TFN M7

• Nursing Theorists

  • Betty Neuman
  • Callista Roy
  • Dorothy Johnson
  • Dorothea Orem
• Betty Neuman's Systems Model


  • A unique, systems-based perspective that provides a unifying focus for approaching a wide range of nursing concerns
  • A comprehensive guide for nursing practice, research, education, and administration that is open to creative implementation
  • It has the potential for unifying various health-related theories, clarifying the relationships of variables in nursing care and role definitions at various levels of nursing practice
• Person


  Humans are defined as "men, women, and children cared for either singly or as social units" and are the "material object" of nurses and others who provide direct care
• Health


  Health is defined as the condition or degree of system stability and is viewed as a continuum from wellness to illness. When system needs are met, optimal wellness exists. When needs are not satisfied, illness exists. When the energy needed to support life is not available, death occurs
• Environment


  The environment is a vital arena that is germane to the system and its function. The environment may be viewed as all factors that affect and are affected by the system. In Neuman Systems Model identifies three relevant environments: (1) internal, (2) external, and (3) created
• Nursing


  Nursing's primary concern is to define the appropriate action in situations that are stress-related or concerning possible reactions of the client or client system to stressors. Nursing interventions aim to help the system adapt or adjust and retain, restore, or maintain some degree of stability between the client system variables and environmental stressors, focusing on conserving energy
• Neuman's Theoretical Assertions


  • Each client system is unique, a composite of factors and characteristics within a given range of responses
  • Many known, unknown, and universal stressors exist. Each differs in its potential for disturbing a client's usual stability level or normal line of defense. The particular interrelationships of client variables at any point in time can affect the degree to which a client is protected by the flexible line of defense against possible reaction to stressors
  • Each client/client system has evolved a normal range of responses to the environment 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
  • 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
  • Whether in a state of wellness or illness, the client is a dynamic composite of the variables' interrelationships. Wellness is on a continuum of available energy to support the system in an optimal system stability state
  • Implicit within each client system are internal resistance factors known as lines of resistance, which function to stabilize and realign the client to the usual wellness state
• Neuman's Nursing Process

  • Assessment of the client's basic structure and known, unknown, and universal stressors
  • Diagnosis, planning, and implementation of nursing interventions at primary, secondary, and tertiary prevention levels
  • Evaluation of the effectiveness of nursing interventions and the client's response
• Callista Roy's Adaptation Model Concepts

  • Health - a state and process of being and becoming integrated and whole that reflects person and environmental mutuality
  • Adaptation - the process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental integration
  • Adaptive responses - responses that promote integrity in terms of the goals of the human system, that is, survival, growth, reproduction, mastery, and personal and environmental transformation
  • Ineffective responses - responses that do not contribute to integrity in terms of the goals of the human system
  • Adaptation levels - represent the condition of the life processes described on three different levels: integrated, compensatory, and compromised
• Roy's Adaptation Model Assertions


  • Roy's model views the person as an adaptive system with coping processes
  • She described the person as a whole comprising parts and which functions as a unity for some purpose
  • It includes people as individuals or in groups (families, organizations, communities, nations, and society as whole)
  • The person is an adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes
  • The environment is viewed as all conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources
  • Nursing is the science and practice that expands
• Roy's Adaptation Model Adaptive Modes

  • Physiological-Physical Mode
  • Self-Concept Group Identity Mode
  • Role Function Mode
  • Interdependence Mode
• Roy's Nursing Process

  • Assessment of Behavior
  • Assessment of Stimuli
  • Nursing Diagnosis
  • Goal Setting
  • Intervention
  • Evaluation
• Ineffective responses


  Responses that do not contribute to integrity in terms of the goals of the human system
• Adaptation levels


  Represent the condition of the life processes described on three different levels: integrated, compensatory, and compromised
• Roy's model views the person as an adaptive system with coping processes
• She described the person as a whole comprising parts and which functions as a unity for some purpose
• It includes people as individuals or in groups (families, organizations, communities, nations, and society as whole)
• The person is an adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes
• Environment


  All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources
• Nursing


  The science and practice that expands adaptive abilities and enhances person and environment transformation
• The goals of nursing are to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity
• Nursing process

  1. Assessment

  2. Diagnosis

  3. Planning

  4. Implementation

  5. Evaluation
• The nursing process is cyclical in nature - the evaluation may also serve as the assessment findings for another set of nursing problems
• The assessment component of the nursing process is the stimuli or the input and the planning and implementation are the throughput processes
• The output is the evaluation which then provides the necessary feedback to the goal of care
• Adaptation


  The nurse decides what necessary actions should be taken next, in the light of the patient's response to the nursing interventions
• Patients adapt, too. The nursing interventions we perform ultimately elicits a response from our patients, our patients may or may not actually adapt according to our expectations
• Nursing (in Johnson's model)


  An external force that acts to preserve the organization of the patient's behavior by means of imposing regulatory mechanisms or by providing resources while the patient is under stress
• Johnson proposed that the science of nursing necessary for effective nursing care included a synthesis of key concepts drawn from basic and applied sciences
• In 1961, she proposed that nursing care facilitated the client's maintenance of a state of equilibrium
• She identified 2 areas that nursing care should be based in order to return the client to a state of equilibrium: reduce stressful stimuli and support natural and adaptive processes
• Johnson's behavioral system theory springs from Nightingale's belief that nursing's goal is to help individuals prevent or recover from disease or injury
• The "science and art" of nursing should focus on the patient as an individual and not on the specific disease entity
• Behavioral system


  Encompasses the patterned, repetitive, & purposeful ways of behaving
• Subsystems

  Mini-systems with its own particular goal & function that can be maintained as long as its relationship to the other subsystems or the environment is not changed or disturbed
• Equilibrium


  A stabilized but more or less transitory, resting state where the person is in harmony with himself & with his environment
• Tension


  The state of being stretched or strained can be viewed as an end-product of a disturbance in equilibrium
• Stressor


  A stimulus, either internal or external, that produce tension and result in a degree of instability
• There is "organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up the system"
• A system "tends to achieve a balance among the various forces operating within and upon it, and that man strives continually to maintain a behavioral system balance and steady-state by more or less automatic adjustments and adaptations to the natural forces occurring on him"