Nursing Theorist Acn-I

Virgina Handerson Theory 1
Liaquat University of Medical & Health Sciences

Jamshoro Sindh
College of Nursing, JPMC, Karachi
BScN Session 2006-2008
Florence Nightingale
Advance Concept in Nursing I
Abdul Hakeem
Mrs. Ruth K. Alam
Date:
Theory is a group of concepts that form a pattern of reality. A theory is a statement
that explains or characterizes a process, an occurrence or an event and is based on observed
facts but lacks absolute or direct proof.
Nursing Theory differentiates nursing from other disciplines and activities in that it
serves the purpose of describing, explaining, predicting and controlling desired outcomes of
nursing care practice.
Florence Nightingale (The Lady of Lamp)
Florence Nightingale observed with a little lamp in her hand making her solitary
rounds. As her slender form glides through the corridor, every poor fellow’s face softens with
gratitude at the sight of her. She had become the heroine. Her name becomes a synonym for
gentleness, efficiency and heroism. Although Florence Nightingale cannot be considered as
the product of her time, since she was ahead of and beyond it. But the season was ripe for her
genius as the founder of modern nursing.
Florence Nightingale has great deal for nursing profession. She has emphasize on
unique role of nurse and believed that nurses should spend their time caring for patients and
not cleaning. Nurses must continue learning throughout their lifetime and not become
stagnant that nurses should be intelligent and should use that intelligence to improve
condition for the patients and that nursing leaders should have social standing. She had a
vision of what nursing could and should be.
Major Theme – A major of Florence Nightingale is “Unique Role of the Nurse”.
Person
Florence Nightingale in context of person stated that “An individual who has the
recuperate powers within self to restore own health”. Health is a pattern of energy that is
mutually enhances and expresses full life potential. Positive health symbolizes wellness.
According to her a person defined as to recover or improve the power for restore the health
after desire process through hygienic conditions.
Environment
According to Florence Nightingale environment involves those external conditions
that affect life and the development of the individual, with a focus on ventilation, warmth,
odours and light, and diet, such as noisy environment could distress patients sleep which
leads to sleeplessness or restlessness causing delay in patient’s recovery.
Assessment
I collect information and examine the client through two ways.
Subjective Data
In subjective data the client tells me about his health. He says that “he is not feeling
comfortable and weakness occurs since last one month.
Objective Data
In objective data, I observe and examine the client carefully and consciously. I look
the 35 years old patient lying on the bed and looking:
 Very irritable.
 Worried.
 Anemic.
 Sleeplessness.
 Depression/Anxiety.
 Dry skin due to lack of nutrition.
 Sunken eyes.
 Fatigue.
His vital signs are:
 Blood Pressure 120/70 mmHg.
 Temperature 99.6°F
 Pulse 92 per min.
 Respiratory Rate 22 per min
 Weight 50 Kg
 Hb 7.8 gm/dl
The following investigations were performed.
 CP.
 Chest X-ray.
 Urine D/R
 Electrolytes.
Acceptable Nursing Diagnosis
 Health-seeking behaviors.
 Ineffective management of therapeutic regimen.
 Ineffective family management of therapeutic regimen.
 Altered health maintenance.
 Risk of infection.
Nursing Diagnosis
Health maintenance altered, due to anxiety secondary to disease process.
Expected Outcome
 The client will relate improvement of health maintenance within 7-10 days.
Nursing Interventions and Rationales
Interventions Rationales
 Facilitate the client to take high  High protein diet is a good source of
protein diet health maintenance.
 Educate the client to take fiber diet.  Fiber diets also improve the health.
 Encourage the client to use fresh  Fresh juices and plenty of water
juices and drink daily 10-12 glasses required for maintenance of health.
of water.
 Teach the client daily go to walk in  For healthy living, daily light
early morning. exercise is essential. This will
improve health status.
 Allow the family as individual’s and  Sharing of feelings among family

as a group to share their feelings. members brings the client towards
life and healthy activities.
 Facilitate the client to take one cup of  To improve and maintain client’s
milk in early morning with one apple. health.
 Prescribe the client to use  To maintain health of the client.

multivitamins and iron form tablets
or capsules as per order of the doctor.
Evaluation
 The client has verbalized that his weakness had reduced, he gained weight and take
more active part in daily life than before.
 The client has verbalized that he had planned for a regular exercise program to
maintain his health status.
I looked the client’s condition and assessed that the client is looking very happy and
comfortable and achieve my desired goal within target period.

Summary
Florence Nightingale major theme is “Unique Role of the Nurse”. She defined person
as to recover or improve the power for restore the health after desire process through hygienic
conditions. Environment involves those external conditions that affect life and the
development of the individual, with a focus on ventilation, warmth, odours and light, and
diet, such as noisy environment could distress patients sleep which leads to sleeplessness or
restlessness causing delay in patient’s recovery. The nurse uses a caring process to help the
individual achieve an optimal degree of inner harmony to promote self-knowledge, self-
healing, and insight into the meaning of life.

References
 Cox, H.C., Hinz, M.D., Lubno M.A., Newfield, S.A., Ridenour, N.C., Slater, M.M.,
Sridaromount, K.L. (1996). Clinical Applications of Nursing Diagnosis: Adult, Child,
Women’s Psychiatric, Gerontic, and Home Health Considerations. 3rd Edition.
New York.
 Kozier, B., Erb, G., Berman, A.J., Burke, K. (2000). Fundamentals of Nursing:
Concepts, Process and Practice. 6th Edition. Prentice Hall Health New Jersey.
 www.yahoo.com.florence nightingale.

Jamshoro Sindh
Martha E. Rogers Theory
Bella Benjamin
Mrs. Ruth K. Alam
Date:
Martha E Rogers’s theory depends on “interaction between person and environment”
from the framework view of energy human beings are said to participate with the
environment to actualize unique potentials. We do not use or exchange energy we are
unceasingly transforming energy with the rest of the universe.
Martha E. Rogers also defines:
 Health
 Nursing
 Goal of Nursing
Health - According to the Martha. E. Rogers it is defined as “Health and illness are
seen as cultural values denoting behaviors of high and low value as defined by individuals
and cultures.”
Health is a rhythmic patterning of energy that is mutually enhancing and expresses
full life potential. Health is participation in the life process by choosing and executing
behaviors that leads to the optimum fulfillment of a persons potential. Health can be viewed
as a process of actualizing potentials for well being by knowing participation in change.
Positive health symbolizes wellness. It is a value term defined by the culture or individual.
Health and illness are considered “to denote behaviors that are of high value and low value”
Nursing - Martha. E. Rogers defined nursing as “A profession with a focus on
promotion protection and restoration of health in people.” It can be more described as a
humanistic science dedicated to compassionate concern with maintaining and promoting
health, preventing illness and caring for and rehabilitating the sick and disabled. Nursing seek
to promote sympatric interaction between the environment and the person, to strengthen the
coherence and integrity of human beings and to direct and to direct and redirect patterns of
interaction between the person and the environment for the realization of maximum health
potential.
Focus of nursing is unitary human being sis mutual process with their environment
and that nursing intervention would be to create ways in which the client might become more
aware of his or her field and collaborate with the nurse in proposing and using patterning
strategies.
Goal of Nursing – According to the Martha E. Rogers, the goal of nursing is “to
promote harmonious interaction between the patient and the environment.” The goal of
nursing according to Rogers’s science of unitary human beings is to promote human
environment filed and the human field is in constant interaction with the environment field.
The best and suitable pattern is the health perception and health management pattern
because in this theory the person is in constant interaction with the environment.
Applicable Nursing Diagnosis
 Total health management deficit.
 Health management deficit.
 Health seeking behaviors.
 High risk for infection.
 High risk for injury (Trauma).
 High risk for poisoning.
 High risk for suffocation.
 Altered protection.
Assessment
The specific data collected about a client’s health needs. I assessed the client and
collect data though the following two ways.

 Subjective Data
In subjective data client tells that he is having pain in abdomen due to surgery.
 Objective Data
In objective data, I observed the client very carefully. The client was 30 years old and
conscious and well oriented to time place and person. She is lying on bead and looking
irritable, facial expressions show pain, redness and tenderness on surgical site and skin is
warm on touching.
Her vital signs are:
• Blood pressure 130/70 mmHg.
• Temperature 99.4°F.
• Pulse 90 per min
• Respiration 22 per min.
Nursing Diagnosis
High risk for infection related to site for organism invasion secondary to surgery.
Expected Outcome
The person will be verbalized risk factors associated with infection and precautions
need and report that she is comfortable within 2-3 days.
• Explain the risk factors associated • To build nurse and patient

with the infection and precautions relationship.
needed.
• Reduce the entry of organisms into • To prevent from infection

individuals by using aseptic
techniques.
• Teach individual and family members • To give awareness about how to

signs and symptoms of infection. minimize infection.
• Limit visitors when appropriate. • To prevent client from further

infection.
• Encourage and maintain caloric and • To improve immunity.

protein intake in diet.
• Administer prescribed antimicrobial • To minimize microbial activity.

therapy within 15 minutes of
schedule time.
• Minimize length of say in hospital. • To minimize the risk of infection.
Evaluation
The client verbalized that she has no complain of pain. On observation, client looks
relaxed and comfortable and tells that, “She is better than before”.
According to Martha E. Rogers’s theory, “science of unitary human beings”, the life
process in human beings is homodynamic, involving continuous and creative change. She
provides three principles of homodynamics to offer a way of perceiving how unitary human
beings develop integrity resonancy and helicy. According to the principle of integrality the
human and environmental fields interact mutually and simultaneously. Resonancy means the
wave pattern in the fields change continuously and from lower to higher frequency patterns.
Helicy probabilistic, and characterized by increasing diversity of field patterns and repeating
rhythmicities. Rogers first presented her theory of unitary human beings in 1970.
Key concepts Rogers uses to describe the individual and the environment are energy
fields, openness pattern and organization, and multidimensionality. Energy fields are dynamic
constantly exchanging energy from one to another. The concept the of openness holds that the
energy field of human and the environment are open systems that infinite, integral with one
another, and in continuous process. Pattern refers to the unique identifying behavior qualities,
and characteristics of the energy fields change continuously and innovatively.

Summary
In her theory, Martha E. Rogers considers the individual as an energy field coexisting
within the universe. The individual is in continuous interaction with the environment, and a
unified whole, possessing personal integrity and manifesting characteristics that are more
than the sum of the parts. Unitary human beings is a four dimensional energy field identified
by pattern and manifesting characteristics that are specific to the whole and which cannot be
predicted from the knowledge of parts. The four dimensions used in Rogers’s theory – energy
fields, openness, pattern and organization and dimensionality are used to derive principles
related to human development. Rogers views nursing primarily as a science and is committed
to nursing research and theory development. Nursing’s body of scientific knowledge is a new
product specific to nursing. Nursing is a humanistic science.

References
 Crips and Taylor. Fundamentals of Nursing. pp 97-98.
 Kozier, B., Erb, G., Jean A, Burke K. Fundamentals of Nursing. 6th Edition; pp 37-45.
 Kozier, B., Erb, G., Blais, K., Wilkinson, J.M., van Leuven K. Fundamentals of
Nursing. 5th Edition; p 50.
 www.google.com.pk/martha e. rogers theory.

Sleep and Rest Pattern
Bella Benjamin
Nazia Javed
Sajida Parveen
Mrs. Ruth K. Alam
Date:
INDEX TABLE
S# Content Page #
1. Pattern Description 01
2. Conceptual Information 01
3. Conceptual Framework 02
 Rapid Eye Movement (REM) 03
 Non-rapid Eye Movement
(NREM) 03
4. Development Consideration 04
 Infant 05
 Toddler and Pre-Schooler 06
 School Age Child 06
 Adolescent 07
 Adults 07
07
 Older Adults
5. Factors that effecting on Sleep and
Rest Pattern 08
6. Applicable Nursing Diagnosis 10
7. Summary 13
12. References 14
OBJECTIVES
At the end of this presentation, audience will
be able to:
1) Define sleep and rest pattern.
2) Describe the conceptual information.
3) Explain conceptual framework.
4) Discuss development consideration.
5) Enlist factors that effecting on sleep and rest
pattern.
6) Identify applicable nursing diagnosis.

1
SLEEP AND REST PATTERN
Pattern Description
The sleep and rest pattern includes relaxation in addition
to sleep and rest. The pattern is based on a 24 hour day and
looks specifically at how an individual rates or judges the
adequacy of his or her sleep, and relaxation in terms of both
quantity and quality. The pattern also looks at the patient’s
energy level in relaxation to the amount of sleep, rest and
relaxation described by the patient as well as any aids to sleep
the patient uses.
1.Does the patient report a problem falling asleep?
2.Does the patient report interrupted sleep?
Conceptual Information
A person at rest feels mentally relaxed, free from anxiety,
and physically calm. Rest need not imply inactivity, and
inactivity does not necessarily afford rest.
 Rest is a reduction in bodily work that results in the
persons feeling refreshed, with a sense of readiness to
perform activities of daily living.
 Sleep is a state of rest that occurs for sustained periods
essential repair and recovery of body systems.
2
 A person who sleeps has temporarily reduced interaction

with the environment.

 Sleep restores a person’s energy and sense of well being.
Recent studies conform that sleep is a cyclic phenomena.
The most common sleep cycle is the
24-hour, diurnal day – night cycle. This 24-hour cycle is also
referred to as the circadian rhythm. In general the
24-hour circadian rhythm is governed by light and darkness.
Additional factors that influence the sleep-wake cycle of the
individual are biological, such as hormonal and
thermoregulation cycles.
The two specialized area of the brain stem that controls
the cyclical nature of sleep are the reticular activating system in
the brain stem and cerebral cortex.
After falling asleep, a person passes through a series of
stages that afford rest and recuperation physically, mentally and
emotionally.
Conceptual Framework
A day of heavy physical exertion a person is likely to
awaking with felling of heavy slept long and soundly.
Stage 4 is only one type of sleep which does not meet all
sleep needs by the end of about 90 min total sleep time
gradually returns up through the lighter stage of sleep to stage
1 instead of awaking at this time, once enters the stage of REM
(rapid eye movement) sleep and there proceeds back through
stage 2, 3, 4 again.
Rapid Eye Movement (REM)
In this stage individual dreams. Other characteristics of
this stage of sleep are:
 Irregular pulse
 Variable blood pressure
 Muscular twitching
 Profound muscular relaxation
 Increase in gastric secretions
 Complete relaxation of lower jaw.
Non-Rapid Eye Movement (NREM)
It is slow wave sleep consist of four stages.
Stage 1
 This is a transition stage 1-7 minutes between
wakefulness and sleep
 The person is relaxed with close eye during this time.
 Respiration and pulse are irregular.
 If awakens, the person will be often say that he has not
been sleeping.
4
Stage 2
 This is the first true sleep.
 Unaware of surroundings
 Little harder to awaken.
Stage 3
 This is the period of moderately deep sleep.
 Person is very relaxed.
 Body temperature falls
 Blood pressure decreases.
 It is difficult to awake the person.
 This stage occurs 20 min after falling asleep.
Stage 4
 Deep sleep occurs.
 The person is very relaxed.
 Respond slowly if awaken.
Development Consideration
In general, as age increases, the amount of sleep per
night decreases. The length of each sleep cycle active (REM)
and quiet (NREM) changes with age. For adults there is no
particular change in the actual number of hours slept, but there
is a change in the amount of deep sleep and light sleep. As age
increases, the amount of deep sleep decreases and the
amount of light sleep increases.
This helps explain why the older patient wakens more easily,
and spends time in sleep throughout the day and night. REM
sleep decreases in amount from the time of infancy (50
percent) to late adulthood (15 percent) the changes in sleep
pattern with age development are.
 INFANT: awakes 7 hours, NREM sleep 8.5 hours REM
sleep 8.5 hours.
 AGE 1: awakes 13 hours NREM sleep 7 hours, REM
sleep 4 hours.
 AGE 10: awakes 15 hours, NREM sleep, 6 hours REM
sleep 3 hours.
 AGE 20: awakes 17 hours, NREM sleep, 5 hours REM
sleep 2 hours.
 AGE 75: awakes 17 hours, NREM sleep, 6 hours, sleep 1
hour.
Infant
The development of sleep and wakefulness can be traced
to intrauterine life. A gestational age of 36 weeks seems to be a
landmark. Term birth leads to a number of profound changes,
especially in respiratory regulation.
Five distinct sleep activity states for the infant have been
noted.
6
1. Regular sleep
2. Irregular sleep
3. Drowsiness
4. Alter inactivity
5. Awaking and crying
Toddler and Pre-Schooler
The toddler needs approximately 10 to 12 hours of sleep
at night with an approximate 2 hours nap in afternoon. The
proportion of REM sleep is 25 percent. The preschooler sleeps
approximately 10 to 12 hours per day. Dreams and nightmares
may occur at this time. Rituals for preparation of sleep are
important, with bedtime associated as separation from family
and fun, quite time to gradually unwind, favorite object for
security are suggested.
School Age Child
The school age child seems to do well without a nap and
requires approximately 10 hours of sleep per day, with REM
sleep being approximately 18.5 percent. Individualized rest
needs are developed by this age. When the school ager alters
the usual routine of sleep and rest, fatigue may be a result.
7
Adolescent
The adolescent sleep approximately 8 – 10 hours per day
with REM sleep being 20 percent. Irregular sleep pattern seem
to be the norm for the adolescent due to high activity levels and
usual peer related activities. There may be a tendency to
overexertion, which is made more pronounced by numerous
physiologic changes that create increased demands on the
body. Fatigue may occur during this time.
Adult
The adult sleeps approximately 8 hours per day with REM
sleep being 22 percent. Research has shown that women of all
ages have higher rates of sleep disturbance than man. This is
due to hormonal changes and postpartum periods.
A new baby does not allow for uninterrupted sleep for
approximately 4-6 weeks after birth.
The major cause of sleep disturbance in menopause is
frequent nocturnal hot flashes coupled with early morning
awakenings.
Older Adult
The older adult requires less sleep on the
average approximately 5 – 7 hours of sleep per day.
8
The proportion of REM sleep may vary from 20 - 25 percent.
Older adults report problems in falling asleep and increased
periods of waking the night. The etiology is unknown, safety
needs during sleep and rest periods should be kept in mind.
Factors that Effecting on Sleep and Rest Pattern
Factors effecting on individual life can contribute to sleep
pattern disturbance.
 Physiological factor
 Psychological factor
 Environment factor
 Life-style factor
 Diet
 Habit and personality
 Drugs
1. Physiological Factor
 Respiratory disease
 Impaired bowel and bladder elimination.
 Pain
 Pregnancy
 Immobility (e.g., traction)
 Hormonal changes
9
2. Psychological Factor
 Stress
 Anxiety
 Fear
 Depression
 Psychotic disorder
3. Environmental Factor
 Hospitalization
 Unfamiliar or uncomfortable sleep environment
 Noise and lighting
 Day time long sleep
 During traveling
 Polluted environment
4. Lifestyle Factor
 Change in working shift
 Change in sleep routine
 Change in activity pattern
 Overload of work
5. Diet
 Food consumed impact on the quality and quantity of
sleep
 Coffee, cola and chocolate
 Heavy and spicy food
 Hungry when going to bed

10
6. Habit and Personality
 Habitual of medication
 Fatty people sleep long time
 Child always want to sleep with mother
 Some people can’t sleep alone.
7. Drugs
Alcohol and nicotine - many medications, both prescription
and over the counter, list fatigue, sleepliness, restlessness,
agitation or insomnia as side effect, all of which will have an
impact on the quality and quantity of rest and sleep.
Disturbed Sleep Pattern
Definition
The state in which an individual experiences or is at risk of
experiencing a change in the quantity or quality of his or her
rest pattern that causes discomfort or interferes with desired life
style.
Defining Characteristics
Adults
 Major (must be present)
a) Difficulty falling or remaining asleep.
11
 Minor (may be present)
a) Fatigue on awakening or during the day mood
alterations
b) Agitation
c) Dozing during the day
Children
Sleep disturbance in children are frequently related to fear,
enuresis, or inconsistence responses of parents to the child's
requests for changes in sleep rules, such as requests to stay
up late.
 Frequent awakening during the night
 Desire to sleep with parents
Many factors in life can contribute to disturbed sleep
pattern. Some common factors are:
 Related to excessive daytime sleeping
 Related to inadequate daytime activities
 Related to pain
 Related to anxiety response
 Related to discomforts secondary to pregnancy
 Related to lifestyle disruptions (e.g., occupational,
emotional, social, sexual, financial)
 Related to environmental changes (e.g., noise, fear,
hospitalization, disturbing roommate or travel).
 Related to fear
12
Related Clinical Concerns
Sleep will be altered due to
 Colic
 Hyperthyroidism
 Anxiety
 Depression
 Chronic obstructive pulmonary disease
 Any post operative state
 Pregnancy, post partum
13
Summary
The nurse who understands the need for rest and sleep as
a basic human need and is knowledgeable about individual
sleep needs and factors that influence sleep will be able to
provide for rest and promote sleep for the patient.
Knowing what foods promote sleep, the importance of
taking a nursing history for sleep, the ability to observe a
sleeping patient and identify abnormal behavior during sleep,
the importance of establishing routine or practicing good sleep
hygiene all will give the nurse a basis for teaching the patient.
14
References
 Tong B.C. and Phipps W.J. (1985). Medical Surgical

Nursing: A Nursing Process Approach. 3rd Edition.
Mosby Boston.
 Cox H.C., Hinz M.D. and Lubno M.A. (1989).

Clinical Applications of Nursing Diagnosis, Williams
and Wilkins London; pp 339-397.
 Carpenito L.J. (1989). Nursing Diagnosis:

Application to Clinical Practice. 3rd Edition. J.B.
Lippincott Company New York.
 Smith S. and Dvell D. (1982). Nursing Skills and
Evaluation: A Nursing Process Approach. Nursing
Review, California, USA.
Self Assessment
The nurse not only proves for the patient’s rest and sleep, but
takes responsibility for personal rest and sleep needs as well by
practicing proper sleep hygiene and knowing individual sleep
needs.
The student is especially vulnerable to unmet sleep needs.
Late night studying, cramming for finals and increases stress (I
wonder if I flunked my chemistry test?) are a few examples of
behavior that interferes with rest and sleep. The student who skips
meals and exists on coffee or cola drinks is subjected to fragmented
sleep at night, irritability, and gastrointestinal symptoms during the
day.
Practicing proper sleep hygiene is the most effective aid to a
good night’s sleep. Ask yourself if you practice the components of
sleep hygiene that are designed to maximize your ability to sleep.
S. # Do you? Yes No
1. Go to bed and get up at the same
time everyday?
2. Have a comfortable mattress, large
enough for turning and stretching?
3. Fall asleep with the television or
radio on? (Light and sound may
help some people to fall asleep, but
can be a detriment to others).
4. Keep your bedroom temperature
comfortable?
S. # Do you? Yes No
5. Use your bedroom as a place for
other activities (studying, craftwork,
ironing clothes)? Except for sexual
activity, the bedroom is a place for
sleeping.
6. Consume large amounts of coffee,
cola, or alcohol during the day?
(More than two cups of coffee can
alter sleep).
7. Nap during the day?
8. Smoke cigarettes? Nicotine is a
stimulant. Do you wake up at night
to have a cigarette?
9. Study just before bedtime? Use the
hour before bedtime to relax. Take
a warm bath, listen to music,
minimize anxiety.
10. Take drugs to keep you awake or
consume more than an ounce of
alcohol in the evening?
A “Yes” answer to questions 3, 5, 6, 7, 8, 9 and 10 may

indicate a violation of one or more components of sleep hygiene. If
you feel tired and poorly rested or do have trouble falling asleep,
consider altering your behavior so you can answer “yes” to
questions 1, 2, 4 and “No” to the rest.

Jamshoro Sindh
Madeleine Leininger Theory
Bushra Sultana
Mrs. Ruth K. Alam
Date:
Madeleine Leininger Theory is a development and current status of transcultural
nursing. In 1970, she observed that one of authropology’s most important contributions to
nursing is, “the realization that health and illness status are strongly influenced and often
primarily determined by the cultural background of an individual”.
Madeleine described the major theme, the person and the environment.
Major Theme – A major aim of transcultural nursing is to understand and assist
diverse cultural groups and members of such groups with their nursing and health care needs.
A through assessment of the cultured aspects of a client’s lifestyle, health beliefs and health
practices will enhance the nurse’s decision making and judgment when providing care.
Nursing interventions that are culturally relevant and sensitive to the needs of the client
decrease the possibility of stress or conflict arising from cultural misunderstandings.
Person – Often problems occur when persons from two cultural backgrounds with
conflicting values meet unless at least one person is willing and able to recognize and adapt
to the values of the other. One method for reducing potential misunderstandings is to sensitize
nurses to their own cultural biases and behaviors as well as to those of their clients. Both the
process of sensitization and the result more sensitive and effective nursing care, are the
concerns of transcultural nursing.
Environment – A conceptual framework in the environment of transculture clarifies
what is important to the development of theory in transcultural nursing. As the model shows
all four concepts must be interrelated to produce transcultural nursing knowledge because the
focus in transcultural nursing is on the cultural dimension of care, each concept is approached
from his perspective. When nurses understand the four central concepts involved, which are
environment, health, people and nursing, they can provide effective transcultural nursing care
to clients. Transcultural nursing care also be provided to childbearing women and her family,
children and adolescents and middle age adults.
Model for Components in Transcultural Nursing
Environmental/Culture People
Physical Cultural variations

Social Biological variations
Health/illness behaviors
Symbolic
Theory
TRANSCULTURAL NURSING
Education Research
Practice Nursing
Health
The professional nurse
Major belief paradigms Nurse-client interactions
Art and practices of healing (cultural encounters)
Health care system Nursing care concepts
Nursing care practices
Nurse/provider culture
According to this theory, Madeleine focused on the value and belief of the client and I
assess the client according to value and belief pattern.
Assessment
I collect information and examine the client about value and belief related the
transculture. I assess the client through two ways.

Subjective Data
In subjective data the client tells me about his culture. He tells me his values and
beliefs are very strong about his culture.
Objective Data
 Lethargic.
 Express anger towards God.
 Verbalizes inner concern about beliefs.
 Separation from religious or cultural ties.
 Challenged beliefs and values system. For example, due to moral or ethical
implications of therapy due to intense suffering.
Nursing Diagnosis
Spiritual distress (distress of the human spirit).
Expected Outcome
Because of the largely subconscious nature of spiritual beliefs and values, it is
recommended that the target data be at least 5 days from the data of diagnosis.
Assist patient to identify and define his Clarifies values and beliefs and helps
or her values, particularly in relation to patient understand the impact of values
health and illness, through the use of and beliefs on health and illness.
value clarification, rank-ordering
exercises, and completion of health
values scales.
Demonstrate respect for and acceptance Spiritual values and beliefs are highly
of the patient’s value and spiritual system personal. A nurse’s attitude can
by not judging, moralizing, arguing, or positively or negatively influence the
advising changes in values or religious therapeutic relationship.
practices.
Adapt nursing therapeutics as necessary Maintains and respects patient’s

to incorporate values and religious preferences during hospitalization.
beliefs, e.g., diet, administration of blood
or blood products, or rituals.
Schedule appropriate rituals as necessary, Provides comfort for patient.

e.g., baptism, confession, or communion.
Arrange visits from needed support Promotes comfort and reduces anxiety.
persons, e.g., pastor, rabbi, priest, or
prayer group, as needed
Provide privacy for religious practices Allows for expression of religious

and rituals as necessary. practices.
Encourage family to bring significant Promotes comfort.

symbols to patient.
Plan to spend at least 15 min twice a day Promotes mutual sharing and builds a
at (times) with patient to allow trusting relationship.
verbalization, questioning, counseling,
and support on a one-to-one basis.
Assist patient to develop problem-solving Involves patient in self-management

behavior through practice of problem- activities. Increases motivation.
solving techniques at least twice daily at
(times) during hospitalization.
Evaluation
The client verbalize that he feels more comfortable spiritually.
According to Madeleine Leininger theory, transcultural nursing is a humanistic and
scientific area of formal study and practice in nursing which is focused upon differences and
similarities among cultures with respect to human care, health and illness based upon the
people’s cultural values, beliefs, and practices and to use this knowledge to provide cultural
specific nursing care to people. Nurses, who have more direct interactions with clients than
any other health team member, should be especially aware of the cultural aspects of nursing
care. Application of transcultural nursing principles can lead to more effective and sensitive
encounters between clients and nurses.

