1.

1
GETTING TO KNOW THE THEORIST
"Each individual has a redisposition to act, with reference to the goal, in
certain ways rather than in other ways."

Dorothy Johnson (1919-1999)

DOROTHY JOHNSON
Behavioral System Model
Dorothy Johnson was born in Savannah, Georgia in 1919, the youngest of
seven. She attained her Bachelor of Science in Nursing from Vanderbilt
University, Nashville, Tennessee, followed by her Masters in Public Health
from Harvard University, Boston, Massachusetts. Following graduation from
Vanderbilt, she quickly began to publish her thoughts on nursing. Most of
her academic career was dedicated to Pediatric Nursing at the University of
California, Los Angeles, before she retired as a Professor Emeritus on
January 1, 1978.
Dorothy Johnson has been a major contributor to nursing since the 1950s,
championing the importance of Research-Based Knowledge concerning the
impact of nursing care on patients. She was a pioneer in advocating for
Nursing as both a Science and an Art, believing that nursing had a body of
knowledge encompassing both disciplines.
Johnson asserted that the science of nursing essential for delivering high-
quality nursing care comprised of a combination of core principles from
both basic and applied sciences.
In 1961, Johnson suggested that nursing care could help the client to reach
a state of equilibrium. Johnson theorized that a stimulus, either from the
external or internal environment, could cause tension in the patient and
consequently lead to a state of disequilibrium. He proposed two main ways
that nursing care could restore balance: reducing stressors and providing
support for the patient's normal coping mechanisms and adaptive
processes.
In 1992, Johnson stated that her ideas had been impacted by Florence
Nightingale's Notes on Nursing, noting that Nightingale had placed greater
emphasis on individuals' primary needs rather than the disease process, and
had given some importance to the relationship between the person and
their environment rather than the disease to the person. As Johnson
expanded her model in the 1950s and 1960s, she was further influenced by
an increasing number of observational studies on child and adult behavior
patterns, as well as the General Systems Theory. All these elements
combined to form her Behavioral Systems Model.
In 1968, Johnson introduced her model of nursing care which focused on
cultivating the patient's competent and helpful behavior in order to

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cultivating the patient's competent and helpful behavior in order to
prevent illness. She viewed the patient as a behavioral system with various
subsystems, thus integrating system models into her work. Johnson further
emphasized that nursing was concerned with the holistic health of the
patient, and this is the special expertise nurses must possess.
In 1980, Johnson's Behavioral System Model for Nursing was introduced in
print. This was the first work from Johnson to outline her definition of the
Behavioral System Model. Johnson's ideas evolved and developed from the
1950s up to her latest work published in 1980, which is evident in the
complexity of the model.

METAPARADIGM IN NURSING
Johnson's Behavioral System Model was heavily influenced by Nightingale's
book, Notes on Nursing. In this model, Johnson proposed that nursing was
an occupation that was making a unique contribution to the wellbeing of
society.
Nursing. The main purpose of nursing is to promote balance within the
individual, which allows nurses to provide care to people at any stage of
the health-illness continuum. Nursing interventions may target behaviors
that are not related to maintaining balance for the individual. Johnson's
earlier works looked at nursing from the perspective of treating those with
impairments. By 1980, she argued that nursing should promote the overall
holistic growth of the individual, yet its primary focus should be to
maintain equilibrium when illness impacts the individual.
Person. Johnson acknowledges that there are two key systems in a person:
the biological and the behavioral. Medicine is typically focused on the
biological system, while nursing emphasizes the behavioral system. He also
notes that when one of these systems is not functioning properly, the
other may be affected as well.
Health. Johnson's behavioral model suggests that health is an ever-
changing state which is shaped by a variety of social, psychological,
biological, and physiological factors. It proposes that individuals are driven
to maintain equilibrium and flexibility in order to preserve a balanced
system, even when disruption to their original balance occurs.
Environment. Johnson argued that an individual's behavior is shaped by the
surrounding events and circumstances. He viewed cultural influences as
having a significant impact on behaviour. However, it is clear that there
are many elements that determine how a group of people behave. These
components are thought to be dissimilar between cultures, even though
the end results are the same.

BEHAVIORAL SYSTEM MODEL

Johnson believes that each person has a unique behavioral system made up
of focusing and repeating behaviors. These behaviors create distinct ideas
that form a functional unit that outlines the person's relationship with
their environment. This behavior is logical, fixed, predictable, secure, and
persistent enough to be accurately described and clarified.
Johnson's Behavioral System Model has seven interconnected subsystems,
which were first introduced in his 1968 paper at Vanderbilt University.

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which were first introduced in his 1968 paper at Vanderbilt University.
These subsystems are interdependent, meaning that any alteration to one
of them will have a ripple effect on the others.

BOX 9.a MAJOR

CONCEPTS AND
DEFINITIONS
Behavior Output of Intraorganismic structures and processes that
are responsive to changes in sensory stimulation, as
they are coordinated and articulated.
System "A whole that functions as a whole by virtue of the
Interdependence of its parts."
Behavioral Engaging in behaviours which are structured, habitual
System and intentional.
Subsystem A miniature system with its own distinct purpose and
operation that will remain stable as long as it is not
disturbed in relation to other subsystems or its external
environment.
Equilibrium A tranquil, long-lasting state of harmony between the
individual and their surroundings.
Sustenal A continual stream of operational needs.
Imperative
Regulation or It is implied that any deviations will be identified and
Control rectified.
Tension A condition of strain which is the result of an imbalance
in equilibrium.
Stressor Stimuli, whether internal or external, that generate
tension and cause a state of imbalance.

SEVEN BEHAVIORAL SUBSYSTEMS:

1. Attachment-Affiliative System Widely recognised as the first response
system to develop in the individual, the affiliative subsystem, with its
favourable functioning, encourages social inclusion, closeness, and the
establishment and maintenance of a secure interpersonal relationship.
Attachment to a significant caregiver has been shown to be essential
for an infant's survival.
2. Dependency System Dependency behaviors differ from those of the
attachment or affiliative subsystem; they are actions that elicit
nurturing behaviors from other people in the surroundings. The result
of such behavior is usually consent, interest, appreciation, or physical
aid.
3. Ingestive System Behavioral aspects associated with the consumption
of food are largely determined by the social norms of a given culture,
rather than by the biological needs of the human body. The significance
and arrangement of the social events surrounding meals are reflective
of this phenomenon.

