Nightingles, orems, roy's handerson etc

1. By :Mahesh Chand
Lecturer

2.  Theory
Has been defined as a supposition or system of ideas
that is proposed to explain a given phenomena.

3. Florence Nightingales’s
Environmental Theory
 considered the founder
of educated and
scientific nursing and
widely known as "The
Lady with the Lamp“
 wrote the first nursing
notes that became the
basis of nursing practice
and research. The notes,
entitled Notes on
Nursing: What it is, What
is not (1860)
 Considered the first
nursing theorist.

4.  Defined Nursing: “The act of utilizing the environment
of the patient to assist him in his recovery.”
 Focuses on changing and manipulating the environment in
order to put the patient in the best possible conditions for
nature to act.
 Identified 5 environmental factors: fresh air, pure water,
efficient drainage, cleanliness/sanitation and light/direct
sunlight.
 Considered a clean, well-ventilated, quiet environment
essential for recovery.
 Deficiencies in these 5 factors produce illness or lack of
health, but with a nurturing environment, the body could
repair itself.

5. Hildegard Peplau’s Interpersonal
Relations Theory
 is a psychiatric nurse,
Introduced her interpersonal
concept in 1952.
 Defined Nursing: “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.
 Nursing is a “maturing force
and an educative instrument”

6.  Identified 4 phases of the Nurse – Patient relationship:
 Orientation – individual/family has a “felt need” and seeks
professional assistance from a nurse (who is a stranger). This is the
problem identification phase.
 Identification – where the patient begins to have feelings of
belongingness and a capacity for dealing with the problem, creating
an optimistic attitude from which inner strength ensues. Here
happens the selection of appropriate professional assistance.
 Exploitation – the nurse uses communication tools to offer
services to the patient, who is expected to take advantage of all
services.
 Resolution – where patient’s needs have already been met by the
collaborative efforts between the patient and the nurse. Therapeutic
relationship is terminated and the links are dissolved, as patient
drifts away from identifying with the nurse as the helping person.

7. Virginia Henderson’s Definition
of the Unique Function of Nursing
 Defined Nursing: “Assisting
the individual, sick or well, in
the performance of those
activities contributing to
health or it’s recovery (or to
peaceful death) that an
individual would perform
unaided if he had the
necessary strength, will or
knowledge”.

8. Identified 14 basic needs :
 Breathing normally
 Eating and drinking adequately
 Eliminating body wastes
 Moving and maintaining desirable position
 Sleeping and resting
 Selecting suitable clothes
 Maintaining body temperature within normal range
 Keeping the body clean and well-groomed
 Avoiding dangers in the environment
 Communicating with others
 Worshipping according to one’s faith
 Working in such a way that one feels a sense of accomplishment
 Playing/participating in various forms of recreation
 Learning, discovering or satisfying the curiosity that leads to
normal development and health and using available health
facilities.

9. Madeleine Leininger’s Transcultural Care
Theory and Ethnonursing
 A well-known nurse anthropologist,
put her views on transcultural nursing
in print in the 1970s and then in 1991
published her book “Culture care
diversity and universality: A theory of
Nursing”
 Nursing is a learned humanistic and
scientific profession and discipline
which is focused on human care
phenomena and activities in order to
assist, support, facilitate, or enable
individuals or groups to maintain or
regain their well being (or health) in
culturally meaningful and beneficial
ways, or to help people face handicaps
or death.

10.  Transcultural nursing as a learned subfield or branch
of nursing which focuses upon the comparative study
and analysis of cultures with respect to nursing and
health-illness caring practices, beliefs and values with
the goal to provide meaningful and efficacious nursing
care services to people according to their cultural
values and health-illness context.
 Focuses on the fact that different cultures have
different caring behaviors and different health and
illness values, beliefs, and patterns of behaviors.
 Awareness of the differences allows the nurse to design
culture-specific nursing interventions.

