NURSING MODELS

ROY'S ADAPTATION MODEL OF NURSING

The Adaptation Model of Nursing was developed by Sister Callista Roy in

1976. After working with Dorothy E. Johnson, Roy became convinced of
the importance of describing the nature of nursing as a service to society.
This prompted her to begin developing her model with the goal of nursing
being to promote adaptation. She first began organizing her theory of
nursing as she developed course curriculum for nursing students at Mount
St. Mary’s College. She introduced her ideas as a basis for an integrated
nursing curriculum.
The factors that influenced the development of the model included:
family, education, religious background, mentors, and clinical experience.
Roy’s model asks the questions:

 Who is the focus of nursing care?

 What is the target of nursing care?
 When is nursing care indicated?

Roy explained that adaptation occurs when people respond positively to

environmental changes, and it is the process and outcome of individuals
and groups who use conscious awareness, self-reflection, and choice to
create human and environmental integration.

The key concepts of Roy’s Adaptation Model are made up of four

components: person, health, environment, and nursing.

PERSON

According to Roy’s model, a person is a bio-psycho-social being in

constant interaction with a changing environment. He or she uses innate
and acquired mechanisms to adapt. The model includes people as
individuals, as well as in groups such as families, organizations, and
communities. This also includes society as a whole.

HEALTH

The Adaptation Model states that health is an inevitable dimension of a

person’s life, and is represented by a health-illness continuum. Health is
also described as a state and process of being and becoming integrated
and whole.

ENVIRONMENT
The environment has three components: focal, which is internal or
external and immediately confronts the person; contextual, which is all
stimuli present in the situation that all contribute to the effect of the focal
stimulus; and residual, whose effects in the current situation are unclear.
All conditions, circumstances, and influences surrounding and affecting
the development and behavior of people and groups with particular
consideration of mutuality of person and earth resources, including focal,
contextual, and residual stimuli.

The model includes two subsystems, as well. The cognator subsystem is a

major coping process involving four cognitive-emotive channels:
perceptual and information processing, learning, judgment, and emotion.
The regulator subsystem is a basic type of adaptive process that responds
automatically through neural, chemical, and endocrine coping channels.

The Adaptive Model makes ten explicit assumptions:

1. The person is a bio-psycho-social being.

2. The person is in constant interaction with a changing environment.
3. To cope with a changing world, a person uses coping mechanisms, both
innate and acquired, which are biological, psychological, and social in
origin.
4. Health and illness are inevitable dimensions of a person’s life.
5. In order to respond positively to environmental changes, a person must
adapt.
6. A person’s adaptation is a function of the stimulus he is exposed to and
his adaptation level.
7. The person’s adaptation level is such that it comprises a zone indicating
the range of stimulation that will lead to a positive response.
8. The person has four modes of adaptation: physiologic needs, self-
concept, role function, and interdependence.
9. Nursing accepts the humanistic approach of valuing others’ opinions
and perspectives. Interpersonal relations are an integral part of nursing.
10. There is a dynamic objective for existence with the ultimate goal of
achieving dignity and integrity.
There are also four implicit assumptions which state:

1. A person can be reduced to parts for study and care.

2. Nursing is based on causality.
3. A patient’s values and opinions should be considered and respected.
4. A state of adaptation frees a person’s energy to respond to other
stimuli.
 The goal of nursing is to promote adaptation in the four adaptive modes.
Nurses also promote adaptation for individuals and groups in the four
adaptive modes, thus contributing to health, quality of life, and dying with
dignity by assessing behaviors and factors that influence adaptive abilities
and by intervening to enhance environmental interactions. The Four
Adaptive Modes of Roy’s Adaptation Model are physiologic needs, self-
concept, role function, and interdependence.

The Adaptation Model includes a six-step nursing process.

1. The first level of assessment, which addresses the patient’s behavior

2. The second level of assessment, which addresses the patient’s stimuli
3. Diagnosis of the patient
4. Setting goals for the patient’s health
5. Intervention to take actions in order to meet those goals
6. Evaluation of the result to determine if goals were met
Throughout the nursing process, the nurse and other health care
professionals should make adaptations to the nursing care plan based on
the patient’s progress toward health.

