The Neuman System’s
Model and the Roy
Adoption Model
The use of different nursing
theories and models has been
crucial in enriching nursing
knowledge.
Introduction
The selection of the different
nursing theories and models is
based on the degree of flexibility
of situations, phenomena and
circumstances.
The Neuman System’s Model and
the Roy Adoption Model have
contributed significantly in
nursing practice.
The Roy
Adaption
Model
Sister Callista Roy
developed the Roy
Adaption Model in
1976.
Sister Roy defined
an individual as
interrelated
systems with
biological, social,
and psychological
characteristics.
The individual
strives to balance
all these systems as
well as the outside
world.
However, Sister
Roy admitted that
an absolute level of
balance.
Using the
Roy
Adaption
Model in
Planning
And
Continuing
Care For
Sgt. Johns
The RAM has six major steps that the nurse can
adopt to address Sgt. Johns's healing process.
• Assess Sgt. John's behavior using the four adaptive modes.
Self-concept identity mode
Role function mode
Physiological-physical mode
Interdependence mode
• Categorize and assess the stimuli related to those behaviors.
• Diagnose Sgt. John, based on his adoptive state.
• Set adaption goals that should be achieved.
• Implement the interventions
• Investigate whether the achievements made concede with
the adaptive goals set
Application the Roy
Theory in nursing
•
•
•
According to the Roy theory, nursing
is aimed at increasing the life
expectancy of the patient
holistically.
The Roy theory has been
contributing to nursing practice,
education, research, and
management for over thirty-five
years.
The theory has also been a pillar in
providing model-based information
that nurses use when taking care of
patients.
Influence
Of Roy's
Theory In
Promoting
Sgt. Johns
Adjusted
Selfconcept
• Using the Roy theory as the guideline,
the nurse will:
- Assess Sgt Johns as an individual
and determine how he adapts to
his new environmental state.
- Encourage Sgt. Johns to express his
thoughts, beliefs, and feelings to
get adequate insight into his
behavior.
- Then assess Sgt. Johns’ view based
on physical self, personal self,
spiritual self, perceiving self,
developing self, and focusing self.
- Produce an effective adaption
process
Why Is It Important For The
Nurse To Listen To Sgt. Johns'
"Story" In His Own Words
• Actively listening to the patient
shows that the nurse respects the
patient’s self-knowledge.
• It also builds trust between the
patient and the nurse.
• Listening to Sgt. Johns helps the
nurse not to miss crucial
information.
• It also enables the nurse to
closely assess his behavior,
opinion, feelings, and values.
The Neuman System Model is a
framework that assists administrators
or caregivers in helping patients
manage stressors.
Neuman
System’s
Model
This helps patients heal mentally,
physically, and spiritually.
The Neuman Systems Model (NSM)
was developed by Betty Neuman.
The Neuman Systems Model that has
been applied, adopted, and accepted
in the nursing practice and curriculum
all over the world.
Four Stressors
From The Case
Study Based On
The Neuman
System’s Model
• From the Sgt. Johns's case
study, several stressors can be
identified which are:
- Sgt. Johns inability to go
back to work where he was
working.
- A severe headache, which is
associated with traumatic
brain injury.
- His inability to see his
friend Joe.
- his inability to sleep
Plan of
Care
Based on
the
Neuman
Systems
Model for
Sgt. Johns.
Plan of care for Sgt. Johns will be based on
coming up with strategies that are aimed at
helping him cope with the identified
stressors. The steps include:
Talking to his employer to continue paying
his full salary or assist him in working from
home.
to ensure that he is assisted to frequently
see his friend Joe.
Ensure doctors diagnose him and provide
him with the right medication to treat
traumatic brain damage.
There is a growing need for integrating
nursing theories and models into daily
nursing practice.
This is encouraging more Evidence-Based
Nursing.
Conclusion
This is because many people now want to
understand why things are done the way
they are done.
Nursing theories and models need to be
incorporated more in nursing practice and
learning to ensure nurses and patients
understand why a specific choice is made
leaving the other.
References
• Ahmadi, Z., & Sadeghi, T. (2017). Application of the
Betty Neuman systems model in the nursing care of
patients/clients with multiple sclerosis. Multiple
Sclerosis Journal–Experimental, Translational and
Clinical, 3(3), 2055217317726798. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC55650
31/
• DeSanto-Madeya, S., & Fawcett, J. (2016). Healing and
transcendence: A Roy adaptation model-guided
comparison. Nursing science quarterly, 29(3), 219-226.
• Saini, N., Sharma, V., Arora, S., & Khan, F. (2017). Roy’s
Adaptation Model: Effect of care on pediatric
patients. Int J Nurs Midwifery Res, 4(1), 52-60.
Orlando’s Theory Guide
Orlando’s Theory Guide
• Also known as the deliberative nursing theory, Orlando's guide
examines how to improve the nursing process to promote positive
outcomes.
