energy.

Reconstitution
The return and maintenance of system stability, following treatment of stressor reaction,
which may result in a higher or lower level of wellness.

Strengths
 The major strength of the Neuman Systems Model is its flexibility for use in all areas of
nursing – administration, education, and practice.
 Neuman has presented a view of the client that is equally applicable to an individual, a family,
a group, a community, or any other aggregate.
 The Neuman Systems Model, particularly presented in the model diagram, is logically
consistent.
 The emphasis on primary prevention, including health promotion, is specific to this model.
 Once understood, the Neuman Systems Model is relatively simple, and has readily acceptable
definitions of its components.
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Weaknesses
The major weakness of the model is the need for further clarification of terms used.
Interpersonal and extrapersonal stressors need to be more clearly differentiated.

Betty Neuman‘s System Model

Please click this link: http://currentnursing.com/nursing_theory/Neuman.html

6. Imogene Martina King

Background of the theorist

Born on Jan. 30, 1923, in West Point, Iowa.

1945 – Diploma in Nursing, St John‘s Hospital School of Nursing, St Louis Missouri
1948 – 1957 - Bachelor‘s and Master‘s degree in Nursing, St Louis University
Contributed for 40 years to NANDA International
1973 – participant at the First National Conference on the Classification of Nursing Diagnoses in St
Louis
Dec 24, 2007 – died at the age of 84.

Basic Assumptions:
Goal attainment theory is that nurse and client communicate information, set goal mutually and then
act to attain those goals, is also the basic assumption of nursing process.

―Each human being perceives the world as a total person in making transactions with individuals and
things in environment‖

The assumptions are:

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(1) The focus of nursing is the care of the human being (patient).
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(2) The goal of nursing is the health care of both individuals and groups.

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(3) Human beings are open systems interacting with their environments constantly.
(4) The nurse and patient communicate information, set goals mutually, and then act to achieve those
goals. This is also the basic assumption of the nursing process.
(5) Patients perceive the world as a complete person making transactions with individuals and things
in the environment.
(6) Transaction represents a life situation in which the perceiver and the thing being perceived are
encountered. It also represents a life situation in which a person enters the situation as an
active participant.

Interacting Systems of Theory of Goal Attainment

King‘s model is composed of three interacting systems:

1. Personal system – each individual is an open, total, unique system in constant interaction with the
environment.

The concepts of personal system;

a. Perception – a process of organizing, interpreting, & transforming information from sense

data & memory.

b. Self
 A composite of thoughts & feelings which constitute a person‘s awareness of his/her
individual existence, his/her conception of who & what he/she is.
 The sum total of all he can call his.
 It includes, among other things, a system of ideas, attitudes, values, and
commitments.
 It is a person‘s total subjective environment.
 It is a distinctive center of experience and significance.
 It constitutes a person‘s inner world as distinguished from the outer world consisting
of all other people and things.
 The self is the individual as known to the individual.
 It is that to which we refer when we say ―I.‖

c. Growth & Development – process that takes place in an individual‘s life that help the
individual move from potential capacity for achievement to self-actualization.

d. Body image – an individual‘s perceptions of his/her own body, others‘ reaction to his/her
appearance which results from others‘ reactions to self.

e. Time – is defined ―a sequence of events moving onward to the future… a continuous flow
of events in successive order that implies a change, a past and a future… ―a duration
between one event and another as uniquely experienced by each human being; it is the
relation of one event to another event.‖

f. Personal space – existing in all directions & is the same everywhere. Space includes that
physical area called territory. Space is defined by the behaviors of those individuals who
occupy it.

g. Coping – the constantly changing cognitive & behavioral efforts to manage specific
internal & external demands that are appraised as taxing or exceeding the resources.

2. Interpersonal system – two interacting individuals form a dyad; three form a triad, and four or
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more form small or large groups.

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The concepts for interpersonal system;

a. Interaction – process of perception and communication between person and environment

and between person and person represented by verbal and nonverbal behaviors that are
goal-directed. It is the observable behaviors of two or more individuals in mutual
presence.

b. Communication – as ―a process whereby information is given from one person to another

either directly in face-to-face meeting or indirectly through telephone, television, or the
written word.‖

c. Stress – dynamic state whereby a human being interacts with the environment to
maintain balance of growth, development & performance… an energy response of an
individual to persons, objects, and events called stressors.‖

d. Stressors – events that produce stress

e. Role – ―a set of behaviors expected of persons occupying a position in a social system;

rules that define rights and obligations in a position; a relationship with one or more
individuals interacting in specific situations for a purpose.‖

f. Transactions – as ―a process of interactions in which human beings communicate with

the environment to achieve goals that are valued… goal-directed human behaviors.