OREM'S SELF-CARE DEFICIT NURSING THEORY

The Self-Care Deficit Theory developed as a result of Dorothea E. Orem

working toward her goal of improving the quality of nursing in general
hospitals in her state. The model interrelates concepts in such a way as to
create a different way of looking at a particular phenomenon. The theory
is relatively simple, but generalizable to apply to a wide variety of
patients. It can be used by nurses to guide and improve practice, but it
must be consistent with other validated theories, laws and principles.
The major assumptions of Orem’s Self-Care Deficit Theory are:

 People should be self-reliant, and responsible for their care, as well

as others in their family who need care.
 People are distinct individuals.
 Nursing is a form of action. It is an interaction between two or
more people.
 Successfully meeting universal and development self-care
requisites is an important component of primary care prevention
and ill health.
 A person’s knowledge of potential health problems is needed for
promoting self-care behaviors.
 Self-care and dependent care are behaviors learned within a socio-
cultural context.
Orem’s theory is comprised of three related parts: theory of self-care;
theory of self-care deficit; and theory of nursing system.
The theory of self-care includes self-care, which is the practice of activities
that an individual initiates and performs on his or her own behalf to
maintain life, health, and well-being; self-care agency, which is a human
ability that is “the ability for engaging in self-care,” conditioned by age,
developmental state, life experience, socio-cultural orientation, health,
and available resources; therapeutic self-care demand, which is the total
self-care actions to be performed over a specific duration to meet self-
care requisites by using valid methods and related sets of operations and
actions; and self-care requisites, which include the categories of universal,
developmental, and health deviation self-care requisites.

Universal self-care requisites are associated with life processes, as well as

the maintenance of the integrity of human structure and functioning.
Orem identifies these requisites, also called activities of daily living, or
ADLs, as:
1. the maintenance of sufficient intake of air, food, and water
2. provision of care associated with the elimination process
3. a balance between activities and rest, as well as between solitude and
social interaction
4. the prevention of hazards to human life and well-being
5. the promotion of human functioning

Developmental self-care requisites are associated with developmental

processes. They are generally derived from a condition or associated with
an event.
Health deviation self-care is required in conditions of illness, injury, or
disease. These include:

1. Seeking and securing appropriate medical assistance

2. Being aware of and attending to the effects and results of pathologic
conditions
3. Effectively carrying out medically prescribed measures
4. Modifying self-concepts to accept onseself as being in a particular state
of health and in specific forms of health care
5. Learning to live with the effects of pathologic conditions

The second part of the theory, self-care deficit, specifies when nursing is
needed. According to Orem, nursing is required when an adult is incapable
or limited in the provision of continuous, effective self-care. The theory
identifies five methods of helping: acting for and doing for others; guiding
others; supporting another; providing an environment promoting personal
development in relation to meet future demands; and teaching another.
The theory of nursing systems describes how the patient’s self-care needs
will be met by the nurse, the patient, or by both. Orem identifies three
classifications of nursing system to meet the self-care requisites of the
patient: wholly compensatory system, partly compensatory system, and
supportive-educative system.

Orem recognized that specialized technologies are usually developed by

members of the health care industry. The theory identifies two categories
of technologies.

The first is social or interpersonal. In this category, communication is

adjusted to age and health status. The nurse helps maintain interpersonal,
intra-group, or inter-group relations for the coordination of efforts. The
nurse should also maintain a therapeutic relationship in light of
pscyhosocial modes of functioning in health and disease. In this category,
human assistance adapted to human needs, actions, abilities, and
limitations is given by the nurse.

The second is regulatory technologies, which maintain and promote life

processes. This category regulates psycho- and physiological modes of
functioning in health and disease. Nurses should promote human growth
and development, as well as regulating position and movement in space.