• The key takeaway from Orlando's nursing theory is the overarching
influence of client dignity and fostering a humanistic relationship
(Adib-Hajbaghery & Tahmouresi, 2018).
• Orlando sought to change and revamp the field of nursing by adding
a personal touch to it.
• According to Orlando’s theory, A nurse’s role is to immediately find
out and fulfill a patient’s need for assistance.
• Sam and Susan’s behavior are a call for help.
• Anne should use her perception of the situation, as well as the
thoughts emanating from how she sees the situation in the home.
• The nurse should check for distress by evaluating whether the
patient’s needs have been met.
QUESTIONS
• During the perception process, does the patient moan or groan?
• Is the patient able to engage in physical activity?
• What are the physiological manifestations of the patient’s condition?
• Is there a need that has not been met?
• Does the patient exhibit a need to be helped?
• What actions can directly or indirectly help to fulfill the patient’s
needs?
CONT’D
• Do the outcomes point to an unmet need?
• What unique attributes does the patient present?
• What nursing actions should be applied to the
patient?
Family Plan of Care
• A nursing process should properly evaluate the needs of an elderly client.
• An investment in resources and parameters like the reasoning skills of nursing
staff is imperative for ensuring the patient’s quality of life.
• Nursing role empowerment is also imperative for enhancing these outcomes
(Nopriyanto et al., 2019).
• The process should also employ effective collaboration in helping the elderly
patient go about their daily life.
• Nurses can make nursing diagnoses.
• A family plan of care for Susan and Sam will begin by identifying the patient’s
problems that arise from their health status.
• A diagnosis has to be formulated for each of the problems.
CONT’D
• Planning for the family entails setting goals to enhance the patient’s
outcomes.
• The goals have to be based on the problems that have been
identified from the initial diagnosis.
• The nurse should then identify Sam’s nutritional and physical
requirements.
• It should be known whether he will need physical assistance for
tasks like going to the toilet, bathing, personal grooming, and even
eating.
CONT’D
• The home should be evaluated for its suitability for a physically
challenged individual.
• Is there a need for any changes to be made to the home to suit the
patient’s needs?
• It should be determined whether the elderly person should be
included in routine family activities.
• The primary goal is to enhance the patient’s positive outcomes by
improving their outlook on life.
1950s and 1960s in the United States
• The 1960s heralded the beginning of the golden age in the minds of
Americans.
• With the ascension of the flamboyant politician, John F. Kennedy to
the presidency marked an era of hope.
• The era was characterized by discrimination against minorities like
gays, lesbians and colored people.
• The era was characterized by endless protests
• Citizens protested against racial discrimination and the unnecessary
war in Vietnam.
• Women faced discrimination in different spheres of life such as
employment (McKenzie, 2015).
• The era also marked the emancipation of the groups that were
discriminated upon.
• Women held marches to demand for equality.
• Colored people sought an end to the segregation laws.
Role of nurses
• The role of the nurse practitioner emerged in the 1960s (Keeling,
2015).
• NPs have been recognized as healthcare workers who can function
and achieve a combination of requirements.
• Merging primary care medical services together with cutting-edge
training and nursing skills, NPs fulfilled the needs of the underserved
remote and rural communities, as well as those who lacked the right
to care in inner cities.
• Nursing was initially an ancillary role to that of the physicians, and
nurses were expected to be obedient to the physicians in charge
(Mishra, 2015).
• Mishra (2015) further asserts that before 1960, the key emphasis of
the nursing code was on the said nurses’ obedience to the
physicians.
• However, after the 1960s, nurses began focusing on patient care,
and this has remained to basis of their activity to date.
• Nurses started exhibiting a wholeness of character, and they had
high integrity because they adhered to their moral values.
• Nursing uniform has markedly changed since the 1960s.
• Nurses in the 1960s were expected to go to work while dressed in
traditional dresses and the famous caps.
• After the era, the nursing cap was eliminated,
• The end of the 1960s was characterized by the modernization of
nurses’ uniforms.
• The dresses were shortened and in some instances, they used
disposable aprons.
• The 1960s was a period of significant social change.
• With the female empowerment that characterized the era, notable
nursing theorists emerged.
• Virginia Henderson drew the most influential theory that guided the
principle and practice of nursing.
• Henderson viewed nursing as a unique role that was expected help
sick or healthy individuals.
• Nursing comprised of activities that facilitated the health, recovery,
or nonviolent death.
• During the era, Hildegard Peplau emerged as a foremost pioneer in the
field of psychiatric nursing.
• Peplau initiated the delineation of psychiatry as a unique field of nursing.
• Her work led to the enactment of standards that allow nurses to gauge
their individual beliefs and intrinsic values.
• Faye Abdellah also expounded the field of theory and research in nursing.
