CATEGORIES OF NURSING THEORISTS LOUIS CARLOS O.

RODEROS, RN
CATEGORIES OF NURSING THEORISTS
A. NEEDS/ PROBLEM ORIENTED
B. INTERACTION ORIENTED
C. ENERGY FIELD THEORY
A. NEEDS/ PROBLEM ORIENTED 1. LYDIA HALL
2. DOROTHEA OREM
LYDIA HALL
Lydia Hall began her prestigious career in nursing as a
graduate of the York Hospital School of Nursing in York,
Pennsylvania. She then earned her B.S. and M.A. degrees
from Teachers College, Columbia University, in New York.
Halls career interests revolved around public health
nursing, cardiovascular nursing, pediatric cardiology and
nursing of long-term illnesses.
 The Person
Social sciences
Therapeutic
use of self-aspects
of nursing
The Core
The Disease
The Body Pathological and
Natural and biological therapeutic sciences
sciences Seeing the patient and
Intimate bodily family through the medical
care-aspects of nursing care-aspects
The Care of nursing
The Cure
 16) LYDIA HALL
CORE, CARE, CURE MODEL
Individuals could be conceptualized in
3 Separate Domains:
1. CARE hands on bodily care
2. CORE using the self in relationship to the
client
3. CURE applying medical knowledge

Nurses function in all 3 Domains but in

different Degrees.
1. CURE limited to helping patients/families
deals w/ the measures instituted by the
physician
2. CARE exclusive for nursing
3. CORE shared w/ Social workers,
Psychologists, Clergy & other Professionals
 16) LYDIA HALL
CORE, CARE, CURE MODEL
APPLICATION
Foundation for classifying the Professional Ns
functions today. Ns are able to carry out Nursing
Interventions INDEPENDENTLY
DEPENDENTLY INTERDEPENDENTLY

CORE maintains that it is the N responsibility to

make sure that the client receives the highest level of
care possible from all concerned Hx Professionals. Ns
ROLES: COLLABORATOR, COORDINATOR and in
COOPERATION with other members of the HX team
that pertains to PATIENTS WELFARE.
 16) LYDIA HALL
CORE, CARE, CURE MODEL

CURE clearly delineates nursing functions

that are DEPENDENT on the members of the
Medical Profession. Interventions carried out
needs a written order from the doctor/s

CARE refers to the independent roles &

functions of the Nurse insofar as her
knowledge & skills about the patients
condition will allow her to carry on with her
Nursing Responsibilities
 CARE CORE CURE

The care circle represents the nurturing component

and is exclusive to nursing.

Refers to the independent roles & functions of the

nurse insofar as her knowledge & skills about the
patients condition will allow her to carry on with her
nursing responsibilities.

Richard Sagasag
RN, MAN, USRN
 CARE CORE CURE

The core circle of patient is based in the social

sciences, involves the therapeutic use of self, and is
shared with other members of the health team

The nurse makes sure that the patient receives the

highest level of care by collaborating, coordinating &
cooperating with other health care team

Richard Sagasag
RN, MAN, USRN
 CARE CORE CURE

The cure circle of patient care is based in the

pathological and therapeutic sciences and is shared
with other members of the health team

It delineates nursing functions that are dependent

on the members of the medical profession

Example: medication administration, diagnostic

procedure

Richard Sagasag
RN, MAN, USRN
DOROTHEA OREM
 14) DOROTHEA OREM:
SELF CARE AND
SELF CARE DEFICIT THEORY
Three (3) Nursing Systems based
on Art of Care of Patient Needs