Orem’s approach to the nursing process provides a method to determine

the self-care deficits and then to define the roles of patient or nurse to
meet the self-care demands. The steps in the approach are thought of uas
the technical component of the nursing process. Orem emphasizes that
the technological component “must be coordinated with interpersonal and
social pressures within nursing situations.
The nursing process in this model has three parts. First is the assessment,
which collects data to determine the problem or concern that needs to be
addressed. The next step is the diagnosis and creation of a nursing care
plan. The third and final step of the nursing process is implementation and
evaluation. The nurse sets the health care plan into motion to meet the
goals set by the patient and his or her health care team, and, when
finished, evaluate the nursing care by interpreting the results of the
implementation of the plan.

VIRGINIA HENDERSON'S NURSING NEED THEORY

The Nursing Need Theory was developed by Virginia Henderson and was
derived from her practice and education. Henderson’s goal was not to
develop a theory of nursing, but rather to define the unique focus of
nursing practice. The theory emphasizes the importance of increasing the
patient’s independence so that progress after hospitalization would not be
delayed. Her emphasis on basic human needs as the central focus of
nursing practice has led to further theory development regarding the
needs of the patient and how nursing can assist in meeting those needs.
Henderson identifies three major assumptions in her model of nursing.
The first is that “nurses care for a patient until a patient can care for him
or herself,” though it is not stated explicitly. The second assumption
states that nurses are willing to serve and that “nurses will devote
themselves to the patient day and night.” Finally, the third assumption is
that nurses should be educated at the college level in both sciences and
arts.
The four major concepts addressed in the theory are the individual, the
environment, health, and nursing.

PERSON

According to Henderson, individuals have basic needs that are

components of health. They may require assistance to achieve health and
independence, or assistance to achieve a peaceful death. For the
individual, mind and body are inseparable and interrelated, and the
individual considers the biological, psychological, sociological, and
spiritual components. This theory presents the patient as a sum of parts
with biophysical needs rather than as a type of client or consumer.

ENVIRONMENT

The environment is made up of settings in which an individual learns

unique patterns for living. All external conditions and influences that
affect life and development. The environment also includes individuals in
relation to families. The theory minimally discusses the impact of the
community on the individual and family. Basic nursing care involves
providing conditions in which the patient can independently perform the
fourteen components explained in the model.

There are fourteen components based on human needs that make up

nursing activities. These components are:

1. Breathe normally. Eat and drink adequately.

2. Eat and drink Adequately
3. Eliminate body wastes.
4. Move and maintain desirable postures.
5. Sleep and rest.
6. Select suitable clothing. That is, dress and undress appropriately.
7. Maintain body temperature within normal range by adjusting clothing
and modifying the environment.
8. Keep the body clean and well groomed and protect the integument.
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or
opinions.
11. Worship according to one’s faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal
development and health and use the available health facilities.

These components show a holistic approach to nursing that cover the

physiological, psychological, spiritual, and social. The first nine
components are physiological. The tenth and fourteenth are
psychological. The eleventh component is spiritual and moral. The twelfth
and thirteenth components are sociological, specifically addressing
occupation and recreation.

HEALTH

The theory’s definition of health is based on an individual’s ability to

function independently as outlined in the fourteen components. Nurses
need to stress the promotion of health and prevention, as well as the
curing of diseases. According to Henderson’s model, good health is a
challenge because it is affected by so many different factors, such as age,
cultural background, emotional balance, and others.

NURSING

Henderson’s definition of nursing states: “I say that the nurse does for
others what they would do for themselves if they had the strength, the
will, and the knowledge. But I go on to say that the nurse makes the
patient independent of him or her as soon as possible.” The nurse is
expected to carry out a physician’s therapeutic plan, but individualized
care is result of the nurse’s creativity in planning for care. The nurse
should be an independent practitioner able to make independent
judgments as long as he or she is not diagnosing, prescribing treatment,
or making a prognosis, since those activities are the function of the
physician.
Henderson explains in Nature of Nursing that the role of a nurse is “to get
inside the patient’s skin and supplement his strength will or knowledge
according to his needs.” The nurse has the responsibility to assess the
needs of the patient, help him or her meet health needs, and provide an
environment in which the patient can perform activity unaided.