Propositions of King‘s Theory

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

3. Social system – a more comprehensive interacting system consists of groups that make up
society. Religious, educational, and health care systems are examples of social systems. The
influential behavior of an extended family on an individual‘s growth and development is another
social system example.

The concepts in support of social system:

a. Organization – a system whose continues activities are conducted to achieve goals.
b. Authority – transactional processes characterized by active, reciprocal relations in which
members‘ values, backgrounds & perceptions play a role in defining, validating and
accepting the directions of an individual within an organization.
c. Power – is the capacity to use resources in organizations to achieve goals…
- is the capacity to use resources in organizations to achieve goals…
- is the process whereby one or more persons influence other persons in a
situation…
- is the capacity or ability of a person or a group to achieve goals…
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- occurs in all aspects of life and each person has potential power determined by
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individual resources and the environmental forces encountered.

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- is a social force that organizes and maintains society.

- is the ability to use and to mobilize resources to achieve goals.

d. Status – is ―the position of an individual in a group or a group in relation to other groups in

an organization‖ and is identified that status is accompanied by ―privileges, duties and
obligation.‖

e. Decision making – dynamic & systematic process by which a goal-directed choice of

perceived alternatives is made, and acted upon, by individuals or groups to answer a
question and attain goal.

King discussed 3 fundamental health needs of human beings:

a. Need for health information
b. Need for care for illness prevention
c. Need for total care

Nursing Metaparadigm

PERSON
Described as a person existing in an open system as a spiritual & rational thinker who makes
choices, set goals, selects alternative courses of action, & has the ability to make decisions.

HEALTH
Dynamic life experience of a human being, which implies continuous adjustment to stressors
in the internal and external environment through optimum use of one‘s resources to achieve
maximum potential for daily living.

ENVIRONMENT
The process of balance involving internal & external interactions inside the social system.
a. internal environment – transform energy to enable person to adjust to continuous
external environment changes.
b. external environment – involves formal and informal organizations.

NURSING
Is a process of action, reaction, and interaction whereby nurse and client share information
about their perceptions in the nursing situation.
The nurse and client share specific goals, problems, and concerns and explore means to
achieve a goal.

GOAL ATTAINMENT THEORY

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.”

ACTION
- defined as a sequence of behaviors involving mental and physical action. The sequence is
first mental action to recognize the presenting conditions; then physical action to begin
activities related to those conditions; and finally, mental action in an effort to exert control over
the situation, combined with physical action seeking to achieve goals.

REACTION
- a form of reacting or a response to a certain stimuli.
Goal of nurse: ―To help individuals to maintain their health so they can function in their roles.‖
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Domain of nurse: ―includes promoting, maintaining, and restoring health, and caring for the
sick, injured and dying.
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INTERACTION
- is a process of perception and communication between person and environment and between
person and person represented by verbal and nonverbal behaviors that are goal-directed.

The Conceptual Framework of Imogene King’s Theory

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Strengths
 The ease with which it can be understood by nurse
 Does describe a logical sequence of events.
 For most parts, concepts are concretely defined and illustrated.
 King‘s definitions are clear and are conceptually derived from research literature.
 Her Theory of Goal Attainment presents ten major concepts, and the concepts are easily
understood and derived from research literature, which clearly establishes King‘s work as
important for knowledge building in the discipline of nursing.

Weaknesses

 Having limited application in areas of nursing in which patients are unable to interact competently
with the nurse. King maintained the broad use of the theory in most nursing situations.
 Lack of development of application of the theory in providing nursing care to groups, families, or
communities.
 King‘s theory also contains some inconsistencies:
(1) She indicates that nurses are concerned about the health care of groups but concentrates
her discussion on nursing as occurring in a dyadic relationship.
(2) King says that the nurse and client are strangers, yet she speaks of their working together
for goal attainment and of the importance of health maintenance.