• Abdellah highlighted the importance of research in nursing practice.
• She was the foremost nursing educator, and she encouraged nursing
practitioners to employ problem-solving, health, and nursing problem,
which continues to influence the present nursing practice.
References
Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse–patient relationship based on the Imogene
King’s theory of goal attainment. Nursing and Midwifery Studies, 7(3), 141.
https://doi.org/10.4103/2322-1488.235636
Keeling, A. W. (2015). Historical perspectives on an expanded role for nursing. Online journal of issues in
nursing, 20(2).
McKenzie, B. L. (2015). The problem of women in the department: Sex and gender discrimination in
the 1960s United States Foreign Diplomatic Service. European journal of American studies,
10(10–1). https://doi.org/10.4000/ejas.10589
Mishra, S. (2015). Respect for nursing professional: Silence must be heard. Indian Heart Journal,
67(5), 413–415. https://doi.org/10.1016/j.ihj.2015.07.003
Nopriyanto, D., Hariyati, Rr. T. S., & Ungsianik, T. (2019). Improving documentation of patient
progress note through role empowerment of head nurse by Orlando theory approach.
Enfermería Clínica, 29, 182–188. https://doi.org/10.1016/j.enfcli.2019.04.051
Peplau’s and Orem’s Theories
Objectives
The discussion of Peplau's theory of Interpersonal Relations.
The 4 phases of the Nurse-Patient relationship
Peplau’s Theory in practice – in managing diabetes II, communication, and training.
Orem’s Self-Care Deficit Theory discussion.
The three parts of Orem’s Self-Care Deficit Theory.
Orem’s Self-Care Deficit Theory in nursing practice
Peplau theory of Interpersonal Relations
• Developed by Hildegard E. Peplau
(1909-1999) (Adams, 2017).
• She had a background in nursing.
• Relates to nursing and working to help
patients.
• Nursing is considered therapeutic,
helping people to getter better.
• Goal achievement is realized after
following all the 4 key steps.
• The theory also helps nurses to
understand their behavior in order to
help others.
Phases of the Nurse-Patient relationship:
1. Orientation Phase
• The nurse engages the client/patient with
the treatment process.
• The client meets the nurse, being the first
engagement to seek assistance (Adams,
2017).
• The process entails defining the problem
and deciding the service needed.
• The client asks questions, gives past
experiences and seeks assistance.
• The nurse responds to the questions as well
as helps the client.
• Factors affecting this stage include values,
beliefs and experiences of both parties as
seen.
Phases of the Nurse-Patient relationship:
2. Identification Phase
The client is now engaged with the nurse.
Both have become familiar with each other and the bond is growing.
The client expresses feelings and appreciates the assistance.
The levels of hopelessness and helplessness decrease with the identification
of the problem.
Appropriate professional assistance is selected.
Phases of the Nurse-Patient relationship:
3. Exploitation Phase
• The client understands the services offered and acquires
them.
• The nurse utilizes professionalism in giving problem-solving
alternatives.
• The client’s needs and interests govern the use of services.
• Interview techniques are essential to help explore and fully
deal with the root problem.
• The nurse should have communication skills to effectively
communicate with the client.
• Again, the nurse explores all alternatives to assist the
client.
Phases of the Nurse-Patient relationship:
4. Resolution Phase
The stage is characterized by an ending relationship.
The client no longer needs the services of the nurse at this point.
The needs have been solved by the professional intervention of the nurse.
Thus, they have to disconnect their therapeutic relationship.
The client becomes self-reliant again (Adams, 2017).
Though psychological dependence may persist, the client moves away, healthier
than before.
Peplau’s Theory in Practice – Managing Diabetes II
• The nurse-patient relationship, Peplau’s Theory of
Interpersonal Relationships, is used in the nursing
practice.
• The theory is used by patients with diabetes type
II for their self-care management (Fernandes &
Naidu, 2017).
• Diabetes is a chronic disease that requires day-today management.
• Nurses’ role is to stimulate the self-care process
by guiding the patient.
• The patient trusts the information given by the
nurse.
• Self-care management is known to lower cost and
improve therapeutic outcomes
Peplau’s Theory in Practice – Communication
• The theory of interpersonal relations is crucial in promoting
communication.
• Since communication is essential in Peplau’s theory, it is also used in
the healthcare setting.
• The nurse students get an opportunity to practice communication
with older adults in the workplace (Deane & Fain, 2016).
• They do not get time to practice communication skills in schools.
• The theory also guides them to improve skills in patient-nurse
relationships in their professions (Deane & Fain, 2016).
Peplau’s Theory in practice– Training
• The theory of interpersonal relations can be applied in nursing
training.
• Head nurses can use the theory to provide supervision by being a
teacher, leader, counselor among others (Hariyati, & Ungsianik,
2017).
