Client-Centered Theory

CLIENT-
CENTERED
THEORY
MODULE 4
Learning Outcome
CLIENT CENTERED NURSING THEORY

Differentiate philosophies, theories and conceptual models of Nursing
focusing on the client-centered theories according to the metaparadigm of
nursing.
Identify and discuss the significance of nursing theories to nursing

education, research and clinical practice.
Lesson 1
CLIENT- CENTERED THEORY
Florence Nightingale
Faye Abdellah
Virginia Henderson
FLORENCE NIGHTINGALE
“Environmental Theory”
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NURSING “the act of utilizing the environment

of the
patient to assist him in his recovery”.
5 environmental factors
-Fresh air
-Pure water
-Efficient drainage
-Sanitation/cleanliness
-Light and direct sunlight
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Nightingale’s Nursing Theory

v The first published nursing theory (1860)
v Persons are in relation with the environment
v Stresses the healing properties of the physical environment
(fresh air, light, warmth, and cleanliness)
v Nursing puts patients in the “best conditions” for nature to act upon them
v Health is “the positive of which the pathology is the negative”
v “Nature alone cures”
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Nightingale’s Nursing Theory

v The first published nursing theory (1860)
v Persons are in relation with the environment
v Stresses the healing properties of the physical environment
(fresh air, light, warmth, and cleanliness)
v Nursing puts patients in the “best conditions” for nature to act upon them
v Health is “the positive of which the pathology is the negative”
v “Nature alone cures”
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Theory basis: the inter-relationship of a healthful environment with nursing External

influences and conditions can prevent, suppress, or contribute to disease or death
Theory goal: Nurses help patients retain their own vitality by meeting their basic needs
through control of the environment
Nursing’s Focus: control of the environment for individuals, families & the community
Components of Nightingale’s
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Environmental Theory:
Health of Houses
Ventilation and Warming
Light
Noise
Variety
Bed and Bedding
Cleanliness of Rooms and Walls
Personal Cleanliness
Nutrition and Taking Food
Chattering Hopes and Advices
Observation of the Sick
Social Considerations
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PERSON
v Referred to by Nightingale as “the
patient”
v A human being acted upon by a
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nurse, or affected by the environment
v Has reparative powers to deal with

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disease
Nightingale’s Theory &
Nursing’s Metaparadigm v Recovery is in the patient’s power as
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long as a safe environment exists

ENVIRONMENT
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vThe foundational component of

Nightingale’s theory
vThe external conditions &
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forces that affect one’s life and

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development
vIncludes everything from a
Nightingale’s Theory & person’s food to a nurse’s
Nursing’s Metaparadigm verbal & nonverbal interactions
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with the patient

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HEALTH
Ø Maintained by using a person’s
healing powers to their fullest extent
Ø Maintained by controlling the
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environmental factors so as to
prevent disease
Ø Disease is viewed as a reparative
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process instituted by nature

Nightingale’s Theory & Ø Health & disease are the focus of the
Nursing’s Metaparadigm Icon
nurse
Ø Nurses help patients through their
healing process
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NURSING
ØNursing education
belongs in the hands of
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nurses!
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Ø Nursing is a discipline distinct

Nightingale’s Theory & from medicine focusing on the
Nursing’s Metaparadigm patient’s reparative process
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rather than on their disease!!

CLIENT-CENTERED THEORY
THANK YOU!
CLIENT-
CENTERED
THEORY
MODULE 4
Learning Outcome

nursing.

Faye Glenn Abdellah
“Patients Centered Approaches”
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v In 1960, influenced by the desire to promote client-centred
comprehensive nursing care,
v Abdellah described nursing as a service to individuals, to families, and,
therefore to, to society.
v pioneer nursing researcher, helped transform nursing theory, nursing
care and nursing education
Faye Glenn Abdellah
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According to her, nursing is based on an art and science that mold 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.
Type Text
Here or
Image or icon Image or icon Image or icon
place an
Image 1. Recognizing the
nursing problems of
the patient
5. Adjusting the total
nursing care plan to
meet the patient’s
8)Helping the individual
to adjust to his
limitations and emotional
2. Deciding the individual needs problems
appropriate course of 6. Helping the 9) Working with allied
action to take in terms individual to become health professions in
of relevant nursing more self directing in planning for optimum
principles attaining or health on local, state,
3. Providing continuous maintaining a healthy national and
care of the individuals state of mind &. international levels
total needs 7. Instructing nursing 10) Carrying out
4. Providing continuous personnel and family continuous evaluation
care to relieve pain and to help the individual and research to improve
discomfort and provide do for himself that nursing techniques and
immediate security for which he can within his to develop new
the individual limitations techniques to meet the
PHILOSOPHICAL UNDERPINNINGS OF
THE THEORY
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Abdellah’s patient-centered approach to nursing
was developed inductively from her practice and
is considered a human needs theory.
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The theory was created to assist with The theory was created to assist
nursing education and is most applicable with nursing education
to the education of nurses. and is most applicable to the
education of nurses.
10 steps to Image or icon Image or icon Image or icon
identify the
client’s 1. Learn to know the
patient
2. Sort out relevant
5. Test generalizations
with the patient and
make additional
8. Explore the
patient’s and family’s
reaction to the
and significant data generalizations therapeutic plan and
problems 3. Make
generalizations
about available data
6. Validate the patient’s
conclusions about his
nursing problems
involve them in the
plan
9. Identify how the
in relation to similar 7. Continue to observe nurses feels about
nursing problems and evaluate the the patient’s nursing
presented by other patient over a period of problems
patients time to identify any 10. Discuss and
4. Identify the attitudes and clues develop a
therapeutic plan affecting his behavior comprehensive
nursing care plan.
Image or icon Image or icon Image or icon
11 nursing
skills 1. Observation of
health
5. Planning and
organization of
8. Problem-
solving
status
2. Skills of work 9. Direction of
communication 6. Use of work of others
3. Application of resource 10. Therapeutic
knowledge materials use of the self
4. Teaching of 7. Use of 11. Nursing
patients and personnel
families procedures
resources
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1. To maintain good hygiene and physical

