Nursing Theory

Maria Sheila A. ClanorRNMAN

Sr. Callista Roy
The Adaptation Model (1997)
 SISTER CALLISTA ROY
 She had published many
books, chapters and
periodical articles and has
presented numerous
lectures and workshops
focusing on her adaptation
model
 She received the national
Founders Award of
excellence in Fostering
Professional Nursing
Standards
 SISTER CALLISTA ROY
 Member of the Sister saint
Joseph of Carondeit, was
born on October 14, 1939
in L.A.
 After earning her nursing
degrees, she began her
education in sociology
 Roy had noticed the great
resiliency of children of the
Department of Nursing at
Mount St. Mary’s College in
L.A.
 SISTER CALLISTA ROY
 She had published many
books, chapters and
periodical articles and has
presented numerous
lectures and workshops
focusing on her adaptation
model
 She received the national
Founders Award of
excellence in Fostering
Professional Nursing
Standards
Sister Callista Roy
“ADAPTATION MODEL”
 Sister Callista L. Roy, was born on October
14, 1939 in Los Angeles, California.
 She is a nurse theorist and a professor at the
William F. Connell School of Nursing at
Boston College, Massachusetts. She earned
her Bachelor of Science in Nursing in 1963
from Mount Saint Mary College, LA.
 Her Master’s degree in Pediatric Nursing was
finished in 1966 and Doctorate in Sociology
was conferred on her in 1977 from the
University of California, Los Angeles.
METAPARADIGM IN NURSING
 Roy’s models view the
person as a
biopsychosocial being in a
constant interaction with
a changing environment.
 Roy viewed
environment as
conditions, circumstances
and influences that
surround and affect the
development and behavior
of the person.
METAPARADIGM IN NURSING
 Health is the process
of being and becoming
an integrated and
whole person.
 Nursing is the
science and practice
that expands adaptive
abilities and enhances
person and
environment
transformation.
 Nursing Person

 The science and  Humans are holistic,

practice that expands adaptive systems
adaptive abilities and  Human system is
enhances person and described as whole with
environmental parts that functions as
transformation. unity for some purpose
 The goal of nursing is  Human System have
the promotion of thinking and feeling
adaptation for capacities, rooted in
individuals and groups consciousness and
in each of the 4 meaning by which they
adaptive models thus adjust effectively to
changes in the
contributing to health, environment and in turn,
quality of life and dying affect the environment
with dignity.
 Health Environment

 Is a state and a  All the conditions,

circumstances and
process of being and influences surrounding
and affecting the
becoming integrated development and
and a whole person. behavior of persons or
groups, with particular
It is a reflection of consideration of the
the adaptation, that mutually of the person
and earth resources that
is, the interaction of includes focal, contextual
and residual stimuli.
the person and
 It is the changing
environment environment that
stimulates the person to
make adaptive responses
KEY CONCEPTS
 The person is adapting in
a stable interaction with
the environment
 The environment serves
as the source of a range of
stimuli
 The person’s major task is
to maintain integrity.
 Sr. Callista Roy
 The person is an adaptive system, employing a
feedback cycle of input (stimuli), throughput
(control process) and output (behavior or
adaptive response)
 All people have certain needs, categorized into
1. Physiological
2. Self-concept
3. Role Function
4. Interdependence
 ADAPTIVE MODES
 Physiological- the way a person
responds as a physical being to
stimuli from the environment.
 ADAPTIVE MODES
 Self-concept-
psychological and
spiritual
characteristics of the
person consist of all
beliefs and feelings
that one has formed
about oneself.
 ADAPTIVE MODES
 Role function- a set of
expectations about how a person
occupying one’s position behaves
towards a person occupying another
position.
 ADAPTIVE MODES
 Interdependence-
coping mechanism from
close relationship which
results to giving and
receiving of love, respect
and value.
 ADAPTATION MODEL

 Adaptive level – represents the

condition of life processes described on
three levels as integrated, compensatory
and compromised
◦ Constantly changing point, made up of focal,
contextual and residual stimuli, which
represents the persons own standard of the
range of stimuli to which one can respond
with ordinary adaptive responses
3 Adaptive Responses
 Focal stimulus – the internal and external
stimulus most immediately confronting the
human system
 Contextual Stimulus – are all other
stimuli present in the situation that
contribute to the effect of the focal stimulus
 Residual Stimulus – are environmental
factors within or without the human system
with effects in the current situation
 Sr. Callista Roy
 Defines adaptation as “the process and
outcome whereby the thinking and feeling
person uses conscious awareness and choice
to create human and environmental
integration”
 Viewed each person as a unified
biopsychosocial system in constant
interaction with the environment
Sr. Callista Roy

