THEORETICAL FOUNDATION OF NURSING

SYSTEMS MODEL
BETTY NEUMAN SYSTEMS MODEL
“Nursing is a unique profession that is concerned with all of the variables affecting an individual’s response to stress.”

• Focus on Stress: The model emphasizes the individual’s relationship to stress and the dynamic process of reconstitution
(returning to balance after a stressor).
• Open System: Humans are seen as open systems exchanging energy with their environment, influenced by physiological,
psychological, sociocultural, developmental, and spiritual factors.
• Core and Lines of Resistance: The core represents essential life resources, surrounded by lines of resistance (internal
defenses against stressors).
• Lines of Defense: The first line is the normal state of equilibrium (wellness), and the second is flexible, adjusting quickly to
stressors.
• Stressors: These are categorized as intrapersonal (within the individual), interpersonal (between individuals), and extrapersonal
(external factors).
• Reaction to Stress: A person’s ability to respond to stress depends on the integrity of their defense systems; if defenses fail, the
system relies on its lines of resistance for recovery.
• Reconstitution: After a stressor, the system adapts and returns to a state of balance, which may be higher or lower than before.
• Prevention Levels: Nursing interventions aim to maintain stability through:
• Primary Prevention: Preventing stressors.
• Secondary Prevention: Addressing symptoms.
• Tertiary Prevention: Restoring stability after treatment.

Core Concepts of the Neuman Systems Model

1. Open System
a. Definition: Humans are seen as open systems, constantly interacting with their environment, which influences their physical, emotional, and
psychological responses.
b. Stress and Stress Response: The interaction between the person and external stressors is central to this model, as stress can disrupt the system's
balance.
2. Client System
3. The client system is composed of five interrelated variables:
a. Physiological: Refers to body structure and function.
b. Psychological: Includes mental processes and emotional responses.
c. Sociocultural: Encompasses social and cultural influences.
d. Developmental: Relates to age-related processes and developmental stages.
e. Spiritual: Involves beliefs and spiritual influences.
4. Basic Structure (Central Core)
a. The central core represents basic survival factors, such as the energy resources (physical, mental, and spiritual) needed for optimal functioning.
5. Lines of resistance → represents resources that help the client defend against a stressor
6. Lines of Defense
a. Normal Line of Defense: Represents the individual's usual state of health or equilibrium.
b. Flexible Line of Defense: The dynamic protective layer that helps the system respond to stressors before they breach the normal line of defense.
c. Lines of Resistance: These are the internal factors or resources that help the system resist or fight stressors once the flexible line of defense has
been overcome.
7. Flexible line of defense
a. Neuman classifies stressors as:
i. Intrapersonal: Stressors within the individual (e.g., mental health issues, physical illness).
ii. Interpersonal: Stressors between individuals or within social relationships (e.g., family conflict).
iii. Extrapersonal: Stressors from external sources (e.g., environmental pollution, societal issues).
8. Reconstitution
a. This refers to the process of restoring the client system to its usual state of wellness after the disruption caused by stressors. Reconstitution can
result in a higher or lower level of stability compared to the pre-stressor state.
9. Preventive Interventions
The model emphasizes the need for primary, secondary, and tertiary prevention:
a. Primary prevention: Aims to reduce risk factors before stressors affect the client.
b. Secondary prevention: Focuses on early detection and treatment once symptoms have appeared.
c. Tertiary prevention: Involves interventions that help the system return to a state of optimal stability after stressor effects.

Nursing Process in the Neuman Systems Model

The nursing process in Neuman's model is organized into three steps:
1. Assessment:
o Identifying the client's normal line of defense and assessing any known, unknown, or universal stressors.
o Evaluating the five system variables (physiological, psychological, sociocultural, developmental, and spiritual) and how they influence the client’s
stress response.
2. Diagnosis, Planning, and Implementation:
o Developing a nursing diagnosis that reflects the client's overall system status.
o Setting goals in collaboration with the client and selecting appropriate interventions based on the identified stressors and level of prevention.
3. Evaluation:
o Assessing the effectiveness of the interventions in terms of the client’s ability to adapt and restore stability.
o Reassessing stressors and their impact, considering changes in the client's environment, and determining if further interventions are needed.

Key Theoretical Assertions

• Uniqueness of Each Client System: Each client is unique, and their response to stressors will depend on the interaction of their system variables and the
specific stressors encountered.
• Health as a Continuum: Health is viewed as a continuum between wellness and illness, with the client’s system constantly adjusting to maintain balance.
• Lines of Defense: The flexibility and integrity of the lines of defense and resistance determine the client’s ability to adapt and maintain health.
• Dynamic Interaction: The client’s state of health is affected by the dynamic interactions between the internal system (client variables) and external
stressors.