ROPER-LOGAN-TIERNEY'S MODEL FOR NURSING

BASED ON A MODEL OF LIVING

The Roper-Logan-Tierney Model for Nursing is a theory of nursing care

based on activities of daily living, which are often abbreviated ADLs or
ALs. The model is widespread in the United Kingdom, especially in the
public sector. The model is named after its developers: Nancy Roper,
Winifred W. Logan, and Alison J. Tierney. The inspiration comes from the
work of Virginia Henderson.
The purpose of the theory is as an assessment used throughout the
patient’s care. In the United Kingdom, where the model is prevalent, it has
been reduced to being used simply as a checklist. It is often used to
assess how the life of a patient has changed due to illness, injury, or
admission to a hospital rather than as a way of planning for increasing
independence and quality of life.

The theory attempts to define what living means. It categorizes the

discoveries into activities of living through complete assessment, which
leads to interventions that support independence in areas that may be
difficult for the patient to address alone. The goal of the assessment and
interventions is to promote maximum independence for the patient.

The nurse uses the model to assess the patient’s relative independence
and potential for independence in the activities of daily living. The
patient’s independence is looked at on a continuum that ranges from
complete dependence to complete independence. This helps the nurse
determine what interventions will lead to increased independence as well
as what ongoing support is needed to offset any dependency that still
exists.

The activities of daily living should not be used as a checklist. Instead,

Roper states they should be viewed “As a cognitive approach to the
assessment and care of the patient, not on paper as a list of boxes, but in
the nurse’s approach to and organization of her care,” and that nurses
deepen their understanding of the model and its application. The patient
should be assessed on admission, and his or her dependence and
independence should be reviewed throughout the care plan and
evaluation. By looking at changes in the dependence-independence
 continuum, the nurse can see whether the patient is improving or not, and
make changes to the care provided based on the evidence presented.
The activities of living listed in the Roper-Logan-Tierney Model of Nursing
are:

 maintaining a safe environment

 communication
 breathing
 eating and drinking
 elimination
 washing and dressing
 controlling temperature
 mobilization
 working and playing
 sleeping
The list also includes death and sexuality as activities of daily living, but
these are often disregarded depending on the setting and situation for the
individual patient.

According to the model, there are five factors that influence the activities
of living. The incorporation of these factors into the theory of nursing
makes it a holistic model. If they aren’t considered, the resulting
assessment is incomplete and flawed. The factors are used to determine
the individual patient’s relative independence in regards to the activities
of daily living.

MODERN NURSING THEORY BY FLORANCE

NIGHTINGALE
Florence Nightingale is a well known name in the field of nursing. Known
as the mother of modern nursing, her nursing theories developed the
practice of nursing into what it is today. From her early observations
during the Crimean War to her book, Notes on Nursing, Nightingale had an
enormous impact on the field of nursing.
In its earliest form, nursing was a practice carried out primarily by nuns,
military personnel, and women who volunteered to work in hospitals to
care for the sick and injured.. However, there were no standards or
regulation for nursing as a practice, so it was not recognized as a formal
profession.

While working as a nurse in a military hospital during wartime, Nightingale

saw the conditions injured soldiers faced while receiving medical care. She
observed a direct correlation between the sanitary conditions of patients
and their health and recovery. That is, patients whose sanitary conditions
were bad often faced additional health problems or did not recover from
their wounds.

These observations led to one major way Nightingale contributed to the

modern practice of nursing and medicine. She worked to create sanitary
conditions for patients. Not only did this include keeping the patient clean,
but the hospital environment. This means sanitized medical tools, clean
bed linens, and the health care professionals keeping themselves clean,
as well. This developed into the nursing theory known as Nightingale’s
Environment Theory, which was a part of the overall changes
Nightingale’s work made to develop what is known as modern nursing.
Thanks to the compassion and care of Florence Nightingale, the changes
made in the field of nursing have created a health care field that is
recognized as a profession, has regulation in education and practice, and
is an area in which men and women can work to care for patients at many
levels, and be involved in getting people to their optimum health.

