Orem'S Self-Care Deficit Nursing Theory

OREM`S SELF-CARE DEFICIT NURSING THEORY
INTRODUCTION
 Dorothea Elizabeth Orem developed the SELF-CARE DEFICIT theory. She is working towards 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.
 This can be used by nurses to guide & improve practice but it must be consistent with other validated theories, laws & principles.
 The theory focuses on each “individual`s ability to perform self0care”, defined as the “practice of activities that individuals initiate & perform on their
own behalf in maintaining life, health & well-being”.
 The Self-Care Deficit theory is composed of 3 interrelated theories: (1) The theory of self-care, (2) The self-care deficit theory, (3) The theory of
nursing systems which is further classified into wholly compensatory, partial compensatory and supportive educative.
HISTORY AND BACKGROUND
DATE EVENT PLACE
July 15, 1914 Born Baltimore, Maryland
1939 Nursing Diploma Providence Hospital School of
Nursing in Washington D.C.
1945 Master of Science in Nursing Providence Hospital School of
Nursing in Washington D.C.
1982 member of the group of nurse North American Nursing
theorists who presented Patterns Diagnosis Association
of Unitary Man (Humans)
1984 Retired
1985 (Published) Continued to work on the 3rd
1991 (completed) edition
January 2001 Orem completed the 6th edition
of Nursing: Concepts of
Practice
She earned several Honorary Doctorate degrees. Among these were:
1980 Honorary Doctorates of Science both Georgetown University in
1976 and Incarnate Word
College
1988 Honorary Doctorate of Humane Illinois Wesleyan University
Letters
1998 Doctorate Honoris Causae University of Missouri in
Columbia in
1940 to 1949 Occupied important nursing Providence Hospital, Detroit
positions like Directorship of
both the nursing school and the
department of nursing
1940 to 1949 Teach Biological Sciences
1959 - 1964 Orem served as the Assistant Catholic University of America
Professor
 Born to father who was a construction worker & a mother who was a homemaker. She was the youngest among two daughters
 During her professional career, she worked as a staff nurse, private duty nurse, nurse educator & administrator & nurse consultant. She had a
distinguished career in nursing
 At the Catholic University of America, Orem served as the Assistant Professor from 1959 to 1964, Associate Professor from 1964 to 1970, and Dean of
the School of Nursing from 1965 to 1966.
 She also served as curriculum consultant to the Office of Education, United States Department of Health, Education and Welfare, Practical Nurse
Section in 1958, 1959 and 1960 to the Division of Hospital and Institutional Services, the Indiana State Board of Health from 1949 to 1957, and to the
Center for Experimentation and Development in Nursing, the John Hopkins Hospital 1969-1971, and to the Director of Nursing Wilmer Clinic, the
John Hopkins Hospital, 1975-1976.
 Orem was given many awards during her career. Among these were:
 The Catholic University of America Alumni Achievement Award for Nursing Theory in 1980
 The Linda Richards Award from the National League for Nursing in 1991
 Named an Honorary Fellow of the American Academy of Nursing in 1992
 She also received accolades for her contributions to the field of nursing including honorary degrees from:
 Georgetown University
 Incarnate Word College
 Illinois Wesleyan University
 University of Missouri-Columbia
 She was inducted into the American Academy of Nursing & received awards from the National League for Nursing and the Sigma Theta Tau Nursing
Honor Society
 Orem died on June 22, 2007 at the age of 92 in Savannah Georgia where she had spent her last 25 years of her life as a consultant and author.
INFLUENCES ON THEORY DEVELOPMENT
 OREM`S association with many nurses over the years provided learning experiences. Her collaborative work with graduate students & colleagues were
valuable contributions to her theory
 There are instances wherein patients are encouraged to bring out the best in them despite being ill for a period of time.
 This is very particular in rehabilitation settings, in which patients are entitled to be more independent after being cared for by the physicians and nurses
 Through these, the Self-Care Nursing Theory or the Orem Model of Nursing was developed by Dorothea Orem between 1959 and 2001
 OREM also cited other nurses who had valuable contributions to nursing such as Nightingale, Henderson, Abdellah & to name a few.
 She also acknowledged the contributions of authors from other disciplines such as Barnard, Selye, Bertalanffy & others
MAJOR CONCEPTS (OREM`S VIEW ON NURSING PARADIGM)
Human Being/Person
 “material object” of nurses & others who provide direct care.
 “men, women and children cared for either singly or as social units”
 has the capacity to reflect, symbolize & use symbols
 a total being with universal, developmental needs & capable of continuous self-care
 Man is an integrated whole that can function biologically, symbolically & socially
 A patient is an individual who is in need of assistance in meeting specific health-care demands because of lack of knowledge, skills, motivation or
orientation.
 For a human being to be considered as a patient, the following conditions must be met:
1. There must be some self-care demand to be met for another person
2. The individual must be motivated that after medical or nursing interventions, the person will be able to adapt some self-caring behaviors
3. The individual is currently unable to meet self-care requisites
 Simply put an individual to constantly strive & maintain a balance between his ability to achieve self-car abilities and the self-care demands
Health
 “being structurally and functionally whole or sound”
 a state that encompasses both the health of individuals and of groups.
 Human health is the ability to reflect on one`s self, to symbolize experience and to communicate with others.
 The essence of health is the capacity to live as a human being within one`s physical, biological & social environment, achieving some measures of
human life potential that contribute to the maintenance & promotion of structural integrity, functioning & development.
 Is the responsibility of total society and all its members
Environment
 Has physical, chemical and biological features. It includes the family, culture and community
 Encompasses elements external to man. Men & environment are considered an integrated system
 These are environmental conditions conducive to development.
1. Opportunities to be helped by being with other persons or groups where care is offered
2. Available opportunities for solitude & companionship
3. Provision of help for personal & group concerns without limiting individual decisions & personal pursuits
4. Shared respects, belief & trust
5. Recognition & fostering of developmental potential
Nursing
 gives specialized assistance to persons with disabilities that makes more than ordinary assistance necessary to meet needs for self-care.
 intelligently participates in the medical care, the individual receives from the physician
 Orem defined nursing as a service, art and a technology
 a SERVICE of deliberately selected & performed actions to assist individuals or groups to maintain self-care including structural integrity, functioning
& development. It is the grieving assistance to a person when he is unable to meet his own self-care needs
 ART of nursing is the ability to assist others in the design, provision & management of systems of self-care to improve or maintain human functioning
at some level of effectiveness
 The ART of nursing according to OREM needs to include:
1. The art of helping
2. The method of helping
3. Helping techniques appropriate to situations
4. Nursing systems
 OREM identified 5 Methods of helping or assisting that nurses must be aware of:
1. Acting for or doing for another
2. Guiding another
3. Supporting another
4. Providing an environment that promotes personal development in relation to becoming able to meet present or future demands for action
5. Teaching another
 nursing as a TECHNOLOGY. She stated nursing has formalized methods or techniques of practice, clearly described ways of performing specific
actions so that some particular result will be achieved
 Techniques:
1. Communicating with persons in states of health or disease
2. Bringing about & maintaining interpersonal, intragroup & intergroup relations for cooperative efforts
3. 3. Giving human assistance adapted to specific human needs & limitations
4. Bringing about maintaining & controlling the position and movements of persons in a physical environment for therapeutic purposes.
5. Sustaining & maintain life processes
6. Promoting processes of human growth & development
7. 7. Appraising, changing & controlling psychological modes of human functioning in health and disease
8. Bringing about & maintaining therapeutic relations based on psychosocial mode of human functioning in health & disease
 although nurses use this technique, they are confined to nursing as nurses works directly with the needs of the patient
KEY Concepts
Theories
 The Self-Care of Self-Care Deficit Theory of nursing is composed of 3 interrelated theories:
1. The Theory of Self- Care
2. The Self-Care Deficit Theory

3. The Theory of Nursing Systems
 These theories are further classified into wholly compensatory, partial compensatory & supportive-educative.
1. THE THEORY OF SELF- CARE
• This theory is basic to the understanding of the Self-Care deficit & the Theory of the Nursing System
• This theory focuses on the performance or practice of activities that individuals initiate & perform on their own behalf to maintain life, health &
well-being.
• This includes:
1. Self-Care
 SELF-CARE means the practice of activities that individuals personally initiate & perform on their own behalf in maintaining life,
health & well-being.
 It is a behavior that exists in concrete life situations
2. Self-Care Agency
 Is defined as the complex acquired ability to meet one`s continuing requirements for care that regulates life processes;
 An AGENT is a person taking action
 A SELF-CARE AGENT is the provider of self-care
 A DEPENDENT SELF- CARE is the provider of infant care or dependent adult care.
3. Therapeutic Self-Care Demand
 humanly constructed entity with an objective basis in information that describes an individual structurally, functionally &
developmentally.
 humanly constructed entity with an objective basis in information that describes an individual structurally, functionally &
developmentally.
4. Self-Care Requisites
 Are expressions of purpose to be attained, or results directed from deliberate engagement in self-care.
 They are actions directed toward the provision of self-care. It is presented in 3 categories:
1. Universal self-care requisites - Common to all ADLs (Activities of Daily Living) of the human beings associated with life
processes & the maintenance of integrity of human structure & functioning Identify these requisites as: (1) The maintenance of
sufficient intake of air (2) The maintenance of sufficient intake of water (3) The maintenance of sufficient intake of food (4) The
provision of care associated with elimination process & excrements (5) The maintenance of a balance between activity & rest (6)
The maintenance of a balance between solitude & social interaction (7) The prevention of hazards to human life, human
functioning & human well-being (8) The promotion of human functioning & development within social groups in accord with
human potential, known human limitations, & the human desire to be normal. These 8 requisites represent the essential physical,
social & spiritual elements of life. These are important to human structure & functioning.
2. Developmental self-care requisites - Are either specialized expressions of universal self-care requisites that have been
particularized for developmental processes. They are associated with developmental processes derived from a condition or
associated with an event such as adjusting to a new job, adjusting to body changes
2 Categories of Developmental Self-Care Requisites:
1. Conditions that support life processes and promote specific developmental stages that include:
a. Intra-uterine life & death
b. Neonatal life, whether born term or premature, with normal or low birth weight
c. Infancy
d. Childhood, adolescence & early adulthood
e. Pregnancy either childhood or adulthood
2. Conditions affecting human development consisting of 2 sub-types:
a. The provision of care to prevent occurrence of deleterious effects of these adverse conditions. E.g. provision of
adequate nutrition & care during infancy
b. The provision of care to prevent or overcome existing deleterious effects of particular conditions or life events such
as parenting, change in socio-economic status which may include:
1. Educational deprivation
2. Problem in social adaptation
3. Loss of relatives, friends or associates
4. Loss of possessions or one`s job
5. A sudden change in living conditions
6. A change in status, either social or economic
7. Poor health, poor living conditions or disability
8. Terminal illness or expected death
9. Environmental hazards
3. Health-deviation self-care requisites - Are required in conditions of illness, injury or disease or may result from medical measures
required to diagnose and correct the condition like:
 Seeking & securing appropriate medical assistance
 Being aware of and attending to the effects results of pathologic conditions & states
 Effectively carrying out medically prescribed diagnostic, therapeutic & rehabilitative measures
 Being aware of & attending to or regulating the discomfort or deleterious effects of prescribed medical measures
 Modifying the self-concept(self-image) in accepting oneself as being in a particular state of health and in need of specific
forms of health care
 Learning to live with the effects of pathologic conditions & states and the effects of medical diagnostic & treatment
measures in a lifestyle that promotes continued personal development
2. THEORY OF SELF-CARE DEFICIT
• Is the critical constituent of Orem`s theory.
• It has its origin in the proper object of nursing: human beings who are subject to health-deprived or health-related limitations for engagement in
self-care or dependent care
• Orem identified 5 methods of helping:
1. Acting for & doing for others
2. Guiding others
3. Supporting another
4. Providing an environment to promote patient`s ability
5. Teaching another
• The central idea of this theory states that all limitations or persons engaging in practical nursing endeavors are associated with subjectivity of
mature & maturing individuals to health-related or health-derived action limitations.
• These limitations render them completely or partially unable to know existent & emerging requisites for regulatory care for themselves or their
dependents.
• These limitations also prevent them from engaging in the continuing performance of care measures to control or in some way manage factors that
are regulatory of their own or their dependent`s functioning and development
• Self-Care Deficit is the qualitative or quantitative inadequacy. It exists when therapeutic self-care demand cannot be met entirely.
3. THEORY OF NURSING SYSTEMS
• This theory is a product of a series of relations between the persons: legitimate nurse & legitimate client.
• This system is activated when the client`s therapeutic self-care demand exceeds available self-care agency leading to the need for nursing.
• Nursing systems are the approaches nurses used to assists patients with deficits in self-care due to a condition of health.
• OREM identified the 3 classifications of nursing systems to meet the self-care requisites of the patient:
1. Wholly Compensatory Nursing System – patient is independent; Nurse is expected to accomplish all the patients. The patient is
unconscious because he had stroke (cerebrovascular accident). The nurse provides a total care for the patient like feeding, hygiene,
turning, elimination, suctioning of secretions to maintain effective respiration, promoting safety, providing exercises of joints &
body par
2. Partially Compensatory Nursing System - The patient can meet some needs. Needs nursing assistance. Both the nurse & the patient
engage in meeting self-care needs. E.g. the patient fell from the stairs in his school and had fracture on his right leg. His leg is now
on cast. The patient do self-care activities like eating, drinking but needs assistance with bathing, toileting, transfer & mobility until
he learns how to use crutches properly
3. Supportive-educative System - The patient can meet self-care requisites but needs assistance with decision-making or knowledge
and skills to learn self-care. E.g. The patient is pregnant for the 1 st time. The physician told her that her pregnancy is normal. The
patient is capable of self-care but she needs to learn self-care for pregnancy like nutrition, activity/rest/exercise, relief of common
discomfort of pregnancy, schedule of pre-natal check-up, labor & delivery, post-partum care & baby`s care.
STRENGTHS
 A major strength of Orem`s theory is that it is applicable for nursing by the beginning practitioner as well as the advanced clinicians
 Orem`s theory provides a comprehensive basis for nursing practice. It has utility for professional nursing in the areas of nursing practice, nursing
education & administration.
 The terms self-care, self-deficit & nursing systems are easily understood by the beginning student nurses and can be explored in greater depth as the
nurse gains more knowledge & experience.
 specifically defines when nursing is needed: Nursing is needed when the individual cannot maintain continuously that amount & quality of self-care
necessary to sustain life & health, recover from disease or injury, or cope with their effects
 Her self-care approach is contemporary with the concepts of health promotion and health maintenance.
 The 3 identifiable nursing systems were clearly delineated and are easily understood.
LIMITATION
 is viewed as a single whole thing while Orem defines system as a single whole thing.
 simple yet complex. be very confusing to the reader.
 definition of health was confined in 3 static conditions which she refers to “concrete nursing system” that connotes rigidity
 Health is often viewed as dynamic and ever-changing

APPLICATIONS TO NURSING PRACTICE, EDUCATION & RESEARCH
 used as a basis for clinical practice in varied settings.
 It motivated the establishment of independent nurse practice, in several outpatient clinics, nursing homes and within the acute care settings
 Orem included skilled observation, delineated the professional and technical levels of nursing practice and put emphasis on the intellectual aspects of
the nursing practice
 Orem`s theory has been the focus of the curriculum in many schools of nursing in the United States
 provides considerable direction to nursing education
 basic system within which the nurse practices, and the group of nursing diagnosis which are used to select and design appropriate self-care actions
within the appropriate nursing system
 Orem`s theory has also provided the conceptual framework for researchers done by several authors; outcome criteria of researches and as a Likert scale
questionnaire for clinical assessment
 It is used for the development of criteria to measure nursing practice in various situations.
 It provides considerable direction to nursing education and delineates many of the skills, techniques & methods which must be learned to become a
nurse practitioner.
 It also defines the basic system within which the nurse practices, and the group of nursing diagnosis which are used to select and design appropriate
self-care actions within the appropriate nursing system
ROGER`S SCIENCE OF UNITARY HUMAN BEINGS NURSING CONCEPTUAL MODEL
INTRODUCTION
 MARTHA ROGERS` theory is known as the SCIENCE OF UNITARY HUMAN BEINGS (SUHB).
 The theory views nursing as both as science and an art as it provides a way to view the unitary human being who is integral with the universe.
 The unitary human being & his or her environment are one. Nursing focuses on people and the manifestation that emerge from the mutual human-
environment field process.
 Her model addresses the importance of the environment as an integral part of the patient, & uses that knowledge to help nurses blend the science & art
of nursing to ensure patients have a smooth recovery & that can get back to the best health possible.
HISTORY & BACKGROUND
Date Event Place
May 12, 1914 Born Dallas Texas
1936 Nursing Diploma Knoxville General Hospital
1937 Bachelor’s Degree George Peabody College in
Nashville, Tennessee
1940 Accepted a position (5 years); in Hartford, CT at the Visiting
1st as an Assistant Supervisor Nurse Association
then as an Assistant Education
Director & lastly as the Acting
Director of Education. At the
same time, she was completing
her course work at Teacher`s
College & completed her
degree requirements (Master`s
degree)
1945 Master`s degree in Public Teacher`s College, Columbia
Health Nursing University in New York
1954 Master`s degree in Public The John Hopkins University in
Health & Doctor of Science Baltimore, Maryland
1954 the Head of the Division of New York University
Nursing
March 13, 1994 Died (80 YRS OLD) Knoxville, Tennessee.
She was a teacher & mentor to an impressive list of nursing scholars & theorist including Newman & Page
Martha Rogers wrote 3 books that enriched the learning experience & influenced the direction of nursing research for countless students: Educational
Revolution in Nursing (1961), Reveille in Nursing (1964): (1963), edited a journal called Nursing science & also the time she formulated ideas about
the publication of her 3rd book “An Introduction to the Theoretical Basis of Nursing (1970) and the last introduced the 4 Rogerian Principles of
Hemodynamic.
 Martha Rogers was honored with numerous awards and citations for her sustained contributions to nursing & science.
 In 1996, she was posthumously inducted into the American Nurses Association`s Hall of Fame
 She had a memorial place in the sidewalk hear her childhood home in Knoxville
 a patient can`t be separated from his/her environment when addressing health & treatment
 “Science of Unitary Human Beings”
PUBLICATIONS OF MARTHA ROGERS
 Theoretical Basis of Nursing (1970)
 Nursing Science & Art: A Prospective (1988)
 Nursing Science of Unitary, Irreducible, Human Beings Update (1990)
 Vision of Space Based Nursing (1990)
MAJOR CONCEPTS & METAPARADIGM OF MARTHA ROGERS NURSING THEORY

