PRAYER BEFORE LECTURE

God our Father, praise and Glory to you for this day of lectures and
clinical activities; send us your Holy Spirit to enlighten our minds
to learn new things, to gain new skills and most especially to have
our hearts formed anew and inclined unto you so we may lovingly
serve and care for the sick among us. This we ask through the most
Holy Name of Jesus Christ your Son, Forever and Ever. AMEN

Our Lady of Fatima, Pray for us.

NURSING CONCEPTUAL MODEL
MARTHA ROGERS
DOROTHEA OREM
IMOGENE KING
MYRA LEVINE
(1ST SEM 2023)
 MARTHA ROGERS
“SCIENCE OF UNITARY HUMAN BEINGS”
• Martha E. Rogers was born in 1914 in Dallas, Texas.
• She received her nursing diploma from the Knoxville General Hospital School of Nursing in 1936, then earned her
Public Health Nursing degree from George Peabody College in Tennessee in 1937.
• Her Master’s degree was from Teachers College at Columbia University in 1945, and her Doctorate in Nursing was
earned from Johns Hopkins University in Baltimore in 1954. Rogers died on March 13, 1994.
• Rogers worked as a professor at New York University’s School of Nursing.
• She was also a Fellow for the American Academy of Nursing.
• Her publications include:
✓ Theoretical Basis of Nursing (1970)
✓ Nursing Science and Art: A Prospective (1988)
✓ Nursing: Science of Unitary, Irreducible, Human Beings Update (1990)
✓ Vision of Space Based Nursing (1990).
 HOMEODYNAMIC PRINCIPLES
Resonance is an arrangement for human and environment that
undergo transformation.
Helicy is the nature of change is unpredictable, continuous and
innovative.
Integrality is the energy fields of human and environment in a
continuous mutual process.
NURSING METAPARADIGM
❖The life process of the unitary human being is one of
wholeness and continuity as well as dynamic and creative change.
❖Environment defines as irreducible pan dimensional energy field
identified by pattern and manifesting characteristics different from those
of the parts.
❖Health symbolize wellness and the absence of disease and major
illness.
❖Nursing is both art and science and the nurse is a factor in healing
environment.
 IMPLICATIONS OF ROGERS THEORY
Nursing Practice Education Research
• That students have individual • It was found that the theory
• Evaluative and diagnostic personalities and patterns to their applies to any environment
phase includes work.
that contains human
determining the patients’ • They are all unitary human beings
and should be interacted with beings.
and their family’s well- differently • Her theory focuses nursing
being status at the time • Culture, family, and experiences interventions on the patient
• Interventive how the affect their reasons and motives to well -being overall and not
become a nurse just their disease state
nurse will go about • Beings focuses on “the integrality • It encourages the use of
implementing nursing of person and environment, the guided imagery, relaxation,
interventions for the individual’s active participation in therapeutic touch, and
change, and each person’s
patient. individual pattern.
meditation.
 Clarity – It is difficult-to-understand principles, lack of operational definitions,
and inadequate tools for measurement. Model has passed the test of time for
the development of nursing science as nursing matured as a science

ANALYSIS OF
Simplicity - when the model is examined in total perspective, some still classify
it as complex. With its continued use in practice, research, and education,
nurses will come to appreciate the model’s elegant simplicity

THE THEORY Generality - Rogers’ conceptual model is abstract and therefore generalizable
and powerful. It is broad in scope, providing a framework for the development
of nursing knowledge through the generation of grand and middle-range
theories

Importance- Rogers’ science has the fundamental intent of understanding

human evolution and its potential for human betterment. The science
“coordinates a universe of open systems to identify the focus of a new
paradigm and initiate nursing’s identity as a science”
 APPLICATION TO NURSING

Mary is a 53-year-old woman who is in end stage leukemia. She has had two failed bone marrow transplants
and three rounds of chemotherapy. She is moving into hospice home care, and the family and Mary become
your client. Mary is the mother of four children: 25, 23, 20, and 17. One child lives at home. Pattern appraisal
includes: Mary—frail, quiet, almost translucent in appearance, resting comfortably in hospital bed in living
room, nasal O2 in place. Tom—husband, quiet, pacing Home—clean, orderly, many personal articles, large
window facing north and looking into the yard. Noise level low. Dog sleeping on the floor.
 ANALYSIS
1. End of life is a process of merging of the past, present, and future
2. Nursing care for Mary offers the opportunity to incorporate a variety of patterning
3. As Mary nears and prepares for the end of her life, many patterning concerns must be addressed for peaceful closure to her life and the
change to another energy form
4. The visible rhythmical pattern is a manifestation of peace (Mary) and a human environmental manifestation of anxiety in husband
5. The unknown and preparation for loss is the focus. The pattern appraisal is ongoing
6. Harmony is noted in her relationship with her husband and family and with her sense of how she has progressed through this disease
process.
 DOROTHEA
OREM
“SELF CARE DEFICIT”
 BACKGROUND
Obtain her basic diploma in nursing at
School of Nursing Washington, BSN (1939)
Dorothea E. Orem (1914-2007), one of the
and MSN in 1945 from Catholic University
prime US theorists born in Baltimore,
of America, and Doctorate degrees
Maryland
(honorary Doctorates awarded from
different Universities).