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 of this phenomenon.
4. Eliminative System Johnson suggests that it may be difficult to
distinguish the biological system of excretion of waste products from
the behaviors surrounding it. Nevertheless, humans have developed
socially accepted ways of dealing with this process, which may vary
from culture to culture, yet still remain consistent.
5. Sexual Subsystem This behavior imitates procreation or reproduction,
with both biological and social factors playing a role. It is heavily
influenced by culture and varies between societies, as well as
according to gender. Ultimately, the goal of these behaviors is the
same in all societies: to create behaviors that are suitable for the
society as a whole.
6. Achievement Subsystem This subsystem involves behaviors that
attempt to exert control over the environment, and it encompasses a
range of intellectual, physical, imaginative, mechanical, and communal
skills, as identified by Johnson. Additionally, other areas of personal
success or accomplishment may also be included.
7. Aggressive-Protective System The aggressive-protective subsystem, as
perceived by Johnson, focuses on defensive measures taken by an
individual when their life or environment is at risk. This subsystem
does not encompass behaviors intended to harm others, but rather
those that are designed to protect and preserve the self and collective.
Active Dynamic Behavioral System (Person, Group, Family)

FIGURE 9.b - Johnson's Behavioral Systems Model (Adopted from

Alligood, M: Nursing Theorists end their Work, 2014)

ACCEPTANCE BY THE NURSING COMMUNITY

Practice
The Johnson Behavioral System Model was employed to create a self-
report and observational tool that could be implemented within the
nursing process. By introducing this instrument, a more thorough and
structured approach to evaluation and treatment was achieved,
leading to improved client and nurse contentment with care.
Using this theory as an example, a tool was created to help nurses

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Using this theory as an example, a tool was created to help nurses
evaluate and care for children in a more objective manner. This tool
enabled nurses to accurately document the child's behavior and to
make appropriate decisions about care.
Education
A core curriculum focusing on the individual as a behavioral system
would involve clear objectives and an organized plan of study. This
would involve examining the client's behavioral system and any
dysfunction that needs to be addressed, and employing the nursing
process to do so. Furthermore, the student would need to be familiar
with systems theory, and also have knowledge of disciplines such as
the social and behavioral sciences, and physical and biological
sciences. This model has been implemented in practice and educational
institutions in Canada, the US and Australia.
Research
Johnson asserts that nursing research is essential to comprehend and
diagnose behavioral system disorders related to illness, and develop
sound rationales for management. The Behavioral System Model
theory directs the researcher to select from two options. One
researcher could study the functioning of the system and subsystem
by concentrating on the Basic Sciences, while another researcher may
focus on exploring ways of gathering diagnostic data or problem-
solving activities which affect the behavioral system.

THEORY ANALYSIS
Dorothy Johnson first recognized the behavioral system, detailing its
properties and how it operated. Subsequently, she expounded on the
properties and behaviors of the subsystems, illustrating how they
worked as part of the system.
Clarity
Johnson provided a well-defined and straightforward set of rules and
regulations for human conduct. The ideas presented are explicit,
consistent, and applicable to all ages and cultures.
Simplicity
Johnson's theory is relatively uncomplicated when it comes to the
amount of concepts involved. It states that an individual is made up
of seven subsystems and is regulated by nursing from the outside.
Despite this simplicity, the theory can be complicated due to the
numerous interconnections among the behavioral systems, their
components, and the forces acting upon them.
Generality
Johnson’s theory is expansive when applied to ill individuals, but has
not been utilized as much in healthy individuals or groups. Johnson
conceptualizes a person as a behavioral system consisting of seven

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conceptualizes a person as a behavioral system consisting of seven
subsystems, which together form an interactive behavioral system.
Initially, Johnson did not explicitly discuss non-illness circumstances
or preventive nursing. In later works, she highlighted the role of
nurses in preventive healthcare for individuals and society. Johnson
declared that Nursing must prioritize creating preventive nursing to
fulfill its societal responsibilities.
Accessibility
Achieving accessibility or empirical precision in research utilizing
Johnson's model has been evidenced to a moderate degree, through the
identification of empirical indicators for the theory that contain
abstract concepts, and by better defining the subconcepts and the
relationships between and among them.
Johnson's use of terms such as balance, stability, equilibrium,
adjustments, adaptations, disturbances, disequilibrium, and behavioral
disorders can be confusing, as they are often used interchangeably.
Clarifying the definitions of these subsystems would make the model
more accessible and precise.
Importance
Johnson’s model provides a framework for nursing practice, education,
and research; it produces fresh insights into nursing and draws a sharp
distinction between nursing and other disciplines. By highlighting
behavior rather than biology, the theory delineates Nursing from
Medicine, although some of the concepts are shared with the
psychosocial professions.
Questions generated from this theory have been used to guide nursing
research, which has been evaluated and accepted as a valid foundation
for creating nursing curricula. Practitioners and patients have both
found that the resulting nursing actions are effective and satisfactory.
This theory has a lot of potential to continue to be utilized in nursing
to reach desired outcomes.

APPLICATION OF JOHNSON'S THEORY

Vignette
Gerald, an 8-week-old infant, was brought in for a check-up and it
was noted that he had not gained any weight since his last
appointment at 4 weeks. His mother reported that she feeds him, but
he does not seem to eat much. She also mentioned that he sleeps for
4-5 hours between feedings, and she holds him in her arms without
making any trunk-to-trunk contact. During assessment, the nurse
observed that the mother never looks or speaks to Gerald. She
explained that he was a planned baby, but she never anticipated how
much work an infant could be. Furthermore, she mentioned that her
own mother had accused her of being a bad mother due to Gerald's
lack of weight gain. She added that she had not informed the nurse of
the issue since she was afraid of being judged the same way her
mother had.

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mother had.
The Nursing Child Assessment Feeding Scale is employed in a normal
feeding session with Gerald, due to the nature of his problem. At the
start of the feeding, Gerald cries and turns to his mother's hand when
she touches his cheek. However, his mother does not verbally
acknowledge his hunger, nor does she speak to him or describe the
environment. Additionally, she does not stroke his body or make eye
contact with him, and Gerald does not reach out to touch her or make
any vocalizations. The assessment scale results show that neither the
mother nor the baby are sending signals to each other effectively
enough to respond appropriately.
BEHAVIORAL ASSESSMENT
All subsystems should be involved
The assessment data that pertain to the attachment-affiliative and
dependency subsystems between the mother and Gerald, as outlined in
the Johnson Behavioral System Model, are the following:
• Attachment-Affiliative subsystem: Focuses on the particular
behaviors exhibited by Gerald that demonstrate his attachment to
his mother.
• Dependency subsystem: These focuses on the particular actions
taken by Gerald to communicate his needs to his mother.
Gerald's primary requirement is to put on weight, while his mother's is
to address her issues with her own mother.
Diagnosis
Lack of growth in the affiliative system
The dependency subsystem has not been sufficiently developed.
Implementation
1. The aim of this is to increase the mother's understanding of the
implications of Gerald's rare signals. By increasing her
understanding of these signs, she can start to reinforce them,
which will make Gerald feel that there is someone in his
environment who cares about him, thus fostering his attachment
to her.
2. If the mother is feeling uncertain about communicating with her
infant who does not yet respond with words, it may be beneficial
to suggest that she reads a storybook out loud to provide Gerald
with the verbal stimulation he needs.
3. The nurse should put themselves in Jose's shoes and talk to his
mother on his behalf. They may observe the mother embracing
Gerald and say things such as “I love it when you kiss me" and “it
feels good when you cuddle me.”
Evaluation
These Interventions are based on two criteria:
1. Gerald's weight gains are closely monitored. Not gaining weight
can put him in a dangerous situation, so it is essential that a
pattern of weight gain is established.
2. The Nursing Child Assessment Feeding Scale can be used to re-
evaluate the mother-infant contact, making it possible to
compare the current observation to those that follow.