Human-Unitary Human Beings
 A person is defined as an irreducible, indivisible, multidimensional energy fields identified by a pattern & manifesting characteristic that are specific to
the whole & which cannot be predicted from knowledge of the parts
 A person is also a unified whole, having its own distinct characteristics that can`t be viewed by looking at, describing or summarizing the parts
Health
 expression of the life process
 signifies an irreducible human field manifestation. It cannot be measured by the parameters of biology or physics or of the social sciences
Environment Field
 An irreducible, indivisible, pan dimensional energy field identified by pattern & integral with the human field.
Nursing
 The study of Unitary, irreducible, indivisible human & environmental fields: people & their world.
 A learned profession that is both a science & an art
 Focus is the care of people & the life process of human beings
 Its purpose is to identify & examine the phenomenon that is central to its concern, the unitary human being.
 The concept of nursing encompasses 2 dimensions:
1. Independent Science of Nursing
 An organized body of knowledge which is specific to nursing is arrived by scientific research & logical analysis
2. Art of Nursing Practice
 Creative use of its knowledge is the art of its practice
 The art of nursing involves the imaginative & creative use of nursing knowledge
 The purpose of nurses is to promote health and well-being for all persons & groups wherever they are using the science & art of nursing
 extend into all areas: at home, at school, at work, at play, in hospital, nursing home, clinics, in this planet & now moving into outer space (space
nursing)
Energy Field
 The fundamental unit of the living & the non-living
 Field is the unified concept
 Energy signifies the dynamic nature of the field; a field is in continuous motion & is infinite
 The energy field continuously varies in intensity, density & extent
Openness
 Refers to qualities exhibited by open systems; human beings & their environment are the open systems.
 The human field & the environment field are constantly exchanging energy. There are no boundaries or barriers to inhibit energy flow between fields
(Rogers, 1970)
 The human beings openly participate in energy transformation with the environment creating mutual change (Leddy, 2004 p. 15)
Pattern
 The distinguishing characteristics of an energy field perceived as a single wave. Rogers call it “an abstraction” that gives identity to the field.
 Patterning “is the dynamic or active process of the life of the human being” that is “accessible to the senses” (Alligood & Fawcett, 2004 p. 11)
 Pattern manifestations include “a person`s experiences, expressions, perceptions and physical, mental, social & spiritual data (Davidson, 2001 p. 103)
Pandimensional
 A nonlinear domain without spatial or temporal attributes
 The parameters in language that humans use to describe events are arbitrary
 The present is relative, there is no temporal ordering of lives
Synergy
 The unique behavior of hole systems, unpredicted by any behaviors of their component functions taken separately.
 Human behavior is synergistic
Principles Of Homeodynamics
 Homeodynamics should be understood as a dynamic version of HOMEOSTASIS (a relatively steady state of internal operation in the living system)
 The principles of Homeodynamics postulate the way of perceiving unitary human beings
 The 3 principles of Homeodynamics as proposed by Rogers are:
1. Resonancy
 Speaks to the nature of the change occurring between human & environmental fields that undergoes continuous dynamic metamorphosis
in the human-environment process.
 The life process of human beings is a symphony of rhythmical vibrations oscillating at various frequencies.
 Is continuous change from lower to higher frequency wave patterns in human and environmental fields
2. Helicy
 unpredictable but continuous, nonlinear evolution of energy fields as evidenced by nonrepeating rhythmicities due to constant
interchange between human & the environment
 innovative; because of constant interchange, an open system is never exactly the same at any two moments; rather, the system is
continually new or different
 The life process evolves in sequential stages along a curve that has the same general shape
 Is continuous innovative, unpredictable, increasing diversity of human & environmental field patterns
3. Integrality
 Is a continuous mutual human & environment field process
 Change occurs by continuous repatterning of the of the human & environmental fields by resonance waves
 The fields are one and integrated but unique to each other
ASSUMPTION
 Man is a unified whole possessing his own integrity & manifesting characteristics that are more than & different from the sum of his parts
 Man & environment are continuously exchanging matter & energy with one another
 The life process evolves irreversibly & unidirectional along the space-time continuum
 Pattern & organization identify the man & reflect his innovative wholeness
 Man is characterized by the capacity for abstraction and imagery, language & thought sensation & emotion
STRENGTHS
 Martha Rogers concepts provide a worldview from which nurses may derive theories & hypotheses & propose relationships specific to different
situations
 Rogers` theory is not directly testable due to lack of concrete hypotheses but it is testable in principle
LIMITATIONS
 Rogers` model does not define particular hypotheses or theories for it is an abstract, unified & highly derived framework
 Testing the concepts` validity is questionable because its concepts are not directly measurable
 The theory was believed to be profound & was too ambitious because the concepts are extremely abstract
 Rogers claimed that nursing exists to serve people, however, nurses roles are not clearly defined
 The purpose of nurses is to promote health & well-being for all persons. However, Rogers` model has no concrete definition of a health state.
APPLICATION
 allows nurses to operate from a place of scientific assurance in the work they do, all the while maintaining focus on the patient they work with
 is a useful model for addressing the growing issue of nursing burnout, which is known to cause increase rates of morbidity & mortality in the clinical
setting.
 Rogers` theory had a strong impact on health & nursing , Rogers helped improve patient centered nursing practice
KING`S CONCEPTUAL SYSTEMS FRAMEWORK & GOAL ATTAINMENT THEORY & TRANSACTIONAL PROCESS
 During her early high school years, she decided to pursue her career in teaching, however, her uncle, the town surgeon, offered to pay her
tuition pay to nursing school
 She accepted the offer and seeing nursing school as a way to escape life in a small town. Thus, began her remarkable career in nursing.
 After receiving her diploma in 1945, she worked in a variety of staff nurse roles
DATE EVENT PLACE
1945 Diploma in Nursing St. John`s Hospital School of
Nursing in St. Louis, Missouri
1947-1958 she worked as an instructor in St/ John`s Hospital School of
Medical-Surgical nursing and Nursing.
was an Assistant Director
1961-1966 develop a master` degree Loyala University in Chicago
program in nursing based on a
nursing conceptual framework
1964 Her 1st theory journal “Nursing
Science”, which nurse Theorist
Martha Rogers edited
1968 to 1972 King served as the Director of Ohio State University in
the School of Nursing Columbus
1972 Returned as a professor Loyola University graduate
program
1972 to 1975 King was a member of the
Defense Advisory Committee
on Women in the service for the
U.S. Department of Defense.
1978 to 1980 Coordinator of Research in Loyola Medical Center
Clinical Nursing Department of Nursing
1975 to 1979 also elected as “alderman” for a Ward 2 at Wood Dale, Illinois
4-year term
 In 1980, King was appointed as a professor at the University of South Florida College of Nursing, in Tampa. She continued to provide a
community service to help plan care through her conceptual system and theory at various health care organizations.
 King earned recognition as a “nurse theorist” through the publication of “Toward a Theory for Nursing: General Concepts of Human
Behavior” in 1971 and “A Theory for Nursing: Systems, Concepts, Process” in 1981, as well as numerous articles related to her conceptual
system and a theory of goal attainment.
 In 1981, the manuscript of her 2nd book, “A Theory for Nursing: Systems, Concepts, Process” was published.
 In addition to her first 2 books, she authored multiple book chapters & articles in professional journals.
 In 1986, her 3rd book, “Curriculum & Instruction in Nursing: Concepts & Process” was published.
 In 1994, King was inducted into the American Academy of Nursing (AAN) & served as AAN Theory of Expert Panel.
 In 1996, she received a Jessie M. Scott Award
 In 1997, King received a Gold Medallion from Gov. Chiles for advancing the nursing profession in the state of Florida.
 In May 1998, she received an honorary doctorate from Loyola University, where her “Nursing Collection” was housed.
 In 1999, King was inducted into the Teachers College, Columbia University Hall of Fame.
 In 2004, she was inducted into the FNA Hall of Fame and the ANA Hall of Fame and as a Living Legend in 2005.
 Despite of her many awards & honors, she considered teaching students to be her important accomplishment. Over the years she enjoyed
watching her nursing students become expert practitioners, teachers & researchers.
 Imogene King died on December 24, 2007, 2 days after suffering from stroke (84 years old)
OVERVIEW OF IMOGENE KING`S “CONCEPTUAL MODEL & THEORY OF GOAL ATTAINMENT
 King`s concepts focus on the methods of a nurse-client communication and working together toward mutually selected goals to help nurses
in the nurse-patient relationship.
 She used a “systems approach” in the development of her systems framework & her subsequent Goal Attainment Theory.
 The “Goal Attainment Theory refers to the 3 interacting systems:
1. Individual or personal
2. Group or interpersonal
3. Society or social
 This theory pertains to the importance of interaction, perception, communication, transaction, self, role, stress, growth & development, time
& personal space.
KING’S THEORY OF GOAL ATTAINMENT
 PERSONAL SYSTEM (INDIVIDUAL)
o The concepts of personal systems are: perception, self, growth & development, body image, space & time.
o These concepts are fundamentals in understanding human being because these refers to how the nurse views & integrates self
from personal goals & beliefs.
o Among the listed concepts, the most important is “perception” because it influences behavior.
o King summarized the connections among these concepts as “An individual perception of self, of body image, of time, of space
that influences the way a person responds to object & events in one`s life.
o As an individual person grow & develop the lifespan experiences with changes in structure & function of their bodies overtime,
this influences the perception of their self.
o Personal systems are individuals, who are regarded as rational, sentient, social beings.
o Concepts related to the personal systems are:
o Perception: a process of organizing, interpreting & transforming information from sense data & memory that gives meaning to
one`s experiences, represents one`s image of reality & influences one`s behavior.
o Self: a composite of thoughts & feelings that constitute a person`s awareness of individual existence, of who they are & what
they are.
o Growth & Development: cellular, molecular & behavioral changes in human beings that are a function of genetic endowment,
meaningful & satisfying experiences & an environment conducive to helping individuals move toward maturity.
o Body Image: a person`s perception of their body
o Time: the duration between the occurrence of one event & the occurrence of another event.
o Space: the physical area called territory that exist in all directions.
o Learning: gaining knowledge
 INTERPERSONAL SYSTEM (NURSE-PATIENT DIALOGUE)
o Concepts associated for the interpersonal system are: interaction, communication, transaction, role & stress.
o King refers to the “2 individuals as dyads, 3 as triads & 4 or more individuals as small group or large group.
o This shows how the nurse interrelates with co-worker or patient, particularly in a nurse-patient relationship.
o Communication between the nurse & the patient can be verbal or non-verbal.
o Collaboration between dyads (nurse-patient) is very important for the attainment of the goal
o Interactions: the acts of 2 or more persons in mutual presence; a sequence of verbal & non-verbal behaviors that are goal directed.
o Communication: the vehicle by which human relations are developed & maintained; encompasses intrapersonal, interpersonal,
verbal & non-verbal communication.
o Transaction: a process of interaction in which human beings communicate with the environment to achieve goals that are valued;
goal-directed human behaviors
o Role: a set of behaviors expected of a person occupying a position in a social system.
o Stress: a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development &
performance, involving an exchange of energy & information between the person & the environment for regulation and control
of stressors.
o Coping: a way of dealing with stress
 SOCIAL SYSTEM (THE FAMILY, THE SCHOOL & THE CHURCH)
o This shows how the nurse interacts with co-workers, superiors, subordinates and the client`s environment in general
o These are groups of people within the community or society that shares a common goals, values & interest
o It provides a framework for social interaction & relationships & establishes rules of behavior & courses of action
o Are organized boundary systems of social roles, behaviors, & practices developed to maintain values & the mechanism to
regulate the practices & roles.
o Organization: composed of human beings with prescribed roles & positions who use resources to accomplish personal &
organizational goals
o Authority: a transactional process characterized by active, reciprocal relations in which member`s values, backgrounds &
perceptions play a role in defining, validating & accepting the authority of individuals within an organization.
o Power: the process whereby one or more persons influence other persons in a situation.
o Status: the position of an individual in a group or a group in relation to other groups in an organization.
o Decision Making: a dynamic & systematic process by which goal-directed choice of perceived alternatives is made & acted upon
by individuals or groups to answer a question & attain a goal.
o Control: being in-charge
 Among the 3 systems, the conceptual framework of interpersonal system had the greatest influence on the development of her theory.
 King stated that “although personal systems & social systems influence quality of care, the major elements in a theory of goal attainment
are discovered in the interpersonal systems in which 2 people, who are usually strangers to each other, come together in a health care
organization to help & to be helped to maintain a state of health that permits functioning in roles. “
 Originated from the elements or concepts in her Interacting Systems Framework but it focuses on the Interpersonal Systems & the
interactions, communications & transactions between 2 individuals (the nurse & the patient)
 The essence of her theory is that the nurse & the patient come together, communicate & make transactions – they set goals & work to
achieve the goals set.
 Each of them had purpose, they perceive, judge, act & react upon each other. At the end of their communication, a goal will be set & with
these transactions will be made.
 King believed that the goal of nursing is to “help individuals maintain their health so they can function in their roles (King, 1981),
transactions occur to set goals related to the health of the patient.
 She proposed that through mutual goal setting & goal attainment, transactions result in enhanced growth and development for the client.
 King used 10 major concepts from the personal and interpersonal systems to support the Theory of Goal Attainment.
 These concepts include: human interactions, perception, communication, role, stress, time, space, growth & development and transactions.
MAJOR CONCEPTS OF IMOGENE KING`S THEORY OF GOAL ATTAINMENT
HUMAN BEING
 Individuals are social beings who are rational & sentient.
 Humans communicate their thoughts, actions, customs & beliefs through language
 Persons exhibit common characteristics such as the ability to perceive, to think, to feel, to choose between alternative courses of action, to
set goals, to select the means to achieve goals & to make decisions.
HEALTH
 Is a dynamic life experience of a human being, which implies continuous adjustment to stressors in the internal & external environment
through optimum use of one`s resources to achieve maximum potential for daily living.
ENVIRONMENT
 Is the background for human interactions
 It is both external to and internal to the individual
NURSING
 Is a action, reaction and interaction whereby nurse & client share information about their perceptions in the nursing situation.
 The nurse & client share specific goals, problems, concerns & explore means to achieve a goal.
ASSUMTIONS OF THE THEORY
 The focus of nursing is the care of the human being (patient).
 The goal of nursing is health care of both individuals and groups.
 Human beings are open systems interacting with their environments constantly.
 The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic assumption
of the nursing process.
 Patients perceive the world as a complete person making transactions with individuals and things in the environment.
 Transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It also represents a life
situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences.
STRENGTHS
 A major strong point of King’s conceptual system and Theory of Goal Attainment is the ease with which it can be understood by nurses.
 The theory of goal attainment also does describe a logical sequence of events.
 For most parts, concepts are concretely defined and illustrated.
 King’s definitions are clear and are conceptually derived from research literature. Her Theory of Goal Attainment presents ten major
concepts, and the concepts are easily understood and derived from research literature, which clearly establishes King’s work as important
for knowledge building in the discipline of nursing.
LIMITATIONS OF THE THEORY
 Theory of Goal Attainment has been criticized for having limited application in areas of nursing in which patients are unable to interact
competently with the nurse. King maintained the broad use of the theory in most nursing situations.
 Another limitation relates to the lack of development of application of the theory in providing nursing care to groups, families, or
communities.
 King’s theory also contains some inconsistencies: (1) She indicates that nurses are concerned about the health care of groups but
concentrates her discussion on nursing as occurring in a dyadic relationship. (2) King says that the nurse and client are strangers, yet she
speaks of their working together for goal attainment and of the importance of health maintenance.
APPLICATION TO NURSING PRACTICE, EDUCATION & RESEARCH
 Professionals have used King’s theory in different specialized area with the use of dynamic, interactive communication between the
nurse and the client as proof.
 The Goal Oriented Nursing Records (GNOR) that King developed have been useful in documenting the outcomes of care that was
performed by nurses.
 It helps nurses to easily facilitate the present problem from careful assessment of the client gathered through the interactive
communication process between the nurse and the client. Her record management facilitates proper and correct range for the use of
education system.
 The significance of King’s theory has been applied to different professional practice setting such as in nursing administration, theory –
based practice in the emergency department, in tertiary hospitals and in the community.
 King’s interacting system has been used to design the nursing curriculum in different schools and universities and framework for
nursing education.
 It provides a systematic means of viewing the nursing profession, organizing nursing knowledge and clarifying the nursing discipline
 King’s theory has been one of the theoretical bases of some researches that helped in formulating a system view of the application of
the nursing practice.
 Some research have formulated a middle range theory out of King’s theory out of King’s theory such as patient’s satisfaction from
nursing care, clients with chronic illness and family health.
 The theory can also help set a framework for nursing studies which can further prove the use and advantages of the nursing practice.
NEUMAN`S SYSTEMS MODEL
BETTY NEUMAN SYSTEMS MODEL

