DOROTHEA OREM

OREM – SELF – CARE DEFICIT THEORY

“Nursing is a helping profession of assisting patients overcome or compensate for their health-
associated limitations and engaging in actions to regulate their own functioning and development or
that of their dependents.”-

The focus of Orem’s model is to enhance the person’s ability for self-care and this also extends to the
care ofDependents / Individuals are capable of caring for themselves or their dependents.”

There are three systems that exist within this professional nursing practice model.

1. Wholly compensatory system – nurse provides total care

2. Partially compensatory system – nurse and patient share responsibility for care

3. Educative-development system – client has primary responsibility for personal health, with nurse
acting as a consultant

· Universal self-care requisites – those needs that all people have

Health deviation self-care requisites - those needs that arise as a result of a patient’s condition and
require medical intervention and management

Developmental self-care requisites – those needs that relate to the development of the individual

IMOGENE KING- INTERACTING

SYSTEMS FRAMEWORK AND GOAL ATTAINMENT
THEORY
Interacting System Framework
Imogene King’s “General Systems Framework” theory emphasizes the importance of the interaction
between the nurse and patients.

Goal Attainment theory by Imogene King says good interaction should take place even when the client
cannot
verbalize, the family can be the secondary person/s to interact with.

Observable behaviors of two or more persons in mutual presence

For an interaction to take place it takes two or more person and includes behaviors that can also be
observable.

There are three interrelated systems that represent the domain of nursing:

1. Personal system

2. Interpersonal system

3. Social system

Personal systems are composed of body image, growth and development, perception, self, space, and
time.

PERCEPTION- Process in which data obtained through the senses and from memory are organized,
interpreted, and transformed.

BETTY NEUMAN- SYSTEM 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.”

Flexible line of defense is a protective layer for preventing stressors from breaking through the usuall
wellness state.
1.Intrapersonal factors occur within the individual.
2.Interpersonal factors occur between one or more individuals.
3.Extrapersonal factors occur outside the individual.

Neuman employed a three step Nursing Process.

1. Assessment
In the initial assessment, the nurse looks at the
client’s basic make up and the known, unknown
and universal stressors.
When examining the client’s basic makeup,
predispositions are considered. They are
important because they affect how the client will
deal with stressors.
2. Diagnosis,
Planning,
Implementation
The next step addresses
the nursing diagnosis
which describes the
context of the whole
client as a system.
Goals are then
determined in
collaboration with the
client.

3. Evaluation
The next step involves nursing
outcomes which refers to
evaluation of the effectiveness
of interventions.
This includes assessing
changes in intrapersonal,
interpersonal, and
extrapersonal factors.

SISTER CALLISTA ROY’S ADAPTATION MODEL

Roy’s model views the person as an adaptive system
with coping processes.

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.

Goals are then determined in collaboration with the client Diagnosis, Planning, Implementing addresses
the nursing diagnosis which describes the context of the whole
client as a system. Goals are then determined in collaboration with the client.
DOROTHY JOHNSON - BEHAVIORAL
SYSTEM
“Nursing is 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.”

Behavior is the output of intra organismic structures and processes as they are coordinated and
articulated by and responsive to changes in sensory stimulation

Johnson stated that by categorizing behaviors, they can be predicted and ordered. Johnson categorized
all human
behavior into seven subsystems:

1.Attachment 2.Achievement 3.Aggressive 4.Dependence 5.Sexual 6.Ingestive 7.Eliminative

Attachment subsystem is probably the most critical, because it forms the basis, for all social
organization. Itprovides survival and security. Its consequences are social inclusion, intimacy, and
formation and maintenance of a
strong social bond)

Behavioral system encompasses the patterned, repetitive, and purposeful ways of behaving

Dependency subsystem promotes helping behavior that calls for a nurturing response

An imbalance in a behavioral subsystem produces tension, which results in

disequilibrium)

(Each subsystem has three functional requirements. These are: Each subsystem must be
“protected from
noxious influences with which the system cannot cope”. Each subsystem must be “nurtured through
the input of
appropriate supplies from the environment.” Each subsystem must be “stimulated for use to enhance
growth and prevent
stagnation”

HILDEGARD PEPLAU THEORY OF

INTERPERSONAL RELATIONS
Hildegard Peplau is considered the mother of Psychiatric Mental Health Nursing.

