A stressor is any environmental force which can potentially affect the stability of the system, they may be: 1. Occur within person, e.g. emotions and feelings 2. Occur between individuals, e.g. role expectations 3. Occur outside the individual, e.g. job or finance pressures

1. Intrapersonal 2. Interpersonal 3. Extrapersonal (Neuman)

NURSING THEORIES - NEUMAN, ROY, & JOHNSON Flashcards by Rayben William Sanchez

The goal of the model was to provide a holistic overview of the physiological, psychological, sociocultural, and developmental aspects of human beings.

NEUMAN’S SYSTEMS MODEL

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Two Major Components of the Neuman’s Systems Model

Stress
Reaction to stress

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Viewed as an open system in which repeated cycles of input, process, output and feedback constitute a dynamic organizational pattern.

Client (Neuman)

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Using the systems perspective, the client may be an individual, a group, a family, a community, or any aggregate.

As they become more complex, the internal conditions of regulation become more complex.

Exchanges with the environment are reciprocal; both the client and the environment may be affected either positively or negatively by the other.

The system may adjust to the environment or adjust the environment to itself.

Client (Neuman)

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Each layer, or concentric circle, of the Neuman model is made up of the five person variables. Ideally, each of the person variables should be considered simultaneously and comprehensively.

Physiological
Psychological
Sociocultural
Spiritual
Developmental
(Neuman)

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refers of the physicochemical structure and function of the body

Physiological (Neuman)

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refers to mental processes and emotions

Psychological (Neuman)

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refers to relationships; and social/cultural expectations and activities

Sociocultural (Neuman)

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refers to the influence of spiritual beliefs

Spiritual (Neuman)

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refers to those processes related to development over the lifespan

Developmental (Neuman)

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The basic structure, or ________, is made up of the basic survival factors that are common to the species (Neuman, 1995, in George, 1996).

CENTRAL CORE (Neuman)

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Factors of the Central Core include:

System variables
Genetic features
The strengths and weaknesses of the system parts
(Neuman)

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Is an open system and therefore is dynamic and constantly changing and evolving.

Person’s System (Neuman)

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Occurs when the amount of energy that is available exceeds that being used by the system.

Stability / Homeostasis (Neuman)

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Is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance.

Homeostatic Body System (Neuman)

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A protective accordion-like mechanism that surrounds and protects the normal line of defense from invasion by stressors.

The outer barrier or cushion to the normal line of defense, the line of resistance, and the core structure.

Acts as a cushion and is described as accordion-like as it expands away from or contracts closer to the normal line of defense.

Can be changed/altered in a relatively short period of time.

If the _______________ fails to provide adequate protection to the normal line of defense, the lines of resistance become activated.

FLEXIBLE LINES OF DEFENSE (Neuman)

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An adaptational level of health developed over time and is considered normal for a particular individual client or system; it becomes a standard for wellness-deviance determination.

Represents system stability over time.

Can change over time in response to coping or responding to the environment.

An example is skin, which is stable and fairly constant, but can thicken into a callus over time.

It is considered to be the usual level of stability in the system.

NORMAL LINE OF DEFENSE (Neuman)

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Protection factors are activated when stressors have penetrated the normal line of defense, causing reaction symptomatology.

Protect the basic structure and become activated when environmental stressors invade the normal line of defense.

Example: activation of the immune response after invasion of microorganisms.

If the _______________ are effective, the system can reconstitute and if the lines of resistance are not effective, the resulting energy loss can result in death.

LINES OF RESISTANCE (Neuman)

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Is the increase in energy that occurs in relation to the degree of reaction to the stressor.

Begins at any point following initiation of treatment for invasion of stressors.

May expand the normal line of defense beyond its previous level, stabilize the system at a lower level, or return it to the level that existed before the illness.

RECONSTITUTION (Neuman)

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Any phenomenon that might penetrate both the flexible and normal lines of defense, resulting in either a positive or negative outcome.

Are capable of having either a positive or negative effect on the client system.

The Neuman Systems Model looks at the impact of ___________ on health and addresses stress and the reduction of stress (in the form of _________).

Any environmental force which can potentially affect the stability of the system.

STRESSORS (Neuman)

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A stressor is any environmental force which can potentially affect the stability of the system, they may be:

Occur within person, e.g. emotions and feelings
Occur between individuals, e.g. role expectations
Occur outside the individual, e.g. job or finance pressures

Intrapersonal
Interpersonal
Extrapersonal
(Neuman)

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The person has a certain degree of _______ to any given stressor at any given time.

reaction (Neuman)

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The nature of the reaction depends in part on the _________________.

strength of the lines of resistance and defense (Neuman)

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As defined by Neuman’s model, _________ is the primary nursing intervention. __________ focuses on keeping stressors and the stress response from having a detrimental effect on the body.

