Conceptual framework

FRAMEWORK FOR
PROFESSIONAL NURSING
PRATICE

HISTORY
 Although the beginning of nursing
theory development can be traced to
florence Nightingale, it was not until
the second half of the 1900’s that
nursing theory caught the attention of
nursing as a discipline.
 Theory development was a major
topic of discussion during 60’s and
70’s

 however in 1980’s attention turned
from the development of a global
theory for nursing as scholars began
to recognize multiple approaches to
theory development in nursing

CONCEPT
 A concept is a term or label that
describes a phenomenon. (
Melies,2004)
- The Phenomenon described by a
concept can be either:
1. Empirical
II. Abstract

EMPIRICAL / ABSTRACT
 Empirical concept is the one that can
be either observed or experienced
through the senses.
 An ABSTRACT concept is one that is
not observable, such as hope, or
caring
( Hickman, 2002)

CONCEPTUAL MODEL
 A conceptual model is defined as a set
of concepts and statements that
integrate the concepts in to a
meaningful configuration ( Lippitt ,
1973)

PROPOSITIONS /
ASSUMPTIONS
 PROPOSITIONS
They are statements that describe
relationship among events , situations, or
actions.
 ASSUMPTIONS
They also describe concepts or connect
two concepts and represent values,
beliefs, or goals
‘WHEN ASSUMPTIONS ARE
CHALLENGED, THEY BECOME
PREPOSITIONS’

STATEMENT
 Conceptual Models are composed of
abstract and general concepts and
propositions that provide a frame of
reference for members of a discipline.
 This frame of reference determines
how the world is viewed by members
of a discipline and guides the
members as they propose questions
and make observations relevant to the
discipline.

THEORY
 It is an organized, coherent, an
systematic articulation of a set of
statements related to significant
questions in a discipline that are
communicated in a meaningful of all.

Theory Vs Conceptual Model
 The primary distinction between a
conceptual model and a theory is the
level of abstraction and specificity.
 A conceptual model is a highly
abstract system of global concepts
and linking statements.
 A theory, in contrast, deals with one or
more specific, concrete concepts and
propositions.
(Fawcett. 1994)

METAPARADIGM
 It is the most global perspective of a
discipline and “acts as an
encapsulating unit, or framework,
within which the more restricted
structures develop.”
( Eckberg & Hill, 1979)

METAPARADIGM -
CONCEPT
 Each discipline singles out
phenomena of interest that it will deal
within a unique manner.
 The concepts and propositions that
identify and interrelate these
phenomena as even more abstract
than those in the conceptual models.

 The conceptual models and theories
of nursing represents various
paradigms derived from the
metaparadigm of the discipline of
nursing.
 Therefore, although each of the
conceptual models might link and
define the FOUR metaparadigm
concepts differently, the four
metaparadigm concepts are present in
each of the models.

Nursing
 The central concepts of the discipline
of nursing are PRESON,
ENVIRONMENT, HEALTH &
NURSING.
 “The person receiving the nursing, the
environment within which the person
exists, the health – illness continuum
within which the person falls at the
time of the interaction with the nurse,
and, finally, the nursing actions
themselves”.

Nursing theories
 To apply nursing theory in practice, the
nurse must have some knowledge of
the theoretical works of the nursing
profession.
 theoretical works in nursing are
generally categorized either as
philosophies, conceptual models,
theories, or middle range theories
depending upon the level of
abstraction.

PHILOSOPHIES IN NURSING
 Philosophies set forth the general
meaning of nursing and nursing
phenomena through reasoning and
the logical presentation of ideas.
 They are broad.
 Nursing philosophies contribute to the
discipline by providing direction,
clarifying values, and forming a
foundation for theory development.

ENVIRONMENTAL THEORY
 By Florence Nightingale
 It include four metaparadigm concepts
of nursing.
 The focus is primarily on the patient
and the environment, with the nurse
manipulating the environment to
enhance patient recovery.
 Interventions include the following…

COMPONENTS
 Ventilation and
warmth
 Health of houses
 Petty management
 Noise - reduction
 Variety – patients
room
 Food intake –
documentation
 Food – patient
preference
 Bed and bedding
 Light
 Cleanliness of
room
 Personal
cleanliness
 Chattering hopes
and advises
 Observation of the
sick.

METAPARADIGM
P
• Recipient of nursing care
E
• External & internal
H
• Health is not only to be well but to be able
to use well every power we have to use.
N
• Alter or manage the environment to
implement the natural laws of health.