comfort
2. To promote
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optimal activity: exercise,
rest and sleep
3. To promote safety through the prevention

of accidents,
injury, or other trauma and through the
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prevention
Abdellah’s Typology of the spread of infection
of 21 Nursing 4. To maintain
Icon good body mechanics and
Problems prevent and correct deformities
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5.To facilitate the maintenance of a

supply of oxygen to all body cells
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6. To facilitate the maintenance of

nutrition for all body cells
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Abdellah’s Typology elimination
of 21 Nursing Icon
Problems 8.To facilitate the maintenance of

fluid and electrolyte balance
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9. To recognize the physiologic

responses of the body to disease
conditions—pathologic, physiologic,
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and compensatory

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Abdellah’s Typology
regulatory mechanisms and
of 21 Nursing functions
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Problems
sensory function
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12. To identify and accept positive and

negative expressions, feelings, and
reactions
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13. To identify and accept the

interrelatedness of emotions and
Icon organic illness
Abdellah’s Typology 14. To facilitate the maintenance of

of 21 Nursing effective verbal and non verbal
Problems
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communication
15. To promote the development of
productive interpersonal relationships
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16. To facilitate progress toward

achievement of personal spiritual
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goals
17. To create and / or maintain a
therapeutic environment
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Abdellah’s Typology 18. To facilitate awareness of self

of 21 Nursing as an individual with varying
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Problems physical , emotional, and

developmental needs
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19. To accept the optimum possible

goals in the light of limitations, physical
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and emotional
20. To use community resources as an

aid in resolving problems arising from
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illness
Abdellah’s Typology
of 21 Nursing 21. To understand the role of social
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Problems problems as influencing factors in the

case of illness
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Ø Nursing is a helping profession. In

Abdellah’s model, nursing care is doing
something to or for the person or
providing information to the person with
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the goals of meeting needs, increasing or

restoring self-help ability, or alleviating
impairment.
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Ø She considers nursing to be

ABDELLAH’S THEORY comprehensive service that is based on art
AND THE FOUR and science and aims to help people, sick
or well, cope with their health needs.
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MAJOR CONCEPTS
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Ø Nursing is a helping profession. In Abdellah’s model,
nursing care is doing something to or for the person or
providing information to the person with the goals of
meeting needs, increasing or restoring self-help ability, or
Icon alleviating impairment.
Ø She considers nursing to be comprehensive service that is

based on art and science and aims to help people, sick or
well, cope with their health needs.
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Ø
Ø Abdellah describes people as having physical, emotional,
and sociological needs. These needs may overt,
ABDELLAH’S THEORY consisting of largely physical needs, or covert, such as
emotional and social needs.
AND THE FOUR Ø Patient
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is described as the only justification for the
existence of nursing.
MAJOR CONCEPTS Ø Individuals (and families) are the recipients of nursing
Health, or achieving of it, is the purpose of nursing services.
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ØIn Patient –Centered Approaches to

Nursing, Abdellah describes health as
a state mutually exclusive of illness.
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ØAlthough Abdellah does not give a

definition of health, she speaks to
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“total health needs” and “a healthy

ABDELLAH’S THEORY state of mind and body” in her
AND THE FOUR description of nursing as a
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MAJOR CONCEPTS comprehensive service.

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vSociety is included in “planning for

optimum health on local, state,
national, and international levels”.
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However, as she further delineated

her ideas, the focus of nursing
service is clearly the individual.
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ABDELLAH’S THEORY
AND THE FOUR vThe environment is the home or
community from which patient
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MAJOR CONCEPTS
comes.
THANK YOU!
CLIENT-
CENTERED
THEORY
MODULE 4
Learning Outcome

nursing.

Virginia Henderson
Icon 14 components of
Nursing
Virginia Henderson
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In 1996, Virginia Henderson’s definition of the unique

function of nursing was a major stepping stone in
the emergence of nursing as a discipline separate
from medicine.
1. Breathing normally
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2. Eating and drinking adequately

3. Eliminating body wastes
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14 components of 4. Moving and maintaining a desirable

position
basic nursing care 5. Sleeping and resting
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6. Selecting suitable clothes

14 components of 7. Maintaining body temperature
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basic nursing care within normal range by adjusting

clothing and modifying the
environment
8. Keeping the body clean and
well groomed to protect the
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integuments
9. Avoiding dangers in the
environment and avoiding
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14 components of injuring others

basic nursing care 10. Communicating with
others in expressing
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emotions, needs, fears, or

14 components of opinions
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basic nursing care 11. Worshipping according

to one’s faith
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12. working in such a way that one

feels a sense of accomplishment
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14 components of
basic nursing care 13. Playing or participating in
various forms of recreation
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14. Learning, discovering, or

14 components of
14 satisfying the curiosity that leads
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basic nursing care to normal development and

health, and using available health
facilities
METAPARADIGM
Individual requiring
assistance to achieve
Person health and independence
or a peaceful death. Mind
Nursing
and body are
inseparable.
Environ- Health h
breathing, eating, drinking, maintaining
All external conditions and comfort, sleeping, resting clothing,
ment influences
that affect life and development.
maintaining body temperature, ensuring
safety, communicating,
worshiping, working, recreation, and
continuing development.
THANK YOU!
CLIENT-
CENTERED
THEORY
MODULE 4
Learning Outcome

nursing.