1. Wholly Compensatory or
Total Compensatory
For paralyzed patients, for
ICU patients
2. Partial Compensatory
Patient performs some of
nursing care needs
3. Supportive-Educative
For up and about patient
 14) DOROTHEA OREM:
SELF CARE AND
SELF CARE DEFICIT THEORY
APPLICATION
The elements of the theory clearly emphasize
the need to understand the importance of
self- care in the Promotion and maintenance of
Health & Wellbeing.
Focus on the pts capacity/ability to perform
self-care activities in order to determine which
self-care activities to perform for the client.
The model emphasizes on Education
& Supportive Measures
Health Education very important
aspect of clinical nursing today
Dorothea E Orem has been publishing about nursing
practice and education SINCE THE 1950s. Orem
explicated self-care as a human need and nursing as
human service; she emphasized nursings special concern
for a persons need for self-care actions on a continuous
basis to sustain life and malized the Self-Care deficit
Theory of nursing as a general theory composed of the
following three related theories:
 1. The theory of self-care
2. The theory of self-care deficit
3. The theory of nursing systems
Her work identifies three types of nursing systems:
1. Wholly compensatory (doing for the patient)
2. Partly compensatory (helping the patient do for
himself or herself)
Supportive-educative (helping the patient learn to do
for himself or herself and emphasizing the important
role of the nurse in designing nursing care).
Self-Care Deficit Theory of
Nursing
 One of Americas foremost nursing theorists
o Born in Baltimore, Maryland in 1914
o Earned her diploma at Providence Hospital Washington,
DC
o 1939- BSN Ed, Catholic University of America
o 1945- MSN Ed, Catholic University of America
o Involved in nursing practice, nursing service, and nursing
education
During her professional career, she worked as a staff
nurse, private duty nurse, nurse educator and
administrator and nurse consultant
Received honorary Doctor of Science degree in 1976
Published first formal articulation of her ideas in Nursing
Concepts of Practice in 1971, second in 1980, and in
1995
Orem retired in 1984 and resides in Savannah, Georgia.
DEVELOPMENT OF THEORY
o1949-1957 Orem worked for the Division of Hospital and
Institutional Services of Indiana State Board of Health
oHer goal was to upgrade the quality of nursing in general
hospitals throughout the state. During this time she developed
her definition of nursing practice.
o1959 Orem subsequently served as acting dean of the School
of Nursing and as an assistant professor of nursing education
oOrems Nursing Concept of Practice was first published in
1971 and subsequently in 1980, 1985, 1991, 1995, and
2001.
METAPARADIGM
Person
oOrems theory addresses clients self-care needs.
oIt is defined as goal-oriented activities that are set
towards generating interest in the part of the client to
maintain life and health devt.
oThe theory is aimed towards making the clients perform
self-care activities in order to live independently.
oConceptualized as a total being with universal,
developmental needs and capable of contionous self
care.
Nursing
oNursing is helping clients to establish or identify ways to
perform self-care activities.
oNursing actions are geared towards the independence of the
client.
oOrem defines nursing as human service.
oIt is a distinguished human service since its focus is on persons
with inabilities to maintain continuous provision of health care.
oNursing is based on values.
oGoal of nursing to render the patient or members of his
family capable of meeting the patients self care needs.
oTo maintain a state of health.
Health
oOrem supports the World Health Organizations
definition of health as the state of physical, mental and
social well-being and not merely the absence of disease
or infirmity.
oOrem presents health based on preventive health care.
oThe model of health care includes the promotion and
maintenance of health, the treatment of disease or injury,
and the prevention of complications.
Environment
oOrems view of health as a phenomenon affected by
inseparable entities shows her view of the surrounding
environment as an external source of influence in the
internal interaction of a persons different aspects.
 Self-Care Deficit Theory of Nursing

Self-Care is an activity that promotes a persons

well-being. It is performed by persons
who are aware of the time frames on
behalf of maintaining life, continuing
personal devt and a healthy functional
living.
Universal Self-care Requisites
oMaintenance of a sufficient intake of airs
oMaintenance of a sufficient intake of food
oMaintenance of a sufficient intake of water
oProvisions of care associated with elimination
oMaintenance of balance between activity & rest
oMaintenance of balance between solitude and social interaction
oPrevention of hazards to human life, human functioning and human well-being
oPromotion of human functioning and development.
ASSUMPTIONS
People should be self-reliant and responsible for their own care and
others in their family needing care
People are distinct individuals
Nursing is a form of action interaction between two or more persons
A persons knowledge of potential health problem is necessary for
promoting self-care behaviors
Self-care and dependent care are behaviors learned within a socio-
cultural context

IMPLICATIONS
To Nursing Practice
Orems Self-care deficit has been used in studies in patients having heart
problems, cancer, and mental illnesses.
This theory had been widely used in dealing with geriatric cases,
especially those having chronic-illnesses.
Orems theory was being used in defining the roles of the nurse in
multiple settings.
To Nursing Education
The use of Orems theory in curriculum development was
reported in the late 1970s.
This theory is used at all levels of curriculum and in continuing
education.
Her theory is used as a strong and effective framework for
curricular design.

To Nursing Research
One of the first instruments developed is the Exercise of Self-
Care Agency (ESCA) which was published in 1979
Another instrument developed is the Appraisal of Self-Care
Agency (ASA)
Both of these instrument tools are used to assess basic
conditioning factors and self-care abilities related to the care
of well and the ill.
 DOROTHEA OREM
Self Care Theory

Born: 1914, Baltimore, Maryland, USA.

Richard Sagasag
RN, MAN, USRN
 Introduction
One of foremost nursing theorists.

Dorothea Orem earned her Bachelor of

science in nursing education in 1939 and
Master of science in nursing in 1945

During her professional career ,she worked as

a staff nurse ,private duty nurse ,nurse
educator and administrator and nurse
consultant

Received honorary Doctor of Science degree in

1976
Richard Sagasag
RN, MAN, USRN
 Introduction

Dorothea Orem as a member of a curriculum

subcommittee at Catholic University,
recognized the need to continue in developing
a conceptualization of nursing.

Published first formal articulation of her ideas

in Nursing: Concepts of Practice in 1971.
Second in 1980,and finally in 1995

Reference:
http://currentnursing.com/nursing_theory/self_care_deficit_theory.
Richard Sagasag
html
RN, MAN, USRN
 Orems general theory of nursing in three
related parts:

Theory of self care

Theory of self care deficit
Theory of nursing system

Richard Sagasag
RN, MAN, USRN
 Theory of Self Care

Richard Sagasag
RN, MAN, USRN
 Self-Care

The performance or practice

of activities that individuals
initiate and perform on their
own behalf to maintain life,
health and well-being

Richard Sagasag
RN, MAN, USRN
 Self-Care Agency
Human ability which is "the
ability in engaging self
care" -conditioned by age,
developmental state, life
experience, socio-cultural
orientation, health and
available resources.