VIRGINIA HENDERSON
DEFINITION OF NURSING AND 14
COMPONENTS OF NURSING CARE

VIRGINIA HENDERSON
 She perhaps best known for her
definition of nursing, which was first
published in 1955
“THE UNIQUE FUNCTION OF THE NURSE IS
TO ASSIST THE INDIVIDUAL , SICK OR
WELL, IN THE PERFORMANCE OF THOSE
ACTIVITIES CONTRIBUTING TO HEALTH OR
ITS RECOVERY ( OR TO A PEACEFUL
DEATH) THAT HE WOULD PERFORM
UNAIDED IF HE HAD THE NECESSARY
STRENGHT, WILL OR KNOWLEDGE AND TO
DO THIS IN SUCH A WAY AS TO HELP HIM
GAIN INDEPENDENCE AS RAPIDLY AS
POSSIBLE”….HEND 1966

BASIC NEEDS BY
HENDERSON
 Breathe normally
 Eat and drink .
 Eliminate body
waste
 Posture
 Sleep & rest
 Cloth
 Maintain body
temp.
 Body clean & well
groomed
 Avoid changes in
environment
 Communication
 Worship
 Work with a sense
of accomplishment
 Play/ recreation
 Learn, discover or
satisfy curiosity

METAPARADIGM
P
• Recipient of care composed of biolgical psychological
sociological and spiritual components.
E
• External Environment (temp. dangers), impact of
community on individual and family
H
• Based on patients ability to function independently.
N
• Assist the person, sick or well, in performance of
activities and help the person gain independence as
rapidly as possible.

JEAN WATSON
PHILOSOPHY AND
SCIENCE OF CARING

Theory – what it says
 The goal of nursing is to help persons
attain a higher level of harmony within
the body mind and spirit.
 Attainment of that goal can potentiate
healing and health.
 This goal is pursued through
transpersonal caring guided by
carative factors and corresponding
caristas processes.

FACTORS - CARITAS
 Watsons theory include 10 carative
factors
Carative factors – termed to CARITAS
 Caritas – means to cherish, to
appreciate, and to give special
attention. It conveys the concept of
love.

METAPARADIGM
P
• A UNITY OF MIND BODY SPIRIT/ NATURE
E
• HEALING SPACE AND ENVIRONMENT… THE NURSE
IS THE ENVIRONMENT.
H
• HARMONY, WHOLENESS AND COMFORT.
N
• RECIPROCAL TRANSPERSONAL RELATIONSHIP IN
CARING MOMENTS GUIDED BY CARATIVE FACTORS
AND CARITAS PROCESSES.

CONCEPTULA MODELS
AND GRAND THEORIES IN
NURSING

MARTHA ROGER’S
SCIENCE OF UNITARY
HUMAN BEINGS

 According to rogers (1994), nursing is
a learned profession, both a science
and an art.
 The art of nursing is the creative use
of the science of nursing for human
betterment.

About concept
 Rogers theory asserts that human
beings are dynamic energy fields that
are integrated with environmental energy
fields so that the person and his or her
environment form a single unit.
 Both human energy fields and
environmental fields are open systems,
pandimensional in nature and in constant
state of change.
 Pattern is the identifying characteristic of
energy fields.

Cont…
 Rogers identified the principles of
helicy, resonancy, and integrality to
describe the nature of change with in
human and environmental energy
fields.
 These principles are known as the
principle of hemodynamics.

Helicy
 Describe the unpredictable but
continuous, nonlinear evolution of
energy fields, as evidenced by a spiral
development that is a continuous,
nonrepeating and innovative
patterning that reflects the nature of
change.

Resonancy …
 Wave frequency and an energy field
pattern evolution from lower to higher
frequency wave patterns and is
reflective of the continuous variability
of the human energy field as it
changes.

Integrality
 Continuous mutual process of person
and the environment.

TOYS - THEORY
 Rogers used two widely recognized
toys to illustrate her theory and
constant interaction of the human-
environmental process.
 They are SLINKY and
KALEIDOSCOPE

SLINKY
 It illustrates the openness, rhythm,
motion, balance, and expanding
nature of the human life process which
is continuously evolving.

KALEIDOSCOPE
 Illustrates the changing patterns that
appear to be infinitely different.

ASSUMPTIONS – BY
ROGERS
MAN IS A UNIFIED WHOLE POSSESSING HIS OWN INTEGRITY
AND MANIFESTING CHARACTERISTICS MORE THAN AND
DIFFERENT FROM THE SUM OF ITS PARTS.
MAN AND ENVIRONMENT ARE CONTINUOUSLY EXCHANGING
MATTER AND ENERGY WITH ONE ANOTHER
THE LIFE PROCESS EVOLVES IRRIVERSIBILY AND
UNDIRECTIONALLY ALONG THE SPACE TIME CONTINUUM
PATTERN AND ORGANIZATION IDENTIFY MAN AND REFLECTS
HIS INNOVATIVE WHOLENESS
MAN IS CHARACTERIZED BY THE CAPACITY FOR
ABSTRACTION AND IMAGERY, LANGUAGE AND EMOTION

METAPARADIGM
P
• AN ENERGY FIELD WITH PATTERN
• HELICY, RESONANCY, INTEGRALITY
E
• IRREDUCIBLE, PANDIMENSIONAL, NEGENTROPIC
ENERGY FIELD WITH PATTERN
H
• HEALTH AND ILLNESS AS APART OF CONTINUUM.
N
• SEEKS TO PROMOTE SYMPHONIC INTERACTION
BETWEEN HUMAN AND ENVT. FIELDS – REALIZATION
OF MAXIMUM POTENTIAL.