 Need for nursing care arises when client

cannot adapt to internal and external
environmental demands
 The nurse determines what demands are
causing problems for the client; assesses
how well the client is adapting to them
 Nursing care, therefore, is directed at
helping the client adapt
 BETTY NEUMAN
 She was born in 1924
on a farm near Lowell,
Ohio
 She was the pioneer
of nursing involvement
in mental health.
 She developed, taught
and refined a
community mental
health program for
postmaster’s level
nurses at UCLA
 BETTY NEUMAN
 She developed her first explicit
teaching and practice model for
mental health consultation,
before the creation of her
system model.
 First nurse licensed in
California as a marriage and
family counselor, Clinical Fellow
of the American Association of
Marriage and Family Therapist
and has maintained a limited
private counseling practiced.
BASIC ASSUMPTIONS
OF NEUMANN’S
THEORY

Thursday, August 12, 2021 24

BASIC ASSUMPTIONS
1. Each client system is unique, a composite of
factors and characteristics within a given range
of responses contained within a basic
structure. I am unique

Thursday, August 12, 2021 25

 BASIC ASSUMPTIONS
2. Many known, unknown and universal
stressors exist. Each differ in it’s potential
for disturbing a client’s usual stability level
or normal Line of Defense.

Thursday, August 12, 2021 26

 BASIC ASSUMPTIONS
3. Stressors both universal and known; some
are unique to the client. They have potential
to disturb equilibrium, thus causing a
change in priority of needs at any given
moment.

Stressors disturbs the

normal equilibrium

Thursday, August 12, 2021 27

 BASIC ASSUMPTIONS
4. Man is a composite of the interrelationship of
the four variables ( biological, psychological,
socio-cultural and developmental) which are at
all times present.

Thursday, August 12, 2021 28

 BASIC ASSUMPTIONS
5. Each client/ client system has evolved a normal
range of responses to the environment that is
referred to as a normal Line of Defense. The
normal Line of Defense can be used as a standard
from which to measure health deviation.

Thursday, August 12, 2021 29

 BASIC ASSUMPTIONS
7. When the flexible Line of Defense is no longer
capable of protecting the client/ client system,
against an environmental stressor, the stressor
breaks through the normal Line of Defense.

Thursday, August 12, 2021 30

 BASIC ASSUMPTIONS
7. When the flexible Line of Defense is no longer
capable of protecting the client/ client system,
against an environmental stressor, the stressor
breaks through the normal Line of Defense.

Thursday, August 12, 2021 31

METAPARADIGM
Person

Environment

Health

Nursing
 SYSTEMS MODEL
 Wholistic client approach  Scholastic approach
 Open system  Content
 Basic structure  Process
 Environment  Input and output
 Created environment  Feedback
 Stressors  Negentropy
 Lines of defense and  Entropy
resistance  Stability
 Degree of Reaction
 Wellness
 Prevention as
 Illness
intervention
 Reconstitution
 BETTY NEUMAN

 Nursing – a unique profession in that it is

concerned with all of the variables
affecting an individual’s response to stress.
 Person – The Neuman Systems Model
presents the concept of person as a
client/client system that may be an
individual, family, group, community or
social issue.
 BETTY NEUMAN

 Health – Neuman considers her work as

wellness model. She views as a continuum
of wellness to illness that is dynamic in
nature and constantly subject to change.
 Environment – is defined as being all the
internal and external factors that surround
or interact with person and client.
Person
Each layer consists of five person variable or subsystems:
Physiological- Refer to the physiochemical structure and function of
the body.
Psychological- Refers to mental processes and emotions.
Socio-cultural- Refers to relationships; and social/cultural expectations
and activities. Spiritual- Refers to the influence of spiritual beliefs.
Developmental- Refers to those processes related to development
over the lifespan.
 Flexible Line of Defense

Normal Line of Defense

CORE
CORE Lines of Resistance
Health
The client system moved toward wellness
when more energy is available than is
needed.