She published her theory in 1959 for the

first time and revised in 1971, 1983, 1987,
She began her nursing career at Providence
and 2001. Her contributions enabled her to
Hospital School of Nursing in Washington,
achieve Excellency from prominent
DC, where she received a diploma of
societies like Sigma Theta Tau International
nursing in the early 1930s.
Society, the National League for Nursing,
and the American Academy of Nursing.
 “Nursing is the ability to care for another human
being, most importantly when they are unable to
OREM
care for themselves. The ultimate goal is
PHILOSOPHY achieving an optimal level of health and
wellness for our patients”. Orem (1971)
 CONCEPTS OF OREM’S MODEL
1. The Self-Care Deficit Theory developed as a result of working toward her goal of improving the quality of nursing in
general hospitals in her state.
2. The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon.
3. The theory is relatively simple, but generalizable to apply to a wide variety of patients.
4. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws
and principles.
 CONCEPTS AND DEFINITION
The Self-Care Deficit Nursing Theory is a general theory composed of the following four related theories:
• The theory of self-care, which describes why and how people care for themselves.
• The theory of dependent-care, which explains how family members and/or friends provide dependent-care for a person who is socially
dependent.
• The theory of self-care deficit, which describes and explains why people can be helped through nursing
• The theory of nursing systems, which describes and explains relationships that must be brought about and maintained for nursing to be
produced.
 THEORY OF SELF CARE
“Self –care comprises the practice of activities that maturing and mature persons initiate and perform, within time frames,
on their own behalf in the interest of maintaining life, healthful functioning, continuing personal development and well-
being through meeting known requisites for functional and developmental regulations.
The Theory of Self-Care has three components:
1. universal self-care needs
2. developmental self-care needs
3. health deviation
 3 COMPONENTS OF SELF CARE
• Universal Self Care Needs • Developmental Self Care Requisites:
✓Air
More specific to the process of growth and development and are
✓Food
influenced by what is happening during the life cycle. It can be
✓Water
positive or negative.
✓elimination/excretion
✓activity & rest
• Health Deviation Self Care Requisites:
✓solitude/social interaction When a condition .permanently or temporarily alters structural,
✓functioning/well being physiological or psychological function.
✓Normalcy
 SELF CARE
• Self Care Agent provides the foundation for understanding the action
requirements and action limitations of persons who may benefit from nursing.
• Theory of dependent care “explains how the self-care system is modified when
it is directed toward a person who is socially dependent and needs assistance
in meeting his or her self-care requisites”
• Therapeutic self-care demand is the totality of self-care actions to be
performed for some duration in order to meet self-care requisites by using valid
methods and related sets of operations and actions.
 THEORY OF DEPENDENT CARE
Dependent care refers to the care that is provided
to a person who, because of age or related factors,
is unable to perform the self-care needed to
maintain life, healthful functioning, continuing
personal development, and well-being.
 Dependent-Care Self-Care Agency Dependent-Care
Demand Agency
Summation of care measures at The self-care agency is a Refers to the acquired ability of
a specific point in time or over complex acquired ability of a person to know and meet the
a duration of time for meeting mature and maturing persons to therapeutic self-care demand of
the dependent’s therapeutic know and meet their continuing the dependent person and/or
self-care demand when his or requirements for deliberate, regulate the development and
her self-care agency is not purposive action to regulate exercise of the dependent’s
adequate or operational. their own human functioning self-care agency.
and development.
 • A self-care deficit occurs when an individual cannot carry out self-care
requisites.
• Orem identifies method of helping:
Acting for and doing for others
THEORY Guiding and directing
Providing Physical and Psychological support
OF Environment of promoting personal development