DOROTHEA OREM’S
SELF CARE DEFICIT
THEORY OF NURSING

content
 GENERA FOCUS/IDEA : People function
and maintain life, health and well-being by
caring for themselves
 THEORIES OF
Self care
Self care deficit
Nursing systems

FRAMEWORK
 SELF CARE - Deliberate self care
actions
 SELF CARE DEFICIT -People who
are incapable of continuous self care
 NURSING SYSTEMS - Describes
therapeutic self care requisites.

PURPOSES OF OREM’S
THEORY
 Directs nursing practice
 Directs learning modalities in
nursing school curriculum
 Directs teaching skills use with
patient care and evaluation.

MAJOR CONCEPTS
Self care
Self care agency
Self care requisites
Therapeutic self-care demands
Self care deficit
Nursing agency
Nursing system
Basic conditioning factors.

THEORY OF SELF CARE
PEOPLE PERFORM ACTION TO
CONTROL FACTORS THAT AFFECT
THEIR OWN DEVELOPMENT TO
ENHANCE LIFE, HEALTH AND WELL
BEING.

SELF-CARE
Learned, goal-directed activity
Directed by individual to regulate
factors that affect their own
functioning
GOAL DIRECTED,LEARNED,
PURPOSEFUL

SELF CARE AGENCY
 Is complex
 Is acquired
 Allows individual to meet continuing
needs
 Is necessary for health of human
structure
 Is necessary for human development
 Promotes well-being.

PERSON
 SELF-CARE AGENT – PROVIDER OF SELF
CARE – AGENT-PERSON TAKING ACTION
 DEPENDENT CARE – GIVEN TO INFANTS,
CHILDREN AND DEPENDENT ADULTS
 DEPENDENT CARE AGENT – PROVIDER OF
CARE TO THE ABOVE GROUPS

SELF CARE REQUISITES
 UNIVERSAL : Common to all human
 DEVELOPMENTAL : Promote
processes for life/maturation…present
negative conditions
 HEALTH DEVIATION : Health issues
affect integrated human functioning
the person must be able to apply
knowledge to own care to become
competent in managing

THERAPEUTIC SELF CARE
DEMAND
 Describes on individual
structurally, functionally &
developmentally
 Basic is self-care as a regulatory
function
 Applies facts & theories from
human & environmental sciences

INDIVIDUAL IN NEED OF
NURSING INTERVENTION

INDIVIDUAL IN RECEIPT OF
NURSING INTERVENTION

SELF CARE DEFICIT
 Deficit : Action demand for self care
>the person’s current capability for self
care
 Self care agency not adequate or
operable
 Needs are not completely known or met
 May apply to some or all of the needs
 Needs may exist currently or be
projected

NURSING AGENCY
 Educated & trained individuals
 Assist others to recognize their self-
care demands
 Assists others in meeting these
demands
 Guide the application or development
of self-care agency (or dependent
care agency)

HELPING METHODS
 Acting or doing for another
 Guiding and directing
 Supporting physical & psychological
 Providing and maintaining an
environment that supports personal
development
 Teaching

CONDITIONING FACTORS
 Age
 Gender
 Developmental
state
 Health state
 Socio cultural
orientation
 Health care
system factors
 Family system
 Living patterns
 Environmental
factors
 Resources

THEORY OF NURSING
SYSTEM
 Nursing actions are:
 Wholly compensatory
 Partly compensatory
 Supportive educative

THEORY OF NURSING
SYSTEM
 Nursing Diagnosis – why the person
needs nursing care
 Prescription – means to be used to
meet the TSCD
 Nursing system design and plan –
co-ordinated deliberate practice action
 Nursing treatment

BASIC NURSING SYSTEMS WHOLLY COMPENSATORY SYSTEM
PARTLY COMPENSATORY SYSTEM
Nurse
action
Patient
action
Patient
action
limited
Accomplishes the patient’s
therapeutic self care
Compensates for the patient’s
Inability to engage in self care
Supports and protects
the patient
Nurse
action
Performs some self care measures
For the patient
Completes for the patient’s self care
limitations
Assists the patient as required
accepts care and assistance
Performs some self care measures
Regulates self care agency

Supportive-Education
Accomplishes self care
Regulates the exercise and development of the
self care agency
Nurse
action
Patient
action

PERSON
 A human-being; receiver of care
 Engages in deliberate action,
interpret experiences and perform
beneficial actions.
 Conditioning factors influences the
person’s ability to perform self care

HEALTH
 Physical, psychological, interpersonal
and social aspects are inseparable
 Promotion and maintenance of health,
treatment of illness and prevention of
complication

ENVIRONMENT
 Human environment is described in terms of
physical, chemical, biologic and social features
which may be interactive.
 It can positively or negatively affect a patient’s
ability to provide self care

NURSING
 A human service and a helping
service
 Focuses on the patient’s continuing
therapeutic care
 Focus of nursing – identification of
self care requisites