Peplau’s Theory of Interpersonal Relations

 “Nursing is the interpersonal therapeutic process of functioning cooperatively with other
human processes that make health possible for individuals in communities through education
that aims to promote forward movement of personality.

There are 4 Phases of the Nurse-Patient relationship which she identified:

1.Orientation
2.Identification
3. Exploitation
4. Resolution

IDA JEAN
ORLANDO’S NURSING PROCESS THEORY
“Nursing is a profession that seeks to find out and meet the patient’s immediate need for help.”
Ida Jean Orlando’s theory was developed observations she recorded between a nurse and patient.

In creating a Nursing Care Plan, nurses should make the patient should be the center of the care
because the patient is the solely recipient of care(PATIENT CENTERED).

Nursing Process Theory

The nursing process is an interaction of three basic elements:
1. The behavior of the patient
2. The reaction of the nurse
3. The nursing actions which are designed for the patient’s benefit.
(The role of the nurse is to find out and meet the patient’s immediate need for help.)

Orlando's theory stresses the reciprocal relationship between patient and nurse remains a MOST
EFFECTIVE PRACTICE
THEORY that is especially helpful to new nurses as they begin their practice.

JOYCE TRAVELBEE’S HUMAN-

TO-HUMAN RELATIONSHIP
MODELS OF NURSING;

According to Travelbee, nursing is accomplished

through human-to-human relationships that
begin with the original encounter that progress
through a series of stages of emerging identities,
developing feelings of empathy, and latter on,
sympathy until such time that the nurse and the
patient have attained rapport in the final stage.

 The establishment of a nurse-patient

relationship and the experience that rapport is
the end of all nursing endeavor.

 Rapport is that which is experienced when nurse

and patient has progresses through the 4
interlocking phases preceding rapport (4 phases of
experience)

Her model emphasizes:

o Empathy
o Sympathy
o Rapport
o Emotional aspects of nursing.

Original encounter refers to the impression by the nurse

of the sick person and vice-versa during their initial
interaction

Emerging identities
perceiving each other’s uniqueness

Empathy
 ability to share in the person’s experience
 To empathize is to gain an intellectual
understanding of the mental world and
psychological state of another.

Sympathy
 when the nurse wants to lessen the cause of
patient’s suffering
 therapeutic use of self
- ability to use one’s personality consciously and in
full awareness in an attempt to establish relatedness
and to structure nursing intervention
 “When one sympathizes, one is involved but not
incapacitated by the involvement.”

More of Feeling sorry for the patient or pity them,

but you don’t specifically understand what
they’re feeling

In therapeutic relationships, communication

allows patient to the nurse to communicate
experience and needs. It serves as the vehicle
through which nurse-patient relationships are
established.
 ERNESTINE WIEDENBACH'S THE
HELPING ART OF CLINICAL
NURSING
“Nursing is the art of nurturing or caring for someone in a motherly fashion.”

• Weidenbach’s contributions to the nursing profession reiterated the helping role of the nurse in terms of
providing direct care to patients needing help.
 Her definition of nursing is rooted in her experience in the field of maternity nursing.

4 Elements in the Art of Nursing:

 Philosophy
 Purpose,
 Practice
 Art

Wiedenbach believed that there were 3 essential components associated with a nursing philosophy:
Reverence for life.
Respect for the dignity, worth, autonomy and individuality of each human being
Resolution to act on personally and professionally held beliefs.

NANCY ROPER, WINIFRED W.

LOGAN, ALISON J. TIERNEY’S
ACTIVITIES OF DAILY LIVING
MODEL
“Nursing is the practice of assisting patients live through life”

• This model incorporates a life span approach wherein the characteristics of the person are considered
with respect to prior development, current level of development, and likely future development.
 In conjunction with the life span approach an independence/dependence continuum is used.
 The model then incorporates a set of 12 activities of living which represent those activities engaged in
by individuals whether sick or well.