Summary
It is concluded that concept of transculture facilitate nursing care that is culturally
relevant and help nurses work more effectively with clients from different cultures. Nurses,
who have more direct interactions with clients than any other health team member, should be
especially aware of the cultural aspects of nursing care. A major aim of transcultural nursing
is to understand and assist diverse cultural groups and members of such groups with their
nursing and health care needs. The development of the theory of transcultural nursing can be
traced to the work of early leaders in the field, who were interested in applying concepts,
primarily from anthropology, to nursing care.
Several themes emerge from this definition. First, cultures can be compared and
contrasted with respect to health beliefs, health behaviors, and nursing care measures.
Second, the goal of such study is to identify, test, refine, and apply such knowledge to the
provision of culturally relevant care. Third, the outcome of such study is a body of
knowledge useful to the practicing nurse. Fourth is the idea that this body of knowledge
defines transcultural nursing.

References
 Cox, H.C. et al. Clinical Applications of Nursing Diagnosis: Adult, Child, Women’s
Psychiatric, Gerontic, and Home Health Considerations. 3rd Edition.
 www.cultrediversity.org/basic.htm. The Basic Concepts of Transcultural Nursing.


Jamshoro Sindh
Betty Neuman Theory
Daisy Nasreen
Mrs. Ruth K. Alam
Date:
Betty Neuman
RN, BSN, MS, PhD, PLC, FAAN
Betty Neuman Theory’s major theme is “System Models”. Her system models are
comprehensive guides for nursing practice, research, education, and administration that are,
open to creative implementation and have the relationship of variables in nursing cared and
role definitions at various levels of nursing practices. The multidimensionality and wholistic
systemic perspective of Neuman systems model is increasingly demonstrating its relevance
and reliability in a wide variety of clinical and education settings throughout the world.
In her system models, she described various aspects of system models, but
I emphasize on the following:
 Health – Health or wellness is equated with system stability. Wellness is the condition
in which all parts and subparts of an individual are in harmony with the whole system.
Wholeness is based on interrelationships of variables that determine the resistance of
an individual to any stressor. Illness indicates lack of harmony among the parts and
subparts of the system of the individual. Health is viewed as a point along a
continuum from wellness to illness; health is dynamic (i.e., constantly subject to
change). Optimal wellness or stability indicates that all a person’s needs are being
met. A reduced state of wellness is the result of unmet systemic needs. The individual
is in a dynamic state of wellness-illness in varying degrees at any given time.

Neuman’s Client System
Basic structure
Basic factors common to all
organisms, i.e.,
• Normal temperature range
• Genetic structure
• Response pattern
• Organ strength or weakness
• Ego structure
• Knowns or commonalities
Basic structure
energy resources
Note:
Physiologic, psychologic,
sociologic, developmental
and spiritual variables
occur and are considered
simultaneously in each
client concentric circle.
 Definition of Nursing – A unique profession focusing on the total person (patient
system) and his or her, or group, reactions to stress and on factors influencing
reconstitution. Neuman sees nursing as a unique profession, which is concerned with
all of the variables, which influence the response a person night have to a stressor.
The person is seen as a whole, and it is the task of nursing to address to whole person.
 Goal of Nursing – To promote system stability. The Neuman systems model is used at
all levels of nursing education from diploma through doctorate. The model is used in
many clinical areas in institutions and community nursing practice at national and
international sites. Additionally, the model is used in physical therapy programs and in
nurse anesthesia.
Assessment
 Does the client verbalize inability to cope?
 Does the client demonstrate inability to problem solve?
 Does the client deny problems or weaknesses in spite of evidence to contrary?
 Did the client delay seeking health care assistance to the detriment of his or her
health?
 Does the client verbalize non-acceptance of health status changes?
 Is the client’s primary caregiver denying the severity of the client’s problem?
 Does the client demonstrate indications of neglect?
 Does the family indicate physical and emotional support for client?
 Does the family or primary caregiver indicate interest in a support group?
 Is there evidence of positive communication and community participation in planning
for predicted community stressors?
 Is the evidence of community conflict and deficits in community participation?

I collect information and examine the client about the stress coping pattern and collect
data in two ways.
 Subjective Data
In subjective data the client tells me about his stress.
 Objective Data
the client lying on the bed and looking:
 Stress
 Uncomfortable
 Irritable.
 Sleepless with sunken eyes.
 Anxiety
 Adjustment, Impaired.
• Ineffective individual coping.
• Powerlessness.
• Sensory-Perceptual alteration.
• Altered thought process.
• Dysfunctional grieving.
 Community coping ineffective and potential for enhanced.
 Family coping ineffective compromised and disabling.
 Individual coping ineffective.
Adjustment, Impaired (the state in which the individual is unable to modify his or her
lifestyle or behavior in a manner consistent with a change in health status).

Planning
Adjustment to a change in health status will require time; therefore, an acceptable
initial target date would be no sooner than 7 to 10 days following the date of diagnosis.
Expected Outcome
 Client will verbalize increase adaptation to change in health status.
 Client will return-demonstrate measures necessary to increase independence.
Establish a therapeutic relationship with A therapeutic relationship promotes

client and significant others by showing cooperation in the plan of care and gives
empathy and concern for client, calling client to talk with.
client by name, answering questions
honestly, involving client in decision
making.
Explain the disease process and Knowledge of disease process and

prognosis of patient. limitations are necessary for adjustment.
Encourage client to ask questions about Verbalization of feelings leads to

health status by allowing opportunity and understanding and adjustment.
by asking client to share his or her
understanding of the situation.
Identify previous coping mechanisms, Determines what coping strategies have

and assist client to find new ones. been successful and provides an
opportunity to try new strategies.
Help client find alternatives or Helps client continue to have satisfaction

modification in previous lifestyle in activities and provides a sense of
behavior by using assistive devices, control in lifestyle.
changing level of participation in
activities, learning new behaviors, etc.
Encourage independence in self-care Provides a sense of control and increase

activities by focusing on client’s self-esteem and adjustment.
strengths, rewarding small successes, etc.
Refer client to psychiatric nurse Collaboration promotes holistic approach

practitioner. to care, and problems may need
intervention by specialist.
Evaluation
 The client has verbalized increase adaptation to change in health status.
 The client has returned-demonstrated measures necessary to increase independence.
Summary
According to Betty Neuman Theory, a system models person environment an
interacting open system that is dynamic and composed of five interacting variables
physiological, psychological, sociocultural development and spiritual has both external and
internal components, the external includes normal lines of defense coping patterns lifestyle,
family flies. Economic status and educational level the internal includes the lives of
resistance defending basic structure.
Health or wellness is equated with systems stability. A unique profession focusing on
the total systems, and his or her group reactions to stress and on factors influencing
reconstitution and to promote system stability.
The Betty Neuman Theory (Client Model) is used in many clinical areas in
institutions and community nursing practice at national and international sites. Additionally,
the model is used in physical therapy programs and in nurse anesthesia.

References
New York.
 http//www.neuman system models.com.

Virgina Handerson

Jamshoro Sindh
Virgina Handerson Theory
Farzana Gulzar
Mrs. Ruth K. Alam
Date:
Virgina Handerson Theory’s major theme is “Basic Needs”, in which she described:
 Person – a unique individual in whom mind and body are inspirable, who has 14
fundamental needs.
 Environment not defined specifically.
Basic Needs
 Physiological
• Breathe normally.
• Eat and drink adequately.
• Eliminate body wastes.
• Move and maintain desirable posture.
• Sleep and rest.
• Select suitable clothes – dress and undress.
• Maintain body temperature within normal range by adjusting clothing and
modifying the environment.
• Keep the body clean and well groomed and protect the integument.
• Avoid dangers in the environment and avoiding injuring others.
• Communicate with others in expressing emotions, needs, fears or opinions.
• Learn, discover or satisfy the curiosity that leads to normal development and
health and use the available health facilities.

 Spiritual
• Worship according to one’s faith.
 Sociological
• Work in such a way that there is a sense of accomplishment.
• Play or participate in various forms of recreation.
 Psychological
Environment
Individuals in relation to families
 Support task of private and public agencies.
 Society expects nurses to act for individuals who are unable to function
independently.
 Basic nursing care involves providing conditions under which the patient can perform
the fourteen activities unaided.
 Analysis
Philosophical Claims - The philosophy reflected in Handerson’s theory is an
integrated approach to scientific study that would capitalize on nursing’s richness and
complexity and not to separate art from science the “doing” of nursing from the “knowing”
the psychological from the physical and the theory from clinical care.
Values and Beliefs - Based on what we’ve found. Handerson believed nursing as
primarily complementing the client by supply what he needs in knowledge, will or strength to
perform his daily activities and to carry out the treatment prescribed for him by the physician.
She strongly believed in “getting inside the skin” of her client in order to know, “what he or
she need?” The nurse should be the substitute for the client, helper to the client and partner
with the client.

Assessment
 Does the client express anger toward a Supreme Being regarding his or her current
condition?
 Does the client verbalize conflict about personal spiritual beliefs?
 Does the client indicate positive thoughts about spirituality?
 Does the patient indicate comfort with self?
Subjective Data
In subjective data the client tells me about his values and beliefs. He tells me his values
and beliefs are very strong about his culture.
Objective Data
In objective data, I observe and examine the client carefully and consciously. I look the
client lying on the bed and looking:
 Lethargic.
 Challenged beliefs and values system.
Nursing Diagnosis
 Spiritual well-being (is the process of an individual developing or unfolding of mystery
through harmonious interconnectedness that spring from inner strengths.
 Spiritual distress (disruption in the life principle that pervades a person’s entire being and
that integrates and transcends one’s biologic and psychosocial nature).
Planning
Short-term - Client will verbalize sense of spiritual peace at least one week from the date
of diagnosis because of the largely subconscious nature of spiritual beliefs and values.
Expected Outcome
 Client will verbalize sense of spiritual peace.
 Client will describe at least support systems to use when spiritual conflict
arises.
Assist patient to identify and define Clarifies values and beliefs and helps
his or her values, particularly in patient understand the impact of
relation to health and illness, through values and beliefs on health and
the use of value clarification, rank- illness.
ordering exercises, and completion of
health values scales.
Demonstrate respect for and Spiritual values and beliefs are

acceptance of the patient’s value and highly personal. A nurse’s attitude
spiritual system by not judging, can positively or negatively influence
moralizing, arguing, or advising the therapeutic relationship.
changes in values or religious
practices.
Adapt nursing therapeutics as Maintains and respects patient’s

necessary to incorporate values and preferences during hospitalization.
religious beliefs, e.g., diet,
administration of blood or blood
products, or rituals.
Schedule appropriate rituals as Provides comfort for patient.

necessary, e.g., baptism, confession,
or communion.
Arrange visits from needed support Promotes comfort and reduces

persons, e.g., pastor, rabbi, priest, or anxiety.
Provide privacy for religious Allows for expression of religious

practices and rituals as necessary. practices.

symbols to patient.
Plan to spend at least 15 min twice a Promotes mutual sharing and builds a
day at (times) with patient to allow trusting relationship.
verbalization, questioning,
counseling, and support on a one-to-
one basis.
Assist patient to develop problem- Involves patient in self-management

solving behavior through practice of activities. Increases motivation.
problem-solving techniques at least
twice daily at (times) during
hospitalization.
Evaluation
During an interview, client indicates through verbalization that he feels more
comfortable spiritually.
Summary
Virgina Handerson presents her theory on fourteen basic needs of the human
needs and absence of these needs cause disease. Their presence cure illness, their
absence need fulfillment and their fulfillment restore health.

References
 Cox, H.C. et al. Clinical Applications of Nursing Diagnosis: Adult, Child,
 http//www.anglefire.com/ut/virginiahanderson/concepts.html.
 www.unc.edu/~ehallora/handerson.htm.
Role and Relationship Pattern
Hidayatullah
Sharifa Bibi
Shagufta Rani
Mrs. Ruth K. Alam
Date:
INDEX TABLE
S# Content Page #
1. Pattern Description 01
2. Definitions 01
 Role 01
 Relationship 01
3. Types of Role 02
 Achieved role 02
 Ascribed role 02
4. Terms 02
5. Why is needed to discuss role relations 04
pattern?
6. Definition of family 05
7. Types of family 05
8. Development consideration 06
9. Manifestation of altered family
functions 09
10. Primary role relationship in family 09
11. Which types of questions we can ask? 11
12 Applicable nursing diagnosis 11
13. Summary 12
14. References 13
OBJECTIVES
At the end of this presentation the learner will be

able to:
1. Define role and relationship.

2. Enlist types of role.
3. Explain terms related to role and relationship.
4. Discuss why it is needed to discuss role relations
pattern.
5. Define family.
6. Identify types of family.
7. Describe development consideration and
manifestation of altered family functions.
8. Enumerate which types of questions we can ask.
9. Summarize applicable nursing diagnosis.
1
Pattern Description
Role relationship pattern is concerned with how a person
he or she is performing the expected behavior delineated himself
and others. Each of us has several roles some related
responsibilities included in our role are family, work and social
relationship.
Disruption in these roles relationship can lead patient to
seek assistance from the health care system like wise
satisfaction with the roles relationship and responsibilities is
patient strength that can be used in planning care for other
health problem areas.
Definitions
1. Role
 Role may be define is a pattern of behavior’s structure
around specific rights and duties, that is associated with
particular status.
 A standardized behavior associated with the status of an
individual.
 A role is a set experience about how the person occupying
one’s position behaves towards a person occupying
another position.
2. Relationship
The connection of an individual to another by blood or

otherwise.
2
Types of Role
1. Achieved Role
It is the one and individual chooses or earns through his
own efforts and actions, such is the role of a nurse.
2. Ascribed Role
It is acquired by an individual at birth or on the attainment
of a certain age: infant, mother, father and gender etc.
Terms
1. Role Performance
Relates what a person does in a particular role to the
behaviors expected of the role.
2. Role Mastery
Mean that the person’s behavior meets social expectation.
Expectation or standards of behavior of a role are set by
the smatter group to which a person belongs. Each person has
several roles, such is husband, parent, brother, son, employee,
friend, nursing association member.
Some roles are assumed for only limited periods such as
client, student, and ill person.
3. Role Development
Involved socialization into a particular role for example

nursing students are socialized into instructions, clinical
3
experience classes, laboratory simulations, and seminars to act
appropriately people need to know who they are in relation to
others and what society expect for the position they hold.
4. Role Ambiguity
Occurs when expectations are unclear, and people do not
know what to do or how to do it and are unable to predict the
reactions of others to this behavior.
This creates confusion and stress to relate or interact
appropriately with others; people also need to know the role
positions that other occupy. Failures to master a role create
frustration and feeling of inadequate often with consequent
lowered self esteem.
5. Multi Roles
Refer to the occupancy of individual for example a nurse a
wife a mother, a member of concealing etc.
6. Role Conflict
It is a condition when two or more roles happened to be
played in a certain social situation and the individual has to
perform one role and reject the other.
Role conflict could be the result of education, industry and
urban life. It keeps on increasing as the number of roles
increase. In rural area of Pakistan people face a little but of role
conflict due to simple culture and simple social life pattern.
7. Effect of Role Conflict

 The decision power becomes weak.
 Peculiar thinking habit develops which result in staying up
late in night or sleeplessness.
 The individual becomes short-tempered and a marked
change is seen in his behavior, he become angry or happy
without any reason.
 The individual may develop different medical problems.
a) Generalized weakness.
b) Indigestion
c) Hyper tension
d) Asthma
e) Neurosis
8. Role Strain
Role strain occurs when the performance expected in
respect to given role is too much demanding for an individual
this stain may be due to one of the following reasons.
 The individual is acting in too many roles.
Why is needed to Discuss Role Relations Pattern?
Feeling of individual, adult performing expected behavior

Role

Alteration in role relationship

Nurses’ role
5
Family
Definition
 This is a structured system of relationship in which
individual are bond to one another by complex,
interlocking relationship, such type of relationship is also
known as kinship system.
 A group of people living together, they are emotionally
involved and related either by blood or adaptation.
Types of Family
1. Nuclear Family
 Husband + wife + unmarried children.
2. Nuclear Dyad
 Husband + wife.
3. Single Parent Family
 One head household (mother or father).
4. Single Adult Alone
 Either by chance or choice, divorce or death of spouse.
5. Three Generation Family
 Three or more generation living in a single house.
6. Kin Networking
Nuclear household or unmarried members living in close
geographical proximity.
6
7. Institutional Family
 Children in orphanage or residential school hostel.
 Homosexual couple with or without children.
Developmental Considerations
1. Neonate and Infant
Attachment behavior
Crying
Attachment
Cuddling Smiling
behavior
Following Clinging
 Depend on parents for basic needs

 Reciprocal interaction b/w infant and parents
 Feelings fear in of loneliness
 Behavior in despair specific consideration
 Fulfilling of basic needs
 Assess infant emotionally especially when he? she is
alone, or in despair
 Understand crying process
 Understand and respond symbolic interaction
7
2. Toddler and Preschooler

Increased sense of indent
a) Toddler
 Sense of right/wrong
 Confirmation of social demands
 Depend on mother (parents)
 Starting of school interactions
b) Pre-schooler
 Make friends of same sex
 Capable of internalizing the social norms
 Tolerate belief separation of their parents
3. School Age Children
 Learn social roles as male, female
 Enjoy school + peer interaction
 Make friends of same sex
 Capability of expressing feelings
 Acknowledge limitations
 Get allowance for increasing interest out side from the
home
4. Adolescent
 Dependence and interdependence
 Intensive relationship with opposites sex
 Spend more time alone
 Peer and social interaction according to family needs
8
5. Young Adult
 Peak level of biophysical and cognitive skill
 Meaningful intimate relationship
 Primary focus on establishment of family
 Marriage and parenting
 Thinking involves reasoning
 Consider past experience, education and possible out
comes of a situation
 Learn how to deal with personal and desired needs of
others
6. Middle Age Adult
 Productive years for an individual
 Parenting role
 Mostly secure in a profession/ career
 Initiation of biophysical, physical changes
 Accept the changes of age
 Prone to chronic disease/ illnesses
7. Older Adult
 Volunteer role (choice, demand)
 Elder role modeling
Depending upon others
9
Manifestation of Altered Family Functions
 Stress
 Life is disturb
 Impaired concentration
 Performance is affected even at job
 Decreased thinking capability
 Affected decision makings process
Primary Role Relationship in Family
1. Husband and Wife
 Economic specialization cooperation, sexual cohabitation
 Joint responsibility for support, care and upbringing of
children.
2. Father and Son
Economic cooperation in masculine activities under
leadership of father, obligation of maternal support vested. In
father during childhood of son and in son during old age of
father responsibilities for instruction and discipline of duty of
obedience and respect on part of son
3. Mother and Daughter
Relationship similar to that between father and son, but
with more emphasis on child care and economic cooperation,
and less on authority material support.
10
4. Father and Daughter
Responsibility of father material support and daughter
economic co-operation and obligation.
5. Mother and Son
Relationship similar to daughter and mother but with more
emphasis on financial and emotional support in later life of
mother.
6. Elder and Younger Brother
Relationship of elder and younger brother as define.
Economic co-operation under leadership of elder, moderate
responsibility of elder for instruction and discipline of younger.
7. Elder and Young Sister
Relationship between alder and younger brother but with
more emphasis on physical care of younger sister.
8. Brother and Sister
Early relationship of playmates different with relative age,
gradual development of an incest Taboo, commonly coupled
with some measure of reassure, moderate, economic
co-operation, and partial assumption parental role especially by
the elder sibling.
11
Which Types of Question We can Ask?
Q1) Tell me about your family?
Q2) What are your relationship like with your other relatives?
Q3 What are your responsibilities in the family?
Q Are you proud of your family members?
Q5 How do you spend your free time?
Q6 Are you involved in any community group?
Q7 Are you most comfortable alone with one person or in a
group?
Q8 Who is most important to you?
Q9 What goals in life are important to you?
Q10 Are you satisfied with your life?
Q11 What are your personal strengths, talents and abilities?
1. Altered family process.
2. Ineffective family coping.
3. Spiritual distress.
4. Impaired verbal communication.
5. Social Isolation.
6. Altered parenting.
7. Impaired social interaction.
8. Ineffective individual coping.
9. Anxiety or fear.
10. Sensory perceptual alteration.
12
Summary
We have learned about the definition of role and
relationship that is the standardized behavior associated with the
status of an individual and relationship is the connection of an
individual to others. Types of role that is achieved and ascribed
roles along with role performance, role mastery role
development, role ambiguity, multi role, role conflict, effect of
role conflict and role strain were also discussed. We learn about
family that is group of people living together which is
emotionally involved and related either by blood or adaptation.
Types of family e.g. nuclear family nuclear dyad, single parent
family, single adult alone, Three generation family, institutional
family, homosexual family.
Development consideration of relationship and primary
relationship in the family including husband and wife, father and
son, mother and daughter, father and daughter, mother and son,
elder and younger brother, sister and sister, brother and sister.
We learn also about types of asking questions and applicable
diagnosis.
13
References
Nursing: A Nursing Process Approach. 3rd Edition. Mosby
Boston.
 Cox H.C., Hinz M.D. and Lubno M.A. (1989). Clinical
Applications of Nursing Diagnosis. Williams and Wilkins
London; pp 339-397.
 Carpenito L.J. (1989). Nursing Diagnosis: Application to
Clinical Practice. 3rd Edition. J.B. Lippincott Company
New York.
Jamshoro Sindh
Rosemarie Parse Theory
Inayatullah
Mrs. Ruth K. Alam
Date:
Theory - is the group of concept that forms a pattern of reality. A theory is a
statement that explains or characterized a process, an occurrence or an event and is
based on observed facts but lacks absolute or direct proof.
Nursing Theory - differentiates nursing from other disciplines and activities in
that it serves the purpose describing, explaining, predicting and controlling desired
outcomes of nursing care practice.
Rosemarie Parse Theory - The human becoming theory of nursing presents an
alternative in both the conventional biomedical approach and the biopsychosocial
spiritual (but still normative) approach of most other theories of nursing.
Person - The human becoming theory posits quality of life from each person’s
own perspective as the goal of nursing practice. Rosemarie Rizzo Parse first published
the theory in 1981 as the Man-living-health theory. The name was officially changed
to the human becoming theory in 1992 to remove the term Man after the change in the
dictionary definition of the word from its former meaning of human kind. The human
becoming theory was developed as a human science nursing theory in the tradition of
Dilthey, Heidegger, Sartre, Merleau-Ponty and Granddame. The assumptions
underpinning 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. The theory is structured around three abiding themes
meaning rhythmicity and transcendence. Person may be an individual or family. The
person as a unitary indivisible human being in constant interchange with the
environment who is free to make decisions and choices about health behaviors based
on parts or present experience.
Environment - The first theme “meaning” is expressed in the first principle of
the theory which states that structuring meaning multidimensionally is cocreating

reality through the language of valuing and imaging. This principle means that people
coparticipate in creating what is real for them through self expression in living their
values in a chosen way. The second theme ‘Rhythmicity’ is expressed in the second
principle of the theory which state cocreating rhythmical pattern of relating is living
the paradoxical unity of revealing concealing and enabling limiting while connecting
separating. This principle means that the unity of life encompasses opportunities and
limitations emerge in moving with and apart from others. The third theme,
“Transcendence” is expressed in the third principle of the theory, which states that
“cotranscending with the possible is powering unique ways of originating in the
process of transforming.’ This principle means that moving beyond the “now”
moment is forging a unique personal path for onself in the midst of ambiguity and
continuous change.
Nurses who practice guided by the human becoming theory live the processes
of the Parse’s practice methodology illuminating meaning synchronizing rhythms and
mobilizing transcendence. Research guided by the human becoming theory sheds
lights on the meaning of universal humanly lived experiences such as hope taking life
day by day grieving suffering and time passing. For references on any of these topics
the practice method the research method or specific studies.
Rosemarie exists on a constantly changing energy field that surrounds the
person and is an integral part of the state of being. According to this theory Rosemarie
focused on the health perception and health managing of the client.
I assess the client according to health perception and health management
pattern.
Assessment
I collect information and examine the client about health perception and health
management.
I collect data in two ways during assessment.

 Subjective Data
In subjective data the client tells me about his health perception and
management of his health in daily life.
 Objective Data
In objective data, I observe and examine the client carefully and consciously. I
saw a 35 years old client lying on the bed and looking here and there.
 Major defining characteristics:
 Temperature change (warmth, coolness).
 Visual changes (image, color)
 Disruption of the field (vacant, hold, spike)
 Movement (wave, spike, tingling, dense).
 Sounds (tone, words).
 Insomnia
 Chronic fatigue syndrome
 Pain
Nursing Diagnosis
 Energy field disturbance.
 Health maintenance Altered.
 Health seeking behavior.
 Infection risk for.
 Injury risk for.
 Management of therapeutic regimen.
 Preoperative positioning injury risk for.
 Protection altered.
Expected Outcome
Client will verbalize a perception of consistent energy level one week after the
date of initial diagnosis (locating the reason(s) for Energy Field Disturbance may
require several days or even weeks).
 Establish trusting relationship  Promotes accurate assessment.

with client.
 Allow client to talk about  Promotes nurse-client relationship.

condition.
 Assess energy field  Alterations, variations and/or

asymmetry in the energy field is
detected through assessment.
 Center self – imaging self as

open system with energy flow
content in, through, and out
of the system.
 Assess for heat or tingling

over specific body areas –
Glide hands, palm down, and
slowly move over body, head
to toe, 2-4 in above body.
 Be sensitive to any images  There may be a loss of energy,

that come to mind: words, disruption or blockage in the flow of
symbols, pictures, colors, energy, or an accumulation of energy
sound, mood, emotion, etc. in a part of the body.
 Attempt to get a sense of the

dynamics of the energy field.
Synthesize assessment data
into an understandable format
 Redirect areas of  Energy transfer or transformation can

accumulated energy, occur without direct physical contact
reestablish the energy flow between two systems. Hands are
and direct energy to depleted focal points for the direction and
areas. Repattern or rebalance modulation of
client’s energy field.
 Do therapeutic touch for no  Could disrupt the energy field of the

longer than 10 min. therapist.
 Assess client’s subjective  Nurse acts as a conduit through

reaction to therapeutic touch. which the environmental or universal
Client should feel more energy passes to the client.
relaxed, less anxious, and less
pain.
 Teach client relaxation  Relaxation requires the client to stop

exercises using some of the trying and to step outside of self and
same techniques as adopt a nontrying attitude. This
therapeutic touch: allows the person to release and use
the inherent energy of self.
Assist client to center self.
Teach client to imagine a
peaceful place. Help client to
verbalize place through all
the senses and to allow the
energy of the imagined place
to bring about a state of
calmness.
Teach patient to scan his or
her body to self-assess areas
of body or muscle tension. Rebalances energy flow through the
body.
Assist client to consciously
relax that tense area of the
body.
Evaluation
Client states that he has established energy level and resolved the problem and
met to expected out come.
Summary
The human becoming theory of nursing presents an alternative in both the
conventional biomedical approach and the biopsychosocial spiritual (but still
normative) approach. The human becoming theory posits quality of life from each
person’s own perspective as the goal of nursing practice. The person as a unitary
indivisible human being in constant interchange with the environment who is free to
make decisions and choices about health behaviors based on parts or present
experience.
Rosemarie Prase theory is structured around three abiding themes; meaning,
rhythmicity and transcendence. The first theme “Meaning” is expressed in the first
principle of the theory which states that structuring meaning multidimensionally is
cocreating reality through the language of valuing and imaging. This principle means
that people coparticipate in creating what is real for them through self expression in
living their values in a chosen way. The second theme ‘Rhythmicity’ is expressed in
the second principle of the theory which state cocreating rhythmical pattern of relating
is living the paradoxical unity of revealing concealing and enabling limiting while
connecting separating. This principle means that the unity of life encompasses
opportunities and limitations emerge in moving with and apart from others. The third
theme, “Transcendence” is expressed in the third principle of the theory, which states
that “cotranscending with the possible is powering unique ways of originating in the
process of transforming.’ This principle means that moving beyond the “now”
moment is forging a unique personal path for onself in the midst of ambiguity and
continuous change.
Rosemarie exists on a constantly changing energy field that surrounds the
person and is an integral part of the state of being. According to this theory Rosemarie
focused on the health perception and health managing of the client.

