Dorothea E. Orem

Dorothea E. Orem
Dorothea E. Orem


A unity who can be viewed as functioning biologically, symbolically, and socially and who initiates  and performs self-care activities on own behalf in maintaining life, health and well-being; self-care activities deal with air, water, food elimination, activity and rest, solitude and social interaction, prevention of hazards to life and well-being, and promotion of human functioning.


The environment is linked to the individual, forming an integrated and interactive system.


Health is a state that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning. It includes physical, psychologic, interpersonal, and social aspects. Well-being is used in the sense of individual’s perceived condition of existence. Well-being is a state characterized by experiences of contentment, pleasure and certain kinds  of happiness; by spiritual experiences; by movement toward fulfillment of one’s ideal; and by continuing personalization. Well-being is associated with health, with success in  personal endeavors, and with sufficiency of resources.


A helping or assisting service to persons who are wholly or partly dependent-infants, children and adults – when they, their parents, guardians, or other adults responsible for their care are no longer able to give  or supervise their care.  A creative effort of one human being to help another human being. Nursing is deliberate action, a function of the practical intelligence of nurses, and action to bring about humanely desirable conditions in persons and their environments. It is distinguished from other human services and other forms of care by its focus on human beings.

Orem’s Self-Care Deficit Theory

Dorothy Orem’s self-care deficit theory, published first in 1971, has been widely accepted by the nursing community. It includes three related theories of self-care, self-care deficit, and nursing system. Self-care theory postulates that self-care and the self-care of dependents are learned behaviors that individuals initiate and perform on theri own behalf to maintian life, health, and well-being. The individual’s ability to perform self care is called self-care agency. Adults care for themselves, whereas infants, the aged, the ill, and the disabled require assistance with self-care activities.

These are three kinds of self-care requisites:

1. Universal requisites, common to all people, include the maintenance of air, water, food, elimination, activity and rest, solitude and social interaction; prevention of hazards to life and well-being; and the promotion of human functioning.

2. Developmental requisites are those associated with conditions that promote known developmental processes throughout the life cycle.

3. Health deviation requisites relates to defects and deviations from normal structure and integrity that impair an individual’s ability to perform self-care.

Self-care deficit theory asserts that people benefit from nursing because they have health-related limitations in providing self-care. Limitations may result from illness, injury, of form the effects of medical tests or treatments.Two variables affect these deficits: self-care agency (ability) and therapeutic self-care demands (the measures of care required to meet existing requisites). Self-care deficit results when self-care agency is not adequate to meet he known self-care demand.

Nursing system theory postulates that nursing systems form when nurses prescribe, design, and provide nursing that regulates the individual’s self-care capabilities and meets therapeutic self-care requirements. Three types of nursing systems are identified:

1. Wholly compensatory systems are required for individuals unable to control and monitor their environment and process information.

2. Partially compensatory systems are designed for individuals who are unable to perform some (but not all) self-care activities.

3. Supportive-educative (developmental) systems are designed for persons who need to learn to perform self-care measures ans need assistance to do so.



Kozier, Barbara Fundamentals of Nursing 5th edition

Addison-Wesley Publishing Company, Inc 1998 p.51


Dorothy E. Johnson

Dorothy E. Johnson
Dorothy E. Johnson

Behavioral System Model (1959,1968,1974,1980)


A behavioral system composed of seven subsystems: affiliative, achievement, dependence, aggressive, eliminative, ingestive, and sexual.


Consists of all factors that are not part of the individual’s behavioral system but that influence the system and some of which can be manipulated by the nurse to achieve the health goal of the client. The individual links to and interacts with the environment.


Health is an elusive, dynamic state of influenced by biologic, psychologic, and social factors. Health is reflected by the organization, interdependence, and integration of the subsystem. Human attempt to achieve a balance in this system; this balance leads to functional behavior. A lack of balance in the structural or functional requirements of the subsystem leads to a poor health.


An external regulatory force that acts to preserve the organization and integration of the client’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found.


Johnson’s Behavioral System Model

Dorothy Johnson used her observations of behavior over many years to formulate a general theory of man as a behavioral system. The theory was originally presented orally in 1968 but was not published until 1980. Johnson defines a system as a whole that functions as a whole by virtue of the interdependence of its parts. Individuals strive to maintian stability and balance in these parts through adjustments and adaptations to the forces that impinge on them. A behavioral system is patterned, repetitive, and purposeful.

Johnson’s key concepts describe the individual  as a behavioral system composed of seven subsystems:

1. The attachment-affiliative subsystem provides survival and security. Its consequences are social inclusion, intimacy, and the formation and  maintenance of a strong social bond.

