NCM 101 REVIEWER FOR MIDTERM

BETTY NEUMAN
(NEUMAN SYSTEM MODEL)

• Born in Lowel, Ohio in 1924.

• Betty Neuman earned her diploma as a Registered Nurse in 1947 from the Peoples Hospital School of
Nursing in Akron, Ohio. She went on to complete her Bachelor of Science in Nursing in 1957 and her
Master of Science in Mental Health, both from the University of California-Los Angeles in 1966.

• She also earned a Ph.D. in clinical psychology from Pacific Western University in 1985. In 1992, Neuman
was given an Honorary Doctorate of Letters at the Neumann College in Aston, Pennsylvania.

• Finally, in 1998, the Grand Valley State University in Michigan gave her an Honorary Doctorate of Science.

ENERGY

Lines of
Resistanc
e
Flexible Normal
Line of Line of
Defens Defens
e e

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 intra-, inter-, 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.

The model's basic central core consists of energy resources (normal temperature range, genetic structure,
response pattern, organ strength or weakness, ego structure, and knows or commonalities) that are surrounded by
several lines of resistance, the normal line of defense, and the flexible line of defense.

The lines of resistance represent the internal factors that help the patient defend against a stressor

The normal line of defense represents the person's state of equilibrium

The flexible line of defense depicts the dynamic nature that can rapidly alter over a short period of time.
 INTERVENTION
Primary Prevention

NURSING
Secondary Prevention

Tertiary Prevention

Nursing interventions occur through three prevention modalities.

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.

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.

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.

SISTER CALLISTA ROY

(ADAPTATION MODEL)

• (born October 14, 1939) is a nursing theorist, professor, and author. She is known for her groundbreaking
work in creating the Adaptation Model of Nursing.

• received her Bachelor of Arts Major in Nursing from Mount Saint Mary’s College in Los Angeles in 1963
and her master’s degree in nursing from the University of California in 1966.

• After earning her nursing degrees, Roy began her sociology education, receiving both a master’s degree in
sociology in 1973 and a doctorate in sociology in 1977 from California.

Sister Callista L. Roy (born October 14, 1939) is a nursing theorist, profession, and author. She is known for her
groundbreaking work in creating the Adaptation Model of Nursing.

FOCUS/DEVELOPMENT

• Viewed humans as Bio-psychosocial beings constantly interacting with a changing environment and who
cope with their environment through Bio-psychosocial adaptation mechanisms.

• Focuses on the ability of Individuals., families, groups, communities, or societies to adapt to change.

• Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or
adaptation.
 SELF CONCEPT-GROUP IDENTITY
PHYSIOLOGIC-PHYSICAL MODE MODE
4 MODES OF ADAPTATION
ROLE FUNCTION INTERDEPENDENCE MODE
MODE

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.”

4 MODES OF ADAPTATION

1.PHYSIOLOGIC-PHYSICAL MODE

– Behavior pertaining to the physical aspect of the human system

– Physical and chemical processes

– Nurse must be knowledgeable about normal processes

– 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection

2. SELF CONCEPT-GROUP IDENTITY MODE

– The composite of beliefs and feelings held about oneself at a given time

– Focus on the psychological and spiritual aspects of the human system

– Need to know who one is, so that one can exist with a state of unity, meaning, and
purposefulness

– 2 modes (physical self, and personal self)

– Goal: psychological integrity

3. ROLE FUNCTION MODE

Set of expectations about how a person occupying one position behaves toward a person occupying another
position

Basic need-social integrity, the need to know who one is in relation to others

Goal: Social integrity

4. INTERDEPENDENCE MODE

– Behaviour pertaining to interdependent relationships of individuals and groups

– Focus on the close relationships of people and their purpose

– Each relationship exists for some reason

 – Involves the willingness and ability to give to others and accept from others

– Balance results in feelings of being valued and supported by others

– Basic need-feeling of security in relationships

DOROTHY JOHNSON
(BEHAVIORAL MODEL SYSTEM)

• was born on August 21, 1919 in Savannah, Georgia.

• She earned her Bachelor of Science in Nursing in 1942 from Vanderbilt University in Nashville, Tennessee.

• In 1948, she received her Master’s degree from Harvard University. During her career, Johnson was an
assistant professor of pediatric nursing, an associate professor of nursing, and a professor of nursing at
the University of California in Los Angeles. She retired in 1978.

Johnson’s Behavioral System Model is a model of nursing care that advocates the fostering of efficient and
effective behavioral functioning in the patient to prevent illness. The patient is identified as a behavioral system
composed of seven behavioral subsystems: affiliative, dependency, ingestive, eliminative, sexual, aggressive, and
achievement. An imbalance in any of the behavioral subsystems results in disequilibrium. It is nursing’s role to
assist the client to return to a state of equilibrium.

