THEORETICAL FOUNDATIONS OF NURSING

Imogene King (Goal Attainment Theory) Three Interacting Systems of the Theory
Background
● Youngest of 3 children, born on January 30, 1923 Personal System
● St. John’s Hospital School of Nursing in St. Louis, Missouri (1946) ● How the nurse views and integrates self-based from personal goals
● Died December 24, 2007, at age 84 and beliefs
● St. Louis University Concepts of Personal Systems
○ BS in Nursing Education (1948) a. The Individual’s Perception
○ MS in Nursing (1957) ○ The person’s representation of reality and it is unique to
● Teachers College, Columbia University each individual
○ New York: EdD (1961) b. Self
➔ Postdoctoral Study in research design, statistics, and ○ The person’s subjective environment, values, ideas,
computers attitudes, and commitment
● Expertise c. Growth and development
○ Adult medical-surgical nursing ○ Involve all the changes that occur ( cellular, molecular, and
● Experiences behavioral). These changes are usually orderly and
○ administrator, an educator, and a practitioner predictable but may vary with individuals.
Imogene King d. Body Image
Nursing Metaparadigm ○ The way a person perceives their body and the reaction of
Person others to their body. Body image is subjective and changes
● Individuals are a spiritual being as the person changes physically or emotionally.
● Have the capacity to think, know, make choices & select e. Space
alternative courses of action ○ Is the immediate physical territory occupied by the person
● Have the ability through their language & other symbols to record and the person’s behavior.
their history & preserve their culture f. Time
● Open system in a transaction with the environment ○ Is the order of events and their relationship to each other
● Unique & holistic, are of intrinsic worth & are capable of rational
thinking & decision making in most situations. Interpersonal System
● Individuals differ in their needs, wants & goals ● Two or more interacting individuals
Three Fundamental Health Needs of Human Beings ● How the nurse interrelates with a co-worker or patient, particularly
● Need for Information in a nurse-patient relationship
● Need for care illness prevention Concepts of Interpersonal System
● Need for total care when a person can’t help themselves a. Interaction
Health ○ Any situation wherein the nurse relates & desks with a
● A dynamic state in life cycle patient
● Illness is an interference in the life cycle b. Communication
● Implies continuous adjustment to stress in the external and internal ○ Refers to the transmission of information from one person to
environments, using personal resources to achieve optimal daily another; either directly or indirectly
living c. Transaction
Environment ○ refers to the interaction between a person & the
● The process of balance involving the internal and external environment for the purpose of goal attainment
interactions inside the social system d. Role
● Interpreted from the general systems theory is an open system with ○ refers to the expected behaviors of a person in a specific
permeable boundaries that allow the exchange of matter, energy, position to the rules that govern the position & affect the
and information interaction between two or more persons
Nursing e. Stress
● An act wherein the nurse interacts and communicates with the ○ refers to an exchange of energy, either positive or negative
client between a person & the environment; objects, persons &
● The nurse helps the client identify the existing health condition, events can serve as stressors
exploring and agreeing on activities that promote health
● The goal of the nurse in King’s theory is to help the the client Social System
maintain health through promotion and maintenance, restoration ● Composed of a larger group of individuals with common interests or
and caring for the sick and dying goals
● How the nurse interacts with co-workers, superiors, subordinates &
Goal Attainment Theory the client environment, in general,
King’s Goal Attainment Theory ○ Families, religious groups, schools, workplace, and peer
● Involve the nurse and the patient mutually communicating groups
information, establishing goals,and taking action to obtain goals Social System comprises the:
● Two people who are usually strangers come together in a 1. Social roles
healthcare organization to help or to be helped to a mutual state of 2. Behaviors
health 3. Practices
Central Focus of the Theory
● Man is a dynamic human being whose perceptions of objects, Concepts of Social System
persons, and events influence his behavior, social interaction, and a. Organization
health ○ Refers to a group of people with similar interests who have
prescribed roles & positions & who use resources to achieve
personal goals & organizational goals
b. Authority
○ Refers to the observable behavior of providing guidance &
order & being responsible for actions
c. Power

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 THEORETICAL FOUNDATIONS OF NURSING

