SISTER CALLISTA ROY - failure to achieve, threaten the goals of adaptation

● Born on October 14, 1939 in Los Angeles, California ENVIRONMENT

● 1976 – Published “Introduction to Nursing; An Adaptation Model ● conditions, circumstances & influences that surround & affect the
● Became a nurse theorist & professor at the William F. Connell School development & behavior of the person.
of Nursing in Boston ● factors in environment categorized as focal, contextual & residual
● Named a Living Legend 1. focal – internal or external stimulus most immediately
Why is Sister Callista Roy a "living legend" in the history of nursing theory? confronting the human system
2. contextual – all other stimuli present in the situation that
The Roy Adaptation Model (RAM) Or Roy’s Adaptation Model contribute to the effect of the focal stimulus.
● Roy was impressed by the ability of the children to adapt in response 3. residual – environmental factors within or without the human
to major physical & psychological changes. system with effects in the current situation that are unclear
● Adaptation – refers to the process & outcome whereby thinking & - stimuli in environment affect ability of person to adapt to their
feeling persons as individuals or in groups, use conscious awareness environment
& choice to create human & environmental integration. stimuli:
● RAM for nursing has been derived from Harry Helson’s work in 1. focal - ex. loss
psychophysics that extended to social and behavioral sciences. 2. contextual - factors contributed to focal like lost wallet
● The RAM views the person as an adaptive system in constant 3. residual - add to stressor in environment- ex. arrive home after loss of
interaction with an internal and external environment. person and wallet, then you let out your stress to someone else

Metaparadigm in Nursing HEALTH

PERSON ● is a state & a process of being & becoming an integrated & whole
– a biophysical being in constant interaction w/ the changing environment person.
Coping Mechanisms: ● the ability to cope with the stressors or stimuli in a competent way
● regulator –coping mechanisms thru neural, chemical, and
endocrine processes NURSING
● cognator –coping mechanism thru learning, judgment, and emotion – the science and practice that expands adaptive abilities & enhances
● 4 adaptive modes (physiological, self concept, role function, person & environment transformation.
interdependence) As a science - nursing is a developing system of knowledge
about persons used to observe, classify & relate the processes
Four Adaptive Modes by which persons positively affect their health status.
Physiological Adaptive Mode As a practice discipline - nursing’s scientific body of
● refers to the “ way a person responds as a physical being to stimuli knowledge is used to provide an essential service to people, that
from the environment. is, to promote ability to affect health positively.
● The five physiological needs of this mode are oxygenation, nutrition,
elimination, activity & rest, and protection ( Andrews and Roy, 1991). Role of the nurse - facilitator of adaptation
Nurse uses the six-step nursing process
Self- Concept Adaptive Mode a) Assessment of stimulus
● psychological & spiritual characteristics of the person ( Roy and b) Assessment of behavior
Andrews, 1999). c) Nursing Diagnosis
● The personal self incorporates self-consistency, self-ideal, and d) Goal-setting
moral-ethical-spiritual self. e) Intervention
● Psychic integrity is the goal of the self-concept mode f) Evaluation

Role function Adaptive Mode open systems prone to the environment and the person have to adapt in
● Refers to the primary, secondary and tertiary roles the person order to survive in the environment- ability of one to manage the diff stimuli
performs in society. which can threaten the condition of the individual
● Social integrity is the goal of the role function ( Roy and Andrews,
1999). major concept/theme of sister callista’s roy model - Adaptation
● primary role - parents
● secondary role - teacher Role of Nurse- to Facilitate Adaptation
● tertiary role - member of society, citizen of bacolod
replicated this from non-nursing theories such as…?
Interdependence Adaptive Mode
● Refers to the coping mechanisms arising from the close relationship relevance
that result in “the giving and receiving of love, respect, and value ( therapeutic curator - influenced by callista roy’s theory
Andrews and Roy, 1991).
● Affectional adequacy is the goal of the interdependence adaptive
mode ( Roy and Andrews,1999).
● strong support system - stronger person

Person -> stimuli in environment (stress) -> uses coping mechanisms ->
person ‘s response could either be adaptive or ineffective
Adaptive
- survival, growth reproduction, transformation
Ineffective
Theorist - Major Concept/ Theme/s • Nursing systems theory
Roy - Adaptation > postulates that nurses prescribe, design, & provide nsg. that regulates
Orem - Self Care / SC deficit the individual's self-care capabilities & meets therapeutic self-care
King - Interaction and Goal Attainment requirements