INTRODUCTION

Person-centered care involves knowledge of the individual as whole person,
involving them – and where appropriate their family and friends – in
helping to assess their own needs and plan their own care. In person-
centered care, caring is central to nursing practice, and nurses’
relationships with the service user are fundamental to that individual’s
experiences of care. There are eleven Nursing Theory that focus on
Client - centered theory.
Lesson 2
CLIENT- CENTERED THEORY
Dorothea Orem
Nola Pender Sr. Callista Roy

Dorothea Orem
Icon Self-care deficit nursing

theory
Orem’s General Theory of Nursing
Orem’s general theory of nursing in three

related parts:-
2. Theory of self
care deficit.
1. Theory of self
care 3. Theory of nursing
systems
v Self care – practice of
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activities that individual
initiates and perform
on their own behalf in
maintaining life ,health and
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well being
v Self care agency – is a human ability which
is "the ability for engaging in self care”
Icon Conditioned by age developmental state, life

experience sociocultural orientation health
and available resources
Theory of Self Care v Therapeutic self care demand – "totality of
self care actions to be performed for some
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duration in order to meet self care requisites
by using valid methods and related sets of
operations and actions"
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vUniversal self care
requisites
vAssociated with life processes and the
maintenance of the integrity of human
Icon structure and functioning
Common to all , ADL
Identifies these requisites as:
vMaintenance of sufficient intake of air ,water,
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food
Provision of care associated with elimination
process
Theory of Self Care vBalance between activity and rest, between
solitude and social interaction
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vPrevention of hazards to human life well
being and
Promotion of human functioning
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v Developmental self care

requisites
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vAssociated with developmental

processes/ derived from a
condition…. Or associated with
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an event
Theory of Self Care
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E.g. adjusting to a new job
adjusting to body changes
vHealth deviation self care
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Required in conditions of illness ,injury, or disease
these include:
Ø Seeking and securing appropriate medical
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assistance
Ø Being aware of and attending to the effects
and results of pathologic conditions
Ø Effectively
Icon carrying out medically prescribed
measures
Theory of Self Care Ø Modifying self concepts in accepting oneself
as being in a particular state of health and in
Icon specific forms of health care
Ø Learning to live with effects of pathologic

conditions
vSpecifies when nursing is
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needed:
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·Nursing is required when an

adult (or in the case of a
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Theory of Self Care dependent ,the parent) is

Deficit incapable or limited in the
provision of continuous effective
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self care
vOrem identifies 5
methods of helping:
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1. Acting for and doing for others

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2. Guiding others
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3. Supporting another
Theory of Self Care
Deficit 4. Providing an environment promoting
personal development in relation to meet
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future demands
5. Teaching another
Nursing Process Orem’s Nursing. Process
Assessment Diagnosis and prescription
;determine why
Nursing diagnosis nursing is needed. analyze
and interpret –make
Plans with scientific
judgment regarding care
rationale
Implementation Design of a nursing system

and plan for delivery of care
evaluation
Production and
management of nursing
systems
Icon 1. The person’s health status
2. The physician’s perspective of the

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person’s health status
3. The person’s perspective of his or her
health
4. The health goals within the context of
life history ,life style, and health status
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Step 1-collect data in

six areas: 5. The person’s requirements for self care
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6. The person’s capacity to perform self

care
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v Nurse designs a system that is wholly or

partly compensatory or supportive-
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educative.
v The 2 actions are:-
v 1. Bringing out a good organization of the
components of patients’ therapeutic self care
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demands
v 2. Selection of combination of ways of
Step 2 helping that will be effective and efficient in
compensating for/ overcoming patient’s self
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care deficits
vNurse assists the patient or family in
self care matters to achieve identified
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and described health and health

related results ..collecting evidence in
evaluating results achieved against
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results specified in the nursing

system design
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vActions are directed by etiology

Step 3
component of nursing diagnosis
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vEvaluation
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is art, a helping service, and a

technology
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Actions deliberately selected and performed

by nurses to help individuals or groups under
their care to maintain or change conditions
in themselves or their environments
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METAPARADIGM Encompasses the patient’s perspective of

health condition ,the physician’s perspective
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, and the nursing perspective

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Goal of nursing – to render the patient or

members of his family capable of
meeting the patient’s self care needs
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To maintain a state of health

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To regain normal or near normal state of

METAPARADIGM health in the event of disease or injury
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To stabilize ,control ,or minimize the

effects of chronic poor health or
disability
HEALTH
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Health and healthy are terms used to

describe living things … it is when they
are structurally and functionally whole
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or sound … wholeness or integrity.
It includes that which makes a person

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human,…operating in conjunction with

METAPARADIGM physiological and psychophysiological
mechanisms and a material structure
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and in relation to and interacting with

other human beings
Environment
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Environment components are

environmental factors
,environmental elements,
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conditions ,and
developmental environment
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METAPARADIGM
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PERSON
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Human being – has the capacity to

reflect ,symbolize and use symbols
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Conceptualized as a total being with

universal ,developmental needs and
capable of continuous self care
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METAPARADIGM A unity that can function biologically,

symbolically and socially
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THANK YOU!
CLIENT-
CENTERED
THEORY
MODULE 4
Learning Outcome

nursing.

Nola J. Pender
Health Promotion
Model
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Nola Pender is a nursing theorist, author and academic.