Richard Sagasag
RN, MAN, USRN
 Self-Care Requisites
Actions directed towards provision
of self care.

Categories of Self-Care Requisites:

1.Universal Self-Care Requisite
- Universally set goals that must
be provided to function in scope
of healthy living

Richard Sagasag
RN, MAN, USRN
 8 Self-Care Requisites common in men,
women and children:
a. Maintenance of sufficient intake of air
b. Maintenance of sufficient intake of food
c. Maintenance of sufficient intake of
water
d. Provision of care associated with
elimination
e. Maintenance of balance between
activity & rest
Richard Sagasag
RN, MAN, USRN
 8 Self-Care Requisites common in
men, women and children:
a. Maintenance of balance between
solitude & social interaction

b. Prevention of hazards to human life,

human functioning & human well-
being

c. Promotion of human functioning &

Richard Sagasag
development
RN, MAN, USRN
 2. Developmental Self-Care Requisites
- Provision of conditions that promote
health
- Prevention of the effects of human
conditions that threatens life

Health deviation Requisites

Required in conditions of illness, injury,
or disease . These include:

Seeking and securing appropriate

medical assistance
Richard Sagasag
RN, MAN, USRN
 Health deviation Requisites

Being aware of and attending to the

effects and results of pathologic
conditions
Effectively carrying out medically
prescribed measures
Learning to live with effects of
pathologic conditions

Richard Sagasag
RN, MAN, USRN
 Therapeutic Self-Care Demand

These are summation of all the

activities needed to alleviate the
existing disease or illness

Richard Sagasag
RN, MAN, USRN
 Theory of Self Care Deficit

Richard Sagasag
RN, MAN, USRN
 Theory of Self Care Deficit
- Specifies when nursing is needed
- Nursing is required when a person is
incapable or limited in the provision of
continuous effective self care.

Orem identifies 5 methods of helping:

Acting for and doing for others
Guiding others
Supporting another
Providing an environment promoting
personal development in relation to
meet future demands
Teaching another
Richard Sagasag
RN, MAN, USRN
 Theory of Self Care Deficit
- Specifies when nursing is needed
- Nursing is required when a person is
incapable or limited in the provision of
continuous effective self care.
Orem identifies 5 methods of helping:
Acting for and doing for others
Guiding others
Supporting another
Providing an environment promoting
personal development in relation to
meet future demands
Richard Sagasag
RN, MAN, USRN
Teaching another
 Theory of Nursing Systems

Richard Sagasag
RN, MAN, USRN
 Theory of Nursing Systems
Describes how the patients self care
needs will be met by the nurse , the
patient, or both

Identifies 3 classifications of nursing

system to meet the self care requisites of
the patient:

a. Wholly compensatory system

b. Partly compensatory system
c. Supportive educative system
Richard Sagasag
RN, MAN, USRN
Basic Nursing Systems

WHOLLY COMPENSATION SYSTEM

Accomplishes patients Patients

therapeutic self-care action
limited
Compensates for
Nurse
patients inability to
Action
engage in self-care
Supports & protects
patient
Basic Nursing Systems
Partly compensatory system
Performs some self-care
measure for patient
Compensates for self-care
Nurse limitations of patient
Action
Assists patient as required

Performs some self-care

measure
Patients
Regulates self-care agency action
Accepts care & assistance from
nurse
Basic Nursing Systems

Support-Educative System

Accomplishes self-care
Patients
action
Nurse Regulates the exercise &
Action development of self-care
agency
B. INERACTION-ORIENTED 1. HILDEGARD PEPLAU
2. IMOGENE KING
HILDEGARD PEPLAU
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL

Peplau is a psychiatric nurse

Focus: Therapeutic process

Attained through: Healthy Nurse-

Patient Relationship
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL
Four (4) Phases of Nurse-Patient
Interaction

1. Orientation
Nurse and patient test the role
each one assumes
Prepares patient for
termination
Patient identifies areas of
difficulty
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL
2. Identification Phase
Patient identifies with the
personnel who can satisfy his
needs

3. Exploitation Phase
Nurse maximizes all the
resources to benefit the patient
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL
4. Resolution Phase or Termination Phase
Occurs when patients needs have
been met
 7) HILDEGARD PEPLAU
INTERPERSONAL RELATIONS MODEL
Application
Significant in terms of the different
phases of the N-Pt. interaction & the
different ROLES the N can play in giving
nursing care to pts. It thus becomes
important for nurses to understand the
principles behind each of these concepts so
that clinical nsg will be more meaningful for
the nurse. Eventually, this will translate to pt.
outcomes like: Improved health
Prevention of Disease pr
Enhancement of care faculties
Hildegard E. Peplaus contributions to nursing in general
and to the specialty of psychiatric nursing in
particular have been enormous since1950s.
Interpersonal Relations in Nursing. She identified four
phases of the nurse-patient relationship:
1. Orientation
2. Identification
3. Exploitation
4. Resolution
Peplau proposed and described six nursing roles:
1. Stranger
2. Resource person
3. Teacher
4. Leader
5. Surrogate
6. Counselor
HILDEGARD PEPLAU
INTERPERSONAL RELATIONS THEORY
INTRODUCTION
Born in Reading, Pennsylvania 1909
Graduated from a diploma program in Pottstown,
Pennsylvania in 1931
Done BA in interpersonal psychology from Bennington
College in 1943
MA in psychiatric nursing from Colombia University New
York in 1947
EdD in curriculum development in 1953
Professor emeritus from Rutgers University
Started first post baccalaureate program in nursing
Published Interpersonal Relations in Nursing in 1952
Became a member of the Army Nurse Corps
Died in 1999
METAPARADIGM
Person
Peplau defines person as a man who is an organism that lives
in an unstable balance of a given system. A developing
organism that tries to reduce anxiety caused by needs.