 Describes the Neuman Systems Model as “a unique, open-system-based perspective that provides a unifying focus for approaching a wide range of
concerns.
 A system acts as a boundary for a single client, a group, or even a number of groups; it can also be defined as a social issue.
 A client system in interaction with the environment that delineates the domain of nursing concerns.”
 The Neuman Systems Model views the client as an open system that responds to stressors in the environment.
 The client variables are physiological, psychological, sociocultural, developmental, and spiritual
 The client system consists of a basic or core structure that is protected by lines of resistance.
 The usual level of health is identified as the normal line of defense that is protected by a flexible line of defense.
 Stressors are intrapersonal, interpersonal and extra personal in nature and arise from the internal, external, and created environments. When stressors
break through the flexible line of defense, the system is invaded and the lines of resistance are activated and the system is described as moving into
illness on a wellness-illness continuum.
 If adequate energy is available, the system will be reconstituted with the normal line of defense restored at, below, or above its previous level.
 Nursing interventions occur through three prevention modalities. Primary, secondary and tertiary.
 Since 1960, Betty has been recognized as a pioneer in the field of nursing, particularly in the area of community mental health
 She developed her model while lecturing in community mental health at UCLA & 1 st published in 1972 under the title “A Model for Teaching the Total
Person Approach to patient Problems” (Neuman & Fawcett, 2011).
 Since that time she has been the prolific writer& her model has been used extensively in colleges of nursing, beginning with Neumann College`s
baccalaureate nursing program in Aston, Pennsylvania.
 Neuman`s model uses a systems approach that is focused on the human needs of protection or relief from stress (Neuman & Fawcett, 2011)
 Neuman believed that the causes of stress can be identified & remedied through nursing interventions
 She emphasized the need of humans for dynamic balance that the nurse can provide through identification of problems, mutually agreeing on goals, &
using the concept of prevention as intervention.
 Neuman`s model is one of only a few considered prescriptive in nature. The model is universal, abstract & applicable for individuals from many
cultures (Neuman & Fawcett, 2011).
 Betty Neuman was born on September 11, 1924 near Lowell, Ohio. She grew up on a farm which later encouraged her to help people who are in need.
 Her father was a farmer who became sick and died at the age of 36. Her mother was a self-educated midwife, that led the young Neuman to be always
influenced by the commitment that took her away from home from time to time.
 She had one older brother and a brother who was younger which makes her the middle child among her siblings.
 Her love for nursing started when she took the responsibility of taking care of her father which later created her compassion in her chosen career path.
 During World War II, she had her first job as an aircraft instrument technician.
 In 1947, she received her RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio.
 Betty Neuman moved to California and worked in a variety of capacities as a hospital nurse and head nurse at Los Angeles County General
Hospital, school nurse, industrial nurse, and clinical instructor at the University of Southern California Medical Center, Los Angeles.
 In 1957, she received a baccalaureate degree in public health and psychology with honors.
 Amidst her hectic life as a nurse, she also managed to work as a fashion model and learned to fly a plane.
 She got married, supported her husband’s medical practice, and had their daughter in 1959.
 She earned a master’s degree in mental health, public health consultation in 1966 from the University of California, Los Angeles (UCLA).
 After her graduation, she was hired as a department chair in the UCLA School of Nursing graduate program.
 Neuman developed the first community mental health program for graduate students in the LA area from 1967 to 1973.
 In 1985, Betty Neuman concluded a doctoral degree in clinical psychology at Pacific Western University.
 She was a pioneer of nursing involvement in mental health.
 She and Donna Aquilina were the first two nurses to develop the nurse counselor role within community crisis centers in Los Angeles.
 Neuman persisted to start a private practice as a marriage and family therapist, specializing in Christian counseling.
 She is a Fellow of the American Association of Marriage and Family Therapy and of the American Academy of Nursing.
 Until 2009, she was the director of the Neuman Systems Model Trustees Group, Inc. that she established in 1988, and still attends as a consultant.
 The Trustees Group was created to preserve and maintain the message of her nursing theory for the health care community.
 In 1970, Betty Neuman designed a nursing conceptual model to expand students’ understanding of client variables beyond the medical model.
 Her teaching programs at UCLA paved the way for developing her nursing model. During those times, she did not write a book but made her concepts
known to Joan Riehl-Sisca and Sr. Callista Roy and incorporated them in their 1971 book, Conceptual Models for Nursing Practice.
 In 1972, Neuman published a draft of her model. She developed and improved the concepts and published her book, The Neuman System Model:
Application to Nursing Education and Practice, in 1982. Further revisions were made in later editions.
 As a speaker and author, she spent countless hours teaching and explaining the many concepts and aspects of the model to students and professors.
 Neuman has also been involved in numerous publications, paper presentations, consultations, lectures, and conferences on application and use of the
model.
 She worked as a consultant nationally and internationally concerning the implementation of the model for nursing education programs and for clinical
practice facilities.
 Betty Neuman has done many things including a nurse, educator, health counselor, therapist, author, speaker, and researcher.
 Throughout the years, she earned many awards and honors including several honorary doctorates and was an honorary member of the American
Academy of Nursing.
 The profound effect of her work on the nursing profession is well known throughout the world.
 Honorary Doctorate of Letters, Neumann College, Aston, PA (1992), Honorary Member of the Fellowship of the American Academy of Nursing
(1993), Honorary Doctorate of Science, Grand Valley State University, Michigan (1998)
 She was honored by President Richard Jusseaume and Provost Dr. Laurence Bove with the Walsh University Distinguished Service Medal, which is
awarded to those who have contributed outstanding professional or voluntary service to others within the national, regional or local community.
 In an annual Nursing Research Day sponsored by Walsh’s Phi Eta Chapter of Sigma Theta Tau, Byers School of Nursing Dean Dr. Linda Linc granted
Neuman with the first annual Neuman Award, named in her honor, for outstanding service in the nursing profession.
INFLUENCES ON HER THEORY
 A nursing theory developed by Betty Neuman is based on the person’s relationship to stress, the response to it, and reconstitution factors that are
progressive in nature.
 She explained that her conceptual model was the result of her observations during her clinical experiences in mental health nursing as well as from
synthesis of knowledge from several theoretical sources.
 The foundations of Neuman’s model are primarily Selye’s stress theory, Von Bertalanffy’s General Systems Theory, and De Chardin’s philosophy of
Life.
 These perspectives support the idea that a holistic viewpoint of humans is crucial.
MAJOR CONCEPTS OF THE THEORY
HUMAN BEING
 Human being is viewed as an open system that interacts with both internal and external environment forces or stressors.
 The human is in constant change, moving toward a dynamic state of system stability or toward illness of varying degrees.
HEALTH
 In Neuman’s nursing theory, Health is defined as the condition or degree of system stability and is viewed as a continuum from wellness to illness.
 When system needs are met, optimal wellness exists. When needs are not satisfied, illness exists. When the energy needed to support life is not
available, death occurs.
ENVIRONMENT
 The environment is a vital arena that is germane to the system and its function.
 The environment may be viewed as all factors that affect and are affected by the system.
 In Neuman Systems Model identifies three relevant environments: (1) internal, (2) external, and (3) created.
 The internal environment exists within the client system. All forces and interactive influences that are solely within boundaries of the client system
make up this environment.
 The external environment exists outside the client system.
 The created environment is unconsciously developed and is used by the client to support protective coping.
NURSING
 The primary concern of nursing is to define the appropriate action in situations that are stress-related or in relation to possible reactions of the client or
client system to stressors.
 Nursing interventions are aimed at helping the system adapt or adjust and to retain, restore, or maintain some degree of stability between and among the
client system variables and environmental stressors with a focus on conserving energy.
KEY CONCEPTS OF THE THEORY
OPEN SYSTEM
 A system in which there is a continuous flow of input and process, output and feedback.
 It is a system of organized complexity, where all elements are in interaction.
BASIC STRUCTURE & ENERGY RESOURCES
 The basic structure, or central core, is made up of those basic survival factors common to the species and represent basic client system energy resources
 These factors include the system variables, genetic features, and strengths and weaknesses of the system parts.
CLIENT VARIABLES
 Neuman views the individual client holistically and considers the variables simultaneously and comprehensively.
 The physiological variable refers to the structure and functions of the body.
 The psychological variable refers to mental processes and relationships.
 The sociocultural variable refers to system functions that relate to social and cultural expectations and activities.
 The developmental variable refers to those processes related to development over the lifespan.
 The spiritual variable refers to the influence of spiritual beliefs.
FLEXIBLE LINE OF DEFENSE

 A protective accordion-like mechanism that surrounds and protects the normal line of defense from invasion by stressors.
NORMAL LINE OF DEFENSE
 An adaptational level of health developed over time and considered normal for a particular individual client or system; it becomes a standard for
wellness-deviance determination.
LINES OF RESISTANCE
 Protection factors activated when stressors have penetrated the normal line of defense, causing a reaction symptomatology.
STRESSORS
 A stressor is any phenomenon that might penetrate both the flexible and normal lines of defense, resulting in either a positive or negative outcome.
1. Intrapersonal stressors are those that occur within the client system boundary and correlate with the internal environment.
2. Interpersonal stressors occur outside the client system boundary, are proximal to the system, and have an impact on the system.
3. Extra personal stressors also occur outside the client system boundaries but are at a greater distance from the system that are interpersonal
stressors. An example is social policy.
STABILITY
 A state of balance or harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of
health thus preserving system integrity.
DEGREE OF REACTION
 The amount of system instability resulting from stressor invasion of the normal line of defense.
ENTROPY
 A process of energy depletion and disorganization moving the system toward illness or possible death.
NEGENTROPY
 A process of energy conservation that increases organization and complexity, moving the system toward stability or a higher degree of wellness.
INPUT/OUTPUT
 The matter, energy, and information exchanged between the client and environment that is entering or leaving the system at any point in time.
RECONSTITUTION
 The return and maintenance of system stability, following treatment of stressor reaction, which may result in a higher or lower level of wellness.
PREVENTION AS INTERVENTION
 Intervention modes for nursing action and determinants for entry of both client and nurse into the health care system.
 Primary prevention occurs before the system reacts to a stressor; it includes health promotion and maintenance of wellness. Primary prevention focuses
on strengthening the flexible line of defense through preventing stress and reducing risk factors. This intervention occurs when the risk or hazard is
identified but before a reaction occurs. Strategies that might be used include immunization, health education, exercise, and lifestyle changes.
 Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing symptoms. Secondary prevention focuses on
strengthening the internal lines of resistance and, thus, protects the basic structure through appropriate treatment of symptoms. The intent is to regain
optimal system stability and to conserve energy in doing so. If secondary prevention is unsuccessful and reconstitution does not occur, the basic
structure will be unable to support the system and its interventions, and death will occur.
 Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Its purpose is to maintain wellness or protect the
client system reconstitution through supporting existing strengths and continuing to preserve energy. Tertiary prevention may begin at any point after
system stability has begun to be reestablished (reconstitution has begun). Tertiary prevention tends to lead back to primary prevention. (Neuman, 1995)
STRENGTHS OF THE THEORY
 The major strength of the Neuman Systems Model is its flexibility for use in all areas of nursing – administration, education, and practice.
 Neuman has presented a view of the client that is equally applicable to an individual, a family, a group, a community, or any other aggregate.
 The Neuman Systems Model, particularly presented in the model diagram, is logically consistent.
 The emphasis on primary prevention, including health promotion, is specific to this model.
 Once understood, the Neuman Systems Model is relatively simple, and has readily acceptable definitions of its components.
 The major weakness of the model is the need for further clarification of terms used.
 Interpersonal and extra personal stressors need to be more clearly differentiated.
 With Neuman’s System Model, nursing practice became unified and holistic in approach.
 The model can be applicable in addressing the problem of an individual, family, community or the society in different settings.
 This model can help nurses to formulate an approach that can prevent and alleviate the client’s condition. It is also applicable in organizing a
framework to plan care at primary, secondary, and tertiary levels of prevention of health care facilities.
 With its holistic approach, it has been applicable in the academe used both by nursing students and educators.
 As the model demonstrated effectiveness in conceptual transition among levels of nursing education, it has formed a basis for continuing study after
graduation thus facilitating growth of nursing knowledge and practice as it is integrated in the nursing curriculum
 Neuman’s model has been one of the widely used framework used in nursing research as it guides the enhancement of nursing care. Nursing research
expanded the use of the model in hospital, health clinics, community and school.
SISTER CALLISTA ROY ADAPTATION MODEL