She is a professor emerita of nursing at the University of
Michigan. She created the Health Promotion Model. She has
been designated a Living Legend of the American Academy of
Nursing. : August 16, 1941 (age 74), Lansing, Michigan, United
States  Fields: Nursing B  ooks: Health Promotion in Nursing
Practice  Institution: Northern Illinois University, University of
Michigan
Nola J. Pender
Overview of Health Promotion

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Model
Purpose: Assist nurses in understanding the major determinants
of health behaviors as a basis for behavioral counseling to
promote healthy lifestyles
Philosophical Roots: Reciprocal Interaction World View in which

humans are viewed holistically, but parts can be studied in the
context of the whole. Human beings interact with their
environment and shape it to meet their needs and goals.
Nola J. Pender
Overview of Health Promotion

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Model
Theoretical Roots: Expectancy value theory – Individuals engage in
actions to achieve goals that are perceived as possible and that
result in valued outcomes.
Social cognitive theory – Thoughts, behavior, and environment
interact. For people to alter how they behave, they must alter how
they think
Brief Description. The model identifies background factors that
influence health behavior. Using the model and working
collaboratively with the patient/client, the nurse can assist the
client in changing behaviors to achieve a healthy lifestyle.
Nola J. Pender
HPM Assumptions
is Icon
based on the following assumptions, which reflect both nursing and
behavioral science perspectives:
1. Persons seek to create conditions of living through which they can express their
unique human health potential.
2. Persons have the capacity for reflective self-awareness, including assessment of

their own competencies.
3. Persons value growth in directions viewed as positive and attempt to achieve a

personally acceptable balance between change and stability.
4. Individuals seek to actively regulate their own behavior.
Nola J. Pender
HPM Assumptions
is based
Icon on the following assumptions, which reflect both nursing and
behavioral science perspectives:
5. Individuals in all their biopsychosocial complexity interact

with the environment, progressively transforming the
environment and being transformed over time.
6. Health professionals constitute a part of the interpersonal

environment, which exerts influence on persons throughout
their lifespan.
7. Self-initiated reconfiguration of person-environment
interactive patterns is essential to behavior change.
Nola J. Pender
HPM Theoretical Propositions derived from the model

provide a basis for investigative work on health
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behaviors. The HPM is based on the following theoretical

propositions:
1. Prior behavior and inherited and acquired
characteristics influence beliefs, affect, and
enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from

which they anticipate deriving personally valued
benefits.
Nola J. Pender

provide
Icon a basis for investigative work on health behaviors.
The HPM is based on the following theoretical propositions:
3. Perceived barriers can constrain commitment to action, a

mediator of behavior as well as actual behavior.
4. Perceived competence or self-efficacy to execute a given

behavior increases the likelihood of commitment to action
and actual performance of the behavior.
Nola J. Pender

provide
The HPM is based on the following theoretical propositions:
5. Greater perceived self-efficacy results in fewer perceived

barriers to a specific health behavior.
6. Positive affect toward a behavior results in greater perceived

self-efficacy.
Nola J. Pender

provide
The HPM is based on the following theoretical
propositions:
7. When positive emotions or affect are associated with a
behavior, the probability of commitment and action is increased.
8. Persons are more likely to commit to and engage in health-

promoting behaviors when significant others model the behavior,
expect the behavior to occur, and provide assistance and support
to enable the behavior.
Nola J. Pender
HPM Theoretical PropositionsTheoretical statements derived from

the
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model provide a basis for investigative work on health
behaviors. The HPM is based on the following theoretical
propositions:
9. Families, peers, and health care providers are important sources

of interpersonal influence that can increase or decrease
commitment to and engagement in health- promoting behavior.
10. Situational influences in the external environment can increase

or decrease commitment to or participation in health-promoting
behavior.
Nola J. Pender
HPM Theoretical Propositions derived from the model provide a

basis for
Icon
investigative work on health behaviors. The HPM is based
on the following theoretical propositions:
.
11. The greater the commitment to a specific plan of action, the

more likely health- promoting behaviors are to be maintained over
time.
12. Commitment to a plan of action is less likely to result in the

desired behavior when competing demands over which persons
have little control require immediate attention.
Nola J. Pender
HPM Theoretical Propositions derived from the model provide a basis

for investigative
Icon
work on health behaviors. The HPM is based on the
following theoretical propositions:
13. Commitment to a plan of action is less likely to result in the

desired behavior when other actions are more attractive and thus
preferred over the target behavior.
14. Persons can modify cognitions, affect, interpersonal influences,

and situational influences to create incentives for health promoting
behavior.
PERSON
Person is a biopsychosocial
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organism that is partially shaped by

the environment but also seeks to
create an environment in which
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inherent and acquired human

potential can be fully expressed.
Thus, the relationship between
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person and environment is
.
reciprocal. Individual characteristics
METAPARADIGM as well as life experiences shape
behaviors including health behaviors.
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ENVIRONMENT
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Environment is the social, cultural

and physical context in which the life
course unfolds. The environment can
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be manipulated by the individual to

create a positive context of cues and
facilitators for health-enhancing
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behaviors
.
METAPARADIGM
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HEALTH
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Health in reference to the individual is defined

as the actualization of inherent and acquired
human potential through goal-directed
behavior,
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competent self-care, and satisfying
relationships with others, while adjustments
are made as needed to maintain structural
integrity and harmony with relevant
environments. Health is an evolving life
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experience. There are definitions for family
.
health and community health that have been
METAPARADIGM proposed by other authors.
Illnesses are discrete events throughout the

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life span of either short (acute) or long

(chronic) duration that can hinder or facilitate
one’s continuing quest for health.
NURSING
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Nursing is collaboration with

individuals, families, and
communities to create the most
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favorable conditions for the

expression of optimal health and
high-level well-being.
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.
METAPARADIGM
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THANK YOU!
CLIENT-
CENTERED
THEORY
MODULE 4
Learning Outcome

nursing.