11.  In order for nurses to assist people of diverse cultures,
Lenienger presents three intervention modes:
1. Culture care preservation and maintenance .
2. Culture care accommodation, negotiation, or both
3. Culture care restructuring and repatterning.

12. Dorothea Orem’s General Theory of Nursing
 Defined Nursing: “The act of
assisting others in the
provision and management of
self-care to maintain/improve
human functioning at home
level of effectiveness.”
 Focuses on activities that adult
individuals perform on their own
behalf to maintain life, health and
well-being.
 Has a strong health promotion
and maintenance focus.

13. Identified 3 related concepts:
1. Self-care – activities an Individual performs
independently throughout life to promote and
maintain personal well-being.
2. Self-care deficit – results when self-care agency
(Individual’s ability) is not adequate to meet the
known self-care needs.
3. Nursing System – nursing interventions needed
when Individual is unable to perform the necessary
self-care activities:

14.  Self-care theory is based on four concepts:
1. Self care- refers to those activities an individual performs
independently throughout life to promote and maintain personal
well-being.
2. Self care agency- is the individual’s ability to perform self care
activities. It consists of two agents: a self-care agent(an individual
who performs self-care independently) and a dependent care agent
(a person other than the individual who provides the care)
3. Self-care requisites- are groups of needs or requirements that
Orem identified. They are classified as either:
a) Universal self-care requisites - those needs that all people have
b) Developmental self-care requisites - 1. maturational: progress
toward higher level of maturation. 2. situational: prevention of
deleterious effects related to development.
c) Health deviation requisites - those needs that arise as a result of a
patient's condition. Result from illness, injury or disease or its
treatment. They include actions such as seeking health care
assistance ,carrying out prescribed therapies, and learning to live
with the effects of illness or treatment.

15. 4. Therapeutic self-care demand-refers to all self-
care activities required to meet existing self-care
requisites, or in other words, actions to maintain
health and well-being.

16. Self care deficit- results when self care agency is not
adequate to meet the known self-care demand. This
theory explains not only nursing is needed but also
how people can be assisted through five methods of
helping: acting or doing for, guiding, teaching,
supporting, and providing an environment that
promotes individual’s abilities to meet current and
future demands.

17. Orem’s 3 types of Nursing Systems:
1. Wholly compensatory – nurse provides entire self-care for the
client.
 Example: care of a new born, care of client recovering from
surgery in a post-anesthesia care unit
2. Partial compensatory – nurse and client perform care, client can
perform selected self-care activities, but also accepts care done by
the nurse for needs the client cannot meet independently.
 Example: Nurse can assist post operative client to ambulate, Nurse
can bring a meal tray for client who can feed himself
3. Supportive-educative – nurse’s actions are to help the client
develop/learn their own self-care abilities through knowledge,
support and encouragement.
 Example: Nurse guides a mother how to breastfeed her
baby, Counseling a psychiatric client on more adaptive coping
strategies.

18. Imogene King’s Goal Attainment Theory
 Nursing is a process of
action, reaction, and
interaction whereby nurse
and client share
information about their
perception in the nursing
situation

19.  King used a “systems” approach in the development
of her dynamic interacting systems framework and in
her subsequent Goal-Attainment Theory.
 She developed a general systems framework and a
theory of goal attainment where the framework refers
to the three interacting systems -individual or
personal, group or interpersonal, and society or social,
while the theory of goal attainment pertains to the
importance of interaction, perception,
communication, transaction, self, role, stress, growth
and development, time, and personal space.
 King emphasizes that both the nurse and the client
bring important knowledge and information to the
relationship and that they work together to achieve
goals.

20.  The relationship of three interacting systems led to
King’s Theory of Goal Attainment are the personal
system (individual), the interpersonal system (nurse-
patient dialogue), and the social system (the family,
the school, and the church). Each system is given
different concepts.
1) The concepts for the personal system are:
perception, self, growth and development, body
image, space, and time. These are fundamentals in
understanding human being because this refers
to how the nurse views and integrates self based
from personal goals and beliefs.

