 UNIT III

NURSING
CONCEPTUAL
MODELS
THE CONSERVATION MODEL
 MYRA ESTRIN LEVINE (1921-1996)

 Born on December 12, 1920.

 A private duty nurse (1944), U.S. Army civilian

nurse (1945), instructor and director at various
nursing schools (1947-1987), surgical supervisor at
University of Chicago and Henry Ford Hospital
(1951-1962).

 Remembered as a nurse, educator, and theorist;

described as a "renaissance woman"; passed away
on March 20, 1996, at age 75.
THEORITICAL SOURCES
 Historical Perspectives on Disease:
o Influenced by Beland’s (1971) presentation of the theory of specific causation and multiple factors.
 Key Thinkers:
o Goldstein (1963), Hall (1966), Sherrington (1906), and Dubos (1961, 1965) influenced her thinking on
disease and health.
o Gibson's (1966) definition of perceptual systems.
o Erikson’s (1964, 1968) differentiation between total and whole.
o Selye’s (1956) stress theory.
o Bates’ (1967) model of external environment.
 Acknowledgements:
o Rogers (1970) edited her first publication.
o Acknowledge Nightingale’s contribution to her thinking about the “guardian activity” of observation
used by nurses to “save lives and increase health and comfort”.
MAJOR CONCEPTS
 Conservation
o "Conservation" comes from the Latin word meaning "to keep together." It is a natural
law describing how complex systems continue to function despite challenges.

 Adaptation
o Adaptation is the method for conserving wholeness (health and integrity) by
helping individuals maintain organismic integrity amidst constant internal and
external changes.
o Three characteristics of adaptation:
 Historicity: Responses passed through genetics and life experiences.
 Specificity: Unique responses to specific environmental challenges.
 Redundancy: Availability of multiple adaptive responses, with aging potentially being a
result of failed redundancy.
MAJOR CONCEPTS
 Organismic Response (Holistic Response)
o The adaptive response is a holistic and integrated reaction involving the entire
bio-psycho-social-spiritual organism.
o Levine identified four levels of protective organismic responses that are
physiologically predetermined and help the organism adapt to its environment.
1. Response to fear (Fight or flight): The fight or flight response is an
adrenocortical-sympathetic reaction, triggered when individuals perceive a
threat, whether real or imagined.
2. Inflammatory-immune response: As the mechanism that protects the organism
from environmental irritants and pathogens, the inflammatory- immune
response is a primary mechanism of healing: however, it drains energy
reserves.
MAJOR CONCEPTS
3. Response to stress: Levine (1969b) built on Selye's (1956) model of
the adaptive stress response, characterized by predictable behavioral
and biological responses (particularly adrenocortical hormones) to
various nonspecific stressors of life.
4. Sensory Response: Individuals experience the perceptual components
of the external environment through biologic sensory stimuli.
 The Four Conservation Principles
1. Conservation of Energy:
o Levine's conservation of energy principle is rooted in the first law of
thermodynamics, emphasizing energy balance for life processes.
MAJOR CONCEPTS
2. Conservation of Structural Integrity:
o Emphasizes the interrelation between structure and function in the human
organism, requiring nursing interventions to balance energy support with
the preservation of normal body structure.
3. Conservation of Personal Integrity:
o Values self-identity, self-worth, and self-respect, emphasizing the connection
between body, mind, emotions, and soul.
4. Conservation of Social Integrity
o Emphasizes the importance of dynamic relationships among individuals,
with family as a critical social unit interwoven in each person's life.
MAJOR ASSUMPTIONS
Although she did not formally specify particular theoretical assumptions, Levine (1973)
valued “a holistic approach to care of all people, well or sick” and respect for the
individuality of each person.

Schaefer (1996) identified the following statements as assumptions about the model:
• The person can be understood only in the context of the environment (Levine, 1973).
• “Every self-sustaining system monitors its own behavior by conserving the use of the
resources required to define its unique identity” (Levine, 1991, p. 4).
• Human beings respond in a singular, yet integrated, fashion (Levine, 1971c).
THEORETICAL ASSERTIONS
1. “The goal of nursing is to promote adaptation and maintain wholeness” (Levine,
1971a, p. 258).

2. “The nurse participates actively in every patient’s environment and much of what
she does supports his adjustments as he struggles in the predicament of illness”
(Levine, 1966a, p. 2452).