○ Is characterized by the ability to use resources for goal

achievement; also a means by which one or more persons Betty Neuman (System Theory in Nursing Practice)
can influence others “Health is a condition in which all parts and subparts are in harmony with
d. Status the whole of the client”
○ Refers to the position occupied by a person in a group or the Background
position occupied by a group in relation to other groups in an ● Born on September 11, 1924, on a farm near Lowell, Ohio
organization; it is accomplished by certain duties, privileges ● 1947
& obligations ○ Received RN Diploma from People's Hospital School of
e. Decision Making Nursing, Akron, Ohio
○ Results from developing & acting on perceived choice for ● Moved to California and gained experience as a hospital, staff, and
goal attainment head nurse; school nurse and industrial nurse; and as a clinical
instructor in medical-surgical, critical care and communicable
6 Characteristics of Man disease nursing.
1. The ability to perceive ● 1972
○ Perceptions will influence behavior and thus life and health ○ Her model was first published in Nursing Research as a
2. The ability to think “Model for teaching total person approach to patient
○ Thinking is based upon the inquiring mind of man problems”
3. The ability to feel ● The model was developed by Dr. Neuman as a way to teach an
○ Have emotions introductory nursing course to nursing students
4. The ability to choose between the alternative course of action ● The model is based on a philosophical view, Gestalt theory, Han’s
5. The ability to set goals Selye’s stress theory & General System’s theory
6. The ability to select means of accomplishing goals General Information
● Systems Model “Neuman’s model focuses on the persons as a
Propositions of King’s Goal Attainment Theory complete system, the subparts of which are interrelated
1. If perceptual accuracy is present in nurse-client interaction, physiological, psychological, sociocultural, spiritual, and
transactions will occur. developmental factors.’
2. If the nurse & client make transactions, goals will be attained ● Neuman’s model deals with stress & stress reduction & is
3. If goals are attained, satisfaction will occur primarily concerned with the effects of stress on health
4. If goals are attained, effective nursing care will occur
5. If transactions are made in nurse-client interactions, growth & Metaparadigm
development will be enhanced Person
6. If role expectations & role performance as perceived by nurse & ● Is viewed by Neuman as a whole multidimensional, dynamic system
client are congruent, transactions will ● Can be individual, family or group, or community
7. If role conflict is experienced by the nurse & client or both, the ● She sees a person as an open system that works together with
stress in nurse-client interactions will occur other parts of its body as it interacts with the environment
8. If nurses with special knowledge & skills communicate appropriate ○ Open system
information to clients, mutual goal setting & goal attainment will ■ characterized by the presence of an exchange of
occur information & reaction with other factors surrounding
a person
● Composed of basic core (genetic features, and the strengths and
weaknesses of the system parts) as well as physiological,
sociocultural, developmental & spiritual variables
Health
● Neuman sees health as being equated with wellness
● She defines health/wellness as “the condition in which all parts and
subparts (variables) are in harmony with the whole of the client
(Neuman, 1995)”.
● Views health as a continuum of wellness to illness that is dynamic
in nature & constantly subject to change
● “Optimal wellness or stability indicates that total system needs
are being met”
● The client is in a dynamic state of either wellness or illness in
varying degrees at any given point of time
Environment
● Defined as being all the internal & external factors that surround or
interact with person & client
○ Internal environment
■ Exists within the client system
○ External environment
■ Exists outside the client system
● Includes stressor, described as environmental forces that interact
with & potentially alter system stability
Nursing
● Neuman believes nursing is concerned with the whole person
(holistic approach), an approach that considers all factors affecting
a client’s health status
● Views nursing as a unique profession that is concerned with all of
the variables affecting an individual’s response to stress
● The primary aim is stability of the patient/client system, through
nursing interventions to reduce stressors.

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 THEORETICAL FOUNDATIONS OF NURSING

■Is set towards disorganization of the system

Systems Model in Nursing Practice producing illness
A. Client Variables G. Degree of reaction
● The client variables can be one or a combination of the ● Is the amount of energy required for the client to adjust to the
following: stressors
○ Physiological, sociocultural, physiological, spiritual &
developmental
● These variables function to achieve stability in relation to the
environmental stressors experienced by the client
B. Lines of Resistance
● Represent the internal factors of a person that help defend
against a stressor (e.g. body’s immune response system)
● It acts to facilitate coping to overcome the stressors that are
present within the individual
C. Normal Line of Defense
● Represents a stability state for the individual or system
● It is maintained overtime & serves as a standard to assess H. Prevention
deviations from the client’s usual wellness
● Interventions are purposeful actions to help the client retain, attain
● It includes system variable & behaviors such as the
& maintain system stability
individual’s usual coping patterns, lifestyle, & developmental
● Used to attain balance within the continuum of health
stage
● These are the actions that generates good results or are aimed
D. Flexible Line of Defense
towards hindering negative outcomes
● Acts as a protective barrier to prevent stressors form
3 Levels of Prevention
breaking through the normal line of defense
1. Primary Prevention
● Is dynamic and can change rapidly over a short time
● Can be affected by variables such as loss of sleep, which ● Refers to intervention before a reaction occurs
reduce a client’s ability to use a flexible line of defense ● Is carried out when a stressor is suspected or identified
against stressors ● Aims to strengthen the capacity of a person to maintain an
optimum level of functioning while being interactive with the
environment, like health promotion & disease prevention
2. Secondary Prevention
● Refers to intervention after a reaction occurs
● Focuses on helping alleviate the actual existing effects of an
action that altered the balance of health of a person
● Aims to reduce environmental influences that lead to the
decline of the level of functioning of a person &
strengthening or restoring a person’s resistance after the
illness exposure
E. Stressors ○ Examples: early detection of disease & prompt
● Are forces that produce tensions, alterations, or a potential treatment
problems causing instability with in the client’s system 3. Tertiary Prevention
● They may be: ● Refers to intervention that occurs after the system has
1. Intrapersonal stressors been treated through secondary
■ Are those stimuli that occur within the ● Focuses on actual treatments or adjustments to facilitate the
individual (e.g. emotions and feelings) strengthening of a person after being exposed to a certain
2. Interpersonal stressors illness
■ Are those stimuli that occur between ● It aims to prevent the reoccurrence of the illness in the
individuals (e.g. pressures related to role manner of rehabilitation, as in the case of disability
expectations) avoidance & physical therapy
3. Extrapersonal Stressors ❖ Reconstitution
■ Are those stimuli that occur outside of the ● Is the adjustment state from the degree of reaction
person (e.g. job or financial pressures) ● It is a state of going back to the actual state of health before
the illness occurred
❖ Once an individual is exposed to stress, the flexible line of defense
will be “alarmed” to protect the normal (solid) line of defense to
keep the system free form the stressor reactions. However, if this
individual is continuously exposed to stress and if the flexible line of
defense is unable anymore to cope with the stressor, the normal
line of defense will be altered. If this happens, there will be a threat
to the wall that protects the basic structure of the individual and
therefore causes instability of the systems and illness develops.