21 NURSING PROBLEMS BY FAYE ABDELLAH

The Twenty-One Nursing Problems Theory was developed by Faye Glenn
Abdellah. Her model of nursing was progressive for the time in that it
refers to a nursing diagnosis during a time in which nurses were taught
that diagnoses were not part of their role in health care.
There are specific characteristics identifiable in the Twenty-One Nursing
Problems. The theory has interrelated the concepts of health, nursing
problems, and problem-solving. Problem-solving is an activity that is
inherently logical in nature. The framework focuses on nursing practice
and individual patients.

The twenty-one nursing problems identified in the nursing theory are

comprised of ten steps used to identify the patient’s problems and eleven
skills used in developing a treatment typology or nursing care plan.
The ten steps to identify the patient’s problems are:

1. Learn to know the patient

2. Sort out relevant and significant data
3. Make generalizations about available data in relation to similar nursing
problems presented by other patients
4. Identify the therapeutic plan
5. Test generalizations with the patient and make additional
generalizations
6. Validate the patient’s conclusions about his nursing problems
7. Continue to observe and evaluate the patient over a period of time to
identify any attitudes and clues affecting his behavior
8. Explore the patient’s and family’s reaction to the therapeutic plan and
involve them in the plan
9. Identify how the nurses feel about the patient’s nursing problems
10. Discuss and develop a comprehensive nursing care plan
The eleven nursing skills in the theory are:

1. observation of health status

2. skills of communication
3. application of knowledge
4. teaching of patients and families
5. planning and organization of work
6. use of resource materials
7. use of personnel materials
8. problem-solving
9. direction of work of others
10. therapeutic use of the self
11. nursing procedure
The twenty-one nursing problems fall into three categories: physical,
sociological, and emotional needs of patients; types of interpersonal
relationships between the patient and nurse; and common elements of
patient care.

The needs of patients are divided into four categories: basic to all
patients, sustenal care needs, remedial care needs, and restorative care
needs.

Needs that are basic to all patients are to maintain good hygiene and
physical comfort; promote optimal activity, including exercise, rest and
sleep; promote safety through the prevention of accidents, injury or other
trauma and through the prevention of the spread of infection; and
maintain good body mechanics and prevent or correct deformity.

Sustenal care needs facilitate the maintenance of a supply of oxygen to all

body cells; facilitate the maintenance of nutrition of all body cells;
facilitate the maintenance of elimination; facilitate the maintenance of
fluid and electrolyte balance; recognize the physiological responses of the
body to disease conditions; facilitate the maintenance of regulatory
mechanisms and functions; and facilitate the maintenance of sensory
function.
Remedial care needs identify and accept positive and negative
expressions, feelings, and reactions; identify and accept the
interrelatedness of emotions and organic illness; facilitate the
maintenance of effective verbal and non-verbal communication; promote
the development of productive interpersonal relationships; facilitate
progress toward achievement of personal spiritual goals; create and
maintain a therapeutic environment; and facilitate awareness of the self
as an individual with varying physical, emotional, and developmental
needs.

Restorative care needs include the acceptance of the optimum possible

goals in light of limitations, both physical and emotional; the use of
community resources as an aid to resolve problems that arise from illness;
and the understanding of the role of social problems as influential factors
in the case of illness.

According to the Twenty-One Nursing Problems model, patients are

described as having physical, emotional, and sociological needs. People
are also the only justification for the existence of nursing. That is, without
people, nursing would not be a profession since they are the recipients of
nursing.

Patient-centered approaches to nursing health are described as a state

mutually exclusive of illness. Abdellah does not provide a definition of
health, but speaks to “total health needs” and “a healthy state of mind
and body” in her description of nursing.

In this nursing model, society is included in “planning for optimum health

on local, state, national, and international levels.” However, the focus of
nursing is the individual. The environment is the home or community from
which the patient comes.
Nursing is a helping profession. Nursing care is doing something for or to
the patient or giving the patient information with the goals of meeting
needs, increasing or restoring self-help ability, or alleviating impairments.
The role of the nurse is to help the patient achieve goals to reach
optimum health.