Each subsystem has a specific task, however, the individual is viewed as a whole by virtue of the
interdependence of each subsystem When there is an equal distribution among all eight subsystems then balance
and equilibrium can be achieved.

1. Affiliative- Behaviors associated with the development and maintenance of interpersonal relationships
with parents, peers, authority figures. Established a sense of relatedness and belonging with others
including attachment behaviors, interpersonal relationships and communication skills.
 2. Dependancy- Behaviors associated with obtaining assistance from others in the environment for
completing tasks and/or emotional supports. Includes seeking of attention, approval, recognition, basic
self-care skills and emotional security.

3. Ingestive- Behaviors associated with the intake of needed resources from the external environments,
including food, fluid, information, objects, for the purpose of establishing an effective relationship with
the environment.

4. Elimination- Behaviors associated with the release of physical waste products

5. Sexual – Behaviors associated with a specific gender identity for the purpose of ensuring
pleasure/procreation, and knowledge and behavior being congruent with biological sex.

6. Aggressive- Behaviors associated with real or potential threat in the environment for the purpose of
ensuring survival. Protection of self through direct or indirect acts. Identification of potential danger.

7. Achievement-Behaviors associated with mastery of oneself and one’s environment for the purpose of
producing a desired effect. Includes problem- solving activities. Knowledge of personal strengths and
weaknesses.

B. NURSING THEORIES

1. Peplau’s Theory of Interpersonal Relationship

2. Orlando’s Theory of Deliberative Nursing Process

3. Travelbee’s Human to Human Relationship

4. Hall’s CORE, CARE, CURE

5. Abdellah’s 21 Nursing Problems

6. Henderson’s Need Theory

7. Leininger Theory of Culture Care Diversity & Universality

8. Margaret Newman’s Theory of Health as Expanding Consciousness

9. Parse’s Theory of Human Care

HILDEGARD PEPLAU
(INTERPERSONAL RELATIONS THEORY)

• (September 1, 1909 – March 17, 1999) 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.”
 “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,

Hildegard E. Peplau’s theory defined Nursing as “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.

ORIENTATION PHASE

4
INTERPERSONAL
RELATIONSHIPS
IDENTIFICATION PHASE

EXPLOITATION PHASE

RESOLUTION PHASE

ORIENTATION PHASE

CLIENT
MEETS TYPE OF SERVICE
NURSE

CLIENT
NURSE SEEKS
RESPONSE ASSISTANCE
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 of past
experiences

Nurse responds, explains roles to the client, helps to identify problems and to use available resources and services

• 2. Identification Phase (Working 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 the exploitation phase, the client makes full use of the services offered.

In the exploitation 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 patients 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 theory has proved of great use to later nurse theorists and clinicians in developing more sophisticated
and therapeutic nursing interventions, which show the dynamic character roles typical in clinical nursing.

It entails that a nurse’s duty is not just to care but the profession also incorporates every activity that may affect
the client’s health.

IDA JEAN ORLANDO

(NURSING PROCESS)

• was a first-generation Irish American born on August 12, 1926.

• She dedicated her life to 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 general hospital supervisor, 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.

• died on November 28, 2007, at the age of 81.

STAGES OF NURSING PROCESS

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.

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.
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.

Implementation - In the implementation stage, the nurse begins using the nursing care plan.

Evaluation - Finally, 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.

Orlando’s nursing theory stresses the reciprocal relationship between

patient and nurse. What the nurse and the patient say and do affects them
both.
Ida Jean Orlando
developed
her Deliberative Orlando views the professional function of nursing as finding out and
Nursing Process that
allows nurses to
meeting the patient’s immediate need for help.
formulate an effective
nursing care plan that She was one of the first nursing leaders to identify and emphasize the
can also be easily
adapted when and if elements of the nursing process and the critical importance of the patient’s
any complexity comes participation in the nursing process.
up with the patient.
Orlando’s theory focuses on how to produce improvement in the patient’s
behavior. Evidence of relieving the patient’s distress is seen as positive
changes in the patient’s observable behavior.
JOYCE TRAVELBEE
(HUMAN TO HUMAN RELATIONSHIP)

• Joyce Travelbee was born in 1926 and 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.

• Travelbee died in 1973 at the age of 47.

5 PHASES OF INTERACTION PROCESS

Mutual Understanding

Inaugural Meeting

Travelbee believed nursing is accomplished through human-to-human relationships. This relationship can only be
established by an interaction process. It has five phases:

That begins with the original encounter (Inaugural meeting) and then progress through stage of emerging
identities, developing feelings of empathy, and later feelings of sympathy until it reaches the final stage of Mutual
understanding.