References
 Cody, W.K. Parse’s Theory of Human Becoming: A Brief Introduction.
www.discoveryinternationalonline.com.
 Cox, H.C. et al. Clinical Applications of Nursing Diagnosis: Adult, Child,
Cognitive Perceptual Pattern
Inayatullah
Kharunnisa
Musarrat Begum
Mrs. Ruth K. Alam
Date:
INDEX TABLE
S# Content Page #
1. Introduction 01
2. Definition 01
3. Aging Changes 01
4. Pattern Assessment 02
5. Conceptual Information 03
6. Developmental Consideration 06
 Infant 06
 Toddler 07
 Pre-School 07
 School Age Children 07
 Adolescent 08
08
 Adult and Older Adult
7. Alteration in Cognitive Perception 10
8. Sensory Perceptual Alteration 12
9. Thought Process 13
10. Uni-lateral Neglect 14
11. Summary 15
12. References 16
OBJECTIVES
be able to:
7) Define cognitive perceptual pattern.
8) Enlist the aging changes.
9) Explain the pattern assessment.
10) Describe the conceptual information.
11) Discuss development consideration according
to age.
12) Identify the alterations in cognitive perception.

COGNITIVE PERCEPTUAL PATTERN

Introduction
The cognitive perceptual
pattern deals with thought,
through processes and know-
ledge as well as the way the
patient acquires and applies
knowledge. A major component
of the process is perceiving.
Perceiving incorporates the
interpretation of sensory stimuli.
Definition
According to Erickson
(1923), “Ability to think is
known as cognitive perception.”
Elderly differ from the
younger in serial aspects of
cognitive and parietal function. The most dramatic changes
occur in central nervous system (Peripheral motor nervous
system, autonomic nervous system).
Aging Changes
Aging changes include:
 Decreased brain weight.
 Diminished enzyme activity.
 Solved reflexes.
 Decreased sensory receptors for temperature.
 Weakness of interneuron connections.
 Increased response time.
 Chronic hypoxia.
These changes affect complex processes such as learning,

laughing, memory, language and mutation.
Florence Nightingale 91
2
Pattern Assessment
1. It includes patient’s description of adequacy of special senses.
Vision: Glasses? Content lenses? Regular check ups,
results of test with Snellen chart.
Hearing: Any changes in hearing, difficulty, hearing aid?
Result of testing?
Taste: Any changes? Any persistent taste sensation results
of testing?
Touch: Any decreased or increased tingling sensations?
Results of testing?
Smell: Any changes? Any persistent odor? Result of
testing.
2. Patient’s description of pain, pain acuity, what has been used to
relieve pain, adequacy of this measure.
3. Any problem with decision making, learning and memory.
4. Patient’s feelings about uncertainty of choices.
5. Delayed decision making.
6. Verbal questioning or actual discussion of specific values being
questioned.
7. Physical manifestations of resultant tension due to inability to
make a decision, such as increased heart rate, restlessness,
tension, failure to relax and carryout usual role.
3
8. Inability to feel at ease regarding the threat of the need to make
a decision to resolve a conflict.
9. Inability to feel at ease regarding the threat of the need to make
a decision to resolve a conflict.
A person who has a normal perceptual pattern experiences
conscious thought, is oriented to reality, solves problems, is able to
perceive through sensory input and responds.
All of these functions depend on a healthy nervous system
containing receptors to detect input, a brain which can transport
decoded information, transmitters which can interpret the information,
and transmitters which can transport decoded information. Bodily
response is also a basic requisite to respond to the sensory and
perceptual demands of the individual.
Cognition is the process obtaining and using knowledge about
one’s word with the use of perceptual abilities symbols and reasoning
with human sensory capabilities, the process leads to perception
which is extracting information in such a way an individual
transforms sensory input into meaning.
In the other sense thinking activities may be considered as
internally adaptive response to intrinsic and extrinsic stimuli. The
thought process serves to express inner impulses and appropriate goal
seeking behavior by the individual.
The senses which serve as the origin of perceptual stimuli are:

1. Extractors (distance sensors)
a) Visual
b) Auditory
2. Proprioceptors (near sensors)
a) Coetaneous (sense via skin e.g. pain, tamp)
b) Chemical sense of taste.
c) Chemical sense of smell.
3. Interceptors (deep senses)
a) Kinesthetic sense (which transducers position, motion of
muscles, tendons and joints)
b) Static or vestibular sense (changes related to marinating
position in space and regulation of organic functions such
as metabolism, fluid balance and sensual stimulation.
Conceptual information is also the process of obtaining and
using knowledge about one’s world through the use of perceptual
abilities, symbols and reasoning. For this reason it includes the use of
human sensory capabilities to receive input about the environment.
There are two general approaches to contemporary cognitive theory.
5
1(a). Information Processing Approach – it attempts to understand
human thought.
1(b). Reasoning Process – it is comparing the mind to a sophisticated
computer system.
2. According to Swiss Psychologist, Jean Piaget, the second
approach is based on work. He considered cognitive adaptation
in terms of two basic processes.
a) Assimilation – is the process by which the person integrates
new perceptual data or stimulus events into existing schemata or
existing patterns of behavior.
b) Accommodation – is the process of changing that model the
individual has of the world by developing in mechanisms to
adjust to reality.
The American Psychologist, Jerome Bruner broadened Piget’s
conception by suggesting that the cognitive process is affected by
three modes.
i) The Enactive Modes – involves representation through
action.
ii) The Iconic Mode – uses visual and mental images.
iii) The Symbolic Mode – uses language.
6
Developmental Consideration
1. Infant
The neonate born with the ability to use the senses generally
papillary reflexes in response to light. The sensory hyalinization is
best developed at the birth for hearing, taste and smell.
Vision - in structure of eye macula is not completely
differentiated. The newborn has ability to see an object held within 8
inches in mid line of the visual field. Binocular flexation and
convergence to near object is possible by 4 month of age.
Hearing - the neonate is capable of detecting a loud sound of 90
decibels and reacts. Ear structure is fully developed at birth. However,
the lack of cortical integration and normal pathway prevents special
response to sound. The two month infant turns the side where as
sound comes.
Smell - seems to be a factor in breast- fed infants response to
mother’s engorgement and leaking. Newborn will turn away face
from strong odors e.g. alcohol.
Taste - newborns respond to various solutions with following
gastofacial reflexes.
 A tasteless solution elicits no expression.
 A sweet solution elicits an eager suck and look of
satisfaction.
 Bitter liquid produces an angry, upset expression
 At one year infant appreciate taste flavors
7
Touch - at birth newborn capable for perception of touch with
mouth, hands and soles of feet.
Propriception - the infant at birth is limited in perceiving itself
in space. There is momentary head control, exacting neurological
reflexes provide in depth supplementary data. He prevents from
falling himself at the age of 7 months.
The infant offers localized reaction in response to pain at 6-9
month of age.
2. Toddler
Vision - binocular is well established. He can differentiate in
different colours.
Hearing, smell and touch are developed as the toddler see on
object, handle it and enjoy with it He can prevent himself from
dangerous objects. Toddlers demonstrate tolerance for painful
procedures by understanding.
3. Pre-School
Pre-School has capacity for magical thinking and enjoys role-
play of parent of same-sex. He enjoys in learning colours and using
words in sentences.
4. School Age Child
He develops significant ability to perform logical operations. He
can fellow simple rules and has concept of death. He begins to
interpret the experience of pain source of pain complications and
attempts to establish a trusting relationship to best manage the pain.
8
5. Adolescent
Vision acuity of 20/20 is reached by now. Squinting should be
investigated.
In hearing further investigations should be done who speak
loudly and fail to respond loud noises.
Touch - under reaction to painful stimuli is cause for further
investigations.
Taste - may prefer food fads for length of time.
He complains of foods not tasty as they used to be.
Smell - he can distinguish a full range of odor.
Proprioception - he is capable of formal operational thought and
abstract ideas. There is an interest in values. The adolescent attempts
to deal with pain as adults. Sexuality factor responds.
6. Adult and Older Adult
Vision - the adult is capable of 20/20 vision but gradual decline
in acuity oater 40 years. There is tendency towards far sightedness.
Colour discrimination decrease in later age. Degenerative process
such as macula degeneration light sensitivity, cataract formation
associated with diabetes.
Hearing - the adult has a sensitivity to accurately differentiate
1600 different frequencies. There should be equal sensation of sound
for right and left ear. With the passage of time acuity of hearing
affected.
9
Smell - at age of 60 there may be deterioration of sensitivity for
smell .There may be attired gastrointestinal enzyme production which
interfere the perception of smell.
Touch - the adult is able to discriminate on a wide range of
tactile stimuli e.g., pressure, temperature, pain with aging changes
such as decrease in subcutaneous fat, loss of skin turgor and decease
in conduction of impulses.
Propriocetion - the adult is well co- ordinate and has a keen
sense of his/her body in space. There are multiple protective
mechanisms which maintain balance. The tolerance and thresh hold
one has for pain is well-established.
In later age, a gradual decline in problem solving capacity which
may be aggravated by illness. Focus should be on factors such as
chronic illness, financial deficits and realization of age integrity,
vascular changes and degeneration of brain and CNS disorders
impaired thought process by later age.
10
Alteration in Cognitive Perception

1. Comfort, Altered Pain
A state in which an individual experiences and reports presence
of severe discomfort or an un-comfortable sensation.
Characteristics (Nanda, 1987)
Major defining characteristics are:
1. Subjective: This is communication of pain description.
2. Objective:
a) Guarding behavior, protective.
b) Self focusing.
c) Narrowed focus (time perception; withdraw from
social contact, impaired thought.
d) Distraction behaves (moaning, crying, restlessness,
seeking out other people.
e) Facial mark of pain.
f) Alteration in muscle tone.
g) Autonomic response.
Related Factors - Pain
Injuring agents (biological, chemical, psychological)
Decisional Conflict
The state of uncertainty about choice among competing actions
involving risk, loss or challenge to personal life values.
Florence Nightingale100
11
Major characteristics are:
 Verbalize un-certainty about choices
 Verbalization of undesired consequences.
 Vacillation between alternative choices.
 Delayed decision making.

Minor characteristics are:
 Verbalized feeling of distress.
 Self focusing.
 Physical signs of distress or tension.
 Questioning personal values and beliefs.
Related Factors
 Un-clear personal values or beliefs.
 Perceived threat to value system.
 Lack of experience with decision making.
 Lack of relevant information.
 Support system deficit.
 Multiple sources of information.
Knowledge Deficit
The situation in which individual experiences a lack of
information or has difficulty in applying information thus increases
the risk of actual compromise in health care.
12
 Verbalization of the problem.
 Inaccurate follow through of instruction.
 Inaccurate performance of test.
 In-appropriate behavior.
Related Factors
 Lack of exposure.
 Lack of recall.
 Information minister petition.
 Cognitive limitation.
 Lack of interest in learning.
 Un-familiarity with information resources
Sensory Perceptual Alteration
A state in which an individual experiences a change in the
amount or patterning of incoming stimuli accompanied by a
diminished, exaggerated disoriented or impaired response to such
stimuli.
Major characteristics include:
 Disoriented in time, place and person.
 Altered abstraction.
 Altered conceptualization.
 Change problem solving abilities.
 Change in sensory acuity.
13
 Change in behavior pattern.
 Anxiety, Apathy
 Change in visual response to stimuli.
 Altered communication pattern.
 Complaints of fatigue.
 Alteration in posture.
 Inappropriate responses.
 Hallucinations.
Related Factors
1. Altered environmental stimuli, excessive or insufficient.
2. Altered sensory reception, transmission, integration.
3. Chemical alteration, endogenous (electrolytes), exogenous
(drugs)
4. Psychological stress.
Thought Process
A state in which an individual experiences a disruption in
cognitive operations and activities
Major characteristics include
 Inaccurate interpretation of environment.
 Memory deficits.
 Egocentricity.
Minor characteristics are
 Inappropriate non-reality based thinking.
14
Uni-lateral Neglect
The state in which an individual is perceptually unaware of and
inattentive to one side of the body.
Major characteristics are consistent in attention to stimuli on an
affected side.
 Inadequate self care.
 Positioning precautions in regard to the affected side.
 Do not look toward the affected side.
 Leaves food on plate on the affected side.
Related Factors
Effects of disturbed perceptual abilities e.g., one side blindness,
neurologic illness or trauma.
15
Summary
In this presentation we discussed about cognitive perceptual
pattern’s definition, description, aging changes, normal pattern
assessment, conceptual information, developmental consideration
according to age and alteration in cognitive perception.
If we understand all these topics, we will be able to make
nursing care plan in nursing practice.
Similarly, if we know the normal assessment pattern of
cognitive perception, we will be able to judge the altered cognitive
perception.
16
References
 Tong B.C. and Phipps W.J. (1985). Medical Surgical Nursing: A
Nursing Process Approach. 3rd Edition. Mosby Boston.
Applications of Nursing Diagnosis, Williams and Wilkins
London; pp 339-397.
Clinical Practice. 3rd Edition. J.B. Lippincott Company New
York.
CONCEPTUAL INFORMATION
ALTERATION IN COGNITIVE PERCEPTION


Jamshoro Sindh
Dorothy Orem Theory
Karim Bux
Mrs. Ruth K. Alam
Date:
Dorothy Orem Major Theme
The major theme of Dorothy Orem is “Self Care Needs”.
Dorothy Orem Theory
Dorothy Orem presented “Self Care Model” in 1980. This model has goal of
consistency for the person and speaks to the concept of self care is the person own action that
has pattern and sequence and when effectively informed contribute to the way he or she
developed and function.
Self Care Model
According to Dorothy Orem self care model defined as “the individual needs for self
care action, which is practice of the activities that individual initiates and perform of own
behalf in maintaining life, health and well-being.”
Person
According to Dorothy a person is defined as “unity functioning biologically,
symbolically, and socially”. Three categories of self care needs are:
 Universal.
 Developmental.
 Caused by the health deviations.

It proposed about the human becoming on main three assumptions.
 Human becoming is freely choosing personal meaning in situations in the
intersubjective process o relating value properties.
 Human becoming is co-creating rhythmic patterns or relating in mutual
process with the universe.
 Human becoming is contranscending multidimensionally with the emerging
possibilities.
These three assumptions focus on meaning, rhythmicity, and contranscendence.
 Meaning arises from a person’s interrelationship with the world and refers to
happenings to which the person attaches varying degrees of significance.
 Rhythmicity is the movement toward greater diversity.
 Contranscendence is the process of reaching out to bond the self.
Environment
Dorothy Orem said that environment elements are seen as external to person and
compose of both physical and psychosocial component. Physical components are included as
nutrition, drug and alcohol, sleep, rest, relaxation and exercise body mechanism, posture
grooming are those physical components are important to achieve the physical wellness of
the person. Psychosocial components included as anxiety, emotion, attitude, behavior,
customs, value and belief, family and society these influences on an individual self care.
Self Perception and Concept Pattern
 Body Image – the picture that each of us creates concerning our physical self is called
body image.
 Self Ideal – it is the ideas about who actually makeup the self care up or
perceived self whereas ideas about who I should be form my ideal self e.g.,
“Me that I would like to be”.

 Self Concept – the complete being of an individual comprising both physical and
psychological characteristics and including both conscious and unconscious
components (Miller and Keane, 1992). According to Arnold and Boggs (1995),
self concept is the term given to the part of self that lies within conscious awareness.
It encompasses all that a person perceived, knows values, feels and holds to be true
about his/her identity. It is made up of the conscious components only.
There are four dimensions of self concept.
• Physical dimension.
• Social dimension.
• Psychological dimension.
• Spiritual dimension.
 Self Esteem – is defined as the individual’s personal judgments of his/her own worth.
It is the key of behavior influences thinking process, emotional desires and
values and goals.
Assessment
Subjective Data
In subjective data the client tells me about his health. He says that “he is not feeling
comfortable due to the repeated admission for Diabetic mellitus.
Objective Data
the 50 years old client lying on the bed and looking:
 Lethargic.
 Sunken eyes.
 Irritable in condition.
 Worried.
 Restlessness.
 General weakness.
 Sleeplessness.
 Depression/Anxiety.
 Pus discharge from the wound having foul spell from septic wound.
 Swelling on wound area.
 Fatigue
 Temperature 99.6°F
 Weight 60 Kg
 Hb 8.8 gm/dl
 CP.
 RBS
 Foot X-ray.
 Urine for ketone.
 Electrolytes.
 Health-seeking behaviors.

 Ineffective family management of therapeutic regimen.
 Risk of infection.
 Anxiety related to repeated hospitalization.
Nursing Diagnosis
Anxiety related to repeated hospitalization due to secondary disease process.
Expected Outcome
 The client will cope up with anxiety within 4-5 days.
 Reassure the client  To build up the trust and confidence.
 To encourage for the hygienic care.  To improve the client’s health status.
 Change wound dressing daily.  To prevent the secondary infection.
 To encourage the high protein diet,  To maintain the nutritional

and high caloric low fat diet. requirement of the body.
 To give the diversion therapy  For mentally satisfaction of the

client.
 Allow the family as individual and as  Because due to sharing of feelings

group to show their feelings. the client has be maintained a good
health.
 To provide safe environment.  For mentally relaxation.
 To educate client about the self  To maintain health and prevent

hygienic care. infection.
Evaluation
 The client has verbalized that, I feel comfortable and relax.
 The client has verbalized that he had planned for a regular exercise program to
maintain his health status.

I looked the client’s condition and assessed that the client is looking very happy and
comfortable and achieve my desired goal within target period.
Summary
The Dorothy Orem theory offers way of conceptualizing a disciple in clear exploit
terms that can be communicated to others because opinions about the nature an structure of
nursing vary, this theory continue to be developed. Her theory consists of four major concepts
vary in accordance with personal philosophy. Scientific orientation, experience in affected the
nursing profession and how the nurses developed and enhance their profession. Her model of
self care has goal of consistency for the person and speaks to the concept of self care is the
person own action that has pattern and sequence and when effectively informed contribute to
the way he or she developed and function. In terms of environment, she emphasize on self
care need consisting of physical and psychosocial components, which influence on an
individual self care.

References
New York.
 www.yahoo.com.dorothy orem theory.


Jamshoro Sindh
Jean Watson Theory
Khar-un-nisa
Mrs. Ruth K. Alam
Date:
Jean Watson
PhD, RN, AHN-BC, FAAN
Theory is a group of concept that forms a patter of reality. A theory is a statement that
explains or characterizes a process, an occurrence or an event and is based on observed facts
but lacks absolute or direct proof.
Jean Watson’s Caring Theory is a human to human process of caring. The Theory of
Human Caring was developed between 1975-1979, while engaged in teaching at the
University of Colorado; it emerged from my own views of nursing, combined and informed
by my doctoral studies in educational-clinical and social psychology. It was my initial attempt
to bring meaning and focus to nursing as an emerging discipline and distinct health
profession with its own unique values, knowledge and practices, with its own ethic and
mission to society. The work also was influenced by my involvement with an integrated
academic nursing curriculum and efforts to find common meaning and order to nursing that
transcended settings, populations, specialty, subspecialty areas, and so forth.
From emerging perspective, Jean Watson tried to make explicit nursing's values,
knowledge, and practices of human caring that are geared toward subjective inner healing
processes and the life world of the experiencing person, requiring unique caring-healing arts
and a framework called "curative factors," which complemented conventional medicine, but
stood in stark contrast to "curative factors." At the same time, this emerging philosophy and
theory of human caring sought to balance the cure orientation of medicine, giving nursing its
unique disciplinary, scientific, and professional standing with itself and its public.
Jean Watson’s caring model or theory can also be considered a philosophical and
moral/ethical four for professional nursing and part of the central focus for nursing at the
disciplinary level, model or caring includes a call for both art and science.
Curative factors include the following original work:
 Formation of a Humanistic-altruistic system of values.
 Instillation of faith-hope.
 Cultivation of sensitivity to one's self and to others.
 Development of a helping-trusting, human caring relationship.
 Promotion and acceptance of the expression of positive and negative feelings.
 Systematic use of a creative problem-solving caring process.
 Promotion of transpersonal teaching-learning.
 Provision for a supportive, protective, and/or corrective mental, physical, societal, and
spiritual environment.
 Assistance with gratification of human needs;
 Allowance for existential-phenomenological-spiritual forces.
Major theme of Jean Watson’s Theory is “The Human to Human Process of Caring”.
Person
She defined person as, “A living constantly growing totality comprising mind, body,
emotion and soul.” She viewed person/client as greater than and different from the sum of the
parts and to be valued, cared for, respected, nurtured, understood, and assisted. The
individuality of each person is important.
According to Watson’s assumptions of caring:
 Human caring in nursing is not just an emotion, concern, attitude, or benevolent
desire. Caring connotes a personal response.
 Caring is an intersubjective human process and is the moral ideal of nursing.
 Caring can be effectively demonstrated only interpersonally.
 Effective caring promotes health and individual or family growth.

 Caring promotes health more than does curing.
 Caring responses accept a person not only as they are now, but also for what the
person may become.
 Caring occasions involve action and choice by nurse and client. If the caring occasion
is transpersonal, the limits of openness expand, as do human capacities.
 The most abstract characteristic of a caring person is that the person is somehow
responsive to another person as a unique individual, perceives the other’s feelings,
and sets one person apart from another.
 Human caring involves values, a will and a commitment to care, knowledge, caring
actions, and consequences.
 The ideal and value of caring is a starting point, a stance, and an attitude that has to
become a will, an intention, a commitment, and a conscious judgment that manifests
itself in concrete acts.
Environment
According to Jean Watson, it is “the external reality of the person. Environment
encompasses social, cultural, and spiritual aspects and all the influences of society, which
provides value to determine how a person should behave and the goals to strive toward.”
A caring environment offers the development of potential while allowing the person to
choose the best action for the self at a given point in time.
According to Watson’s caring theory, I assess the client according to health perception
and health management.
Pattern Description
Nurses assist individuals, families, and communities who have limited knowledge or
understanding of:
 Their current health status.

 How to achieve a good health status.
 How to maintain a good health status.
This lack of perception (awareness) leads to problems for the individual or family in
the management (control) of their health status. The nursing diagnoses in this pattern result
from this lack of perception and management.
Pattern Assessment
 Review the client’s vital signs. Is the temperature within normal limits?
 Review the results of the complete blood cell count (CBC). Are the cell counts within
normal limits?
 Review sensory status. Is the client’s sensory-status within normal limits?
 Was client and family satisfied with the usual health status?
 Did the client, family, or community describe the usual health status as good?
 Had the client, family, or community sought any health care assistance in the past
year?
 Did the client, or family follow the routine the prescribed?
 Did the client or family have any accidents or injuries in the past year?
 Is there a disruption of the flow of energy surrounding the person?
 Was the client, family, or community able to meet therapeutic needs of all members?
 Is the client scheduled for surgery, or has he or she recently undergone surgery?
Assessment
I collect information and examine the client about the health perception and health
management and therefore I collect data in the following two ways.
 Subjective Data
In subjective data the client tells me about his health perception and health
management.
 Objective Data
In objective data, I observed and examine the client very carefully and consciously. I
saw a 46 years old client lying on bed and looking here and there.
• Very irritable.
• Looks very anemic.
• Sleeplessness.
• Very weak.
• Depression/Anxiety.
• Dry skin due to malnutrition.
• Uncomfortable.
Vital signs:
• Pulse 100 per min
• Respiration 22 per min
• Blood Pressure 122/72 mmHg.
Investigations:
• Hb 8.8 g/dl
• Weight 49 Kg
 Energy Field Disturbance (A disruption of the flow of energy surrounding a person’s
being which results in a disharmony of the body, mind and spirit).
 Health Maintenance, Altered (Inability to identify, manage, and/or seek out help to
maintain health).
 Health Seeking Behaviors (A state in which an individual in stable health is actively
seeking ways to alter personal health habits and/or the environment in order to move
toward a higher level of health.
 Infection, Risk for (The state in which an individual is at increased risk for being
invaded by pathogenic organisms).
 Injury, Risk for (A state in which the individual is at risk for injury as a result of
environmental conditions interacting with the individual’s adaptive and defensive
resources).
 Management of Therapeutic Regiment (Individual), Effective (A pattern of regulating
and integrating into daily living a program for treatment of illness and its sequelae
that is satisfactory for meeting specific health goals).
 Management of Therapeutic Regimen (Individuals, Families, Communities,
Ineffective).
 Perioperative Positioning Injury, Risk for (A state in which the client is at risk for
injury as a result of the environmental conditions found in the perioperative setting).
 Protection, Altered (The state in which an individual experiences a decrease in the
ability to guard the self from internal or external threats such as illness or injury).
Nursing Diagnosis
 Health maintenance altered.
Related Clinical Concern
 Spiritual distress.
 Ineffective coping.
 Altered family process.
 Activity intolerance or self-care deficit.
 Powerlessness
 Knowledge deficit.
 Impaired home maintenance management.
Expected Outcome
 The client will describe at least (number) contributing factors that lead to health
maintenance alteration and at least one measure to alter each factor by (date).
 The client will design a positive health maintenance plan by (date).
• Assist client to identify factors • Healthy living habits reduce risk.

contributing to health maintenance Assistance is often required to
alteration through one-to-one develop long-term change. Identi-
interviewing and value clarification fication of the factors significant to
strategies. the client will provide the foundation
for teaching positive health
maintenance.
• Develop with the client a list of • Increase client’s sense of control and
assets and deficits as he or she keeps the idea of multiple changes
perceives them. From this list, assist from being overwhelming.
the patient in deciding what lifestyle
adjustments will be necessary.
• Identify, with patient, possible • The more the client is involved with
solutions, modifications, etc., to cope decisions, the higher the probability
with each adjustment. that the client will incorporate the
changes.
• Develop a plan with the client, which • Avoids overwhelming the client by
shows both short-term and long-term indicating that not all goals have to be
goals. For each goal specify the time accomplished at the same time.
the goal is to be reached.
• Have client identify at least two • Provides additional support for

support persons. Arrange for these patient in maintaining plan.
persons to come to the unit and
participate in designing the health
maintenance plan.
• Assist client and significant others to • People most often approach change
develop a list of potential strategies with more of the same solution. If an
that would assist in the development individual does not think that the
of the lifestyle changes necessary for strategy will have to be implemented,
health maintenance. After the list is he or she will be more inclined to
developed, review each item with the develop creative strategies for
client, combining and eliminating change.
strategies when appropriate.
• Develop with the client a list of • Placing items in priority according to

benefits and disadvantages of client’s motivation increases
behavior changes. Discuss each item probability of success.
with the client as to the strength of
motivation that each item has.
• Develop a behavior change contract • Positive reinforcement enhances self-

with the client, allowing the client to esteem and supports continuation of
identify appropriate rewards and desired behaviors. This also promotes
consequences. Remember to establish client control which in turn increases
modest goals and short-term rewards. motivation to implement the plan.
Note reward schedule here.
• Teach client appropriate information • Provides the client with the basic
to improve health maintenance such knowledge needed to enact the
as hygiene, diet, medication needed changes.
administration, relaxation techniques,
and coping strategies.
• Review activities of daily living with • Incorporation of usual activities

client and support person. personalizes the plan
Incorporate these activities into the
design for a health maintenance plan.
• Assist client and support person to • Provides a visual reminder.

design a monthly calendar that
reflects the daily activities needed to
succeed in health maintenance.
• Have client and support person • Permits practice in a nonthreatening

return-demonstrate health mainten- environment where immediate
ance procedures at least once a day feedback can be given.
for at least 3 days before discharge.
Times and types of skills should be
noted here.
• Set a time to reassess with the patient • Provides an opportunity to evaluate

and support person progress toward and to give the client positive
the established goals. This should be feedback and support for
on a frequent schedule initially and achievements.
can then gradually decrease as the
client demonstrates mastery. Note
evaluation times here.
• Communicate the established plan to • Provides continuity and consistency

the collaborative members of the in care.
health care team.
• Refer client to appropriate • Ensures the services can complete

community health agencies for their assessment and initiate
follow-up care. Be sure referral is operations before the client is
made at least 3-5 days before discharged from the hospital. Use of
discharge. the network of existing community
services provides for effective
utilization of resources.
• Schedule appropriate follow-up • Facilitates client’s keeping of

appointments for client before appointments and reinforces
discharge. Notify transportation importance of health maintenance.
service and support persons of these
appointments. Write appointment on
brightly colored card for attention.
Include date, time, appropriate name,
address, telephone number and name
and telephone number of person who
will provide transportation.
Evaluation
 The client has described at least (number) contributing factors that lead to health
maintenance alteration and at least one measure to alter each factor by (date).
 The client has designed a positive health maintenance plan by (date).