Abdellah explained nursing as a comprehensive service, which includes:

1. Recognizing the nursing problems of the patient

2. Deciding the appropriate course of action to take in terms of relevant
nursing principles
3. Providing continuous care of the individual’s total needs
4. Providing continuous care to relieve pain and discomfort and provide
immediate security for the individual
5. Adjusting the total nursing care plan to meet the patient’s individual
needs
6. Helping the individual to become more self-directing in attaining or
maintaining a healthy state of body and mind
7. Instructing nursing personnel and family to help the individual do for
himself that which he can within his limitations
8. Helping the individual to adjust to his limitations and emotional
problems
9. Working with allied health professions in planning for optimum health
on local, state, national, and international levels
10. Carrying out continuous evaluation and research to improve nursing
techniques and to develop new techniques to meet people’s health
needs

The twenty-one problems can be applied to the nursing process. In the

assessment phase, the nursing problems provide guidelines for data
collection. The results of data collection determines the patient’s specific
problems, which leads to the nursing diagnosis. The statements of nursing
problems resemble goal statements, so once the patient has been
diagnosed, nursing goals have already been established. The goals can be
used as a framework to develop a plan and nursing interventions. In terms
of evaluation, the nurse’s progress or lack of progress toward the
achievement of stated goals is the appropriate evaluation. The theory
provides a basis for determining and organizing nursing care, as well as a
basis for organizing nursing strategies.

MODELING AND ROLE MODELING THEORY

The Modeling and Role Modeling Theory was developed by Helen Erickson,
Evelyn M. Tomlin, and Mary Anne P. Swain. It was first published in 1983
in their book Modeling and Role Modeling: A Theory and Paradigm for
Nursing. The theory enables nurses to care for and nurture each patient
with an awareness of and respect for the individual patient’s uniqueness.
This exemplifies theory-based clinical practice that focuses on the
patient’s needs.
The theory draws concepts from a variety of sources. Included in the
sources are Maslow’s Theory of Hierarchy of Needs, Erikson’s Theory of
Psychosocial Stages, Piaget’s Theory of Cognitive Development, and Seyle
and Lazarus’s General Adaptation Syndrome.

The Modeling and Role Modeling Theory explains some commonalities and
differences among people.

The commonalities among people include:

 Holism, which is the belief that people are
more than the sum of their parts. Instead,
mind, body, emotion, and spirit function as
one unit, affecting and controlling the parts
in dynamic interaction with one another.
This means conscious and unconscious
processes are equally important.
 Basic needs, which drive behaviour. Basic
needs are only met when the patient
perceives they are met. According to
Maslow, whose hierarchical ordering of basic
and growth needs is the basis for basic
needs in the Modelling and Role Modelling
Theory, when a need is met, it no longer
exists, and growth can occur. When needs
are left unmet, a situation may be perceived
as a threat, leading to distress and illness.
Lack of growth-need satisfaction usually
provides challenging anxiety and stimulates
growth. Need to know and fear of knowing
are associated with meeting safety and
security needs.
 Affiliated Individuation is a concept unique
to the Modelling and Role Modelling Theory,
based on the belief that all people have an
instinctual drive to be accepted and
dependent on support systems throughout
life, while also maintaining a sense of
independence and freedom. This differs
from the concept of interdependence.
 Attachment and Loss addresses the idea
that people have an innate drive to attach to
objects that meet their needs repeatedly.
They also grieve the loss of any of these
objects. The loss can be real, as well as
perceived or threatened. Unresolved loss
leads to a lack of resources to cope with
daily stressors, which results in morbid grief
and chronic need deficits.
 Psychosocial Stages, based on Erikson’s
theory, say that task resolution depends on
the degree of need satisfaction. Resolution
of stage-critical tasks lead to growth-
promoting or growth-impeding residual
attributes that affect one’s ability to be fully
functional and able to respond in a healthy
way to daily stressors. As each age-specific
task is negotiated, the person gains
 enduring character-building strengths and
virtues.
 Cognitive Stages are based on Piaget’s
theory, and are the thinking abilities that
develop in a sequential order. It is useful to
understand the stages to determine what
developmental stage the patient may have
had difficulty with.