12 Activities of Living:
1. Maintaining a safe environment
2. Breathing
3. Communication
4. Mobilizing
5. Eating and Drinking
6. Eliminating
7. Personal cleansing and dressing
8. Maintaining body temperature
9. Working and playing
10. Sleeping
11. Expressing sexuality
12. Dying
 Together these elements are referred to as a “model of living”

LYDIA HALL'S CORE, CARE,

CURE MODEL

Core
refers to the person or the recipient of care and includes the use of therapeutic self to relate with the
patient. It is anchored in the social sciences.
The Core Circle is based in the social sciences, involves the therapeutic use of self, and is shared with other members
of the health team. The professional nurse, by developing an interpersonal relationship with the patient, is able to
help the patient verbally express feelings regarding the disease process and its effects. Patient is able to gain self-
identity and further develop maturity. Patient is able to make conscious decisions

Care
Is limited to helping the patients or families deal with the measures instituted by the physician.
 Exclusive to nursing
 Explains the role of nurses and focused on performing that noble task of the nurturing patients.

The care circle is about the nurturing component of care. It is also referred to as the "mothering"
concept as it provides teaching and learning activities. The goal is to “comfort” the patient.

Cure
refers to medical interventions that are performed on the patient. The foundation of this concept stems
from pathological and therapeutic sciences that include microbiology, parasitology, pharmacology, and
pathology.
 It includes nursing activities that are dependent upon the orders of the physician.

The cure concept is based on pathological and therapeutic sciences. Nurse helps patient through
the medical, surgical and rehabilitative prescriptions made by the physician. The cure aspect is
different from the care circle because many of the nurse’s actions take on a negative quality of
avoidance of pain rather than a positive quality of comforting.
Nurse’s role changes to positive quality to negative quality
FAYE ABDELLAH’S (21) TWENTY
ONE NURSING PROBLEMS
Abdellah’s 21 Nursing Problems Theory
 According to Faye Glenn Abdellah’s theory, “Nursing is based on an art and science that moulds the
attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability
to help people, sick or well, cope with their health needs.”

The twenty-one nursing problems identified in the nursing theory are comprised of 10 steps used to
identify the patient’s problems and eleven skills used in developing a treatment typology or nursing care
plan.

the primary concern of Abdellah’s theory IS CLIENT ORIENTATION

Professors and educators realized the importance of client centered care rather than focusing on
medical interventions. Nursing education then slowly deviated its concentration from the complex,
medical concepts, into exercising better attention to the client as the primary concern of the
theory.

According to Abdellah, the most appropriate evaluation would be the nurse progress or lack of
progresstoward the achievement of the stated goals.
The evaluation takes place after the interventions have been carried out. The most convenient
evaluation would be the
nurse’s progress or lack of progress toward the achievement of the goals established in the
planning phase.

The needs of patients are further divided into four categories:

Basic Needs
The basic needs of an individual patient are to maintain good hygiene and physical comfort; promote optimal health
through healthy activities, such as exercise, rest and sleep; promote safety through the prevention of health hazards
like accidents, injury or other trauma and through the prevention of the spread of infection; and maintain good body
mechanics and prevent or correct deformity.

Elevating the head of bed is an example of basic care that will aid the patient to maintain
physical comfort.

Sustenal Care Needs

Sustenal care needs facilitate the maintenance of a supply of oxygen to all body cells; facilitate the maintenance of
nutrition of all body cells; facilitate the maintenance of elimination; facilitate the maintenance of fluid and electrolyte
balance; recognize the physiological responses of the body to disease conditions; facilitate the maintenance of
regulatory mechanisms and functions; and facilitate the maintenance of sensory function.

Remedial Care Needs

Remedial care needs to identify and accept positive and negative expressions, feelings, and reactions; identify and
accept the interrelatedness of emotions and organic illness; facilitate the maintenance of effective verbal and non-
verbal communication; promote the development of productive interpersonal relationships; facilitate progress toward
achievement of personal spiritual goals; create and maintain a therapeutic environment; and facilitate awareness of
the self as an individual with varying physical, emotional, and developmental needs.
Restorative care needs

Restorative care needs include the acceptance of the optimum possible goals in light of
limitations, both physical and emotional; the use of community resources as an aid to resolving
problems that arise from illness; and the understanding of the role of social problems as
influential factors in the case of illness.

The theory identifies ten (10) steps to identify the patient’s problem and 11 nursing skills
used to develop a treatment typology.

VIRGINIA HENDERSON’S 14 BASIC

NEEDS OR NURSING NEED’S
THEORY

-VIRGINIA HENDERSON is The First Lady of Nursing.

The Nightingale of Modern Nursing”
 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."