F. Reaction
● Are the outcomes or produced results of certain stressors & actions
of the lines of resistance of a client
● Can be positive or negative depending on the degree of reaction
the client produces to adjust & adapt with the situation
● Neuman specified these reactions as
○ Negentropy
■ Is set towards stability or wellness
○ Egentropy

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 THEORETICAL FOUNDATIONS OF NURSING

Patricia Benner (From Novice to Expert: Excellence in

Power in Clinical Nursing Practice)
Background
● Patricia Benner, R.N., Ph.D., F.A.A.N.
● Professor at the University of California-San Fransisco
● Obtained a bachelor of Arts degree from Pasadena College in 1964
● Earned a master’s degree in nursing from the University of
California, San Francisco School of Nursing in 1970
● She published From Novice to Expert in 1984 and became a Fellow
in the America Academy of Nursing 1985

Metaparadigm
Person
● a self-interpreting being, that is, the person does not come into the
world predefined but gets defined in the course of living a life.
● The four major aspects of understanding that the person must deal
with:
1. The role of the situation
2. The role of the body
3. The role of personal concerns
4. The role of temporality
Health
● Health
○ What can be assessed
● Well-being
❖ Using Neuman’s System Model in the above situation, the identified
○ Human experience of health or wholeness
possible stressors that contributed to Mr. Yoso’s condition were as
● Illness
follows: work, personality, and attitude. Mr. Yoso is no anymore able
○ The human experience of loss or dysfunction
to handle the stressors and that has caused a “breakdown” of his
● Disease
lines of defense. Without seeking help from his family and friends,
○ Is what can be assessed at the physical level
he was not able to maintain his flexible line of defense which
Environment
brought instability to his system.
● She used the word situation because it suggests a social
environment with social definition and meaning
● Situation
○ Defined by the person’s engaged interaction, interpretation,
and understanding of the situation
● Persons enter into situations with their own sets of meaning, habits
& perspectives
Nursing
● Nursing as a caring relationship, an “enabling condition of
connection and concern”
● Viewed nursing practice as the care and study of the lived
experience of health, illness, and disease and the relationships
among these three elements

Benner’s Stages of Clinical Competence (1984;2004)

Novice
● No experience of the situations in which they are expected to
perform
● Learn context-free rules to guide action (stimulus-response
thinking)
● Rule-governed behavior is typical, tends to be inflexible
● Has difficulty discriminating between relevant and irrelevant aspects
of a situation
Advanced Beginner
● Can demonstrate marginally acceptable performance
● Have begun to identify recurring meaningful situational aspects and
apply these in new situations
● Unable to see the entirety of a new situation (may miss some
critical details)
● They feel more responsible for managing patient care, yet they still
rely on the help of those who have more experienced
Competent
● Considers consistency, predictability & time management as
essential components & gaining a sense of mastery
● There is an increased level of efficiency but the focus is on time
management & the nurses' organization of the tack are more
important rather than timing in relation to the patient’s needs
● This stage is critical becasue the nurse must know how to
recognize the patterns & identify which element of the situation
needs attention & which ones to ignore

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 THEORETICAL FOUNDATIONS OF NURSING

Proficient Sr. Callista Roy (Adaptation Model)

● Perceives situations as wholes rather than in terms of aspects Background
● Performance is guide by maxims (cryptic instructions that make ● Born on October 14, 1939 in Los Angeles California
sense only if there is already a deep understanding of the situation) ● She is a nurse theorist and a professor
● Perception is a key word ● She is a fellow in the American Academy of Nurisng, an honorary
● Possesses a web of perspectives on a situation nursing society that elects nursing leaders annually
● Demonstrate an increased confidence in their knowledge & abilities ● Has numerous publications, including books & journal articles on
Expert nursing theory & other professional topics
● No longer relies on an analytic principle (rule, guideline, maxim) to
connect understanding of a situation to appropriate action
Metaparadigm
● Operates from a deep understanding of the toal situation
Person
● Possessing an intuitive grasp if the problem
● Is the recipient of nursing care; main focus of nursing
● There is a qualitative change as the expert performer “knows the
● A biophyschosocial being in constant interaction with a changing
patient”, which means that knowing typical patterns of responses &
environment
knowing the patient as a person
● The person is an open adaptive system who uses coping skills to
● Key aspects of the expert nurse practice:
deal with stressors
○ Demonstrating a clinical grasp and resource-based practice
● It includes people as individuals or in groups (families,
○ Possessing embodied knowledge
organizations, communities, nations & society as a whole)
○ Seeing the big picture
● An adaptive system has cognator and regulator subsystems to
○ Seeing the unexpected
maintain the 4 adaptive modes
Environment
Seven Domains of Nursing Practice ● Conditions, circumstances and influence that surround and affect
● Helping role the development and beahvior of the person
● Diagnostic client-monitoring function ● Consists of internal and external environemnts, which provide input
● Effective management of rapidly changing situations in the form of stimuli
● Administering & monitoring therapeutic interventions & regimens ● Stressors are stimuli that are significant in human adaptation:
● Monitoring & ensuring health care practices stages of development, family & culture
● Organizational & work-role performance Health
● Teaching or coaching function
● Was originally described by Roy as a health-illness continuum;
health & illness were considered an inevitable dimension of the
person’s life
● More recently, Health is the process of being and becoming an
integrated and whole person
● It is a reflection of adaptation that is the interaction of the person &
environment
● Adaptation is defined as the process and outcome whereby thinking
and feeling, as individuals and groups, use conscious awareness
and choice to create human and environmental integration
Nursing
● The science and practice that expands adaptive abilities and
enhances person and environment transformation
● Roy’s goal of nursing is the promotion of adaptationin each of the 4
modes thus contributing to health, quality of life and dying with
dignity
● Nursing is about the increase, enhancement, modification and
alteration of the stimulus to achieve adaptation