These are based on the general systems theory (assess what kind of Basic Nursing systems
non-nursing theory is this based on) • Wholly compensatory system
- nurse accomplishes patient's therapeutic self-care
Dorothea Elizabeth Orem - supports & protects patient
o Born in Baltimore, Maryland on July 15, 1914 o Partially compensatory system
• Died on June 22, 2007 in Savannah, USA at the age of 92 - patient performs some self-care measures
• 1949-1957 - she developed the definition of nursing practice. - nurse assists patient as required
• 1959 - First published her concept of self-care o Supportive-educative system
- patient accomplishes self-care
three theories that are interrelated - both the nurse & patient regulates the exercise & development of
1. self care self-care agency
2. self care deficit
3. nursing systems Metaparadigm in Nursing
4. independence O Person
- viewed as functioning biologically, symbolically, and socially. He initiates
Best Applicable: rehabilitation (according to Marisha’s answer) and ICU & performs self-care activities on own behalf in maintaining life, health,
(intensive care unit) where you trust in the medical team - comatose well-being.
patients and cardiac arrest, vehicle accidents, when the patients can no
longer care for themselves O Environment
- the surrounding environment is an external source of influence in the
theories must be universal and have generality in principles- self care internal interaction of a person's different aspects.
- environment as encompassed by two dimensions that are interactive
Theory - Self-care Deficit Nursing Theory a) physical, chemical & biologic features
Orem's general theory of nursing is expressed in three related parts: b) socioeconomic features
A. Theory of Seli- Care - pwede na wala nurse
B. Theory of Self- Care Deficit - open to others to care for somebody else • Health
C. Theory of Nursing Systems - ara si nurse and cannot be removed from - is a state that is characterized by soundness or wholeness of developed
the picture - but it can also include the patient human structures and of bodily & mental functioning.
● wholly compensatory system - nurse does all work
● partly compensatory system - nurse and patient work together o Nursing - restore the client's self-care capability to enable him or her to
● supportive-educative system - nurse teaches the patient, like in sustain structural reliability, performance, and growth through purposeful
cases of diabetes - the patient must learn to be independent nursing intervention.
- Nurse helps clients identify & establish ways to perform self-care
people by nature want to be independent and have time for themselves activities.
-privacy and boundaries, personal spaces - in ability to care for ourselves-
we will reach a point where we have to trust other people to care for us - Roles of Nurse
we will be dependent on other people ● Diagnostic
- nurse establishes N-P relationship
Self-Care Theory - nurse determines the extent to which the patient is limited in
- postulates that self-care & the self-care of dependents are learned providing effective self-care.
behaviors that individuals initiate & perform on their behalf to maintain
health, & well-being. ● Prescriptive
- describes why and how people care for themselves - planning stage in which the nurse confirms patient's needs

Universal Self-care Requisites that must be undertaken by the person in ● Regulatory