Health
She considers health as a word that symbolizes movement of
the personality and other ongoing human processes that directs
the person towards creative, constructive, productive and
community living.
Nursing
Peplau described Nursing as a significant, therapeutic
interpersonal process.
It functions cooperatively with human processes that present health
as a possible goal for individuals

Environment
She defines Environment as forces outside the organism and in the
context of the socially-approved way of living, from which vital
human social processes are derived such as norms, customs and
beliefs.
 Theory of Interpersonal Relations
Peplau described the nurse-patient relationship as a four phase
phenomenon.
One can view them as separate entities.
Each phase is unique and has distinguished contributions on the
outcome of the nurse-patient intreaction;
Phases of Nurse-Patient Relationship are
1. Orientation
2. Identification
3. Exploitation
4. Resolution
Orientation phase
Problem defining phase
Starts when client meets nurse as stranger
Defining problem and deciding type of service
needed
Client seeks assistance, conveys needs, ask
questions, shares preconceptions and
expectations of past experiences.
Nurse responds, explains roles to client, helps to
identify problems and to use available
resources and services.
Factors influencing orientation phase
Identification Phase
Selection of appropriate assistance.
Patient begins to have a feeling of belonging and a
capability of dealing with the problem which decreases the
feeling of helplessness and hopelessness.
Exploitation Phase
Use of professional assistance for problem solving alternatives
Advantages of services are used is based on the needs and
interest of the patients.
Individual feels as an integral part of helping environment.
Patient may fluctuates on independence.
Nurse must be aware about the various phases of
communication.
Nurse aids the patient in exploiting all avenues of help and
progress is made towards the final step.
Resolution Phase
Termination of professional relationship.
The patients needs have already been met by the collaborative
effect of patient and nurse
Now they need to terminate their therapeutic relationship and
dissolve the links between them
Sometimes may be difficult for both a psychological dependence
persists.
Patient drifts away and breaks bond with nurse and healthier
emotional balance is demonstrated and both becomes mature
individuals.
INTERPERSONAL THEORY AND NURSING PROCESS
Both are sequential and focus on therapeutic ralationships
Both use problem solving techniques for the nurse and patient to
collaborate on, with end purpose of meeting the patients needs.
Both use observation communication and recording as basic tools
utilized in nursing.
IMPLICATIONS
To Nursing Practice
Some of Peplaus ideas were not widely accepted at the time
they were introduced, such as the concepts of learning through
experiences between the patients and the students.
However, as the concepts that form her Interpersonal Relations
Model were applied and tested, many nursing experts now
recall Peplau as the one who brought a new perspective, a new
approach and a theoretical foundation for nursing practice.
To Nursing Education
Hildegard Peplaus book, Interpersonal Relations in Nursing
(1951), is being used as a manual of instruction to help
graduate nurses and nursing students alike in creating a
significant nurse-patient relationship in any setting they are
into.
To Nursing Research
At the arrival of the Interpersonal Model, nursing
researchers follow the major assumption that patient
problems were within the person phenomena and were
dealt inside the nurse-patient interaction studies.

LIMITATIONS:
Intra family dynamics, personal space considerations and
community social service resources are considered less.
Health promotion and maintenance were less emphasized.
Cannot be used in a patient who doesnt have a felt need
eg. With drawn patients, unconscious patients
Some areas are not specific enough to generate
hypothesis.
 HILDEGARD PEPLAU

September 1, 1909 - March 17, 1999

Richard Sagasag
RN, MAN, USRN
 Regarded as mother of psychiatric nursing

Born in 1909, Reading, Pennsylvania

Graduated from a diploma program in Pottstown,

Pennsylvania in 1931

BA in interpersonal psychology from Bennington

College in 1943

MA in psychiatric nursing from Colombia University,

New York in 1947

Richard Sagasag
RN, MAN, USRN
 EdD in curriculum development in 1953

Professor emeritus from Rutgers University

Started first post baccalaureate program in
psychiatric nursing

Certified in psychoanalysis by William Alanson

White Institute of New York City

Worked as executive director and president of

ANA

Worked with WHO, NIMH and nurse corps

Died in 1999

Richard Sagasag
RN, MAN, USRN
 PUBLICATIONS
In 1952 published Interpersonal Relations
in Nursing
Originally delayed because of no physician
co-author

Credited with transformation of nursing from a

group of skilled workers to a profession

Richard Sagasag
RN, MAN, USRN
 HISTORICAL EVOLUTION OF THE THEORY

1943-45 served in the Army Nurse Corps

312th Field Station Hospital in England
American School of Military Psychiatry

Worked with leading figures in British and

American psychiatry

After war worked to reshape mental health

system in U.S.
Passage of National Mental Health Act of 1946

Richard Sagasag
RN, MAN, USRN
 PURPOSE
The purpose of this theory is to
facilitate the development of
problem solving skills, within the
context of the interpersonal
relationship between nurse and
client, using education and
therapeutic interactions

Richard Sagasag
RN, MAN, USRN
 PERSON
A developing organism that tries to reduce
anxiety caused by needs
An individual is made of physiological,
psychological and social spheres striving
towards equilibrium in life

Environment
Being and occurring in the context of the
nurse client relationship

Richard Sagasag Existing forces outside of the individual

RN, MAN, USRN
 HEALTH

Peplau viewed health as "a word

symbol that implied forward
movement of personality and other
ongoing human processes in the
direction of creative, constructive,
productive, personal, and community
living
(Peplau,1992, p.12).