Sister Callista Roy
v Sister Callista Roy was born in October 1939 in California
v She is a member of the Sisters of Saint Joseph of
CarondeletShe received undergraduate degrees in
Icon nursing, has both a masters and doctorate in sociology
v She held professor status at Mount St Mary’s College and
was a postdoctoral fellow at University of California-Roy
has authored many books and articles and has received
numerous personal and professional achievement
recognitions-
v Roy was challenged by Johnson to create a model for
nursing; Roy, a pediatric nurse at the time, had great
interest in children and their ability to adapt especially in
the face of great physical and psychological changes.
v First operationalized at Mount St Mary’s college as
foundation of nursing school; 1977 model was
presented.
Sister Callista Roy
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Sister Callista Roy
The Roy Adaptation Model
+ Diagrammatic Representation of Human Adaptive Systems
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Sister Callista Roy
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Four Adaptive Modes
v 1. Physiologic-physical mode: physical and chemical processes
involved in the function and activities of living organisms; the
underlying need is physiologic integrity as seen in the degree of
wholeness achieved through adaptation to changes in needs. In
groups, this is the manner in which human systems manifest
adaptation relative to basic operating resources. The basic need of
this mode is composed of the needs associated with oxygenation,
nutrition, elimination, activity and rest, and protection. The complex
processes of this mode are associated with the senses, fluid and
electrolytes, neurologic function, and endocrine function
Sister Callista Roy
Four Adaptive Modes

2. Self-concept-group identity mode: focuses on psychological
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and spiritual integrity and a sense of unity, meaning,

purposefulness in the universe.
3. Role function mode: refers to the roles that individuals occupy

in society fulfilling the need for social integrity; it is knowing who
one is, in relation to others.
4. Interdependence mode: the close relationships of people and
their purpose, structure and development individually and in
groups and the adaptation potential of these relationships.
Sister Callista Roy
Subconcepts
v Adaptive responses are those that promote the integrity of the person.
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v The person’s integrity, or wholeness, is behaviorally demonstrated when the

person is able to meet the goals in terms of survival, growth, reproduction and
mastery.
v Ineffective responses do not support these goals. (Roy & Andrews, 1991)
v Coping mechanisms describe the control processes of the person as an adaptive

system. Some coping mechanisms are inherited or genetic, such as white blood
cell defense mechanism against bacteria that seek to invade the body.
v Other mechanisms are learned, such as the use of antiseptics to cleanse a
wound.
Sister Callista Roy
Two Coping Subsytems

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A. Cognator subsystem“A major coping process involving four

cognitive-emotive channels: perceptual and information processing,
learning, judgment, and emotion.”
B. Regulator subsystemA basic type of adaptive process that

responds automatically through neural, chemical, and endocrine
coping channels.
v
Sister Callista Roy
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v Focal stimuli . Those stimuli that are the proximate causes of the
situation.
v Contextual stimuli. All other stimuli in the internal or external
environment, which may or may not affect the situation.
v Residual stimuli. Those immeasurable and unknowable stimuli that

also exist and may affect the situation.
PERSON
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“The human adaptive system”

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and defined as “a whole with
parts that function as a unity for
some purpose. Human systems
Icon include people… groups…
. communities, and
organizations,
METAPARADIGM society as a whole.” (Roy &
Andrews, 1999)
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ENVIRONMENT
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. Conditions, circumstances and

influences that… affect the
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development and behavior of

humans as adaptive systems.
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.
METAPARADIGM
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HEALTH
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A state and process of being and

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becoming integrated and whole.

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.
METAPARADIGM
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NURSING
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Goal of nursing
The “promotion of adaptation in each of the
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four modes.”
Adaptation
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.
The “process and outcome whereby
METAPARADIGM thinking and feeling persons as individuals
or in groups use conscious awareness and
choice to create human and environmental
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integration.”
THANK YOU!
TFN Module 4: Client Centered Nursing
Theories
Conservation Model
Historical Evolution
✓Developed in early 1970s
✓Initially constructed as a teaching framework for medical-

surgical nursing
✓Based on physical science principles, Gives rationale behind

nursing actions
✓Integrated numerous authors and their work to help develop

the concepts of Conservation Model.
Conservation Model
is based on 3 concepts
Conservation
Wholeness
Adaptation
Wholeness…
▪Levine stated that “the unceasing interaction of the individual

organism with its environment does represent an ‘open and fluid’
system, and a condition of health, wholeness, exists when the
interaction or constant adaptations to the environment, permit
ease—the assurance of integrity…in all the dimensions of life.”
 Adaptation
Adaptation is the process of change, and conservation is

the outcome of adaptation
“A process of change whereby the individual retains his

integrity within the realities of his internal and external
environment” (Levine 1969, p.95)
Conservation
▪“conservation is about achieving a balance of energy supply and
demand that is within the unique biological realities of the
individual.”
▪“Through conservation, individuals are able to confront disability”
▪The primary focus of conservation is keeping together of the
wholeness of the individual,
METAPARADIGM CONCEPTS
METAPARADIGM CONCEPTS
THE PERSON
THE ENVIRONMENT
HEALTH
NURSING
PERSON AND ENVIRONMENT

1. PERSON
• A holistic being—not only in the physical needs, but also the psycho-
social, cultural and spiritual aspects—who constantly strives to preserve
wholeness and integrity.
• A unique individual in unity and integrity, feeling, believing, thinking and is
a whole system.
2. Environment
▪The environment completes
the wholeness of the individual.
▪Where the individual lives her life.

3. Health
▪Health and disease are patterns of adaptive change.
▪Ability to function normally and able to return to daily activities, self-
hood, and ability to pursue one's interest without constraints
▪Not just an absence of disease and successful adaptation and not
merely healing of an affected part
4. Nursing
▪ Nursing involves engaging in “human interactions”
▪ “The nurse enters into a partnership of human experience

where sharing moments in time—some trivial, some
dramatic—leaves its mark forever on each patient”
(Levine, 1977, p. 845).
5. Person and
Environment
▪Levine’s Conservation Model discussed the way in which
the person and the environment become congruent over time.
▪The terms described are; adaptation and organismic response.
Adaptation
▪Process of interacting with environment