3. “When nursing intervention influences adaptation favorably, or toward renewed

social well-being, then the nurse is acting in a therapeutic sense; when the response
is unfavorable, the nurse provides supportive care” (Levine, 1966a, p. 2452).

4. “Nursing principles are all ‘conservation’ principles” (1973, p. 13). The four
conservation principles are the conservation of energy, structural integrity, personal
integrity, and social integrity of the individual (1967b, 1989).
THEORETICAL ASSERTIONS
• “Nursing intervention is based on the conservation of the
individual patient’s energy” (Levine, 1967b, p. 49).

• “Nursing intervention is based on the conservation of the

individual patient’s structural integrity” (Levine, 1967b, p. 56).

• “Nursing intervention is based on the conservation of the

individual patient’s personal integrity” (Levine, 1967b, p. 56).

• “Nursing intervention is based on the conservation of the

individual patient’s social integrity” (Levine, 1967a, p. 179 )
THEORETICAL ASSERTIONS
THEORETICAL ASSERTIONS
Levine (1991) discussed two early-stage theories from her
model:

1. The theory of therapeutic intention aims to guide nursing

interventions by emphasizing the biological realities of patients,
stemming from conservation principles.
2. The theory of redundancy explores the redundancy in adaptation,
providing insights into the alternative options available during
processes like aging and the physiological changes in a failing
heart.
Importance of the conservation model

 Levine’s conservation model is recognized as one of the

earliest nursing models to organize and clarify elements of
patient care for nursing practice. The continuing use of
Levine’s model in this 21st century provides evidence of the
ongoing usefulness of the model as a guide for both practice
and research.
Unitary human beings
 MARTHA E. ROGERS (1914-1994)

Martha E. Rogers was a prominent nursing theorist,

best known for her “Science of Unitary Human Beings”
theory. She earned a Bachelor of Science in Nursing
from the University of Tennessee, a Master’s in Nursing
from the Teachers College at Columbia University, and
a Doctorate in Nursing from the University of
California, San Francisco. Her diverse educational
background and experiences in public health and
nursing education informed her theoretical
development.
MAJOR ASSUMPTIONS
1. Humans as Unified Beings: Rogers viewed humans as integral
parts of their environment, emphasizing the interrelationship
between individuals and their surroundings.

2. Energy Fields: She proposed that both humans and their

environments are energy fields that are dynamic and constantly
interacting.

3. Health as a Process: Health is seen as a continuum rather than a

static state, influenced by the interaction of various life processes.
THEORETICAL ASSERTIONS
 Rogers emphasized the importance of understanding the whole person,
rather than focusing solely on specific illnesses or symptoms.
 She advocated for the promotion of health through environmental and
energy field manipulation.

USE OF EMPIRICAL EVIDENCE

Rogers’s theory is largely conceptual and was not heavily grounded in
empirical research during its initial development. Instead, it relies on a
philosophical framework and her clinical observations, although later
adaptations and implementations in nursing practice have sought to
incorporate empirical studies to validate her concepts.
THEORETICAL ASSERTIONS LOGICAL FORM

Rogers’s theory is built on

abstract concepts that are
interrelated. It employs a
holistic view, integrating
various aspects of human
experience rather than reducing
individuals to mere biological or
psychological components.
ACCEPTANCE BY THE NURSING COMMUNITY
Rogers’s theory has had a significant impact
on nursing education and practice,
particularly in holistic and integrative
nursing approaches. While some
practitioners have embraced her ideas,
others have critiqued them for their abstract
nature and lack of empirical support.
However, her contributions have undeniably
influenced nursing theory development and
the understanding of patient care.
SELF-CARE DEFICIT THEORY OF NURSING
 DOROTHEA E. OREM (1914 - 2007)
● Born in 1914, Baltimore, Maryland
● Renowned American nursing theorist
● Developed the Self-Care Deficit Theory of
Nursing
● Significant contributions to nursing education
and practice
● Bachelor’s degree in Nursing Education from
Catholic University of America
● Master’s degree in Nursing Education from the
same institution
● Extensive experience in clinical settings and
academia
Self-care deficit theory of nursing
● Introduced in 1959
● Focuses on the individual's ability to perform self-care
● Three interrelated theories: Self-Care, Self-Care Deficit, and Nursing Systems

Core components
● Self-Care: Activities individuals perform to maintain personal well-being.
● Self-Care Deficit: When individuals cannot meet their self-care needs.
● Nursing Systems: Actions taken by nurses to assist individuals in meeting
their self-care needs.
Theoretical assertions
•Theory of Self-Care
 Self-care is a human regulatory function that individuals must, with

deliberation, perform themselves or must have performed for them to

maintain life, health, development, and well-being.