 Sister Callista Roy, a member of the Sisters of Saint Joseph of Carondelet, was born on October 14, 1939, in Los Angeles, California.
 She received a bachelor’s degree in nursing in 1963 from Mount Saint Mary’s College in Los Angeles and a master’s degree in nursing from the
University of California, Los Angeles, in 1966.
 After earning her nursing degrees, Roy began her education in sociology, receiving both a master’s degree in sociology in 1973 and a doctorate degree
in sociology in 1977 from the University of California.
 While working toward her master’s degree, Roy was challenged in a seminar with Dorothy E. Johnson to develop a conceptual model for nursing.
 While working as a pediatric staff nurse, Roy had noticed the great resiliency of children and their ability to adapt in response to major physical and
psychological changes.
 Roy was impressed by adaptation as an appropriate conceptual framework for nursing.
 Roy developed the basic concepts of the model while she was a graduate student at the University of California, Los Angeles, from 1964 to 1966.
 Roy began operationalizing her model in 1968 when Mount Saint Mary’s College adopted the adaptation framework as the philosophical foundation of
the nursing curriculum.
CAREER MILESTONES
 Roy was an associate professor and chairperson of the Department of Nursing at Mount Saint Mary’s College until 1982.
 She was promoted to the rank of professor in 1983 at both Mount Saint Mary’s College and the University of Portland. She helped initiate and taught in
a summer master’s program at the University of Portland.
 From 1983 to 1985, she was a Robert Wood Johnson postdoctoral fellow at the University of California, San Francisco, as a clinical nurse scholar in
neuroscience.
 She conducted research on nursing interventions for cognitive recovery in head injuries and on the influence of nursing models on clinical decision
making.
 In 1987, Roy began the newly created position of nurse theorist at Boston College School of Nursing
BOOKS & WORKS PUBLISHED
 Roy has published many books, chapters, and periodical articles and has presented numerous lectures and workshops focusing on her nursing
adaptation theory (Roy & Andrews, 1991).
 The refinement and restatement of the Roy Adaptation Model is published in her 1999 book, The Roy Adaptation Model (Roy & Andrews, 1999).
ACHIEVEMENTS & AWARDS
 Received the National Founder’s Award for Excellence in Fostering Professional Nursing Standards in 1981.
 Received an Honorary Doctorate of Humane Letters from Alverno College (1984), honorary doctorates from Eastern Michigan University (1985) and
St. Joseph’s College in Maine (1999)
 Received American Journal of Nursing Book of the Year Award for Essentials of the Roy Adaptation Model (Andrews & Roy, 1986).
 Roy has been recognized as:
o The World Who’s Who of Women (1979);
o Personalities of America (1978);
o Fellow of the American Academy of Nursing (1978);
o Recipient of a Fulbright Senior Scholar Award from the Australian American Educational Foundation (1989), )
 Received the Martha Rogers Award for Advancing Nursing Science from the National League for Nursing (1991).
 Received the Outstanding Alumna award and the prestigious Carondelet Medal from her alma mater, Mount Saint Mary’s.
 The American Academy of Nursing honored Roy for her extraordinary life achievements by recognizing her as a Living Legend (2007), named a
Living Legend by the American Academy of Nursing and the Massachusetts Registered Nurses Association.
 2010 – Inductee, Sigma Theta Tau International Nurse Researcher Hall of Fame
 2010 – “Sixty Who have Made a Difference”, UCLA School of Nursing, 6th Anniversary
 2010 – Inducted to Nurse Researcher Hall of Fame, Inaugural Class, Sigma Theta Tau International, Honor Society of Nursing
 2010 – University of Southern Alabama Picture Gallery of Theorist, University of Alabama
 2011 – The Sigma Mentor Award, Sigma Theta Tau International Alpha Chi Chapter
 2011 – Faculty Senior Scientist Poster Exemplar Award, Yvonne L. Munn Center for Nursing Research and the Nursing Research Expo Committee,
Massachusetts General Hospital
 2011 – Nursing Science Quarterly Special Issue Honoring the work of Callista Roy, Vol. 24, Num. 4, Oct. 2011
 2013 – Excellence in Nursing, The University of Antioquia, Medellin Colombia
 2013 – Alumni Award for Professional Achievement, UCLA
 2013 – Honorary Doctoral Degree, Holy Family University
 2013 – Distinguished Graduate Award, Bishop Conaty/Our Lady of Loretto High School
 Roy’s model was conceived when nursing theorist Dorothy Johnson challenged her students during a seminar to develop conceptual models of nursing.
Johnson’s nursing model was the impetus for the development of Roy’s Adaptation Model.
 Roy’s model incorporated concepts from Adaptation-level Theory of Perception from renown American physiological psychologist Harry Helson,
Ludwig von Bertalanffy’s System Model, and Anatol Rapoport’s system definition.
THEORETICAL SOURCES
 Roy combined Helson’s work with Rapoport’s definition of system to view the person as an adaptive system.
 With Helson’s adaptation theory as a foundation, Roy (1970) developed and further refined the model with concepts and theory from Dohrenwend,
Lazarus, Mechanic, and Selye.
 Roy gave special credit to co-authors Driever, for outlining subdivisions of self-integrity, and Martinez and Sato, for identifying common and primary
stimuli affecting the modes.
MAJOR CONCEPTS OF THE THEORY
PERSON
 “Human systems have thinking and feeling capacities, rooted in consciousness and meaning, by which they adjust effectively to changes in the
environment and, in turn, affect the environment.”
 Based on Roy, humans are holistic beings that are in constant interaction with their environment. Humans use a system of adaptation, both innate and
acquired, to respond to the environmental stimuli they experience. Human systems can be individuals or groups, such as families, organizations, and
the whole global community.
HEALTH
 “Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them in a competent way.”
 Health is defined as the state where humans can continually adapt to stimuli. Because illness is a part of life, health is the result of a process where
health and illness can coexist. If a human can continue to adapt holistically, they will be able to maintain health to reach completeness and unity within
themselves. If they cannot adapt accordingly, the integrity of the person can be affected negatively.
ENVIRONMENT
 “The conditions, circumstances and influences surrounding and affecting the development and behavior of persons or groups, with particular
consideration of the mutuality of person and health resources that includes focal, contextual and residual stimuli.”
 The environment is defined as conditions, circumstances, and influences that affect the development and behavior of humans as an adaptive system.
The environment is a stimulus or input that requires a person to adapt. These stimuli can be positive or negative.
 Roy categorized these stimuli as focal, contextual, and residual. Focal stimuli are that which confronts the human system and requires the most
attention. Contextual stimuli are characterized as the rest of the stimuli that present with the focal stimuli and contribute to its effect. Residual
stimuli are the additional environmental factors present within the situation, but whose effect is unclear. This can include previous experience with
certain stimuli.
NURSING
 “[The goal of nursing is] the promotion of adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health, quality
of life, and dying with dignity.”
 In Adaptation Model, nurses are facilitators of adaptation. They assess the patient’s behaviors for adaptation, promote positive adaptation by enhancing
environment interactions and helping patients react positively to stimuli. Nurses eliminate ineffective coping mechanisms and eventually lead to better
outcomes.
ADAPTATION
 Adaptation is the “process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create
human and environmental integration.”
 The person is able to adapt if he is able to cope with the constantly changing environment through two types of system:
1. Regulator
 The regulator subsystem is a person’s physiological coping mechanism. It’s the body’s attempt to adapt via regulation of our bodily processes,
including neurochemical, and endocrine systems.
2. Cognator
 The cognator subsystem is a person’s mental coping mechanism.
 A person uses his brain to cope via self-concept, interdependence, and role function adaptive modes.
 The level of adaptation of a person is determined by the combined effect of stimuli which could either be:
 Focal stimuli are those that immediately confront the person e.g. Pricking of the skin during injection
 Contextual stimuli are all other stimuli present or contributing factors in the situation, e.g. inability to explain the procedure and the need for the drug
 Residual stimuli are unknown factors such as beliefs, attitudes, or traits that have an intermediate effect or influence on the present situation, e.g. the
false belief that a patient cannot take a bath after undergoing a procedure such as x – ray
FOUR ADAPTIVE MODES
The four adaptive modes of the subsystem are how the regulator and cognator mechanisms are manifested; in other words, they are the external expressions of
the above and internal processes.
1. Physiologic-Physical Mode
Physical and chemical processes involved in the function and activities of living organisms. These are the actual processes put in motion by the regulator
subsystem.
The basic need of this mode is composed of the needs associated with oxygenation, nutrition, elimination, activity and rest, and protection. The complex
processes of this mode are associated with the senses, fluid and electrolytes, neurologic function, and endocrine function.
2. Self-Concept Group Identity Mode
In this mode, the goal of coping is to have a sense of unity, meaning, the purposefulness in the universe, as well as a sense of identity integrity. This
includes body image and self-ideals.
3. Role Function Mode
This mode focuses on the primary, secondary and tertiary roles that a person occupies in society, and knowing where he or she stands as a member of society, e.g.
role of a mother, father…
4. Interdependence Mode
This mode focuses on attaining relational integrity through the giving and receiving of love, respect and value. This is achieved with effective communication
and relations.
LEVELS OF ADPATATION
1. Integrated Process
2. The various modes and subsystems meet the needs of the environment. These are usually stable processes (e.g., breathing, spiritual realization, successful
relationship).
3. Compensatory Process
The cognator and regulator are challenged by the needs of the environment, but are working to meet the needs (e.g., grief, starting with a new job, compensatory
breathing).
4. Compromised Process
The modes and subsystems are not adequately meeting the environmental challenge (e.g., hypoxia, unresolved loss, abusive relationships).
ASSUMPTIONS OF THE THEORY
SCIENTIFIC ASSUMPTIONS
 Systems of matter and energy progress to higher levels of complex self-organization.
 Consciousness and meaning are constructive of person and environment integration.
 Awareness of self and environment is rooted in thinking and feeling.
 Humans by their decisions are accountable for the integration of creative processes.
 Thinking and feeling mediate human action.
 System relationships include acceptance, protection, and fostering of interdependence.
 Persons and the earth have common patterns and integral relationships.
 Persons and environment transformations are created in human consciousness.
 Integration of human and environment meanings results in adaptation.
PHILOSOPHICAL ASSUMPTIONS
 Persons have mutual relationships with the world and God.
 Human meaning is rooted in the omega point convergence of the universe.
 God is intimately revealed in the diversity of creation and is the common destiny of creation.
 Persons use human creative abilities of awareness, enlightenment, and faith.
 Persons are accountable for the processes of deriving, sustaining, and transforming the universe.
 The Adaptation Model of Callista Roy suggests the influence of multiple causes in a situation, which is a strength when dealing with multi-faceted
human beings.
 The sequence of concepts in Roy’s model follows logically. In the presentation of each of the key concepts, there is the recurring idea of adaptation to
maintain integrity. Every concept was operationally defined.
 The concepts of Roy’s model are stated in relatively simple terms.
 A major strength of the model is that it guides nurses to use observation and interviewing skills in doing an individualized assessment of each person.
The concepts of Roy’s model are applicable within many practice settings of nursing.
DOROTHY JOHNSON`S BEHAVIORAL SYSTEMS MODEL

 Dorothy Johnson was born on August 21, 1919 in Savannah, Georgia.
 She was the youngest of seven children.
 Her father was the superintendent of a shrimp and oyster factory and her mother was very involved and enjoyed reading.
 In 1938, she finished her associate degree in Armstrong Junior College in Savannah, Georgia.
 Due to the Great Depression, she took a year off from school to be a governess, or teacher, for two children in Miami, Florida. This is when she began
to realized her love for children, nursing and education.
 Dorothy Johnson’s professional nursing career began in 1942 when she graduated from Vanderbilt University School of Nursing in in Nashville,
Tennessee. She was the top student in her class and received the prestigious Vanderbilt Founder’s Medal.
 In 1948, she received her Master in public health from Harvard University in Boston, Massachusetts.
 After graduation, Dorothy Johnson’s professional experiences involved mostly teaching, although she was a staff nurse at the Chatham-Savannah
Health Council from 1943 to 1944.
 She was an instructor and an assistant professor in pediatric nursing at Vanderbilt University School of Nursing.
 From 1949 until her retirement in 1978 and her subsequent move to Key Largo, Florida, Johnson was an assistant professor of pediatric nursing, an
associate professor of nursing, and a professor of nursing at the University of California, Los Angeles.
 In 1955 and 1956, Johnson was a pediatric nursing advisor assigned to the Christian Medical College School of Nursing in Vellore, South India. From
1965 to 1967, she served as chairperson on the committee of the California Nurses Association that developed a position statement on specifications for
the clinical specialist.
 Dorothy Johnson was a prolific writer on the subject of nursing theory.
 Her many publications on this subject profoundly influenced theoretical thinking in nursing during the second half of the twentieth century.
 Johnson’s publications include four books, more than 30 articles in periodicals, and many papers, reports, proceedings, and monographs.
 She held a strong conviction that continuing improvement of care was the ultimate goal of nursing.
 Her 1968 paper, entitled, One Conceptual Model of Nursing, is a classic contribution to Nursing literature.
 Two of the many works written by Johnson include: Theory Development: What, Why, How? and Barriers and Hazards in Counseling.
 Of the many honors she received, Dorothy Johnson was proudest of the 1975 Faculty Award from graduate students, the 1977 Lulu Hassenplug
Distinguished Achievement Award from the California Nurses Association, and the 1981 Vanderbilt University School of Nursing Award for
Excellence in Nursing.
 Dorothy Johnson died in February 1999 at the age of 80. Before she died, she was pleased that her theory had been found useful in furthering the
development of a theoretical basis for nursing and was being used as a model for nursing practice on an institution-wide basis, but she reported that her
greatest source of satisfaction came from following the productive careers of her students.
 Johnson’s model was greatly influenced by Florence Nightingale’s book, Notes on Nursing.
 It advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness and stresses the importance of research-based
knowledge about the effect of nursing care on patients.
 Her model was also influenced by observational studies and on child and adult behavioral patterns that were available during the time.
 The General Systems Theory also influenced the development of her model.
MAJOR CONCEPTS
HUMAN BEINGS
 Johnson views human beings as having two major systems: the biological system and the behavioral system. It is the role of medicine to focus on the
biological system, whereas nursing’s focus is the behavioral system.
 The concept of human being 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
 Health is seen as the opposite of illness, and Johnson defines it as “some degree of regularity and constancy in behavior, the behavioral system reflects
adjustments and adaptations that are successful in some way and to some degree… adaptation is functionally efficient and effective.”
ENVIRONMENT
 Environment is not directly defined, but it is implied to include all elements of the surroundings of the human system and includes interior stressors.
NURSING
 Nursing is seen as “an external regulatory force which acts to preserve the organization and integration of the patient’s behavior at an optimal level
under those conditions in which the behavior constitutes a threat to physical or social health, or in which illness is found.”
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 mini system maintained in relationship to the entire system when it or the environment is not disturbed.
STRUCTURE
 The parts of the system that make up the whole.
VARIABLES
 Factors outside the system that influence the system’s behavior, but which the system lacks power to change.
BOUNDARIES
 The point that differentiates the interior of the system from the exterior.
HOMEOSTASIS
 Process of maintaining stability.