▪Process of change or of life
▪Can be equated with
▪Homeostasis
▪Stability
▪Equilibrium
▪Balance
Three Parts of Adaptation
Historicity Specificity Redundancy
• Refers to • There is a • Person
person’s system to deal displays
genetic with each task multiple
makeup • unique responses to
• Happens at stimulus- dysfunction
the cellular response • Multiple
level pathways, task systems deal
• based on oriented with threat
personal and • Interacting
genetic past sequences of
history events
Organismic response
▪ A change in behavior of an individual during an attempt to adapt to the

environment is called an organismic response.
▪ It helps individual to protect

and maintain their integrity.
▪ There are four types

Types of responses
Fight or flight
• Quick response to threat or perceived threat
Inflammatory-immune
• Restores physical wholeness (healing)
Stress
• Integrated Response developed over time
Perceptual awareness
• Focusing on specific aspects of environment
CONSERVATIONAL
PRINCIPLES
• Protects • Physical
functional healing
integrity • Physiologic
• Pacing activities
activities to
restore Conservatio
function Conservatio n of
n of Energy Structural
Integrity
Conservatio
Conservatio
n of
n of Social
Personal
Integrity
Integrity
• Ability to
function in • Recognition of
groups self
• Self is • Protection of
developed in personal
family and space
society
Conservation of energy
▪It refers to balance between energy expenditure

and conservation. Patient activity is dependent
on energy balance.
▪Energy is measured in everyday nursing

practice via body temperature, blood gases,
pulse, and blood pressure; fluctuations
determine either energy expenditure or
conservation
Examples
▪Availability of adequate rest
▪Maintenance of adequate nutrition
Conservation of structural integrity
▪Focused on preserving the anatomical structure of the body and
preserving healing.
▪Nursing Intervention aims in helping the individual to prevent

skin breakdown and limiting the amount of tissue involvement in
infectious disease.
Examples
▪ Maintenance of clean, dry,
wrinkle free linen.
▪ Regular turning of patient
side to side every 2 hours
to patients who are
bedridden
▪ Perform ROM exercises
▪ Maintenance of patient’s
personal hygiene
Conservation of personal integrity
▪A client is a person with dignity, sense of identity and self-worth.
▪Individual strives for recognition, respect, self awareness, self-
hood and self-determination.
▪Individuals require privacy
Examples
▪ Expression of patient’s feelings
▪ Involvement of patient in plan of care,
▪ Recognize and protect patient’s space

needs
Conservation of Social Integrity
▪Social beings interacts with in a family, a community, a
religious group, an ethnic group, a political system and a
nation.
▪Nursing Intervention: Helping the individual to preserve his or

her place in the family, community and society.
Examples
▪Position patient in bed to foster social interaction with other

patients
▪Avoid sensory deprivation
▪Promote patient’s use of news paper, magazines, radio. TV
▪Provide support and assistance to family

THEORIES DERIVED FROM THE CONSERVATIONAL MODEL
▪ Conservational model provides the basis for development of two theories
Theory of Theory of
redundanc therapeutic
y intention
Theory of redundancy
▪Untested ,speculative theory that redefined aging and everything else
that has to do with human life
▪Aging is diminished availability of redundant system necessary for

effective maintenance of physical and social well being
Theory of therapeutic intention
▪To seek a way of organizing nursing interventions out of the

biological realities which the nurse has to confront
▪Therapeutic regimens should support the following goals:
-Facilitate healing through natural response to disease
-Provide support for a failing auto regulatory portion of the
integrated system
-Restore individual integrity and well being
Theory of therapeutic intention
-Provide supportive measure to ensures comfort
-Balance a toxic risk against the threat of disease
-Manipulate diet and activity to correct metabolic imbalance and
stimulate physiological process
-Reinforce usual response to create a therapeutic changes
Contributions to
Nursing/Healthcare
Provided nursing with a systematic

way to view patient holistically and intervene accordingly
Advocated for use of scientific process in nursing

Now called…Evidence Based Practice
SUMMARY
▪Myra Levine’s Theory interrelates the concepts of conservation,
adaptation, and integrity.
▪The purpose of conservation is health, or integrity- the wholeness of
an individual
▪Adaptation is the process by which conservation occurs.
Conservation Theory
Internal environment
adapts to
external environmental cues
through conservation
so that
person maintains integrity
LYDIA HALL’S THEORY OF NURSING
THE CORE
THE CARE THE CURE

The Care Circle
THE CARE
Care
Nurturing component of care
Involves the concept of “Mothering”
Provides bodily care for the patient and helps the patient to complete
such basic daily biologic activities
Provides teaching and learning activities
Nurses goal is to “comfort” the patient
Patient may explore and share feelings with nurse
Care
 Nurse is concerned with intimate bodily care
 Nurse applies knowledge of natural and biological sciences to provide a

strong theoretical base for nursing implementations.
 Nurse act as potential comforter

 INTERPERSONAL RELATIONSHIP
 EXPLORATION OF FEELINGS
CORE CIRCLE
THE
CORE
Core
Patient care is based on social sciences

Involves the Therapeutic use of self
The nurse is able to help the patient verbally express
feelings regarding the disease process and its effects, as
well as discuss the patient’s role in recovery or healing
process.
Patient is able to maintain who they are (self-identity)
Core
Patient able to develop a maturity level when nurse

listens to them and acts as sounding board
Patient able to make informed or conscious decisions
based on understood and accepted feelings and
motivations.
Helps the patient look at and explore feelings regarding
his or her current health status
 Emphasis on social,emotional,spiritual and intellectual needs
 Patient makes more rapid progress towards recovery and rehabilitation
 INTERPERSONAL PROCESS
UNDERSTANDING THEMSELVES
PROBLEM FOCUSSING AND PROBLEM

SOLVING
CURE CIRCLE
THE CURE
Cure
Care based on pathological and therapeutic sciences