Please click this link: https://nurseslabs.com/imogene-m-kings-theory-goal-attainment/

7. Hildegard Peplau
Background of the theorist

Born on September 01, 1909 at Reading Pennsylvania

The only American nurse to serve the American Nurses Association (ANA) as Executive Director and
later as President.
She became the first published nursing theorist since Florence Nightingale.
She was well-known for her Theory of Interpersonal Relations, which helped to revolutionize the
scholarly work of nurses.
Known to many as the ―Mother of Psychiatric Nursing‖ and the ―Nurse of the Century.‖
March 17, 1999, died peacefully at home in Sherman Oaks, California.

Interpersonal Relations Theory

Hildegard Peplau‘s Interperosonal Relations Theory

 Emphasized the nurse-client relationship as the foundation of nursing practice.
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 It gave emphasis on the give-and-take of nurse-client relationships.

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 Form an interpersonal model emphasizing the need for a partnership between nurse and
client as opposed to the client passively receiving treatment and the nurse passively acting
out doctor‘s orders.

Hildegard E. Peplau‘s theory defined Nursing as ―An interpersonal process of therapeutic interactions
between an individual who is sick or in need of health services and a nurse especially educated to
recognize, respond to the need for help.‖ It is a ―maturing force and an educative instrument‖ involving
an interaction between two or more individuals with a common goal.

Assumptions

The assumptions of the Theory are:

(1) Nurse and the patient can interact.
(2) Emphasized that both the patient and nurse mature as the result of the therapeutic
interaction.
(3) Communication and interviewing skills remain fundamental nursing tools.
(4) Believed that nurses must clearly understand themselves to promote their client‘s
growth and to avoid limiting the client‘s choices to those that nurses value.

Nursing Metaparadigm

PERSON – define as a man who is an organism that lives in an unstable balance of a given system. It
has which is a developing organism that tries to reduce anxiety caused by needs.

HEALTH – a word that symbolizes movement of the personality and other on-going human processes
that directs the person towards creative, constructive, productive and community living. It has
which is a word symbol that implies forward movement of personality.

ENVIRONMENT – are forces outside the organism and in the context of the socially approved way of
living, from which vital human social processes are derived. It has which consists of existing
forces outside of the person, and put in the context of culture.

NURSING – an interpersonal process of therapeutic interactions between an individual who is sick or

in need of health services and a nurse especially educated to recognize, respond to the need
for help.‖ It has which is a significant therapeutic interpersonal process that functions
cooperatively with other human process that make health possible for individuals in
communities.

Four sequential Phases of Nurse-Patient Relationship

A. Orientation Phase
 Problem defining phase
 Starts when client meets nurse as stranger
 Defining problem and deciding the type of service needed
 Initial interaction between the nurse & the patient wherein the latter has a felt need
and expresses the desire for professional assistance.
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B. Identification Phase
 Begins when the client works interdependently with the nurse, expresses feelings,
and begins to feel stronger.
 Selection of appropriate professional assistance
 Patient begins to have a feeling of belonging and a capability of dealing with the
problem which decreases the feeling of helplessness and hopelessness

C. Exploitation Phase
 The client makes full use of the services offered.
 Use of professional assistance for problem-solving alternatives.
 Advantages of services are used is based on the needs and interests of the patients.
 The individual feels like an integral part of the helping environment.
 They may make minor requests or attention-getting techniques.
 The principles of interview techniques must be used in order to explore, understand.
and adequately deal with the underlying problem.
 Patient may fluctuates on independence.
 Nurse must be aware about the various phases of communication
 Nurse aids the patient in exploiting all avenues of help and progress is made towards
the final step.

D. Resolution Phase
 Client no longer needs professional services and gives up dependent behavior.
 The client no longer needs professional services and gives up dependent behavior.
The relationship ends.
 Termination of professional relationship.
 Patients needs have already been met by the collaborative effect of patient and
nurse.
 Now they need to terminate their therapeutic relationship and dissolve the links
between them.
 Sometimes may be difficult for both as psychological dependence persists.
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 Patient drifts away and breaks the bond with the nurse and healthier emotional
balance is demonstrated and both becomes mature individuals.
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Seven Nursing Roles in the Therapeutic relationship identified by Peplau:

a. Role of a stranger – Initial contact, the nurse and client are strangers to each other. Nurse
attempts to know the client better, treat them with outmost courtesy, which includes
same acceptance and courtesy that the nurse would to any stranger

b. Role of the resource person – Responsibility of the nurse to appropriately change her
responses to the client‘s level of understanding.

c. Teaching role – Gives much importance for self-care & in helping him understand the
therapeutic plan. Helping the client to learn formally or informally.

d. Leadership role – As a leader must act in behalf of the client‘s best interest & at the same
time enable him to make decisions over his own care, through cooperation and active
participation.

e. Surrogate role - Serving as a substitute for another such as a parent or a sibling. Assist the
client to make sure that her surrogate role is different and only temporary.

f. Counselling role - Strengthens the nurse-patient relationship as the nurse become a

listening friend, an understanding family member and someone who gives sound and
emphatic advices.

g. Technical expert role - Providing physical care for the patient and operates equipment

Anxiety was defined as the initial response to a psychic threat.