SISTER CALLISTA ROY:
ADAPTATION MODEL

INTRODUCTION
 BEGINS WITH MAN
 MAN AS A BIO PSYCHOSICIAL
BEING
 IN CONSTANT INTERACTION WITH
HIS ENVIRONMENT

FOCUS OF NURSING
 MAN’S POSITION ON THE HEALTH –
ILLNESS CONTINUUM
 INFLUENCED BY ABILITY TO ADAPT TO
CONFRONTED STIMULI

MAJOR CONCEPTS AND DEFINITIONS
SYSTEM :- A SET OF UNITS SO
RELATED OR
CONNECTED AS TO FORM A UNIT
CHARACTERISED BY
INPUTS, OUT PUTS,
CONTROL AND FEEDBACK
PROCESS

ADAPTATIONAL LEVEL:
* A CONSTANTLY CHANGING POINT.
* MADE UP OF FOCAL,CONTEXTUAL AND
RESIDUAL STIMULI.
* REPRESENT THE PERSONS OWN
STANDARD OF THE RANGE OF STIMULI.
* TO WHICH ONE CAN RESPOND WITH
THE ORDINARY ADAPTIVE RESPONSE

 ADAPTATION PROBLEMS:
* THE OCCURANCE OF SITUATIONS OF
INADEQUATE RESPONSES TO NEED
DEFICITS OR EXCESSES

 FOCAL STIMULUS:
* STIMULUS MOST IMMEDIATELY
CONFRONTING THE PERSON
* MUST MAKE AN ADAPTIVE
RESPONSE
* FACTOR THAT PRECIPITATES
BEHAVIOUR
INDIVIDUAL NEEDS- FAMILY ADAPTATION LEVEL

 CONTEXTUAL STIMULI:
* ALL OTHER STIMULI PRESENT
* CONTRIBUTE TO BEHAVIOUR
CAUSED BY THE FOCAL
STIMULI
OTHER STIMULI THAT INFLUENCE SITUATION

 RESIDUAL STIMULI:
* FACTORS THAT MAY BE
AFFECTING BEHAVIOUR
* EFFECT NOT VALIDATED
INDIVIDUALS BELIEFS THAT OR ATTITUDES
INFLUENCING SITUATION

 REGULATOR:
* SUBSYSTEM COPING MECHANISM
* RESPONDS AUTOMATICALLY THROUGH
NEURAL-CHEMICAL-ENDOCRINE
PROCESSES

 COGNATOR:
* SUBSYSTEM COPING MECHANISM
* COGNITIVE – EMOTIVE PROCESS
* RESPONDS THROUGH PERCEPTION,
INFORMATION
PROCESSING, LEARNING, JUDGEMENT AND
EMOTION

 ADAPTIVE (EFFECTOR) MODES:
* CLASSIFICATION OF WAYS OF COPING
* MANIFESTS REGULATOR AND
COGNATOR ACTIVITY
* PHYSIOLOGIC, SELF CONCEPT, ROLE
FUNCTION AND INTERDEPENDENCE

 ADAPTIVE RESPONSES:
PROMOTE INTERGRITY OF THE PERSON
IN TERMS OF THE GOALS OF SURVIVAL,
GROWTH, REPRODUCTION AND
MASTERY.

 INEFFECTIVE RESPONSES:
DOES NOT CONTRIBUTE TO ADAPTIVE
GOALS

MODEL – HUMAN ADAPTIVE
SYSTEMS

PHYSIOLOGICAL MODE:
* INVOLVES BODY’S BASIC
NEEDS AND WAYS OF DEALING
WITH ADAPTATION
* IN RELATION TO
 FLUID AND ELECTROLYTES
 EXERCISE AND REST
 ELIMINATION
 NUTRITION
 CIRCULATION
 OXYGEN

 PHYSIOLOGICAL MODE:
CONTINUED
* REGULATION INCLUDES:
THE SENSES
TEMPERATURE
ENDOCRINE REGULATION

 SELF – CONCEPT MODE:
* COMPOSITE OF BELIEF AND
FEELING
* FORMED FROM PERCEPTIONS
* DIRECTS ONE’S BEHAVIOUR
* COMPONENTS ARE :
 THE PHYSICAL SELF
 THE PERSONAL SELF

 ROLE PERFORMANCE MODE:
* PERFORMANCE OF DUTIES
* BASED ON GIVEN POSITIONS IN
SOCIETY

 INTERDEPENDENCE MODE:
* ONE’S RELATION WITH SIGNIFICANT
OTHERS
* SUPPORT SYSTEM
* MAINTAINS PSYCHIC INTEGRITY
* MEETS NEEDS FOR NURTURANCE AND
AFFECTION

MAJOR ASSUMPTIONS
 FROM SYSTEM THEORY
 FROM HELSON’S THEORY
 FROM HUMANISM

ASSUMPTIONS FROM SYSTEMS
THEORY
 A SYSTEM IS A SET OF UNITS SO RELATED OR
CONNECTED AS TO FORM A UNIT OR WHOLE
 A SYSTEM IS A WHOLE THAT FUNCTIONS AS A WHOLE BY
VIRTUE OF THE INTERDEPENDENCE OF ITS PARTS
 SYSTEMS HAVE INPUTS, OUTPUTS AND CONTROL AND
FEEDBACK PROCESSES
 INPUT, IN THE FORM OF A STANDARD OR FEEDBACK
(INFORMATION)
 LIVING SYSTEMS ARE MORE COMPLEX THAN
MECHANICAL SYSTEMS AND HAVE STANDARDS AND
FEEDBACK TO DIRECT THEIR FUNCTIONING AS A WHOLE.