Prevention (Neuman)

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Occurs before the system reacts to a stressor. It strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors, and on the other hand manipulates the environment to reduce or weaken stressors. Includes health promotion and maintenance of wellness. Strategies that might be used include immunization, health education, exercise, and lifestyle changes.

Primary Prevention (Neuman)

Occurs after the system reacts to a stressor and is provided in terms of existing systems. Focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor.

Secondary Prevention (Neuman)

Occurs after the system has been treated through secondary prevention strategies. Offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.

Tertiary Prevention (Neuman)

“Unique profession in that is concerned with all of the variables affecting an individual’s response to stress.”

Nursing (Neuman)

The focus is on the client as a system (which may be an individual, family, group, or community) and on the client’s responses to stressors. The client system includes five variables (physiological, psychological, sociocultural, developmental, and spiritual). It is conceptualized as an inner core (basic energy resources) surrounded by concentric circles that include lines of resistance, a normal defense line, and a flexible line of defense.

Neuman’s System Model

Is an open system that interacts with internal and external environment forces or stressors Constantly changing, moving toward a dynamic state of system stability or illness of varying degrees

Human Being (Neuman)

Is a vital arena that is germane to the system and its function. May be viewed as all factors that affect and are affected by the system. In Neuman Systems Model identifies three relevant _____________: (1) internal, (2) external, and (3) created.

Environments (Neuman)

The (1) _________ environment exists within the client system. All forces and interactive influences that are solely within the client system’s boundaries make up this environment. The (2) _________ environment exists outside the client system. The (3) _________ environment is unconsciously developed and is used by the client to support protective coping.

(1) internal (2) external (3) created (Neuman)

Is defined as the condition or degree of system stability and is viewed as a continuum from wellness to illness. When system needs are met, optimal wellness exists. When needs are not satisfied, illness exists. When the energy needed to support life is not available, death occurs.

Health (Neuman)

A system in which there is a continuous flow of input and process, output and feedback. It is a system of organized complexity, where all elements are in interaction.

Open System (Neuman)

A state of balance or harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal health level, thus preserving system integrity.

Stability (Neuman)

The amount of system instability resulting from stressor invasion of the normal line of defense.

Degree of Reaction (Neuman)

A process of energy depletion and disorganization moving the system toward illness or possible death.

Entropy (Neuman)

An energy conservation process that increases organization and complexity, moving the system toward stability or a higher degree of wellness.

Negentropy (Neuman)

The matter, energy, and information exchanged between the client and environment entering or leaving the system at any point in time.

Input/Output (Neuman)

A prominent nursing theory aiming to explain or define the provision of nursing science. Sees the individual as a set of interrelated systems that maintain a balance between these various stimuli.

Roy Adaptation Model

Prominent nursing theory aiming to explain or define the provision of nursing science. Sees the individual as a set of interrelated systems that maintain a balance between various stimuli. Grounded on humanism with the belief that a person has his own creative power and has coping abilities to enhance wellness.

ADAPTATION THEORY (Roy)

Physical and chemical processes are involved in the function and activities of living organisms. Behavior pertaining to the physical aspect of the human system. Determined by physiological needs, e.g., sleeping after a day's work. In the physiologic mode, the focus is on five needs (oxygenation, nutrition, elimination, activity, rest and protection) and on four regulatory processes (the senses, fluids and electrolytes, neurologic, and endocrine functions).

PHYSIOLOGIC ADAPTIVE MODE (Roy)

The composite of beliefs and feelings held about oneself at a given time. Focus on the psychological and spiritual aspects of the human system. Need to know who one is, so that one can exist with a state of unity, meaning, and purposefulness of 2 modes (physical self, and personal self). Determined by interaction with others. For example, it's nice to hear someone say, “you’re beautiful in your suit."

SELF-CONCEPT MODE (Roy)

This mode focuses on the primary, secondary, and tertiary roles that a person occupies in society and knowing where they stand as a member of society. Set of expectations about how a person occupying one position behaves toward another occupying another position. Refers to the performance of duties based on given societal norms or expectations. Basic need : social integrity, the need to know who one is in relation to others so that one can act. The need for role clarity of all participants in a group. Example: In today's society, a “mothering" role often includes being a breadwinner and so a working woman needs to return to her work soon after the delivery of her baby.