• Head nurses must cultivate interpersonal skills in training novice
nurses.
• Training focuses on knowledge attainment, to assist patients to
recover.
• The head nurses also pass interpersonal skills to the new nurses
and communicate the organizational goals.
Orem’s Self-Care Deficit Theory
• Established by theorist Dorothea Orem (1914-2007)
(Dejange et al., 2018).
• She was a duty nurse, nurse administrator, consultant, and
educator.
• The theory supports that individuals should practice selfcare.
• They have the ability to improve their health through selfcare.
• Dorothea Orem’s photo included.
Major
assumptions of
Orem’s Theory
• People should take their own care.
• People are distinct.
• Nursing is interaction between persons, thus an
action.
• What is important in primary care is to meet
universal self-care fundamentals.
• To promote self-care, knowledge of health problems
is crucial.
• Self-care is learned within the social-cultural setting.
Orem’s three related parts: 1. Theory of Self-care
Self-care – these are activities that are performed by individuals to maintain their health.
Self-care agency – ability to undertake self-care based on age, condition, among other issues.
Self-care requisites – actions needed to deliver self-care. It has three categories;
Universal self-care requisite – these are universal standards needed to maintain health.
Developmental self-care requisite – it is linked with an event or condition.
Health deviation self-care requisite – linked with a disease and its recovery.
Orem’s three related parts:2. Theory of self-care deficit
• It entails a situation when
nursing is needed.
• Guides what to do when
nursing is needed. Five
helping methods are listed;
• Guiding others (Malekzadeh,
Amouzeshi, Mazlom, 2017).
• Supporting others.
• Acting for/doing for others.
• Teaching another.
• Providing an environment to
promote personal
development.
Orem’s three related parts:3. Theory of
Nursing Systems
• It designates the process of meeting
the patient’s self-care requests.
• Self-care is classified into 3; wholly,
partly, and supportive/educative
compensatory systems (Malekzadeh,
Amouzeshi, Mazlom, 2017).
• It defines the scope of nursing care
and nurse-patient relationships.
• Technology can be developed by
health professionals to assist selfcare.
Current Nursing
Practice Where
Orem’s Theory
Is Used
• Self-care is essential in managing breast cancer.
• About 1.38 million women are diagnosed with
breast cancer annually (Dejange et al., 2018).
• With high rate of deaths, many women result in
anxiety.
• They develop psychological complications such
as stress and depression.
• Their quality of health also deteriorates.
• Research by Dejange et al. (2018) indicated that
Orem’s self-care model training can reduce such
anxiety.
• Under the Peplau's theory of Interpersonal Relations, nurses can care for
the patients. It was developed by Hildegard E. Peplau.
• The 4 phases of the Nurse-Patient relationship form a framework from
the time a nurse engages with the client until the client leaves.
• The phases include orientation, identification, exploitation, and finally
resolution.
Conclusion
• Peplau’s Theory can be used in managing diabetes II, in communication,
and in training.
• Orem’s Self-Care Deficit Theory supports individuals managing their care.
• The three parts of Orem’s Self-Care Deficit Theory include the theory of
self-care, theory of self-care deficit and theory of nursing systems.
• Orem’s Self-Care Deficit Theory is used in nursing to help women with
breast cancer.
Reference
•
Adams, L. Y. (2017). Peplau's contributions to psychiatric and nursing knowledge. Journal
of Mental Health and Addiction Nursing, 1(1), 10-18. DOI: 10.22374/jmhan.v1i1.3
•
Deane, W. H. & Fain, J. A. (2016). Incorporating Peplau’s Theory of Interpersonal Relations
to Promote Holistic Communication Between Older Adults and Nursing Students. Journal
of Holistic Nursing, 34(1), 35–41, 10.1177/0898010115577975
•
Dejange et al. (2018). Effect of Orem's Self-Care Model Training Program on Anxiety of
Women with Breast Cancer: A Clinical Trial Study. Medical - Surgical Nursing Journal, 7(2),
DOI: 10.5812/msnj.80605
•
Fernandes, S. & Naidu, S. (2017). Promoting Participation in Self Care Management
among Patients with Diabetes Mellitus: An Application of Peplau’s Theory of Interpersonal
Relationship. International Journal of Nursing Education, October-December 9(4), 129134. DOI Number: 10.5958/0974-9357.2017.00109.X
•
Hariyati, S. T., & Ungsianik, T. (2017). Improving the interpersonal competences of head
nurses through Peplau’s theoretical active learning approach. Enfermería Clínica, 27(I),
149-153
•
Malekzadeh, J., Amouzeshi, Z., Mazlom, S. R. (2017). A quasi-experimental study of the
effect of teaching Orem’s self-care model on nursing students’ clinical performance and
patient satisfaction. Nursing Open, 5, 370–375. DOI: 10.1002/nop2.151
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