order to attain healthy living: nurse uses the systems of care
1. Maintenance of a sufficient intake of air, water & food.
2. Provision of care associated with elimination processes & ● Control
excrements. - nurse make judgments about quantity and quality of self-care,
3. Maintenance of balance between activity & rest. development of self-care agency, and nursing assistance.
4. Maintenance of balance between solitude & social interaction.
5. Prevention of hazards to human life, human functioning & human AREAS OF HOSPITAL WHERE YOU CAN APPLY DEFICIT THEORY - ICU
well-being. (Intensive care units) and NICU (neonatal intensive care unit)
6. Promotion of human functioning & development within social groups.
GIST
o Self-care deficit theory self care and self care deficit - nursing systems is under self care deficit -
- asserts that people benefit from nursing because they have SELF CARE
health-related limitations in providing self-care. goal of nurse is to ensure that after discharge, the patient would become
- describes & explains why people can be helped through nursing independent
IMOGENE KING METAPARADIGM
Born in January 30,1923 PERSON
• Died on December 24, 2007 at the age of 84 ● Individuals are social, conscious, rational, reacting beings
- established to facilitate the dissemination & utilization of her interacting
systems framework Health
● Dynamic state in the life cycle
King's Theory. ● Illness is an interference in the life cycle.
Interacting Systems Framework( Systems Interaction Model) & Goal ● Health implies continuous adjustment to stress in internal &
Attainment Theory external environment
● Requires optimum use of one’s resources to achieve maximum
psych nursing - therapeutic intervention potential for daily living
general idea - (jimelphs answer)
Environment
Theme of her theory - Interaction & Goal Attainment - Is the background for human interactions. It involves
Interacting Systems Framework a. internal environment
Composed of the b. external environment
1. PERSONAL systems
2. INTERPERSONAL systems Nursing
3. SOCIAL systems - A process of human interactions between nurse and client whereby each
perceives the other and the situation, and through communication, they
APPLICATION: set goals, explore means, and agree on means to achieve goals
- agreement with patient to reach a goal of healing - compromise
1. personal systems ● Perceptions
- nurse is not working alone there are systems within the nurse - the means by which humans process sensory
that affects information & construct understandings of the world.
2. interpersonal systems ● Judgment
- relationship bata kag nanay - is derived from one's perception of the situation
case example: mother refuses to let the nurse give medication to the son ● Action
mental health practitioner based on australia - dr octaviano former dean of - sequence of behaviors or activities based on the
rci is the mentor person's judgment of the situation
● Reaction
Interacting Systems Framework - form of reacting or a response to a certain stimuli
• King proposed that the nurse interacts in the system simultaneously at ● Interaction
three different levels, namely: - any situation wherein the nurse relates & deals with
• PERSONAL( Individuals) - how the nurse views and integrates self the client or patient
based from personal goals and beliefs ● Transaction
• INTERPERSONAL( Groups) - how the nurse interrelates with a - reaching some agreement to pursue an action plan to
co-worker or patient, particularly in a nurse-patient relationship achieve the desired outcome
• SOCIAL SYSTEMS (Society) – include health care settings, workplaces,
educational institutions, religious organizations, and families • Nurse & client mutually agrees on goals for client's health.
Nurse must work with patient for recovery

SUMMARY
● Imogene King has formulated a Conceptual System from which
Each system identifies human beings as the basic element in the system she derived a Theory of Goal Attainment.
- focuses on human behavior in a variety of social environment ● The conceptual system consists of three systems - personal,
interpersonal, and social . .. All of which are in continuous
Theory of Goal Attainment: exchange with their environments.
Basic Assumption: The nurse and the client communicate information, set ● Imogene King proposed a goal-oriented nursing record to
goal mutually, and then act to attain those goals. document, and a Goal Attainment Scale to measure goal
attainment as results of her research.
Martha Elizabeth Rogers Health
● Born on May 12, 1914 in Dallas, Texas. – is a rhythmic patterning of energy that is mutually enhancing & expresses
● Died on March 13, 1994 at the age of 79. full life potential
● 1970 – published her conceptual model - An Introduction to the Health occurs when patterns of living are in harmony with environmental
Theoretical Basis of Nursing. change
● Diploma: Knoxville General Hospital Illness occurs when patterns of living conflicts with environmental change
● School of Nursing (1936) and are deemed unacceptable.
● Graduation in Public Health Nursing- 1937 HARMONY vs CONFLICT
● MA : Teachers College, Columbia
● University New York,1945 Nursing
● Doctorate in Nursing: John Hopkins University, - 1954 – creative use of the art & science of nursing for human betterment
● Position: Professor Emerita, Division of Nursing, New York University, Role of the nurse – repattern the person & the environment to achieve
Consultant maximum health potential for the person.

Theory - Science of Unitary Human Beings Rogers envisions a nursing practice of noninvasive modalities
> Human beings are energy fields that interact constantly with the such as therapeutic touch, humor, guided imagery, use of color,
environment light, music, medication focusing on health potential of the person.
Modality of treatment - noninvasive therapy
Concepts used: Humor therapy - used in mentally ill people
● Energy fields – fundamental unit of both living & nonliving Music therapy - depressed patients
This energy field provides a way to perceive people and their
environment as irreducible wholes.
SUMMARY
● Openness – human field & environmental field have no boundaries ● Rogers’ “ Science of Unitary Human Beings Theory” emphasizes
that inhibit their energies to each other on viewing human beings and their environment as irreducible
wholes, which has brought nursing focus on holism.
Abstract concepts essential gasses for us to live in the world: ● Rogers stresses that human beings are unified wholes, greater
Oxygen & Importance of ecosystem - how plants and animals than the sum of their parts.
exchanged gases for us to live
If there is conflict - we are affected

● Pattern – the identity of the energy field & is perceived as a

single wave.
- reveals itself through manifestations( person’s experiences,
expressions, perceptions, and physical, mental, social and
spiritual data.