Theoretical View of Metaparadigms

1. Nursing:
o Nursing focuses on understanding and addressing the client’s response to stressors. The goal is to help the system adapt and maintain stability,
conserving energy and resources.
2. Person:
o A person is viewed as an individual or social unit (e.g., family or community), and nursing care is directed toward helping these systems maintain or
regain stability.
3. Health:
o Health is defined as the level of stability in the client system, which can range from wellness to illness. Optimal health occurs when system needs are
met; illness arises when these needs are unmet.
4. Environment:
o The environment consists of factors that influence the client system, categorized as:
▪ Internal environment: Factors inside the body (e.g., physiological processes).
▪ External environment: Factors outside the body (e.g., pollution, climate).
▪ Created environment: A symbolized environment developed unconsciously by the client to express the whole system.
 THEORETICAL FOUNDATION OF NURSING

ADAPTATION MODEL OF NURSING

SISTER CALLISTA ROY
✔ The model assumes that systems of matter and energy progress to higher levels of complex self-organization.
✔ Consciousness and meaning comprise person and environment integration while awareness of self and environment is
rooted in thinking and feeling.
✔ System relationships include acceptance, protection and fostering of independence
✔ Man and his environment have common patterns and integral relationships and transformations are created in human
consciousness.
✔ Integration of man and environment meanings result in adaptation.
✔ Roy’s model of nursing is best exemplified in the nursing process

The nursing process is a problem solving approach for gathering data, identifying the capacities and needs of the human
adaptive system, selecting and implementing approaches for nursing care, and evaluating the outcome of care provided. It
includes the

1. Assessment of Behavior:
The first step involves gathering data about how a person behaves as an adaptive system in response to stimuli, focusing on adaptive modes
(physiological, self-concept, role function, and interdependence).
2. Assessment of Stimuli:
This step identifies internal and external stimuli affecting the person’s adaptive behaviors. Stimuli are categorized as:
o Focal: Immediate, pressing stimuli.
o Contextual: Other stimuli affecting the situation.
o Residual: Unclear stimuli whose effects are uncertain.
3. Nursing Diagnosis:
This step formulates statements based on data, describing the person's adaptation status and the related stimuli influencing their behavior.
4. Goal Setting:
Establishing clear, behavioral outcomes for nursing care to guide the process.
5. Intervention:
Determining the best strategies to help the person achieve the set goals.
6. Evaluation:
Judging the effectiveness of the interventions by comparing the outcomes with the established goals.

Four Adaptive Modes:

1. Physiological-Physical Mode:
Involves physical and chemical processes necessary for life, including needs for oxygenation, nutrition, elimination, activity/rest, and protection.
2. Self-Concept Group Identity Mode:
Focuses on an individual's sense of identity, self-esteem, and body image, helping them maintain a unified sense of purpose and integrity.
3. Role Function Mode:
Concerns the roles an individual occupies in society and their sense of belonging and purpose in these roles.
4. Interdependence Mode:
Focuses on the relational aspect of adaptation, achieving integrity through love, respect, and communication in relationships.

Major Concepts & Definitions:

• Health:
A dynamic state of being that reflects the integration of the person with the environment. Health and illness coexist as part of the adaptation
process.
• Adaptation:
A process by which individuals or groups use conscious awareness and choice to create integration between themselves and their environment.
• Adaptive Responses:
Responses that promote the goals of the human system: survival, growth, reproduction, and transformation.
• Ineffective Responses:
Responses that do not promote the goals of the human system, leading to maladaptation.
• Adaptation Levels:
Three levels of adaptation:
o Integrated: Optimal functioning.
o Compensatory: Adjustments to environmental demands.
o Compromised: Inadequate adaptation leading to illness or dysfunction.

Theory Assertions:
• Adaptive System:
Roy views the person as an adaptive system with cognitive (thought-based) and regulatory (physiological) subsystems that work together to
maintain adaptation across the four modes.
• Mutuality of Person and Environment:
The person and environment interact in a mutual relationship where the environment provides stimuli that challenge the person to adapt.
• Nursing's Role:
Nursing aims to expand adaptive abilities and promote adaptation by assessing behavior, identifying stimuli, and intervening to enhance
adaptation and environmental interactions.

Theory in View of Metaparadigms:

• Nursing:
Nurses facilitate adaptation by assessing adaptive behaviors, promoting positive adaptation, eliminating ineffective coping mechanisms, and
enhancing the relationship between the patient and their environment.
• Person:
Humans are holistic beings in constant interaction with their environment, using adaptive processes to respond to stimuli. Both individuals and
groups can be viewed as adaptive systems.
• Health:
Health is the ability to adapt to stimuli. If a person can continuously adapt to changing environments, they maintain health. Failure to adapt
effectively leads to compromised health.
• Environment:
The environment consists of all external conditions and influences that affect the individual’s adaptive system. These stimuli can be both
positive and negative, requiring the person to adapt.

Application of the Theory:

• The nursing process is cyclical—assessment, diagnosis, planning, implementation, and evaluation repeat in a cycle, with each step feeding
into the next.
• Assessment gathers data (stimuli); planning and implementation are the throughput processes, and evaluation is the output, determining
the effectiveness of nursing interventions.
• The nurse’s role is to facilitate adaptation by adjusting care based on the patient’s responses to stimuli. Adaptation occurs when patients react
positively to interventions, achieving improved outcomes or new adaptive responses.
 THEORETICAL FOUNDATION OF NURSING

BEHAVIORAL SYSTEMS MODEL

DOROTHY JOHNSON
“Nursing is an external force that acts to preserve the organization of the patient9s behavior by means of imposi ng regulatory
mechanisms or by providing resources while the patient is under stress.”