Application of medical knowledge by nurses
Nurse assisting the doctor in performing tasks
Nurse is patient advocate in this area
Nurses role changes from positive quality to negative quality
Medical surgical and rehabilitative care
COPERATE WITH FAMILIES OR CARE GIVERS
Interaction All Three Aspects
THE CORE
THE CARE
THE CURE
Emphasis placed on the importance of total person approach
Importance placed on all three aspects functioning together
All three aspects interact and change in size , depending on the patient’s total
course of progress.
HALLS THEORY AND NURSING’s metaPARADIGM
INDIVIDUAL
HEALTH
ENVIRONMENT
NURSING
INDIVIDUAL
The individual human who is 16 years of age or older and past the
acute stage of a long term illness is the focus of nursing care in Hall’s
work.
The source of energy and motivation for healing is the individual care
recipient, not the health care provider.
HEALTH
Health can be inferred to be a state of self-awareness

with conscious selection of behaviors that are optimal
for that individual.
SOCIETY/ENVIRONMENT
The concept of society/environment is dealt with in relation to the

individual.
Hall is credited with developing the concept of Loeb Center
because she assumed that the hospital environment during
treatment of acute illness creates a difficult psychological
experience for the ill individual.
NURSING
Nursing is identified as consisting of participation in the

care, core, and cure aspects of patient care.
SUMMARY
Lydia Hall’s Theory involves three interlocking circles, each
representing on aspect of nursing.
1. The care aspect represents intimate bodily care
2. The core aspect deals with the innermost feelings and
motivations of the patient
3. The cure aspect tells how the nurse helps the patient
and the family through the medical aspect of care.
SUMMARY
Of the major concepts of nursing’s metaparadigm, only
nursing is defined as the function necessary to carry
out care, core, and cure. Hall presents a philosophical
view of humans as having the energy and motivation of
self awareness and growth. Definitions of health,
person, and environment are inferred.
SUMMARY
Lydia Hall’s theory may be applied in the nursing process. The
limitations of Hall’s theory-illness orientation, age, restrictions on
family contact, and use of reflection only-can be overcome by
taking a broader view of care, core, and cure and by emphasizing
the aspects that are most appropriate for a particular situation..
Key Concepts
What does mean
by energy fields?
The fundamental unit of both the
living and nonliving; infinite,
pandimensional, unpredictable –
Roger’s definition of Unitary
Human Being.
What does Martha
means by patterns?
Energy fields that
represents the
person’s whole
existence – they are
intangible, non visible
manifestations but
perceptually present in
all interactions.
Martha’s definition of Homeodynamics
➢The way which a person’s life process

evolve
➢Physiological equilibrium (homeostasis) of

person
Consists of:
❑Resonancy: continuous movement from
lower to higher frequency wave patterns
between person and environment; postulated
to be associated with a heightened sense of
❑Helicy: the unpredictable changes between
person and environment which foster creativity,
innovation, and problem solving.
❑Integrality: continuous interactive rhythms

between person and environment.
•Synchrony: continuous change that happens

simultaneously between person and
environment.
•Reciprocy: continuous interaction between

Roger’s Metaparadigm
NURSING
▪ Requires specific learning
▪ Considered a profession
▪ Both an Empirical science and art
▪ Purpose is to promote health and well being for all
persons
▪ Exits for the people and life process of humans
PERSON
▪An open system continuously connected to
the environment
▪Whole in the truest sense and non-reducible

comprised of patterns and pandimensional
energy fields.
HEALTH
▪ Passive means without illness (wellness)
▪ Relates to a person’s value systems and
personal cultural interpretation, consisting of
both high and low values.
▪ “life process” is filled with dynamic and
creative unity with one’s environment.
ENVIRONMENT
▪Irreducible pandimensional sharing of energy
and patterns with humans through
synchronous interactions.
THE
END
DOROTHY E.
JOHNSON
Behavioral Systems Model - 1968
Definition of Nursing
▪By 1980, Johnson defined nursing as:
“an external regulatory force which acts to preserve the
organization and integration of the patient’s behavior at
an optimal level under those conditions in which the
behavior constitutes a threat to physical or social health,
or in which illness is found”
LENIE R. AGPALASIN,RN,MAN 06/09/2022 2

▪Based on the definition, four goals of
nursing are to assist the patient to become
a person:
1. Whose behavior is commensurate with social

demands
2. Who is able to modify his behavior in ways that
support biologic imperatives
3. Who is able to benefit to the fullest extent during
illness from the physician’s knowledge and skill
4. Whose behavior does not give evidence of
unnecessary trauma as a consequence of illness.

Overview of johnson’s “behavioral
system model”

▪Johnson’s Behavioral System Model is a
model of nursing care that advocates the
fostering of efficient and effective
behavioral functioning in the patient to
prevent illness.
▪The three functional requirements for each
subsystem include protection from
noxious influences, provision for a
nurturing environment, and stimulation for
growth.

Seven subsystems of behavior

1. Attachment or affiliative
subsystem
▪ “social inclusion, intimacy, and the formation and

attachment of a strong social bond.”

2. Dependency subsystem
▪“approval, attention or
recognition, and physical
assistance (helping or nurturing)

3. Ingestive subsystem
▪“the emphasis is on the meaning
and structures of the social
events surrounding the occasion
when the food is eaten.”

4. Eliminative subsystem
▪Relates to behavior surrounding
the excretion of waste products
from the body.

5. Sexual subsystem
▪“both biological and social factor
affect the behavior in the sexual
subsystem.”

6. Aggressive subsystem
▪“related to the behavior

concerned with protection and
self-preservation.”

7. Achievement subsystem
▪“provokes behaviors that attempt

to control the environment.”

An eight subsystem, RESTORATIVE is
added.
▪Concerned with rest, sleep,

comfort/freedom from pain

Each subsystem has three
functional requirements:
1. System must be “protected” from

noxious influences with which system
cannot cope
2. Each subsystem must be “nurtured”
through the input of appropriate
supplies from the environment.
3. Each subsystem must be “stimulated”
for use to enhance growth and prevent
stagnation

Nursing Metaparadigm

PERSON
▪views human beings as having two major systems: the biological
system and the behavioral system.
▪It is the role of medicine to focus on the biological system,
whereas nursing’s focus is the behavioral system.