•Theory of Self-Care Deficit

 Self-care deficit is a term that expresses the relationship between the

action capabilities of individuals and their demands for care. Self-care

deficit is an abstract concept that, when expressed in terms of action
limitations, provides guides for the selection of methods for helping and
understanding patient roles in self-care.
Theoretical assertions
•Theory of Nursing Systems
 Nursing Systems are action systems formed (designed and produced) by

nurses through the exercise of their nursing agency for persons with health-
derived or health-associated limitations in self-care or dependent-care.

Three Types of Nursing Systems

• Wholly Compensatory System: Nurse performs all self-care activities.
• Partly Compensatory System: Nurse and patient share self-care activities.
• Supportive-Educative System: Nurse provides education and support,
patient performs self-care independently.
Theoretical assertions
•Theory of Dependent-Care
 Explains how the self-care system is modified when it is directed
toward a person who is socially dependent and needs assistance
in meeting his or her self-care requisites.
 It guides nurses in assessing, planning, and implementing care
for patients who rely on others. By applying this theory, nurses
can ensure that the care provided is comprehensive,
individualized, and effective, ultimately enhancing patient
outcomes.
Importance of Self-Care Deficit Theory

 The SCDNT differentiates the focus of nursing from other

disciplines. The significance of Orem’s work extends far
beyond the development of the SCDNT. In her works, she
provided expression of the form of nursing science as practical
science, along with a structure for ongoing development of
nursing knowledge in the stages of theory development.
Conceptual system and middle-range theory of goal
attainment
 IMOGENE M. KING (1923 – 2007)

 Imogene M. King, born on January 30, 1923, in West Point, Iowa.

 She was a pioneering nurse theorist who developed the "Theory
of Goal Attainment."
 She earned her diploma in nursing from St. John's Hospital School
of Nursing in 1945 and later obtained her BSN in 1948 and MSN
in 1957 from St. Louis University.
 King worked as an instructor and assistant director in medical-
surgical nursing and continued her education, receiving her EdD
from Columbia University in 1961.
 Her first theory article was published in 1964, under the
editorship of Martha Rogers.
 King passed away on December 24, 2007, in St. Petersburg,
Florida.
THEORIES OVERVIEW

USE OF EMPIRICAL EVIDENCE

 King (1975b) identified two methods for developing

theory:

(1) A theory can be developed and then tested in

research, and
(2) Research provides data from which theory may be
developed.
USE OF EMPIRICAL EVIDENCE
She developed a conceptual
framework to capture the complex
dynamics of human behavior in
nursing, representing the interplay
of personal, interpersonal, and
social systems as essential to the
nursing domain.
USE OF EMPIRICAL EVIDENCE
She provided examples of personal systems, such as
patients or nurses, and specified key concepts like body
image, growth and development, perception, self, space,
and time to better understand individuals as persons.
MAJOR ASSUMPTIONS
Nurse-patient interactions are key to health outcomes.

Both the nurse and the patient bring knowledge and expectations
to the interaction.
Patients have the right to participate in decisions about their
health.
Health is dynamic, not just the absence of illness.

Goals can be identified, agreed upon, and pursued collectively.

THEORITICAL ASSERTIONS LOGICAL FORM
King’s theory centers on nurse- In her 1968 article, King set
patient interactions, where forth her first conceptual frame
effective communication and of reference with four concepts
collaboration result in goal that center on human beings:
attainment. This interaction 1. Health
occurs within personal, 2. Interpersonal relationships
interpersonal, and social 3. Perceptions
systems. 4. Social systems
CONCEPTUAL SYSTEM AND
ACCEPTANCE BY THE NURSING
THEORY OF GOAL
COMMUNITY
ATTAINMENT
•King’s theory is widely
accepted in nursing,
influencing patient-
centered care, education,
and research due to its
emphasis on collaboration
and communication in
healthcare.
SYSTEMS MODEL
 BETTY NEUMAN (1924 – 2022)