Richard Sagasag
RN, MAN, USRN
 NURSING

An educative and therapeutic

relationship in which the nurse makes
the client a partner in their health
care and promotion

A significant therapeutic
interpersonal process

Richard Sagasag
RN, MAN, USRN
 FOUR PHASES OF A NURSE CLIENT
RELATIONSHIP

ORIENTATION
IDENTIFICATION
EXPLOITATION
RESOLUTION

Richard Sagasag
RN, MAN, USRN
 Orientation Phase
Nurse and patient meet as two
strangers
Individual has a felt need
Seeks professional assistance
Trust and empowerment
Encourage active participation
Nurse determines what help client
Richard Sagasag
needs Lets REVIEW
RN, MAN, USRN
 If you are a nurse
and patient comes
to you for the first
time, how do you
entertain the
client/patient?
Richard Sagasag
RN, MAN, USRN
Factors influencing the blending of the
nurse-patient relationship
 Identification Phase
Identify problems to be worked on
during the relationship
Clarify perceptions and expectations
Level of dependence/independence

Capability to deal with identified

problem/s
Decreases helplessness and
hopelessness
Richard Sagasag
RN, MAN, USRN
 ExploitationPhase

Goals are implemented by the nurse

but power is shifted to the patient
as these goals would be achieved
through personal or self-effort

Dependent person becomes

independent.

Richard Sagasag
RN, MAN, USRN
 ResolutionPhase

Client needs met, patient earns full

independence from the relationship

Mutual termination of relationship

Goal, support systems, problem

prevention

Richard Sagasag
RN, MAN, USRN
 ExploitationPhase

Readiness is one of the most

important factors in the learning
process and learning is initiated
by a need or purpose.

Termination occurs only with the

successful completion of the
previous phases.
Richard Sagasag
RN, MAN, USRN
 NURSING ROLES
Nursing roles are different
roles that the nurse
assumes which empower
her in meeting the needs of
the patient

Richard Sagasag
RN, MAN, USRN
 Role of the Stranger
Nurse should treat the patient
courteously.

Nurse should not prejudged

the patient.

Nurse should treat the patient as

emotionally able.
Richard Sagasag
RN, MAN, USRN
 Role of the Resource Person
Nurse provides specific answers
to questions by determining the
level of understanding of the
patient:
- Health information
- Advices
- Explanation of the health care
teams course of care
Richard Sagasag
RN, MAN, USRN
 Teaching Role
Nurse must determine how
the patient understands the
subject at hand.

Nurse must develop her discussion

around the interest of the patient
& ability of using the information
provided.
Richard Sagasag
RN, MAN, USRN
 Leadership Role

Involves the democratic process

Nurse helps the patient meet the

tasks at hand through a:
- relationship of cooperation
- active participation

Richard Sagasag
RN, MAN, USRN
 Surrogate Role
The patient dependency for his
care gives the nurse a surrogate
(temporary care giver) role.

The nurse must assist the patient

to accept that her surrogate role is
different & only temporary

Richard Sagasag
RN, MAN, USRN
 Counseling Role
Has the greatest emphasis in psychiatric
nursing

Nurse becomes a listening friend, an

understanding family member, and
someone who gives sound & emphatic
advises

Interpersonal techniques help the

patient remember and understand fully
the experience & how it be integrated into
Richard Sagasag
his daily life.
RN, MAN, USRN
 Case Analysis

Richard Sagasag
RN, MAN, USRN
 Scenario:

Mario, a street vendor was hit

by a car and obtained
multiple injuries in his body.
He was brought in the hospital
for treatment.

Richard Sagasag
RN, MAN, USRN
 ORIENTATION PHASE
- During admission/Assessment

Role of a stranger
- Nurse accepts client regardless of the
economic status.

- Establish Trust & Rapport

-Courteously asks questions to gather

data
Richard Sagasag
RN, MAN, USRN
 IDENTIFICATION PHASE
- Problem Identification
- Nursing Diagnosis/Planning
Problem Identified: Multiple injuries (Risk for
infection)

Counseling Role
- Nurse listens to the client and gives
emphatic advises
- Nurse helps client understand problems by
explaining the fracture obtained as well as
the multiple injuries
Richard Sagasag
RN, MAN, USRN
 IDENTIFICATION PHASE
Problem Identified: Multiple injuries (Risk
for infection)
- Nurse & client together plan for the
activities that help the client in his
recovery
Example:
- Ways of preventing of infection
- Procedures ordered by doctor (x-
ray)
Richard Sagasag
- Medications (ordered by doctor)
RN, MAN, USRN
 Exploitation Phase (Implementation)