The Roy Adapation Model (RAM)

Key Concepts
● The person is adapting in a stable interaction with the environment,
either internal or external
● The environment serves as the source of a range of stimuli that will
either threatern or promote the person’s unique wholeness
● The person’s major task is to maintain integrity in face of these
stimuli
○ Integrity
■ The degre of wholeness achieved by adapting to
changes in needs.
○ System
■ A set of parts connected to function as a whole for
some purpose & that does so by virtue of the
interdependence of its parts
■ Considered the recipient of care to be an open
adaptive system
■ React & interact with other systems in the
environment
■ Have boundaries that are flexible & open to permit
interaction with other systems
■ Employ a feedback cycle of input, throughput &
output
○ Input

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 THEORETICAL FOUNDATIONS OF NURSING

■ Defines as stimuli which can come from the Control Processes

environment or form within a person ● Stabilizer subsystem & innovator subsystem
Types of Stimuli (Helson, 1964) ● Stabilizer subsystem
Focal ○ Analogous to regulator: concerned with stability
● The internal or external stimulus most immediately confronting the ● Innovator subsystem
person, it attracts the most attention ○ Analogous to cognator: concerned with creativity, change &
Contextual growth
● All other stimuli present in the situation that strengthens/ contribute Adaptation Level
the effect of the focal stimulus Integrated
Residual ● Adaptation level at which the structures and functions of a life
● Those stimuli that can affect the focal stimulus but the effects are process are working as a whole to meet human needs
unclear. ○ Stable processes of ventilation, the complex process of
The three types of stimuli act together and influence the adaptation level breathing that exchanges air between lungs and
which is defined as the ability to respond positively to a situation. atmosphere
● Throughput Compensatory
○ Makes use of a person’s processes & effectors ● Adaptation level at which the cognator and regulator have been
○ Processes refer to the control mechanism that a person activated by a challenge to the integrated life processes
uses as an adaptive system ○ Grieving, role transition
○ Effectors refer to the physiologic function, self-concept & Compromised
role function involved in adaptation ● Adaptation level resulting from inadequate integrated and
● Output compensatory life processes; adaptation problem
○ Is the outcome of the system, when a system is a person, ○ Hypoxia
the output refers to the person’s behaviors ○ Ventilatory impairment
○ Adaptive response ○ Unresolved loss
■ Those that promote integrity in terms of the goals of ○ Abusive relationships
the human system Adaptive Modes
○ Ineffective responses ● Are categories of behavior to adapt to stimuli
■ Those that do not contribute to integrity in terms of ● Can be used to determine a person’s adaptation level
the goals of the human system ● Can be used to identify adaptive or ineffective responses by
observing a person’s behavior in relation to the adaptive modes
Coping Mechanism and Control Processes
Coping Mechanism 4 Adaptive Modes
● Are the processes that a person uses for self-control Physiological
● Are innate or acquired ways of interacting with the changing ● The way a person responds as a physical being to a stimuli from
environment the environment
● Innate coping mechanisms are genetically determined or common ● Goal: Physiological Integrity
to the species & are genetically viewed as automatic process ● Five Physiologic Needs: oxygenation, nutrition, activity & rest, &
● Acquired coping mechanisms are developed through strategies protection
such as learning ● Four Complex Processes: senses; fluids, electrocytes & acid-base
Regulator Subsystem balance; neurologic function; endocrine function
● Major coping process involving the neural, chemical, and endocrine Self-Concept-Group Identity Mode
system ● Focuses specifically on the psychological & spiritual aspects of the
○ E.g. increase in vital signs human system
■ Sympathetics response to stress Self-Concept
● Defines as the composite of beliefs & feelings about oneself at a
given thime & is formed from internal perceptions of ther’s reaction
○ Physical self (body sensation and body image)
○ Personal Self (self consistency, self ideal, and moral ethical
spirtitual self)
Group Identity
● Reflects how people in groups perceive themselevs based on
environmental feeback
● Comprised of interpersonal relationships, group self-image &
culture
Cognator Subsystem ● Goal: Psychological Integrity
● A major coping process involving four cognitive-emotive channels Role Function Mode
○ Perceptual & Information Processing ● A role is a set of expectations about how a person occupying one’s
○ Learning position behaves towards a person occupying another position
○ Judgement & Emotion ● Goal: Social Integrity
● E.g. effects of prolonged hospitalization for a 4 year-old child ● Roles are carried out with both instrumental behaviors (the actual
physical performance of a behavior) and expressive behaviors (are
the feelings, attitudes, likes or dislikes that a person has about a
role or about the performance of a role)
● Persons perform primary, secondary, & tertiary roles
● Primary
○ Determines the majority of behavior engaged in by the
person during a particular period of life (age, sex,
developmental stage)
● Secondary
○ Are those that a person assumes to complete the task
associated with a developmental stage & primary role
(husband, wife)