SELF-CARE Teaching
Examples of self-care requisites are:
DEFICIT Wound care
Activities of Daily Living
Bowel program
Glucose monitoring
 THEORY OF NURSING SYSTEMS
• Wholly compensatory support - patient is unable to complete any self-care
independently; nursing compensates for patient’s inability to perform self-care.
• Partial compensatory support - patient is able to perform self-care tasks with
partial or no assistance from nursing.
• Supportive/educative compensatory - patient able to perform tasks
independently. Nursing provides ongoing education and support.
 FOUR MAJOR CONCEPTS OF OREM
Health is a state characterized by soundness or wholeness of developed human
structures and of bodily and mental functioning.
People is viewed biologically, symbolically and socially but still as a whole
person. This person is considered to be able to provide self-care
Nursing is how a healthcare professional develops a plan of care to meet the
patient’s self-care needs
Environment is the physical, chemical, biologic and social factors that
make up who a person is.
 SIGNIFICANCE OF THE THEORY
Nursing Practice Education Research

It has achieved a significant level of The SCDNT was introduced as the basicIt uses the SCDNT or components,
acceptance by the international nursing structure for nursing management in Biggs (2008) found more than 800
community, as evidenced by the magnitude of
German hospital DRG (diagnosis-related
references. Berbiglia identified selected
published material and presentations at the
International Orem Society World group) implementation. The movement practice settings and SCDNT conceptual
Congresses. toward SCDNT-based nursingfoci from a review of more than 3
management. decades of use of the SCDNT in practice
and research and publicized selected
The influence of Orem’s SCDNT has international SCDNT practice models
continued at the international level for the twenty-first century.
through the translation of Nursing
Concepts of Practice into several
languages.
 ANALYSIS OF THE THEORY
• Clarity- Orem defined the term and elaborated the substantive structure of the concept in a way that is unique while also congruent with other
interpretations.
• Simplicity- Orem’s theory is expressed in a limited number of terms. These terms are defined and used consistently in the expression of the theory.
Orem’s general theory, the SCDNT, comprises the following four constituent theories: self-care, dependent-care, self-care deficit, and nursing systems
• Generality - As a general theory, it serves nurses engaged in nursing practice, in development and validation of nursing knowledge, and in
teaching and learning nursing.
• Accessibility - As a general theory, the SCDNT provides a descriptive explanation of why persons require nursing and what processes are
needed for the production of required nursing care
The SCDNT differentiates the focus of nursing from other disciplines. Although other disciplines find the theory of self-care helpful and contribute to its
development, the theory of nursing systems provides a unique focus for nursing.
 APPLICATION TO NURSING
Mr. Shoaib is a 62 years old male patient admitted to a medical ward. He has right ischemic
CerebroVascular Accident (CVA) and a resultant left sided body paralysis. He has no sensations or
movement in the left side of the body. He has lost his gag reflux and is unable to swallow food. A
nasogastric (N/G) tube is placed for providing him nutrition. Mr. Shoaib is not able to change his position
and is dependent on care givers for changing his position. He is also not able to carry out his routine daily
life activities. His family is worried whether he would be able to regain control of his life or not. They are
also worried whether they would be able to provide him the care he needs when he is discharged from
hospital.
APPLY THE CASE UTILIZING
1.Universal Self care requisite
2.Health deviant self care
3.Development of self care requisite
 IMOGENE KING
“GOAL ATTAINMENT THEORY”
• Theorist : Imogene King - born in 1923.
• Bachelor in science of nursing from St. Louis University in 1948
• Master of science in nursing from St. Louis University in 1957
• Doctorate from Teacher’s college, Columbia University.
• Theory describes a dynamic, interpersonal relationship in which a person grows and develops
to attain certain life goals.
• Factors which affects the attainment of goal are:
✓ Roles
✓ Stress
✓ Space
✓ Time
KING’S OPEN SYSTEM FRAMEWORK

• Nursing Focus is the care of human being

• Nursing Goal is the health of the individual and
health care for the group
• Human Beings are open system in constant
interaction with the environment.
 ASSUMPTIONS
• The basic assumption of Nursing Process is that the nurse and patient
communicate information, set mutual goal, and act to achieve these
goals.
• Each human being perceives the world as a total person in making
transaction with individual and things in the environment.
 NURSE PATIENT TRANSACTION MODEL
• Action is a means of behavior or activities that are towards the accomplishments of certain act. It
is both physical and mental.
• Reaction is a form of reacting or a response to a certain stimuli.
• Interaction is any situation wherein the nurse relates and deals with a clientele or patient.
• Transaction is a unique observable in which human being communicate with the environment.
 METAPARADIGM
• Person existing in an open system who makes choices and select alternative action.
• Health as continuous adjustment to stress in the internal and external environment.
• Environment as the process of balance involving internal and external interactions
inside the social system.
• Nursing is an observable behavior found in the health care systems in society”. The goal
of nursing “is to help individuals maintain their health so they can function in their roles”.
 SIGNIFICANCE
Nursing Practice Education Research