ASSUMPTIONS FROM HELSON’S THEORY
 HUMAN BEHAVIOUR REPRESENTS ADAPTATION TO
ENVIRONMENTAL AND ORGANISMIC FORCES
 ADAPTIVE BEHAVIOUR IS A FUNCTION OF THE STIMULUS
AND ADAPTATION LEVEL, THAT IS, THE POOLED EFFECT
OF THE FOCAL, CONTEXTUAL AND RESIDUAL STIMULI
 ADAPTATION IS A PROCESS OF RESPONDING
POSITIVELY TO ENVIRONMENTAL CHANGES
 RESPONSES REFLECT THE STATE OF THE ORGANISM
AS WELL AS THE PROPERTIES OF STIMULI AND HENCE
ARE REGARDED AS ACTIVE PROCESSES.

ASSUMPTIONS FROM HUMANISM
 PERSONS HAVE THEIR OWN CREATIVE POWER
 A PERSONS BEHAVIOUR IS PURPOSEFUL AND NOT
MERELY A CHAIN OF CAUSE AND EFFECT
 PERSON IS HOLISTIC
 A PERSON’S OPINIONS AND VIEW POINTS ARE OF VALUE
 THE INTERPERSONAL RELATIONSHIP IS SIGNIFICANT.

ELEMENTS
NURSING HEALTH
ENVIRONMENT PERSON

NURSING
 A SCIENCE AND PRACTICE
DISCIPLINE
 A THEORETICAL SYSTEM OF
KNOWLEDGE
 PRESCRIBES A PROCESS OF
ANALYSIS AND ACTION
 RELATED TO THE CARE OF THE ILL
OR POTENTIALLY ILL PERSON

PERSON
 A BIOPSYCHOSOCIAL BEING
 A LIVING, COMPLEX, ADAPTIVE
SYSTEM
 WITH INTERNAL PROCESSES (THE
COGNATOR AND REGULATOR)
 ACTING TO MAINTAIN ADAPTATION TO
THE FOUR MODES

HEALTH
 A STATE AND A PROCESS OF BEING
AND BECOMING AN INTEGRATED AND
WHOLE PERSON

ENVIRONMENT
 ALL THE CONDITIONS,
CIRCUMSTANCES AND INFLUENCES
SURROUNDING AND AFFECTING THE
DEVELOPMENT AND BEHAVIOUR OF
PRSONS OR GROUPS

MAJOR CONCEPTS AND
DEFINITIONS
IMOGENE KING: THEORY OF
GOAL ATTAINMENT

INTERACTION
A PROCESS OF PERCEPTION AND
COMMUNICATION
 BETWEEN PERSON AND
ENVIRONMENT
 BETWEEN PERSON AND PERSON
 REPRESENTED BY VERBAL AND
NONVERBAL BEHAVIOURS
 GOAL DIRECTED
 EACH INDIVIDUAL BRINGS
DIFFERENT KNOWLEDGE , NEEDS,

COMMUNICATION
 INFORMATION FROM
PERSON TO PERSON
 DIRECTLY OR INDIRECTLY
 INFORMATION
COMPONENT OF
INTERACTION

PERCEPTION
 EACH PERSON’S
REPRESENTATION OF
REALITY

TRANSACTION
 PURPOSEFUL
INTERACTION
LEADING TO GOAL
ATTAINMENT

ROLE
 A SET OF BEHAVIOURS
EXPECTED OF PERSON’S
OCCUPYING A POSITION
IN A SOCIAL SYSTEM
 RULES THAT DEFINE
RIGHTS AND
OBLIGATIONS IN A
POSITION

STRESS
 DYNAMIC STATE
 HUMAN BEING INTERACTS
WITH THE ENVIRONMENT

GROWTH AND
DEVELOPMENT
 CONTINOUS CHANGES IN
INDIVIDUALS
 AT CELLULAR, MOLECULAR
AND BEHAVIOURAL LEVELS
OF ACTIVITIES
 HELPS INDIVIDUALS MOVE
TOWARDS MATURITY

TIME
 SEQUENCE OF
EVENTS
 MOVING ONWARDS
TO THE FUTURE

SPACE
 EXISTING IN ALL
DIRECTIONS
 SAME EVERYWHERE
 IMMEDIATE
ENVIRONMENT
(NURSE AND CLIENT
INTERACTION)

NURSING
 OBSERVABLE BEHAVIOUR
 IN HEALTH CARE SYSTEM
IN SOCIETY
 GOAL – TO HELP
INDIVIDUALS MAINTAIN
HEALTH
 INTERPERSONAL
PROCESS OF ACTION;
REACTION, INTERACTION
AND TRANSACTION