Environment
▪is not directly defined, but it is implied to

include all elements of the surroundings
of the human system and includes interior
stressors.

Health
▪seen as the opposite of illness, and

Johnson defines it as “some degree of
regularity and constancy in behavior, the
behavioral system reflects adjustments
and adaptations that are successful in
some way and to some degree…
adaptation is functionally efficient and
effective.”

Nursing
▪seen as “an external regulatory force

which acts to preserve the organization
and integration of the patient’s behavior at
an optimal level under those conditions in
which the behavior constitutes a threat to
physical or social health, or in which
illness is found.”

Analysis
▪Johnson’s behavioral model is clearly an Individual-oriented
framework. Its extent to consider families, groups and
communities was not considered.

Analysis
▪ Categorizing different behaviors in seven subsystems divided the
focus of nursing interventions. In turn quality of care given by the
nurse may be lessened because of fractionalized care which does not
support seeing the individual as a whole adaptive system.
A lack of an authenticated schematic diagram by Johnson which is

seen necessary was not presented. Johnson has developed multiple
concepts thus a diagram showing each and every concepts
relationship might be helpful.

Summary
▪Johnson’s Behavioral System Model of
nursing care that advocates the
fostering of efficient and effective
behavioral functioning in the patient to
prevent illness. The patient is identified
as a behavioral system composed of
seven behavioral subsystems: affiliative,
dependency, ingestive, eliminative,
sexual, aggressive, and achievement.

Summary
▪Each subsystem is composed of four
structural characteristics: drive, set, choices,
and observable behaviors. The three
functional requirements for each subsystem
include protection from noxious influences,
provision for a nurturing environment, and
stimulation for growth. An imbalance in any of
the behavioral subsystems results in
disequilibrium.
▪ It is nursing’s role to assist the client to
return to a state of equilibrium.

Rosemarie Rizzo Parse
Theory of Human Becoming
Rosemarie
Rizzo Parse
Humanbecoming
She began her work on the Human Becoming theory in the 1970s and was first
published in 1981. The human becoming theory was developed as a human
science nursing theory
The assumptions underlining the theory were synthesized from works by the
European philosophers, Heidegger, Sartre, and Merleau-Ponty, along with
works by the pioneer American nurse theorist, Martha Rogers.
Rosemarie
Rizzo Parse
Human Becoming Theory
Theory was based on Dr. Parse’s lived experience in nursing & its poor fit with
the existing paradigms
The theory focuses on the human-universe-health process and is based on the

premise that the human being pursues and creates his own process of being
with the world
Rosemarie
Rizzo Parse

The uniqueness of the theory is its perspective on paradoxes of human
becoming.
The theory emphasizes the relationship between human & environment with
paradoxical rhythmical patterns
She developed the Theory of Human Becoming through a combination of

concepts from Martha Rogers and from existential-phenomenological thought.
Her nine assumptions are based on the three main themes of meaning,
rhythmicity, and transcendence.
Rosemarie
Rizzo Parse
Each theme leads to a principle: meaning relates to imagining,

valuing, and languaging;
rhythmicity relates to revealing-concealing, enabling-limiting, and connecting-
separating;
transcendence relates to powering, originating, and transforming.
Rosemarie
Rizzo Parse
Assumptions about the Human

& the Becoming
I.The human is coexisting while reconstituting rhythmical
patterns with the universe. – Individuals take an active party in
creating their own patterns and reality.
II.The human is open, freely choosing meaning in situation,

bearing responsibility for decisions. – Human beings make
choices on how to act and react. They are responsible for the
outcome of these choices.
Rosemarie
Rizzo Parse

& the Becoming
III.The human is unitary, continuously reconstituting patterns of relating. –
People are more than a sum of their parts. One can be distinguished from
another by patterns of appearance, mannerisms, voice and other
characteristics
IV. The human is transcending multidimensionally with the possibles – The
human is capable of changing and growing beyond their limitations.
V.Becoming is an open process, experienced by the human. – Becoming is

continous growth towards more diversity & complexity. Growing includes
choosing who one will be in a given situation.
Rosemarie
Rizzo Parse

& the Becoming
VI.Becoming is a rhythmically reconstituting human universe process – Health &
becoming are intertwined. The elements of our environment in which we connect
and separate from, change us. With these elements we reconstitute our health.
VII. Becoming is the human’s patterns of relating value priorities. – Health is living
the ideals chosen by the individual.
VIII.Becoming is an inter subjective process of transcending with the possible–

Health is reaching beyond the actual to the possible through subject to subject
interchange. This interchange can occur through two persons or with another
element of the environment
Rosemarie
Rizzo Parse

& the Becoming
VI.Becoming is a rhythmically reconstituting human universe
process – Health & becoming are intertwined. The elements of our
environment in which we connect and separate from, change us.
With these elements we reconstitute our health.
VII. Becoming is the human’s patterns of relating value priorities.

– Health is living the ideals chosen by the individual.
t
Rosemarie
Rizzo Parse

& the Becoming
VIII.Becoming is an inter subjective process of transcending with the
possible– Health is reaching beyond the actual to the possible through
subject to subject interchange. This interchange can occur through two
persons or with another element of the environment
IX. Becoming is human unfolding – We are continuously changing, never

to return to our previous state
PERSON
Human Beings/Person – an
open being in mutual process
with the universe cocreating
patterns of relating with others
.
METAPARADIGM
ENVIRONMENT
Environment/Society –
assumed under the larger view
of human beings – universe;
inseparable, complementary
and evolving together
.
METAPARADIGM
HEALTH
Health – a process of changing

life’s meanings a personal
power emerging from the
individual’s collective
relationships with others and
the u.niverse
METAPARADIGM
NURSING
Nursing – a basic science the

practice of which is a
performing art.
.
METAPARADIGM

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CLIENT-

CLIENT CENTERED NURSING THEORY

Identify and discuss the significance of nursing theories to nursing