The theory focuses on the importance of increasing the

patient's independence to hasten their progress in the
hospital. Henderson's theory emphasizes on the
basic human needs and how nurses can assist in
meeting those needs

She described the nurse's role as substitutive (doing

for the person), supplementary (helping the
person), complementary (working with the person),
with the goal of helping the person become as
independent as possible.

THE (14) FOURTEEN COMPONENTS OF THE

NURSING NEEDS THEORY

Physiological Components
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and undress
7. Maintain body temperature within normal range by adj
8. Keep the body clean and well groomed and protect th
 9. Avoid dangers in the environment and avoid injuring
Others

Psychological Aspects of Communicating and

Learning
10. Communicate with others in expressing emotions,
needs, fears, or opinions.
14. Learn, discover, or satisfy the curiosity that leads to
normal development and health and use the available
health facilities.

SPRIRITUAL AND MORAL

11.Worship according to one’s faith

Sociologically Oriented to Occupation and

Recreation

12. Work in such a way that there is sense of

accomplishment
13. Play or participate in various forms of recreation

Maslow's
Level 1Physiological needs
Level 2Safety Needs
Level 3Belongingness and love needs
Level 4 Esteem needs

NOLA PENDER’S HEALTH PROMOTION MODEL

Designed by Nola J. Pender to be a

“complementary counterpart to models of
health protection.”

The health promotion model describes

the multidimensional nature of persons
as they interact within their
environment to pursue health.

The Health Promotion Model notes that

each person has unique personal
characteristics and experiences that affect
subsequent actions. The set of variables for
behavioral specific knowledge and affect
have important motivational significance.
These variables can be modified through
nursing actions. Thus, nurses becomes a
part of a client's interpersonal
environment

Pender’s health model pertains to the frequency of the same or similar behavior in the past
OR Prior related behaviour

The Major Concepts and Definitions of the Health Promotion Model

Individual Characteristics and Experience
1. Prior related behaviour
· Frequency of the similar behaviour in the past. Direct and indirect effects on the likelihood of
engaging in health promoting behaviours. 2. Personal Factors · Personal factors categorized as
biological, psychological and socio-cultural. These factors are predictive of a given behavior and
shaped by the nature of the target behaviour being considered.
3. Personal biological factors
· Include variable such as age gender body mass index pubertal status, aerobic capacity,
strength, agility, or balance. 4. Personal psychological factors · Include variables such as self
esteem self motivation personal competence perceived health status and definition of health.
5. Personal socio-cultural factors
· Include variables such as race ethnicity, accuculturation, education and socioeconomic status.
Behavioural Specific Cognition and Affect
6. Perceived Benefits of Action
· Anticipated positive outcomes that will occur from health behaviour.
7. Perceived Barriers to Action · Anticipated, imagined or real blocks and personal costs of
understanding a given behaviour

Perceived Benefits of Action pertains to anticipated positive outcomes that will occur from health
behavior.

8. Perceived Self Efficacy

· Judgment of personal capability to organise and execute a health-promoting behaviour.
Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered
perceptions of barriers to the performance of the behaviour.

9. Activity Related Affect · Subjective positive or negative feeling that occur before, during and
following behaviour based on the stimulus properties of the behaviour itself. Activity-related affect
influences perceived self-efficacy, which means the more positive the subjective feeling, the
greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive
affect.

10. Interpersonal Influences

· Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal influences
include: norms (expectations of significant others), social support (instrumental and emotional
encouragement) and modelling (vicarious learning through observing others engaged in a
particular behaviour). Primary sources of interpersonal influences are families, peers, and
healthcare providers. 11. Situational Influences · Personal perceptions and cognitions of any
given situation or context that can facilitate or impede behaviour. Include perceptions of options
available, demand characteristics and aesthetic features of the environment in which given health
promoting is proposed to take place. Situational influences may have direct or indirect influences
on health behaviour.
Behavioural Outcome

12. Commitment to Plan of Action

· The concept of intention and identification of a planned strategy leads to implementation of
health behaviour.

13. Immediate Competing Demands and Preferences · Competing demands are those
alternative behaviour over which individuals have low control because there are environmental
contingencies such as work or family care responsibilities. Competing preferences are alternative
behaviour over which individuals exert relatively high control, such as choice of ice cream or
apple for a snack

14. Health Promoting Behaviour

· Endpoint or action outcome directed toward attaining positive health outcome such as optimal
well-being, personal fulfillment, and productive living.