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 THEORETICAL FOUNDATIONS OF NURSING

● Tertiary
○ Related primarily to secondary roles & represent ways in Dorothy Johnson (Behavioral System Model)
which individuals meet their role associated obligations Background
○ Temporary in nature, freely chosen by the individual
● Aug 19,1919
Interdependence Mode ○ Born in Savannah, Georgia
● Focuses on close relationships which results to giving & receiving of ● Februrary, 1999
love, respect, value, nurturing, knowledge, skills, commitments, ○ Died
material possessions, time & talents ● 1942
● Occurs between the person and the most significant other or ○ BSN from Vanderbilt University
between the person and the support system ● 1948
● Goal: Affectional Adequacy ○ MSN in Public Health, Harvard
● 1949
Goal of Nursing in RAM ○ Faculty at UCLA (Unvierstiy of Califronia, Los Angeles)
● Promote adaptation in each of the four adaptive modes ● 1977
● Adaptive or ineffective response result from the 4 modes of coping ○ Retired in Florida
mechanisms ● Johnson first proposed her model in 1968 to foster the efficient &
● Adaptive response support the integrity of the person and the goals “effective behavioral functioning in the patient to prevent illness”
of adaptation ● She based her model on Florence Nightingale’s beleif that nursing
● Ineffective responses neither promote integrity nor contribute to the is designed to help people prevent or recover from illness or injury
goals of adaptation ● She borrowed ideas from systems theory to explain that nursing is
concerned with the individual as an integrated whole
Nursing Process ● Johnson,1990
● A problem-solving approach for gathering data, identifying the ○ The person experiencing a disease is more important than
capacities and needs of the human adaptive system, selecting and the disease itself
implementing approaches for nursing care, and evaluation of the Dorothy Johnson Behavioral Systems Model
outcome of care provided ● The person is a beavioral system comprised of a set of organized,
interactive, interdependent, and integrated subsystems
6 Steps in Nursing Process ● Constancy is maintained through actions & behaviors are regulated
Assesment of Behavior & controlled by biological, psychological, and social factors
● Data gathering about the behavior of the person as an adaptive ● Preserved the optimal level of an individual
system in each of the adaptive modes Metaparadigm
○ Observable behavior: vital signs Person
○ Non-observable behavior: feelings experience by the person ● Views person as having two major systems: biological and
(anxiety) beahviral system
Assesment of Stimuli ● As a beahvioral system with patterned, repetitive & purposeful ways
● A stimulus is defines as any change in the internal and external of behaving that link the person to the environment
environment that induces a response in the adaptive system ● An individual composed of seven open & interactive subsytsems; a
● Is is classified as focal, contextual or residual disturbance in one usually affects the others
● In this level of assessment, the nurse analyzes the subjective and ● Continualy strives to maintain a steady state by adapting &
objective behaviors and look more deeply for possible cause of a adjusting to environmental forces that cause an imbalace; when an
particular set of behaviors imabalce or health problem occurs, the person’s physical, social or
Nursing Diagnosis psychological integrity is threatened
● Formulation of statements that interpret data about the adaptaion Health
on status of the person, including the beahvior and the most ● A state that is affected by social, biological, psychological, and
relevant stimuli physiological factors
Goal Setting ● The individual strives to maintain stability in these factors
● Establishment of clear statements of the behavioral outcomes for Environment
nursing care which is realistic and attainable. This is done together ● Consists of all the factors that are not part of the individual’s
with the client behavioral system, but influence the system, some of which can be
Intervention manipulated by the nurse to achieve the health goal for the patient
● Determination of how best to assist the person in attaining the ● An individual’s beahvior is influenced by all the events in the
established goals environment. It varies from culture to culture.
Evaluation Nursing
● Judging the effectiveness of the nursing interventions in relation to ● Is an external force acting to preserve the organization of the
the behavior after it was performed in comparison with the goal patient’s behavior by means of imposing regulatory mechanisms or
established by providing resources while the patient is under stress
● A steady is maintained through adjusting and adapting to internal
❖ Not all beautiful is always good, But all good is always beautiful. and external forces
❖ There is always room for improvement, and that is the biggest room
in the house. Johnson’s 7 Subsystems
Attatchement or Affiliative Subsystem
● Forms the basis for all social organization
● Promotes survival & provides a sense of security
● Results in social inclusios, intimacy & the formation of strong bonds
Dependency Subsystem
● Promotes helping or nurturing behavior from others
● Results in approval, attention, recognition & physical assistance
Ingestive Subsystem
● Involves food intake

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 THEORETICAL FOUNDATIONS OF NURSING