2. The dependency subsystem promotes helping behavior that calls for a nurturing response. Its consequences are approval, attention or recognition, and p[physical assistance.

3. The ingestive subsystem satisfies appetite. It is governed by social and psychologic considerations as well as biologic.

4. The eliminative subsystem excrete body wastes.

5. The sexual subsystem functions dually for procreation and gratification.

6. The achievement subsystem attempts to manipulate the environment. It controls or masters an aspect of the self or environment to some standard of excellence.

7. The aggressive subsystem protects and preserves the self and society within the limits imposed by society.

Each of the above subsystem has the same functional requirements: protection, nurturance, and stimulation. The subsystems’ responses are developed through motivation, experience, and learning and are influenced by biopsychosocial factors.

Other concepts associated with Johnson’s model are equilibrium, a stabilized more or less transitory resting state in which the individual is in harmony with the self and the environment; tension, a state of being stretched or strained; and stressors, internal or external stimuli that produce tension ans result in a degree of instability.



Kozier, Barbara Fundamental of Nursing 5th edition

Addison-Wesley Publishing Company, Inc 1998 p.49


Betty Neuman

Betty Neuman
Betty Neuman

Health Care System Model




Open system consisting of a basic structure or central core of survival factors surrounded by concentric rings that are bounded by lines of resistance , a normal line of defense, and a flexible line of defense. The total person is a composite of physiologic, psychologic, sociocultural, and developmental variables.


Both internal and external environments exists and a person maintains varying degrees of harmony and balance between them. It is all factors affecting and affected by the system.


Wellness is the condition in which all parts and sub-parts 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 sub-parts of the system of the individual. Health is viewed as a point along a continuum from wellness to illness; health is dynamic. 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 Health Care Systems Model

Betty Neuman’s systems model, first published in 1972, is based on the individuals relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. Reconstitution is the state of adaptation to stressors.

Neuman views the client as an open system consisting of a basic structure or central core of energy sources surrounded by two concentric boundaries or rings referred to as lines of resistance. The two lines of resistance represent internal factors that help the client defend against a stressor. The inner or normal line of defense represents the person’s state of equilibrium of the state of adaptation developed and maintained over time  and considered normal for that person. The flexible line of defense is dynamic and can be rapidly altered over a short period of time. It is a protective buffer that prevents stressors from penetrating  the normal line of defense.

The nurse’s focus is all the variables affecting an individual’s response to stressors. Nursing interventions are carried out on three preventive levels:

1. Primary prevention identifies risk factors, attempts to eliminate the stressor, and focuses on protecting the normal line of defense and strengthening the flexible line of defense. A reaction has not yet occurred, but the degree of risk is known.

2. Secondary prevention relates to interventions or active treatment initiated after symptoms have occurred. The focus is to strengthen internal lines of resistance, reduce the reaction, and increase resistance factors.

3. Tertiary prevention refers to intervention following that in the secondary stage. It focuses on readaptation and stability and protects reconstitution or return to wellness follwing treatment. The nurse emphasizes educating the client in strengthening resistance to stressors and ways to help prevent recurrence of reaction or regression.

Betty Neuman’s model of nursing has been widely accepted by the nursing community, nationally and internationally. it is applicable to a variety of nursing practice settings involving individuals, families, groups, and communities.


Kozier, Barbara Fundamentals of Nursing 5th edition

Addison-Wesley Publishing Company, Inc.1998 p.49


Imogene King

Imogene King
Imogene King

Goal Attainment Theory (1971,1981,1986,1987,1989)


Three interacting systems; individuals (personal system), groups (interpersonal system), and society (social system); the personal system is a unified, complex, whole self who perceives, thinks, desires, imagines, decides, identifies goals, and selects means to achieve them.


Adjustments to life and health are influenced by an individual;s interactions with environment. The environment is constantly changing.


A dynamic state in the life cycle; illness is an interference in the life cycle. Health implies continuous adaptation to stress in the internal and external environment through the use of one’s resources to achieve a maximum potential for daily living.


A helping profession that assists individuals and groups in society to attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity. Nursing is perceiving, thinking, relating, judging and acting a vis-avis the behavior of individuals who come to a nursing situation.  A nursing situation is the immediate environment, spatial and temporal reality, in which nurse and client establish a relationship to cope with health state and adjust to changes in activities of daily living if the situation demands adjustment. It is an interpersonal process of action, reaction, interaction, and transaction whereby nurse and client share information about their perceptions in the nursing situation.