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1.2

GETTING TO KNOW THE THEORIST

" Individuals, families, groups and communities need to be taught
self-care"

Dorothea Orem (1914-2007)

DOROTHEA OREM
Self-Care Deficit Nursing Theory
Dorothea Elizabeth Orem, a well-known American nursing theorist,
was born in Baltimore, Maryland in 1914. She began her nursing
career at the Providence Hospital School of Nursing in Washington,
D.C., earning her diploma in the early 1930’s. Orem obtained a BS in
Nursing Education from the Catholic University of America (CUA) in

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Nursing Education from the Catholic University of America (CUA) in
1939, and in 1946, she was awarded an MS in Nursing Education from
the same institution.
Orem's early career in nursing saw her involved in many different
roles, such as operating room nursing, private duty nursing in both
home and hospital settings, hospital staff nursing on pediatric and
adult medical-surgical units, evening supervisor in the emergency
room, and biological science teaching. She was also in charge of both
the nursing school and the department of nursing at Providence
Hospital in Detroit from 1940 to 1949. After leaving Detroit, she
worked in the Division of Hospital and Institutional Services of the
Indiana State Board of Health for 8 years, from 1949 to 1957, to
upgrade the quality of nursing throughout the state. This period also
saw Orem formulating her definition of nursing practice.
In 1957, Orem relocated to Washington, D.C. to work as a curriculum
consultant at the Office of Education, US Department of Health,
Education, and Welfare. There, she undertook a project to enhance
practical nurse training that prompted her to ask: What is the
subject matter of nursing? As a result, the Guides for Developing
Curricula for the Education of Practical Nurses was published (Orem,
1959). Subsequently, in the same year, Orem became an assistant
professor of nursing education at the Catholic University of America
(CUA). She subsequently held the posts of acting dean of the School
of Nursing and associate professor of nursing education. At CUA, she
continued to refine her concepts of nursing and self-care, which she
sometimes worked on independently and at other times with the
help of others. Members of the Nursing Models Committee at CUA
and the Improvement in Nursing Group (later known as the Nursing
Development Conference Group (NDCG)) all contributed to the
advancement of the theory. Orem provided the intellectual leadership
for the development of her ideas.Demonstrating exemplary leadership
while working collaboratively is essential to achieving success.
In 1970, Orem departed from CUA and established her own consulting
firm. Her first book, Nursing: Concepts of Practice, was published in
1971 (Orem, 1971). During this time, she also acted as an editor for
the NDCG as they developed and later amended Concept
Formalization in Nursing Process and Product (NDCG, 1972, 1979).
Subsequent editions of Nursing Concepts of Practice were released in
1980, 1985, 1991, 1995, and 2001. Orem retired in 1984 and moved to
Savannah, Georgia, where she continued to work alone and with
colleagues on the Self-Care Deficit Nursing Theory until her passing
in 2007.

METAPARADIGM IN NURSING
Orem's theory is geared towards meeting the self-care requirements

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Orem's theory is geared towards meeting the self-care requirements
of clients. It is characterized by goal-directed actions that prompt
the client to take an active role in sustaining their health and
wellbeing. The theory is focused on empowering the clients to carry
out self-care activities in order to live autonomously.
Nursing. Orem's assertion is that Nursing is focused on aiding clients
to recognize and execute self-care activities, with the aim of
encouraging their autonomy. If the patient is highly reliant, then the
nurse must provide assistance and meet their needs.
Additionally, Orem identifies Nursing as a unique form of human
service, as it is centered around providing continuous care to those
with limited abilities. Additionally, she emphasizes that Nursing is
founded on a set of values.
Person. Orem asserts that humans possess a unique capacity that
sets them apart from other living things; the ability to contemplate
their experiences, environment, and themselves, and to express those
reflections through symbolic language and creative thought in order
to achieve positive outcomes.
Orem postulates that humans possess the capability to learn and
grow, with functioning being a unified system comprising physical,
psychological, interpersonal, and social components.
Health. Orem endorses the World Health Organization's
understanding of health as "the state of complete physical, mental,
and social wellbeing, and not just the lack of sickness or disability."
She feels strongly that these interconnected components of health
are inseparable.
Oftentimes, Orem's approach to health care emphasizes preventive
measures. This model includes not only treating existing diseases or
injuries, but also the promotion and maintenance of overall health to
prevent future complications.
Environment. Orem's conception of health as a consequence of the
entanglement of elements reveals her perception of the external
environment as a factor in the inner dynamics of an individual's
components.

SELF-CARE DEFICIT NURSING THEORY

Orem's Self-Care Deficit Nursing Theory consists of four
interconnected theories that work together to form a comprehensive
view of nursing practice. These theories are:
1. Self-Care Theory: Describes why and how people take care of themselves.
2. Dependent-Care Theory: This outlines the process of providing support for
someone who is reliant on their family or friends for care.

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 someone who is reliant on their family or friends for care.
3. Self-Care Deficit Theory: describes and explains why people can be helped
through nursing.
4. Nursing Systems Theory: This describes the necessary connections that
must be established and maintained for nursing care to be provided.
Self-Care
Self-care is an activity that promotes one's well-being, with the aim
of sustaining life, progressing in personal growth, and leading a
healthy lifestyle.
Dependent-Care
Dependent-care describes the assistance given to an individual who,
due to age or any other factor, is unable to take care of themselves
and is unable to sustain life, function adequately, progress, and stay
in good health.
Self-Care Requisites
Self-care requisites are an understanding of the actions or needs
that an individual must take in order to attain a state of mental and
physical health. These are the motivations behind any self-care
activities that must be undertaken. The key components of self-care
requisites are:
1. The factor that must be regulated or administered in order to maintain
certain aspects of human functioning and growth within the standards
that are conducive to life, health, and overall well-being.
2. The nature of the required action.
Universal Self-Care Requisites
These are essential objectives that must be achieved for an individual
to lead a healthy lifestyle. The eight self-care necessities which are
applicable to all men, women and children include:
1. Ensuring an adequate supply of air is maintained.
2. Ensuring that enough food is consumed.
3. Ensuring adequate hydration by consuming enough water.
4. Provision of care related to elimination.
5. Ensuring an adequate balance between activity and rest.
6. Maintaining a balance between spending time alone and engaging in social
activities.
7. Prevention of harm to the environment Protecting human life, functioning,
and well-being, as well as safeguarding the environment.
8. Encouraging growth and progress of individuals.
Developmental Self-Care Requisites
The following are steps that can be taken to promote personal
growth and development:
1. Ensuring the implementation of conditions that foster growth.
2. Pursuing personal growth
3. Preventing the detrimental effects of human conditions that endanger life.
Health Deviation Requisites