21.  Among all these concepts, the most important is
perception, because it influences behavior.
 King summarized the connections among these
concepts as “An individual Perception of self, of body
image, of time, of space influences the way he or she
responds to object and events in his/her life.
 As individuals grow and develop through the lifespan
experiences with changes in structure and function of
their bodies over time influence their perceptions of
self”
2. Personal systems are individuals, who are regarded
as rational, sentient, social beings.

22.  Concepts related to the personal system are:
a) Perception— a process of organizing, interpreting, and
transforming information from sense data and memory that
gives meaning to one's experience, represents one's image of
reality, and influences one's behavior.
b) Self— a composite of thoughts and feelings that constitute a
person's awareness of individual existence, of who and what he
or she is.
c) Growth and development— cellular, molecular, and
behavioral changes in human beings that are a function of
genetic endowment, meaningful and satisfying experiences,
and an environment conducive to helping individuals move
toward maturity.
d) Body image—a person's perceptions of his or her body.
e) Time—the duration between the occurrence of one event and
the occurrence of another event.
f) Space—the physical area called territory that exists in all
directions.
g) Learning—gaining knowledge.

23. The concepts associated for the interpersonal
system are: interaction, communication, transaction,
role, and stress.
King refers to two individuals as dyads, three as triads
and four or more individuals as small group or large
group .
 This shows how the nurse interrelates with a co-
worker or patient, particularly in a nurse-patient
relationship.
Communication between the nurse and the client can
be verbal or nonverbal. Collaboration between the
Dyads (nurse-patient) is very important for the
attainment of the goal.

24. The concepts associated with this system are:
a) Interactions—the acts of two or more persons in mutual
presence; a sequence of verbal and nonverbal behaviors that
are goal directed.
b) Communication—the vehicle by which human relations are
developed and maintained; encompasses intrapersonal,
interpersonal, verbal, and nonverbal communication.
c) Transaction—a process of interaction in which human beings
communicate with the environment to achieve goals that are
valued; goal-directed human behaviors.
d) Role—a set of behaviors expected of a person occupying a
position in a social system.
e) Stress—a dynamic state whereby a human being interacts
with the environment to maintain balance for growth,
development, and performance, involving an exchange of
energy and information between the person and the
environment for regulation and control of stressors.
f) Coping—a way of dealing with stress.

25. Interpersonal
dyad
(Nurse-client)-
interaction
action
reaction
Disturbance(problem)
Mutual goal setting and decision
making
Exploration if means to achieve the
goal
Agreement on means to achieve
the goals
Transaction directly observable
Goal attainment
King’s definition of interaction and transaction

26. 3.The final interacting system is the social system.
 This shows how the nurse interacts with co workers,
superiors, subordinates and the client environment in
general.
 These are groups of people within the community or
society that share a common goals, values and interests.
 It provides a framework for social interaction and
relationships and establishes rules of behavior and courses
of action.
 Social systems are organized boundary systems of social
roles, behaviors, and practices developed to maintain
values and the mechanisms to regulate the practices and
roles.

27. The concepts related to social systems are:
a) Organization—composed of human beings with prescribed
roles and positions who use resources to accomplish personal
and organizational goals.
b) Authority—a transactional process characterized by active,
reciprocal relations in which members' values, backgrounds,
and perceptions play a role in defining, validating, and
accepting the authority of individuals within an organization.
c) Power—the process whereby one or more persons influence
other persons in a situation.
d) Status—the position of an individual in a group or a group in
relation to other groups in an organization.
e) Decision making—a dynamic and systematic process by
which goal-directed choice of perceived alternatives is made
and acted upon by individuals or groups to answer a question
and attain a goal.
f) Control—being in charge.