Summary
According to Jean Watson theory is the theory of the human to human process of
caring, which rely on unity and harmony within mind, body and soul of the person and the
external reality of the person. Health encompasses a high level of overall physical, mental,
and social functioning and nursing combine the research process with the problem-solving
approach and is concerned with promoting and restoring health, preventing illness and caring
for the sick.
Watson’s theory of human caring has received worldwide recognition and is a major
force in redefining nursing as a caring-health health model. Therefore according to Watson’s
theory, nurses should assist individuals, families, and communities who have limited
knowledge or understanding of their current health status, how to achieve a good health status
and how to maintain a good health status. The nurse uses a caring process to help the
individual achieve an optimal degree of inner harmony to promote self-knowledge, self-
healing, and insight into the meaning of life.

References
New York.
 Jean Watson and the Theory of Human Caring.1.htm (2006). Watson’s Caring Theory:
Theory Evolution.
 Jean Watson and the Theory of Human Caring.2.htm (2006). Watson’s Caring Theory:
Transpersonal Caring and the Caring Moment Defined.
 Jean Watson and the Theory of Human Caring. (2006). Watson’s Caring Theory:
implications of Caring Theory.

Introduction
I am studying in Advance Concepts of Nursing, which is related to nursing care
concepts make theories and are used in patient’s care. Theories provide a framework which is
criteria for sen method for nursing care. My theorist name is “Betty Neuman”. Her major
theme is “Provide holistic are and develop health model system.”
Betty Neuman was born on a farm in Lowell, Ohio in 1924. Her first nursing
education was completed in Peoples Hospital (now named as General Hospital), School of
Nursing in Akron, Ohio in 1947. She completed her BS Nursing in 1957 and then MS in
Mental Health, Public Health Consultation from UCLA in 1966 and finally PhD in clinical
psychology. She began developing health model while a lecture in community health nursing
in the University of California. Major Theme of her model is “provide holistic care and
develop health model system.” Health is equated with optional stability that is the best
possible wellness stale, at any given time.
There are ten basic assumptions underlying Neuman’s Conceptual Framework.
 Though each individual client or group as a client system is unique, each system is a
composite of common known factors or innate characteristics within a normal, given
range of response contained within a basic structure.
 The particular interrelationships of client variable physiological, psychological,
sociocultural-developmental and spiritual at any point in time can affect the degree to
which a client is protected by the flexible time of defense against possible reaction to
a single stressor or a combination of stressors.
 Each individual client/client system, over time, has evolved a normal range of
response to the environment that is referred to as a normal line of defense, or usual
wellness/stability state.
 When the cushioning accordion like effect of the flexible line of defense is no longer
capable of protecting the client system against an environment stressor, the stressor
breaks through the normal line of defense.
 The client, whether in state of wellness or illness is a dynamic composite of the
interrelationships of variables physiological, psychological, sociocultural,
developmental and spiritual wellness is on a continuum of available energy to support
the system in its optimal state.
 Implicit within each client system is a state of internal resistance factors known as
lines of resistance, which function to stabilize and return the client to the usual
wellness state (normal line of defense) or possibly to a higher level of stability
following an environmental stressor reaction.
 Primary prevention relates to general knowledge that is applied in client assessment
and intervention in identification and reduction or mitigation of risk factors associated
with environmental stressor to prevent possible reaction.
 Secondary prevention relates to symptomalogy following a reaction to stressors,
appropriate ranking of intervention priorities and treatment to reduce their noxious
effects.
 Tertiary prevention relates to the adjustive processes taking place as reconstitution
begins and maintenance factors move the client back in a circular manner toward
primary prevention.
 The client is in dynamic constant energy of change with the environment.
Betty Neuman began developing her health system model while a lecture in
community health nursing at the University of California. Her framework is basically a
system model with the major components of stressors, reaction to stressors, and the person. It
is also dynamic and can be altered rapidly over a short period of time. Its effectiveness can be
reduced by such changes as loss of sleep, malnutrition, or any alteration in activities of daily
living. The model was published in 1972 as “A Model for Teaching Total Person Approach to
Patient Problem’s in Nursing Research”. It was refined and subsequently published in the first
edition of conceptual models for nursing practice 1974, and in the second edition in 1980.
Health – the assumption of this model can lead one to see wellness as a dynamic composite
of physical, psychological, sociocultural developmental and spiritual balance that is, flexible
yet retains an unbroken ability to resist disequilibrium. Goal of Nursing – the primary goal of
nursing is the retention and attainment of client system stability. The assessment or
intervention instrument various aspects of Neuman’s model but is flexible enough to allow
for inclusion of any additional data deemed necessary. Factors influencing in use of the
instrument would be the client, client situation. In Neuman’s work the in men is accompanied
by an explanatory section that includes specific role charts to categorize data, and plan for
interventions at all levels. The nurse helps the client through primary,
secondary, and tertiary prevention modes to adjust to environment stressors and maintain
client system stability. In later writings, she stated that health is equated with optimal system
stability, that is the best possible wellness state.
Conclusion
Conceptual models are imperative to the development of nursing as a profession.
Neuman’s total person approach to health care is one such model. In essence, she presents an
approach to viewing the person’s perception of the stressors affecting the part of the whole
individuals in constant interaction with the environment. In as much as the model emphasizes
to total person it transcends the nursing model to become a health care model, applicable to
all health care disciplines. Even though the model is interdisciplinary, it certainly has
universal applicability to nursing. One of its greatest strengths is the clear direction it gives
for interventions through primary, secondary and tertiary prevention. Nursing theory, nursing
research and nursing practice, the applicability of the model to all health disciplines could
foster a common perspective and thereby fail to point over the distinctive contribution of
nursing or any other health disciplines to health care.


Jamshoro Sindh
Moyra Allen Theory
Musarrat Begum
Mrs. Ruth K. Alam
Date:
Moyra Allen Theory
The theory of Moyra Allen is depend on the nature of healthy living, a continuum
process of aging, dealing actively with life situations, losing some functional ability cognitive
interpersonal physiological, withdrawing from life dying, the family or other social group in
which learning is initiated natured and directed, the social context in which learning take
place, this may be at home, the workplace, community group, a hospital or a clinic.
Major Theme
“The nature of healthy living”. According to Moyra Allen, dealing actively with life
situation, losing some functional ability cognitive interpersonal physiological withdrawing
from life dying.
Person
According to Moyra Allen theory, the family or other social group in which learning
is initiated natured and directed throughout life individuals develop notions of their personal
freedom and independence in activities of living. In old age, persons continue to maintain
these notions while coping with the phases of the aging process. Elderly persons who become
ill are placed in a position of dependency and their reaction to this state varies in view of their
past experience and stage of aging. Thus a person still dealing actively with life may exhibit a
high degree of dependency is so doing; while another person may demonstrate much
autonomy of self in approaching death. In other words, aging is reflected in the varying
stages of disengagement of the individual from life, and to some extent, independently of this
disengagement, individuals perceive their ability to control what happens to them, the
decisions they make and the choices or alternatives that are available to them.
Environment
According to Moyra Allen theory, the social context in which learning take place, this
may be at home, the workplace, community group, a hospital or a clinic. In addition to the
perception and status of the individual person, the nurse has a method for making decision
about a person’s need, areas of autonomy the types and number of choices, etc. Her approach
to this problem may be established a prior for the varying phases of aging and disengagement
or, on the other hand, she may respond to the individual and assist him to make his
perceptions and ideas of living operative for him within the hospital or other community
setting. Thus we have differential responses of nursing to aging persons and to their lifestyle.
According to this theory, she focused on the cognitive perception of the client. I,
therefore also assess the client according to cognitive perception.
Pattern Description
Rationality, the ability to think, has often been described as the defining attribute of
human beings. Thus, the cognitive-perceptual pattern becomes the essential premise for all
other patterns used in the practice of nursing. The cognitive-perceptual pattern deals with
thought, thought processes and knowledge as well as the way the client acquires and applied
knowledge. A major component of the process is “Perceiving”. Perceiving incorporates the
interpretation of sensory stimuli. Understanding, how a client thinks, perceives, and
incorporates these processes to best adapt and function is paramount in assisting the patient to
return to or maintain the best health state possible. Alterations in the process of cognition and
perception are an initial step in any assessment.

Pattern Assessment
 Does ICP fluctuate following a single activity?
 Does the client have a problem with appropriate response to stimuli?
 Does the client have a problem with fluctuating levels of consciousness?
 Does the client indicate difficulty in making choices between options for care?
 Is the client delaying decision making regarding care options?
 Has the client been disoriented to person, place, and time for over three months?
 Can the client respond to simple directions or instructions?
 Does the client indicate lack of information regarding his or her problem?
 Can the client restate regimen he or she needs to follow for improved health?
 Review the mental status examination. Is the client fully alert?
 Does the client or his or her family indicate that the client has any memory problems?
 Review sensory examination. Does the client display any sensory problems?
 Does the client use both sides of body?
 Does the client verbalize that he or she is experiencing pain?
 Has the pain been experienced for more than six months?
 Does the client display any distraction behavior?
Assessment
I collect information and examine the client about cognitive perception and collect
data in the following two ways.
 Subjective Data
In subjective data the client tells me about his cognitive perception.
 Objective Data
In objective data, I observed and examine the client very carefully and consciously.
I saw a 40 years old client lying on bed and looking here and there.
Major Defining Characteristics
 Distraction behaves (moaning, crying, restlessness, seeking out other people).
 Physical significant (signs of distress or tension).
 Behavior (inappropriate behavior).
 Orientation (with time, place and person).
 Memory (memory deficits).
 Consistent in attention to stimulation.
 Adaptive capacity, decreased intercranial.
 Confusion, acute and chronic.
 Decisional conflict.
 Environmental interpretation syndrome, impaired.
 Memory, impaired.
 Pain.
 Sensory-Perceptual alteration.
 Thought process, altered.
 Unilateral neglect.
Nursing Diagnosis
 Chronic pain
Related clinical concerns:
• Any surgical diagnosis.

• Any condition labeled chronic, for example rheumatoid arthritis.
• Any traumatic injury.
• Any infection.
• Anxiety or stress
• Fatigue.
Expected Outcome
 The client will verbalize a decrease in pain within 1-2 days.
 The client will practice selected noninvasive pain relief measures.
 The client will verbalize an increase in psychological and physiological comfort level
and demonstrate ability to cope with anxiety as evidenced by normal vital sign and a
verbalize reduction in pain intensity within one week.
• Establish trusting relationship with • Promotes accurate assessment.

client.
• Allow the client to talk about • Promotes nurse-client relationship.
condition.
• Assess client’s level of pain • Determines a baseline for further
determining the intensity at its beast assessment.
and worst.
• Listen to client while he or she • Acknowledging client’s pain
discusses the pain, acknowledge the decreases anxiety by communicating
presence of pain. acceptance and validating his or her
perceptions.
• Teach relaxation techniques such as • Reduces skeletal muscle tension and
deep breathing, progressive muscle anxiety, which potentates the
relaxation, and imagery. perception of pain.
• Teach client and his family about • Make the client and his family aware
treatment approaches (biofeedback, of the availability of treatment
hypnosis, massage therapy, physical options.
therapy, acupuncture and exercise).
• Teach client about the use of • Lack of knowledge and fear may
medication for pain relief. Provide prohibit the client from taken
accurate information to reduce fear of analgesic medications as prescribed.
addiction.
• Encourage the client to rest at • Fatigue increases the perception of
intervals during the day. pain.
Evaluation
 After practicing relaxation techniques, the client rates his pain as a 2 to 3 on the pain
intensity scale.
 The client has demonstrated the use of deep breathing and progressive muscles
relaxation.
Summary
The Moyra Allen theory is a social process, a way of living rather than a state of
being, and similar in meaning to health behavior. It is something that can be measured and
can be modified. A professional response to the person’s nature search for health living and
assist people to enhance their problem solving skills in dealing with health matters.
Pain may be define as an unpleasant sensory and emotional experience associated
with acute or potential tissue damage and whenever, the client says, it is existing, whenever
the client says it does.
Invasive techniques are interventions used when the noninvasive and pharmacological
measures do not provide adequate relief, methods include nerve block, neurosurgery,
radiation therapy and acupuncture.
According to Moyra Allen aging is reflected in the varying stage of disengagement of
the individual from life and to some extent independently of this disengagement individuals
perceive their ability to control what happens to them, the decisions they make, and the
choices or alternatives that are available to them.

References
 Article published in Nursing Papers (1972). 4(2):23, 33. (National Health Grant
Project No. 604-7-667).
New York.
 White, L. (2001). Foundations of Nursing: Caring for the Whole Person. Demar
USA.

Jamshoro Sindh
Jean Watson Theory
Nazia Javed
Mrs. Ruth K. Alam
Date:
Theory is a group of concepts that form a pattern of reality. It is a statement that
explains or characterizes a process, an occurrence or an event and is based on observed fact
Theory is defined as:
 A set of proper argued ideas intended to explain facts or event.
 It is a statement that purports to account for or characterizes some phenomena.
Nursing Theory is any description or explanation the phenomena about nursing and
patient care. It is also the purpose of describing, explaining, predicting and controlling
desired outcomes of nursing care and practices.
The theory of the Jean Watson depends on man living health. Human beings are
inseparable interchanging energy unfolding together for greater complexity and diversity and
influencing one another’s rhythmic patterns of relating. The Jean Watson Theory is about
human caring and also described health, nursing about health and goal of nursing.
Health – According to Jean Watson health is “unity and harmony within mind, body
and soul of the person encompasses a high level of overall physical, mental and social
functioning.” It is a subjective state, one which each person defines.
Nursing About Health – According to Jean Watson, the definition of nursing about
health is “a human art and science directed towards the protection, enhancement and
prevention of human dignity.”
Jean Watson also described nursing as:
 Human caring in nursing is not just an emotion, concern, attitude, or benevolent desire
caring cannot a personal response.
 Caring is an intersubject human process and is the moral ideal of nursing.
 Caring can be effectively demonstrated only interpersonally.
 Effective caring promotes health and individual or family growth.

 Caring promotes health more than does caring.
 Caring responses accept a person not only as they are now, but also for what the
person may become.
 A caring environment offers the development of potential while allowing the person
to choose the best action for the self at a given point in time.
 Caring, occasions involve action and choice by nurse and client. If the caring occasion
is transpersonal, the limit of openness expands, as do human capacities.
 The most abstract characteristics of a caring is that the person is somehow responsive
to another person as a unique individual, perceives the other’s feelings and sets one
person apart from another.
 Human caring involves values, a will and a commitment to care, knowledge caring
action and consequences.
 The ideal and value of caring is a starting point, a stance, and an attitude that has to
become a will, an intention, a commitment and a conscious judgment that manifests
itself in concrete acts.
According to the theory of Jean Watson, the goal of nursing, are to help people, gain
more self knowledge, self control and readiness for self healing regardless of the external
health condition.
Nursing intervention related to human care referred to as “curative factor” a guide
Watson refers to as the “core of nursing”. Watson outlined the following ten factors.
 Forming a humanistic altruistic system of values.
 Instilling faith and hope.
 Cultivating sensitivity to one’s self and others.
 Developing a helping trust (human care) relationship.
 Promoting and accepting the expression of positive and negative feeling.

 Systematically using the scientific problem-solving method for decision making.
 Promoting interpersonal teaching – learning.
 Providing a supportive, protective or corrective mental, physical, sociocultural, and
spiritual environment.
 Assisting with the gratification of human needs.
 Allowing for existential – phenomenologic forces.
Watson's theory of human caring has received worldwide recognition and is a major
force in redefining nursing as a caring-healing health model.
Functional Health Pattern – the nursing care plan that is very much interrelated to
this theory. The best and suitable pattern is the health perception/health management, because
in this theory life and if he/she knows about health perception/health management, I think
he/she maintains the good health. Good health is a part of our life and it our health is not
good or healthy, we cannot do anything. So according to this theory health perception and
health management of the patient/client is very important and I assess the client.
Nursing Care Plan
According to this pattern:
Assessment - I collect information and examine the patient about health status and
also assess the client thought two ways: subjective data and objective data.
Subjective Data
In subjective data the client tells me about his health. He tells me, he is not feeling
comfortable and having weekness since last one month.
Objective Data
In objective data I observe and examine the client very carefully and consciously.
I look the 30 years old male patient lying on bed and looking:
 Worried
 Non cooperative
 Disturb nutrition pattern
 Nausea and vomiting
 Lack of self-confidence
 Irritability
 Angry out bursts
 Crying
Vital Sign
 Temperature: 98 °F
 Blood Pressure: 110/70 mmHg
 Pulse rate: 98 per min
 Respiration rate: 22 per min
Investigations
 Haemoglobin: 7.8 g/dl
 Weight: 50kg
Nursing Diagnosis
Health maintenance altered due to anxiety secondary to disease process.
Expected Outcome
The client will relate improvement of health maintenance within 7-10 days.
 Decrease level of anxiety within 7 days.
 The person will be increase psychological and physiologic comfort.

Assess the client to identity the level of These actions help the client.
anxiety.
Help the client to coping pattern and their Identify usual coping mechanism.
effectiveness.
Provide reassurance and comfort. Try to Decrease the sense of aloneness.

stay with the client
Decrease sensory stimulation. Excessive stimulation may increase the

client anxiety.
Provide privacy and assist the client to Client will feel more easier to express
express feelings. in supportive environment.
Support the client to expressing feeling of Provide accurate information and

grief or anger, reduce to change body reduce anxiety.
image.
Convey a sense of empathic Touch and allow crying decrease the

understanding. sense of aloneness.
Establish the trusting relationship. Gain confidence.
Allow the family as individual’s and as a Due to sharing of feelings, the client
group to share their feelings. can maintain good health.
Evaluation
The patient verbalized that I am relax and reduce anxiety.
I look the patient condition and arsers that I achieve my goal and patient is
comfortable better then before.
Patient anxiety has relieve and facial expression showed taking food and asleep very
comfortable .He is very relaxed and free from anxiety
 Energy filled disturbance.
A disruption, the flow energy surrounding a person, which results in disharmony of
the body, mind and spirit.

 Health maintenance altered
Inabilities to identify manage and seek out help to maintain health.
 Health seeking behavior
A state in which individual in stable health is actively seeking way to alter personal
health habits in order to move toward a higher of health.
 Infection risk for
The state in which an individual is at increased risk for being invaded by pathoyenic
organisms.
 Injury risk for
A state in which the individual is at risk for injury as a result of environment
condition.
 Management of therapeutic regimen
A pattern of regulating and integrating into daily living a program for treatment of
illness.
 Preoperative positioning injury risk for
A state in which the client is at risk for injury, as a result of the environmental
condition found in the preoperative setting.
 Protection altered
The state in which an individual experience a decrease in the ability to guard the self
from internal or external threats.

References
 Barbara, Kozier Glenora Erb Audrey, Jean and Karen Burke. Fundamental of Nursing
6th Edition. Pp. 39 to 44.
 Lynda Suall Carpenito- Moyet. Nursing diagnosis. 10th edition.

Liaquat University of Medical & Health Sciences, Jamshoro Sindh
BScN Year-I, Session 2006-2008
Madeleine Leininger Theory
Advance Concept of Nursing
Naheed Jamal
Mrs. Ruth K. Alam
Dated: _____________
Madeleine Leininger Theory is a development and current status of transcultural
nursing. In 1970, she observed that one of authropology’s most important contributions to
nursing is, “the realization that health and illness status are strongly influenced and often
primarily determined by the cultural background of an individual”.
Madeleine described the major theme, the person and the environment.
Major Theme – A major aim of transcultural nursing is to understand and assist
diverse cultural groups and members of such groups with their nursing and health care needs.
A through assessment of the cultured aspects of a client’s lifestyle, health beliefs and health
practices will enhance the nurse’s decision making and judgment when providing care.
Nursing interventions that are culturally relevant and sensitive to the needs of the client
decrease the possibility of stress or conflict arising from cultural misunderstandings.
Person – Often problems occur when persons from two cultural backgrounds with
conflicting values meet unless at least one person is willing and able to recognize and adapt
to the values of the other. One method for reducing potential misunderstandings is to sensitize
nurses to their own cultural biases and behaviors as well as to those of their clients. Both the
process of sensitization and the result more sensitive and effective nursing care, are the
concerns of transcultural nursing.
Environment – A conceptual framework in the environment of transculture clarifies
what is important to the development of theory in transcultural nursing. As the model shows
all four concepts must be interrelated to produce transcultural nursing knowledge because the
focus in transcultural nursing is on the cultural dimension of care, each concept is approached
from his perspective. When nurses understand the four central concepts involved, which are
environment, health, people and nursing, they can provide effective transcultural nursing care
to clients. Transcultural nursing care also be provided to childbearing women and her family,
children and adolescents and middle age adults.
Model for Components in Transcultural Nursing
Environmental/Culture People
Physical Cultural variations

Social Biological variations
Health/illness behaviors
Symbolic
Theory
TRANSCULTURAL NURSING
Education Research
Practice Nursing
The professional nurse

Health Nurse-client interactions
(cultural encounters)
Major belief paradigms Nursing care concepts
Art and practices of healing Nursing care practices
Health care system Nurse/provider culture
According to this theory, Madeleine focused on the value and belief of the client and I
assess the client according to value and belief pattern.
Assessment
I collect information and examine the client about value and belief related the
transculture. I assess the client through two ways.

Subjective Data
In subjective data the client tells me about his culture. He tells me his values and
beliefs are very strong about his culture.
Objective Data
 Lethargic.
 Challenged beliefs and values system. For example, due to moral or ethical
implications of therapy due to intense suffering.
Nursing Diagnosis
Spiritual distress (distress of the human spirit).
Expected Outcome
Because of the largely subconscious nature of spiritual beliefs and values, it is
recommended that the target data be at least 5 days from the data of diagnosis.
Assist patient to identify and define his Clarifies values and beliefs and helps
or her values, particularly in relation to patient understand the impact of values
health and illness, through the use of and beliefs on health and illness.
value clarification, rank-ordering
exercises, and completion of health
values scales.
Demonstrate respect for and acceptance Spiritual values and beliefs are highly
of the patient’s value and spiritual system personal. A nurse’s attitude can
by not judging, moralizing, arguing, or positively or negatively influence the
advising changes in values or religious therapeutic relationship.
practices.
Adapt nursing therapeutics as necessary Maintains and respects patient’s

to incorporate values and religious preferences during hospitalization.
beliefs, e.g., diet, administration of blood
or blood products, or rituals.
Schedule appropriate rituals as necessary, Provides comfort for patient.

e.g., baptism, confession, or communion.
Arrange visits from needed support Promotes comfort and reduces anxiety.
persons, e.g., pastor, rabbi, priest, or
Provide privacy for religious practices Allows for expression of religious

and rituals as necessary. practices.

symbols to patient.
Plan to spend at least 15 min twice a day Promotes mutual sharing and builds a
at (times) with patient to allow trusting relationship.
verbalization, questioning, counseling,
and support on a one-to-one basis.
Assist patient to develop problem-solving Involves patient in self-management

behavior through practice of problem- activities. Increases motivation.
solving techniques at least twice daily at
(times) during hospitalization.
Evaluation
The client verbalize that he feels more comfortable spiritually.
According to Madeleine Leininger theory, transcultural nursing is a humanistic and
scientific area of formal study and practice in nursing which is focused upon differences and
similarities among cultures with respect to human care, health and illness based upon the
people’s cultural values, beliefs, and practices and to use this knowledge to provide cultural
specific nursing care to people. Nurses, who have more direct interactions with clients than
any other health team member, should be especially aware of the cultural aspects of nursing
care. Application of transcultural nursing principles can lead to more effective and sensitive
encounters between clients and nurses.

Conclusion
It is concluded that concept of transculture facilitate nursing care that is culturally
relevant and help nurses work more effectively with clients from different cultures. Nurses,
who have more direct interactions with clients than any other health team member, should be
especially aware of the cultural aspects of nursing care. A major aim of transcultural nursing
is to understand and assist diverse cultural groups and members of such groups with their
nursing and health care needs. The development of the theory of transcultural nursing can be
traced to the work of early leaders in the field, who were interested in applying concepts,
primarily from anthropology, to nursing care.
Several themes emerge from this definition. First, cultures can be compared and
contrasted with respect to health beliefs, health behaviors, and nursing care measures.
Second, the goal of such study is to identify, test, refine, and apply such knowledge to the
provision of culturally relevant care. Third, the outcome of such study is a body of
knowledge useful to the practicing nurse. Fourth is the idea that this body of knowledge
defines transcultural nursing.

References
 Cox, H.C. et al. Clinical Applications of Nursing Diagnosis: Adult, Child, Women’s
Psychiatric, Gerontic, and Home Health Considerations. 3rd Edition.
 www.cultrediversity.org/basic.htm. The Basic Concepts of Transcultural Nursing.
Retrieved on November 18, 2007.