PERSON
 SOCIAL BEINGS
 SENTIENT BEINGS
 RATIONAL BEINGS
 PERCEIVING BEINGS
 CONTROLLING BEINGS
 PURPOSEFUL BEINGS
 ACTION – ORIENTED
BEINGS
 TIME – ORIENTED BEINGS

HEALTH
 DYNAMIC STATE IN THE
LIFE CYCLE
 CONTINOUS ADAPTATION
TO STRESS
 TO ACHIEVE MAXIMUM
POTENTIAL FOR DAILY
LIVING
 FUNCTION OF NURSE,
PATIENT, PHYSICIANS,
FAMILY AND OTHER
INTERACTIONS

ENVIRONMENT
 OPEN SYSTEM
 CONSTANTLY
CHANGING
 INFLUENCES
ADJUSTMENT TO
LIFE AND HEALTH

PERSONAL SYSTEM
CONCEPTS
• PERCEPTION
• SELF
• BODY IMAGE
• GROWTH AND DEVELOPMENT
• TIME
• SPACE

INTERPERSONAL SYSTEM
CONCEPTS
• INTERACTION
• TRANSACTION
• COMMUNICATION
• ROLE
• STRESS

SOCIAL SYSTEM
CONCEPTS
 ORGANIZATION
 AUTHORITY
 POWER
 STATUS
 DECISION MAKING

ASSUMPTIONS
 PERCEPTIONS, GOALS, NEEDS AND VALUES OF THE NURSES
AND CLIENT INFLUENCE INTERACTION PROCESS
 INDIVIDUALS HAVE THE RIGHT TO KNOWLEDGE ABOUT
THEMSELVES AND TO PARTICIPATE IN DECISIONS THAT
INFLUENCE THEIR LIFE, HEALTH AND COMMUNITY SERVICES
 HEALTH PROFESSIONALS HAVE THE RESPONSIBILITY THAT
HELPS INDIVIDUALS TO MAKE INFORMED DECISSIONS
ABOUT THEIR HEALTH CARE
 INDIVIDUALS HAVE THE RIGHT TO ACCEPT OR REJECT
HEALTH CARE
 GOALS OF HEALTH PROFESSIONALS AND RECIPIENTS OF
HEALTH CARE MAY NOT BE CONGRUENT

DOROTHY.E .JOHNSON
BEHAVIORAL SYSTEM
MODEL

INTRODUCTION
 Dorothy Johnson began
her work on the model in
the late 1950 and wrote
into the 1990.
 Focus-needs,human as
a behavioral system and
relief of stress as
nursing care.

• The focus of her model is on needs, the
human as a behavioral system, and relief of
stress as nursing care.
• She wanted the curricula to be focused on
nursing rather than derived from the
knowledge bases of other health care
disciplines.
• She believed that nursing, although relying
on the contributions of other sciences, is a
discrete and a unique discipline.

BACKGROUND OF THE
THEORIST
 1919 August 21 Dorothy
was born
 1938 A.A.From Arm
Strong Junior College.
 1942 B.S.N from
Vanderbilt University
 1948 M.P.H from Harvard
university

 1943-1944 she was a staff nurse at
the Chatham-Savannah Health
Council
 1949-1978 She was an assistant
professor in Pediatric Nursing,
Assoc.Professor of Nursing and
Professor of Nursing at the
University of California in Los
Angeles
 1955-1956 Johnson was pediatric
Nursing advisor assigned to the
CMC in Vellore.
 1965-1967 She Chaired the

 1975 Faculty award from
graduate students.
 1977 Lulu Hassenplug
Distinguished Achievement
Award from the California
Nurses’ Association
 1981 Vanderbilt University
School of Nursing Award for
Excellence in Nursing.
 1999 She died in February at
the age of 80.

PHILOSOPHICAL UNDERPINNINGS
OF THE THEORY
 Johnson stated that Nightingale’s
work inspired her model.
 Person experiencing a disease
more important that the disease
itself.
 She reported that she derived
portions of her theory from the
works of Selye on stress,Grinker’s
theory of human behavior,and

MAJOR ASSUMPTIONS
 There are four assumptions about man’s
behavioral subsystems.
 First is the belief that drives serve as focal
points Which behavioral are organized to
achieve specific goals.
 Second, it is assumed that behavior is
differentiated and organized within the
prevailing dimensions of set and choice.

 Third, the Specialized parts or
systems of the behavioral system are
structured by dimensions of goal, set,
choice, and actions; each has
observable behaviors.
 Finally, interactive and interdependent
subsystems tend to achieve and
maintain balance between and
among subsystems through control
and regulatory mechanisms.

METAPARADIGMS
 Nursing is seen as “ an external
regulatory force which acts to preserve
the organization and integration of the
patient’s behavior constitutes a threat to
physical or social health, or in which
illness is found”
 Human was defined as a behavioral
system that strives to make continual
adjustments to achieve, maintain or
regain balance to the steady-state that
is adaptation.