28. Among the three systems, the conceptual framework of
Interpersonal system had the greatest influence on the
development of her theory.
She stated that “Although personal systems and social
systems influence quality of care, the major elements in a
theory of goal attainment are discovered in the
interpersonal systems in which two people, who are usually
strangers, come together in a health care organization to
help and to be helped to maintain a state of health that
permits functioning in roles”

29. Finally according to her, nursing's focus is on the care
of the patient, and its goal is the health care of
patients and groups of patients.

30. Callista Roy’s Adaptation Theory
 Sister 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.
 This model comprises the four
domain concepts of person, health,
environment, and nursing and
involves a six step nursing process

31. 1) Roy's models sees the person as "a biopsychosocial
being in constant interaction with a changing
environment“
 The person is an open, adaptive system who uses
coping skills to deal with stressors.
2) Roy sees the environment as "all conditions,
circumstances and influences that surround and affect
the development and behaviour of the person".
 Roy describes stressors as stimuli and uses the term
'residual stimuli' to describe those stressors whose
influence on the person is not clear .

32. 3) Originally, Roy wrote that health and illness are on a
continuum with many different states or degrees possible.
More recently, she states that health is the process of being
and becoming an integrated and whole person
4) Roy's goal of nursing is "the promotion of adaptation in
each of the four modes, thereby contributing to the
person's health, quality of life and dying with dignity".
These four modes are physiological, self-concept, role
function and interdependence.

33. A. In the Physiologic mode, adaptation involves the
maintenance of physical integrity. Basic human needs
such as nutrition, oxygen, fluids, and temperature
regulation are identified with this mode.
 In assessing a family, the nurse would ask how the family
provides for the physical and survival needs of the family
members.
B. A function of the Self-concept mode is the need for
maintenance of psychic integrity. Perceptions of one’s
physical and personal self are included in this mode.
 Families also have concepts of themselves as a family unit.
Assessment of the family in this mode would include the
amount of understanding provided to the family members,
the solidarity of the family. the values of the family, the
amount of companionship provided to the members, and
the orientation (present or future) of the family.

34. C. The need for social integrity is emphasized in the
Role function mode. When human beings adapt to
various role changes that occur throughout a lifetime,
they are adapting in this mode.
According to Hanson, the family’s role can be assessed
by observing the communication patterns in the
family.
 Assessment should include how decisions are
reached, the roles and communication patterns of the
members, how role changes are tolerated, and the
effectiveness of communication.
 For example, when a couple adjusts their lifestyle
appropriately following retirement from full-time
employment, they are adapting in this mode.

35. D.The need for social integrity is also emphasized in the
interdependence mode.
 Interdependence involves maintaining a balance between
independence and dependence in one’s relationships with
others.
 Dependent behaviors include affection seeking, help
seeking, and attention seeking.
 Independent behaviors include mastery of obstacles and
initiative taking.
 According to Hanson, when assessing this mode in
families, the nurse tries to determine how successfully the
family lives within a given community.
 The nurse would assess the interactions of the family with
the neighbors and other community groups, the support
systems of the family, and the significant others .

36. The goal of nursing is to promote adaptation of the
client during both health and illness in all four of the
modes.
Actions of the nurse begin with the assessment
process, The family is assessed on two levels. First, the
nurse makes a judgment with regard to the presence or
absence of maladaptation.
Then, the nurse focuses the assessment on the stimuli
influencing the family’s maladaptive behaviors. The
nurse may need to manipulate the environment, an
element or elements of the client system, or both in
order to promote adaptation .

37. Roy employs a six-step nursing process which
includes: assessment of behaviour, assessment of
stimuli, nursing diagnosis, goal setting,
intervention and evaluation.
In the first step, the person's behaviour in each of the
four modes is observed. This behaviour is then
compared with norms and is deemed either adaptive
or ineffective.
The second step is concerned with factors that
influence behaviour. Stimuli are classified as focal,
contextual or residual.