Individualized the plans of • It is used in curriculum design

It is design and
•

care while encouraging active in nursing programs

participation from clients • It provides a systematic conducted to implement
• The profession of nursing means of viewing nursing as this system in hospital,
function through individuals profession, an organized body ambulatory, community
and groups within the of knowledge and clarifying and home care nursing.
environment. nursing as discipline.
 ANALYSIS OF THE THEORY
• Clarity- Theory of Goal Attainment is the ease with which it can be understood by nurses. Concepts are concretely defined and illustrated.
• Simplicity- King’s definitions are clear and are conceptually derived from research literature.
• Generality – It has been criticized for having limited application in areas of nursing in which patients are unable to interact competently with the
nurse.
• Accessibility - A descriptive study was conducted to identify the characteristics of transaction and whether nurses made transactions with
patients
• Importance- middle-range Theory of Goal Attainment focused on all aspects of the nursing process: assessment, planning, implementation, and
evaluation. The body of literature clearly establishes King’s work as important for knowledge building in the discipline of nursing.
 APPLICATION TO NURSING
• Communication between nurse and patient is the cornerstone of the interpersonal system and the most important prerequisite for transaction to occur.
It can be established both verbally and nonverbally.
• A middle-aged female patient referred to the emergency room with weakness and feebleness. The attending physician gave the diagnosis of acute
pulmonary edema. Emergency staffs needed to start invasive interventions to manage her acute condition. However, they failed to understand her
conditions and did not provide her with adequate treatment-related information. She did not give consent for treatments and treatments were not
administered. This example shows that nurses and physicians need to give high priority to the establishment of effective communication with
patients to help them make wiser decisions to retain their own health as their main goal. Moreover, they need to allow patients articulate their
perceptions of their illnesses, personal illness-related experiences, and the level of their stress. It is only in this way that nurse and patient can help
each other and create a favorable environment for decision-making.. Consequently, the goal of health is attained when both sides of relationship
properly interact with each other and collaboratively work together to attain their goals.
MYRA ESTRIN LEVINE
“CONSERVATION MODEL”
• After earning an MS in nursing at Wayne State
University in 1962, she authored 77 published
articles which included “An Introduction to
Clinical Nursing” with multiple publication years
in 1969, 1973, and 1989.
• She also received an honorary doctorate from
Loyola University in 1992.
• She died in 1996.
CONSERVATION MODEL

The core of the conservation model is to improve a

person’s physical and emotional well-being by
considering the four domains of conservation she
set out.

Nursing’s role in conservation is to help the person

with the process of “keeping together” the total
person through the least amount of effort.
THREE CHARACTERISTICS OF ADAPTATION
Historicity - Adaptation is a historical process. Responses are based on past experiences both
personal and genetics

Specificity - Adaptation is also specific. It refers to the individual responses and their adaptive
pattern, which varies on the basis of specific genetic structure.

Each system has particular responses. The physiologic responses that “defend oxygen supply to the
brain are distinct from those that maintain the appropriate blood glucose levels.” (Levine, 1989)

Redundancy - represents the fail-safe options available to the patient to ensure continued
adaptation.
Stable state normal alterations in physiologic Homeorhesis is the orchestrated or
parameters respond to environmental changes; an coordinated control in metabolism of
body tissues necessary to support a
energy sparing state, a state of conservation.
physiological state
 Three Aspects of Environment Drawn
upon Bates’ (1967)

➔ The perceptual environment consists of

information that is recorded by the sensory
organs.

➔ The operational environment consists of the

undetected natural forces and that impinge on
the individual.

➔ The conceptual environment is influenced by

language, culture, ideas, and cognition.
LEVINES CONSERVATION MODEL
 CONSERVATION OF ENERGY
It refers to balancing energy input and
output to avoid excessive fatigue. It includes
adequate rest, nutrition and exercise.

Examples: Availability of adequate rest;

Maintenance of adequate nutrition
CONSERVATION OF STRUCTURAL INTEGRITY

It refers to maintaining or restoring the structure of

body preventing physical breakdown and promoting
healing.

Examples: Assist patient in ROM exercise; Maintenance of

patient’s personal hygiene
CONSERVATION OF PERSONAL INTEGRITY

It recognizes the individual as one who

strives for recognition, respect, self
awareness, selfhood and self determination.

Example: Recognize and protect patient’s

space needs
CONSERVATION OF SOCIAL INTEGRITY
An individual is recognized as some one who resides with in a
family, a community, a religious group, an ethnic group, a
political system and a nation.

Example: Help the individual to preserve his or her place in a

family, community, and society.