Jamshoro Sindh
Margrate Campbell Theory
Romana Javed
Mrs. Ruth K. Alam
Date:
The UBC model for nursing was developed in 1972, which takes the position that
individual behavior is motivated by basic that universal human needs, even though we may
have dramatically diverse individualized goals that we aim for within these needs.
Major Theme
Margrate Campbell’s theory major theme is “The person as a behavioral system with
interacting and interdependent subsystem each is representing a basic human need.”
Margarate Campbell’s U.B.C. Model of Nursing
The U.B.C Model of Nursing conceives of individual systems composed of nine
subsystems or, one together represents the whole. The main prime systems theory that are,
critical for our purpose while all of the parts interact to make a whole understand parts “as if”
they were separate in step in learning how to understand whole system their complexity.
The model tells us that there is no “random” behavior in the behavior of people can be
understood, when people act in a manner that seems counter productive, they are doing so for
the purpose of attempting to meet one or more of their needs.
In the UBC model, the system is made up of subsystems, each of which represents
one of need. The names assigned to reflect the need they represent and are:
Need and Goal of Nine Subsystems
Subsystem Need (Universal) Goal (Individualized)
Achieving Mastery Feelings of accomplishment;

satisfaction with accomplishments
Affective Love, belongingness and Feelings of love, belongingness

dependence and dependence
Ego-Valuative Self respect Self esteem
Excretory Collection and removal of Absence of accumulated wastes

accumulated wastes
Ingestive Intake of food and fluid; Nourishment; satisfaction of

nourishment hunger and thirst.
Protective Safety and security Integrity of the system.
Reparative Balance between production Capacity for activity.

and utilization of energy
Respiratory Intake of oxygen Oxygenation; easy respirations.
Satiative Stimulation of the system’s Sensory satisfaction senses.
The subsystems of U.B.C. Model of Nursing also coincide with the Maslow’s
Hierarchy of needs model, which is as under:
Self-actualization
Esteem Self-esteem
Love Belonging Closeness

Maslow’s Safety Security Protection
Sex Activity Exploration Manipulation Novelty
Food Air Temperature Elimination Rest Pain avoidance
Hierarchy of Needs Model

Health
According to Margrate Campbell, “Optimal health is the highest level of behavioral
system stability perceived by an individual as achievable at any given time”. The behaviors
or the range of the behaviors that an access to in order to meet a particular need in the
subsystem structure. The philosophy of basic human needs tells us that the need produce and
continual striving towards meeting them. In general people repertoire of coping behaviors
from which in order to maintain meeting their need such breathing to meet the basic needs for
oxygen make predictable adaptations to meet need changing circumstances.
The questions of when nurses should or should not involve themselves with an
individual as client have become increasingly more complex with time. Decades ago, sick
people needed nurses, well people did not. More recently nursing considered its mandate as
clients who were hospitalized.
Definition of Nursing
According to Margrate Campbell, “The nurturing of individuals experiencing critical
periods in the life cycle, so that they may develop and use a range of coping behaviors that
prevent them to satisfy their basic human needs, to achieve stability and to reach optimal
health”. Margrate Campbell’s subsystem structure includes the inner need, abilities and
coping behaviors, as well as psychological environment, with the individualized goals and
forces some understanding of all important for the nurse to understand client as a behavioral
system.
Goal of Nursing
In the context, Margrate Campbell stated that, “To nurture the behavioral system that
is the person.” As the Margrate Campbell’s theory focused on the basic needs of human i.e.,
nutrition, I therefore, decided to study a case having nutritional imbalance less than body
requirement.
 Adjustment impaired.
 Coping ineffective individual.
 Altered nutrition (less than body requirements)
 Fluid volume deficit.
 Impaired skin integrity.
 Post trauma syndrome.
Assessment
I assess the client carefully and collect information. I examine the client though the
following two ways.
 Subjective Data
The client tells about her nutritional status. She is eating less with less intake of water,
resulting loss of weight from the last six months.
 Objective Data
A 50 years old woman lying on bed in restless condition with:
• Lethargic.
• Fatigue.
• Pale.
• Sleeplessness.
• Sunken eyes.
Her vital signs are:
• Blood Pressure 100/80 mmHg
• Temperature 98°F
• Pulse 90 per min.

• Respiratory rate 20 per min.
Investigation performed includes:
• CBC
• LFT’s
Nursing Diagnosis
Nutrition imbalance, less than body requirement related to decrease desire of eat.
Expected Outcome
The client will be take daily requirement of diet and also increase desire of eat within
2-3 days.
• Reassure the client • To build trust and confidence.
• Determine daily calorie requirement. • To improve health status.
• Explain the importance of adequate • To give knowledge about nutrition.

nutrition.
• Make diet menu and ask about • To increase interest in eating food.
favorite dishes of client.
• Provide pleasant and relaxed • To give psychological support.

atmosphere
• Teach good oral hygiene • To increase desire of eating.
• Offered frequent small feeding (six • To give nourishment.

per day plus snacks)
• Teach the client to use spices to help • To change taste.

improve the taste and aroma of food.
• Give medicine to improve desire of • To provide energy.

eat as prescribed.
Evaluation
 The client has expressed desired of eat food.

 The client has gained weight and made plan to use balance diet.
Summary
The philosophy of basic human needs tells us that the need produce and continual
striving towards meeting them. In general people repertoire of coping behaviors from which
in order to maintain meeting their need such breathing to meet the basic needs for oxygen
make predictable adaptations to meet need changing circumstances.
Margrate Campbell’s subsystem structure includes the inner need, abilities and coping
behaviors, as well as psychological environment, with the individualized goals and forces
some understanding of all important for the nurse to understand client as a behavioral system.
Her model “The UBC Model for Nursing” is a mechanism for the development and
refinement of systematic thinking in nursing at the same time as it orients the nurse towards
some rather than complex and abstract values about clients and nursing. It creates a means by
which holistic interpretation can be developed, individual meaning understood, and context
specific plans created by encouraging a systematic, holistic clinical reasoning process. It aims
to provide the beginning nurse with coherent intellectual directions and the more experienced
nurse with a strong logical structure on which to defend and articulate skilled nursing
judgments.
References
 Bigge, M.L. (1971). What is Field Psychology in Learning Theories for Teachers.
2nd Edition. Harpes and Row New York.
 Campbell, M.A. (1987). The UBC Model for Nursing Direction for Practice .
New York.
 http://216.109.125.130/search/cache.p=margaret Campbell UBC model of nursing.
Need and Goal of Nine Subsystems.


Jamshoro Sindh
Hildegarde Peplau Theory
Sharifa Bibi
Mrs. Ruth K. Alam
Date:
Hildegarde Peplau Theory
Hildegarde Peplau (1952), widely regarded as a pioneer among contemporary nursing
theorists and herself a psychiatric nurse, defined nursing in interpersonal terms: “Nursing is a
significant, therapeutic, interpersonal process, Nursing is an educative instrument that aims to
promote forward movement of personality in the direction of creative, constructive,
productive, personal and community living”. She reinforced the idea of the client as an active
collaborator in his own care.
Major Theme
Hildegrade Pepalu major theme is "Psychodynamic Nursing - Interpersonal process
within the Nurse-Patient Relationship”.
Peplau's training in mental health evident in her work. Her theory is not useful if
patient unable to interact. Focuses only on individuals; not communities or groups
Person
A self-system of biochemical, physical, and psychological characteristics and needs
(with emphasis on the psychological). It is defined as an individual organism who lives in an
unstable equilibrium. Peplau's model describes the individual as a system comprising the
components of the physiological, psychological and social spheres. The model views the
individual as being an unstable system where equilibrium is a desirable state, but occurs only
through death. This is supported by Peplau's statement that "man is an organism that lives in
an unstable equilibrium (i.e., physiological, psychological, and social fluidity) and life is the
process of striving in the direction of stable equilibrium, i.e., a fixed pattern that is never
reached except in death".
Environment
Within the concept of the environment, Peplau's Interpersonal Relations Model
sharply differs from other models pertaining to nursing. The model views the environment as
being and occurring in the context of the nurse client relationship. The interpersonal focus of
the model on this relationship is unique as it examines not only the client, but also the self-
reflection of the nurse in the context of the ongoing relationship between the nurse and the
client. This interpersonal relationship between the nurse and the client as described by Peplau
has four clearly discernible phases. These phases are orientation, identification, exploitation
and resolution. Each of these phases are seen as being interlocking and requiring overlapping
roles and functions as the nurse and the client learn to work together to resolve difficulties in
relation to health problems.
During the orientation phase of the relationship, the client and nurse come together as
strangers meeting for the first time. During this phase, the development of trust and
empowerment of the client are primary considerations. An essential component during
orientation as described by Peplau is "The patient needs to recognize and understand his
difficulty and the extent of need for help". This is best achieved by encouraging the client to
participate in identifying the problem and allowing the client to be an active participant in
what is of concern to them. Peplau stated that "such orientation is essential to full
participation and to full integration of the illness event into the stream of life experiences of
the patient". The client, by asking for and receiving help, will feel more at ease expressing
their needs knowing that the nurse will take care of those needs. Once orientation has been
accomplished, the relationship is ready to enter the next phase.

During the identification phase of the relationship, the client in partnership with the
nurse, identify problems that require working on within the relationship. At this stage, the
client will selectively respond to a nurse that seems to offer the kind of help needed by the
client. Once the client has identified the nurse as a person willing and able to provide the
necessary help, the main problem and other related sub-problems can then be worked on, in
the context of the nurse client relationship. Throughout the identification phase, both the
nurse and the client must clarify each other's perceptions and expectations. The perceptions
and expectations of the nurse and the client will affect the ability of both to identify problems
and the necessary solutions. When clarity of perceptions and expectations is achieved, the
client will learn how to make use of the nurse client relationship. In turn, the nurse, will make
full use of their professional education to assist the client in achieving full use of the
relationship. Once identification has occurred, the relationship enters the next phase.
During the phase of exploitation, the client takes full advantage of all available
services. The degree to which these services are used is based upon the needs and the interest
of the client. During this time, the client begins to feel like an integral part of the helping
environment and starts to take control of the situation by using the help available from the
services offered. Within this phase, clients begin to develop responsibility and become more
independent. From this sense of self-determination, clients develop an inner strength that
allows them to face new challenges. This is best described by Peplau who stated that
"Exploiting what a situation offers gives rise to new differentiation's of the problem and to
the development and improvement of skill in interpersonal relations". It's important to note
that although the nurse client relationship may predominately be more in one phase, all
phases can be seen in every interaction between the nurse and the client. As the relationship
passes through all of the aforementioned phases and the needs of the client have been met,
the relationship passes to closure or the phase of resolution.

Resolution occurs when all of the needs of the client are met. Peplau states "the stage
of resolution implies the gradual freeing from identification with helping persons and the
generation and strengthening of ability to stand more or less alone".
 Caregiver role strain.
 Role performance, ineffective.
 Family coping, readiness for enhanced
 Disabled family coping.
 Anxiety
 Family process interrupted.
 Coping, ineffective community.
 Coping, ineffective individual.
 Parenting, impaired.
Assessment
I assess the client according to the role relationship pattern. I collect information and
examine the client though the following two ways.
 Subjective Data
According to the client, he was alright before fracture of femur. He developed fever
and hospitalized for last three months. Being head of the family, he is having
tension/stress of his family responsibilities for daily living and who is taking care of
them. Therefore, presently, he is total unaware about what is his role in his family
being a father.
 Objective Data
A 40 years old man lying on bed in restless condition, with:
• Weakness.
• Fatigue.
• Anxiety.
• Pale skin.
• Pulse 100 per minute.
• Blood Pressure 120/80 mmHg.
Nursing Diagnosis
Parental role conflict related to illness (Fracture femur).
Expected Outcome
The client will:
• Verbalize the role of being parent in the family at end of my shift.
• Develop broad minded sense for his parental role in his family.
• Reassure the client. • To relieve anxiety of the client.
• Relaxing to helping the client. • To reduce client’s tension and

anxiety.
• Encourage the client to take caregiver • To give moral and psychological

role by active listening and reflection support to the client.
• Discuss the expectations and the role • To clear the role ambiguity and
conflict. understanding of role.
• Encourage the client to think deeply • To provide relaxation to the client so

usually in silence in order to relax. that he or she can think about actual
problem with less tension and
anxiety.
• Facilitate the client for charm and • To relieve fatigue and feel fresh.
quite.
• Encourage the client to think • To reduce ambiguity and tension.

positively.
• Develop the faith over good and • Family can provide mental and
improve mutual understanding with psychological support.
family.
Evaluation
 The client has verbalized the role of being parent in the family.
 The client has developed broad minded sense for his parental role in his family after
discharge.
Summary
According to Hildegarde Peplau Theory, defined nursing in interpersonal terms:
“Nursing is a significant, therapeutic, interpersonal process, Nursing is an educative
instrument that aims to promote forward movement of personality in the direction of creative,
constructive, productive, personal and community living”. Peplau's training in mental health
evident in her work. Her theory is not useful if patient unable to interact.
Peplau's model describes the individual as a system comprising the components of the
physiological, psychological and social spheres. The model views the individual as being an
unstable system where equilibrium is a desirable state, but occurs only through death.
Peplau's Interpersonal Relations Model views the environment as being and occurring
in the context of the nurse client relationship. The interpersonal focus of the model on this
relationship is unique as it examines not only the client, but also the self-reflection of the
nurse in the context of the ongoing relationship between the nurse and the client. This
interpersonal relationship between the nurse and the client as described by Peplau has four
clearly discernible phases. These phases are orientation, identification, exploitation and
resolution. Each of these phases are seen as being interlocking and requiring overlapping
roles and functions as the nurse and the client learn to work together to resolve difficulties in
relation to health problems.

References
 Chitty, K.K. (1993). Professional Nursing: Concepts and Challenges. W.B. Saunders
Co. Philadelphia.
New York.
 wps.prenhall.com/…/0,11275,2665105-2665118,00.html. Peplau, H.E. (1992).
Interpersonal Relations in Nursing.
 http://www.hsc.dlsu.edu.ph/cnm/lectures/nsg%20theories .doc

Jamshoro Sindh
Sister Callista Roy Theory
Shamim Lawrence
Mrs. Ruth K. Alam
Date:
Sister Callista Roy
Sister Callista Roy is a highly respected nurse theorist, writer, lecturer, researcher and
teacher who currently hold a position of Professor and Nurse Theorist at the Boston College
School of Nursing in Chestnut Hill, MA. She teaches courses on epistemology of nursing and
strategies for creating knowledge at the master's and doctoral levels, as well as directing
doctoral dissertation research. Her current scholarly interests include research involving
families in the cognitive recovery of patients with mild head injury and nurse coaching as an
intervention for patients after ambulatory surgery. In addition, she is also interested in
conceptualizing and measuring coping, developing the philosophical basis of adaptation
nursing including the distinction between veritivity and relativity, and in group projects on
emerging nursing knowledge and practice outcomes.
Sister Callista Roy Theory
The major concepts of Sister Callista Roy’s theory are the person or group as an
adaptive system; the environment as internal and external stimuli; health as being and
becoming whole and integrated; and nursing as the art and science of promoting adaptation.
The philosophic and scientific assumptions are basic underlying concepts. The model aims to
direct nursing practice, research and education. The widespread us of the model in each of
these areas is well documented, for example, in all areas of practice, all levels of education,
and in quantitative and qualitative research. According to Sr. Callista Roy, "The model
provides a way of thinking about people and their environment that is useful in any setting. It
helps one prioritize care and challenges the nurse to move the patient from survival to
transformation."
Major Theme
The major theme of Dr. Roy’s theory is “Adaptation”.
Adaptive Modes of Sister Callista Roy

Adaptive Modes Individual Group

Five needs-oxygenation, nutrition,
elimination, activity and rest,
Operating resources: partici-
protection. Four complex processes-
Physiologic-physical pants, capacities, physical
senses; fluid, electrolyte, and acid-base
facilities, and fiscal resources
balance; neurologic function;
endocrine function
Need is group identity integrity
through shared relations, goals,
Need is psychic and spiritual integrity
values, and coresponsibility for
Self-concept-group so that one can be or exist with a sense
goal achievement; implies
identity of unity, meaning, and purposefulness
honest, soundness, and
in the universe
completeness of identifications
with the group
Need is role clarity,
Need is social integrity; knowing who understanding and committing
one is in relation to others so one can to fulfill expected tasks so
acct; role set is the complex of group can achieve common
Role function positions individual holds; involves goals; process of integrating
role development, instrumental and roles in managing different roles
expressive behaviors, and role taking and their expectations;
process complementary roles are
regulated
Need is to achieve relational
integrity using processes of
Need is to achieve relational integrity developmental and resource
using process of affectional adequacy, adequacy, i.e., learning and
Interdependence i.e., the giving and receiving of love, maturing in relationships and
respect, and value through effective achieving needs for food,
relations and communication shelter, health, and security
through independence with
others
As the discipline of nursing grew in articulating its scientific and philosophical
assumptions, Dr. Roy also articulated her assumptions. Early descriptions included systems
theory and adaptation-level theory, as well as humanist values. Later Dr. Roy developed the
philosophical assumption of veritivity as a way of addressing the limitations she saw in the
relativistic philosophical basis of other conceptual approaches to nursing and a limited view
of secular humanism.
Health
Health: a state and process of being and becoming integrated and whole that reflects
person and environmental mutuality. It has a number of meanings depending on the purpose,
time or circumstances governing its use. Dr. Roy defined health as “Health is a function of
the degree of change and the state of the person experiencing the change”. It is an ideal state
or exuberant well-being, ability to fulfill social roles or to contain or limit symptoms and a
strong sense of coherence. There are no universal norms of health perceptions vary across
individuals and cultures. Health is viewed as a formal wholeness or completeness which
continually changes.
According to Dr. Roy, “Nursing is the science and practice of promoting adaptation in
individuals, or groups in order to help them achieve health”. Thus nursing is the science and
practice that expands adaptive abilities and enhances person and environment transformation.
Goal of Nursing
According to Dr. Roy, goal of nursing is “to assist the patient to achieve a higher level
of wellness”. Nursing goals are to promote adaptation for individuals and groups in the four
adaptive modes, thus contributing to health, quality of life, and dying with dignity. This is
done by assessing behavior and factors that influence adaptive abilities and by intervening to
expand those abilities and to enhance environmental interactions. A problem solving
approach for gathering data, identifying the capacities and needs of the human adaptive
system, selecting and implementing approaches for nursing care, and evaluation the outcome
of care provided.
 Assessment of Behavior: the first step of the nursing process which involves gathering
data about the behavior of the person as an adaptive system in each of the adaptive
modes.
 Assessment of Stimuli: the second step of the nursing process which involves the
identification of internal and external stimuli that are influencing the person’s
adaptive behaviors. Stimuli are classified as: 1) Focal- those most immediately
confronting the person; 2) Contextual-all other stimuli present that are affecting the
situation and 3) Residual- those stimuli whose effect on the situation are unclear.
 Nursing Diagnosis: step three of the nursing process which involves the formulation
of statements that interpret data about the adaptation status of the person, including
the behavior and most relevant stimuli.
 Goal Setting: the forth step of the nursing process which involves the establishment of
clear statements of the behavioral outcomes for nursing care.
 Intervention: the fifth step of the nursing process which involves the determination of
how best to assist the person in attaining the established goals.
 Evaluation: the sixth and final step of the nursing process which involves judging the
effectiveness of the nursing intervention in relation to the behavior after the nursing
intervention in comparison with the goal established.
Assessment
I collect information about health perception and health management and therefore
collect data in the following two ways.

Subjective data
In subjective data the client tells me about her health perception and management of
her health in daily life.
Objective data
In objective data, I observe and examine the client carefully and consciously. I saw a
40 years client lying on the bed. She is looking:
 Very irritable.
 Anemic.
 Sleeplessness.
 Weak.
 Temperature change (warmth, coolness)
 Visual change (image and color)
 Health Maintenance, Altered (Inability to identify or manage)
 Distribution of the field (vacant, hold, spike)
 Movement (wave, spike, tingling, dense)
 Sound (Tone, words)
 Insomnia
 Chronic fatigue syndrome
 Pain
 Sensory-Perceptual alteration.
 Thought process, altered.
Nursing Diagnosis
 Health maintenance altered.

Nursing interventions and rationales
 Establish trusting a relationship  Promotes accurate assessment.

with client.
 Allow client to talk about  Promote nurse and client relation Ship.
condition.
 Assess energy field  Alterations, variations or symmetry in

the energy field is deducted through
assessment
• Develop with the client a list of • Increase client’s sense of control and
assets and deficits as he or she keeps the idea of multiple changes from
perceives them. From this list, being overwhelming.
assist the patient in deciding what
lifestyle adjustments will be
necessary.
• Teach client appropriate • Provides the client with the basic

information to improve health knowledge needed to enact the needed
maintenance such as hygiene, changes.
diet, medication administration,
relaxation techniques, and coping
strategies.
 Be sensitive to any image that  There may be a loss of energy,

come to mind words, symbols, disruption or blockage in the flow of
pictures colors, sounds, mood energy in a part of body.
emotions etc.
 Allow the family as individual’s  Due to sharing of feelings, the client can
and as a group to share their maintain good health.
feelings.
 Redirect area of accumulated  Energy transfer or transmission can

energy, Reestablish the energy flow occur with out direct physical contact
and direct Energy to depleted area. between two systems. Hands or focal
Repattern or Rebalance clients Points for direction and modulation.
energy field
 Do therapeutic touch for no longer  Could disrupt the energy field of

than 10 minutes. Therapist.
 Teach client relaxation exercise  Relaxation requires the client to nurse

using Assess client’s subjective acts as a conduit through which the
reaction to therapeutic touch. Client environmental or universal stopping and
should feel more relaxed, less step outside of self and energy passes to
anxious and less pain. the client.
 Some of the same techniques as  Adopt a non-trying attitude. This allows

therapeutic touch Assist client to the person to release and use the
centre self. Teach client to imaging inherent energy of self. Rebalance
a peaceful place. Help client to energy flow through the body.
Verbalize place through all the
senses and To Allow the energy of
the imagined place to bring about a
state of calmness. Teach patient to
scan his or her body to Self
assesses area of body or muscle
tension. Assist client to consciously
relax that tense area of the body
 Assist patient to develop problem-  Involves patient in self-management

solving behavior through practice activities. Increases motivation.
of problem-solving techniques at
least twice daily at (times) during
hospitalization.
Expected Outcome
 Client has verbalized various factors that lead to health maintenance alteration and at
least one measure to alter each factor.
 Client has designed a positive health maintenance plan within one week.
Summary
The Adaptation Model introduced by Sister Callista Roy for nursing has been widely
accepted by the Nursing Community, Nationally, and Internationally. She also describes an
Adaptive system with copying processes described as a whole comprised of part and includes
people as individuals are in groups (families, organizations, communities, nations and society
as a whole). Also describe the process and out come where by thing feeling persons as
individuals and in groups use conscious awareness and choice to create human and
environmental integration. This also responses that promotes integrity in terms of the goals of
the human system, that is, survival, growth, reproduction mastery and personal and
environmental transformation.
Sister Callista Roy explains the process of being and becoming and whole that
reflexes person and environment. She also explain process and outer come there thing and
feeling person, as individual and in groups, conscious and awareness and choice to recreate
human and environmental integration. She drew upon expanded insights in relating
spirituality and science to present a new definition of adaptation and related scientific and
philosophical assumptions. 1) expanding the adaptive modes to include relational persons as
well as individual persons and 2) describing adaptation on three levels of integrated life
processes, compensatory processes, and compromised processes. Dr. Roy has also outlined a
structure for nursing knowledge development based on the Roy Adaptation Model and
provided examples of research within this structure. Dr. Roy remains committed to
developing knowledge for nursing practice and continually updating the Roy Model as a
basis for this knowledge development.

References
New York.
 www.yahoo.com.sister callista roy theory.


Jamshoro Sindh
Shagufta Majeed
Mrs. Ruth K. Alam
Date:
Margrate Campbell theory
The UBC model for nursing was developed in 1972, which takes the position that
individual behavior is motivated by basic that universal human needs, even though we may
have dramatically diverse individualized goals that we aim for within these needs.
Major Theme
The person as a behavioral system with interacting and interdependent subsystem
each is representing a basic human needs. The model conceives of individual systems
composed of nine subsystems or, one together represents the whole. The main prime systems
theory that are, critical for our purpose while all of the parts interact to make a whole
understand parts “as if” they were separate in step in learning how to understand whole
system their complexity.
The model tells us that there is no “random” behavior in the behavior of people can be
understood, when people act in a manner that seems counter productive, they are doing so for
the purpose of attempting to meet one or more of their needs.
In the UBC model, the system is made up of subsystems, each of which represents
one of need. The names assigned to reflect the need they represent and are:
Need And Goal of Nine Subsystems
Achieving Mastery Feelings of accomplishment;

satisfaction with accomplishments
Affective Love, belongingness and Feelings of love, belongingness

dependence and dependence
Ego-Valuative Self respect Self esteem
Excretory Collection and removal of Absence of accumulated wastes

accumulated wastes
Ingestive Intake of food and fluid; Nourishment; satisfaction of

nourishment hunger and thirst.
Protective Safety and security Integrity of the system.
Reparative Balance between production Capacity for activity.

and utilization of energy
Respiratory Intake of oxygen Oxygenation; easy respirations.
Satiative Stimulation of the system’s Sensory satisfaction senses.
Person
An individual with nine basic human needs constantly striving to satisfy these needs
by using a range of coping behaviors, both innate and acquired. The behaviors or the range of
the behaviors that an access to in order to meet a particular need in the subsystem structure.
The philosophy of basic human needs tells us that the need produce and continual striving
towards meeting them. In general people repertoire of coping behaviors from which in order
to maintain meeting their need such breathing to meet the basic needs for oxygen make
predictable adaptations to meet need changing circumstances.
The abilities and the coping behaviors are a “core” of subsystem, important parts, the
goals each person has it to illustrate the way in which our understanding of a person ought to
include not only the concrete from we see before us but also all of the objects and events that
have some meaning in that person’s life.
Environment
The questions of when nurses should or should not involve themselves with an
individual as client have become increasingly more complex with time. Decades ago, sick
people needed nurses, well people did not. More recently nursing considered its mandate as
clients who were hospitalized. Now we recognized that some well people need nurses to stay
well. Some ill people are fine on their own, and being in hospital may signal the need for
nursing care but it is not a very reliable signal. The nurses recognition the individual is in a
need and the forces that influence how the need conceptualizing these as part of the “psyche
environment” or that theoretical area of mind perceptions and aspirations, that extend beyond
function of the substance. The idea of psyche environment is to guide us to get know our as
we can in order to be as accurate as possible matters to them and what factors are influence
obviously. An unconscious client provides a challenge than does an insightful and verbal
adult. The subsystem structure includes the inner need, abilities and coping behaviors, as well
as psychological environment, with the individualized goals and forces some understanding
of all important for the nurse to understand client as a behavioral system.
According to this theory, Margrate Campbell focused on the stress coping behavior
and tolerance of the client.
 Adjustment impaired.
 Coping ineffective individual.
 Caregiver role strain.
 Defensive coping.
 Infective denial.
 Coping disabled family.
 Compromised family coping.
 Coping ineffective community.
 Post trauma response.
 Post trauma syndrome.
 Relocation stress syndrome.
 Self harm, risk for.
 Self abuse.
 Suicide, risk for.
 Violence, risk for.
Assessment
I assess the client according to the coping stress tolerance pattern. I collect
information and examine the client though the following two ways.
 Subjective Data
A 50 years old woman admitted in Psychiatric unit. Her sister states that she was
alright 15 days back, when she loss her son in an accident. After that she is not
interested in taking food, isolated, hostile, insomnia.
In subjective data client tells that he is having pain in abdomen due to surgery.
 Objective Data
A 50 years old woman lying on bed in restless condition with:
• Self destructive behavior.
• Dysfunctional grieving.
• Express anger towards her environment.
• Lethargic.
• Pale skin.
Nursing Diagnosis
Ineffective coping.
Expected Outcome
The client will:
• Express feelings in a non-self-destructive manager within 2-3 days and verbalize plans for
using alternative ways of dealing with stress and emotional problems when they occur
after discharge.
• Encourage the client to ventilate his • Ventilating feelings can help the
or her feelings; convey your client to identify, accept, and work
acceptance of the client’s feelings. through feelings, even if these are
painful or otherwise uncomfortable.
• Involve the client as much as possible • Participating in his or her plan of care
in planning his or her own treatment. can help increase the client’s sense of
responsibility and control.
• Convey your interest in the client and • Your presence demonstrates interest
approach him or her for interaction at and caring. The client may be testing
least once per shift. your interest or pushing you away to
isolate him-/her-self. Telling the
client you will return conveys your
continued caring.
• Encourage the client to express fears • Ventilating feelings can help the
and emotions. Help the client identify client identify and work through
situations in which he or she would those feelings, even if they are
feel more comfortable expressing painful or otherwise uncomfortable.
feelings; use role-playing to practice Role playing allows the client to try
expressing emotions. out new behaviors in a supportive
environment.
• Provide opportunities for the client to • The client needs to develop skills
express emotions and release tension with which to replace self-destructive
in non-self-destructive ways such as behavior.
discussion, activities, and physical
exercise.
• Teach the client about depression, • The client may have very little
self-destructive behavior, or other knowledge of or insight into his or
psychiatric problems. her behavior and emotions.
• Discuss the future with the client; • Anticipatory guidance can help the
hypothetical situations, emotional client prepare for future stress, crises,
concerns, significant relationships, and so forth. Remember: although the
and future plans. client may not be suicidal, he or she
may not yet be ready for discharge.
• Teach the client about the problem- • The client may never have learned a
solving process: identify a problem, logical, step-by-step approach to
identify and evaluate alternative problem resolution.
solutions, choose and implement a
solution, and evaluate its success.
• Teach the client social skills, and • The client may lack skills and
encourage him or her to practice with confidence in social interactions; this
staff members and other clients. Give may contribute to the client’s anxiety,
the client feedback regarding social depression, or social isolation.
interactions.
• Encourage the client to pursue • Recreational activities can help

personal interests, hobbies, and increase the client’s social interaction
recreational activities. Consultation and provide enjoyment.
with a recreational therapist may be
indicated.
• Administer prescribed antimicrobial • To minimize microbial activity.

therapy within 15 minutes of
schedule time.
• Minimize length of say in hospital. • To minimize the risk of infection.
Evaluation
 The client has expressed feelings in non-self-destructive managers.
 The client has verbalized plans for using alternative ways of dealing with stress and
emotional problems.
Summary
The UBC model for nursing represents a mechanism for the development and
refinement of systematic thinking in nursing at the same time as it orients the nurse towards
some rather than complex and abstract values about clients and nursing. It creates a means by
which holistic interpretation can be developed, individual meaning understood, and context
specific plans created by encouraging a systematic, holistic clinical reasoning process. It aims
to provide the beginning nurse with coherent intellectual directions and the more experienced
nurse with a strong logical structure on which to defend and articulate skilled nursing
judgments.
References
 Bigge, M.L. (1971). What is Field Psychology in Learning Theories for Teachers.
2nd Edition. Harpes and Row New York.
 Campbell, M.A. (1987). The UBC Model for Nursing Direction for Practice .
New York.
 http://216.109.125.130/search/cache.p=margaret Campbell UBC model of nursing.
Need and Goal of Nine Subsystems.