STABILITY
 Balance or steady-state in maintaining balance of behavior within an acceptable range.
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.
INSTABILITY
 State in which the system output of energy depletes the energy needed to maintain stability.
SET
 The predisposition to act. It implies that despite having only a few alternatives from which to select a behavioral response, the individual will rank
those options and choose the option considered most desirable.
FUNCTION
 Consequences or purposes of action.
7 SUBSYSTEMS IN JOHNSON`S BEHAVIORAL SYSTEM MODEL
ATTACHMENT OR AFFILIATIVE SUBSYSTEM
 Attachment or affiliative subsystem is the “social inclusion, intimacy and the formation and attachment of a strong social bond.”
 It is probably the most critical because it forms the basis for all social organization.
 On a general level, it provides survival and security.
 Its consequences are social inclusion, intimacy, and the formation and maintenance of a strong social bond
INGESTIVE SUSBSYSTEM
 Is the “emphasis on the meaning and structures of the social events surrounding the occasion when the food is eaten.”
 It should not be seen as the input and output mechanisms of the system.
 All subsystems are distinct subsystems with their own input and output mechanisms.
 The ingestive subsystem “has to do with when, how, what, how much, and under what conditions we eat.”
ELIMINATIVE SUBSYSTEM
 Eliminative subsystem states that “human cultures have defined different socially acceptable behaviors for excretion of waste, but the existence of such
a pattern remains different from culture to culture.”
 It addresses “when, how, and under what conditions we eliminate.”
 As with the ingestive subsystem, the social and psychological factors are viewed as influencing the biological aspects of this subsystem and may be, at
times, in conflict with the eliminative subsystem.
SEXUAL SUBSYSTEM
 Sexual subsystem is both a biological and social factor that affects behavior.
 It has the dual functions of procreation and gratification.
 Including, but not limited to, courting and mating, this response system begins with the development of gender role identity and includes the broad
range of sex-role behaviors.
AGGRESSIVE SUBSYSTEM
 Aggressive subsystem relates to the behaviors concerning protection and self-preservation, generating a defense response when there is a threat to life
or territory.
 Its function is protection and preservation.
 Society demands that limits be placed on modes of self-protection and that people and their property be respected and protected.
ACHIEVEMENT SUBSYSTEM
 Achievement subsystem provokes behavior that tries to control the environment.
 It attempts to manipulate the environment.
 Its function is control or mastery of an aspect of self or environment to some standard of excellence.
 Areas of achievement behavior include intellectual, physical, creative, mechanical, and social skills.
 NOTE: an eight subsystem, restorative is added. The restorative subsystem is concerned with rest, sleep, comfort/freedom from pain
 Each subsystem has three functional requirements namely:
3. The system must be protected from toxic influences with which the system cannot cope.
4. Each system has to be nurtured through the input of appropriate supplies from the environment.
5. The system must be stimulated for use to enhance growth and prevent stagnation.
 Each subsystem comprises four structural characteristics:
Goal – based on universal drive
1. Set – a tendency to act in a certain way in a given situation
2. Choice – refers to the alternate behaviors the person considers in any given situation.
3. Action – the observable behavior of the person
 There is “organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up the system.”
 A system “tends to achieve a balance among the various forces operating within and upon it, and that man strive continually to maintain a behavioral
system balance and steady state by more or less automatic adjustments and adaptations to the natural forces occurring on him.”
 A behavioral system, which requires and results in some degree of regularity and constancy in behavior, is essential to man. It is functionally
significant because it serves a useful purpose in social life as well as for the individual.
 “System balance reflects adjustments and adaptations that are successful in some way and to some degree.”
 Dorothy Johnson’s theory guides nursing practice, education, and research; generates new ideas about nursing; and differentiates nursing from other
health professions.
 It has been used in inpatient, outpatient, and community settings as well as in nursing administration. It has always been useful to nursing education and
has been used in practice in educational institutions in different parts of the world.
 Another advantage of the theory is that Johnson provided a frame of reference for nurses concerned with specific client behaviors. It can also be
generalized across the lifespan and across cultures.
 The theory is potentially complex because there are a number of possible interrelationships among the behavioral system, its subsystems, and the
environment. Potential relationships have been explored, but more empirical work is needed.
 Johnson’s work has been used extensively with people who are ill or face the threat of illness. However, its use with families, groups, and communities
is limited.
 Though the seven subsystems identified by Johnson are said to be open, linked, and interrelated, there is a lack of clear definitions for the
interrelationships among them which makes it difficult to view the entire behavioral system as an entity.
 The problem involving the interrelationships among the concepts also creates difficulty in following the logic of Johnson’s work.
APPLICATIONS TO NURSING PRACTICE EDUCATION & RESEARCH
 The Johnson Behavioral System Model was used to develop a self – report and observational instrument to be carried out with the nursing process. The
implementation of the instrument provided a more comprehensive and organized step to assessment and intervention, thereby increasing patient and
nurse satisfaction with care
 A core curriculum based on a person as a behavioral system would have definite goals and clear course of planning.
 Nursing research according to Johnson is vital to explain and identify the behavioral system disorders which arise in relation with illness, and develop
good reasoning for the means of management.
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP
INTRODUCTION
 Hildegard Peplau’s Interpersonal Relationship Theory emphasized the nurse-client relationship as the foundation of nursing practice.
 It gave emphasis on the give-and-take of nurse-client relationships that was seen by many as revolutionary.
 Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively
receiving treatment and the nurse passively acting out doctor’s orders.
 Hildegard Peplau’s was an American nurse who is the only one to serve the American Nurses Association (ANA) as Executive Director and later as
President.
 She became the first published nursing theorist since Florence Nightingale.
 Peplau was well-known for her Theory of Interpersonal Relations, which helped to revolutionize the scholarly work of nurses.
 Her achievements are valued by nurses all over the world and became known to many as the “Mother of Psychiatric Nursing” and the “Nurse of the
Century.”
 She was the second daughter, having two sisters and three brothers.
 Though illiterate, her father was persevering while her mother was a perfectionist and oppressive.
 With her young age, Peplau’s eagerness to grow beyond traditional women’s roles was precise.
 She considers nursing was one of few career choices for women during her time.
 After graduation, she worked as a staff nurse in her place and in New York City.
 A summer position as a nurse for the New York University summer camp led to a recommendation for Peplau to become the school nurse at
Bennington College in Vermont, where she earned a Bachelor’s degree in interpersonal psychology in 1943.
 Peplau’s lifelong work was largely focused on extending Sullivan’s interpersonal theory for use in nursing practice.
 She studied psychological issues together with Erich Fromm, Frieda Fromm-Reichmann, and Harry Stack Sullivan at Chestnut Lodge, a private
psychiatric hospital in Maryland.
 She met and worked with all the leading figures in British and American psychiatry.
 After the war, Peplau was at the table with many of these same men as they worked to reshape the health system in the United States through the
passage of the National Mental Health Act of 1946.
 She was certified in psychoanalysis by the William Alanson White Institute of New York City.
DATE EVENT PLACE
September 1, 1909 born & was raised by her Reading, Pennsylvania
parents of German descent,
Gustav and Otyllie Peplau.
1918 she witnessed the devastating
flu epidemic that greatly
influenced her understanding
on the impact of illness and
death on families.
1931 Graduated Pottstown, Pennsylvania
School of Nursing.
1947 Peplau held her master’s and Teachers College, Columbia
doctoral degrees University.
1943-1945 Served in Army Nurse Corps was assigned to the 312th
Field Station Hospital. in
England, where the American
School of Military Psychiatry
was located
early 1950s she developed and taught the at Teachers College.
first batch of graduates in
psychiatric nursing students
1954-1974 (retirement) Peplau was a member of the the College of Nursing at
faculty. Rutgers University
professor emerita
 At Rutgers University, she created the first graduate level program for the preparation of clinical specialists in psychiatric nursing.
 She was a prolific writer and was equally well known for her presentations, speeches, and clinical training workshops.
 Peplau vigorously advocated that nurses should become further educated so they could provide truly therapeutic care to patients rather than the
custodial care that was prevalent in the mental hospitals of that era.
 During the 1950s and 1960s, she supervised summer workshops for nurses throughout the United States, mostly in state psychiatric hospitals.
 In these seminars, she taught interpersonal concepts and interviewing techniques, as well as individual, family, and group therapy.
 Peplau was an advisor to the World Health Organization and was a visiting professor at universities in Africa, Latin America, Belgium, and
throughout the United States.
 A strong advocate for graduate education and research in nursing, Peplau served as a consultant to the U.S. Surgeon General, the U.S. Air Force,
and the National Institute of Mental Health.
 She participated in many government policy making groups.
 Peplau was devoted to nursing education at full length of her career.
 After her retirement from Rutgers, she served as a visiting professor at the University of Leuven in Belgium in 1975 and 1976. There she helped
establish the first graduate nursing program in Europe.
 She was the only nurse who served the ANA as executive director and later as president, she served two terms on the Board of the International
Council of Nurses (ICN).
 And as a member of the New Jersey State Nurses Association, she actively contributed to the ANA by serving on various committees and task
forces.
 Her fifty-year career in nursing left an unforgettable mark on the field and on the lives of the mentally challenged in the United States.
 During the peak of her career, she became the founder of modern psychiatric nursing, an innovative educator, advocate for the mentally ill,
proponent of advanced education for nurses, Executive Director and then President of the ANA and prolific author.
 And just like any other famous personalities, her life was often marked with controversy, which she faced with boldness, prowess and conviction.
PUBLISHED BOOKS AND WORK
1. Interpersonal Relations In Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing
2. Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau
3. Basic principles of patient counseling: Extracts from two clinical nursing workshops in psychiatric hospitals
4. A Glance Back in Time:
 An article from Nursing Forum, On Semantics (psychiatric nursing):
 An article from: Perspectives in Psychiatric Care, The Psychiatric Nurse–Accountable? To Whom? For What?
 An article from: Perspectives in Psychiatric Care, and Psychotherapeutic Strategies
 An article from: Perspectives in Psychiatric Care.
 Peplau was acknowledged with numerous awards and honors for her contributions to nursing and held 11 honorary degrees.
 She was awarded honorary doctoral degrees from universities including: Alfred, Duke, Indiana, Ohio State, Rutgers, and the University of Ulster in
Ireland.
 She was named one of “50 Great Americans” in Who’s Who in 1995 by Marquis.
 She was also elected fellow of the American Academy of Nurse and Sigma Theta Tau, the national nursing honorary society.
AWARDS AND HONOR
 In 1996, the American Academy of Nursing honored Peplau as a “Living Legend.”
 She received nursing’s highest honor, the “Christiane Reimann Prize,” at the ICN Quadrennial Congress in 1997. This award is given once every four
years for outstanding national and international contributions to nursing and healthcare.
 And, in 1998, the ANA inducted her into its Hall of Fame.
 On March 17, 1999, Peplau died peacefully in her sleep at her home in Sherman Oaks, California.
INFLUENCES OF THE THEORY
 Peplau’s theory was the first nursing theory to borrow concepts from other disciplines.
 The theory was influenced by the Psychoanalytic theory of Freud, Maslow’s Hierarchy of Needs and Sullivan’s theory of Interpersonal Relationship
MAJOR CONCEPTS OF PEPLAU`S THEORY
PERSON
 A developing organism that tries to reduce anxiety caused by needs
 An individual is made of physiological, psychological and social spheres striving towards equilibrium in life
HEALTH
 Peplau didn't include an exact definition of health within her model.
 Peplau viewed health as "a word symbol that implied forward movement of personality and other ongoing human processes in the direction of creative,
constructive, productive, personal, and community living.
ENVIRONMENT
 Being and occurring in the context of the nurse client relationship
 Existing forces outside of the individual
NURSING
 “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to
recognize, respond to the need for help.”
 It is a “maturing force and an educative instrument” involving an interaction between two or more individuals with a common goal
 In nursing, this common goal provides the incentive for the therapeutic process in which the nurse and patient respect each other as individuals, both of
them learning and growing as a result of the interaction.
 An individual learns when she or he selects stimuli in the environment and then reacts to these stimuli.
 A significant therapeutic interpersonal process
KEY CONCEPT OF PEPLAU`S THEORY
THERAPEUTIC NURSE-CLIENT RELATIONSHIP
 A professional and planned relationship between client and nurse that focuses on the client’s needs, feelings, problems, and ideas.
 The attainment of this goal, or any goal, is achieved through a series of steps following a sequential pattern.
4 PHASES OF THE THERAPEUTIC NURSE-CLIENT RELATIONSHIP
1. ORIENTATION PHASE
 The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and
answering questions.
 Problem defining phase
 Starts when the client meets nurse as a stranger
 Defining problem and deciding the type of service needed
 Client seeks assistance, conveys needs, asks questions, shares preconceptions and expectations experiences
 Nurse responds, explains roles to the client, helps to identify problems and to use available services
2. IDENTIFICATION PHASE
 The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger.
 Selection of appropriate professional assistance
 Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and
hopelessness
3. EXPLOITATION PHASE
 In this phase, the client makes full use of the services offered.
 Use of professional assistance for problem-solving alternatives
 Advantages of services are used is based on the needs and interests of the patients
 The individual feels like an integral part of the helping environment
 They may make minor requests or attention-getting techniques
 The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem
 Patient may fluctuate on independence
 Nurse must be aware of the various phases of communication
 Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step
4. RESOLUTION PHASE
 In the resolution phase, the client no longer needs professional services and gives up dependent behavior. The relationship ends.
 Termination of professional relationship
 The patient’s needs have already been met by the collaborative effect of patient and nurse
 Now they need to terminate their therapeutic relationship and dissolve the links between them.
 Sometimes may be difficult for both as psychological dependence persists
 Patient drifts away and breaks the bond with the nurse and healthier emotional balance is demonstrated and both becomes mature individuals.
 Peplau’s model has proved of great use to later nurse theorists and clinicians in developing more sophisticated and therapeutic nursing
interventions
ROLES OF THE NURSE IN THE THERAPEUTIC RELATIONSHIP IDENTIFIED BY PEPLAU:
 STRANGER
 Offering the client the same acceptance and courtesy that the nurse would to any stranger
 RESOURCE PERSON
 Providing specific answers to questions within a larger context
 TEACHER
 Helping the client to learn formally or informally
 LEADER
 Offering direction to the client or group
 SURROGATE
 Serving as a substitute for another such as a parent or a sibling
 COUNSELOR
 Promoting experiences leading to health for the client such as expression of feelings
 TECHNICAL EXPERT
 Providing physical care for the patient and operates equipment
 Peplau also believed that the nurse could take on many other roles but these were not defined in detail. However, they were “left to the intelligence and
imagination of the readers.”
 ADDITIONAL ROLES INCLUDE:
 Consultant
 Health teacher
 Tutor
 Socializing agent
 Safety agent
 Manager of environment
 Mediator
 Administrator
 Recorder observer
 Researcher
ANXIETY
 Another concept of Peplau and is defined as the initial response to a psychic threat. There are four levels of anxiety described below.
 4 LEVELS OF ANXIETY
1. MILD ANXIETY
 Is a positive state of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems.
The person can take in all available stimuli (perceptual field).
2. MODERATE ANXIETY
 Involves a decreased perceptual field (focus on immediate task only); the person can learn a new behavior or solve problems only
with assistance. Another person can redirect the person to the task.
3. SEVERE ANXIETY
 Involves feelings of dread and terror.
 The person cannot be redirected to a task; he or she focuses only on scattered details and has physiologic symptoms of tachycardia,
diaphoresis, and chest pain.
4. PANIC ANXIETY
 Can involve loss of rational thought, delusions, hallucinations, and complete physical immobility and muteness. The person may
bolt and run aimlessly, often exposing himself or herself to injury.
1. Nurse and the patient can interact.
2. Peplau emphasized that both the patient and nurse mature as the result of the therapeutic interaction.
3. Communication and interviewing skills remain fundamental nursing tools.
4. Peplau believed that nurses must clearly understand themselves to promote their client’s growth and to avoid limiting the client’s choices to those that
nurses’ value.
 Peplau’s theory helped later nursing theorists and clinicians develop more therapeutic interventions regarding the roles that show the dynamic character
typical in clinical nursing.
 Its phases provide simplicity regarding the natural progression of the nurse-patient relationship, which leads to adaptability in any nurse-patient
interaction, thus providing generalizability.
LIIMITATION
 Though Peplau stressed the nurse-client relationship as the foundation of nursing practice, health promotion, and maintenance were less emphasized.
 Also, the theory cannot be used in a patient who doesn’t have a felt need such as with withdrawn patients.
 Peplau’s ideas paved way for integrating other scientific disciplines into nursing especially in formulating the paradigm of psychiatric nursing in early
days.
 As it became apparent that nursing practice is its true value could only be accomplished through starting and strengthening the nurse – patient
relationship, many clinicians now believe that it’s in the interest of the profession and of the patient to utilize her Interpersonal Model extensively.
 In Psychiatric Nursing, Peplau’s Interpersonal Model is used in counselling women undergoing depression.
 Because of the maintained and strengthened nurse – patient relationship, women were able to describe patterns that resulted from their negative
thinking and independently found strategies to manage them.
 Hildegard Peplau’s book, Interpersonal Relations in Nursing is being used as a manual of instruction to help graduate nurses and nursing students alike
in creating a significant nurse – patient relationship.
 Her theoretical ideas, particularly her views of nursing and nursing process, the psychodynamic theory, and her prescribed methods, have been an
essential part of the collective culture of the nursing profession
 When Peplau’s model was slowly integrated into research, research has shifted to perspectives within the social system as newer studies indicate that
broader relationships could also affect a person in many ways.
ORLANDO`S THEORY OF DELIBERATIVE NURSING PROCESS
INTRODUCTION
 Ida Jean Orlando developed her Deliberative Nursing Process that allow nurses to formulate an effective nursing care plan that can also be easily
adapted when & if any complexity comes up with a patient.
 Her theory stresses the reciprocal relationship between patient & nurse.
 It emphasizes the critical importance of the patient`s participation in the nursing process
 Orlando also considered nursing as a distinct profession & separated it from medicine when nurses as determining nursing action rather than being
prompted by physician`s orders, organizational needs & past personal experiences
 She believed that physician`s orders are for patients and not for nurses
 She proposed that “patients have their own meanings & interpretations of situations & therefore nurses must validate their inferences &
analysis with patients before drawing conclusions”
 Ida Jean Orlando was a first - generation Irish American born on August 12, 1926.
 She dedicated her life studying nursing and graduated in 1947 and received a Bachelor of Science degree in public health nursing in 1951.
 In 1954, she completed her Master of Arts in Mental Health consultation. While studying she also worked intermittently and sometimes concurrently as
a staff nurse in OB, MS, ER; as a supervisor in a general hospital, and as an assistant director and a teacher of several courses.
 And in 1961, she was married to Robert Pelletier and lived in the Boston area.
 As for being a respectable and credible role-model, Orlando was well educated with many advanced degrees in nursing.
 In 1947, she received a diploma in nursing from the Flower Fifth Avenue Hospital School of Nursing in New York.
 In 1951, she received a Bachelor of Science degree in public health nursing from St. John’s University in Brooklyn, New York.
 And in 1954, Orlando received her Master of Arts degree in mental health consultation from Teachers College, Columbia University
 Ida Jean Orlando had a diverse career, working as a practitioner, consultant, researcher, and educator in nursing.
 Orlando devoted her life to mental health and psychiatric nursing, working as a clinical nurse and researcher.
 After receiving her master’s degree in 1954, Orlando went to the Yale University School of Nursing in New Haven, Connecticut as an associate
professor of mental health and psychiatric nursing for eight years.
 She was awarded a federal grant and became a research associate and the principal project investigator of a National Institute of Mental health Institute
of the United States Public Health Service’s grant entitled “Integration of Mental Health Concepts in a Basic Curriculum.”
 The project sought to identify those factors relevant to the integration of psychiatric-mental health principles into the nursing curriculum.
 During 1958-1961, Orlando, as an associate professor and the director of the graduate program in mental health and psychiatric nursing at Yale
University, used her proposed conceptual nursing model as the foundation for the curriculum of the program.
 From 1962-1972, Orlando served as a clinical nurse consultant at Mclean Hospital in Belmont, Massachusetts.
 In this position, she studied the interactions of nurses with clients, other nurses and other staff members and how these interactions affected the process
of the nurse’s help to clients.
 Orlando convinced the administration that an educational program for nurses was needed, whereupon Mclean Hospital initiated an educational program
based on her nursing model.
 From 1972 to 1984, she also served on the board of the Harvard Community Health Plan in Boston, Massachusetts.
 In 1981, Orlando became an educator at Boston University School of Nursing and held administrative positions from 1984 to 1987 at Metropolitan
State Hospital in Waltham, Massachusetts.
 In September 1987, she became the Assistant director of Nursing for Education and Research at the said institution.
 She was also a project consultant for the Mental Health Project for Associate Degree Faculties created by the New England Board of Higher Education.
 Finally in 1992, Orlando retired and received the Nursing Living Legend award by the Massachusetts Registered Nurse Association.
PUBLISHED BOOKS & WORKS
 After working as a researcher, she wrote a book on her findings from Yale, entitled “The Dynamic Nurse-Patient Relationship: Function, Process, and
Principles.” Her book was published in 1961.
 A year later, she also continued her research studies published her second book “The Discipline and Teaching of Nursing Process” in 1972.
 Ida Jean Orlando retired from nursing in 1992.
 After becoming well-educated, researching over 2,000 nurse-patient interactions, and coming up with a theory that changed nursing, she was
recognized as a “Nursing Living Legend” by the Massachusetts Registered Nurse Association.
 Ida Jean Orlando died on November 28, 2007 at the age of 81.
 Ida Jean Orlando developed her theory from a study conducted at the Yale University School of Nursing, integrating mental health concepts into a
basic nursing curriculum.
 She proposed that “patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses
with patients before drawing conclusions.”
MAJOR CONCEPTS OF ORLANDO`S THEORY
 The nursing metaparadigm consists of four concepts: person, environment, health, and nursing.
 Of the four concepts, Ida Jean Orlando only included three in her theory of Nursing Process Discipline: person, health, and nursing.
HUMAN BEING
 Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of the nurse-patient relationship.
 For her, humans in need are the focus of nursing practice.
HEALTH
 In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity for nursing.
 She stated that nursing deals with individuals who are in need of help.
ENVIRONMENT
 Orlando completely disregarded environment in her theory, only focusing on the immediate need of the patient, chiefly the relationship and actions
between the nurse and the patient (only an individual in her theory; no families or groups were mentioned).
 The effect that the environment could have on the patient was never mentioned in Orlando’s theory.
NURSING
 Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help in an immediate situation.
 The efforts to meet the individual’s need for help are carried out in an interactive situation and in a disciplined manner that requires proper training.
KEY CONCEPTS OF ORLANDO`S THEORY
FUNCTION OF PROFESSIONAL NURSING
 The function of professional nursing is the organizing principle. This means that finding out and meeting the patient’s immediate needs for help.
 According to Orlando, nursing is responsive to individuals who suffer, or who anticipate a sense of helplessness.
 It is focused on the process of care in an immediate experience, and is concerned with providing direct assistance to a patient in whatever setting they
are found in for the purpose of avoiding, relieving, diminishing, or curing the sense of helplessness in the patient.
 The Nursing Process Discipline Theory labels the purpose of nursing to supply the help a patient needs for his or her needs to be met.
 That is, if the patient has an immediate need for help, and the nurse discovers and meets that need, the purpose of nursing has been achieved.
PRESENTING BEHAVIOR
 Is the patient’s problematic situation.
 Through the presenting behavior, the nurse finds the patient’s immediate need for help.
 To do this, the nurse must first recognize the situation as problematic.
 Regardless of how the presenting behavior appears, it may represent a cry for help from the patient.
 The presenting behavior of the patient, which is considered the stimulus, causes an automatic internal response in the nurse, which in turn causes a
response in the patient.
DISTRESS
 The patient’s behavior reflects distress when the patient experiences a need that he cannot resolve, a sense of helplessness occurs.
IMMEDIATE REACTION
 The immediate reaction is the internal response.
 The patient perceives objects with his or her five senses.
 These perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act.
 These three items are the patient’s immediate response.
 The immediate response reflects how the nurse experiences his or her participation in the nurse-patient relationship.
NURSE REACTION
The patient behavior stimulated a nurse reaction, which marks the beginning of the nursing process discipline.
NURSE`S ACTION
 When the nurse acts, an action process transpires.
 This action process by the nurse in a nurse-patient contact is called nursing process.
 The nurse’s action may be automatic or deliberative.
AUTOMATIC NURSING ACTIONS
 Are nursing actions decided upon for reasons other than the patient’s immediate need.
DELIBERATIVE NURSING ACTIONS
 Are actions decided upon after ascertaining a need and then meeting this need
THE FOLLOWING LISTS IDENTIFIES THE CRITERIA FOR DELIBERATIVE ACTIONS:
 Deliberative actions result from the correct identification of patient needs by validation of the nurse’s reaction to patient behavior.
 The nurse explores the meaning of the action with the patient and its relevance to meeting his need.
 The nurse validates the action’s effectiveness immediately after completing it.
 The nurse is free of stimuli unrelated to the patient’s need when she acts.
NURSING PROCESS DISCIPLINE
 Is the investigation into the patient’s needs.
 Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his or her need, or finding out he or she has no
needs at that time.
 The nurse cannot assume that any aspect of his or her reaction to the patient is correct, helpful, or appropriate until he or she checks the validity of it by
exploring it with the patient.
 The nurse initiates this exploration to determine how the patient is affected by what he or she says and does.
 Automatic reactions are ineffective because the nurse’s action is determined for reasons other than the meaning of the patient’s behavior or the patient’s
immediate need for help.
 When the nurse doesn’t explore the patient’s reaction with him or her, it is reasonably certain that effective communication between nurse and patient
stops.
 The nurse decides on an appropriate action to resolve the need in cooperation with the patient.
 This action is evaluated after it is carried out.
 If the patient behavior improves, the action was successful and the process is completed. If there is no change or the behavior gets worse, the process
recycles with new efforts to clarify the patient’s behavior or the appropriate nursing action.
 The action process in a person-to-person contact functioning in secret. The perceptions, thoughts, and feelings of each individual are not directly
available to the perception of the other individual through the observable action.
 The action process in a person-to-person contact functioning by open disclosure. The perceptions, thoughts, and feelings of each individual are directly
available to the perception of the other individual through the observable action.
IMPROVEMENT
 Improvement is the resolution to the patient’s situation.
 In the resolution, the nurse’s actions are not evaluated.