● Pandimensionality – a nonlinear domain where life process

exists along an irreversible space-time continuum.
- best expresses the idea of unitary whole

Homeodynamic Principles
● Resonancy – intensity of change
● Helicy – postulates an ordering of the human’s evolutionary
emergence; the life process evolves in sequential stages along a
curve that has the same general shape
● Integrality- fields are one(complete) & integrated but unique to each
other

“Helicy is the nature of change, integrality is the process by which

change takes place, and resonancy is how change takes place.”

Metaparadigm in Nursing
Person
– each being is unique & consists of more than the collective sum of parts
- person behaves as a totality
- an open system who is in constant process with another open system
Wholism - totality

Environment
– defined as the irreducible, pandimensional energy field identified by
pattern
Environment & human fields change continuously in a mutual process.
Betty Neuman • Flexible line of defense
• Born in 1924 on a farm near Lowell, Ohio - outermost boundary with broken lines
• 1972 – first published her model & finally came out with her book The - serve as an initial response to stressors
Neuman Systems Model: Application to Nursing Education & Practice
• Became a licensed clinical marriage & family therapist – emphasized on • Reconstitution – is the increase in energy that occurs
Christian counseling in relation to the degree of reaction to the stressor

Background Metaparadigm in Nursing

• The foundations of Neuman’s model are primarily Hans Selye’s stress
theory, Ludwig Von Bertalanffy’s general systems theory, Gerald PERSON
Caplan’s levels of prevention, Kurt Lewin’s field theory, and Pierre - An open system who may be an individual, family, community or
Teilhard de Chardin’s philosophy of life. society
- Viewed as being in constant change or motion as he interacts with
The Neuman model is considered a systems model. In a systems model, the environment
the main focus is the interaction of the parts, or subsystems within the - person adjusting to it or adjusting it to himself (reciprocal
system. interaction)
(jertrude’s answer)
ENVIRONMENT
Theory - System Model in Nursing Practice defined as being all the internal & external factors that surround the
( Health Care Systems Model) person.
- Basic components stress & reaction to stress Environmental forces:
a) Internal environment – intrapersonal stressors (stressors contained
Concept Definition: within the client)
• Open system b) External environment – interpersonal or extrapersonal (stressors
– elements are exchanging information energy within its complex occurring outside the client)
organization c) Created environment – intrapersonal
• Client variables - unconsciously developed; dynamic in nature
> clients are viewed as wholes (wholistic) whoseparts are in dynamic - can be a healthy adaptation (relaxation) OR can be maladaptive
interaction (schizophrenia)
> variables are physiological, psychological, developmental, socio-cultural
& spiritual HEALTH
● a continuum of wellness to illness that is dynamic in nature &
constantly subject to change.
● Wellness - harmonious interaction among the parts of the
client system (system needs are met)
● Illness - disharmony in the interaction among parts of the client
system ( unmet needs in varying degrees)
● Stability - client system successfully copes with stressors

NURSING
● views nursing as a “unique profession in that it is concerned with
all of the variables affecting an individual’s response to stress.”
● nurse is an active participant with the client
● nurse’s perception influences the care given
Focus is on the Primary
Secondary Prevention
Tertiary
a) Primary prevention
- carried out when the reaction has not yet occurred, but the degree of risk
is known
- reduces the possibility of encountering the stressors
– it is what the person does to prevent illness

• Lines of resistance b) Secondary prevention

- series of broken rings surrounding the basic core structure - initiated after symptoms from stress have occurred
- represent resource factors that help the client defend against a stressor - reduces the effect or possible effect of stressors
- helps restore balance - it is what is done when illness strikes treatment of symptoms

• Normal line of defense c) Tertiary Prevention

- model’s outer solid circle. - attempts to reduce the residual stressor effects after treatment
- represents a stability state for the individual or system - it is what is done to rehabilitate a person after illness or accident
- they are what usually protects us from stressors - can move the person back to primary prevention again
- baseline in determining the level of wellness of client within the
continuum of health.
EXAMPLES
Primary prevention - enough rest / sleep - enough defenses against
stressors - if physically fatigue - prone to infection and viral disorders - eat
healthy foods etc