ROLE FUNCTION MODE (Roy)

Behavior pertaining to interdependent relationships of individuals and groups. Focus on the close relationships of people and their purpose. Each relationship exists for some reason. Involves the willingness and ability to give to others and accept from others. Balance results in feelings of being valued and supported by others. Basic need: feeling of security in relationships Involves ways of seeking help, affection, and attention. It is also the ability to love, respect, value and accept. Includes people as individuals or in groups-families, organizations, communities, and society as a whole.

INTERDEPENDENCE MODE (Roy)

An adaptive system with coping mechanisms manifested by the adaptive modes: physiologic, self-concept, role function and interdependence A set of interrelated systems that strives to maintain a balance between various stimuli

Man (Roy)

A state and a process of being and becoming an integrated whole human being. Conversely, illness is a lack of integration. Integrity – soundness or an unimpaired condition leading to wholeness

Health (Roy)

Encompasses all conditions, circumstances, and influences surrounding and affecting the development and behavior of humans as adaptive systems, with particular consideration of person and earth resources Elements - represented by stimuli from within the human adaptive system and stimuli from around the system

Environment (Roy)

”Health care profession that focuses on human life processes and patterns and emphasizes the promotion of health for individuals, families, groups, and society as a whole.” The science and practice that expands adaptive abilities and enhances person and environment transformation An external regulatory force that can modify stimuli, which produce adaptations

Nursing (Roy)

Something that provokes a response, point of interaction for the human system and the environment Nursing can either maintain, increase or decrease stimuli. The consequence of nursing is the person's adaptation to these stimuli depending on his position on the health-illness continuum.

Stimulus (Roy)

To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions.

Goal (Roy)

The process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental integration

Adaptation (Roy)

Innate or acquired ways innate or of interacting with the changing of environment

Coping Process (Roy)

Person’s physiological coping mechanism A basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels; automatic response to stimulus

Regulator subsystem (Roy)

Person’s mental coping mechanism A major coping process involving 4 cognitive-emotive channels: perceptual and information processing, learning, judgment and emotion;

Cognator Subsystem (Roy)

Responses that promotes integrity of the human system, that is, survival, growth, reproduction, mastery, and personal and environmental transformation

Adaptive Responses (Roy)

Internal or external stimulus immediately affecting the system Those that immediately confront the person, e.g., pricking of skin tissue during injection of drugs.

Focal Stimuli (Roy)

Are all other stimuli present or contributing factors in the situation, e.g., inability to explain the procedure and the need for the drug.

Contextual Stimuli (Roy)

Are unknown factors such as beliefs, attitudes or traits that have an intermediate effect or influence on the present situation. For example, the false belief that a patient cannot bathe after an injection. Significant stimuli in all human adaptation include stage of development, family, and culture

Residual Stimuli (Roy)

Responses that do not contribute to integrity of the human system.

Ineffective Responses (Roy)

Revolves around the concept of man as an adaptive system. The person scans the environment for stimuli and ultimately adapts. The nurse, as part of his environment, assists the person in his effort to adapt by appropriately managing his environment.

ADAPTATION THEORY (Roy)

The various modes and subsystems meet the needs of the environment. These are usually stable processes (e.g., breathing, spiritual realization, successful relationship).

Integrated Process (Roy)

The cognator and regulator are challenged by the environment’s needs but are working to meet the needs (e.g., grief, starting with a new job, compensatory breathing).

Compensatory Process (Roy)

The modes and subsystems are not adequately meeting the environmental challenge (e.g., hypoxia, unresolved loss, abusive relationships).

Compromised Process (Roy)

A nurse’s role in the ___________ is to manipulate stimuli by removing, decreasing, increasing, or altering stimuli so that the patient. 1. Assess the behaviors manifested from the four adaptive modes. 2. Assess the stimuli, categorize them as focal, contextual, or residual. 3. Make a statement or nursing diagnosis of the person’s adaptive state. 4. Set a goal to promote adaptation. 5. Implement interventions aimed at managing the stimuli. 6. Evaluate whether the adaptive goal has been met.

Adaptation Model (Roy)

Advocates fostering efficient and effective behavioral functioning in the patient to prevent illness and stresses the importance of research-based knowledge about the effect of nursing care on patients. Patterned, repetitive, and purposeful way of behaving. Determines and limits the interaction between the person and their environment. Best applied in the evaluation phase, during which time the nurse can determine whether or not there is balance in the subsystems of the patient. If a nurse helps a patient maintain an equilibrium of the behavioral system through an illness in the biological system, they have been successful in the role.