 Instead, the result of his or her actions are evaluated to determine whether his or her actions served to help the patient communicate his or her need for
help and how it was met.
 In each contact, the nurse repeats a process of learning how he or she can help the patient.
 The nurse’s own individuality, as well as that of the patient, requires going through this each time the nurse is called upon to render service to those
who need him or her.
5 STAGES OF DELIBERATIVE NURSING PROCESS
1. ASSESSMENT
 In the assessment stage, the nurse completes a holistic assessment of the patient’s needs.
 This is done without taking the reason for the encounter into consideration.
 The nurse uses a nursing framework to collect both subjective and objective data about the patient.
2. DIAGNOSIS
 The diagnosis stage uses the nurse’s clinical judgment about health problems.
 The diagnosis can then be confirmed using links to defining characteristics, related factors, and risk factors found in the patient’s assessment.
3. PLANNING
 The planning stage addresses each of the problems identified in the diagnosis.
 Each problem is given a specific goal or outcome, and each goal or outcome is given nursing interventions to help achieve the goal.
 By the end of this stage, the nurse will have a nursing care plan.
4. IMPLEMENTATION
 stage, the nurse begins using the nursing care plan.
5. EVALUATION
 In the evaluation stage, the nurse looks at the progress of the patient toward the goals set in the nursing care plan.
 Changes can be made to the nursing care plan based on how well (or poorly) the patient is progressing toward the goals.
 If any new problems are identified in the evaluation stage, they can be addressed, and the process starts over again for those specific problems.
ASSUMPTIONS OF ORLANDO`S THEORY
 When patients are unable to cope with their needs on their own, they become distressed by feelings of helplessness.
 In its professional character, nursing adds to the distress of the patient.
 Patients are unique and individual in how they respond.
 Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child.
 The practice of nursing deals with people, environment, and health.
 Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency needs.
 People are able to be secretive or explicit about their needs, perceptions, thoughts, and feelings.
 The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse and the patient.
 People attach meanings to situations and actions that aren’t apparent to others.
 Patients enter into nursing care through medicine.
 The patient is unable to state the nature and meaning of his or her distress without the help of the nurse, or without him or her first having established a
helpful relationship with the patient.
 Any observation shared and observed with the patient is immediately helpful in ascertaining and meeting his or her need, or finding out that he or she is
not in need at that time.
 Nurses are concerned with the needs the patient is unable to meet on his or her own.
STRENGTHS OF ORLANDO`S THEORY
 The guarantee that patients will be treated as individuals is very much applied in Orlando’s theory of Deliberative Nursing Process. Each patient will
have an active and constant input into their own care.
 Assertion of nursing’s independence as a profession and her belief that this independence must be based on a sound theoretical framework.
 The model also guides the nurse to evaluate her care in terms of objectively observable patient outcomes.
LIMITATIONS OF ORLANDO`S THEORY
 The lack of the operational definitions of society or environment was evident which limits the development of research hypothesis.
 Orlando’s work focuses on short term care, particularly aware and conscious individuals an
 Therapeutic effectiveness of nurses in rendering care
 Nurses quick decision making & critical thinking skills most especially in special areas
TRAVELBEE`S HUMAN TO HUMAN RELATIONSHIP
INTRODUCTION
 JOYCE TRAVELBEE developed the Human-to-Human Relationship Model presented in her book Interpersonal Aspects of Nursing (1966,1971)
 She dealt with interpersonal aspects of nursing
 She explains “human-to-human relationship is the means through which the purpose of nursing is fulfilled”
 Travelbee believed that nursing is accomplished through human-to-human relationships that begin with the original encounter & the progress through
stages of emerging identities, developing feelings of empathy & later feelings of sympathy.
 Travelbee`s ideas have greatly influenced the hospice movement in the west.
 Joyce Travelbee was born on December 14, 1926 in Louisiana, USA.
 She is known for her work as a nursing theorist.
 In 1956, Travelbee earned her Bachelor of Science in Nursing degree from Louisiana State University.
 She was given a Master of Science in Nursing degree in 1959 from Yale University.
 Her career dealt predominantly with psychiatric nursing and education.
 She worked as a psychiatric nursing instructor at the DePaul Hospital Affiliate School in New Orleans, Louisiana, and worked later in the Charity
Hospital School of Nursing in Louisiana State University, New York University, and the University of Mississippi.
 She died in 1973 at the age of 47.
INFLUENCES ON THE THEORY OF TRAVELBEE
 The assumptions of the model are based on Soren Kierkegaard’s philosophy of existentialism and Viktor Frankl’s logotherapy.
 Existentialism places the accountability for people’s choices in life on the people who make those choices.
 Logotherapy, which was first proposed in Frankl’s Man’s Searching for Meaning (1963), is a form of psychotherapy that makes the assumption that
fulfillment is the best protection against emotional instability.
MAJOR CONCEPTS
PERSON
 Person is defined as a human being. Both the nurse and the patient are human beings.
HEALTH
Health is subjective and objective.
 Subjective health is an individually defined state of well - being in accord with self-appraisal of physical-emotional-spiritual status while Objective
health is an absence of discernible disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual
director or psychological counselor.
ENVIRONMENT
 Is not clearly defined.
NURSING
 “An interpersonal process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with experience or
illness and suffering, and if necessary, to find meaning in these experiences.”
KEY CONCEPTS
 Travelbee believed nursing is accomplished through human-to-human relationships that begin with the original encounter and then progress through
stages of emerging identities, developing feelings of empathy, and later feelings of sympathy.
 The nurse and patient attain a rapport in the final stage.
 For meeting the goals of nursing, it is a prerequisite to achieving a genuine human-to-human relationships.
 This relationship can only be established by an interaction process. It has five phases:
1. The inaugural meeting or original encounter
2. Visibility of personal identities/ emerging identities.
3. Empathy
4. Sympathy
5. Establishing mutual understanding and contact/ rapport
 Other concepts of the nursing theory are suffering, meaning, nursing, hope, communications, self-therapy, and a targeted intellectual approach. Each of
these concepts is defined by Travelbee to help nurses understand the model.
 Suffering ranges from a feeling of unease to extreme torture, and varies in intensity, duration, and depth.
 The role of nursing in Travelbee’s theory is to help the patient find meaning in the experience of suffering, as well as help the patient maintain hope.
 Hope is defined as a faith that can and will bring change that will bring something better with it. It has six characteristics:
1. It is strongly associated with dependence on other people.
2. It is oriented with the future.
3. It is linked to elections from several alternatives or escape routes out of its situation.
4. The desire to possess any object or condition, to complete a task or have an experience.
5. Confidence that others will be there for one when you need them.
6. The hoping person is in possession of courage to be able to acknowledge its shortcomings and fears and go forward toward its goal
 Travelbee’s theory has a wide scope of application.
 It seems to be working with
 Patients in distress and life changing events, and with those who are chronically ill, those undergoing rehabilitation and the dying and terminally ill.
 The definition of Travelbee’s theory are not consistent in clarity and origin.
 She had more focus on adult individuals who are sick and the nurse’s role in helping them find meaning in sickness and suffering.
APPLICATION TO NURSING PRACTICE
 Travelbee's theory has significantly influenced nursing and health care and the hospice movement in the west.
Hall's CORE, CARE, CURE
INTRODUCTION
 The Care, Cure, Core Theory of Nursing was developed by Lydia Hall, who used her knowledge of psychiatry and nursing experiences in the Loeb
Center as a framework for formulating the theory.
 It contains three independent but interconnected circles: the core, the care, and the cure.
 The focus of the nurse’s role is on the care circle. This is where she acts as a professional in order to help the patient meet his or her needs and attain a
sense of balance.
 Lydia Eloise Hall (September 21, 1906 – February 27, 1969) was a nursing theorist who developed the Care, Cure, Core model of nursing. Her theory
defined Nursing as “a participation in care, core and cure aspects of patient care, where CARE is the sole function of nurses, whereas the CORE and
CURE are shared with other members of the health team.”
 She was an innovator, motivator, and mentor to nurses in all phases of their careers and an advocate for chronically ill patients and worked to involve
the community in public health issues as well.
 Lydia Hall was born on September 21, 1906 in New York City as Lydia Eloise Williams. She was the eldest child of Louis V. Williams and Anna
Ketterman Williams and was named after her maternal grandmother. Her brother, Henry, was several years younger. At a young age, her family
decided to move to York, Pennsylvania, where her father was a physician in general practice.
Education
 Lydia Hall graduated from York Hospital School of Nursing in 1927 with a diploma in nursing. However, she felt as if she needed more education. She
entered Teacher’s College at Columbia University in New York and earned a Bachelor of Science degree in public health nursing in 1932. After a
number of years in clinical practice, she resumed her education and received a master’s degree in the teaching of natural life sciences from Columbia
University in 1942. Later, she pursued a doctorate and completed all of the requirements except for the dissertation.
 In 1945, she married Reginald A. Hall who was a native of England.
Care, Cure, Core Theory
 Lydia Hall used her knowledge of psychiatry and nursing experiences in the Loeb Center as a framework for formulating her theory. Also known as
“the Three Cs of Lydia Hall,” it contains three independent but interconnected circles: the core, the care, and the cure.
 The core is the patient receiving nursing care. The core has goals set by him or herself rather than by any other person, and behaves according to his or
her feelings and values.
 The cure is the attention given to patients by medical professionals. Hall explains in the model that the cure circle is shared by the nurse with other
health professionals, such as physicians or physical therapists. These are the interventions or actions geared toward treating the patient for whatever
illness or disease he or she is suffering from.
 The care circle addresses the role of nurses, and is focused on performing the task of nurturing patients. This means the “motherly” care provided by
nurses, which may include comfort measures, patient instruction, and helping the patient meet his or her needs when help is needed.
 Hall’s theory emphasizes the total patient rather than looking at just one part and depends on all three components of the theory working together.
Death
 Hall died on February 27, 1969, at Queens Hospital in New York. Genrose Alfano continued her work at the Loeb Center until the focus of the center
was changed to that of custodial care in 1985
PUBLISHED BOOKS & WORKS