Jamshoro Sindh
Florence Nightingale
Sofia Noreen Javed
Mrs. Ruth K. Alam
Date:
Florence Nightingale (The Lady of Lamp)
Florence Nightingale observed with a little lamp in her hand making her solitary
rounds. As her slender form glides through the corridor, every poor fellow’s face softens with
gratitude at the sight of her. She had become the heroine. Her name becomes a synonym for
gentleness, efficiency and heroism. Although Florence Nightingale cannot be considered as
the product of her time, since she was ahead of and beyond it. But the season was ripe for her
genius as the founder of modern nursing.
Major Theme – A major of Florence Nightingale is “Unique Role of the Nurse”.
Health
Health is an ideal state or exuberant well-being, ability to fulfill social roles or to
contain or limit symptoms and a strong sense of coherence. Health is viewed as a formal
wholeness or completeness which continually changes. In context of health, Florence
Nightingale stated that “Absence of disease and the ability to use one’s own abilities to the
highest potential, with emphasis on the reparative process of getting well”. Therefore, health
is a pattern of energy that is mutually enhances and expresses full life potential. Positive
health symbolizes wellness.
Florence Nightingale stated that it is “A profession for women, separate and distinct
from medicine, using nature’s laws of health in the service of humanity.”

Nursing is the pivotal health care profession, highly valued for its specialized
knowledge, skill and caring in improving the health status of the public and ensuring safe,
effective, quality care. It mirrors the diversion of population, and serves and provides
leadership to create positive changes in health policy and delivery systems.
Goal of Nursing
According to Florence Nightingale goal of nursing is “to place the patient in the best
condition for nature to act by providing an environment conductive to healthy living and a
nourishing diet.” As she focused on healthy living and nourishing diet, I therefore assess the
client according to altered nutrition – risk for more than body requirements or risk for obesity.
Assessment
Subjective Data
In subjective data the client verbalizes about his increased eating habits resulting
increase in body weight since last two months. His working capacity is reduced and he feels
fatigue.
Objective Data
 Lethargic.
 Weakness.
 Fatigue.
 Altered nutrition more than body requirements
 Sleeplessness.
 Temperature 98°F
 Weight 102 Kg
 CP.
 FBS
 Lipid Profile
 ECG
Nursing Diagnosis
Altered nutrition (more than body requirements or obesity).
Expected Outcome
 Client will have good knowledge of importance of balance nutrition diet within
2-3 days.
 Client will verbalize daily intake nutritional diet to control weight/obesity and
exercise pattern.
 Reassure the client  To build trust and confidence.
 Increase individual awareness of  To give the knowledge about

amount and type of food consumed importance of nutrition.
 Teach the client to keep a diet diary  Helps to decrease the dietary intake.
for one week
 Review high and low calories food.  To decrease body weight.

 Plan daily walking program and  To maintain physical health.

gradually increase rate and length of
walk.
 Establish a regular exercise daily.  To maintain body weight.
 Teach behavior modification  To restrict diet.

technique.
 Educate client to eat slowly and chew  For good absorption and elimination.
thoroughly.
 Encourage client to give maximum  For good absorption of food and

time between two meals. elimination.
Evaluation
 The client has verbalized that he had reduced weight and take more active part in
daily life than before.
 The client has verbalized that he had planned for a regular exercise program to reduce
weight.
Summary
Health is an ideal state or exuberant well-being, ability to fulfill social roles or to
contain or limit symptoms and a strong sense of coherence. Health is viewed as a formal
wholeness or completeness which continually changes.
Nursing is the pivotal health care profession, highly valued for its specialized
knowledge, skill and caring in improving the health status of the public and ensuring safe,
effective, quality care. It mirrors the diversion of population, and serves and provides
leadership to create positive changes in health policy and delivery systems. The nurse uses a
caring process to help the individual achieve an optimal degree of inner harmony to promote
self-knowledge, self-healing, and insight into the meaning of life.

References
New York.
 www.yahoo.com.florence nightingale.

Jamshoro Sindh
Moyra Allen Theory
Sajida Parveen
Mrs. Ruth K. Alam
Date:
Moyra Allen
Moyra Allen was born in 1921. She obtained her initial nursing education at the
Montreal General Hospital School of Nursing and went on to obtain a Bachelor of Nursing
from McGill University and a Master degree at Chicago University in 1954. She joined the
McGill University’s School of Nursing as Assistant Professor in 1958 and became Associate
Professor. She obtained her PhD in education from Stanford University in 1967 and then
return to McGill to devote her career to nursing research and education. In 1983, she was
appointed as a Acting Director of the School of Nursing and was retired in 1984. She passed
away peacefully in Ottawa on May 2, 1996.
Moyra Allen Theory
The theory of Moyra Allen is depend on the nature of healthy living, a continuum
process of aging, dealing actively with life situations, losing some functional ability cognitive
interpersonal physiological, withdrawing from life dying, the family or other social group in
which learning is initiated natured and directed, the social context in which learning take
place, this may be at home, the workplace, community group, a hospital or a clinic.
Major Theme
“The nature of healthy living”. According to Moyra Allen, dealing actively with life
situation, losing some functional ability cognitive interpersonal physiological withdrawing
from life dying.

Health
Health has a number of meanings depending on the purpose, time or circumstances
governing its use. It is an ideal state or exuberant well-being, ability to fulfill social roles or
to contain or limit symptoms and a strong sense of coherence. There are no universal norms
of health perceptions vary across individuals and cultures. Health is viewed as a formal
wholeness or completeness which continually changes.
According to Moyra Allen, health is a social process, a way of living rather than a
state of being. Similar in meaning to health behavior, it is something that can be measured
and can be modified.
According to Moyra Allen theory, the definition of nursing is taking a unique, active
and complementary role in providing health care.
Nurses engage the person/family to actively participate in learning about health. Over
the years, the nursing has been developed, refined, tested and implemented in various practice
settings and has gained widespread acceptance and a useful framework for nursing practice.
This health reform created an increased demand for health care services by the public. Many
viewed the reform as an opportunity to expand nursing roles and services.
Moyra Allen developed and established the complementary role of the nurse in the
1970s. This innovative role recognized the unique contribution nurses bring to the person and
its family. Through a series of field experiments entitled the workshop – A health resource –
L’ atelier a votre Sante, the model was developed. Nurses provides a vehicle for holistic
nursing care identifying unmeet needs as they become health care needs and considering all
dimensions. Nursing seeks to promote symphonic interaction between the environment and
man, to strengthen the coherence and integrity of the human beings, and to direct and redirect
patterns of interaction between man and his environment for realization of maximum health
potential.
Focus of nursing is unitary human beings in mutual process with their environment
and that nursing intervention would be to create ways in which the client might become more
aware of his or her field and collaborate with the nurse in proposing and using patterning
strategies.
Moyra Allen sought to transform the nature and the image of the profession. The
nurses role within the health care system as complementary to rather than replacement of
other professionals.
Goal of Nursing
According to Moyra Allen, the main goal of nursing is to form a partnership with the
person/family to foster health. From that conviction, Moyra Allen along with contributors
from the school of nursing developed a model best known today as the “McGill Model of
Nursing.” Moyra Allen model of human becoming emphasizes how individuals choose and
bear responsibility for patterns of personal health.
The goal of nursing is directed at understanding the interrelationship of health, illness
and human behavior. This model is designed around the caring process, assisting clients to
attain or maintain health or to die peacefully. This caring process requires that the nurse be
knowledgeable about human behavior and human responses to actual or potential health
problems and individual needs. The nurse assists the client in interacting with the
environment and re-establishing health. The nurse assists the client in this growth by
sustaining a safe and protective environment.
 Comfort altered pain.
 Impaired thought process.
 Sensory – Perceptual alteration.
Assessment
I collect information and examine the client about health status. I assess the client
through two ways.
 Subjective Data
In subjective data the client tells me about his cognitive perception.
 Objective Data
In objective data, I observed and examine the client carefully and consciously.
I saw a 30 years old client lying on bed.
 Looking very irritable.
 Restlessness.
 Weak and pale.
 Look lethargic.
 Facial expressions show severe pain.
 Increase pulse rate.
Vital Signs
 Temperature 99°F.
 Respiratory Rate 22 per min.
Nursing Diagnosis
 Pain related to tissue trauma and reflex muscle spasms secondary to surgery.
Expected Outcome
 The client will verbalize reduction of pain within 1-2 hours.
• Establish trusting relationship with • Promotes accurate assessment.

client.
• Explain causes of pain to the patient. • To develop the trust of the patient.
• Assess pain by using Colderra very • To assess the level of pain.

one hour.
• Check vital sign two hourly. • To maintain baseline data.
• Encourage use of relaxation • To promote relaxation.

technique
• Provide diversional activities, e.g., • To divert mind from pain.
books, watch TV, play games, etc.
• Instruct on techniques to reduce • This will reduce the intensity of the
skeletal muscle tension. pain.
• Provide optimal pain relief with • To reduce pain.
prescribed analgesic.
• After administering a pain relief • To assess effectiveness of medication.
medication, return in 30 minutes.
Evaluation
 The client verbalized that pain has reduced from 7/10 to 2/10 on the pain scale 0-10.
 Facial expressions show relaxed.
I look the client’s condition and assess that, I achieved my desired goal and the client
is looking better than before.

Summary
The Moyra Allen theory is a social process, a way of living rather than a state of
being, and similar in meaning to health behavior. It is something that can be measured and
can be modified. A professional response to the person’s nature search for health living and
assist people to enhance their problem solving skills in dealing with health matters. Each
nursing theory bears the wave up the person or group who developed it and reflects the
beliefs of developed.
According to Moyra Allen aging is reflected in the varying stage of disengagement of
the individual from life and to some extent independently of this disengagement individuals
perceive their ability to control what happens to them, the decisions they make, and the
choices or alternatives that are available to them.
The Moyra Allen theory describes the nature of living health.

References
New York.
 www.yahoo.com.moyra allen theory.

Value and Belief Pattern
Sofia N. Javed
Roman Javed
Mrs. Ruth K. Alam
Date:
INDEX TABLE
S# Content Page #
1. Definitions:
 Value 01
 Belief 01
2. Pattern description 01
3. Pattern assessment 02
4. Conceptual information 02
5. Developmental consideration 03
 Infant 03
 Toddler and Pre-Schooler 03
 School Age Child 03
 Adolescent 04
 Adult 04
04
 Older adult
6. Factors effecting on value and belief 04
 Situational or Environmental
factor 04
 Treatment or Clinical factor 04
7. Possible Nursing Diagnosis 05
 Spiritual distress 05
 Spiritual well being, potential
for enhances 05
8. Summary 06
9. References 07
OBJECTIVES
be able to:
13) Define value and belief.
14) Describe the pattern.
15) Explain pattern assessment.
16) Discuss conceptual information.
17) Classify developmental consideration.
18) Enlist factors effecting on value and belief.
19) Identify possible nursing diagnosis.

1
VALUES AND BELIEF PATTERN
Definition
1. Value
Value is a standard idea or things, which are given
importance by the people living in society. The people like them
want them to be implemented.
2. Belief
 It is a state or habit of mind in which trust, or confidence in
some unknown person or thing without any previous
experience.
 It is mental acceptance of something offered to society as
truth.
Most of religious activities are based on belief e.g., “God is
one”.
Pattern Description
1. A person value and belief system is interconnected with
his/her spiritual site and environment.
2. Value and belief gives meaning of life.
3. It enables us to exit during in between time, damage or in
face of death.
4. Value and belief can be in many things a superior being
environment, self, family and community.
Pattern Assessment
1. Does the patient express anger towards Supreme Being
regarding his/her current condition?
2. Does the patient verbalize conflict about spiritual distress?
3. Does the patient indicate positive thought about
spirituality?
4. Does the patient indicate comfort with self?
5. Collect subjective and objective data.
6. Question about his/her faith (belief).
7. Provide privacy encourage patient to express his/her
reason for living or meaning of life?
1. The value and belief system of person can be described
as the predomination force (spirituality). The
predomination force can be faith in Supreme Being of god.
2. It is conceptual that each person must find his/her place in
world nature and relationship with other being.
3. The value and belief system is show by individual;
informed of organized religion, attitude action and related
to individual senses of what is right cultural belief and
internal motivation.
4. The spirituality is what gives like meaning and allow

person to function in a more total manner.
5. Value/belief effect on behavior to attitude what is
right/wrong and with life style.
Developmental Consideration
The geographical, social, political and home environment,
which one lives has a major effect on how a person develop,
how he or she will view health, and how spirituality, values and
beliefs are formulated.
1. Infant
The infants are totally dependent on the parents of those
about him or her and is busy building trust or mistrust. Unable
at this stage to form values or distinguish spirituality.
2. Toddler and Pre-Schooler
The toddler imitates those about him or her parents,
siblings and other adults. The toddler develops by mimicking
observed behavior and receiving either positive or negative
reinforcement. Values begin to form as the toddler starts to
become aware of others and to interact with those around him
or her.
3. School Age Child
begins to be influenced by peers outside the family
structure are begin question and make choice and want be
implemented.
4
4. Adolescent
The adolescent searches for his or her own identity and

begins to practice values that are separate and yet congruent
with his or her family units. The adolescent is still struggling
with his or her own independence and formulating his or her
own values beliefs.
5. Adult
Usually strengthen the values and beliefs. They have
formed according to their life experiences. The adult is
continually exploring and trying to see if his or her value system
fits within his/her lifestyle.
6. Older Adult
Older adult find great solace in their spirituality and the
values and beliefs they have formed through a lifetime.
Factors Effecting on Value and Belief
The main two factors effecting value and belief are:
1. Situational or Environmental Factor
 Death or illness.
 Intensive care restriction.
 Lack of privacy.
 Related to divorce/separation from loved one.
2. Treatment or Clinical Factor
 Abortion
 Amputation
 Dietary restriction.
 Isolation.
 Cancer.
 Mental retardation
5
Possible Nursing Diagnosis
1. Spiritual distress (distress of human spirit) is defined
as, “Disruption in the life principle that pervades a person’s
entire being and that integrates and transcends one’s
biologic and psychosocial nature.”
2. Spiritual well being, potential for enhances is defined
as, “Spiritual well being is the process of an individual’s
developing or unfolding of mystery through harmonious
interconnectedness that springs from inner strengths.
6
Summary
In this presentation, we discussed various aspects of
value and belief pattern. Value is a standard idea or things,
which are given importance by the people living in society.
Belief is a state or habit of mind in which trust, or confidence in
some unknown person or thing without any previous
experience.
The value and belief system is show by individual;

informed of organized religion, attitude action and related to
individual senses of what is right cultural belief and internal
motivation.
If we understand all aspects of value and belief, we will be
able to make nursing care plan in nursing practice up to the
standard.
7
References

Nursing: A Nursing Process Approach. 3rd Edition. Mosby
Boston.
Applications of Nursing Diagnosis. Williams and Wilkins
London.
Clinical Practice. 3rd Edition. J.B. Lippincott Company New
York.
 Smith S. and Dvell D. (1982). Nursing Skills and
Evaluation: A Nursing Process Approach. Nursing Review,
California, USA.
Irshad Akhter
Theoretical Framework
Mrs. Ruth K. Alam
December , 2007
Irshad Akhter
Mrs. Ruth K. Alam
December , 2007
Topic: Theoretical Framework

Theorist: Florence Nightingale
Introduction
My subject is “Advance Concept of Nursing.” The term theory and conceptual
framework are often used interchangeably in nursing literature. Strictly speaking, they differ
in their levels of abstraction. My theorist is “Florence Nightingale.”
Florence Nightingale born on May 12, 1820, in Florence Italy. She belonged to a
renowned British Family. She was the second daughter of William Edward Nightingale and
France Smith. Florence was educated more than an average English girl. Her father taught her
Greek, Latin, French, German, Italian, History, Philosophy and Mathematic. She was also
interested in Political Science and Languages. Throughout her life, she read widely in many
languages. Social life meant differently to her not the pomp and show of formalities.
Florence showed interest in nursing from her childhood. She visited the sick of her
neighborhood and helps them. Florence who knew the humanitarian aspect of service in
nursing spent a number of years studying the hospitals in England, Scotland, Ireland, France
and Belgium before she went for training to the institute for Dacconnesses at Kaiser Worth in
Germany. With reference to the value of professional train she wrote “I should like to advise
all young ladies to feel the call to came to the definite profession train yourselves for it in the
way man train for his work. Do not believe that you can to understand it in any other way”.
Crimean war broke out in 1854. At that time England had only untrained men to look
after soldiers. She offered her services to the Minister of War Sir Sidney Herbert. With his
help she collected 38 nurses from different Orders and went to help at Scutari. She worked in
the Barracks Hospital. The hospital was dirty, crowded and poorly ventilated. There was no
clothing or other hospital equipment. The quality of food was poor, 42% of parents used to
die due to infection and poor sanitary conditions.

As an excellent commander, Florence Nightingale accepted the responsibility of
nursing the soldiers. For emergencies she used her own money. Her nurses worked under
strict discipline with doctors and improved the hygienic and dietary conditions of the soldiers.
She employed soldier’s wives to help the nurses. She visited the soldiers with a lighted lamp
during shifts so she was known as the lady with the lamp.
In 1855 she contacted Crimean fever. After her recovery in 1856 peace was declared
and hospitals at Scutari were closed. She returned to England. Born with a silver spoon in her
mouth, Florence Nightingale was known to the wounded soldiers as the “Lady with the
Lamp” all over the world. Her life was meant to alleviate pain and give relief to the suffering
humanity when other young women of her age were absorbed in the gaiety of social life. She
undertook the task of nursing and developed it. Nurses all over the world rightly
conermmerate her birthday as “International Nurses Day”.
The work of Florence Nightingale during the Crimean war was admirable. She
reformed the army medical service. Her dedicated work in the profession brought about a
revolution in the whole nursing system. She attracted the most intelligent and scrupulous
women to join the profession.
Florence Nightingale died on August 13, 1910. Her life is a guiding beacon to all the
nurses. Let us have her everlasting spirit and selfless dedication in our nursing profession.
She improved the health facilities of the soldiers with the help of Sir Sydney Herbert
in England. In 1859, she wrote note on nursing. The Nightingale school at the St. Thomas
Hospital, England, was started in June 1860. Nursing become a career for women. The
nursing graduated from the Nightingale school went all over the world and started nursing
school graduates of this school became the early pioneers in nursing education.
Florence major theme is “unique role of the nurse”. Her framework for Health stated
that “health is a state or exuberant well being ability to fulfill social roles or to contain or
limit symptoms and a strong sense of coherence. Health is viewed as a formal wholeness or
completeness with continually changes. In context of health, Florence stated that being well
and using one’s powers to the fullest extent. Health is maintained through prevention of
disease via environment health factors. Disease is a reparative process nature institutes
because of some want of attention. While defining ‘Nursing’, Florence Nightingale stated
that “provision of optimal conditions to enhance the person’s reparative processes
and prevent the reparative processes from being interrupted.” Nursing is the pivotal
health care profession, highly values for its specialized knowledge, skill and caring in
improving the health status of the public and ensuring safe and effective quality care.
Goal of Nursing – Florence Nightingale goal of nursing is to place the patient in
the best condition for nature to act by providing an environment continuative to
health and nourishing diet.
Analysis
Florence Nightingale believed that she was called by God to help others and to
improve the well being of mankind. According to Gordon’s functional health patterns values
and beliefs, she was always deeply strong religious. Nightingale’s main focus is on the
environment. She defines that concept in the context of her time only. Florence Nightingale’s
contributions are numerous and far-reaching recognizing that: nutrition is an important part of
nursing, institutions occupational and recreational therapy for sick people, identifying
personal needs of the client and the role of the nursing in meeting those needs, establishing
standards for hospital management, establishing a respected occupation for women,
establishing nursing education, recognizing the two components of nursing health and illness,
believing that nursing is separate and distinct from medicine. Stressing the need for
continuing education for nurses, Florence Nightingale elevated the status of nursing to a
respected occupation, improved the quality of nursing care and founded modern
nursing education.
Nightingale’s theory is noted in her writing notes on nursing, demonstrates her major
areas of environmental control: ventilation, warmth, effluvia, noise, and light. Ventilation
especially with increase fresh air provided without drafts is of a primary importance. Light
refers to sunlight for the most part and is secondary. Warmth, noise and effluvia (smell) are
seen as areas in which attention must be given to provide a positive environment. She did
recognize that a negative environment could cause physical stress. Her basic environmental
concept, interrelated with nursing process can give us specific directions.
The environment of the patient was quite encompassing. She did not specifically
distinguish among the physical, social or psychological environments as such she speaks of
all three in the practice of nursing. The cleanliness of the physical environment has a direct
bearing on the prevention of disease and mortality rates within the social environment of the
community. Also all patients’ psychological environments are strongly affected by physical
surroundings. The effect of the mind on the body could cause physical stress.
Nightingale’s theory related with Human or Individual has vital reparative powers to
deal with disease. Nursing – the goal is to place the individual in the best condition for nature
to act by basically affecting the environment. Health Disease – the focus is on the reparative
process of getting well. Society Environment – involves those external conditions that affect
life and the development of the individual. The focus is on ventilation, warmth, odors, noises,
and light. Nightingale’s theory of nursing is closely related to scientific theories frequently
used in nursing practice today. Most significant are the theories of adaptation, need and
stress. The Major components of Nightingale’s theory is, the greater the degree of poor air,
poor water, poor light, and other negative environmental factors and the longer the duration,
the lesser the potential for the patient to cope with his or her illness. As a matter of fact given
a health individual within a poor environment with multiple stressors of long duration illness
would soon occur.
Florence Nightingale theories especially all Gordon Function Health Patterns that
effect human life.
Conclusion
Nightingale’s major focus was on the environment of the patient. Nursing goals
focused on providing an environment that allowed nature to act on behalf of patient.
Environmental factors involved clean air and water, control of noise, proper drainage,
reduction of chills and a variety of activities. Nightingale emphasized fresh air as primary and
good lightening as secondary to the effective care of the patient and utilizing her theory today
as a theoretical base for practice as it was during her time.

References
 Jacob, A. (1997). Fundamentals of Nursing, (Vol. 1). India: Vikas Publishing House
Pvt Ltd.
 George, J.B. (1990). Nursing Theories: the base for professional nursing practice,
(3rd ed.). USA.
 Taylor, C. (1993). Fundaments of Nursing, (2nd ed.). Lippincott.

Mussarat Parveen
Mrs. Ruth K. Alam
December , 2007
Sister Callista Roy (RN, PhD)


Theorist: Sister Callista Roy
Introduction
In subject “Advanced Concepts of Nursing” we learned about concepts of different
theorists, which they applied in the process of nursing. I will introduce my theorist
“Sister Callista Roy”.
Sister Callista Roy born in 1939 is a RN and PhD, is a nurse theorist, Boston College,
Massachusetts. Previous to this appointment, Roy was a Post-Doctoral Fellow and Robert
Wood Johnson Clinical Nurse Scholar at the University of California, San Francisco. Roy has
served in many positions including Chair of the Department of Nursing, Mount Saint Mary’s
College, Los Angeles; Adjunct Professor, Graduate Program, School of Nursing, University
of Portland; and Acting Director and Nurse Consultant, Saint Mary’s Hospital, Tucson,
Arizona. Roy earned her BS in nursing in 1963 from Mount Saint Mary’s College, Los
Angeles; her MS in nursing in 1966 and doctorate in sociology in 1977 from the University
of California, Los Angeles. She is a Fell of the American Academy of Nursing and active in
many nursing organizations including Sigma Theta Tau and the North American Nurses
Diagnosis Association. She is the author or co-author of a number of works including
introduction to nursing: An adaptation model, essentials of the Roy Adaptation Model, and
Theory Construction in Nursing: An Adaptation Model. The Major Theme of Sister Callista
Roy Theory is “Roy Adaptation Model”.
The adaptive system has input coming from the external environment as well as input
coming internally from the person. Roy identifies inputs as stimuli. A stimulus is a unit of
information, matter, or energy from the environment or from within the person that elicits a
response. Along with stimuli, the adaptation level of the person acts as input to that person as
an adaptive system. The adaptation level is the range of stimuli to which the person can
adaptively respond with ordinary effort. This range of response is unique to the individual.
Each person’s adaptation level is constantly changing aspect which is influenced by the
coping mechanisms of that person.
Outputs of the person as a system are the behaviors of the person. Output behaviors
can be both external and internal. Thus, these behaviors may be observed, measured, or
subjectively reported. Output behaviors become feedback to the system. Roy has categorized
outputs of the system as either adaptive responses or ineffective responses. Adaptive
responses are those that promote the integrity of the person. 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. Ineffective responses do not support these goals.
Sister Callista Roy has used the term coping mechanisms to describe the control
processes of the person as an adaptive system. Some coping mechanisms are inherited or
genetic, such as the white blood cell defense system against bacteria seeking to invade the
body. Other mechanisms are learned, such as the use of antiseptics to cleanse a wound. Roy
presents a unique nursing science concept of control mechanisms. She has also outlined a
structure for nursing knowledge development based on the Roy Adaptation Model and
provided examples of research within this structure. She remains committed to developing
knowledge for nursing practice and continually updating the Roy Model as a basis for this
knowledge development.
The Roy model defined Health as a continuum from death to high-level wellness.
This is no longer used in the present model. Instead, Roy presently defines health as “a state
and process of being and becoming integrated and whole person.” The integrity of the person
is expressed as the ability to meet the goals of survival, growth, reproduction, and mastery.
The nurse using Roy’s model uses the concept of health as the goal point for the person’s
behavior. When a disproportionate amount of the person’s energy is used in coping, less
energy is available to meet the goals of survival, growth, reproduction, and mastery. Nursing
aims to promote the health of the person by promoting adaptive responses. Energy freed from
ineffective behavior becomes available for promotion of health. Nursing is the science and
practice that expands adaptive abilities and enhances person and environment transformation.
Nursing’s aim of promoting adaptation is contributory to the health of the person and to the
unity and solidarity of the person within himself or herself and in relation to others.
Nursing Goals are to promote adaptation for individuals and groups in the four adaptive
modes, thus contributing to health, quality of life, and dying with dignity. This is done by
assessing behavior and factors that influence adaptive abilities and by intervening to expand
those abilities and to enhance environmental interactions.
Conclusion
The Roy model consists of the five elements of person, goals of nursing, nursing
activities, health and environment. Persons are views living adaptive systems whose
behaviors may be classified as adaptive senses or ineffective responses. These behaviors are
derived from the cognator mechanisms. These mechanisms work within the adaptive modes
of physiological function, self concept, role function, interdependence. The goal of nursing is
to promote adaptive response relation to the four adaptive modes, using information about the
person adaptation level, and focal, contextual, and residual stimuli. Nursing activities involve
the manipulation of these stimuli to promote adaptive responses. Health is a process of
becoming integrated and able to meet goals of survival, growth, reproduction, and mastery.
The environment consists of the person’s internal and external stimuli.
These elements are in a nursing process that consists of first and second levels
assessments, diagnosis, goal setting, intervention, and evaluation. First level assessment, or
behavioral assessment, deals with the four adaptive modes, whereas second level assessment
focuses on the three areas of stimuli. Diagnosis consists of stating the problem. Goals are set
in relation to the problem and are written in behavioral terms. Interventions are planned to
manipulate the stimuli, and evaluation compares the person’s output behaviors with the
desired behaviors established in the goals.
References
 Erb, K., & Wilkinson, B. (1998). Fundamentals of Nursing: Concepts, Process and
Practice, (5th ed.). New Jersey: Prentice Hall Health.
(3rd ed.). USA.
 www.google.com.pk.sister callista roy. Retrieved on December 18, 2007.