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Health Deviation Requisites
In order to be deemed ill or unwell, there must be certain criteria
met. Disease can impair the fundamental components of a person's
body and its operations, and these health disparities provide criteria
for the amount of care that is necessary.
Therapeutic Self-Care Demand
Summing up all the necessary actions to handle the current illness or
disease is essential. Taking control of the factors involved can lead to
an effective treatment plan.
Self-Care Agency
This is a complex process of controlling the steps necessary for
creating a care plan for a client.
Dependent-Care Agency
This would refer to the developed capacity of an individual to
recognize and satisfy the therapeutic needs of a dependent
individual, as well as regulating the growth and application of the
dependent's autonomy.
Nursing Agency
A nursing agency provides a nurse with the requisite skills and
authority to deliver care to a client, thereby enabling them to meet
their health care needs.
Nursing Design
These are duties that must be completed by the nurse in order to
meet the requirements of their patients. It acts as a reference point
for expected and desired outcomes.
Nurse Systems
Orem identified three distinct types of nursing systems which involve
a series of intentional, practical actions taken by nurses, often in
collaboration with their clients, in order to recognize and fulfill
aspects of the client's therapeutic self-care needs, while also
protecting and promoting the client's self-care agency.
1. Wholly compensatory - Clients who lack the capacity to regulate and
observe their surroundings and analyze data.
2. Partly compensatory - Those clients who are unable to do some self-care
activities, but not all.
3. Supportive-Educative (Developmental) - This is designed for clients who
require guidance in order to learn how to carry out self-care measures.
Helping Methods
These refer to actions that can help to counter or make up for the
health-related restrictions that people face in taking action to
manage their own health and wellbeing, or that of those they care

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manage their own health and wellbeing, or that of those they care
for. These actions could include:
1. Acting on behalf of someone else
2. Guiding and directing
3. Offering physical or psychological support
4. Creating and sustaining an atmosphere that encourages individual growth
5. Educating
Basic Conditioning Factors
It is thought that certain factors may have an influence on an
individual's need for therapeutic self-care and/or their capacity for
self-care at certain points in time and in certain situations. These
elements include:

1. Age 6. Health care system factors

2. Gender 7. Family system factors
3. Developmental state 8. Socio-cultural factors
4. Health state 9. Availability of resources
5. Pattern of living 10. External environmental factors

ACCEPTANCE BY THE NURSING COMMUNITY

Practice
Studies utilizing Orem's Self-care Deficit Theory have been conducted
on clients with heart ailments, cancer, and mental health issues. This
theory has seen extensive application when caring for geriatric
patients with chronic conditions, and has opened up new avenues of
research into health promotion, self-care, and the stress of family
caregivers.
Several government health agencies in the communities have
implemented her theory in their practice. The concepts of Orem are
also utilized in the field of occupational health in order to craft
nursing activities that address job-related risks. It is essential for
occupational health nurses to have the capacity to recognize health
issues, decipher data, and draw conclusions.
The Self-Care Deficit Theory of Orem has been utilized to delineate
the duties of nurses in many settings, and there are numerous
accounts of it being employed to create clinical assessment
techniques.
Education
Since the late 1970s, Orem's theory has been employed for the
development of curriculums at all levels, from undergraduate to
continuing education. This theory has been accepted as a reliable and
helpful structure for curriculum design by many universities in the

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helpful structure for curriculum design by many universities in the
United States, and there has been a gradual shift towards
incorporating preventive health care into nursing schools.
Research
Research studies based on Orem's theory can be categorized into two
groups: the development of research instruments to measure the
components of the theory, and studies that assess the validity of
these components.
The Exercise of Self-Care Agency (ESCA) was one of the earliest
instruments developed, first published in 1979. Following this, the
Appraisal of Self-Care Agency (ASA) was created to measure the core
concept of Orem's Self Care Deficit Theory. These two instrument
tools are used to evaluate the fundamental factors associated with
self-care and the care of both healthy and ill individuals.

THEORY ANALYSIS
Orem’s Self-Care Deficit Nursing Theory gave direction and guidance
for nursing practice due to its practicality.
Clarity
Orem's theory provides a well-defined and comprehensive framework
for understanding concepts related to health and nursing, which can
be utilized to improve nursing practice and knowledge. The
connections between the concepts are consistent throughout this
theory.
Simplicity
Orem's theory is articulated in a concise set of terms which are
consistently employed throughout her theories. The Self-Care Deficit
Theory of Nursing is a comprehensive integration of data related to
theoretical concepts such as self-care, self-care agency, therapeutic
self-care-demand, the relational entity self-care deficit, and nursing
agency.
The theory can be grasped easily due to its straightforward
presentation.
Generality
Orem's Self-Care Deficit Theory is useful for nurses in a variety of
clinical contexts. It is built on a number of conceptual elements that
are common to all forms of nursing. Furthermore, the theory can be
used to create and validate nursing knowledge, and to help train and
educate nurses.
Accessibility
Orem's theory is a widely accepted approach for researchers, both in

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Orem's theory is a widely accepted approach for researchers, both in
qualitative and quantitative methodologies. Despite its widespread
use, there is still a need for the development of instruments to
accurately measure certain components of the theory. Orem's theory
is highly valuable due to its scope, complexity, and clinical use. It can
be effectively employed in forming hypotheses and adding to the
existing body of nursing knowledge.
Importance
Orem's theory distinguishes nursing from other disciplines by
emphasizing its focus. Although other fields may use the tools
derived from this theory, the distinct emphasis of nursing systems on
care and outcomes sets it apart. Orem's theory provides guidance to
nurses in determining the self-care demands and self-management
systems of their patients.
Orem's impact on the nursing profession goes much further than the
creation of Self-Care Deficit Theory. In her writings, she framed
nursing as a scientific discipline and a practical science, perpetually
advancing the nursing knowledge. She was ahead of her time in
recognizing the potential for the profession to evolve and mature.

APPLICATION OF OREM’S THEORY

Vignette
Manong Leo, a 46-year-old jeepney driver, was involved in a serious
vehicular accident along Marcos Highway after a direct collision with
a delivery truck. Fortunately, he was still alive when the paramedics
and rescue squads arrived and was immediately taken to the hospital
for emergency treatment due to severe blood loss. Upon examination,
it was revealed that he had suffered a complete fracture of his lower
left leg, severe injury to his right inner thigh and foot, massive
muscle damage, and head injuries. An emergency surgery was carried
out to repair the extensive damage, but unfortunately, Leo slipped
into a coma due to a blood clot on the brain. Another operation was
done to remove the clot and was successful, yet Leo still did not
wake up. The physicians are not giving up, understanding that few
people are able to recover from a comatose state. His family
continues to pray for a miraculous recovery.
After a month of being in a coma, Leo awoke, only to find that his
body had become like a vegetable. The physicians declared that Leo
would be paralyzed for life, but he held onto his faith and refused to
accept this. He declared to the doctors around him, “Walang
imposible sa Diyos, Dok. Siya lang ang paniniwalaan ko nang lubos”
(“There is no impossible in God. It is only to Him, that I will put my
full trust.”). Leo devoted himself to his recovery, and refused to give
up on his dream of walking. Every day, with a determined mindset,