38. The nursing diagnosis is the statement of the
ineffective behaviours along with the identification of
the probable cause.
 In the fourth step, goal setting is the focus. Goals need
to be realistic and attainable and are set in
collaboration with the person.
 Intervention occurs as the fifth step, and this is when
the stimuli are manipulated. It is also called the 'doing
phase'.
In the final stage, evaluation takes place. The degree of
change as evidenced by change in behaviour, is
determined. Ineffective behaviours would be
reassessed, and the interventions would be revised

39. Jean Watson’s The Philosophy and Science of Caring
 The Philosophy and Science of
Caring has four major concepts:
human being, health,
environment/society, and nursing.
Jean Watson refers to the human
being as "a valued person in and of
him or herself to be cared for,
respected, nurtured, understood and
assisted; in general a philosophical
view of a person as a fully functional
integrated self. Human is viewed as
greater than and different from the
sum of his or her parts."

40. 1) Health is defined as a high level of overall physical, mental,
and social functioning; a general adaptive-maintenance level
of daily functioning; and the absence of illness, or the presence
of efforts leading to the absence of illness.
2) Watson's definition of environment/society addresses the
idea that nurses have existed in every society, and that a caring
attitude is transmitted from generation to generation by the
culture of the nursing profession as a unique way of coping
with its environment.
3) The nursing model states that nursing is concerned with
promoting health, preventing illness, caring for the sick, and
restoring health. It focuses on health promotion, as well as the
treatment of diseases. Watson believed that holistic health
care is central to the practice of caring in nursing. She defines
nursing as "a human science of persons and human health-
illness experiences that are mediated by professional, personal,
scientific, esthetic and ethical human transactions."

41. 4) The nursing process outlined in the model contains the
same steps as the scientific research process: assessment,
plan, intervention, and evaluation.
 The assessment includes observation, identification, and
review of the problem, as well as the formation of a
hypothesis.
 Creating a care plan helps the nurse determine how
variables would be examined or measured, and what data
would be collected.
 Intervention is the implementation of the care plan and
data collection.
 Finally, the evaluation analyzes the data, interprets the
results, and may lead to an additional hypothesis.

42. Watson's model makes seven
assumptions:
 Caring can be effectively demonstrated and practiced only
interpersonally.
 Caring consists of carative factors that result in the satisfaction
of certain human needs.
 Effective caring promotes health and individual or family
growth.
 Caring responses accept the patient as he or she is now, as well as
what he or she may become.
 A caring environment is one that offers the development of
potential while allowing the patient to choose the best action for
him or herself at a given point in time.
 A science of caring is complementary to the science of curing.
 The practice of caring is central to nursing.

43. The first three carative factors are the "philosophical
foundation" for the science of caring, while the
remaining seven derive from that foundation. The ten
primary carative factors are:
 The formation of a humanistic-altruistic system of values,
which begins at an early age with the values shared by
parents. The system of values is mediated by the nurse's life
experiences, learning gained, and exposure to the
humanities. It is perceived as necessary to the nurse's
maturation which in turn promotes altruistic behavior
toward others.
 The installation of faith-hope, which is essential to the
carative and curative processes. When modern science has
nothing else to offer a patient, a nurse can continue to use
faith-hope to provide a sense of well-being through a belief
system meaningful to the individual.

44.  The cultivation of sensitivity to one's self and to others,
which explores the need of nurses to feel an emotion as it
presents itself. The development of a nurse's own feeling is
needed to interact genuinely and sensitively with patients.
By striving to become more sensitive, the nurse is more
authentic. This encourages self-growth and self-
actualization in both the nurse and the patients who
interact with the nurse. The nurses promote health and
higher-level functioning only when they form person-to-
person relationships.
 The development of a helping-trust relationship, which
includes congruence, empathy, and warmth. The strongest
tool a nurse has is his or her mode of communication,
which establishes a rapport with the patient, as well as
caring by the nurse. Communication includes verbal and
nonverbal communication, as well as listening that
connotes empathetic understanding.