Secondary prevention - already ill - intervene to prevent complications -

nurse do tsb or sponge bath

tertiary prevention
After illness or accident

SUMMARY
• Neuman System Model is based in General System Theory and views the
client as an open system that responds to stressors in the environment.
• The client system is composed of a basic or core structure that is
protected by lines of resistance. The usual level of health is identified as
the normal line of defense that is protected by a flexible line of defense.
• When stressors break through the flexible line of defense, the system is
invaded, the lines of resistance are activated, and the system is described
as moving into illness on a wellness-illness continuum.
• Nursing interventions occur through three prevention modalities:
A. Primary Prevention
B. Secondary Prevention
C. Tertiary Prevention

EXAMPLE -
INSERTION - naso gastric tube because they cannot feed themselves -
SECONDARY PREVENTION
Balanced diet - PRIMARY PREVENTION
Restore capacity to go back to daily living - TERTIARY PREVENTION

STRESSORS - affect individual

2 basic components in understanding neuman’s model

Stress
Reaction to stress
Dorothy E. Johnson
● Born on August 21, 1919 in Savannah, Georgia ● Dependency subsystem:
● Influence on nursing (1950s) publications stressed the importance - “approval, attention or recognition and physical assistance”
● of research-based knowledge about the effect of nursing care on - calls for a nurturing response
clients ● Ingestive subsystem:
● 1980 published “Behavioral System Model for Nursing” - “when, how, what, how much & under what
● Died in February 4, 1999 at the age of 80. conditions we eat.”
● Mentor of Roy - manners & behaviors during social gatherings
● Eliminative subsystem
Theory Behavioral System Model - “when, how & under what conditions we eliminate”
“ The client is a living open system; a collection of behavioral subsystems - pattern remains different from culture to culture.”
that interrelate to form a behavioral system” ● Sexual subsystem:
- behavior is affected by both biological and social factors
- The function is procreation and gratification.
● Aggressive subsystem
- relates to the behaviors concerned with protection & self
preservation.
- generates defensive response from the individual when life or
territory is being threatened
● Achievement subsystem
” provokes behavior that attempt to control the environment
(intellectual, physical, creative, mechanical and social skills
achievement)
- refers to standard of excellence
● Restorative subsystem
- concerned with rest, sleep, comfort/ freedom from pain

Metaparadigm in Nursing
Person
- a behavioral system comprised of subsystem constantly trying to
maintain a steady state

Environment
- relates to the environment on which the individual exists; the
individual’s behavior is influenced by the events in the environment

Major Concepts: Health

Equilibrium - is a purposeful, adaptive response, physically, mentally, emotionally, and
- defined as a stabilized but more or less transitory, resting state in which socially to internal and external stimuli in order to maintain stability and
the individual is in harmony with himself & his environment comfort.

Tension Nursing
– state of being stretched or strained * primary goal to foster equilibrium within the individual especially when
- Can be viewed as an end-product of a disturbance in equilibrium illness occurs
The Nurse must assist the client to return to a state of equilibrium.
Stressor
– internal & external stimuli that produce tension & result in a degree of SUMMARY
instability ● Johnson’s Behavioral System Model is a model of nursing care that
advocates the fostering of efficient and effective behavioral
Behavioral system functioning in the patient to prevent illness.
encompasses the patterned, repetitive, and purposeful ways of behaving.
- a person tries to achieve stability & balance reflects adjustments and The patient is identified as a behavioral system composed of seven
adaptations behavioral subsystems:
1. Affiliative/ Attachment Subsystem
Subsystem – specialized tasks have its own particular function and goal 2. Dependency Subsystem
- continues to change through maturation, experience and learning. 3. Ingestive Subsystem
4. Eliminative Subsystem
Johnson’s Behavioral Subsystems 5. Sexual Subsystem
- proposed that the client is a behavioral system, organized into seven 6. Aggressive Subsystem
subsystems of behavior which are as follows: 7. Achievement Subsystem

● Attachment or affiliative subsystem: ● An imbalance in any of the behavioral subsystems results in

- social inclusion intimacy disequilibrium.
-formation and attachment of a strong social bond ● It is nursing’s role to assist the client to return to a state of
- provides survival & security equilibrium.