1. Phase of the Original Encounter

-This is described as the first impression by the nurse of the sick person and vice versa. The nurse and patient see
each other in stereotyped or traditional roles.

2.Phase of Emerging Identities

This phase is described by the nurse and patient perceiving each other as unique individuals.
At this time, the link of the relationship begins to form.
3. Phase of Empathy: This phase is described as the ability to share in the person’s experience. The result of the
empathic process is the ability to expect the behaviour of the individual with whom he or she empathized

4. Phase of Sympathy: Sharing, feeling and experiencing what others are feeling and experiencing is accomplished.
This phase demonstrates emotional involvement and discredits objectivity as dehumanizing.

5. Phase of Rapport: Rapport is described as nursing interventions that lessens the patient’s suffering. The nurse
and the sick person are relating as human being to human being. The sick person shows trust and confidence in the
nurse. “A nurse is able to establish rapport because she possesses the necessary knowledge and skills required to
assist ill persons, and because she is able to perceive, respond to, and appreciate the uniqueness of the ill human
being.”

“A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the whole person.
The existence of the suffering whether physical, mental or spiritual is the proper concern of the nurse.” – Joyce
Travelbee

LYDIA HALL
(CARE, CORE, CURE THEORY)

• was born on September 21, 1906 in New York City.

• In 1927, she earned her nursing diploma and went on to complete a Bachelor of Science in Public Health
Nursing in 1937. She earned a Master’s degree to teach natural sciences in 1942.

• Hall worked as the first director of the Loeb Center for Nursing. Her nursing experience was in clinical
nursing, nursing education, research, and in a supervisory role.

• Hall died in 1969.

• The theory contains of three independent but interconnected circles:

• .According to the theory;

The CORE is the person or patient to whom nursing care is directed and needed. The motivation and energy
necessary for healing exist within the patient, rather than in the health care team.

The CURE, is the attention given to patients by the medical professionals. The model explains that the cure circle is
shared by the nurse with other health professionals. These are the interventions or actions geared on treating or
“curing” the patient from whatever illness or disease he may be suffering from.

The CARE circle explains the role of nurses, and focused on performing that noble task of nurturing the patients,
meaning the component of this model is the “motherly” care provided by nurses, which may include limited to
provision of comfort measures, provision of patient teaching activities and helping the patient meet their needs
where help is needed.

FAYE ABDELLAH
(21 NURSING PROBLEMS)

• was born on March 13, 1919.

 • Abdellah was the first nurse officer to earn the ranking of a two-star rear admiral. She was the first nurse
and the first woman to serve as a Deputy Surgeon General.

• Her work changed the focus of nursing from disease-centered to patient-centered, and began to include
the care of families and the elderly in nursing care.

• The Patient Assessment of Care Evaluation developed by Abdellah is now the standard used in the United
States.

Typology of 21 Nursing Problems

BASIC TO ALL PATIENT

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

 SUSTENAL CARE NEEDS

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.

10. To facilitate the maintenance of regulatory mechanisms and functions

11. To facilitate the maintenance of sensory function

REMEDIAL CARE NEEDS

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

RESTORATIVE CARE 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
 VIRGINIA HENDERSON
(NEED THEORY)

 was born on November 30, 1897 in Kansas City, Missouri, and was the fifth of eight children in her family.

 n 1921, Henderson graduated from the Army School of Nursing at Walter Reed Hospital in Washington,
D.C. In 1932, she earned her Bachelor’s Degree and in 1934 earned her Master’s Degree in Nursing
Education, both from Teachers College at Columbia University.

 Henderson died on March 19, 1996.

These components show a holistic approach to nursing that cover the physiological,
psychological, spiritual, and social. The first nine components are physiological. The tenth and fourteenth are
psychological. The eleventh component is spiritual and moral. The twelfth and thirteenth components are
sociological, specifically addressing occupation and recreation.

-Henderson’s definition of nursing states: “I say that the nurse does for others what they would do for themselves
if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient
independent of him or her as soon as possible.”
-The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is result of the nurse’s
creativity in planning for care. The nurse should be an independent practitioner able to make independent
judgments as long as he or she is not diagnosing, prescribing treatment, or making a prognosis, since those
activities are the function of the physician.

-The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is result of the nurse’s
creativity in planning for care. The nurse should be an independent practitioner able to make independent
judgments as long as he or she is not diagnosing, prescribing treatment, or making a prognosis, since those
activities are the function of the physician.

-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.