Nargis Bashir
Mrs. Ruth K. Alam
December , 2007
Betty Neuman
RN, BSN, MS, PhD, PLC, FAAN

Theorist: Betty Neuman
Introduction
I am studying in Advance Concepts of Nursing, which is related to nursing care
concepts make theories and are used in patient’s care. Theories provide a framework which is
criteria to see method for nursing care. My theorist name is “Betty Neuman”. Her major
theme is “Provide holistic are and develop health model system.”
Betty Neuman was born on a farm in Lowell, Ohio in 1924. Her first nursing
education was completed in Peoples Hospital (now named as General Hospital), School of
Nursing in Akron, Ohio in 1947. She completed her BS Nursing in 1957 and then MS in
Mental Health, Public Health Consultation from UCLA in 1966 and finally PhD in Clinical
Psychology. Her teaching experience includes mental health, consultation and organization,
leadership and counseling. She was a pioneer in the community mental health movement in
the late 1960s. During her UCLA work in organization and planning with the community
mental health movement, she developed her nursing model of the “whole person approach”
based on a systems adaptation framework. Her theoretical approach to nursing is exemplified
in a holistic approach to her own life. She has a great zest for life and a keen sense of using
time creatively and usefully. She began developing health model while a lecture in
community health nursing in the University of California. Major Theme of her model is
“provide holistic care and develop health model system.” Health is equated with optional
stability that is the best possible wellness stale, at any given time.
Betty Neuman began developing her health system model while a lecture in
community health nursing at the University of California. Her framework is basically a
system model with the major components of stressors, reaction to stressors, and the person. It
is also dynamic and can be altered rapidly over a short period of time. Its effectiveness can be
reduced by such changes as loss of sleep, malnutrition, or any alteration in activities of daily
living. The model was published in 1972 as “A Model for Teaching Total Person Approach to
Patient Problem’s in Nursing Research”. It was refined and subsequently published in the first
edition of conceptual models for nursing practice 1974, and in the second edition in 1980.
Health – the assumption of this model can lead one to see wellness as a dynamic composite
of physical, psychological, sociocultural developmental and spiritual balance that is, flexible
yet retains an unbroken ability to resist disequilibrium. She further stated that, wellness is the
condition in which all parts and subparts of an individual are in harmony with the whole
system. Wholeness is based on interrelationships of variables that determine the resistance of
an individual to any stressor. Illness indicates lack of harmony among the parts and subparts
of the system of the individual. Health is viewed as a point along a continuum from wellness
s to illness; health is dynamic (i.e., constantly subject to change). The person retains varying
degrees of balance and harmony between internal and external environment. The factors
effecting on the health are physiological factor, physiosocial factor, activity and exercise, and
nutrition, as communication with other people and adjustment to other. Health is also affected
by socioculture to know about other cultures and spiritual believes about health and how they
perceive it, perceiving of coping stress and how person cope the stress. Goal of Nursing – the
primary goal of nursing is the retention and attainment of client system stability. The
assessment or intervention instrument various aspects of Neuman’s model but is flexible
enough to allow for inclusion of any additional data deemed necessary. Factors influencing in
use of the instrument would be the client, client situation. In Neuman’s work the in men is
accompanied by an explanatory section that includes specific role charts to categorize data,
and plan for interventions at all levels. The nurse helps the client through primary, secondary,
and tertiary prevention modes to adjust to environment stressors and maintain client system
stability. In later writings, she stated that health is equated with optimal system stability that
is the best possible wellness state.

There are ten basic assumptions underlying Neuman’s Conceptual Framework.
 Though each individual client or group as a client system is unique, each system is a
composite of common known factors or innate characteristics within a normal, given
range of response contained within a basic structure.
 The particular interrelationships of client variable physiological, psychological,
sociocultural-developmental and spiritual at any point in time can affect the degree to
which a client is protected by the flexible time of defense against possible reaction to
a single stressor or a combination of stressors.
 Each individual client/client system, over time, has evolved a normal range of
response to the environment that is referred to as a normal line of defense, or usual
wellness/stability state.
 When the cushioning accordion like effect of the flexible line of defense is no longer
capable of protecting the client system against an environment stressor, the stressor
breaks through the normal line of defense.
 The client, whether in state of wellness or illness is a dynamic composite of the
interrelationships of variables physiological, psychological, sociocultural,
developmental and spiritual wellness is on a continuum of available energy to support
the system in its optimal state.
 Implicit within each client system is a state of internal resistance factors known as
lines of resistance, which function to stabilize and return the client to the usual
wellness state (normal line of defense) or possibly to a higher level of stability
following an environmental stressor reaction.
 Primary prevention relates to general knowledge that is applied in client assessment
and intervention in identification and reduction or mitigation of risk factors associated
with environmental stressor to prevent possible reaction.

 Secondary prevention relates to symptomalogy following a reaction to stressors,
appropriate ranking of intervention priorities and treatment to reduce their noxious
effects.
 Tertiary prevention relates to the adjustive processes taking place as reconstitution
begins and maintenance factors move the client back in a circular manner toward
primary prevention.
 The client is in dynamic constant energy of change with the environment.
Conclusion
Conceptual models are imperative to the development of nursing as a profession.
Neuman’s total person approach to health care is one such model. In essence, she presents an
approach to viewing the person’s perception of the stressors affecting the part of the whole
individuals in constant interaction with the environment. In as much as the model emphasizes
to total person it transcends the nursing model to become a health care model, applicable to
all health care disciplines. Even though the model is interdisciplinary, it certainly has
universal applicability to nursing. One of its greatest strengths is the clear direction it gives
for interventions through primary, secondary and tertiary prevention. Nursing theory, nursing
research and nursing practice, the applicability of the model to all health disciplines could
foster a common perspective and thereby fail to point over the distinctive contribution of
nursing or any other health disciplines to health care.

References
 Erb, K., & Wilkinson, B. (1998). Fundamentals of Nursing: concepts, process and
practice, (5th ed.). New Jersey: Upper Saddle River
(3rd ed.). USA.
Pvt Ltd.
Nargis Qureshi
Mrs. Ruth K. Alam
December , 2007
A Brook and Showers
O'er rocks and rills,

From spills to spill,
It wanders on it's way,
While fairies dance,
and raindrops prance,
Upon it's waters gay
The sun shines through,
In misty hue,
Upon the rippling stream.
The fleecy clouds,
In silver shrouds,
Are clothed in fancies dream.
(Poem written by Martha Rogers, aged 16, on April 15, 1931, from the collection of
Erline McGriff, photo courtesy of the late Joan Hoexter).

Theorist: Martha E. Rogers
Introduction
According to my subject “Advance Concept of Nursing” I was assigned to explain
Nursing Theorist and her conceptual framework. My theorist is “Martha E. Rogers.”
Martha Elizabeth Rogers was born on May 12, 1914; sharing a birthday with Florence
Nightingale. She began her academic career when she entered the University of Tennessee in
Knoxville in 1931 where she remained for two years. She stated that: "I took the science-med
course. It was more substantial than straight pre-med and included more science and maths.
I took psychology, French, Zoology, Genetics, Embryology and many other courses" (Hektor,
1989).
However, she didn’t complete the course, instead she entered nursing school at
Knoxville General Hospital in September 1933. She received her nursing diploma in 1936
and her Bachelor of Science degree in Public Health Nursing form the George Peabody
College in Nashville in 1937 and then became a public health nurse in rural Michigan where
she stayed for two years before returning to further study. In 1945 she earned her master’s
degree from Teacher’s College Columbia University, New York. She then became a public
health nurse in Hartford, CT, advancing from staff nurse to acting Director of Education.
After this she established and eventually became the Executive Director of the first Visiting
Nurse Service in Phoenix. She left Arizona in 1951 and returned to school at the Johns
Hopkins University, Baltimore. Rogers was appointed Head of the Division of Nursing at
New York University in 1954. In about 1963 Martha edited a journal called Nursing Science.
It was during that time that Rogers was beginning to formulate ideas about the publication of
her third book An Introduction to the Theoretical Basis of Nursing (Rogers, 1970). Rogers
officially retired as Professor and Head of the Division of Nursing in 1975 after 21 years of
service. In 1979 she became Professor Emeritus and continued to have an active role in the
development of nursing up until the time of her death on March 13, 1994.
Early development of the conceptual framework, the Science of Unitary Human
Beings, was first seen in Reveille in Nursing, Rogers’ second book, which was published in
1964. Six years later, in 1970, Rogers published her major work which was entitled
An Introduction to the Theoretical Basis of Nursing.
In the 20 years or so following the publication of An Introduction to the Theoretical
Basis of Nursing, considerable changes have taken place within the conceptual framework to
the Science of Unitary Human Beings (Rogers, 1980, 1983, 1986, 1990). It is beyond the
scope of this section to chart these changes but it will give the reader the current definitions
of the concepts subsumed under the Science of Unitary Human Beings, relating these to
earlier definitions where appropriate.
In 1970, Rogers formulated five basic assumptions that describe man and the life
process in man (Rogers, 1970). These assumptions or "building blocks" underlay the
conceptual framework and consist of the concepts of: Wholeness - in which the human being
is regarded as a unified whole which is more than and different from the sum of the parts.
Openness - where the individual and the environment are continuously exchanging matter
and energy with each other. Unidirectionality - where the life process exists along an
irreversible space time continuum. Pattern and Organization - which identifies individuals
and reflects their innovative wholeness. Sentience and Thought - which states that of all life,
human beings are the only ones capable of abstraction and imagery, language and thought,
sensation and emotion.
In terms of Health she stated that, “Positive health symbolizes wellness. It is a value
term defined by the culture or individual. Health and illness are considered “to denote
behaviors that are of high value and low value.” Nursing – a humanistic science dedicated to
compassionate concern with maintaining and promoting health, preventing illness, and caring
for and rehabilitating the sick and disabled. Nursing seeks to promote symphonic interaction
between the environment and the person, to strengthen the coherence and integrity of the
human beings, and to direct and redirect patterns of interaction between the person and the
environment for the realization of maximum health potential.
A unified whole possessing integrity and manifesting characteristics that are more
than and different from the sum of its parts; an organized pattern energy field that continually.
The concept of Unitary Health Care emerged from the dynamic and innovative work of the
nursing academic Professor Martha E Rogers during the 1950s in New York. She created the
conceptual health care system that became known throughout the world as the Science of
Unitary Human Beings.
Many examples have been given of the direct application of the conceptual
framework in nursing practice. In discussion and position papers and in those describing
accounts of care delivery, Bradley (1987) and Hover-Kramer (1990) promote the importance
of the concept of energy fields and its potential operationalization using techniques such as
therapeutic touch (although the pioneering work of Dolores Krieger (1979), the foremost
authority on therapeutic touch, should not be regarded as having directly evolved from the
work of Rogers). Whelton (1979) presented a comprehensive and detailed but far from clear
assessment and care plan based on the Science of Unitary Human Beings. It was shown to be
useful in guiding nursing intervention and predicting outcomes in the examples given, that is,
the care of a patient with decreased cardiac output, diabetes and hypertension and in the care
of a patient with a recurrent meningioma. However, there is no evidence in the literature that
this care plan has been used since it was first published. Another assessment tool to be used in
nursing practice has been developed by Barrett (1988) who has also stated that nurses need to
assess "pattern manifestation" and to promote "deliberative mutual patterning"

(Barrett, 1990). The nursing care of an adolescent with a "borderline personality disorder" has
been described by Thompson (1990) who used the conceptual framework to describe the
interpersonal processes of transference and counter-transference that existed. Further
explorations of patient care scenarios using the Science of Unitary Human Beings are given
by Meehan (1990) who described caring for a man with pain due to metastatic cancer, Madrid
(1990) who gave a moving account of successful deliberative mutual patterning in the care of
a patient who was in considerable discomfort due to pain, hospitalizations and
gastrointestinal bleeding and Chapman (1994) who described an ICU incident.
Analysis
Purpose or intent of the analysis in part determines the criteria for analysis" and that
the purpose can either be to "compare and contrast the cognitive processes used by the
creators of the models" or "to determine the acceptability of a model by the nursing
profession". An analysis using an explicit framework can reduce the possibility of bias
occurring in the evaluation process and augments the potential for further theory refinement.
In addition, it is important to perform an analysis in order to establish whether the work, in
this instance the Science of Unitary Human Beings, is a suitable framework to use as the
philosophical basis for a major piece of research. When considering this suitability, a
consideration needs to made not only of the degree of internal consistency and development
but also of its applicability to nursing from a United Kingdom perspective.
Conclusion
A critical analysis of the Science of Unitary Human Beings needs to be performed in
order to: (a) judge how suitable the framework will be as a philosophical base or structure for
the present research, (b) assess how well the Science of Unitary Human Beings meets criteria
judging the internal suitability of the framework, (c) determine how applicable the Science of
Unitary Human Beings might be for nursing all over the world, and (d) clarify whether the
framework is indeed a philosophy, model or theory.
It is hoped that some of these issues can be addressed and questions can be answered
following this session. These questions are: (1) How is people defined and described?
(b) How is environment defined and described? (c) How is health defined and described?
(d) How is nursing defined and described? (e) Goal?

References
 George, J.B. (1990). The base for professional nursing practice, (3rd ed.). USA.
Pvt Ltd.
 Taylor, C. (1993). Fundaments of Nursing, (2nd ed.). Lippincott.
 An Article: Retrieved from www.medweb.uwcm.ac.ukmartha/ - 2k – on December
14, 2007.
Yasmeen Naheed
Mrs. Ruth K. Alam
December ,2007

Theorist: Lydia E. Hall
Introduction
My subject is ‘Advance Concept of Nursing.’ Conceptual nursing theories or models
were developed to provide a basis to help the nurse make decisions regarding which types of
information and observations are essential to ensure accurate evaluative judgments. The term
theory and conceptual framework are often used interchangeably in nursing literature. Strictly
speaking, they differ in their levels of abstraction. My theorist is “Lydia E. Hall.”
Lydia E. Hall received her basic nursing education at York Hospital, School of
Nursing in York, Pennsylvania. Bother her BS in Public Health Nursing and MA in teaching
Natural Sources are from Teachers College, Columbia University, New York.
Lydia Hall was the first Director of the Loeb Center for Nursing and Rehabilitation
and continued in that position until her death in 1969. Her experience in nursing spans the
clinical, educational, research and supervisory components. Her publications include several
articles on the definition of nursing and quality of care. Lydia Hall put firth what she
considered a basic philosophy of nursing upon which the nurse may have patient care. This
philosophy is still used as a working reality at the Loeb Center for Nursing.
Her major theme of theory is three interlocking circles: care, cure and core.
We will discuss here three components of the theoretical framework. Major theme, what is
the main concept of the theory? What theorist said about her concept? Person: the recipient
of nursing care (including individual, families, groups, and communities); what theorist
explains about the person? Environment: the internal and external surrounding that effect the
person. It may be home or hospital; what are my theorist’s concepts about environment.
Major theme of Lydia E. Hall was nursing care consists of three interlocking circles:
Care, cure and core.
Care – the care circle represents the nurturing. Component of nursing and is exclusive
to nursing. Nurturing involves using the factors that make up the concept of mothering (care
and comfort of the person) and provide for teaching-learning activities. When functioning in
the care circle, the nurse applies knowledge of the natural and biological sciences to provide a
strong theoretical base for nursing implementation. Core – the core circle is the therapeutic
use of self or helping the patient to grow in self identity. The professional nurse, by use of the
reflective technique (acting as a mirror for the patient), helps the patient look at and explore
feeling regarding his or her current health status and related potential changes in the life style.
Cure – is based in the pathological and therapeutic sciences, involves working with the
patient and family in relation to the medical care, and is shared with other members of the
health team. Although the concept of Hall is directly emphasizes on the health and related to
the person’s health perception and the cognitive process. How a person, express his or her
feeling about the health status, and lifestyle? How he or she perceived about an interpersonal
relationship with the nurse? Person – the individual human who is sixteen years of age or
older and past the acute stage of a long term illness is the focus of nursing care in Hall’s
theoretic framework. The source of energy and motivation for healing is the individual
care recipient, not the health care provider. Hall emphasizes the importance of the individual
as unique, capable of growth and learning, and requiring a total person approach.
Environment – Hall’s concept of environment is deal within relation to the individual.
Hall is credited with developing the concept of Loeb Centre because she assumed the hospital
environment during treatment of acute illness creates a difficulty psychological experience
for the ill individual. Loeb Center focuses on providing an environment that is conductive to
self development. The focus of the action of nurses is the individual, so that any actions
taken in relation to environment would be for the purpose of assisting the individual
in attaining a personal goal.
Conclusion
Although Lydia Hall first presented her theory of nursing during the late 1950’s and
early 1960’s, Loeb Center for Nursing and Rehabilitation is still using Hall’s theory to
provide patient care. Hall’s theory of nursing involves three interlocking circles, each
representing one aspect of nursing. The care aspect represents intimate bodily care of the
person. The core aspect deals with the innermost feeling and motivation of the person.
The cure aspect tells how the nurse helps the person and family through the medical aspect of
care. The main tool, the nurse uses to help the person realize his or her motivations and to
grow in self awareness is that of reflection. Hall presents a philosophical view of humans as
having the energy and motivation for self awareness and growth. Definition of environment
and person must be inferred. Lydia Hall’s theory may be used in the nursing process.
The core, care and cure aspects are all applicable to each phase of the nursing process.
The limitations of Hall’s theory illness orientation, age, family contact restrictions, and use of
reflection only can e overcome by taking a broader view of care, core and cure and by
emphasizing the aspect that is most appropriate for a particular situation.
References
 Crisp & Taylor (2001). Fundamentals of Nursing, (6th ed.). Singapore: Kyob.
 George, J.B. (1990). Nursing theories the base for professional nursing practice,
(3rd ed.). USA.
 Lydia Hall (1926-1969). Article. Retrieved from www.enursescribe.com/
Lydia_Hall.htm on December 9, 2007.

Reflection Log: Fair of Loneliness
Advance Concept of Nursing-I
Azra Nasreen
Mrs. Ruth K. Alam

Introduction
On September 3, 2007, I was deputed to Thoracic Medicine (Ward-12) to fulfill
requirement of my BScN Year-I clinical requirement. On the first day, I met with the Head
Nurse. She welcomed me and gave orientation of the ward. My goals for clinical are to assess
the patient according to Gorden’s Health Pattern and develop a care plan according to
patient’s actual problem.
Analysis
During orientation, I observed that the ward is housed in well established building.
One portion of it is being used as offices and minor procedures and other portion for indoor
patients. During my clinical, I observed shortage of health care team workers. Cleanliness
was up to the standard, but there is a lack of communication between health team members
and patients. Similarly, I also found improper care of patients, lack of proper and prompt
investigation facilities, etc. This may be due to the shortage of manpower and lack of
communication between them. To achieve my goal that is to assess patients according to
Gordon’s health pattern, I selected patients to prepare their care plan after necessary
discussion with Head Nurse.
Observation
During my clinical, I observed that resources are not up to the task but Head Nurse
and co-workers tried their best to do the needful for the patients’ care. Each of them was
working according to the task given to them. I also discussed the problems related to patients,
availability of medicine, equipment, shortage of staff, etc.
One day, I saw a patient having being carried out for X-ray and Ultrasound diagnosis,
but he is not will for the same. On inquiry it came into my notice that he is hospitalized first
time. Besides his suffering of lungs obstruction, he is also having a fear that he will be left all
alone by his family members. He is also not willing that his attendant left him alone.
Loneliness is an emotional state of dissatisfaction with the quality or quantity of
relationships. Risk factors include schizophrenia, bipolar affective disorder, personality
disorder, social isolation, inadequate social and relational skills, passivity, low self-esteem,
hopelessness, powerlessness, anxiety or fear, inadequate leisure activity skills, inadequate
resources for transportation or leisure activities, chronic illness or disability, etc.
(Carson, 2000).
Facilitating the client’s development of social, relationship and leisure activity skills;
promoting the client’s self-esteem and identifying sources of social contact and support in the
client’s living situation and community. These include interpersonal relationships, adopting a
pet if the client is able to care for an animal, referral to supportive groups, placement in an
appropriate group-living situation, identification of continued treatment resources, and so on.
In addition, educating the client and significant others about loneliness, and teaching the
client how to communicate needs for support and intimacy (e.g., helping the client learn how
to tell others when he or she is feeling lonely, and helping the client’s significant others learn
how to respond by listening or attending to the client) can be effective interventions.
Keeping in view the above strategy and with the consent of Head Nurse, I counseled
the client and built a trustworthy environment between the client and myself and then
encourage the client to communicate his problem of fear of loneliness and hospitalization, as
he is admitted in the hospital for the first time and also unaware of hospital environment.
After spending some time with him, I made him understand that he is here for his own
benefits of getting necessary health care investigations and treatment. He agreed with my
views and gives his consent for the diagnostic procedures.
The nurse needs to be aware of the risk for and situation of loneliness when working
with clients in inpatient facilities, in partial treatment settings, and in the community.
Facilitating the client’s development of social, relationship and leisure activity skills;
promoting the client’s self-esteem and identifying sources of social contact and support in the
client’s living situation and community. These include interpersonal relationships, adopting a
pet if the client is able to care for an animal, referral to supportive groups, placement in an
appropriate group-living situation, identification of continued treatment resources, and so on.
In addition, educating the client and significant others about loneliness, and teaching the
client how to communicate needs for support and intimacy (e.g., helping the client learn how
to tell others when he or she is feeling lonely, and helping the client’s significant others learn
how to respond by listening or attending to the client) can be effective interventions.
During my clinical visit, I had experienced many things like managing of ward with
limited resources and shortage of staff. How to deal with patients suffering from anxiety and
fear of hospitalization? etc. etc.
In future, I try my best to provide special care to the patients having problems of not
coping with the indoor situation and environment. Beside this special attention should be
given to the condition that health care providers could visit each patient within a specific time
period, so that any suffering of the patient come into the notice of the Head Nurse, which
need immediate attention. Awareness to the attendant and the client should also be given to
how to communicate and try to solve their problems by their own. Attention provided by the
health care team works to the client during their hospitalization can solve many problems and
facilitate them to provide a good care to the patients.

References
 Carson, V.B. (2000). Mental health nursing. The nursing patient journey.
2nd Edition.
 Kozier, B., Erb, G., Berman, A.J., & Burke, K. (2000). Fundamentals of nursing:
concepts, process and practice. 6th Edition. New Jersey: Prentice Hall Health.
 Scott, J. (2001). Cognitive therapy for depression. British Medical Bulletin;
57:101-113. Retrieved from http://www.google.com.pk/ on October 2, 2007.

Reflection Log: Communication
Irshad Akhter
Mrs. Ruth K. Alam

Introduction
Being a student of BScN Year-I, I had to complete my clinical requirement, therefore,
my first placement was made at Medical Unit III (Ward-7). First week of my clinical was an
orientation week. On the first day I met with the Head Nurse who is maintaining this unit in
well organized way. She gives an orientation and told us that this unit consists of 50 beds,
which are divided into two wings for male and female patients. My goals for clinical are to
assess the patient according to Gorden’s Health Pattern and develop a care plan according to
Analysis
During orientation, I seen an emergency trolley that was usually considered or met for
any sort of life saving emergency occurred. It was maintained properly. Record of drugs and
other items was maintained in the register duly signed by the Charge Nurse and
countersigned by the Head Nurse. Head Nurse assigned the work to each coworker, therefore,
everyone know his work and expert in his routine work. The Head Nurse frequently visits the
patients and was well aware of patients’ diseases, treatment and progress, etc.
To achieve my goal that is assess patients according to Gordon’s health pattern,
I selected patients to prepare their care plan after necessary discussion with Head Nurse.
Observation
During my clinical, I observed the routine work being carried out by the Head Nurse
and sub-ordinates. I also discussed the problems related to patients, availability of medicine,
equipment, shortage of staff, etc.
One day when I was on my clinical routine work, I found a patient of known diabetes
mellitus having a complaint about his diet. In his diet a fruit, Papaya was included, but he
dislikes it and wants to have some other fruit, instead of Papaya.