45.  The promotion and acceptance of the expression of
both positive and negative feelings, which need to be
considered and allowed for in a caring relationship
because of how feelings alter thoughts and behavior.
The awareness of the feelings helps the nurse and
patient understand the behavior it causes.
 The systematic use of the scientific method for
problem-solving and decision-making, which allows
for control and prediction, and permits self-correction.
The science of caring should not always be neutral and
objective.

46.  The promotion of interpersonal teaching-learning,
since the nurse should focus on the learning process as
much as the teaching process. Understanding the
person's perception of the situation assists the nurse to
prepare a cognitive plan.
 The provision for a supportive, protective and/or
corrective mental, physical, socio-cultural, and
spiritual environment, which Watson divides into
interdependent internal and external variables,
manipulated by the nurse in order to provide support
and protection for the patient's mental and physical
health. The nurse must provide comfort, privacy, and
safety as part of the carative factor.

47.  Assistance with satisfying human needs based on a
hierarchy of needs similar to Maslow's. Each need is
equally important for quality nursing care and the
promotion of the patient's health. In addition, all needs
deserve to be valued and attended to by the nurse and
patient.
 The allowance for existential-phenomenological forces,
which helps the nurse to reconcile and mediate the
incongruity of viewing the patient holistically while at the
same time attending to the hierarchical ordering of needs.
This helps the nurse assist the patient to find strength and
courage to confront life or death. Phenomology is a way of
understanding the patient from his or her frame of
reference. Existential psychology is the study of human
existence.

48.  Watson's hierarchy of needs begins with lower-order
biophysical needs, which include the need for food
and fluid, elimination, and ventilation. Next are the
lower-order psychophysical needs, which include the
need for activity, inactivity, and sexuality. Finally, are
the higher order needs, which are psychosocial. These
include the need for achievement, affiliation, and self-
actualization.

49. Betty Neuman's Systems Model
 “Health is a condition in
which all parts and
subparts are in harmony
with the whole of the
client.”
 Developed this model
based on the individual’s
relationship to stress,
the reaction to it, and
reconstitution factors
that are dynamic in
nature.
 Reconstitution is the
state of adaptation to
stress.

50. KEY CONCEPTS
 Viewed the client as an open system consisting of a basic
structure or central core of energy resources which
represent concentric circles
 Each concentric circle or layer is made up of the five
variable areas which are considered and occur
simultaneously in each client concentric circles. These are:
1. Physiological - refers of bodily structure and function.
2. Psychological - refers to mental processes, functioning
and emotions.
3. Sociocultural - refers to relationships; and
social/cultural functions and activities.
4. Spiritual - refers to the influence of spiritual beliefs.
5. Developmental - refers to life’s developmental
processes.

51. Basic Structure Energy Resources-This is otherwise known as
the central core, which is made up of the basic survival factors
common to all organisms. These include the following:
1. Normal temperature range – body temperature regulation
ability
2. Genetic structure – Hair color and bodily features
3. Response pattern – functioning of body systems
homeostatically
4. Organ strength or weakness
5. Ego structure
6. Knowns or commonalities – value system
 The person's system is an open system - dynamic and constantly
changing and evolving
 Stability, or homeostasis, occurs when the amount of energy that
is available exceeds that being used by the system.
 A homeostatic body system is constantly in a dynamic process of
input, output, feedback, and compensation, which leads to a
state of balance

52.  Central core of energy resources surrounded by two concentric
boundaries or rings referred to as lines of resistance.
Lines of Resistance
 The last boundary that protects the basic structure or it
represents the internal factors that help client defend against s
stressor
 Protect the basic structure and become activated when
environmental stressors invade the normal line of defense. An
example is that when a certain bacteria enters our system, there
is an increase in leukocyte count to combat infection.
 If the lines of resistance are effective, the system can reconstitute
and if the lines of resistance are not effective, the resulting
energy loss can result in death.
 Outside the lines of resistance are two lines of defense:

53. 1. Normal Line of Defense
 Represents client’s usual wellness level.
 Can change over time in response to coping or responding
to the environment, which includes intelligence, attitudes,
problem solving and coping abilities. Example is skin
which is constantly smooth and fair will eventually form
callous over times.
2. Flexible Lines of Defense
 Is the outer boundary to the normal line of defense, the
line of resistance, and the core structure.
 Keeps the system free from stressors and is dependent on
the amount of sleep, nutritional status, as well as the
quality and quantity of stress an individual experiences.
 If the flexible line of defense fails to provide adequate
protection to the normal line of defense, the lines of
resistance become activated.

54. Neuman categorizes Stressors as:
 Stressors
 Are capable of producing either a positive or negative effect on the
client system.
 Is any environmental force which can potentially affect the stability of
the system:
1. Intrapersonal - occur within person, example is infection, thoughts
and feelings
2. Interpersonal - occur between individuals, e.g. role expectations
3. Extrapersonal - occur outside the individual, e.g. job or finance
concerns
 A person’s reaction to stressors depends on the strength of the lines of
defense.
 When the lines of defense fails, the resulting reaction depends on the
strength of the lines of resistance.
 As part of the reaction, a person’s system can adapt to a stressor, an
effect known as reconstitution.

55. Reconstitution
 Is the increase in energy that occurs in relation to the
degree of reaction to the stressor which starts after
initiation of treatment for invasion of stressors.
 May expand the normal line of defense beyond its previous
level, stabilize the system at a lower level, or return it to the
level that existed before the illness.
 Nursing interventions focus on retaining or maintaining
system stability.
 By means of primary, secondary and tertiary interventions,
the person (or the nurse) attempts to restore or maintain
the stability of the system.

56. Prevention
 Is the primary nursing intervention.
 Focuses on keeping stressors and the stress response from having a detrimental
effect on the body.
1. Primary prevention -focuses on protecting the normal line of defense and
strengthening the flexible line of defense. This occur before the system reacts
to a stressor and strengthens the person (primarily the flexible line of defense)
to enable him to better deal with stressors and also manipulates the
environment to reduce or weaken stressors. Includes health promotion and
maintenance of wellness.
2. Secondary prevention- focuses on strengthening internal lines of resistance,
reducing the reaction of the stressor and increasing resistance factors in order
to prevent damage to the central core. This occurs after the system reacts to a
stressor. This includes appropriate treatment of symptoms to attain optimal
client system stability and energy conservation.
3. Tertiary prevention -focuses on readaptation and stability, and protects
reconstitution or return to wellness after treatment. This occurs after the
system has been treated through secondary prevention strategies. Tertiary
prevention offers support to the client and attempts to add energy to the
system or reduce energy needed in order to facilitate reconstitution.

57. Rosemarie Rizzo Parse’s Theory
of Human Becoming
Nursing is a scientific
discipline, the practice of
which is a performing art

58. Three assumption about Human Becoming:
1. Human becoming is freely choosing personal
meaning in situation in the intersubjective process of
relating value priorities
2. becoming is co-creating rhythmic patterns or
relating in mutual process in the universe
3. Human becoming is co-transcending
multidimensionally with emerging possibilities.

59.  These three assumptions focus on meaning,
rhythmicity, and contrascendence:
1. Meaning arises from a person’s interrelationship
with the world and refers to happenings to which
the person attaches varying degree of significance.
2. Rhythmicity is the movement toward greater
diversity
3. Contrascendence is the process of reaching out
beyond the self.