The client system moves toward illness

and death when more energy is needed
than is available.

.
Health

Flexible Line of Defense

Normal Line of Defense

CORE
CORE Lines of Resistance

Health
 Interpersonal S
S
Intrapersonal T
T
Extrapersonal R
R
E
E Flexible Line of Defense
S
S Normal Line of
Defense S
CORE
CORE
Lines of Resistance
S
O
Interpersonal
Interperson
O al
R
R Intrapersonal
Intraperson
al S
S Extrapersonal
Extrapersona
l
Nursing
 a unique profession hat requires
holistic approach – considers all
factors affecting a client’s health

 aims to promote optimal

wellness to its client through
retention, attainment, or
maintenance of the stability of
client’s system
Nursing (cont.)
 nurse helps the different levels of clientele:
individual, family, and groups in achieving and
maintaining an optimal wellness through
intervention with the goal of reducing stress
factors and its adverse effects to the optimal
functioning of an individual in any given situation

 nursing consists of intervention modalities of

prevention which can be: (1.) primary, (2.)
secondary, (3.) tertiary
Health

Flexible Line of Defense

(Primary Prevention)
Normal Line of Defense
(Secondary Prevention)

CORE
CORE Lines of Resistance
(Tertiary
Prevention)

Health
 Flexible Line of
Defense

Normal Line of
Defense
CORE
CORE
Lines of
ST R E S S O R Resistance
S
(Intrapersonal,
Interpersonal,
Extrapersonal)

ILLNESS
 Sample Situation:

Mr. Yoso is a 38 year-old business executive. His colleagues

describe him as hard working, perfectionist, and very dedicated to
work. His day starts by leaving the house very early from Laguna
to Makati and begins work by delegating various tasks with firm
expectations and deadlines that somewhat impossible to meet.
He usually responds with pressure and intimidating remarks for
works not perfectly done. He smokes and drinks alcohol whenever
he is stressed. Recently, the company experienced continuous
dropped in their sells and his bosses started to put blame to him.
 continuation…

Mr. Yoso began exhibiting weird mannerisms and behaviors

that appear strange to his family and people around him. He
misses breakfast and lunch very often and sleeps very late at
night while doing work. He has no time anymore for his family
and focuses to hard on meeting deadlines and his preconceived
objectives. Because of these weird changes in him, the company
decided to temporarily relieve him from his position as executive
manager. A week later, he started to have periods of mania and
depression. His family becomes worried and called up the hospital
to seek assistance after he locked himself in the room, refusing to
eat, and most of the time quiet and staring blankly on the wall.
Later, he developed pneumonia.
Using Neuman’s System Model in the above
situation, the identified possible stressors that
contributed to Mr. Yoso’s condition were as follows:
work, personality, and attitude. Mr. Yoso is not
anymore able to handle the stressors and that had
caused the “breakdown” of his lines of defense.
Without seeking help from his family and friends,
he was not able to maintain his flexible line of
defense and brought instability to his system. (The
diagram on the next page shows the effect of the
stress in his lines of defense and the corresponding
prevention that might have or may be done to
prevent illness/or complications from occurring.)
Primary Prevention:
•Stress management activities Tertiary Prevention
•Relaxation techniques •Re-assessing patient’s ability to
•Anger-management independently perform and
techniques maintain variables of health.
•Smoking cessation •Regular consult to psychologist.
•Maintaining client’s support
system
Effects on Flexible Line of Defense:
•sleeps very late at night
•misses breakfast and lunch
•responds with pressure and
intimidating remarks for works not
perfectly done Effects on Lines of
•smokes and drinks alcohol whenever CORE
CORE Resistance:
he is stressed
•weakened immune
response
•developed pneumonia
Work-related stressors

Effects on Normal Line of Secondary Prevention

Defense: •Medication (to treat
•exhibiting weird mannerisms
symptoms)
and behaviors
•periods of mania and •Opportunities to
depression verbalize feelings and
concerns
 IMOGENE KING
Goal Attainment Theory
 IMOGENE KING
 She worked as an instructor in
MSN and as an assistant director
at St. John’s hospital School of
Nursing.
 She concluded that “a systematic
representation of nursing is
required ultimately for
developing a science to
accompany a century or more of
art in the everyday world of
nursing”.
 She consults students who are
developing theories within the
interacting systems framework.
Imogene King