● Betty Neuman, born in 1924 in rural Ohio,

developed a compassion for those in need,
which shaped her nursing career. After
completing nursing school with honors in 1947,
she worked in various roles, including hospital
and school nursing, and as a clinical instructor.
Neuman later developed the Neuman Systems
Model, becoming widely involved in
publications, lectures, and consultations.
THE NEUMAN SYSTEM MODEL
MAJOR CONCEPTS & DEFINITIONS
The Neuman Systems Model is a holistic, open-systems
approach to nursing care that considers clients as systems,
including individuals, families, groups, communities, and
social issues. It emphasizes the integration of physiological,
psychological, sociocultural, developmental, and spiritual
variables, ensuring all aspects of the client are considered
simultaneously. The model emphasizes the importance of a
flexible line of defense and reconstitution.
MAJOR CONCEPTS & DEFINITIONS
 CONCEPTS

• Wholistic Approach • Created Environment

• Client System Structure
• Open System
• Health, Wellness, illness
• Process and function
• Stressor Degree of Reaction
• Input, Output,
• Prevention as Intervention
• Feedback
• Reconstitution
• Negentropy
• Primary Prevention
• Stability
• Secondary prevention
• Environment
• Tertiary Prevention
MAJOR ASSUMPTIONS
 Neuman's nursing approach emphasizes the holistic care of
the whole person, considering all factors affecting clients'
environment. Health is a dynamic continuum, with optimal
wellness being the best stability. Neuman identifies three
environments: internal, external, and created, with created
environments helping clients manage stress by influencing
self-perception.
THEORETICAL ASSERTIONS
 Theoretical assertions represent the relationships among key concepts
within a model. In Neuman's model, the nurse plays an active role in a
reciprocal relationship with the client, focusing on maintaining stability
within the client system. Neuman connects the four essential concepts—
person, environment, health, and nursing—through her discussions of
primary, secondary, and tertiary prevention. Earlier publications outlined
basic assumptions that linked these concepts, now recognized as
propositions that define, describe, and interconnect the model's
components. Numerous theoretical assertions have been proposed, tested,
and published, highlighting the collaborative works of Neuman and Fawcett.
THEORETICAL ASSERTIONS
 Neuman's model emphasizes the nurse's role in maintaining client
stability through primary, secondary, and tertiary prevention. The model
connects four essential concepts: person, environment, health, and
nursing. Numerous theoretical assertions have been proposed, tested,
and published.

LOGICAL FORM
 Neuman used deductive and inductive logic in developing her model.
Neuman derived her model from other theories and disciplines.
APPLICATIONS BY THE NURSING COMMUNITY
 Alligood (2014) distinguishes between conceptual models, which
provide a frame of reference, and grand theories, which offer testable
directions or actions. The Neuman Systems Model functions as both,
serving as a conceptual framework for nursing practice, research, and
education, while also proposing nursing phenomena and actions for
empirical testing. This model is applicable across all levels of nursing
education and various practice areas, demonstrating adaptability in
transcultural contexts. It is widely utilized in countries including the
United States, Canada, and several others around the world.
APPLICATIONS BY THE NURSING COMMUNITY
 PRACTICE
• The Neuman Systems Model promotes holistic client care, preventing care
fragmentation and promoting evidence-based practices. It is effective in clinical
nursing practice, administration, community health assessments, and geriatric care.
Its versatility extends to acute care settings and nursing staff support, addressing
issues like resilience and compassion fatigue.
 EDUCATION
• The Neuman Systems Model has been widely adopted in nursing education across
various countries, including Canada, Denmark, the Netherlands, Japan, Korea, Kuwait,
Portugal, Taiwan, and the United Kingdom. Guidelines for its application in health
profession education have been established, and it is recognized for aligning with
modern quality initiatives.
APPLICATIONS BY THE NURSING COMMUNITY
 RESEARCH
• Over the past decade, extensive research has been conducted on the
Neuman Systems Model to advance nursing as a scientific discipline.
Fawcett outlined rules for nursing research based on the model’s
content, while additional guidelines have been published to assist in its
application for research purposes.

• The model's acceptance in practice and education underscores its

significance as a conceptual framework for research projects in both
the United States and internationally.
ADAPTATION MODEL
 SISTER CALLISTA ROY (1939 – 1963)

Sister Callista Roy, a member of the Sisters of

Saint Joseph of Carondelet, was born in 1939 in
Los Angeles. She earned a bachelor's and
master's degree in nursing and sociology, and
developed the Roy Adaptation Model, a nursing
theory that reshaped nursing practice and
education.
THEORETICAL SOURCES
Sister Callista Roy made appropriate derivations of
these concepts for use in describing situations of
people in health and illness:

1.Focal Stimuli – immediately confront the individual.