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up on his dream of walking. Every day, with a determined mindset,
he visualized himself walking, as the nurses did range-of-motion
exercises, massaged, cared, and cleaned his body.
After a few months of therapy, the attending physicians were
astounded when one morning Leo suddenly sat up in bed. Little by
little he was able to move his legs, until after a few weeks he was
able to stand and walk with a limp. In order to ensure proper
guidance and support, the physicians instructed that Manong Leo be
given and taught how to use a crutch as an assistive device, and
Rose, an orthopedic nurse, was assigned to provide him with health
teaching and guidance.
Assessment
Taking Orem's Self-Care theory into account, the nurse would then
recognize the potential needs of the client and evaluate their
capacity for autonomy. Nursing care would begin with the patient's
wholly compensatory state, ranging from comatose to paralysis.
Following this, they would move onto a partially compensatory state,
wherein the individual would be trained in the use of assistive
devices to help with mobility. The nurse would also review the
fundamentals of crutch walking, such as the right way to use them,
posture and movement. In addition, the support system of the
patient is taken into consideration, including their own view of their
impairment and the potential changes that may need to be made to
their lifestyle.
Diagnosis
• Deficit in self-care due to complete paralysis
• Lack of understanding regarding the use of crutches
Planning
The nurse and client would work together to establish achievable
objectives, with priority placed on giving the client control and
helping them to become independent as soon as possible.
Implementation
1. Evaluate the client's understanding of disability, modifications to
their lifestyle, and strategies for dealing with difficult situations.
2. Show how to use crutches correctly with the help of visual aids,
appropriate therapeutic communication, and a demonstration.
3. Incorporate the input of your support system (family, loved ones)
into the conversation and address any questions or concerns
they may have.
4. Advise the client to consult with a physical therapist for
additional assistance and support.
5. Request that the client demonstrate their understanding and
ability to assess their capacity for self-care.
Evaluation
After a few days of instruction and counseling, the nurse and the
client would come to a consensus on whether Leo had achieved his
goal or not; he would then be motivated to establish fresh objectives

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goal or not; he would then be motivated to establish fresh objectives
for himself.

1.3

GETTING TO KNOW THE THEORIST

"Professional practice in nursing seeks to promote symphonic interaction
between man and environment, to strengthen the coherence and integrity
of the human field, and to direct and redirect patterning of the human and
environmental fields for realization of maximum health potentials."

Martha Rogers (1914-1994)

MARTHA ROGERS
Theory of Unitary Human Beings
Martha E. Rogers was born in Dallas, Texas in 1914. She obtained her
nursing diploma from Knoxville General Hospital School of Nursing in 1936
and subsequently earned her Public Health Nursing degree from George
Peabody College in Tennessee in 1937. Later on, she was granted her
Master's degree from Teachers College at Columbia University in 1945 and
her Doctorate in Nursing from Johns Hopkins University in Baltimore in
1954. Rogers sadly passed away on March 13, 1994.
Martha E. Rogers was a professor at New York University's School of

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Martha E. Rogers was a professor at New York University's School of
Nursing and a Fellow for the American Academy of Nursing. Her notable
publications include Theoretical Basis of Nursing (1970), Nursing Science
and Art: A Prospective (1988), Nursing: Science of Unitary, Irreducible,
Human Beings Update (1990), and Vision of Space Based Nursing (1990).
Additionally, she wrote An Introduction to the Theoretical Basis of Nursing,
Educational Revolution in Nursing (Macmillan, 1961 Edition), Reveille in
Nursing, and Martha E. Rogers: Her Life and Her Work.

METAPARADIGM IN NURSING
Roger's theory is the result of consolidated various sources of information,
particularly the nonlinear dynamics of quantum physics and the principles
of general system theory.
The Science of Unitary Human Beings, despite its abstractness, does not
provide any direct testable empirical indicators. Rather, it outlines a
worldview and philosophy which can be used to analyse the phenomena
related to nursing.
Nursing. Nursing is both a science and an art, providing a therapeutic
energy field for the patient in order to maximize their health potential.
Nursing interventions enable the interaction between the person and the
environment, creating an optimal atmosphere for healing.
Person. A single human being is an open system that constantly interacts
with the environment. It is not possible to look at a person's individual
characteristics, they must be taken into account as a whole.
Health. According to Rogers, health is a manifestation of the life cycle. It is
the result of the mutual, simultaneous exchange between the human and
environmental fields, and health and sickness are both part of this
continuum. The various events that take place during the life cycle
demonstrate how much a person is able to reach their highest health
potential. These events range from the very best of health to conditions
that are incompatible with the continuation of life.
Environment. Rogers' theory of Unitary Human Beings encompasses all
energy fields aside from the physical body. These energy fields are not
confined by space or time, but rather identified by their arrangement and
configuration.

THE SCIENCE OF UNITARY HUMAN BEINGS

The notion of the inseparability of humans and their environment
has had a great impact on the progress towards better health. This
concept is the foundation of Martha Rogers' theory, aptly
named “Science of Unitary Human Beings,” which was instrumental
in the recognition of nursing as a scientific field.
Rogers' theory expound that Nursing is a combination of art and
science, emphasizing a humanistic and humanitarian approach. Its
primary focus is on individual human beings, and its aim is to assist
in the process of growth and transformation. Nurses strive to be

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in the process of growth and transformation. Nurses strive to be
involved in this process of change.
Rogers suggested that the Science of Unitary Human Beings
comprises of two components: the science of nursing, which is based
on scientific research and is specific to the nursing profession; and
the art of nursing, which involves using the science of nursing in an
artistic way to improve the patient's quality of life.
The postulates of Rogers' Science of Unitary Human Beings are as
follows:
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.
TABLE 9.b
ROGER’S
SCIENCE OF
UNITARY
HUMAN BEINGS
MAJOR and
SUBCONCEPTS
Human- A person is an indivisible, multi-faceted energy
unitary pattern exhibiting characteristics that cannot be
Human Beings determined simply by looking at the individual
components.
Environmental A non-reducible, unbreakable, all-encompassing
Field energy field that is recognized by its pattern and
intertwined with the human energy field.
Energy Field The energy field is the basic component of both living
and non-living entities. It provides an understanding
of individuals and their surroundings as an
unbreakable unity. The energy fields are constantly
fluctuating in strength, density, and scope.
Openness There are no limits that impede the exchange of
energy between the human and environmental fields,
an openness that is highlighted in Rogers' theory.
This reflects the characteristics of open systems, like
human beings and their environment.
Pan- Pan-dimensionality is a non-linear domain that lacks
dimensional spatial or temporal characteristics. The labels that