 Health an elusive, dynamic state
influenced by biological ,psychological
,and social factors.
 Environment, is implied to include all
elements of the surroundings of the
human system and includes interior
stressors.

Concepts in Johnson’s Behavioral
System Theory
Concept Definition
Behavioral system :Man is a system that indicates the
state of the system through
behaviors
System : That which functions as a whole by
virtue of organized independent
interaction of its parts
Subsystem :A minisystem maintained in
relationship to the entire system
when it or the environment
is not disturbed

Johnson (1980) delineated seven
subsystems to which the model applied.
These are as follows:
1.Attachment or affiliative subsystem-serves
the need for security through social inclusion
or intimacy.
2.Dependency subsystem-behaviors designed
to get attention, recognition and physical
assistance
3.Ingestive subsystem -fulfills the need to
supply the biologic requirements for food and
fluids
4.Eliminative subsystem -functions to excrete

5.Sexual subsystem -serves the biologic
requirements of procreation and
reproduction
6.Aggressive subsystem -functions in
self and social protection and
preservation
7Achievement system-functions to
master and control the self or the
environment

Equilibrium :Process of maintaining stability
Stressor :A stimulus from the internal or external world
that results in stress or instability
Tension :The system’s adjustment to demands,change or
growth, or to actual disruptions

Functional requirements of human
in Johnson’s(1980) model
1.To be protected from noxious
influences with which the
person cannot cope
2.To be nurtured through the
input of supplies from the
environment
3.To be stimulated to enhance
growth and prevent
stagnation

USEFULNESSUSEFULNESS
• Johnson’s model
guides-
• nursing practice
• education
• research

Faye Abdellah
 “Nursing research and theorist”
 “First woman to become a surgeon general as a
nurse”
 “Influenced nursing theory aimed towards the
patient”
 “Graduated with a Doctoral degree from Columbia
University”
 “Theory revolved around the idea that nurses
should make decisions competently and focus
primarily on the patient. Abdellah theorized 21
problems to help influence this idea”

Abdellah’s Theory and Nursing
Influence
PATIENT
Physiologic
SociologicPsychologic
al

Rehabilitation Nursing
 Focused on returning patient’s to their optimal level
of functioning physically, emotionally, and
cognitively
 Areas include: Neuro, Spinal Cord Injury, TBI,
Orthopedic, Pain Management, and several
progressive disease processes
 Inpatient environment offers physical therapy ,
occupational therapy, speech therapy, and nursing
care

Physiologic
 Hygiene and Comfort
 Activity, Exercise, and Sleep
 Safety (Accidents vs. Infections)
 Body Mechanics
 Nutrition
 Fluid and Electrolyte Maintenance
 Disease Process
 Maintaining or Improving Sensory
Function
 Oxygenation
 Elimination

Psychological
 Effective verbal and nonverbal
communication
 Helping the patient accept self during
and after disease
 Continued motivation to accomplish
goals
 Acknowledging and identifying the
patient’s emotions

Sociological
 Therapeutic Relationships
 Spirituality/ Religious Beliefs
 Supportive Environment
 Community Resources
 “Being aware of domestic concerns and
how they may potentially affect care or
treatment of the patient”

Application of Theory related to
Rehabilitation Nursing
 Physiological- PAIN, HYGIENE,
SAFETY, ELIMINATION, HEALING
 Psychological-TRAUMA, EMOTIONS,
COGNITIVE FUNCTION
 Sociological- Environmental Factors,
Family Dynamics

How the 21 Problems Theory Influences Future uses
in Practice and Potential Limitations of these
Concepts:
 Future Uses in Practice: Framework relates
to all fields and specialties of nursing, this
was a theory based off of research so further
innovations in research could help clarify or
breakdown topics into specialty practice
standards. For ex: how can hygiene and
activity better be applied to a newborn rather
than remaining generalized.
 Potential Limitations include: research
funding, standards of care, healthcare laws
and regulations, and the later effects of a
nursing shortage can affect the number of
nursing educators and researchers in the
future.

Conclusion
 The 21 Problems theorized by Faye
Abdellah directly relate to nursing care
in all specialties. It focuses on patient
care overall and can be utilized in
nursing to provide an outline that
encompasses all aspects of
psychological , physiological, and
sociological needs. The theory also
ensures that the nurse taking care of
the patient practices competent care
and makes precise nursing
judgements.

Betty Neuman, RN, BSN, MSN, PhD, FAAN
 Born in Ohio & lives in
Watertown, Ohio
 Worked in many areas of
nursing practice
 Professor at UCLA
 Family Therapist
 Founder/ Director of the
NSMTG, Inc.
 Holds two Honorary Doctorates
(1992-Honorary Doctorate of
Letters, Neumann College;
1998-Honorary Doctorate of
Science, Grand Valley State
University)
 Fellow, American Academy of
Nursing, 1993

KEY TERMS: Client/client system is
conceptualized as:
 Individual
 Family
 Group/ aggregate
 Community

INTERACTING VARIABLES:
 Physiological Variable
 Psychological Variable
 Sociocultural Variable
 Developmental Variable
 Spiritual Variable

Environments:
Internal environment
External environment
Created environment

Stressors:
 Intra-personal stressors – EMOTIONS
FEELINGS
 Inter-personal stressors –
COMPETITION, DISCRIMINATION
 Extra-personal stressors -
ENVIRONMENTAL

Central Core:
 The central or core structure consists
of basic survival factors [normal temp
range, genetic structure, response
pattern, organ strength/ weakness,
ego structure] (Neuman, 2002).