King’s Goal Attainment Theory

Imogene King’s theory of goal attainment, first published in 1971, was derived from conceptual framework of three dynamic interacting systems; (a) personal systems (individuals), (b) interpersonal systems (groups), and social systems (society). Key concepts are identified for each system as follows:

1. Personal system concepts: perception, self, body image, growth and development, space and time

2. Interpersonal system concepts: interaction, communication, transaction, role and stress

3. Social system concepts: organization, authority, power, status, and decision making.

The client ans nurse are personal systems subsystems within interpersonal and social systems. To identify problems and to establish goals, the nurse and client perceive one another, act and react, interact, and transact. Transactions are defined as purposeful interactions that lead to goal attainment. Transactions have the following characteristics:

1. They are basic to goal attainment and include social exchange, bargaining and negotiating, and sharing a frame of reference toward mutual goal setting.

2. They require perceptual accuracy in nurse-client interactions and congruence between role performance and role expectation for nurse and client.

3. They lead to goal attainment, satisfaction, effective care, and enhanced growth and development.

King postulates seven hypothesis in goal attainment theory:

1. Perceptual congruence in nurse-client interactions increases mutual goal setting.

2. Communication increases mutual goal setting between nurses and clients and leads to satisfactions.

3. Satisfaction in nurses and clients increase goal attainment.

4. goal attainment decreases stress and anxiety in nursing situations.

5. Goal attainment increases client learning and coping ability in nursing situations.

6. Role conflict experienced by clients, nurses, or both decreases transactions in nurse-client interactions.

7. Congruence in role expectations and role performance in creases transactions in nurse-client interactions.

King’s theory highlights the importance of the participation of all individuals in decision making and deals with the choices, alternatives, and outcomes of nursing care. The theory offers insight into nurses’ interactions with individuals and groups within the environment t.



Kozier, Barbara Fundamentals of Nursing  5th edition

Addison-Wesley Publishing Company, Inc pp.48-49

Fundamentals Theorists

Virginia Henderson (1955, 1966, 1969, 1978)

Person/Client: A whole, complete, and independent being who has 14  fundamental needs to breathe, eat and drink, eliminate, move and maintain posture, sleep and rest, dress and undress, maintain body temperature, keep clean, avoid danger, communicate, worship, work, play and learn.

Environment: The aggregate of the external conditions and influences affecting the life and development of an organism

Health: Viewed in terms of the individuals ability to perform 14 components of nursing care unaided (eg, breathe normally, eat and drink adequately). Health is quality of life basic to human functioning and requires independence and interdependence.  It is the quality of health rather life itself that allows people to work most effectively and to teach their highest potential level of satisfaction in life. Individuals will achieve or maintain health if they have necessary strength, will, or knowledge.

Nursing: The unique function of the nurse is to assist clients, sick or well, in performing those activities contributing to health, its recovery, or peaceful death – activities that client would perform unaided if they had the necessary strength, will, or knowledge. Al;so, to do so in such a way as to help clients gain independence as rapidly as possible.

Henderson’s Definition of Nursing:

In 1955, Virginia Henderson formulated a definition of the unique function of nursing. This definition was a major stepping-stone in the emergence of nursing as a discipline separate from medicine. Basic to her definition are various assumptions about the individual: namely, that the individual (a) needs to maintain physiologic and emotional balance, (b) requires assistance to achieve health and independence or a peaceful; death, and (c) needs the necessary strength, will, or knowledge to achieve or maintain health. These needs give direction to the  nurse’s role.

Henderson cenceptualized the nurse’s role as assisting sick or well individuals in a supplementary or complementary way. The nurse needs to be a partner with the patient, a helper to the paitent, and, when necessary, a substitute for the patient. The nurse’s focus is to thelp individuals and families (which she viewed as a unit) to gain independence in meeting 14 fundamental needs (Henderson 1966):

1. Breathing normally.

2. Eating and drinking adequately.

3. Eliminaitng body wastes.

4. Moving and maintining a desirable position.

5. Sleeping and resting.

6. Selecting suitbale clothes.

7. maintianing body temperature within normal range by adjusting clothing and modifying the environamnet.

8. Keeping the body clean and well-groomed to protect the integument.

9. Avoiding dangers in the environment and avoiding inhuring others.

10. Coomunicating with others in expressing emotions, needs, fears, or oipinions.

11. worshiping according to one’s faith.

12. working in such a way that one feels a sense of accomplishment.

13. Playing or participating in various forms of recreations.

14. Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities.

Kozier, Barbara  Fundamentals of Nursing. 5th edition

Addison-Wesley Publishing company, Inc. 1998. p. 47

Fundamentals Theorists

Florence Nightingale (1860)

Nightingale’s Environmental Theory

Florence Nightingale, the “mother of modern nursing,” considered nursing to be a religious calling to be fulfilled only by women. Her theory focused on the environment, although this term never appeared in her writings. She linked health with five environmental factors: (1) pure or fresh air (2) pure water (3) efficient drainage (4) cleanliness, and (5)light, especially direct sunlight. Deficiencies in these five factors produced lack of health or illness.