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dimensional spatial or temporal characteristics. The labels that
people utilize in discourse to depict instances are
arbitrary, and the present is viewed as relative; there
is no temporal ordering of existences.
Synergy The behavior of an entire system, which cannot be
predicted based on the behavior of its individual
components, is known as synergistic. This is
especially true for human behavior.
Pattern The unique trait of a single wave energy field is its
abstract nature, providing it with an identity.
Principles of Homeodynamics should be seen as a dynamic form of
Homeodynami homeostasis, which is a state of relative stability
cs within a living system. The three principles of
homeodynamics offer an understanding of how
individual humans function. These principles
are:resonancy, helicy, and integrality.
Principles of Argues that the relationship between humans and
Reciprocy their environment is inseparable, and that the
ongoing changes in life processes are ongoing,
unpredictable modifications resulting from the
interactions between people and their environment.
Principles of This principle postulates that the alteration in
Synchrony human behavior will be determined by the
concurrent interplay of the present condition of the
individual and the present condition of the
environment at any point in the space-time
continuum.
Principles of The continual connection between people and their
Integrality (Sy environment means that changes in life processes
nchrony + are the result of their interactions. This creates a
Reciprocy) dynamic situation where both sides are constantly
influencing and being influenced by one another,
with both being altered simultaneously.
Principle of This speaks to the dynamic nature of the
Resonancy relationship between humans and their environment,
which is characterized by a variety of rhythms and
frequencies. These wave patterns demonstrate the
continual transformation of the human and
environmental fields, transitioning from longer,
lower frequency waves to shorter, higher frequency
waves.
Principle of The human-environment field is a dynamic, open
Helicy system in which change is ongoing due to the ever-
evolving exchange between the human and
environment. This alteration is also progressive. Due
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 environment. This alteration is also progressive. Due
to the continual exchange, an open system is never
identical at any two points in time; instead, the
system is constantly new or different.

Science of Unitary Human Beings and Nursing Process

The nursing process has three steps in Rogers’ Science of Unitary
Human Beings: Assessment, Voluntary Mutual Patterning, and
Evaluation.
The areas of assessment are:
1. The overall sequence of occurrences in any given moment and location.
2. Concurrent states of the patient and their surroundings
3. Rhythms of the life process
4. Additional information
5. Categorical disease entities
6. Subsystem pathology
7. Pattern appraisal

The evaluation should be an all-encompassing examination of both

human and environmental areas.
Mutual patterning of the human and environmental fields includes:
1. Sharing knowledge
2. Offering choices
3. Empowering the patient
4. Fostering patterning
5. Evaluation
6. Repeat pattern appraisal, which includes nutrition, work/leisure activities,
wake/sleep cycles, relationships, pain, and fear/hopes
7. Identify dissonance and harmony
8. Validate appraisal with the patient
9. Self-reflection for the patient

ACCEPTANCE BY THE NURSING COMMUNITY

Practice
Nursing interventions are always centred around the individual, and
aim to alter the energy field between the person and their
environment. This includes non-invasive interventions such as
imagery, therapeutic touch, humour, music therapy, and more, which
are used to enhance the individual's potential. Additionally, greater
emphasis should be placed on pain management, supportive therapy,
and rehabilitation.
Education
Great emphasis should be placed on the comprehension of the

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Great emphasis should be placed on the comprehension of the
patient, the self, energy fields, and the environment. For instance,
nurse training should prioritize the instruction of non-invasive
interventions such as meditation, guided imagery, therapeutic touch,
the use of humor, and service learning initiatives.
Research
The Martha Rogers theory has been utilized in numerous studies and
has consistently proven to be effective in various investigations. For
instance, a research was conducted to evaluate the efficacy of
meditation in reducing stress among working women in Iloilo City.

THEORY ANALYSIS
The theory's educational foundations being profound, it offers a
demanding structure from which to deliver nursing care.
Clarity
Overall, the complexities of Rogerian Science of Unitary Human
Beings are widely acknowledged, yet efforts are ongoing to further
elucidate its concepts.
Simplicity
Although the ideas may appear complex, the underlying assumptions
are straightforward yet the theory is highly useful.
Generality
The usefulness of non-invasive modalities in nursing is still highly
valued today. The Science of Unitary Human Beings serves as the
basis for a variety of theories and can be applied to all aspects of life.
Accessibility
Many research works have applied Rogerian theory and found it
testable and applicable, however, several limitations have been
noted, such as difficulty in grasping the concepts, a lack of
operational definitions and instruments to properly evaluate the
instruments.
Importance
The aim of the theory is to comprehend human evolution and its
prospects for enhancing the human condition. Rogers examined the
four components of the nursing metaparadigm, although the
emphasis is on the interconnection of human-environmental field
phenomenon. Her proposal of various additional and future studies
supports the notion that the model is beneficial.
Roger's theory encourages nurses to provide care that takes into
account both the patient and their environment, and stresses the

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account both the patient and their environment, and stresses the
importance of understanding the patient as an individual with
multiple ties to their surroundings.

APPLICATION OF ROGER'S THEORY

Vignette
Mrs. Garcia, a 71-year-old female, was admitted to the ICU in an
unresponsive state with septicemia. She had been suffering from
hypertension and diabetes mellitus for seven years, and had
experienced a stroke a year ago resulting in right sided hemiplegia.
Receiving regular treatment, she was given three days of care in the
ICU before being transferred to the general medical ward.
She was drowsy and unable to express her emotions in the ICU. A
nasogastric tube was used to feed her, and a Foley catheter was
draining her urine. Her bowel movements were regular. There was a
decubitus ulcer on her sacral area, and her right side was limited in
movement. After regaining consciousness and her condition
becoming stable, she was moved to the medical ward. She seemed
more relaxed and was able to take in fluids orally.
Mrs. Garcia, a widow, resided with her son and said, “for seven years,
my son has been spending a great deal on my medical care, causing
a strain on him and his family.” Despite this, her son showed his
unwavering support and said, “our mother has worked hard to raise
us, and we want to take care of her in return.” He went on to say,
“my mother is very devoted and has the strength to confront the
hardships of life.”
After spending three weeks in the hospital, Mrs. Garcia was
discharged and able to tolerate soft foods. She was still accompanied
by a Foley catheter and her family had been instructed on how to
take care of her at home, as well as being referred to social workers.
Upon discharge, Mrs. Garcia was able to sit up in bed with support,
and move her left limbs, though she was still reliant on others for
the majority of her daily activities.
ASSESSMENT
Pattern
Mrs. Garcia, a right sided hemiplegic, expressed her feelings of
dependence, saying, "I cannot do anything on my own. I rely on
others for everything." She is only able to eat fluids and soft foods,
and her intake is diminished. Additionally, she has a severe bedsore
on her sacral region.
Mrs. Garcia's son remarked that although she is religious and
courageous, her circumstances have caused her to lose her self-
assurance and become lonely and cut off from those around her. She
expressed that her routine was being dictated by others in the
hospital, making it difficult for her to interact with them.