Four Levels of Anxiety

Mild anxiety – a positive state of heightened awareness and sharpened senses, allowing the
person to learn new behaviors and solve problems. The person can take in all
available stimuli (perceptual field).
Moderate anxiety – involves a decreased perceptual field (focus on immediate task only); the
person can learn a new behavior or solve problems only with assistance. Another
person can redirect the person to the task.
Severe anxiety – involves feelings of dread and terror. The person cannot be redirected to a
task; he or she focuses only on scattered details and has physiologic symptoms of
tachycardia, diaphoresis, and chest pain.
Panic anxiety – can involve loss of rational thought, delusions, hallucinations, and complete
physical immobility and muteness. The person may bolt and run aimlessly, often
exposing himself or herself to injury.

Strengths
 Helped later nursing theorists and clinicians develop more therapeutic interventions regarding
the roles that show the dynamic character typical in clinical nursing.
 Its phases provide simplicity regarding the natural progression of the nurse-patient
relationship,

Weaknesses
 Health promotion, and maintenance were less emphasized.
 The theory cannot be used in a patient who doesn‘t have a felt need.

Please click the link: https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/

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8. Ida Jean Orlando

Background of the theorist

Born on August 12,1926

An internationally known psychiatric health nurse, theorist and researcher who developed
the “Deliberative Nursing Process Theory.
She wrote a book on her findings from Yale, entitled “The Dynamic Nurse-Patient Relationship:
Function, Process, and Principles.” Her book was published in 1961.
Died on November 28, 2007 at the age of 81.

Orlando’s Deliberative Nursing Process Theory

1. Allows nurses to formulate an effective nursing care plan that can be easily adapted when and if
any complexity comes up with the patient.
2. Stresses the reciprocal relationship between patient and nurse.
3. It emphasizes the importance of the patient‘s participation in the nursing process.
4. Orlando considered nursing as a distinct profession and separated it from medicine where nurses
as determining nursing action rather than being prompted by physician‘s orders, organizational
needs and past personal experiences.
5. Believed that the physician‘s orders are for patients and not for nurses.

Nursing Metaparadigm

PERSON – emphasizes individuality and the dynamic nature of the nurse-patient relationship.

HEALTH – assumption that being without emotional & physical discomfort & having a sense of
well-being contribute to a healthy state.

ENVIRONMENT – assumes it as a nursing situation that occurs where there is a nurse-client

contact & that both nurse & client perceive, think, feel & act in the immediate situation.

NURSING – a unique and independent in its concerns for an individual‘s need for help in an
immediate situation. The efforts to meet the individual‘s need for help are carried out in an
interactive situation and in a disciplined manner that requires proper training.

Five major interrelated concepts:

1. Function of Professional Nursing

 It is the organizing principle – means finding out and meeting the patient‘s immediate needs
for help.
 Nursing is responsive to individuals who suffer, or who anticipate a sense of helplessness.
 It is focused on the process of care in an immediate experience, and is concerned with
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providing direct assistance to a patient in whatever setting they are found in for the purpose of
avoiding, relieving, diminishing, or curing the sense of helplessness in the patient.
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2. Presenting Behavior
 It is the patient‘s problematic situation.
 The nurse finds the patient‘s immediate need for help.
 Nurse must first recognize the situation as problematic.
 Regardless of how the presenting behavior appears, it may represent a cry for help from the
patient.
 The patient, which is considered the stimulus, causes an automatic internal response in the
nurse, which in turn causes a response in the patient.

Distress – it is when the patient experiences a need that he cannot resolve, a sense of helplessness
occurs.