● Relates to the biological need for food & the psychological Virginia Avel Henderson (Definition of Nursing)
meanings & structures of social events surrounding food Background
consumption
● Born: November 30, 1897, Kansas CIty
● Results in appetite satisfaction
● Died: March 19, 1996, Branford, Connecticut
Eliminative Subsystem ● Died at the age of 98
● Involves behavior surrounding the excretion of waste from the body Education
● Includes the psychological meanings & structures of socially
● Early education at home in Virginia at Army School of Nursing,
acceptable behaviors for waste elimination
Washington, D.C.,
Sexual Subsystem ● Graduated 1921
● Involves behavior associated with procreation & sexual gratification ● Teachers COllege, Columbia University,
such as courtship & mating ○ BS, 1931
● Results in the development of sex role identity & sex role behavior ○ MS, 1934
Aggresive Subsystem ● Began her career in public health nursing in the Henry street
● Involves behavior realted to self-protection & preservation of the Settlement & in the visiting nurse service in Washington D.C
self & society ● Was motivated to develop her ideas because she had concerns
● Includes the belief that aggression is learned & harmful & that about the function of nurses & the nurse registration laws
people & property must be respected & protected ● “First lady of nursing”
● Includes acknowledgement of real or imaginary dagenrs todevelop ● “First Truly International Nurse”
defenses to these threats ● She designed a plan to create district organizations within the state
Achievement System ● Advocate for the inclusion of psychiatric nursing in the curriculum
● Involves behavior realted to manipulation of the environment to gain
mastery & control over some aspect of oneself or environment, this
The Nature of Nursing
control is measured against a standard of excellence
● She first published her Definition of Nursing in a revised version
● Includes intellectual, physical, creative, mechanical & social skills
the textbook- The Principles & Practice of Nursing, as a result of
Restorative Subsystem
working on this book, Henderson felt the need to clarify the role of
● Sleep, freedom from pain,comfort, and rest
nurses even further
3 Functional Requirements of Humans ● 1966
● To be protected from noxious influences with which the person ○ Clarified her definition of nursing in the book, The Nature of
cannot cope Nursing
● To be nurtured through the input of supplies from the environment ● She was honored by the Virginia Nurses Association in 1988 when
● To be stimulated to enhance growth and prevent stagnation the Virginia Historical Nurse Leadership Award ws presented to her
● In 2000, the Virginia Nurses Association recognized Henderson as
one fifty-one Pioneer Nurses in Virginia
● Halloran, a nurse theorist wrote, “Henderson was to the twentieth
century as Nightingale was to the nineteenth century. Both wrote
extensive works that have influenced the world”

General Information
● VH views her work as a philosophical statement rather than a
theory
● In her definition, she emphasizes the care of both sick & well
individuals, and she was one of the first theorists to include
spiritual aspects of nursing care
● According to VH, the nurse assist the patient with essential
activities to maintain health, recover from illness or achieves a
peaceful death
● Patient’s independence is an important criterion for health
● Henderson identifies 14 basic needs that form the components of
nursing care; the nurse helps the patient meet these needs

14 Basic Needs
Physiological
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain a desirable position or posture
5. Sleep and rest
6. Select suitable clothes- dress and undress
7. Maintain body temperature within normal range by adjusting
clothing and modifying the environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others
10. Communicate with others in expressing emotions, needs, fears, or
opinions
Spiritual
1. Worship according to one’s faith
Sociological
1. Work in such a way that there is a sense of accomplishment
2. Play or participate in various forms of recreation
Psychological

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 THEORETICAL FOUNDATIONS OF NURSING

Learn, discover, or satisfy the curiosity that leads to normal development Faye Abdellah (Twenty One Nursing Problems)
and health and use the available health facilities Background
● Henderson also emphasized the need to view the patient and his ● Born on March 13,1919 in New York City
family as a single unit ● Began her nursing career in 1942 when she received her diploma in
● For the patient to achieve health, he must be able to meet his need nursing from Fitkin Memorial Hospital school of Nursing in Neptune,
for support system- provided by the family New Jersey
● 1945
Metaparadigm in Nursing ○ BSN
Person ● 1947
● Referred as patient ○ MA, doctoral of Education
● An individual requiring assistance to achieve health & ● 1955
independence or a peaceful death, the person & family are viewed ○ from Teacher’s College, Columbia University, New York City
as a unit ● Became the 1st Nurse & 1st woman to serve as Deputy Surgeon
● The mind & body are inseparable General of the United States
● Must be able to maintain physiological & emotional balance ● Was inducted into the US National Women’s Hall of Fame in 2000
Health due to her contributions in the field of Education & Nursing
● Is a quality of life that is basic to human functioning ● She was motivated to develop her typology by a desire to promote
● Health requires independence & interdependence comprehensive, client-centered nursing care- she used the problem
● Promotion of health is more important than care for the sick solving approach as basis for her typology
● Individuals will achieve or maintain health if they have the ● Her typology of Nursing problems was first published in 1960 in
necessary strength, will or knowledge Patient Centered Approaches in Nursing
Environment
● Not specifically defined Metaparadigm on Nursing
● Involves the relationship one shares with one family, also involves Person
the community & its responsibility for providing health care. ● The recipient of nursing care
● VH believes that society wants & expects nurses to provide a ● One who has physical, emotional or sociological needs, helping a
service for individuals incapable of functioning independently person with these needs is nursing’s only justification
Nursing ● According to Abdellah: the typology of nursing problems evolve
● “The unique function of the nurse is to assist the individual, sick or from the recognition of a need for patient-centered care approached
well in the performance of those activities contributing to health or to nursing
its recovery (or to peaceful death) that he would perform unaided if ● Includes families as well as individuals
he had the necessary strength, will or knowledge. And to this in ● Is capable of learning & self-help to varying degrees
such a way as to help him gain independence as rapidly as Health
possible” ● Defined as the center & purpose of nursing services
● Requires working interdependently with other members the health ● She speaks to a “total health needs” & a “healthy state of mind &
care team; the nurse functions independently of the physician but body”
uses the physician’s plan of care to provide holistic care to the ● Viewed as a state that excludes illness
patient ● Can also be described as a state in which the person has no unmet
● The Nurse functions in relation with the patient, physicain and other needs & no anticipated or actual impairments
members of the health team Environment
The Nurse-Patient Relationship ● Least discussed concept in Abdellah’s model
● The nurse as a substitute for the patient ● Includes the atmosphere of a client’s room, home & community
● Making up for what the patient lacks to be whole & independent Nursing
again ● Is a helping profession
● The nurse as a helper to the patient ● Considers nursing to be an all-inclusive service that is based on the
○ Instituting medical interventions to assist the patient meet disciplines of art & science that servs individuals sick or well, cope
his basic needs with their health needs
● The nurse as partner with the patient ● Uses the nursing process, a problme-solving approach
○ Fostering a therapeutic relationship with the patient & ● Can use the 21 nursing problems as a guide from nursing care
functioning as a member of the health care team
The Nurse-Physician Relationship
General Information
● Henderson asserted that nurses function independently from
● A theoretical statement from Abdellah’s works can be created by
physicians
utilizing her 3 chief concepts of Health, Nursing Problems, and
● The plan of care must be implemented in such a way that will
Problem Solving
promote the physician’s prescribed therapeutic plan
● Abdellah’s theory proposes that nursing is the “utilization of the
The Nurse as Member of the HealthCare Team
problem-solving techniques with chief nursing problems related to
● For a team to work together in harmony, every member must work
the helath requirements of clients.
interdependently
● It gives much importance to problem-solving as a medium for
● The nurse, as a member of the healthcare, works & contributes in
nursing problems as the client is geared in the direction of health,
carrying out the total program of care
which is the outcome
❖ “She is temporarily the consciousness of the unconscious, the love
of life for the suicidal, the leg of the amputee, the eyes of the newly
blind, a means of locomtion for the infant, knowledge and
Nursing Problems
confidence for the young mother, the mouthpiece for those too ● A Nursing Problem is defined as any condition presented or faced
weak or withdrawn to speak. by a client or family for which a nurse can offer assistance
● Health needs are seen as problems, which may be:
● Overt
○ Obvious or can be seen condition
● Covert
○ Unseen or masked one