 Described nursing as “a helping profession

that assists individuals and groups in society
to attain, maintain, and restore health”
 If this is not possible, nurses help individuals
die with dignity.
 Imogene King
 Viewed nursing as an interaction process
between client and nurse
 During this process of perceiving, setting
goals and acting on them, transitions occur
and goals are achieved.
INTERACTING SYSTEMS
FRAMEWORK AND THEORY OF
GOAL ATTAINMENT
 Presented a conceptual system from
which she derived a theory of goal
attainment
 The conceptual system consist of 3
system:
◦ Personal
◦ Interpersonal
◦ Social (all are in continuous exchange with
their environment)
Person
 Are spiritual beings
 Have the capacity to think, know, make
choices and select alternative courses of
action
 Have the ability through their language and
other symbols to record their history and
preserve their culture
 Open system in transaction with the
environment
 Are unique and holistic
 Differ in their needs, wants and goals
Health

 Is a dynamic state in the life cycle;

illness is interference in the life
cycle. Health implies continuous
adjustments to stress in the
internal and external environment
through optimum use of one’s
resources to achieve maximum
potential for daily living.
 Environment
 Believe that “an understanding of the ways
that human beings interact with their
environment to maintain health is essential for
nurses”.
 Balance between internal and external
interaction
Nursing
 Is a process of action, reaction and interaction
whereby the nurse and client share
information about their perception in the
nursing situation.
 Imogene King
“Goal Attainment Theory”
 Imogene King earned a
diploma in nursing from St. John’s
Hospital of Nursing in St. Louis,
Missuori in 1945. While working
in a variety of staff nurse roles,
she began a course work toward
a Bachelor of Science in Nursing
education, which she received
from St. Louis University in 1948.
 From 1961 to 1966, King was
an Associate Professor of
Nursing at Loyola University
in Chicago, where she
developed a Master’s Degree
program in Nursing based on
a nursing conceptual
framework. Her first theory
article appeared in 1964nin
the journal Nursing Science
edited by Dr. Martha Rogers.
 From 1968 to 1972, King
was the director of the
School of Nursing at
Ohio State University in
Columbus. While at Ohio
State, her book, Toward a
Theory for Nursing: General
Concepts of Human
Behavior (1971), was
published.
 Inthis early work, King
concluded, “a systematic
representation of nursing is
required ultimately for
developing a science to
accompany a century or
more of art in the everyday
world of nursing.”
METAPARADIGM IN NURSING
 person - existing in an open
system as an spiritual being
and rational thinker who
makes choices, selects
alternative courses of action,
and has the ability to record
their history through their
own language and symbols,
unique, holistic and have
different needs, wants and
goals.
METAPARADIGM IN NURSING
 Health - the ability
of a person to adjust
to the stressors that
the internal and
external environment
exposes to the client.
METAPARADIGM IN NURSING
 Environment- the process of
balance involving internal and
external interactions inside the
social system.
METAPARADIGM IN NURSING
 Nursing for King is an act
wherein the nurse interacts
and communicates with the
client. The goal of the nurse in
King’s theory is to help the
client maintain health through
health promotion and
maintenance, restoration, and
caring for the sick and dying.
 INTERACTING SYSTEMS
FRAMEWORK
King proposed that the nurse interacts in
the system simultaneously at three different
levels, namely:
1. Personal- how the nurse views and
integrates self based from personal goals
and beliefs.
2. Interpersonal- how the nurse
interralates with a co-worker or patient,
particularly in a nurse-patient relationship.
INTERACTING SYSTEMS
FRAMEWORK
3. Social- how the
nurse interacts
with co- workers,
superiors,
subordinates and
the client
environment in
general.
 Goal Attainment Theory
 Action is a means of
behavior or activities that
are towards the
accomplishment of a certain
act. It is both physical and
mental.

 Reaction is a form of
reacting or a response to a
certain stimuli.
 Goal Attainment Theory
 Interaction is any situation
wherein the nurse relates and deals
with a clientele or patient.
 Open system is the absence of
boundary existence.
Topic for next week
 Peplau
 Orlando
 Travelbee
 Leinenger
 Parse
 Fitzpatrick
 Boykin & Schoenhoffer
 M. Neuman
THANK YOU!!!