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hospital, making it difficult for her to interact with them.
Mrs. Garcia works diligently to attain the best possible health for
herself.
Resonancy
Mrs. Garcia is undergoing treatment and is complying with it. She
expresses her worries about the impact of her illness on her son,
saying, “If I don't take these medicines, my condition may worsen.
My son has been greatly burdened by my illness.” Fortunately, her
son is very supportive. Those around her have noticed that she can
be both pleasant and withdrawn at times. When she was feeling
down, she remarked, “I'm feeling depressed and guilty about my
illness. I don't know what the future holds.”
Helicy
Mrs. Garcia has accepted her illness, and is determined to recover
with all the resources available to her. She is not afraid of death,
and her son has vowed to support and care for her for the remainder
of her life.
Integrality
As Mrs. Garcia is ready for discharge from the hospital, her family
must make some necessary modifications to their home.
Additionally, she will need to receive treatment for her Hypertension
and Diabetes Mellitus. Her son expressed his concern, saying, “I'm
not sure how to care for her at home and prevent any potential
issues.”

1.4

GETTING TO KNOW THE THEORIST

"Ethical behavior is not the display of one's moral rectitude in times
of crisis, it is the day-to-day expression of one's commitment to
other persons and the ways in which human beings relate to one
another in their daily interactions."

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Myra Estrin Levine (1921-1996)
MYRA ESTRIN LEVINE
Conservation Model
Myra Estrin Levine, born in Chicago in 1920, achieved a diploma in
nursing from the Cook County School of Nursing in 1944.
Subsequently, she attained her Bachelor of Science in Nursing from
the University of Chicago in 1949, and her Masters of Science in
Nursing from Wayne State University in Detroit in 1962. In 1992, she
was awarded an honorary doctorate from Loyola University.
Throughout her career as a nurse, Levine gained experience in
Oncology Nursing while working at the Gardiner General Hospital as
a civilian nurse. She then went on to become the Director of Nursing
at Drexel Home in Chicago, a clinical instructor at Bryan Memorial
Hospital in Lincoln, Nebraska, an administrative supervisor at the
University of Chicago, Chairperson of Clinical Nursing at her alma
mater, the Cook County School of Nursing, and a visiting professor at
Tel Aviv University in Israel.
Levine, renowned for her book Introduction to Clinical Nursing, which

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Levine, renowned for her book Introduction to Clinical Nursing, which
was first released in 1969 and had subsequent editions in 1973 and
1989, passed away in 1996 aged 75.

METAPARADIGM IN NURSING
In her model, Levine drew upon theories and concepts from the fields
of nursing, physiology, psychology, and sociology to analyze nursing
practice situations and explain nursing activities and abilities.
Nursing. Nursing is a profession that involves interacting with people
in order to facilitate their well-being. The purpose of nursing is to
help individuals adjust and stay healthy, recognizing that everyone
needs a different set of interventions.
Person. The person is a unified being who is always seeking to
maintain their integrity and completeness, one who is conscious,
reflective, looking to the future, and mindful of the past. The
individual's wholeness necessitates that their life has significance in
the realm of social life. This person is also portrayed as a distinct
individual in unity and completeness, experiencing, trusting,
reasoning, and a complete system of systems.
Health. Health is implied to mean unity and integrity and “is a
wholeness and successful adaptation.” Nursing seeks to enhance
health, which Levine defines as “...the avenue of return to the daily
activities compromised by ill health. It is not only the insult or the
injury that is repaired but the person himself or herself. ..It is not
merely the healing of an afflicted part. It is rather a return to self-
hood, where the encroachment of the disability can be set aside
entirely, and the individual is free to pursue once more his or her
own interests without constraint.”
Environment. The individual is made up of both an internal and
external environment, which together form a complete whole.
1. The internal environment is a combination of the physiological and
pathophysiological aspects of the individual, and is constantly challenged
by the external environment. This environment is not a state of
homeostasis, but rather a state of homeorhesis, which is a stabilized flow
rather than a static balance. It emphasizes the fluidity of change within a
space-time continuum, and describes the pattern of adaptation which
allows the individual's body to sustain its well-being in the face of ever-
changing environmental factors.
2. External environment is divided into the following:
• Perceptual environment: This is the part of the external environment that
individuals sense through their sense organs, such as light, sound, touch,
temperature, smells and tastes, as well as their feeling of balance and
position.
• Operational environment:The external environment which affects living
tissue, even though it is not sensed by individuals, includes all forms of
radiation, microorganisms, and pollutants. This means that these elements

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 radiation, microorganisms, and pollutants. This means that these elements
may have an impact on individuals without them being aware of it.
• Conceptual environment:The external environment is composed of
language, ideas, symbols, and concepts, as well as inventions, all of which
enable the exchange of language, the capacity for thought and feeling,
values, religious beliefs, ethnic and cultural customs, and individual
psychological tendencies derived from life experiences.

CONSERVATIONAL MODEL
Levine's Conservation Model promotes adaptation and wholeness
using the principles of conservation. The nurse's primary focus is on
the organismic level, aiming to preserve energy, structure, and
personal and social integrity. While conservation is a key factor
when using the model, Levine also highlighted two other significant
concepts: adaptation and wholeness.
Adaptation
Adaptation is the process of change, with conservation being the
result. It is the way the client is able to stay true to themselves
while still functioning in their environment. It is done through the
"economical, efficient, limited and regulated utilization of
environmental resources that is in the individual's best interest.
Adaptive responses across multiple levels - molecular, physiologic,
emotional, psychologic, and social - are essential for conservation to
be successful. These responses are informed by three fundamental
elements: historicity, specificity, and redundancy.
1. Historicity: This concept suggests that adaptive responses are shaped by
an individual's unique combination of personal and genetic history. As
such, the responses that an individual exhibits are based on a combination
of their personal experiences and their genetic makeup.
2. Specificity: The unique ways in which each system of the human body
responds to stressors is a phenomenon known as stimulus-response
pathways. When a stressor is encountered, the body reacts in a task-
oriented way, often with a sequence of reactions that can be either
beneficial or detrimental. These responses are usually synchronized among
multiple pathways.
3. Redundancy: Redundancy is the idea that if one system or pathway is not
able to effectively adapt, a different pathway may be able to compensate
and fulfill the task. This can be beneficial when the response is meant to
fix a problem (e.g. receiving allergy shots over a long period to reduce the
severity of allergies by desensitizing the immune system). However,
redundancy can also be detrimental, such as when previous failed
responses are reinstated (e.g. when autoimmune conditions cause the
body's own immune system to attack healthy tissue).
A shift in behavior of an individual as they strive to adjust to their
surroundings is referred to as an organismic response. This response
ensures that the individual can preserve and safeguard their
wellbeing. Generally, four types of organismic responses exist:

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wellbeing. Generally, four types of organismic responses exist:
1. Flight or fight is an immediate reaction to a perceived or real danger, and
it is the most basic response.
2. An inflammatory response that is designed to maintain structural stability
and facilitate healing.
3. The long-term effects of stress on an individual are determined by the
cumulative impact of the stressful experiences they have encountered.
4. Taking in information from the environment and transforming it
into a meaningful understanding is known as perceptual
awareness.
Wholeness
Erikson's description of wholeness as an open system suggests
“Wholeness emphasizes a sound, organic, progressive mutuality
between diversified functions and parts within an entirety, the
boundaries of which are open and fluid.” According to Levine, “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." This perpetual
interaction between the individual and the environment forms the
basis of holistic thinking, which sees the individual as a unified being.
Conservation
The ability of complex systems to persist despite serious challenges
is known as conservation. By utilizing conservation, individuals are
able to overcome difficulties and still maintain their individuality.
“The goal of conservation is health and the strength to confront
disability" as “...the rules of conservation and integrity hold" The
most important aspect of conservation is preserving the overall
unity of the individual. Although nursing interventions may address
one particular conservation principle, nurses must also be aware of
the effects of other conservation principles.
The core concept of Levine's theory is conservation, in which an
individual's adaptive responses can productively adjust to change
with the least effort while maintaining optimal function and
identity. This is accomplished by effectively utilizing adaptive
pathways and behaviors that are suitable for the various responses
needed by humans to function.
In Levine's model, the Four Conservation Principles are outlined.
These principles emphasize the importance of preserving an
individual's overall well-being. Her philosophy of nursing is based on
the idea of human interaction, and her four conservation principles
are concerned with an individual's unity and integrity. These
principles are: energy, structural integrity, personal integrity, and
social integrity.
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social integrity.
1. Conservation of energy
Refers to maintaining equilibrium between energy expenditure
and intake to prevent excessive exhaustion. This includes getting
sufficient sleep, nutrition, and physical activity.
2. Conservation of structural integrity
Referring to the practice of preserving or restoring the physical
integrity of the body, such as helping clients with range of
motion (ROM) exercises and good personal hygiene, in order to
prevent physical deterioration and facilitate healing.
3. Conservation of personal integrity
Acknowledge the person's ambition for acknowledgement,
esteem, self-comprehension, identity and autonomy. An
illustration of this would be to recognize and safeguard the
client's need for personal space.
4. Conservation of social integrity
An individual is acknowledged as a part of a family, a
community, a religious order, an ethnic group, a political
structure, and a nation. This is demonstrated when nurses aid
them in maintaining their place within these groups and within
society as a whole.
Assumptions and Assertions
Levine's model highlighted various other assertions and assumptions,
such as:
1. The nurse fosters a setting that facilitates healing.
2. A person is greater than the mere accumulation of their components.
3. People tend to react in a predictable way and are in control of their own
decisions, even when they are feeling emotional.
4. People recognize and evaluate the things, circumstances, and occurrences
around them.
5. People use their senses, think logically, and comprehend.
6. People prioritize their actions when making decisions.
7. Adaptive modifications involve the individual in its entirety.
8. Everyone has their own special talent for adapting to their life
experiences, resulting in a distinctive message.
9. Change is inevitable in life.
10. Nursing is associated with the regulation of exercise, the development of
caregiving capabilities, and the provision of care.

ACCEPTANCE BY THE NURSING COMMUNITY

Practice
Levine's definition of nursing, which includes activities and scientific
principles, has been used as a framework for nursing care in a variety
of clinical settings, such as cardiology, obstetrics, gerontology, acute
care, pediatrics, long-term care, emergency care, primary care,
critical care, and the homeless community. Scaefer (2017) cites Pond

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critical care, and the homeless community. Scaefer (2017) cites Pond
as using the framework to guide nursing care for homeless
individuals in clinics, shelters, and on the streets. Additionally, Bayley
discussed the care of severely burned teenagers based on four
conservational principles, taking into consideration the client's
perceptual, operational, and conceptual environment.
Education
Levine's Introduction to Clinical Nursing presented novel content to
the nursing curricula, including at Allentown College of St. Francis de
Sales in Pennsylvania, and also served as a blueprint for instructing
Medical-Surgical Nursing to novice nursing students.
Research
Hanson and his team applied the Principle of Conservation during
their research into the incidence and prevalence of pressure ulcers in
hospice patients, while Newport employed the Principle of
Conservation of Energy and Social Integrity to compare the body
temperature of infants who were placed on their mother's chest
immediately after birth to those placed in a warmer.

THEORY ANALYSIS
Levine utilized deductive reasoning when creating her model, which
was designed to establish a structure for educating novice nursing
students.
Clarity
Levine's Conservation Model offers nursing a comprehensive, logical
perspective of the individual (Fawcet as cited by Scaefer, 2017).
George as cited by Scaefer (2017) confirms that this theory directs
nursing interventions that generate positive nursing outcomes.
Although the model has many terms, Levine explains them in a way
that is easy to comprehend.
Simplicity
Although the four conservation principles may seem straightforward
at first glance, they are actually quite complex, with underlying
principles and multiple variables. Despite this, this model remains
one of the easier ones developed
Generality
All nursing contexts can benefit from the implementation of the four
conservation principles.
Accessibility

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Utilizing deductive logic, Levine constructed her model, which can be
utilized to craft research questions. By applying her Conservation
Model, she confirmed the effectiveness of inductive reasoning to
expand and elucidate her model.
Importance
Levine's model is widely known for its four conservation principles,
which remain one of the earliest nursing models used to organize and
clarify elements of practice. This model continues to be a useful tool
for nursing practice and research, and has garnered increased
attention in the 21st century.

APPLICATION OF LEVINE'S MODEL

Vignette
Mrs. Garcia, a 55-year-old married woman who is in the middle of a
divorce, is in the hospital for a bilateral mastectomy. She has two
children and has been out of the workforce for a number of years;
she was diagnosed with breast cancer.
ASSESSMENT
• Energy:The incapability of providing care for children.
• Personal Integrity: Body image disturbance.
• Structural Integrity: Wound healing and weakness.
• Social Integrity:The relationship between society and an individual may
be tense or strained.
DIAGNOSIS
• Acute pain
• Impaired mobility
• Risk tor impaired skin integrity
• Potential low self-esteem
PLANNING
1. Instructing on wound management and post-treatment care.
2. Look into the necessity of providing aid for domestic requirements to
help support kids.
3. Seek advice from a social worker regarding joining a divorce and/or
cancer support group.
INTERVENTIONS
• Discuss with the client any worries or anxieties they may have
regarding their body image.
• Talk over the necessity for having help around the house
• Ensure that privacy, dignity, and respect are maintained throughout
the entire course of treatment.
• Ensure that appropriate wound management and sufficient
nourishment are administered post-operatively.
• Obey instructions related to managing pain.
• Encourage taking regular breaks.
EVALUATION
• Fight/Flight response: Are vital signs within normal limits? Evaluate
the patient's ability to cope.

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 the patient's ability to cope.
• Inflammatory response: Is the wound healing? Review and assess
laboratory results.
• Response to stress: Evaluate dietary consumption; Analyze
relationships with important people.
• Perceptual awareness: What changes has the client had to make to
accommodate her new body setup? Has she taken the necessary steps
to ensure she has the right resources for ongoing care?

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