Analysis
I communicate with the client and tried to satisfy him about his dietary requirement
being a known patient of Diabetes mellitus. I also requested to the Head Nurse to check the
diet chart and exclude Papaya from his diet menu. Later on, I told the patient about his diet
and no more Papaya is included in his diet menu.
Communication refers to giving, receiving or sharing of ideas, knowledge and
feelings, etc. It is also recognized as a permanent change in behavior through the process of
training and experience. The primary purpose of communication is to help client come to
know themselves in ways that allow them to recognize possibilities in their lives and to alter
ineffective life pattern. The nurse’s role in the communication process is to help patients
transform vague, tangential, or distorted statements into clear, concrete, workable statements
that have common meaning to both. The nurse uses these mutually developed statements as
the basis for therapeutic intervention. The nurse enlists the patients as collaborators in the
process of self-discovery and uses words, actions and knowledge to help patients develop a
more positive view of themselves and more adaptive ways of interacting in the world
(Nancy, et al., 1998)
Another problem I found there was shortage of staff due to which patients do not get
quality care for which they were admitted for. I discussed the problem with the Head Nurse
as an incidence was occurred last night that one of the patients was not feeling well and he
tried to call staff member but nobody responded at the movement. The Head Nurse confirmed
about complain and said that this was happened during night shift duty. She asked the patient
that in future if he had any complain he should contact her.
I analyzed that due to a good conduct and communication, the patient was satisfied.
From this situation, I had learned that how can we manage and enhance our learning process
through critical thinking, effective health care of the client and as well as communicate
effectively.
The success of any organization depends on the good relation between team members
and quality of communication. To achieve the purpose, a team leader should pay special
attention to the quality of team relations and of communication as a means of maintaining
good relations.
During my stay in the ward, I tried my best to become a role model for others
especially for the nurse student so that they should get awareness about their responsibilities
and the care provided by them to the patient. This becomes a great source for me to observe
the change in nurses’ behavior and attitude.
In future, I also tried my best to emphasize on good communication between the
health care providers and patients. This will facilitate client to focus on other people or
interactions cyclic, which interrupted negative thoughts, moreover positive feedback
increases the likelihood that the client will continue the good behavior.
References
 Kozier, B., Erb, G., Berman, A.J., & Burke, K. (2000). Fundamentals of Nursing:
 Nancy, R., Long, W.W., & Tierney, A. J. (1998). The element of nursing (4th ed).
Singapore.
Reflection Log: Aseptic Measures
Khurshida Hussain
Mrs. Ruth K. Alam

Introduction
It was my first week as the clinical posting at the Department of Nephrology
(Ward-22), Jinnah Postgraduate Medical Centre, Karachi. This clinical placement took place
to fulfill my requirement of BScN Year-I Degree Program.
First week of my clinical replacement is recognized as an orientation week and my
goals are to assess patient according to Gorden’s Health Pattern and develop a care plan
according to patient’s actual problem.
Analysis
On the morning of September 3, 2007 at 08:15 AM, I reached at the Department of
Nephrology and met with the Head Nurse. She welcomed me. As she was busy in managing
ward routine work, she asked me to wait for a while and then she took me and gave
orientation of the ward. The Department of Nephrology is housed in ground plus two floors
with provision of lifts. It is reserved for the admission, diagnosis and treatment of the clients
suffering from Kidney, ureter and urinary bladder diseases. The new facilities added recently
include facility of dialysis for renal failure patients.
Observation
While orientation, I had discussed various matters with the Head Nurse and she
answered my question up to my satisfaction. Although, I observed good management, but
seen shortage of staff especially in the dialysis room, moreover, staff working in the dialysis
room do not follow coming in and out with observing precaution measures, which is against
the ethics of nursing profession and patient’s right. The more surprising thing which I had
observed there is that no nursing staff was posted in the dialysis room. The staff nurses
performing duties in the ward also provide care to the patients in the dialysis room.
During my posting at the unit, I encountered a female patient, who was a case of
chronic renal failure, while I was on my schedule duty at the department, it was time for the
injection dispensing to the client. The on duty nurse came and she attempted to pass the
intravenous (I/V) cannula, without taking standardized aseptic techniques required as
prerequisite to pass I/V Canula.
I witnessed that the duty nurse had handled the tip of I/V cannula by placing her
fingers on it, so making the cannula contaminated with microorganisms, which might be
present on her hands. After observing the non-sterilized technique of I/V cannulization by the
nurse on duty, I immediately interrupted the duty nurse, to not to pass that I/V cannula and
discard it. I also asked her to use other I/V cannula by adopting proper sterilized technique to
pass I/V line. She obeyed my instruction as directed by me.
According to Hauswirth and Sherk (2007), Aseptic technique is a set of specific
practices and procedures performed under carefully controlled conditions with the goal of
minimizing contamination by pathogens. Crow (1989) stated that, “Aseptic technique is the
effort taken to keep patients as free from hospital microorganisms as possible”.
The founder of the technique is considered to be Joseph Lister. It is a method used to
prevent contamination of wounds and other susceptible sites by organisms that could cause
infection. This can be achieved by ensuring that only sterile equipment and fluids are used
during invasive medical and nursing procedures.
Ayliffe et al. (2000) suggest that there are two types of asepsis: medical and surgical
asepsis. Medical or clean asepsis reduces the number of organisms and prevents their spread;
surgical or sterile asepsis includes procedures to eliminate micro-organisms from an area and
is practised by nurses in operating theatres and treatment areas.
Aseptic technique is employed to maximize and maintain asepsis, the absence of
pathogenic organisms, in the clinical setting. The goals of aseptic technique are to protect the
patient from infection and to prevent the spread of pathogens. Often, practices that clean
(remove dirt and other impurities), sanitize (reduce the number of microorganisms to safe
levels), or disinfect (remove most microorganisms but not highly resistant ones) are not
sufficient to prevent infection.
The Centers for Disease Control and Prevention (CDC) estimates that over 27 million
surgical procedures are performed in the United States each year. Surgical site infections are
the third most common nosocomial (hospital-acquired) infection and are responsible for
longer hospital stays and increased costs to the patient and hospital. Aseptic technique is vital
in reducing the morbidity and mortality associated with surgical infections.
In addition to environmental safety, a major concern of health practitioners is the
danger of spreading microorganisms from person to person and from place to place.
Microorganisms are naturally present in the environment. Some are beneficial and some are
not. Some are harmless to most people, and others are harmful to many people. Still others
are harmless, except in certain circumstances.
In future, I will emphasis on providing awareness of standardized aseptic techniques
because in the medical management of the clients the aseptic techniques are necessary to
avoid the unnecessary secondary infection and hospital acquired infection, which increases
the mortality and morbidity of the clients. Similarly the secondary infections during
hospitalization cause the extra burden on the hospital budget, which may be used on other
areas of health management.

References
 Hauswirth, K. & Sherk, S.D. (2007). Aseptic technique forum: A guideline for
patients and caregivers. Retrieved from www.google.com.pk on October 4, 2007.
 Kozier, B., Erb, G., Berman, A.J., & Burke, K. (2000). Fundamentals of nursing:
concepts, process and practice. 6th Edition. New Jersey: Prentice Hall Health.
 www.google.com.pk/Aseptic technique retrieved from Wikipedia on October 4, 2007.

Liaquat University of Medical and Health Sciences, Jamshoro Sindh
Reflection Log: Professional Responsibility
Nargis Bashir
Mrs. Ruth K. Alam

Introduction
On September 10, 2007, when I reached College of Nursing, Jinnah Postgraduate
Medical Centre, Karachi, it came into my notice that I was deputed in Gynecology and
Obstetrics (Ward-8) for first clinical to fulfill requirement of my BScN Year-I Degree
Program. First week is an orientation week and my goals are to assess patient according to
Gorden’s Health Pattern and develop a care plan according to patient’s actual problem.
Analysis
I and one of my classmates reached there and reported to the Head Nurse, who
welcomed both of us and gave us orientation of the ward. Gynecology and Obstetrics is a
housed in two storied building comprising facilities for admitting indoor patients, having 150
beds. Ground floor consists of offices, ward, and ICU.
During orientation, I had observed many problems which include lack of
communication between health care provider team and patients, unsatisfactory sanitation
condition of the ward. I also observed that patients also come from the rural areas of Sindh
Provinces, who faced difficulty in conveying their problems due to language differences.
One of the major issues, which I had observed was shortage of staff. This problem can
be observed in each and every public sector hospitals, which resulted in negative thinking and
concept of people. According to WHO’s nurse/patient ratio must be 1/10 but this is not
achieved yet and that is why we are still unable to provide good and reasonable nursing care.
Observation
Once, during my clinical round, I observed a postoperative patient is suffering from
severe pain, but no one is there to provide her relief from pain. Being a nurse, I immediately
provide care to the patient and also spent some time with her while communication. This will
help the client to divert her attention. When I observed that she is now relaxed, I went to the
Head Nurse and asked for the patient condition.

According to the Head Nurse, the client had delivered a baby two days back after
Cesarean section, due to sudden rise in her blood pressure she was operated in emergency and
so she delivered her first baby. Postoperative pain is a natural phenomenon; therefore she
needs counseling, more attention and care. We had given awareness to the attendant of the
patient, that how can she cope with such a situation.
It is the responsibility of a nurse to take care of such patients especially postoperative
patients, as we have more opportunities to communicate and interact with the clients and
therefore it is our responsibility to provide special care to those clients who are critically ill or
need postoperative care.
According to Jammerson (1987), “Responsibility denotes an obligation to accomplish
a task.” Delegation is the process by which the responsibility for performing a task, function,
activity, or decision is transferred to another individual who accept that responsibility. On the
other hand, “Responsibility is transferred and accountability is shared.” As s nurse we should
perform those tasks for which we are responsible (Adcock, 1971). Rob (1901), suggested that
“Nurse should always make her it rule to think of every client as an individual human bean
being, whose, fancies and peculiarities for her all the considerations possible at her hand.”
I discussed the matter with the Head Nurse regarding responsibilities of Nurses while
performing her duties. She agreed with me and we decided to observe student nurses that how
they communicate with patients and care was provided by them. I also arranged a session for
giving them some awareness in respect to there responsibilities toward clients.
During my last day of clinical, I observed change in the behavior and attitude of
nurses and they were showing a very responsible behavior. I was very much surprised and
satisfied. The reason of this change was that the Head Nurse now trying her bests to manager
the ward with well planned manner. She gives task to each and every team work and takes
round of the ward.

I had learned lot from this clinical placement. Being a nurse we are responsible for
many things while providing health care facilities to the clients. We have to administer
medication on time, we not only maintain I/V line but also have to take care either I/V line is
working properly, how we are interacting with the clients and coworkers, etc. The main thing
which I like to be adopted in my future is that I will use all my efforts to manage a ward with
limited resources. I also give awareness to the clients and their attendant how to manage pain,
if health care provider was not available. In addition to the above, I also adopt such policies
and encourage each member of health care provider team to be sincere with their work and
during duty hours should work with responsibility for the task given to them.
References
 Ellis, J.R., & Harley, C. (2001). Managing and coordinating nursing care (3rd ed)
USA.
 Hickkey, J.R., & Venegonsi, S.L. (1993). Advanced practice nursing (2nd ed.) USA:
Lippincot.
Singapore.
 Rowe, J.A. (2000). Accountability: The fundamental component of nursing practice.
British Journal of Nursing, 9(9), 249-252.

Reflection Log: Culture Difference
Nargis Qureshi
Mrs. Ruth K. Alam

Introduction
On September 3, 2007, I was deputed to Ward-13 to fulfill requirement of my BScN
Year-I clinical requirement. On the first day, I met with the Head Nurse. She welcomed me
and later on gave orientation of the ward.
My goals for clinical are to assess the patient according to Gorden’s Health Pattern
and develop a care plan according to patient’s actual problem.
Analysis
During orientation, I observed that the ward is housed in two rooms, which are not
well ventilated. Patients are suffering from air pollution and unhygienic conditions. Other
factors which I had observed there are shortfall of staff members, improper communication
between health caregivers and patients, improper care of patients, etc.
To achieve my goal that is assess patients according to Gordon’s health pattern,
I selected patients to prepare their care plan after necessary discussion with Head Nurse.
Observation
and co-workers tried their best to do the needful for the patients’ care. I also discussed the
problems related to patients, availability of medicine, equipment, shortage of staff, etc.
One day when I was on my clinical round, I observed a patient is not willing to
administer injection. On inquiry, it came to my not that he is admitted first time in the
hospital therefore, he is afraid. Moreover, he does not understand Urdu and he is also facing
difficulty in communication due to language differences. To solve the problem I used critical
thinking and to communicate between the client and health caregivers, I called one of the
relative of another patient.

By obtaining assistance of another person well worse with client’s language,
I communicate with the patient and counsel him and also make him understand for the
purpose of administering injection to him. The patient agreed to have injection.
Nurses function in a health care environment that mirrors the diversity and cultural
complexities of the larger society. The diversity of clients is varied and related to gender, age,
socioeconomic status, education, physical and mental disabilities, regional locations, sexual
life-style, and racial and ethnic backgrounds. The essential role of the nurse in cultural
transactions within health care, and proposes an approach to cultural inclusiveness crafted
from the nursing process. In addition to a fundamental approach to care, nurses must bring
the will and commitment to change. Culture is dynamic. Its changes are usually gradual, but
always constant. Culture is one of the few attributes important enough that no one was left
out. We all have at least one; many of us have more than one. It includes values, beliefs,
attitudes, customs, rituals, and behaviors. It will vary within the group by age, gender,
religion, and social class. Nurses must recognize the process of continually cultural change
through acculturation or assimilation. Once the dynamism of cultures is accepted, a static
description of behaviors or the naming of specific cultural attributes has limited utility
(Dennis & Small, 2003).
Another problem I found there was shortage of staff due to which patients do not get
quality care for which they were admitted for. I discussed the problem with the Head Nurse,
she told about the shortage of staff especially in night shift. She had made several requests
but no action was taken so far. The unhygienic condition of the ward is one of the other
problems, as there is no permanent cleaner was deputed.
During my stay in the ward, I tried my best to become a role model for others. I felt
no hesitation to take assistance of other so that communication link between patients and
health care worker could be continued and proper counsel could be also done.
In future, I may use communication skill and to cope with the daily requirement and
management of ward asked for proper equipment and staff. This will facilitate to provide
proper care to the clients admitted for their treatment.

References
 Dennis, B.P., & Small, E.B. (2003). Incorporating cultural diversity in nursing care:
an action plan. ABNF Journal.
Singapore.
Liaquat University of Medical and Health Sciences, Jamshoro Sindh
Reflection Log: Critical Thinking
Naeema
Mrs. Ruth K. Alam

Introduction
To fulfill first clinical requirement of my BScN Year-I Degree Program, I was deputed
to Department of Gynecology and Obstetric (Ward-8). On the morning at 08:15 AM of
September 3, 2007, I reached to Ward-8. First week is an orientation week and my goals are
to assess patient according to Gorden’s Health Pattern and develop a care plan according to
Analysis
After reaching at Ward-8, I met to the Head Nurse, and told her my purpose of being present
there. She welcomed me and after distributing work tasks between the coworkers, she gave
me orientation of the department and later on of the ward.
Department of Gynecology and Obstetrics is a housed in two storied building
comprising facilities for indoor patients, having 150 beds. It was further divided into two
wards. Ward-8 at ground floor consists of offices, ward, and ICU, etc. and ward-9 on the first
floor with all the same facilities. Both ward have high bed occupancy rate, this is due to
patients coming for treatment not only from Karachi but also from far flung areas of
Provinces of Sindh and Balochistan. Due to high occupancy rate, work load was increased
manifold, which resulted in shortage of staff and burden on other facilities.
During orientation, I had observed many problems which include lack of
communication between health care provider team and patients, this may cause due to heavy
work load and shortage of staff, unsatisfactory sanitation condition of the ward as only two
cleaners were present. One of the major issues, was shortage of staff and this issue was found
in each and every public sector hospitals. According to WHO’s nurse/patient ratio must be
1/10 but this is not achieved yet and that is why we are still unable to provide good and
reasonable nursing care to the patients.

Observation
During my clinical round, an incidence was occurred that one of the Student Nurse is
trying to maintain I/V line of the patient, but patient is not willing to let her do so. When
I enquired about the reasons, the Student Nurse told me that she cannot understand my
language and is afraid of administering medication via I/V line.
I observed that patient belong to rural area of the Sindh and cannot talk or understand
Urdu. I critical think about the situation and to solve the issue search for a patient attendant
who can understand Urdu and can be helpful to communicate with both of us. I was
successful to find one of them. I asked her to communicate with both of us and make the
patient understand that to maintain I/V line is important for her and can improve her
condition. After spending some time with both of them, I succeed to make the patient
understand the reasons and purposes of maintaining I/V line. Later on I called the Student
Nurse and asked her to do the needful.
Critical thinking is the process of examining underlying assumptions, interpreting and
evaluating arguments, imagining and exploring alternative and developing a reflective
criticism for the purpose of reaching a reasoned conclusion that can be justified.
According to Field (1987), critical thinking is a process highly sensitive to content the
emotional and rational dimension. Kemp (1985) stated that, “Critical thinking is an attitude of
inquiry involving the use of facts, principles, theories, observations, deductions,
interpretations and evaluation.”
We had adopted such a profession in which have to face many critical situations.
Critical thinking competency, general thinking competency, specific critical thinking
competencies in clinical situations and special critical thinking competency in nursing helped
us out to solve the problem while bold and prompt decision. Therefore, Head Nurses are
expected to use knowledge from various disciplines to solve problems of patients, staff and
the organization as well as problems in their own personal and professional lives.
In nursing, it is common to equal critical thinking with problem solving, analyzes of
data, clinical decision making or judgment and use of the nursing process. It helps in
anticipating problem to bring change and understanding each other and identifying actual or
potential problems and its helps to make decision about an action plan.
During my stay at my clinical placement, I had learned lot of things, which I will
apply whenever, I got opportunity. The main things, which I had learned are that how to
manage a ward with limited resources, how to depute coworker so that each task can be met
and completed within time.
I will use all my efforts to manage a ward with limited resources. I also encourage to
coworker to learn additional languages especially Urdu, as they can be posted at any part of
the country. In addition to the above, I also adopt such policies and encourage each member
of team to work sincerely and with responsibility as the care of the patient while
hospitalization lies on their shoulder. Little bit of negligence can cause problems for the
others.
References
 Hickkey, J.R., & Venegonsi, S.L. (1993). Advanced practice nursing (2nd ed.) USA:
Lippincot.
Concepts, Process and Practice. 6th Edition. New Jersey: Prentice Hall Health.
 Nancy, R., Long, W.W., & Tierney, A.J. (1998). The element of nursing. 4th Edition.
Singapore.
 Sullivan, E.J., & Decker, P.J. (1990). Effective Management in Nursing. 3rd Edition.
 Rowe, J.A. (2000). Accountability: The fundamental component of nursing practice.
British Journal of Nursing, 9(9), 249-252.

Reflection Log: Gastrostomy Tube Care
Shamshad Begum
Mrs. Ruth K. Alam

Introduction
On September 3, 2007, I was deputed to Ward-4 to fulfill requirement of my BScN
Year-I clinical requirement. The ward is also recognized by the name of Cancer Ward. On the
first day, I met with the Head Nurse. She welcomed me and gave orientation of the ward. My
goals for clinical are to assess the patient according to Gorden’s Health Pattern and develop a
care plan according to patient’s actual problem.
Analysis
During orientation, I observed that the ward is housed in an old barrack, which was
renovated several times. Being a Cancer Ward standard of ventilation is not found
satisfactory. Patients are suffering from pollution due to environmental conditions. Other
factors which I had observed there are shortage of staff members, improper cleanliness,
improper communication between health team members and patients, improper care of
patients, lack of proper and prompt investigation facilities, etc. To achieve my goal that is to
assess patients according to Gordon’s health pattern, I selected patients to prepare their care
plan after necessary discussion with Head Nurse.
Observation
and co-workers tried their best to do the needful for the patients’ care. I also discussed the
problems related to patients, availability of medicine, equipment, shortage of staff, etc.
One day when I saw a patient having gastrostomy tube passed, but no proper care was
taken about taking hygienic procedure to protect the wound or gastrostomy tube. Patient was
also feeling uncomfortable while sitting or in spine position on the bed. I inquired from the
Head Nurse about the condition and treatment being given to the patient. She told me that
patient was suffering from stomach cancer and after gastrostomy, tube was inserted for
further treatment and care. After taking consent from the Head Nurse, I examined the patient
thoroughly and arranging necessary material and antiseptics, I changed dressing and also
clean the tube by taking necessary precaution measures.
Gastrostomy refers to a surgical opening into the stomach. Creation of an artificial
external opening into the stomach for nutritional support or gastrointestinal compression.
Typically this would include an incision in the patient's epigastrium as part of a formal
operation. It can be performed through surgical approach or percutaneous endoscopic
gastrostomy (PEG). The opening may be used for feeding, such as with a gastrostomy tube
(Wikipedia, 2007).
To take care of gastrostomy feeding tube, dressing should be changed every 1 to 2
days, clean around tube with hydrogen peroxide, apply antibiotic ointment to skin around
tube, dress with gauze pads and tape, and position tube so it does not kink. While taking
shower, cover dressing with a double layer of plastic wrap and tape edges. Remove plastic
wrap and change dressing after you shower (Golzarian, et al.).
Other problems I found there was shortage of staff, due to which patients do not get
quality care, unhygienic condition of the ward and environmental factors. I discussed these
problems with the Head Nurse, she agreed with me and said that we had asked for more staff
but our requirement was not fulfilled, yet. Regarding unsatisfactory sanitary conditions she
added that we have no regular or permanent Sanitary Worker. Administration sends one of
them who work for few hours and thereafter go back whenever they received call from their
superiors.
During my clinical, I learned lot of thing which included how to manage a ward
especially with shortage of staff. How one can communicate with the patients and team
workers, how to take care of patients to who tubes were passed. Moreover, how to provide
patients better facilities with limited resources.

In future, I may try my best to provide special care to the patients having nasogastric
tube or gastrostomy tube passed. Special antiseptic measures should be taken and cleanliness
of tube should be checked after every food intake. Awareness regarding how to take care of
gastrostomy tube should be given to the attendant of the patient and patient too. On the other
hand necessary measures should also be taken with the Administration for deputing enough
trained staff, which can cope with the requirement of Cancer patients and for cleanliness of
the ward proper arrangements should be made. Rectifying of these problems may improve the
care given to the clients admitted.

References
 Golzarian, J., Sun, S., Sharafuddin, M., & Mimura, H. How to care for your feeding
tube (Gastrostomy Tube)? Retrieved on October 2, 2007.
 www.google.com.pk/wikipedia Gastrostomy. Retrieved on October 2, 2007.

Reflection Log: Privacy
Yasmeen Naheed
Mrs. Ruth K. Alam

Introduction
On September 3, 2007, I went to Medical ICU for my first clinical to fulfill
requirement of my BScN Year-I degree program. First week is an orientation week and my
goals are to assess patient according to Gorden’s Health Pattern and develop a care plan
according to patient’s actual problem.
Analysis
I met to the Head Nurse, who welcomed me and later gave orientation of the ward.
Medical ICU is a 20 bedded ward where health care was provided to those patients suffering
from critical medical illness. During my clinical I came to known that mortality rate was at
higher side, this is due to the admission of such a critical ill patients who required immediate
attention and need more medical care facilities. One of the major problems which I had
observed is that there was no interaction between doctors and nurses. This might be due to
over load as everyone was busy with their own work.
The time I spent for my clinical, I had learned how to assess patient according to
functional health pattern of Gorden. During head to toe assessment applied physical
assessment techniques, I have learned more during my first placement in clinical area. I had
selected different diseased patients for assessment and to develop their care plan according to
their actual problems. Interaction between the health workers and patients is one of the
important elements of health care settings. Being a Nurse, we are more attached to the
patients. Attention towards the patient and listening their conversation with full concentration
will be more beneficial for client and also for nurses. Secondly, maintaining patients’ privacy
is our fundamental role and basic ethical principle.
During my clinical days, I come across with one situation that still irritating me. One
patient, who was in very critical condition and suffering from ascities, Doctor came to him to
conduct catheterization procedure without adopting any privacy method. Only one bed sheet
was spread around, which was not enough to provide complete privacy. Patient felt hesitation
and refused to catheterize. Doctor left the patient and attends other patients. When I asked the
doctor about this patient, he replied that I haven’t found screen for privacy of this patient.
Later on I talked to patient about refusing for the procedure as it is necessary for him. He
replied that, “is it a way to expose anyone in front of all people especially in front of ladies
and you tell me that this sheet is enough for my privacy. In this situation, I never give
permission to attend me.” These were patient’s feeling about his basic right, which is privacy.
I went to the Ward Manager and asked for screen, which I found from the neighbored
Ward-7. I screened the patient and counsel the patient that now you are in privacy and then he
agreed for catheterization procedure.
Being a nurse it was important for me that I have to maintain patient’s privacy
because it is patient’s right to have privacy. Whenever, I recall this incidence, I always get
anxious. The whole situation came in front of me and a question arises in my mind that isn’t
privacy a patient’s right and what would be patient’s feelings at that time? I have been taught
and emphasized from beginning in our training to maintain privacy before doing any
procedure. But it has been observed that at most of the times, privacy of the patient was
ignored or not maintained. There may be many reasons for this ignorance; one of them could
be a large number of patients and lack of resources.
According to Paraland (2000), practical difficulties in hospital such as lack of
resource may make it difficult for patient privacy. It can cause conflicts for nurses whose aim
to maintain patient’s privacy.” Gabbie (2001) stated, “It is the responsibility of every
professional nurse to understand the critical importance of the principles of privacy.”
In future, when I will be back in my respective institute, I will respect patient and
pride to maintain their privacy. I will try to bring change by giving awareness to the health
providers about patient’s privacy and its importance. Finally, I must say that respect patient’s
privacy. It is a good practice and is patient’s basic right. No matter health care provider is a
nurse or a doctor.
References
 Gebbie, K.M. (2001). Privacy: the patient’s right. American journal of nursing.
101(6):73.
 Paraland, J.M., et al. (2000). Autonomy and clinical practice 2: patient privacy and
nursing practice. British journal of nursing. 9(9):567.

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Virgina Handerson Theory 1

Liaquat University of Medical & Health Sciences

College of Nursing, JPMC, Karachi

BScN Session 2006-2008

Advance Concept in Nursing I

Mrs. Ruth K. Alam

Theory is a group of concepts that form a pattern of reality. A theory is a statement

that explains or characterizes a process, an occurrence or an event and is based on observed

facts but lacks absolute or direct proof.

nursing care practice.

Florence Nightingale (The Lady of Lamp)

gentleness, efficiency and heroism. Although Florence Nightingale cannot be considered as

genius as the founder of modern nursing.

vision of what nursing could and should be.

Major Theme – A major of Florence Nightingale is “Unique Role of the Nurse”.

after desire process through hygienic conditions.

According to Florence Nightingale environment involves those external conditions

leads to sleeplessness or restlessness causing delay in patient’s recovery.

I collect information and examine the client through two ways.

comfortable and weakness occurs since last one month.

the 35 years old patient lying on the bed and looking:

 Dry skin due to lack of nutrition.

His vital signs are:

 Blood Pressure 120/70 mmHg.

 Pulse 92 per min.

 Respiratory Rate 22 per min

The following investigations were performed.

Acceptable Nursing Diagnosis

 Ineffective management of therapeutic regimen.

 Ineffective family management of therapeutic regimen.

 Altered health maintenance.

Health maintenance altered, due to anxiety secondary to disease process.

Nursing Interventions and Rationales

 Allow the family as individual’s and  Sharing of feelings among family

 Prescribe the client to use  To maintain health of the client.

more active part in daily life than before.

maintain his health status.

comfortable and achieve my desired goal within target period.

individual achieve an optimal degree of inner harmony to promote self-knowledge, self-

healing, and insight into the meaning of life.

Sridaromount, K.L. (1996). Clinical Applications of Nursing Diagnosis: Adult, Child,

Women’s Psychiatric, Gerontic, and Home Health Considerations. 3rd Edition.

Liaquat University of Medical & Health Sciences

College of Nursing, JPMC, Karachi

BScN Session 2006-2008

Martha E. Rogers Theory

Advance Concept in Nursing I

Mrs. Ruth K. Alam

Martha E Rogers’s theory depends on “interaction between person and environment”

environment to actualize unique potentials. We do not use or exchange energy we are

unceasingly transforming energy with the rest of the universe.

Martha E. Rogers also defines:

Health is a rhythmic patterning of energy that is mutually enhancing and expresses

as a process of actualizing potentials for well being by knowing participation in change.

Nursing - Martha. E. Rogers defined nursing as “A profession with a focus on

promotion protection and restoration of health in people.” It can be more described as a

humanistic science dedicated to compassionate concern with maintaining and promoting

nursing according to Rogers’s science of unitary human beings is to promote human

Applicable Nursing Diagnosis

 Altered health maintenance.

 Ineffective management of therapeutic regimen.

 Total health management deficit.

 Health management deficit.