3. Immediate Reaction
 The patient behavior stimulated a nurse reaction, which marks the beginning of the nursing
process discipline.
 It is the internal response.
 Comprised of three sequential parts:
a. the nurse perceives the behavior through any of her senses.
b. the perception leads to automatic thought.
c. the thought produces an automatic feeling, causing the patient to act.
 These three items are the patient‘s immediate response.
 The immediate response reflects how the nurse experiences his or her participation in the
nurse-patient relationship.

Nurse‘s Action
When the nurse acts, an action process transpires. This action process by the nurse in a
nurse-patient contact is called nursing process.

The nurse‘s action may be automatic or deliberative.

a. Automatic Nursing Actions – decided upon for reasons other than the patient‘s
immediate need.
b. Deliberative Nursing Actions are actions decided upon after ascertaining a need
and then meeting this need

Criteria for deliberative actions:

1. Deliberative actions result from the correct identification of patient needs by

validation of the nurse‘s reaction to patient behavior.
2. The nurse explores the meaning of the action with the patient and its relevance to
meeting his need.
3. The nurse validates the action‘s effectiveness immediately after completing it.
4. The nurse is free of stimuli unrelated to the patient‘s need when she acts.

4. Nursing Process Discipline

 It is the investigation into the patient‘s needs.

 Any observation shared and explored with the patient is immediately useful in ascertaining
and meeting his or her need, or finding out he or she has no needs at that time.
 The nurse cannot assume that any aspect of his or her reaction to the patient is correct,
helpful, or appropriate until he or she checks the validity of it by exploring it with the patient.
 The nurse determines how the patient is affected by what he or she says and does.
 Automatic reactions are ineffective because the nurse‘s action is determined for reasons
other than the meaning of the patient‘s behavior or the patient‘s immediate need for help.
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 The nurse decides on an appropriate action to resolve the need in cooperation with the
patient. This action is evaluated after it is carried out. If the patient behavior improves, the
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action was successful and the process is completed. If there is no change or the behavior
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gets worse, the process recycles with new efforts to clarify the patient‘s behavior or the
appropriate nursing action.

5. Improvement
 It is the resolution to the patient‘s situation.
 The nurse‘s actions are not evaluated.
 The result of his or her actions are evaluated to determine whether his or her actions served
to help the patient communicate his or her need for help and how it was met.
 In each contact, the nurse repeats a process of learning how he or she can help the patient.
 The nurse‘s own individuality, as well as that of the patient, requires going through this each
time the nurse is called upon to render service to those who need him or her.

The Dynamic Nurse-Patient Relationship

Orlando‘s nursing process discipline is rooted in the interaction between a nurse and a patient at a
specific time and place.

A sequence of interchanges involving patient behavior and nurse reaction takes place until the
patient‘s need for help, as he perceives it, is clarified.

If the patient behavior improves, the action was successful and the process is completed.

If there is no change or the behavior gets worse, the process recycles with new efforts to clarify the
patient‘s behavior or the appropriate nursing action.

5 Stages of the Deliberative Nursing Process

Assessment
 The nurse completes a holistic assessment of the patient‘s needs.
 The nurse uses a nursing framework to collect both subjective and objective data about the
patient.

Diagnosis
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 This stage uses the nurse‘s clinical judgment about health problems.
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 It can then be confirmed using links to defining characteristics, related factors, and risk factors
found in the patient‘s assessment.

Planning
 This stage addresses each of the problems identified in the diagnosis.
 Each problem is given a specific goal or outcome, and each goal or outcome is given nursing
interventions to help achieve the goal.
 By the end of this stage, the nurse will have a nursing care plan.

Implementation
 This stage, the nurse begins using the nursing care plan.

Evaluation
 Finally, this stage, the nurse looks at the progress of the patient toward the goals set in the
nursing care plan.
 Changes can be made to the nursing care plan based on how well (or poorly) the patient is
progressing toward the goals.
 If any new problems are identified in the evaluation stage, they can be addressed, and the
process starts over again for those specific problems.

Strengths
1. The guarantee that patients will be treated as individuals.
2. Assertion of nursing‘s independence as a profession and her belief that this independence must
be based on a sound theoretical framework.
3. Guides the nurse to evaluate her care in terms of objectively observable patient outcomes.

Weaknesses
1. The lack of the operational definitions of society or environment.
2. Orlando‘s work focuses on short term care, particularly aware and conscious individuals and on
the virtual absence of reference group or family members.