Behavioral System Model (Johnson)

Output of intraorganismic structures and processes as they are coordinated and articulated by and responsive to changes in sensory stimulation. Affected by actual or implied presence of other social beings.

BEHAVIOR (Johnson)

”…a whole that functions as a whole by virtue and independence of its parts” “organization, interaction, interdependency, and integration of the parts and elements”

SYSTEM (Johnson)

Maintained concerning the entire system when it or the environment is not disturbed. Parts of the system evolve into subsystems with specialized tasks. “Minisystem with its own particular goal and function that can be maintained as long as its relationship to the other subsystems or the environment is not disturbed.”

SUBSYSTEMS (Johnson)

7 Identified Subsystems:

1. Attachement-affiliative 2. Dependency 3. Ingestive 4. Eliminative 5. Sexual 6. Achievement 7. Aggressive-protective (Johnson)

“Social inclusion intimacy and the formation and attachment of a strong social bond.” It is probably the most critical because it forms the basis for all social organizations. Forms the basis for all social organizations Provides survival and security. Consequences: Social inclusion Intimacy Formation Strong social bond

ATTACHMENT-AFFILIATIVE SUBSYSTEM (Johnson)

“approval, attention or recognition and physical assistance.” Promotes helping behavior that calls for a nurturing response. Consequences: Approval Attention Recognition Physical assistance

DEPENDENCY SUBSYSTEM (Johnson)

“emphasis on the meaning and structures of the social events surrounding the occasion when the food is eaten.” ”Has to do with then, how, what, how much, and under what conditions we eat” “Serves the broad function of appetitive satisfaction”

INGESTIVE SUBSYSTEM (Johnson)

”When, how, and under what conditions we eliminate” “human cultures have defined different socially acceptable behaviors for excretion of waste, but the existence of such a pattern remains different from culture to culture.”

ELIMINATIVE SUBSYSTEM (Johnson)

Dual functions of procreation and gratification. Development of gender role identity and includes the broad range of sex-role behaviors. Both a biological and social factor that affects behavior.

SEXUAL SUBSYSTEM (Johnson)

Attempts to manipulate environment. Mastery of an aspect of self or environment to some standard of excellence.

ACHIEVEMENT SUBSYSTEM (Johnson)

Relates to protection and self-preservation, generating a defense response when there is a threat to life or territory. Protection and preservation. Limits placed on modes of self-protection. People and their property should be respected.

AGGRESSIVE-PROTECTIVE SUBSYSTEM (Johnson)

”Stabilized but more or less transitory, resting state in which individual is in harmony with himself and with his environment.” “not synonymous with a state of health, since it may be found in either health or illness.”

EQUILIBRIUM (Johnson)

Each subsystem must have a constant supply of function requirements.

FUNCTIONAL REQUIREMENTS AND SUSTENAL IMPERATIVES (Johnson)

Deviations will be detected and corrected. Feedback is required. Self-regulation by the client.

REGULATION/CONTROL (Johnson)

State of being stretched or strained and can be viewed as an end-product of a disturbance in equilibrium.

TENSION (Johnson)

Result of tension produced by internal and external stimuli. “Stimuli may be positive in that they are present; or negative in that something desired or required is absent.”

STRESSOR (Johnson)

“an external regulatory force which acts to preserve the organization and integration of the patient’s behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health, or in which illness is found.” Maintain and restore the person’s behavioral system balance and stability. Help the person achieve a more optimum level of balance and functioning. Do not depend on medical authority, but they are complementary to medicine.

Nursing (Johnson)

“has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual.” As a behavioral system with patterned, repetitive, and purposeful ways of behaving that link the person with the environment. Concept is basically a motivational one.

Person (Johnson)

“some degree of regularity and constancy in behavior. The behavioral system reflects adjustments and adaptations that are successful somehow, and to some degree… adaptation is functionally efficient and effective.” Elusive, dynamic state influenced by biological, psychological, and social factors. Reflected by the organization, interaction, interdependence, and integration of the subsystems of the behavioral system. Balance in the structural or functional requirements in the subsystems leads to health.

Health (Johnson)

All the factors that are not part of the individual’s behavioral system. Forces can disturb the behavioral system balance and threaten person’s stability. The source of the sustenal imperatives of protection, nurturance, and stimulation that are necessary to maintain health.

Environment (Johnson)

Having two major systems: the biological system and the behavioral system. It is the role of medicine to focus on the biological system, whereas nursing focuses on the behavioral system. Defined as a behavioral system that strives to make continual adjustments to achieve, maintain, or regain balance to the steady-state adaptation.

Human Being (Johnson)