The above factors attain significance when one considers that sanitation conditions in hospitals of the mid 1800s were extremely poor, and the women working in the hospital were unreliable, uneducated, and incompetent to care for the ill.

In addition to the factors above, Nightingale also stressed the importance of keeping the patient warm, maintaining a noise-free environment, and attending to the patient’s diet in term,s of assessing intake, timeliness of the food, and its effect to the person.

Nightingale set the stage for further work in the development of nursing theories. Her general concepts about ventilation, cleanliness, quiet, warm, and diet remain integral parts of nursing and health care today.

Kozier, Barbara Fundamentals of Nursing 5th edition

Addison-Wesley Publishing  Company, Inc.  pp. 46 & 50

Fundamentals Theorists

Martha E. Rogers (1970, 1980, 1983, 1986, 1989)

Rogers’s Science of Unitary Human Beings

Martha Rogers first presented her theory of unitary human beings in 1970. She views the person as an irreducible whole, the whole being greater than the sum of its parts. Whole is differentiated from holistic, the latter often being used to mean only the sum of all parts. She states that humans are dynamic energy fields in continuous exchange with environmental fields, both of which are infinite. Both human and environmental fields are characterized by pattern, a universe of open systems, and four-dimensionality.  According to Rogers, unitary man

  • Is an irreducible, four-dimensional energy field, identified by pattern.
  • Manifests characteristics different from the sum of the parts.
  • Interacts continuously and creatively with the environment.
  • Behaves as a totality.
  • As a sentient being, participates creatively in change.

The key concepts Rogers uses to describe the individual and the      environment are:

  • Energy fields – are the fundamental level of humans and the environment(all that is outside a given human field).  It is dynamic, constantly exchanging energy from one to the other.
  • Openness – holds that the energy fields of humans and the environment are open systems, that is infinite, integral with one another, and in continuous process.
  • Pattern –  refers to the unique identifying behaviors, qualities, and characteristics of the energy fields that change continuously and innovatively.
  • Four-dimensionality – is a nonlinear domain without temporal or spiritual attributes. All reality is considered to be four-dimensional.

Three Principles of Homeodynamics that offers a way of perceiving how unitary human beings develop:

1. Integrality – the human and environmental fields interact mutually and simultaneously.

2. Resonancy – means the wave pattern in the fields change continuously and from lower-to higher-frequency patterns.

3. Helicy – postulates that the field changes are innovative, probabilistic, and characterized by increasing diversity of field patterns and repeating rhythmicities.

Kozier, Barbara Fundamentals of Nursing 5th edition

Addison –  Wesley Publishing Company, Inc. p.50

Fundamentals Theorists

Sister Callista Roy

Roy’s Adaptation Model

Sister Callista Roy’s adaptation model, originating in 1970, is widely used by nurse educators, researchers, and practitioners. Roy focuses on the individual as a biopsychosocial adaptive system. Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an ongoing purposive response. Adaptive responses contribute to health, the process of being and becoming integrated; ineffective or maladaptive responses do not.

As an  open system, an individual recieves inputs or stimuli from both the self and the environment. Roy identifies three classes of stimuli:

  1. Focal stimulus – the internal or external stimulus most immediately confronting the person and contributing to behavior
  2. Contextual stimuli – all other internal or external stimuli present
  3. Residual stimuli – beliefs, attitudes, or traits having an indeterminate effect on the person’s behavior but whose effects are no validated.

Roy’s adaptive system consists of two interrelated subsystems:

  1. The primary subsystem – is a functional or internal control process that consists of the regulator and the cognator. The regulator processes input automatically through neural-chemical-endocrine channels. The cognator processes input through cognitive pathways, such as perception, information processing, learning, judgment, and emotions. Roy views the regulator and cognator as methods of coping.
  2. The secondary subsystem – is an effector system that manifests cognator and regulator activity. It consists of four adaptive modes:
  • The physiologic mode involves the body’s basic physiologic needs and ways of adapting in regard to fluid and electrolytes, activity and rest, circulation ans oxygen, nutrition and elimination, protection, the senses, and neurologic and endocrine function.
  • The self-concept mode includes two components: the physical self, which involves sensation and body image, and the personal self, which involves self-ideal, self-consistency, and the moral-ethical self.
  • The role function mode is determined by the need for social integrity and refers to the performance of duties based on given positions within the society.
  • The interdependence mode involves one’s relations with significant others and support systems that provide help, affection, and attention.

Kozier, Barbara Fundamentals of Nursing 5th edition

Addison-Wesley Publishing  Company, Inc. pp.51-52