Leadership Role
- Nurse motivates the patient to
actively participate and cooperate in
all the activities rendered by nurses and
physicians

Teaching Role
-Nurse teaches and demonstrates to
the client proper hand washing to
prevent infection.
Richard Sagasag
RN, MAN, USRN
 Exploitation Phase (Implementation)

Resource person
-Courteously explain to the client the
reasons why client has to undergo x-ray
-Explains the importance of the
medications and how it could help in his
recovery
Surrogate Role
-Nurse serves as the temporary care giver
and treats the client like his own family
- Nurse attends to his need
Richard Sagasag
RN, MAN, USRN
 Resolutiontion Phase

- Evaluation, Recovery & Discharge

-Nurse evaluate the effectiveness of the
nursing actions/interventions
implemented
Example:
- Evaluate the understanding of the
client regarding his condition
- Evaluate if client learned about hand
washing
Richard Sagasag
RN, MAN, USRN
 Example:

- Evaluate if client understand the

purpose why he needs to undergo x-
ray
- Evaluate If client understand why he
needs to take the medications

If Client recovers from his previous

condition then recovery takes place and
discharge is ordered by the physician
Richard Sagasag
RN, MAN, USRN
Overlapping phases in nurse-patient relationships

Admission/
ORIENTATION Assessment

IDENTIFICATION Nursing Diagnosis/

Planning

EXPLOITATION Implementation

RESOLUTION Evaluation/
Termination/Discharge/
IMOGENE KING
6) IMOGENE KING
GOAL ATTAINMENT THEORY
Patient has THREE (3) interacting
systems

Individuals / Personal systems

How the nurse views and integrates self
based from personal goals and beliefs.
Group systems / Interpersonal
systems
How the N interrelates w/ a co-workers or
pt. particularly in N-Pt. relationship
Social systems
how the N interacts w/ co-workers,
superiors, subordinates & the ct.
environment in general
 6) IMOGENE KING
GOAL ATTAINMENT THEORY
Action
A means of behavior or activities that are
towards the accomplishment of certain act. It is both
PHYSICAL & MENTAL.
Mental (POA)

Action (Goal Setting w/ Ct.)

Perform Achieve Goal

Reaction
A form of reacting or response to a certain
Stimuli.

Interaction
Any situation wherein the N relates & deals
With a ct. or pt.

Transaction
 6) IMOGENE KING
GOAL ATTAINMENT THEORY
Application:
Provides enough direction to how
nurses should be able to behave or act in the
presence of pts. Since majority of nursing
activities involves direct interaction w/ pts.,
Ns should understand the basic implications
of the Action-Reaction-Interaction-Transaction
model of the N-Pt. Relationship.
Imogene King has been publishing since the mid1960s.
Toward a Theory for Nursing was published in 1971 and a
Theory for Nursing was published in 1981. Kings
conceptual; framework specifies the following interacting
systems: personal system, interpersonal system and
social system. The concepts of the personal systems are
perception, self, body image, growth and development
and time and space. The concepts of interpersonal
system are role, interaction, communication and
transaction and stress.
INTRODUCTION

Imogene King was born in 1923

Completed her Bachelor in Science of Nursing from St. Louis University in
1948
Completed her Master of Science in Nursing from St. Louis University in 1957
Completed her doctorate degree from Teachers College, Columbia university

METAPARADIGM
To Nursing Practice
King described a person existing in an open system as a spiritual being and
rational thinker who makes choices.
Selects alternative courses of action, and has the ability to record their
history through their own language and symbols, unique, holistic and have
different needs, wants and goals.
METAPARADIGM
Person
King described a person existing in an open system as a
spiritual being and rational thinker who makes choices.
Selects alternative courses of action, and has the ability to
record their history through their own language and
symbols, unique, holistic and have different needs, wants
and goals.

Nursing
Nursing is an act wherein the nurse interacts and
communicates with the client.
The nurse helps the client identify the existing health
condition.
The goal of the nurse in this theory is to help the client
maintain health through health promotion and
maintenance, restoration and caring for the sick and dying.
Health
King viewed health as the ability of a person to adjust to
the stressors that the internal and external environment
exposes to the client
Adjusting to the environment bring the client back to their
usual roles before the reaction occurred.

Environment
Environment is the background for human interactions. It
involves:
Internal environment transforms energy to enable
person to adjust to continuous external environmental
changes.
External environment involves formal and informal
organizations. Nurse is a part of the patients
environment.
Interacting Systems Framework
King proposed that the nurse interacts in the system
simultaneously at three different levels, namely Personal,
Interpersonal and social Frameworks.
Personal how the nurse views and integrates self based
from personal goals and beliefs.
Interpersonal - how the nurse interrelates with a co-worker
or patient particularly in a nurse-patient relationship.
Social - how the nurse interacts with co-workers, superiors,
subordinates and the client environment in general.
ASSUMPTIONS

Basic assumption of goal

attainment theory is that nurse and client
communicate information, set goal mutually
and the act to attain those goals, is also the
basic assumption of nursing process.
IMPLICATION
To Nursing Practice
Professional have used Kings theory in different
specialized area with the use of dynamic interactive
communication between the nurse and the client as a
proof.
Professional need communication to successfully and
correctly make decisions for their plan of care.
The significance of Kings theory have been applied to
different professional practice setting such as in nursing
administration, theory based practice in the emergency
department, in tertiary hospitals and in the community.
To Nursing Education
Kings interacting system has been used to design the
nursing curriculum in different schools and universities and
framework for nursing education.
It provides a systematic means of viewing the nursing
profession, organizing nursing knowledge and clarifying
the nursing discipline.