 Aside from being a nurse, Lydia Hall also managed to balance her time in writing. In the 1960s, she authored 21 publications and a bulk of articles
regarding the Loeb Center and her theories of long-term care and chronic disease control. Her work was presented in “Nursing: What Is It?” in The
Canadian Nurse. In 1969, it was discussed in “The Loeb Center for Nursing and Rehabilitation” in the International Journal of Nursing Studies. In her
innovative work at the Loeb Center, Hall argued that a need exists in society for the provision of hospital beds grouped into units that focus on the
delivery of therapeutic nursing. The Loeb plan has been seen in many ways as similar to what later emerged as “primary nursing.”
AWARDS & HONORS
 1967 - Lydia Hall received the Teacher’s College Nursing Education Alumni Association (TCNEAA) Achievement in Nursing Practice Award
 1967 - also was their Nursing Hall of Fame inductee
 1984 - She was inducted into the American Nurses Association (ANA) Hall of Fame.
 Hall did not consider herself as a nurse theorist, but instead talked about her views of nursing care as she learned it over the years with the influence of
Lilian Wald, Carl Rogers, John Dewey, and many others (Tomey, 1995).
 Hall felt that care represented the nurturing influence of the professional nurse and was exclusive to nursing.
 From her experience at Loeb Center, she developed her care cure core framework which also emerged formally as the model upon when rehabilitative
care was based
MAJOR CONCEPTS
 The following the major concepts of Lydia Hall’s Care, Core, Cure nursing theory including their definitions.
INDIVIDUAL/PERSON
 Hall's work focus in nursing care is the individual human who is 16 years of age or older and past the acute stage of long-term illness.
 The source of energy and motivation for healing is the individual care recipient, not the health care provider. -Hall emphasizes the importance of the
individual as unique, capable of growth and learning, and requiring a total person approach.
HEALTH
 Health can be inferred to be a state of self-awareness with a conscious selection of behaviors that are optimal for that individual.
 Hall stresses the need to help the person explore the meaning of his or her behavior to identify and overcome problems through developing self-identity
and maturity.
SOCIETY AND ENVIRONMENT
 The concept of society or environment is dealt with in relation to the individual. -Hall is credited with developing the concept of Loeb Center because
she assumed that the hospital environment during treatment of acute illness creates a difficult psychological experience for the ill individual.
 Loeb Center focuses on providing an environment that is conducive to self-development.
 In such a setting, the focus of the action of the nurses is the individual, so that any actions taken in relation to society or environment are for the
purpose of assisting the individual in attaining a personal goal.
NURSING
 Hall identified Nursing as consisting of participation in the care, core, and cure aspects of patient care.
KEY CONCEPTS
BEHAVIOR
 Hall broadly defines behavior as everything that is said or done. Behavior is dictated by feelings both conscious and unconscious
REFLECTION
 Reflection is a Rogerian method of communication in which selected verbalizations of patients is repeated back to them with different phraseology to
invite them to explore feelings further.
SELF-AWARENESS
 Self-awareness refers to the state of being that nurses endeavor to help their patients achieve. The more self-awareness a person has of their feelings,
the more control they have over their behavior.
SECOND-STAGE ILLNESS
 The patient enters the second phase of medical care once the doctors begin giving only follow up care. Hall defines second-stage illness as a nonacute
recovery phase of illness. This stage is conducive to learning and rehabilitation. The need for medical care is minimal, although the need for nurturing
and learning is great. Therefore, this is the ideal time for wholly professional nursing.
WHOLLY PROFESSIONAL NURSING
 Wholly Professional Nursing implies nursing care given exclusively by professional registered nurses, educated in the behavioral sciences who take the
responsibility and opportunity to coordinate and deliver the total care of their patients. This concept includes the roles of nurturing, teaching and
advocacy in the fostering of healing.
CENTRAL CONCEPTS
CARE
 Care alludes the “hands on”, intimate bodily care aspect of nursing of the patient and implies a comforting, nurturing relationship. While intimate
physical care is given, the patient and the nurse develop a close relationship representing the teaching and learning aspect of nursing. The natural and
biological sciences (the Body).
 Nurturing component of care
 It is exclusive to nursing
 “Mothering”
 Provides teaching and learning activities
 Nurses goal is to “comfort” the patient
 Patient may explore and share feelings with nurse
 Nurse is concerned with intimate bodily care
 Nurse applies knowledge of natural and biological sciences
 Nurse act as potential comforter
CORE
 Core involves the therapeutic use of self in communicating with the patient. The nurse through the use of reflective technique helps the patient clarify
motives and goals, facilitating the process of increasing the patient’s self-awareness. The social sciences (the person).
 Patient care is based on social sciences
 Therapeutic use of self
 Helps patient learn their role is in the healing process
 Patient is able to maintain who they are
 Patient able to develop a maturity level when nurse listens to them and acts as sounding board
 Patient able to make informed decisions
 Emphasis on social, emotional, spiritual and intellectual needs
 Patient makes more rapid progress towards recovery and rehabilitation
CURE
 Cure is the aspect of nursing involved with the administration of medications and treatments. The nurse functions in his role as an investigator and
potential cause of pain related to skills such as injections and dressing changes. Seeing the patient and family through the medical care aspect of
nursing. The pathological and therapeutic sciences (the disease).
 Care based on pathological and therapeutic sciences
 Application of medical knowledge by nurses
 Nurse assisting the doctor in performing tasks
 Nurse is patient advocate in this area
 Nurse is a patient advocate
 Nurses role changes from positive quality to negative quality
 Medical surgical and rehabilitative care
 COPERATE WITH FAMILIES OR CARE GIVERS
ASSUMPTIONS
The assumptions of Hall’s Care, Cure, Core Theory are as follows:
1. The motivation and energy necessary for healing exist within the patient, rather than in the healthcare team.
2. The three aspects of nursing should not be viewed as functioning independently but as interrelated.
3. The three aspects interact, and the circles representing them change size, depending on the patient’s total course of progress.
STRENGTHS
 Lydia Hall’s model appears to be completely and simply logical. Her work may be viewed as the philosophy of nursing.
 The three Cs (care, core and cure) in this theory were unique. In all the circles of the model, the nurse is present, although focus of the nurse’s role is on
the care circle.
LIMITATIONS
 Hall’s Theory of Nursing has a limited generality. Hall’s primarily targets are the adult patients who have passed the acute phase of his or her illness
and have a relatively good chance of rehabilitation. This concept severely limits the application of the theory to a small population of patients of
specific age and stage illness. The theory would be most difficult to apply to infants, small children and comatose patients.
 The function of the nurse in preventive health care and health maintenance is not addressed nor is the nurses’ role in the community health, even
though the model could be adapted.
 Hall viewed the role of nurses as heavily involved in the care and core aspects of patient care. Unfortunately, this concept provides for little interaction
between the nurse and the family, because her theory delineates the family aspect of patients care in the cure circle.
 The only communication technique Hall described in her theory as means to assist patient to self-awareness was reflection. This is very limited
approach to therapeutic communication because not all nurses can effectively use the technique of reflection and it is not always the most effective and
most successful communication tool in dealing patients.

 Care, Cure, Core Nursing Theory is applicable in assessment, planning and implementation of patient care.
 The theory will help Nurses to improve to meet the needs of the patient with better professional nursing care.
 The theory will help the establishment of nurse-patient relationships and so as the collaboration with other health professionals.
ABDELLAH’S 21 NURSING PROBLEMS THEORY
INTRODUCTION
 Abdellah’s model describes concerns of nursing rather than a theory describing relationships among phenomena. Her theory provides a foundation for
determing and organizing nursing care.
 The patient-centered approach to nursing was developed from Abdellah’s practice, and the theory is considered a human needs theory. It was
formulated to be an instrument for nursing education, so it most suitable and useful in that field. The nursing model is intended to guide care in hospital
institutions, but can also be applied to community health nursing, as well.
 Patient- centered Approaches to Nursing is A HUMAN NEEED THEORY – human beings have universal and objective needs for health and autonomy
and a right to their optimal satisfaction.
 Focus on Nursing Education abd Nurse Practice
 The purpose is to guide patient care in the hospital and community settings.
 "Nursing is based on an art and science that mold the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and
ability to help people , sick or well, cope with their health needs." – Abdellah
 Abdellah’s model describes concerns of nursing rather than a theory describing relationships among phenomena. Her theory provides a foundation for
determing and organizing nursing care.
 The patient-centered approach to nursing was developed from Abdellah’s practice, and the theory is considered a human needs theory. It was
formulated to be an instrument for nursing education, so it most suitable and useful in that field. The nursing model is intended to guide care in hospital
institutions, but can also be applied to community health nursing, as well.
 Patient- centered Approaches to Nursing is A HUMAN NEEED THEORY – human beings have universal and objective needs for health and
autonomy and a right to their optimal satisfaction.
 Focus on Nursing Education abd Nurse Practice
 The purpose is to guide patient care in the hospital and community settings.
 Faye Glenn Abdellah is a pioneer in nursing research who developed the “Twenty-One Nursing Problems.” 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.
 She was the first nurse officer to earn the ranking of a two-star rear admiral and the first nurse and the first woman to serve as a Deputy Surgeon
General.
 Was born on March 13, 1919 in New York to a father of Algerian heritage and Scottish mother.
 Her family subsequently moved to New Jersey where she attended high school.
 Years later, on May 6, 1937, the German hydrogen-fueled airship Hindenburg exploded over Lakehurst.
 Abdellah and her brother witnessed the explosion, destruction and the fire subsequent to the ignited hydrogen that killed many people. That
incident became the turning point in Abdellah’s life. It was that time when she realized that she would never again be powerless to assist when
people were in so dire need for assistance. It was at that moment she vowed that she would learn nursing and become a professional nurse. Deputy
Surgeon General Faye G. Abdellah, RN, MA, EdD, died on February 24, 2017, at the age of 97.
PUBLISHED BOOKS & AWARDS
 Lists of some of popular works or most widely held works by Faye G Abdellah
 Preparing Nursing Research for the 21st Century : Evolution, Methodologies, Challenges -has 12 editions published
 New Directions in Patient-Centered Nursing; Guidelines for Systems of Service, Education, and Research -has 9 editions published
 Patient-Centered Approaches to Nursing -has 16 editions published
 The Nursing Shortage : Dynamics and Solutions -has 1 edition published
 Effect of Nurse Staffing on Satisfactions with Nursing Care : A Study of How Omissions in Nursing Services, as Perceived by Patients and Personnel,
are Influenced by the Number of Nursing Hours Available -has 5 editions published
INFLUENCES
 1937- She wanted to be a nurse on the day she saw Hindenburg explode.
 1949 - She spent 40 years in Public Health Service where she first became involved in research, being assigned to perform studies to improve nursing
practices.
 1960 - She was influenced by the desire to promote client-centered comprehensive nursing care.
MAJOR CONCEPTS
 The model has interrelated concepts of health and nursing problems, as well as problem-solving, which is an activity inherently logical in nature.
PERSON
 She describes the recipients of nursing as individuals (and families), although she does not delineate her beliefs or assumptions about the nature of
human beings.
 Abdellah describes people as having physical, emotional, and sociological needs.
 Patient is described as the only justification for the existence of nursing.
HEALTH
 In Patient–Centered Approaches to Nursing, Abdellah describes health as a state mutually exclusive of illness.
 Health, or the achieving of it, is the purpose of nursing services. Although Abdellah does not give a definition of health, she speaks to “total health
needs” and “a healthy state of mind and body.”
SOCIETY AND ENVIRONMENT
 Society is included in “planning for optimum health on local, state, and international levels.” However, as Abdellah further delineates her ideas, the
focus of nursing service is clearly the individual.
 The environment is the home or community from which patient comes.
NURSING
 Nursing is a helping profession.
 Nursing care is doing something to or for the person or providing information to the person with the goals of meeting needs, increasing or restoring
self-help ability, or alleviating impairment.
 Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment.
 Nursing to be comprehensive service.
KEY CONCEPT
ABDELLAH’S TYPOLOGY OF 21 NURSING PROBLEMS
 The 21 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. She used Henderson’s 14 basic human needs and nursing research to establish the
classification of nursing problems. Abdellah’s 21 Nursing Problems are the following:
1. To maintain good hygiene and physical comfort
2. To promote optimal activity: exercise, rest, sleep
3. To promote safety through prevention of accident, injury, or other trauma and through prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformity
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition for all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease conditions—pathologic, physiologic, and compensatory
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement and personal spiritual goals
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs
19. To accept the optimum possible goals in the light of limitations, physical and emotional
20. To use community resources as an aid in resolving problems that arise from illness
21. To understand the role of social problems as influencing factors in the cause of illness
 Needs of patients are further divided into four categories: basic to all patients, sustenal care needs, remedial care needs, and restorative care needs.
BASIC NEEDS
 The basic needs of an individual patient are to maintain good hygiene and physical comfort; promote optimal health through healthy activities, such as
exercise, rest and sleep; promote safety through the prevention of health hazards like 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
 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
 Remedial care needs to 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
 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 resolving problems that arise from illness; and the understanding of the role of social problems as influential factors in the case of
illness.
Abdellah’s work, which is based on the problem-solving method, serves as a vehicle for delineating nursing (patient) problems as the patient moves toward a
healthy outcome. The theory identifies ten steps to identify the patient’s problem and 11 nursing skills used to develop a treatment typology.
 The ten steps 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 or her behavior.
8. Explore the patient and his or her family’s reactions 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 11 nursing skills 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 resources
8. problem-solving
9. direction of work of others
10. therapeutic uses of the self
11. nursing procedure
 Focus of Care Pendulum of Faye Abdellah’s Theory. The nursing-centered orientation to client care seems contrary to the client-centered approach that
Abdellah professes to uphold. The apparent contradiction can be explained by her desire to move away from a disease-centered orientation. In her
attempt to bring nursing practice to its proper relationship with restorative and preventive measures for meeting total client needs, she seems to swing
the pendulum to the opposite pole, from the disease orientation to nursing orientation, while leaving the client somewhere in the middle.
ASSUMPTIONS
 The assumptions Abdellah’s “21 Nursing Problems Theory” relate to change and anticipated changes that affect nursing; the need to appreciate the
interconnectedness of social enterprises and social problems; the impact of problems such as poverty, racism, pollution, education, and so forth on
health and health care delivery; changing nursing education; continuing education for professional nurses; and development of nursing leaders from
underserved groups.
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 this behavior.
8. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan.
9. Identify how the nurse feels about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.
STRENGTH
The following are the strengths of Faye Abdellah’s “21 Nursing Problems” theory.
 The problem-solving approach is readily generalizable to the client with specific health needs and specific nursing problems.
 With the model’s nature, healthcare providers and practitioners can use Abdellah’s problem-solving approach to guide various activities within the
clinical setting. This is true when considering nursing practice that deals with clients who have specific needs and specific nursing problems.
 The language of Faye Abdellah’s framework is simple and easy to comprehend.
 The theoretical statement greatly focuses on problem-solving, an activity that is inherently logical in nature.
LIMITATIONS
 The major limitation to Abdellah’s theory and the 21 nursing problems is their very strong nurse-centered orientation. She rather conceptualized nurses’
actions in nursing care which is contrary to her aim.
 Another point is the lack of emphasis on what the client is to achieve was given in terms of client care.
 Framework seems to focus quite heavily on nursing practice and individuals. This somewhat limits the ability to generalize although the problem-
solving approach is readily generalizable to clients with specific health needs and specific nursing.
 Abdellah’s framework is inconsistent with the concept of holism. The nature of the 21 nursing problems attests to this. As a result, the client may be
diagnosed as having numerous problems that would lead to fractionalized care efforts, and potential problems might be overlooked because the client is
not deemed to be in a particular stage of illness.
 ABDELLAH’S “Ten way’s of Identifying a Client’s Problem” is utilized in the clinical setting and are necessary in initiating and implementing the
nursing care plan.
 Nursing Programs encourage nusing students to utilize patient-centered approaches in the clinical setting.
 Problem Solving approach is utilized by practioners in guiding treatment plans within their practice. Especially within practices that deals with clients
who have specific health care needs and specific nursing problems.(Nursing Theories, 2010)
EDUCATION
 She attended her high school in New Jersey after her family have move there.
 In 1940’s she attended the Fitkin the memorial Hospital’s School now known as Ann May School of Nursing where she earned her Nursing diploma in
1942.
 In 1945’s she attended Columbia University where she expanded her education and choose to become a Doctor
 In 1945’s she attended the Columbia University where she earned 3 degrees which are: bachelor degree in nursing in 1945, master of art degree in
physiology in 1947, and Doctor of education in 1955.
RESEARCH (LESSING, 2004)
 Assisted international nursing research studies during the Korean War (China, Japan, Australia, Russia)
 Abdellah’s research findings led to the first federally-tested coronary care unit in Connecticut Theory and research data led to establishment of the
office of Long-Term Care.
Henderson’s Need Theory
INTRODUCTION
 Virginia Avenel Henderson was a nurse, theorist, and author
 She was known for her Need Theory
 She was born on November 30, 1897
 She died on March 19, 1996
 Henderson define nursing as “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 peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.”
 Henderson is also known as “The First Lady of Nursing,” “The Nightingale of Modern Nursing,” “Modern-Day Mother of Nursing,” and “The 20th
Century Florence Nightingale.”
 Henderson was born in Kansas City, Missouri, the fifth of the eight children of Daniel Brosius Henderson and Lucy Minor Abbot.
 Virginia Henderson received her early education at home in Virginia with her aunts, and uncle Charles Abbot, at his school for boys in the community
Army School of Nursing at Walter Reed Hospital in Washington D.C.
 In 1921 She received her Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington D.C.
 In 1921 after receiving her Diploma, Virginia Henderson worked at the Henry Street Visiting Nurse Service for two years after graduation.
 She began her career as a nurse educator in 1924 at the Norfolk Protestant Hospital in Virginia where she was the first and only teacher in the school of
nursing. After five years there she returned to New York to begin formal degree studies in nursing at Teacher's College.
 From 1924 to 1929, she worked as an instructor and educational director in Norfolk Protestant Hospital, Norfolk, Virginia. The following year, in 1930,
she was a nurse supervisor and clinical instructor at the outpatient department of Strong Memorial Hospital, Rochester, New York.
 From 1934 to 1948, 14 years of her career, she worked as an instructor and associate professor at Teachers College, Columbia University in New York.
Since 1953, Henderson was a research associate at Yale University School of Nursing and as a research associate emeritus (1971 -1996).
 She consistently stressed a nurse’s duty to the patient rather than to the doctor and her efforts provided a basis to the science of nursing, including a
universally used system of recording observations of the patient and have helped make nurses far more valuable to doctors.
 She emphasized the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed (Henderson,1991)
 She died at the Connecticut Hospice featured in her writings and experienced the peaceful death she desired for all mankind. She is buried in the family
plot of the churchyard of St. Stephen's Church, Forest, Bedford County, Virginia.
 She categorized nursing activities into 14 components, based on human needs.
 She described the nurse's role as substitutive (doing for the person), supplementary (helping the person), complementary (working with the person),
with the goal of helping the person become as independent as possible.
PUBLISHED BOOKS AND WORKS
THE NEED THEORY
 Emphasizes on the importance of increasing the patience independence and focus on the basic need so that progress after Hospitalization would not be
delayed
 1939, she was the author of three editions of “Principles and Practices of Nursing”
 1966 published the “Basic Principles of Nursing” and has been revised in 1972. It has been published in 27 languages by international council of
nursing.
NURSING RESEARCH: SURVEY ASSESSMENT
 Most formidable research projects
 She gathered, reviewed, catalogued, classified, annotated, and cross-referenced every known piece of research on nursing published in English,
resulting in the four-volume
 Written with Leo Simmons
 Published in 1964
 and her four-volume “Nursing Studies Index,” completed in 1972.
PRINCIPLES AND PRACTICE OF NURSING
 Henderson was a co-authored of the fifth (1955) sixth (1978) edition of the textbook of Principles and Practice of Nursing
 At age 75, she began the sixth edition of the Principles and Practice of Nursing text, over the next five years of her life
PRINCIPLES AND PRACTICE OF NURSING