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 THEORETICAL FOUNDATIONS OF NURSING

● According to Abdellah, the practice of component nursing care in Ida Jean Orlando (Nursing Process Theory)
the future is for the nursing student to realize that identifying & Background
answering overt & covert nursing problems is the core of Nursing
● Born on August 12, 1926
● The Typology of 21 Nursing Problems: the identification &
● Nursing diploma
classification of problems
○ New York Medical College
● Abdellah’s typology as divide into three areas:
● BS in Public Health Nursing
a. Physical, sociological & emotional needs of the patients
○ St. John’s University, NY,
b. Types of interpersonal relationships between the nurse &
● MA in Mental Health Nursing
the patient
○ Columbia University, New York
c. Common elements of patient care
● Associate Professor at Yale School of Nursing and Director of the
Graduate Program in Mental Health Psychiatric Nursing.
Typology of 21 Nursing Problems ● Project Investigator of a National Institute of Mental Health grant
1. To maintain good hygiene & physical comfort entitled: Integration of Mental Health Concepts in a Basic Nursing
2. To promote optimal activity: exercise, rest, sleep Curriculum
3. To promote safety through the prevention of accident, injury, or ● Published in her 1961 book
other trauma & through the prevention of the spread of infection ○ The Dynamic Nurse-Patient Relationship
4. To maintain good body mechanics & prevent & correct deformity ● Revised 1972 book
5. To facilitate the maintenance of a supply of oxygen to all body cells ○ The Discipline and Teaching of Nursing Processes
6. To facilitate the maintenance of nutrition of all body cells ● A board member of Harvard Community Health Plan
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid & electrolyte balance Nursing Process Theory
9. To recognize the physiological responses of the body to disease
● Allow nurses to formulate an effective nursing care plan that can
conditions- pathological, physiological & compensatory
also be easily adapted when and if any complexity comes up with
10. To facilitate the maintenance of regulatory mechanisms & functions
the patient
11. To facilitate the maintenance of sensory function
● Stresses the reciprocal relationship between patient and nurse
12. To identify & accept positive & negative expression, feelings &
● It emphasizes the critical importance of the patient’s participation in
reactions
the nursing process
13. To identify & accept the interrelatedness of emotions & organic
● Orlando also considered nursing as a distinct profession and
illness
separated it from medicine where nurses as determining nursing
14. To facilitate the maintenance of effective verbal & nonverbal
action rather than being prompted by physician’s orders,
communication
organization needs, and past personal experiences.
15. To promote the development of productive interpersonal
● She believed that the physician’s orders are for patients and not for
relationships
nurses.
16. To facilitate progress toward achievements & personal spiritual
goals
17. To create or maintain a therapeutic environment
Major Dimensions
18. To facilitate awareness of self as an individual with varying physical, ● The role of the nurse is to find out and meet the patient’s immediate
emotional & developmental needs need for help
19. To accept the optimum possible goals in the light of limitations, ● The patient’s presenting behavior may be a plea for help, however,
physical &emotional the help needed may not be what it appears to be
20. To use community resources as an aid in resolving problems arising ● Therefore, nurses need to use their perception, thoughts about the
from illness perception, or the feeling engendered from their thoughts to explore
21. To understand the role of social problems as influencing factors in with patients the meaning of their behavior
the cause of illness ● This process helps nurse find out the nature of the distress and
what help the patient needs.