Credentials and Background of Dorothy E. Johnson:

• Born: August 21, 1919, Savannah, Georgia
• Education:
o BSN: Vanderbilt University, Nashville, Tennessee
o MPH: Harvard University, Boston
• Career Highlights:
o Staff nurse at the Chatham-Savannah Health Council (1943-1944)
o Awarded the 1975 Faculty Award from graduate students for her contributions to nursing.
o Early proponent of nursing as both a science and an art.
o Believed nursing had a unique body of knowledge reflecting both science and art.

Theoretical Contributions:
• In 1959, Johnson proposed that nursing care should facilitate a client's maintenance of equilibrium, defined as a balanced state of health and wellbeing.
• Johnson’s theory focused on stress as a critical concept, emphasizing how internal and external stimuli (stressors) cause disturbances (tensions) in a
person’s equilibrium, leading to disequilibrium.
• Nursing’s role is to reduce these stressful stimuli and support the client’s natural adaptive processes to return to equilibrium.

Theoretical Sources:
• Johnson’s behavioral system theory draws on Florence Nightingale’s belief that nursing’s goal is to help individuals prevent or recover from disease or
injury.
• Nursing’s focus should be on the patient as an individual, not merely the disease, and should be based on a systems model where interrelated parts
work together to maintain balance.
• Behavioral System Model: Johnson emphasized that patterns of behavior form a system—a whole comprised of interconnected parts, where each part
(subsystem) influences the others.

Seven Subsystems of Human Behavior:

1. Attachment Subsystem:
o Key to survival and social organization; promotes security and social bonding.
2. Achievement Subsystem:
o Focuses on self-control, mastery, and achieving excellence in various aspects (intellectual, physical, creative).
3. Aggressive Subsystem:
o Protects and preserves by responding to threats; aggressive behavior, though learned, is meant to protect and defend.
4. Dependence Subsystem:
o Fosters help-seeking behaviors, receiving care and assistance, and seeks approval, attention, or recognition.
5. Sexual Subsystem:
o Involves behaviors related to procreation and sexual gratification, beginning with gender role identity development.
6. Ingestive Subsystem:
o Pertains to behaviors related to eating, including when, how, and what is consumed.
7. Eliminative Subsystem:
o Relates to elimination behaviors—when and how waste products are expelled from the body.
Each subsystem is aimed at achieving a specific goal and functions in a way that helps the individual maintain overall equilibrium.

Key Concepts & Definitions:

• Behavior:
The output of physiological and psychological processes responding to changes in sensory stimuli.
• System:
A whole composed of interrelated parts that function together. For the system to be functional, the parts must be organized and interconnected.
• Behavioral System:
A system that encompasses repetitive, patterned behaviors that serve a purposeful function for the individual.
• Equilibrium:
A stable state where the person is in harmony with their environment, but this state can be dynamic and transient.
• Tension:
The disturbance in equilibrium, often resulting from external or internal stimuli.
• Stressor:
Any stimulus, internal or external, that disrupts equilibrium and creates tension.

Theory Assumptions:
1. System Assumptions:
o Organization, interaction, and integration of behavioral parts create a cohesive system.
o The behavioral system works toward maintaining balance or equilibrium, using automatic adjustments to external forces.
o A balanced system leads to successful adaptation.
2. Structure Assumptions:
o Behavior can be understood by observing its form and the goal it aims to achieve.
o Each person has a predisposition to act in certain ways toward achieving a goal.
o Each subsystem has a scope of action—a repertoire of behavioral choices.
3. Function Assumptions:
o The system must be protected from harmful influences.
o Subsystems need nurturing through environmental input.
o Subsystems must be stimulated to enhance growth and prevent stagnation.

Theory in View of Metaparadigms:

• Nursing:
Nursing is seen as an external force that helps maintain the organization of a person’s behavior, either by regulating the system or by providing resources
to help restore balance under stress.
• Person:
A person is viewed as a behavioral system with interdependent parts (subsystems) that maintain balance. To restore equilibrium, individuals may expend
excess energy.
• Health:
Health is a dynamic state where a person can adapt to internal and external stimuli. A lack of balance in the system leads to illness.
• Environment:
The environment consists of external factors that influence the person’s behavioral system. Nurses can manipulate environmental factors to help restore
balance and health.

Application of the Theory:

• Subsystem Interdependence:
Subsystems are interconnected—an imbalance in one subsystem can affect others. Nurses need to consider the person holistically and address all
subsystems to restore balance.
• Nursing Care:
Nurses provide quality care by considering the whole person and understanding how individual subsystems interact. By manipulating environmental factors
or regulating behavior, nurses help clients regain balance and health.