The differences among people include:

 Inherent Endowment, which is genetic as

well as prenatal and perinatal influences
that affect health status.
 Model of the World is the patient’s
perspective of his or her own environment
based on past experiences, knowledge,
state in life, etc.
 Adaptation is the way a patient responds to
stressors that are health- and growth-
directed.
 Adaptation Potential is the individual
patient’s ability to cope with a stressor. This
can be predicted with an assessment model
that delineates three categories of coping:
arousal, equilibrium, and impoverishment.
 Stress is a general response to stressful
stimuli in a pattern of changes
involving the endocrine, GI, and lymphatic
systems.
 Self-Care is the process of managing
responses to stressors. It includes
what the patient knows about him or herself,
his or her resources, and his or
her behaviours.
 Self-Care Knowledge is the information
about the self that a person has
concerning what promotes or interferes with
his or her own health, growth,
and development. This includes mind-body
data.
 Self-Care Resources are internal and
external sources of help for coping
with stressors. They develop over time as
basic needs are met and developmental
tasks are achieved.
  Self-Care Action is the development and
utilization of self-care knowledge
and resources to promote optimum health.
This includes all conscious and unconscious
behaviors directed toward health, growth,
development, and adaptation.
In the theory, modeling is the process by which the nurse seeks to know
and understand the patient’s personal model of his or her own world, as
well as learns to appreciate its value and significance. Modeling
recognizes that each patient has a unique perspective of his or her own
world. These perspectives are called models. The nurse uses the process
to develop an image and understanding of the patient’s world from that
patient’s unique perspective.

Role modeling is the process by which the nurse facilitates and nurtures
the individual in attaining, maintaining, and promoting health. It accepts
the patient as he or she is unconditionally, and allows the planning of
unique interventions. According to this concept, the patient is the expert
in his or her own care, and knows best how he or she needs to be helped.

This model gives the nurse three main roles. They are facilitation,
nurturance, and unconditional acceptance. As a facilitator, the nurse helps
the patient take steps toward health, including providing necessary
resources and information. As a nurturer, the nurse provides care and
comfort to the patient. In unconditional acceptance, the nurse accepts
each patient just as he or she is without any conditions.

The basic theoretical linkages used in nursing practice for this model are:
developmental task resolution (residual) and need satisfaction are related;
basic need status, object attachment and loss, growth and development
are all interrelated; and adaptive potential and need status are related.

According to the theory, the five goals of nursing intervention are to build
trust, promote the patient’s positive orientation, promote the patient’s
control, affirm and promote the patient’s strengths, and set mutual,
health-directed goals.

Modeling refers to the development of an understanding of the patient’s

world, while role modeling is the nursing intervention, or nurturance, that
requires unconditional acceptance. This model considers nursing as a self-
care model based on the patient’s perception of the world, as well as his
or her adaptation to stressors.

When it comes to research, the following are some theoretical

propositions presented by the model:
  The individual’s ability to contend with new
stressors is directly related
to the ability to mobilize resources needed.
 The individual’s ability to mobilize resources
is directly related to their need deficits and
assets.
 Distressors are unmet basic needs; stressors
are unmet growth.
 Objects that repeatedly facilitate the
individual patient in need take on
significance for that individual patient. When
this occurs, attachment to the significant
object occurs.
 Secure attachment produces feelings of
worthiness.
 Feelings of worthiness result in a sense of
futurity.
 Real, threatened, or perceived loss of the
attachment object results in morbid grief.
 Basic need deficits co-exist with the grief
process.
 An adequate alternative object must be
perceived as available in order for the
patient to resolve his or her grief process.
 Prolonged grief due to an unavailable or
inadequate object results in morbid grief.
 Unmet basic and growth needs interfere
with growth processes for the patient.
 Repeated satisfaction of basic needs is a
prerequisite to working through
developmental tasks and resolution of
related developmental crises.
 Morbid grief is always related to need
deficits.
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