Problem Solving
● The process of identifying overt & covert nursing problems &
Goals
interpreting, analyzing & selecting appropriate actions to solve ● To develop a theory of effective nursing practice.
these problems ● The theory explains that the role of the nurse is to find out and meet
● The steps resemble the pace of the Nursing process of the patient’s immediate needs for help
Assessment, Diagnosis, Planning, Implementation & Evaluation ● All patient behavior can be a cry for help
● The Problem-solving Process includes ● The nurse’s job is to find out the nature of the patient’s distress and
1. Identifying the problem provide the help he or she needs
2. Selecting relevant data
3. Devising hypotheses Assumptions
4. Testing hypotheses through the assessment of data ● When patients are unable to cope with their needs their own, they
5. Revising hypotheses when necessary on the basis of become distresses by the feeling of helplessness
conclusions obtained from the data ● 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 nurse and the patient
● Peopl attach meaning to situations and actions that aren’t apparent
to others
● Patients enter into nursing care though medicine

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 THEORETICAL FOUNDATIONS OF NURSING

● The patient is unable to state the nature and meaning of his or her ○ Person perceives with any one of his five sense organs an
distress without the help of the nurse, or without him or her first object or objects
having established a helpful relationship with the patient ○ The perceptions stimulate automatic thought
● Any observation shared and observed with the patient is ○ Each thought stimulates an automatic feeling then the
immediately helpful in ascertaining and meeting his or her need, or person acts
finding out that he or she is not in need at that time ○ THe first three items taken together are defines as the
● Nurses are concerned with the need the patient is unable to meet person’s immediate reaction
on his or her own Nursing process discipline
● Investigation
Terms ○ Any observation shared and explored with the patient is
● Distress immediately useful in ascertaining and meeting his need or
○ The experience of a patient whose need has not been met finding out that he is not in need at that time
● Nursing role ○ The nurse does not assume that any aspect of her reaction
○ To discover and meet the patient’s immediate need for help to the patient is correct, helpful or appropriate until she
○ Patient’s behavior may not represent the true need checks the validity of it in exploration with the patient
○ The nurse validates his/her understanding of the need with Improvement
the patient ● Resolution
● Nursing actions ○ It is not the nurses activity that is evaluated but rather its
○ Directly or indirectly provide for the patient’s immediate need result: whether the activity srves to help the patient
● Outcome communicate her or his need for help and how it is met
○ A change in the behavior of the patient indicating either a ○ In each contact the nurse repeats a process of learning how
relief from distress or an unmet need to help the individual patient
○ Observable verbally and nonverbally
Nursing Process
Metaparadigm Assesment
Human ● The nurse completes a holistic assesment of the patient’s needs
● Orlando uses the concept of human as she emphasizes ● This is done without taking the reason for the encounter into
individuality and the dynamic nature of the nurse-patient consideration
relationship Diagnosis
● For her, humans in need are the focus of nursing practice ● The diagnosis stage uses the nurse’s clinical judgement about
Health health problems
● In Orlando’s theory, health is replaced by a sense of helplessness ● The diagnosis can then be confirmed using links to defining
as the initator of a necessity for nursing characteristics, related factors, and risk factors found in the
● She stated that nursing deals with individuals who are in need of patient’s assesment
help Planning
Environment ● The planning stage addresses each of the problems identifued in
● Orlando completely disregarded environment in her theory the diagnosis
● Only focusing on the immediate needs of the patient ● Each problme is given a specific goal or outcome, and nursing
● Chiefly the relationship and actions between the nurse and the interventions to help achieve the goal
patient Implementation
Nursing ● The nurse begins using the nursing care plan
● Orlando speaks of nursing as unique and independent in its Evaluation
concerns for an individual’s need for help in an immediate situation ● The nurse looks at the progress of the patient toward the goals set
● The efforts to meet the individual’s need for help are carried out in in the nursing care plan
an interactive situation and in a disciplined manner that requires ● Changes csn be made to the nursing care plan based on how well
proper training (or poorly) the patient is progressing toward the goals

Concepts Conclusion
Function of professional Nursing ● Focuses on the interaction between the nurse and patient,
● Organizing principle perception validation, and the use of the nursing process to produce
○ Finding out and meeting the patients immediate needs for positive outcomes or patient imrovement.
help ● Define the function of nursing
○ “Nursing is responsive to individuals who suffer or anticipate ● Orlando’s theory remains one of the most effective practice theories
a sense of helplessness,it is focusd on the process of care available
in an immediate experience ● The use of her theory keeps the nurse’s focus on the patient
○ It is concerned with providing direct assistance to individuals ● The strength of the theory is that it is clear, concise, and easy to
in whatever setting they are found for the purpose of use
avoiding, relieving, diminishing or curing the individual sense ● While providing the overall framework for nursing, the use of her
of helplessness.” - Orlando theory does not exclude nurses from using other theories while
Presenting behavior caring for the patient
● Problematic situation
○ To find out the immediate need for help the nurse must first
recognize the situation as problematic
○ The presenting behavior of the patient, regardless of the
form in which it appears, may represent a plea for help
○ The presenting behavior of the patient, the stimulus, cause
an automatic internal response in the nurse, and the nurses
behavior cause a response in the patient
Immediate reaction
● Internal response

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