Please click this link: https://nurseslabs.com/ida-jean-orlandos-deliberative-nursing-process-theory/

9. Joyce Travelbee

Background of the theorist

Born in 1926.
A psychiatric nurse, educator and writer
Her theory ―HUMAN TO HUMAN RELATIONSHIP MODEL‖.
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She passed away at the prime age of 47 after a brief sickness

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Nursing Metaparadigm

PERSON – a human being is unique, irreplaceable individual who is in the continuous process of
becoming, evolving and changing.

HEALTH – measured by:

> Subjective health – state of well-being in accord with self-appraisal of physical, emotional
and spiritual status.
> Objective health – absence of discernable disease, disability or defect as measured by
physical examination, laboratory tests and assessment by spiritual director or
psychological counselor.

ENVIRONMENT – not clearly defined by Travelbee

- She defined human conditions and life experiences encountered by all men as sufferings,
hope, pain and illness.

Illness – being unhealthy, but rather explored the human experience of illness

Suffering – is a feeling of displeasure which ranges from simple transitory mental, physical or
spiritual discomfort to extreme anguish and to those phases beyond anguish—the malignant
phase of dispairful ―not caring‖ and apathetic indifference

Pain – is not observable. A unique experience. Pain is a lonely experience that is difficult to
communicate fully to another individual.

Hope – the desire to gain an end or accomplish a goal combined with some degree of
expectation that what is desired or sought is attainable

Hopelessness – being devoid of hope

NURSING – an interpersonal process whereby the professional nurse practitioner assists an

individual, family or community to prevent or cope with the experience of illness & suffering.

Interactional Phases of Human – to – Human Relationship Model

Original encounter
 First impression of the nurse of the sick person and vice versa.

Emerging identities
 Time when relationship begin to form.
 The nurse and patient perceives each other‘s uniqueness

Empathy
 The ability to share the person‘s experience. (Trust)

Sympathy
 When the nurse wants to lessen the cause of the client‘s suffering.
 It goes beyond empathy—―When one sympathizes, one is involved but not
incapacitated by the involvement.‖
 Therapeutic use of self

Rapport
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 Described as nursing interventions that lessens the patient‘s suffering.

 It is a harmonious relationship
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 ―A nurse is able to establish rapport because she possesses the necessary

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knowledge and skills required to assist ill persons and because she is able to
perceive, respond to and appreciate the uniqueness of the ill human being.‖

Please click this link: http://slsu-coam.blogspot.com/2008/09/joyce-travelbee-human-to-human.html

LEARNING ACTIVITIES:

1. Choose two (2) theories and make your reflections: (Format)

 Bibliography
Theorist name
Birthdate and place
Educational background
Accomplishments
Assumption of the Theory
Metaparadigm
Brief description of the theory
 Importance of the theory towards self.
 Cite personal examples for each theory.
 Make a research as to what type of facility (hospital or nursing home) utilizes this type of theory.

Note: Do not just copy paste it from the source. Be creative in making your reflections.
Make it in 5 sheets of bond paper only.

2. Journal writing (Choose only one (1) theory

 First paragraph : About the Theory
 Second paragraph : Relate the theory to personal experience
 Third paragraph : Impact of the theory to self and for the future
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3. Date of Submission: October 22, 2020 at 12:00 noon

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REFERENCES and SUPPLEMENTARY REFERENCES:

References
Books : Alligood, Martha Raile. (2018). Nursing Theorists and their Work. Elsevier
(Singapore) Pte. Ltd
George, Julia B. (2010). Nursing Theories: The Base for Professional Nursing
Practice. 4th edition. USA Appleton and Lange.
Octaviano, Eufemia and Balita, Carl. (2009). Theoretical Foundations of Nursing The
Philippine Perspective. Ultimate Learning Series

Internet Sources : http://nursingtheories.blogspot.com/2009/07/myra-levines-conservation-theory.html

https://nurseslabs.com/martha-e-rogers-theory-unitary-human-beings/
http://currentnursing.com/nursing_theory/behavioural_system_model.html
http://currentnursing.com/nursing_theory/Roy_adaptation_model.html
http://currentnursing.com/nursing_theory/Neuman.html
https://nurseslabs.com/imogene-m-kings-theory-goal-attainment/
https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/
https://nurseslabs.com/ida-jean-orlandos-deliberative-nursing-process-theory/
http://slsu-coam.blogspot.com/2008/09/joyce-travelbee-human-to-human.html

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