2.Contextual stimuli – are all other stimuli present that
contribute to the effect of the focal stimulus.
3.Residual Stimuli – are environmental factors of which the
effects are unclear in a given situation.
MAJOR CONCEPTS AND DEFINITIONS
 System – is “a set of parts connected to function as a whole for
some purpose and that does so by virtue of interdependence of
its parts.”
 Adaptation level – represents the condition of the life
processes describes on three levels as integrated, compensatory
and compromised.”
 Adaptation Problems – are “broad areas of concern related to
adaptation. These describe the difficulties related to the
indicators of positive adaptation.”
MAJOR ASSUMPTIONS
Nursing – defines nursing as a profession that promotes health and enhances adaptation
for individuals and society. It involves assessing behaviors and stimuli, with interventions
aimed at improving health, quality of life, and dignity across four adaptive modes.

Health – is a state of integration, reflecting a person's interaction with their

environment. Roy sees health as a continuum where health and illness coexist. It is
defined by the ability to cope with challenges, with effective adaptation promoting well-
being, while ineffective coping can lead to illness.

Environment – defines the environment as all conditions and influences affecting

individuals or groups, emphasizing the relationship between people and Earth’s
resources. It includes focal, contextual, and residual stimuli that drive adaptive
responses. Changes in the environment require energy for adaptation, with both internal
and external factors impacting coping abilities
CONTRIBUTION
•Sister Callista Roy developed the Adaptation Model of
Nursing, a prominent nursing theory. Nursing theories frame,
explain or define the practice of nursing. Roy's model sees
the individual as a set of interrelated systems (biological,
psychological and social) in 1976.
BEHAVIORAL SYSTEM MODEL
 DOROTHY E. JOHNSON (1919 – 1999)
Dorothy E. Johnson's theory focuses on the "Behavioral
System Model," which emphasizes the importance of
understanding individuals as systems composed of
interrelated behaviors. Her model identifies seven
subsystems—attachment, dependency, ingestive,
eliminative, sexual, aggressive, and achievement—that
are crucial for maintaining balance and health. Johnson's
ultimate aim is to help nurses provide care that
promotes optimal functioning and addresses any
disruptions in these behaviors, ultimately enhancing
patient well-being.
MAJOR ASSUMPTIONS
Dorothy Johnson’s Behavioral System Model has Four Major Assumptions:

1. Nursing – aimed at helping individuals achieved optimal functioning and

adapt to stressors through supportive care.

2. Person – viewed as a behavioral system with interrelated parts,

emphasizing individuality and capacity for growth.

3. Health – defined as a balanced state with the behavioral system,

encompassing overall well-being beyond just the absence of disease.

4. Environment – includes external factors influencing behavior and health,

highlighting the importance of their interaction for effective nursing care.

CORE CONCEPTS
Behavior: Johnson accepted the definition of behavior as expressed by behavioral and

biological scientist-that is, the output of intra organismic structures and processes as they

are coordinated and articulated by and responsive to changes in sensory stimulation.

System: Using Rapoport’s 1968 definition of system, Johnson (1980) stated, “A system is

a whole that functions as a whole by virtue of the interdependence of its parts”.

Behavioral System: A behavioral system encompasses the patterned, repetitive, and

purposeful ways of behaving.

Subsystems: The behavioral system has many tasks to perform; therefore parts of the

system evolve into subsystems with specialized tasks.

GOALS OF THE MODEL
To enhance patients’ ability to function effectively within their environment
To support the development of healthy behaviors that promote overall well
being
To empower patients to take an active role in their health

IMPORTANCE OF THE MODEL

 Johnson’s theory guides nursing practice, education, and research;
generates new ideas about nursing; and differentiates nursing from other
health professions.
BEHAVIORAL ASSESSMENT
Using Johnson’s Behavioral System Model, the following behavioral

assessment is developed:
1. Attachment-affiliative – emotional connections and relationships

2. Dependency – reliance on others for support

3. Ingestive – eating and nutrition behaviors

4. Sexual – processes related to sexual expression

5. Aggressive protective – behaviors related to asserting oneself

6. Achievement – pursuit of goals and accomplishments

7. Eliminative – process related to waste elimination

THANK YOU!!!
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