 Henderson was a co-authored of the fifth (1955) sixth (1978) edition of the Textbook of Principles and Practice of Nursing
 At age 75, she began the sixth edition of the Principles and Practice of Nursing text, over the next five years of her life
BASIC PRINCIPLES OF NURSING CARE
 1953, she was completely rewriting the Harmer and Henderson Textbook on the Principles and Practice of Nursing when she utilized her description of
nursing.
 Henderson was asked by the International Council of Nurses to write an essay on nursing that was considered applicable in any part of the world and
relevant to both nurses and their patients, sick or well.
 The Basic Principles of Nursing (ICN, 1960) resulted from this and became one of the landmark books in nursing and is considered the 20th century
equivalent of Nightingale’s Notes on Nursing.
NURSING STUDIES INDEX
 One of the prominent works of Henderson is The Nursing Studies Index (ICN, 1963)
 1953, she accepted a position at Yale University School of Nursing as a research associate for research project designed to survey and assess the status
of nursing research in the United States
 1959 to 1971, Henderson was funded to direct the Nursing Studies Index Project.
 1900 and 1960, the first annotated index of nursing research published.
AWARDS AND HONORS
 She received honorary doctorate degrees from the following universities; Catholic University of America, Pace University, University of Rochester,
University of Western Ontario,
Yale University, Rush University, Old Dominion University, Boston College, Thomas Jefferson University, Emory University and many others.
 Henderson has received numerous honors are the following:
o The International Council of Nurses presented her with the inaugural Christiane Reimann Prize in 1985 considered the most prestigious
award in nursing, which is considered nursing's most prestigious award. An inspiration to nurses everywhere, she has influenced nursing
practice, education, and research throughout the world.
o In 1977 she was created an Honorary Fellow of the American Academy of Nursing. On the subsequent year, she was created an Honorary
Fellow of the Royal College of Nursing of the United Kingdom for her unique contribution to the art and science of nursing.
o She was selected to the American Nurses Association Hall of Fame and has received honorary degrees from thirteen universities.
o She received the Virginia Historical Nurse Leadership Award in 1985.
o The Virginia Henderson Global Nursing e-Repository or The Virginia Henderson International Nursing Library was named in her honor by
the nursing society, Sigma Theta Tau International, for the global impact she made on nursing research. The library, in Indianapolis, has been
available in electronic form through the Internet since 1994.
o Henderson was recognized as one of fifty-one pioneer nurses in Virginia in 2000
 She lived long enough to complete a set of widely translated and influential works, the likes of which were last written by Florence Nightingale.
 In 1939, she revised: Harmer’s classic textbook of nursing for its 4th edition, and later wrote the 5th; edition, incorporating her personal definition of
nursing (Henderson,1991)
MAJOR CONCEPTS
INDIVIDUAL
 Henderson states that individuals have basic needs that are component of health and require assistance to achieve health and independence or a peaceful
death. According to her, an individual achieves wholeness by maintaining physiological and emotional balance.
 She defined the patient as someone who needs nursing care but did not limit nursing to illness care. Her theory presented the patient as a sum of parts
with biopsychosocial needs and the mind and body are inseparable and interrelated.
ENVIRONMENT
 Although the Need Theory did not explicitly define the environment, Henderson stated that maintaining a supportive environment conducive for health
is one of the elements of her 14 activities for client assistance.
 Henderson’s theory supports the tasks of the private and the public health sector or agencies in keeping the people healthy. She believes that society
wants and expects the nurse’s service of acting for individuals who are unable to function independently
HEALTH
 Although not explicitly defined in Henderson’s theory, health was taken to mean balance in all realms of human life. It is equated with the
independence or ability to perform activities without any aid in the 14 components or basic human needs.
 Nurses, on the other hand, are key persons in promoting health, prevention of illness and being able to cure. According to Henderson, good health is a
challenge because it is affected by numerous factors such as age, cultural background, emotional balance, and others.
NURSING
 Virginia Henderson wrote her definition of nursing before the development of theoretical nursing. She defined nursing as “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 that he would perform unaided
if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.” The nurse’s
goal is to make the patient complete, whole, or independent. In turn, the nurse collaborates with the physician’s therapeutic plan.
 Nurses temporarily assist an individual who lacks the necessary strength, will, and knowledge to satisfy one or more of the 14 basic needs. She states:
“The nurse is temporarily the consciousness of the unconscious, the love life for the suicidal, the leg of the amputee, the eyes of the newly blind, a
means of locomotion for the infant, knowledge, and confidence of the young mother, the mouthpiece for those too weak or withdrawn to speak”
 Additionally, she stated 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.”
 Her definition of nursing distinguished the role of a nurse in health care: The nurse is expected to carry out a physician’s therapeutic plan, but
individualized care is the result of the nurse’s creativity in planning for care.
 The nurse should be an independent practitioner able to make an independent judgment. In her work Nature of Nursing, she states the nurse’s role 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.
KEY COMPONENTS
14 Components of the Need Theory
 The 14 components of Virginia Henderson’s Need Theory show a holistic approach to nursing that covers the physiological, psychological, spiritual
and social needs.
 Physiological Components
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest

6. Select suitable clothes – dress and undress
7. Maintain body temperature within normal range by adjusting clothing and modifying 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. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.
 Spiritual and Moral
1. Worship according to one’s faith
 Sociologically Oriented to Occupation and Recreation
1. Work in such a way that there is sense of accomplishment
2. Play or participate in various forms of recreation
 Henderson’s 14 Components as Applied to Maslow’s Hierarchy of Needs
o Since there is much similarity, Henderson’s 14 components can be applied or compared to Abraham Maslow‘s Hierarchy of Needs.
Components 1 to 9 are under Maslow’s Physiological Needs, whereas the 9th component is under the Safety Needs. The 10th and 11th
components are under the Love and Belongingness category and 12th, 13th and 14th components are under the Self-Esteem Needs.
ASSUMPTIONS
 Nurses care for patients until they can care for themselves once again. Although not precisely explained,
 Patients desire to return to health.
 Nurses are willing to serve and that “nurses will devote themselves to the patient day and night.”
 Henderson also believes that the “mind and body are inseparable and are interrelated.
STRENGTHS
 There is interrelation of concepts.
 Concepts of fundamental human needs, biophysiology, culture, and interaction, communication are borrowed from other discipline. Eg. Maslow’s
theory.
 Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chosen goal.
 Relatively simple yet generalizable.
 Applicable to the health of individuals of all ages.
 Can be the bases for hypotheses that can be tested.
 Assist in increasing the general body of knowledge within the discipline.
 Her ideas of nursing practice are well accepted.
 Can be utilized by practitioners to guide and improve their practice.
LIMITATION
 Lack of conceptual linkage between physiological and other human characteristics.
 No concept of the holistic nature of human being.
 If the assumption is made that the 14 components prioritized, the relationship among the components is unclear.
 Lacks inter-relate of factors and the influence of nursing care.
 Assisting the individual in the dying process she contends that the nurse helps, but there is little explanation of what the nurse does.
 “Peaceful death” is curious and significant nursing role.
 Henderson’s Needs Theory can be applied to nursing practice as a way for nurses to set goals based on Henderson’s 14 components. Meeting the goal
of achieving the 14 needs of the client can be a great basis to further improve one’s performance towards nursing care. In nursing research, each of her
14 fundamental concepts can serve as a basis for research although the statements were not written in testable terms.
 Henderson’s work is considered a nursing theory because it contains a definition of nursing, a nurse’s role and function, and basic needs of nursing
care. She focuses on patient care to help patients reach a level of independence and supports her definition with the 14 components of basic nursing
care (George, 2002).
 By Henderson’s nursing need theory within the curricula, educators can teach nurses how to create practical therapeutic plans that supplement a
patient’s own strengths, allowing the patient to gradually become more independent and eventually regain their ability to care for themselves.
 Development of 3 phases of curriculum development that students should progress in their learning. The focus in all three phases remains the same
these are;
1. Assisting the patient when he needs strength, will or knowledge in performing his daily activities or in carrying out prescribed therapy with
the ultimate goal of independence.
2. Develop a habit of inquiry; take courses in biological, physical, and social sciences and in humanities; study with students in other fields,
observe effective care, and give effective care in a variety of settings.
3. Involve students in the complete study of the patient and all his needs.
 Research questions arise from each of the 14 components of basic nursing care.
 Henderson concluded no profession, occupation or industry in this age can evaluate adequately or improve it practice without research.
 Offer a framework for generating knowledge and new ideas.
 She emphasized the importance of research in evaluating and improving nurses’ practice.

NOLA PENDER: HEALTH PROMOTION MODEL
INTRODUCTION
 Health Promotion Model (HPM) was created by Nola J. Pender after witnessing that medical professionals start to intervene after the
patient conceive acute or chronic health problems.
 She believed that patients’ quality of life could be improved by the prevention of problems before it gets worst. This way, money was
saved and having a healthy lifestyle was promoted.
 As she further research about the models, she discovered that more are most focused on negative motivation, therefore she developed a
model that focused on positive motivation.
 Her model was written in 1982 and get revised by 1996 with the mandate of assisting nurses in understanding the major determinants of
health behaviors as a basis for behavioral counseling to promote healthy lifestyles.
 The Health Promotion Model (HPM) can be used as a foundation to structure nursing protocols and interventions.

 Nola J. Pender was born on August 16, 1941 in Lansing, Michigan, United States. Daughter of Frank and Eileen Blunk.
 Attended Michigan State University to earn her bachelor and master’s degrees in 1964 and 1965, respectively.
 Earned her Doctorate Degree (Ph.D.) from Northwestern University in 1969.
 Pender has served as a member of numerous organizations such as: co-founder of the Midwest Nursing Research Society; serves as a
trustee; professor emerita in the Division of Health Promotion and Risk Reduction at the University of Michigan School of Nursing; serves
as a Distinguished Professor at Loyola University Chicago’s School of Nursing.
 She spends her time consulting on health promotion research nationally and internationally and currently retired.
PUBLISHED BOOKS AND WORKS

 Health Promotion in Nursing Practice (6th Edition)
 Study Guide for Health Promotion in Nursing Practice
 Philosophies and Theories for Advanced Nursing Practice
 Program to Increase Physical Activity Participation (Nursing Research, 2006)
Works:
 As regards to health promotion, Nola Pender has written and issued various articles on exercise, behavior change, and relaxation training.
She also has served on editorial boards and as an editor for journals and books.
 Pender is also known as a scholar, presenter, and consultant in health promotion. She has worked in collaboration with nurse scientists in
Japan, Korea, Mexico, Thailand, the Dominican Republic, Jamaica, England, New Zealand, And Chile.
 By contributing leadership as a consultant to research centers and giving scholar consultations, Pender resumes influencing the field of
nursing. She also collaborates with the editor of the American Journal of Health Promotion, promoting legislation to support health
promotion research.
AWARDS AND HONORS
 In1972 Distinguished Alumni Award from Michigan State University School of Nursing
 In 1988, she received the Midwest Nursing Research Society’s Distinguished Contributions to Research Award.
 Pender was the president of the academy from 1991 to 1993.
 She also obtained an Honorary Doctorate of Science degree from Widener University, Chester, Pennsylvania, in 1992.
 The American Psychological Association awarded her the Distinguished Contributions to Nursing and Psychology Award in 1997.
 She was awarded the Mae Edna Doyle Teacher of the Year Award from the University of Michigan School of Nursing the following year.
 In 2005, she received the Lifetime Achievement Award from the Midwest Nursing Research Society.
 She was known as a “Living Legend of the American Academy of Nursing” in 2012. This award has only been awarded to nurses who
have made outstanding contributions to the profession.
 Selected for Portraits of Excellence, FITNE Series, Volume II
 She is in demand as a consultant for health research both nationally and internationally and shares her knowledge to advance the field of
nursing.
 She also serves as Distinguished Professor of Nursing at Loyola University School of Nursing in Chicago, Illinois.
 She has been listed as a noteworthy Community health nursing educator.

 During her doctoral period, Pender became interested in health promotion.
 She was influenced by a Doctoral advisor, James Hall, who studies how people’s thoughts shape their motivations and behaviors.
MAJOR CONCEPTS
 Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential. It is an
approach to wellness.
 Health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain
functioning within the constraints of illness.
 The HPM concentrates on three major categories: individual characteristics and experiences, behavior-specific cognitions and affect
and lastly, the behavioral outcomes.
 Individual Characteristics and experiences - explores the concept that each individual has his or her own set of characteristics and
experiences, which in turn help shape their actions. Pender emphasized that one’s past actions have a direct link to whether they would
partake in future health-promoting behaviors. Personal attributes and habits can also be a barrier to health-promoting behaviors.
 Behavior-specific cognitions and affect - involves the behavior-specific cognitions and affect which have a direct impact on the
individual’s motivation for change.
NOLA PENDER: HEALTH PROMOTION MODEL
 Behavioral Outcomes - The start of the outcome begins with the person committing to taking the steps necessary to make a change.
During this phase the individual must be supported with barriers addressed in order to produce a positive health-promoting behavior
Person- the central focus of the model. One must assess the learned behaviors we gain from our family and community environments. These
learned behaviors influence the individual’s ability to participate in health-promoting behaviors
Environment - includes the person’s physical, social, and economic conditions. A healthy environment is free of toxins, has economic
stability, and allows access to resources that promote healthy living.
Health- It is not defined solely as the absence of disease but the state of well-being. How one defines health has a direct impact on the
promotion of well-being and prevention of disease. In order to foster positive health-promoting behaviors the nurse must take into account the
individual’s self-worth, benefits for the change, environmental control, and any potential barriers to change.
Nursing- A major focus is encouraging health-promoting behaviors.
KEY CONCEPTS
Personal Factors - Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior
and shaped by the nature of the target behavior being considered.
 Personal biological factors- Include variables such as age gender body mass index pubertal status, aerobic capacity, strength, agility,
or balance.
 Personal psychological factors- Include variables such as self-esteem, self-motivation, personal competence, perceived health status,
and definition of health.
 Personal socio-cultural factors- Include variables such as race, ethnicity, acculturation, education, and socioeconomic status.
Perceived Benefits of Action - Expected beneficial effects from health behavior that would occur.
Perceived Barriers to Action - Anticipated, imagined or real blocks and personal costs of understanding a given behavior.
Perceived Self-Efficacy - Judgment of personal capacity to coordinate and conduct a behavior that promotes wellbeing. Perceived self-efficacy
impacts perceived obstacles to action, so greater effectiveness contributes to decreased expectations of obstacles to behavioral success.
Activity-Related Affect - Subjective positive or negative feeling that occurs before, during and following behavior based on the stimulus
properties of the behavior itself.
Interpersonal Influences - Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal influences include norms
(expectations of significant others), social support (instrumental and emotional encouragement) and modeling (vicarious learning through
observing others engaged in a particular behavior). Primary sources of interpersonal influences are families, peers, and healthcare providers.
Situational Influences - Personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. Include
perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed
to take place. Situational influences may have direct or indirect influences on health behavior.
Commitment to Plan of Action - The concept of intention and identification of a planned strategy leads to the implementation of health
behavior
Immediate Competing Demands and Preferences - Competing demands are those alternative behaviors over which individuals have low
control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative
behaviors over which individuals exert relatively high control, such as choice of ice cream or apple for a snack.
Health-Promoting Behavior - A health-promoting behavior is an endpoint or action outcome that is directed toward attaining positive health
outcomes such as optimal wellbeing, personal fulfillment, and productive living.
ASSUMPTIONS
The Health Promotion Model makes four assumptions:
1● Individuals seek to actively regulate their own behavior.
2● Individuals, in all their biopsychosocial complexity, interact with the environment, progressively transforming the environment as well as
being transformed over time.
3● Health professionals, such as nurses, constitute a part of the interpersonal environment, which exerts influence on people through their life
span.
4● Self-initiated reconfiguration of the person-environment interactive patterns is essential to changing behavior.
STRENGTHS
 The Health Promotion Model is simple to understand yet it is complex in structure.
 Nola Pender’s nursing theory gave much focus on health promotion and disease prevention making it stand out from other nursing theories.
 It is highly applicable in the community health setting.
 It promotes the independent practice of the nursing profession being the primary source of health promoting interventions and education
LIMITATIONS
 There was no emphasis on its applicability to an individual currently experiencing a disease.
 it contains multiple concepts which can be hard to take in by the reader.
APPLICATION TO NURSING PRACTICE, EDUCATION AND RESEARCH
 health promotion interventions are essential for improving the health of populations everywhere. People of all ages can benefit from health
promotion care which should be delivered at sites where people spend much of their time (e.g., schools and workplace)
 nurses can develop and execute health-promoting interventions for individuals, groups, and families in schools, nursing centers,
occupational health settings, and the community at large.
 The HPM has been used by a very significant number of nursing scholars and researchers and has been useful in explaining and predicting
specific health behaviors.

Orem'S Self-Care Deficit Nursing Theory

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OREM`S SELF-CARE DEFICIT NURSING THEORY

2. The Self-Care Deficit Theory

MAJOR CONCEPTS & METAPARADIGM OF MARTHA ROGERS NURSING THEORY

BETTY NEUMAN SYSTEMS MODEL

FLEXIBLE LINE OF DEFENSE

HISTORY & BACKGROUND

HISTORY & BACKGROUND

 Process of maintaining stability.

 In the resolution, the nurse’s actions are not evaluated.

PUBLISHED BOOKS & WORKS

APPLICATION TO NURSING PRACTICE, EDUCATION & RESEARCH

PRINCIPLES AND PRACTICE OF NURSING

5. Sleep and rest

HISTORY AND BACKGROUND

PUBLISHED BOOKS AND WORKS

INFLUENCES OF THE THEORY

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