60.  Model of human becoming emphasizes how
individuals choose and bear responsibility for patterns
of personal health.
 Contends that the client , not the nurse , is the
authority figure and decision maker.
 The nurse’s role involves helping individuals and
families in choosing the possibilities for changing the
health process.

61. MARTHA ROGERS' SCIENCE OF UNITARY
HUMAN BEINGS
 Described
the irreducible nature of
individuals as being different
from the sum of their parts
 She theorized that the identity
of nursing as a science arises
from the integrality of people
and the environment that
coordinates with a
multidimensional universe of
open systems

62.  Rogers' model provides the way of viewing the unitary
human being. Humans are viewed as integral with the
universe: the unitary human being and the
environment are one, not dichotomous

63.  The basic characteristics that describe the life process
of human include energy field, openness, pattern,
and pan-dimensionality. The basic concepts of the
theory include unitary human being, environment,
and homeodynamic principles.

64. Concepts of Rogers' mode
1. Energy field The energy field is the fundamental unit of
both the living and nonliving. This energy field "provides
a way to perceive people and environment as irreducible
wholes". The energy fields continuously varies in
intensity, density, and extent.
2. Openness The human field and the environmental field
are constantly exchanging their energy back and forth.
There are no boundaries or barriers that inhibit energy
flow between the fields.
3. Pattern Pattern is defined as the distinguishing
characteristic of an energy field. "Pattern is an
abstraction and it gives identity to the field“.

65. 4. Pan-dimensionality Pan-dimensionality is defined as "non linear
domain without spatial or temporal attributes". The parameters that
humans use in language to describe events are arbitrary. The present
is relative; there is no temporal ordering of lives.
5. Unitary Human Being (person A unitary human being is an
"irreducible, indivisible, pan-dimensional (four-dimensional) energy
field identified by pattern and manifesting characteristics that are
specific to the whole and which cannot be predicted from knowledge
of the parts" and "a unified whole having its own distinctive
characteristics which cannot be perceived by looking at, describing,
or summarizing the parts". The person has the capacity to participate
knowingly and probabilistically in the process of change.
6. Environment The environment is an "irreducible, pan-dimensional
energy field identified by pattern and integral with the human field".
The two fields coexist and are integral. Manifestations emerge from
this field and are perceived by the person.

66. 7. Health Rogers defined health as an expression of the life process;
they are the "characteristics and behavior emerging out of the
mutual, simultaneous interaction of the human and environmental
fields". Health and illness are the part of the same continuum. The
multiple events taking place along life's axis denote the extent to
which man is achieving his maximum health potential and vary in
their expressions from greatest health to those conditions which are
incompatible with maintaining life processes.
8. Nursing
a) Nursing as a science The theory asserts the independent science of
nursing because an organized body of knowledge which is specific to
nursing is arrived at by scientific research and logical analysis.
b) Nursing as an art Rogers claimed that the creative use of science for
the betterment of humans and the creative use of its knowledge is
the art of its nursing.

67. C. Assumptions about people and nursing
 Nursing exists to serve people.
 It is the direct and overriding responsibility to the society.
 The safe practice of nursing depends on the nature and
amount of scientific nursing knowledge the individual
brings to practice.
 People need knowledgeable nursing.
9. Homeodynamic principles-The principles of
homeodynamic postulates the way unitary human beings
are perceived. The fundamental unit of the living system
is an energy field.
10. Resonancy-Resonancy is an ordered arrangement of
rhythm characterizing both human field and
environmental field that undergoes continuous dynamic
metamorphosis in the human environmental process.

68. 11. Helicy - Helicy describes the unpredictable, but
continuous, nonlinear evolution of energy fields as
evidenced by non repeating rhythmicties The principle of
helicy postulates an ordering of humans' evolutionary
emergence.
12. Integrality - Integrality is the mutual, continuous
relationship of the human energy field and the
environmental field. Changes occur by the continuous
repatterning of the human and environmental fields by
resonance waves. The fields are one and integrated, but
unique from each other.