To Nursing Research
Kings theory has been one of theoretical basis of some
researchers that helped in formulating a system view of
the application of the nursing practice.
ANALYSIS
Simplicity
Kings theory was as a result of careful research
study. Her research literature was based on the existing
evidences during her study. She maintains the simplicity of
her theory even if she presented different complex concepts.

Generality
Kings theory has been said to have limited
application for the nursing practice. It was stated that the
interaction between the nurse and the client also comprises
non-verbal communication that cannot be clearly defined
and evaluated.
 IMOGENE KING
Goal Attainment Theory

Richard Sagasag
RN, MAN, USRN
 OVERVIEW
IMOGENE KINGS Theory derived
from her conceptual framework
which shows the relationship of
personal systems (individuals),
interpersonal systems (nurse-
patient), social systems
(educational system, health care
system)
Richard Sagasag
RN, MAN, USRN
 OVERVIEW
Kings Theory offers insight to nurses
interactions with individuals and
groups w/in the environment.

It highlights the importance of clients

participation in decision, that
influence care and focuses on both
the process of nurse-client interaction
and the outcomes of care.
Richard Sagasag
RN, MAN, USRN
 INTRODUCTION

Imogene King was born in 1923.

Completed her Bachelor in science of

nursing from St. Louis University in 1948

Completed her Master of science in

nursing from St. Louis University in 1957

Completed her Doctorate from Teachers

college, Columbia University
Richard Sagasag
RN, MAN, USRN
 4 METAPARADIGM IN NURSING

PERSON
- is social being who has the ability to :

Perceive
Think
Feel
Choose
Set goals
Select means to achieve goals and
To make decision
Richard Sagasag
RN, MAN, USRN
 4 METAPARADIGM IN NURSING

PERSON
- is social being who has the ability to :

Perceive
Think
Feel
Choose
Set goals
Select means to achieve goals and
To make decision
Richard Sagasag
RN, MAN, USRN
 4 METAPARADIGM IN NURSING

PERSON
According to King, human being has three
fundamental needs:

(a) The need for the health information

(b) Need for care for illness prevention

(c) The need for care when human beings are

unable to help themselves.
Richard Sagasag
RN, MAN, USRN
 4 METAPARADIGM IN NURSING

HEALTH

Health is viewed as ability of a

person to adjust to the stressors
that the internal or external
environment expose to the client

Richard Sagasag
RN, MAN, USRN
 4 METAPARADIGM IN NURSING

ENVIRONMENT
Process of balance involving internal &
external interactions inside the social
system.

External environment is the factor that

exist outside the boundary.

Internal environment transforms energy to

enable person to adjust to continuous
external environmental changes.
Richard Sagasag
RN, MAN, USRN
 4 METAPARADIGM IN NURSING

NURSING

An act wherein the nurse interacts and

communicates with the client.

The goal of the nurse is to help the client

maintain health through health promotion
& maintenance, restoration, caring for the
sick and dying.

Richard Sagasag
RN, MAN, USRN
 INTERACTING SYSTEM FRAMEWORK
Personal how the nurse views and
integrates self based from personal
goals & beliefs

Interpersonal how the nurse interrelates

with co-worker or patient, particularly
in a nurse-relationship

Social how the nurse interacts with co-

workers, superiors, subordinates and
the client environment in general
Richard Sagasag
RN, MAN, USRN
 INTERACTING SYSTEM FRAMEWORK

Action means of behavior or activities

that are towards the accomplishment of
certain act.

The accomplishment of a task begins with

mental action whereby a person seeks or
formulates plan of activities and
proceeded by physical action

Richard Sagasag
RN, MAN, USRN
 INTERACTING SYSTEM FRAMEWORK
Actions are aimed towards setting goals
through communication between the nurse
and the client then exploring and
agreeing means to perform thereby
achieving the set goals

Reaction
In her theory reaction is not specified but
somehow relate reaction as part of
action or a form of response to a certain
Richard Sagasag
stimuli
RN, MAN, USRN
 INTERACTING SYSTEM FRAMEWORK
Interaction
Any situation wherein the nurse relates &
deals with a client or patient

Open System
The absence of boundary existence,
where a dynamic interaction between the
internal & external environment can
exchange information without barriers or
hindrances.
Richard Sagasag
RN, MAN, USRN
 KINGS GOAL ATTAINMENT THEORY
10 essential KNOWLEDGE for use by nurses in concrete situations:
Self, Role, Perception, Communication, Interaction, Transaction, Growth &
Development, Stress, Time & Personal Space
Perception Feedback

Judgment

Action
Nurse
Reaction Interaction Transaction
Patient

Action

Judgment

Perception
Feedback
ENERGY FIELD THEORIST MARTHA ROGERS
5) MARTHA ROGERS
SCIENCE OF UNITARY HUMAN BEING
Views the person as a irreducible
whole, the whole being greater
than the sum of its parts
Man is composed of energy fields,
which are in constant interaction
with the environment
Seek to promote harmonic
interactions between the two
energy fields (Human and
Environmental)
 5) MARTHA ROGERS
SCIENCE of UNITARY HUMAN BEING