Flexible Line of Defense
(FLD)
 Forms the outer boundary of the
defined client system [individual/
family/ group/ community] (Neuman,
2002)
 Acts as a protective buffer system for
the client’s normal line of defense or
wellness state
 Prevents stressor invasion of the client
system

Normal Line of Defense
(NLD)
 The client/ client system’s normal or usual
wellness level
 This line represents what the client has
become/ evolved over time (Neuman, 2002)
 The NLD defines the stability and integrity
of the client system, its ability to maintain
stability and integrity
 This normal defense line is the standard
against determining any variance from
wellness

Lines of Resistance
 A protective mechanism that attempts
to stabilize the client system and
foster a return to the usual wellness
 LOR contain certain known and
unknown internal and external
resource factors that support the
client’s basic structure and NLD
(mobilize WBC, activate immune
system mechanisms)

Optimal System Stability
 Optimal wellness is the greater
possible degree of system stability at
a given point in time (Neuman, 2002).
 Optimal client system stability means
the highest possible health condition
achievable at a given point in time
(Neuman, 2002).

Variance from Wellness
 Varying degrees of system instability
(Neuman, 2002).
 The difference from the normal or
usual wellness condition (Neuman,
2002).

Illness
 Illness is a state of insufficiency with
disrupting needs unsatisfied (Neuman,
2002).
 Illness is an excessive expenditure of
energy… when more energy is used
by the system in its state of
disorganization than is built and
stored, the outcome may be death
(Neuman, 2002).

Reconstitution
 Is the determined energy increase related
to the degree of reaction to a stressor, and
represents the return and maintenance of
system stability following treatment for
stressor reactions (Neuman, 2002)
 May be viewed as feedback from the input/
output of secondary intervention
 Complete reconstitution may occur beyond
the previously determined NLD or usual
wellness state, may stabilize the system to
a lower level, or return to the level of
wellness prior to illness.

Prevention as Intervention
 Basis for health promotion
 Nursing is prevention as intervention
encompass three dimensions:
(1) Primary Prevention
(2) Secondary Prevention
(3) Tertiary Prevention

Neuman’s Nursing Process
 Nursing Diagnosis
 Nursing Goals
 Nursing Outcomes

INTRODUCTION
 The Health Belief Model (HBM) is one
of the first theories of health behavior.
 It was developed in the 1950s by a
group of U.S. Public Health Service
social psychologists

Cont..
 They wanted to explain why so few
people were participating in programs
to prevent and detect disease.
 HBM is a good model for addressing
problem behaviors that evoke health
concerns (e.g., high-risk sexual
behavior and the possibility of
contracting HIV) (Croyle RT, 2005

AREAS OF ACTION
 The health belief model proposes that
a person's health-related behavior
depends on the person's perception of
four critical areas:
◦ the severity of a potential illness,
◦ the person's susceptibility to that illness,
◦ the benefits of taking a preventive action,
and
◦ the barriers to taking that action.

ABOUT THE THEORY
 HBM is a popular model applied in
nursing, especially in issues focusing
on patient compliance and preventive
health care practices.
 The model postulates that health-
seeking behaviour is influenced by a
person’s perception of a threat posed
by a health problem and the value
associated with actions aimed at
reducing the threat.

ABOUT THE THEORY
 HBM addresses the relationship
between a person’s beliefs and
behaviors. It provides a way to
understanding and predicting how
clients will behave in relation to their
health and how they will comply with
health care therapies.

THE MAJOR CONCEPTS AND
DEFINITIONS OF THE HEALTH
PROMOTION MODEL

SIX MAJOR CONCEPTS
 1. Perceived Susceptibility
 2. Perceived severity
 3. Perceived benefits
 4. Perceived costs
 5. Motivation
 6. Enabling or modifying factors

PERCEIVED SUSCEPTIBILITY
 Perceived Susceptibility: refers to a
person’s perception that a health
problem is personally relevant or that
a diagnosis of illness is accurate.

PERCEIVED SEVERITY:
 Perceived severity: even when one
recognizes personal susceptibility,
action will not occur unless the
individual perceives the severity to be
high enough to have serious organic
or social complications

PERCEIVED BENEFITS
 Perceived benefits: refers to the
patient’s belief that a given treatment
will cure the illness or help to prevent
it.

PERCEIVED COSTS
 Perceived Costs: refers to the
complexity, duration, and accessibility
and accessibility of the treatment

MOTIVATION
 Motivation: includes the desire to
comply with a treatment and the belief
that people should do what.

MODIFYING FACTORS
 Modifying factors: include
personality variables, patient
satisfaction, and socio-demographic
factors

Conceptual framework

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