Application
Her theory is relevant in todays nurses
focusing on the Totality of the Person. Nurses
should strive to promote symphonic
interaction between the 2 energy fields in
order to strengthen the coherence &
integrity of the person.
Martha E. Rogers has publishes widely since the early
1960s and is considered one of the most creative
thinkers in nursing. Her work regarding unitary human
beings appears in An Introduction to the Theoretical
Basis of Nursing.
 MARTHA ROGERS
UNITARY HUMAN BEINGS
Born: May 12, 1914, Dallas, Texas
Diploma : Knoxville General Hospital School of Nursing
(1936)
Graduated in Public Health Nursing, George Peabody
College, TN, 1937
MA : Teachers College, Columbia University, New York,
1945
MPH : John Hopkins University, Baltimore,1952
Doctorate in nursing: John Hopkins University, Baltimore,
1954
Position: Professor Emerita, Division of Nursing, New York
University, Consultant, Speaker
ROGERS NURSING THEORY
Nursing is both a science and art, the uniqueness of nursing, like
that of any other science, lies in the phenomenon central to its
focus.
Nurses long established concern with the people and the world
they live is in a natural forerunner of an organized abstract
system encompassing people and the environment
The integralness of people and the environment that coordinate
with multidimensional universe of open systems points to a new
paradigm.
The purpose of nurses is to promote health and well-being for
all persons wherever they are.
METAPARADIGM
Person
Defines person as an open system in continuous process with
the open system that is the environment.
She defines unitary human being as an irreucible, indivisible,
pandimensional energy field identified by pattern and
manifesting characteristics that are specific to the whole.
The people has the capacity to participate knowingly and
probabilistically in the process of change.
Man is a unified whole possessing his own integrity.

Nursing
Nursing is a learned profession, both a science and an art.
An organized body of kowledge which is specific to nursing is
arrived at by scientific research and logical analysis.
Health
Rogers defined health as an expression of the life process,
they are the characteristics and behavior emerging out of the
mutual, simultaneous interaction of the human and
environmental fields.
Health and illness are the part of the sane continuum.
Health and illness are manifestations of pattern and are
considered to denote behaviors that are of high value and
low value.

Environment
Rogers defines environment as an irreducible, pandimensional
energy field pattern and manifesting characteristics different
from those of the parts.
IMPLICATIONS
To Nursing Practice
The Rogerian model is an abstract system of ideas from which
to approach the practice of nursing.
Nursing is based on theoretical knowledge that guides nursing
practice.
The professional practice of nursing is creative and imaginative
and exists to serve people.
It is rooted in intellectual judgment, abstract knowledge, and
human compassion.

To Nursing Education
Rogers clearly articulated guidelines for the education of
nurses within the Science of Unitary Human Beings.
Rogers discusses structuring nursing education programs to each
nursing as a science and as a learned profession.
To Nursing Research
Rogers conceptual model provides a stimulus and direction for
research and theory development in nursing science.
Emerging from Rogers model are theories that explain human
phenomena and direct nursing practice.
The Rogerian model, with its implicit assumptions, provides broad
principles that conceptually direct theory development.

THEORETICAL ASSERTIONS
The principles of hemodynamics postulate a way of perceiving unitary
human beings.
Rogers identified the principles of change as helicy, resonancy and
integrality.
The helicy principle describes spiral devt in continuous, nonrepeating
and innovative patterning.
Principle of resonancy , patterning changes with devt from lower to
higher frequency with varying degrees of intensity.
 Principles of Homeodynamics

Resonancy Helicy Integrality

Midrange

Bultemeier (1993) Barrett (1990a) Floyd (1983)

 MARTHA ELIZABETH ROGERS
Science of Unitary Human
Beings

Richard Sagasag
RN, MAN, USRN
 Concepts of Rogers Model

Richard Sagasag
RN, MAN, USRN
 1. Energy Field
- Energy field is the fundamental unit of both
the living & non-living
- This energy field provide a way to perceive
people & environment as irreducible whole
- The energy field continuously varies in
intensity, density, and extent

2. Openness
- Human field & environmental field are
constantly exchanging their energy

3. Pattern
- Defined as the distinguishing characteristic of
an energy field perceived as a single wave

Richard Sagasag
RN, MAN, USRN
 Homeodynamic Principles
-The way of perceiving unitary
human beings

a. Resonance
b. Helicy
c. Integrality

Richard Sagasag
RN, MAN, USRN
 Resonance
-An ordered arrangement of rhythm
between human field & environmental field
-Field that undergoes continuous dynamic
Helicy
-Describes the unpredictable, but continuous,
non-linear evolution of energy field as
evidenced by non repeating rhythmicities

Integrality
-It covers the mutual, continuous
relationship of the human energy field and
the environmental field
-The fields are one & integrated but unique to
Richard Sagasag each other
RN, MAN, USRN
 Margaret Newman
Health as an Expanding
Consciousness

Richard Sagasag
RN, MAN, USRN
GOD BLESS! THANK YOU!