By the end of this lecture the student
you will be able to:
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
Explain what is meant by a theory and a model of
nursing
Discuss the main features of at least two theories of
nursing:
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Orem’s Theory
Roper, Logan & Tierney
Callister Roy’s model
Characterize the conceptual models:
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the Omaha System,
Neuman System Model
Community – oriented ,population
focused care:
Community orientation :
Is a process that is actively shaped by the
unique experiences ,knowledge ,concern ,value
and cultures.
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Community – oriented ,population focused
care
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Employs population based skills and is
shaped by the characteristics and needs of a
given community
Relation ship-based care
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Incorporate the value of establishing and
maintaining a reciprocal ,caring relationship
with the community
Theory……
“…is a general statement that summarizes and
organizes knowledge by proposing a general
relationship between events - if it is a good
one it will cover a large number of events
and predict events that have not yet occurred
or been observed”
Robson C.
Theories and models for community health
nursing in a General Sense (Philosophies)
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Florence Nightingale
Virginia Henderson
Ernestine Wiedenbach
Theories about Broad Nursing Practice
Areas: Grand Theories
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Myra Estrin Levine's Conservation Model
Betty Neuman's Systems Model
Sister Callista Roy's Adaptation Model
Dorthea Orem's Self-Care Model
Theories about Specific Nursing
Actions, Processes, or Concepts:
Middle-Range Theories
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Katharine Kolcaba's Theory of Comfort
Sister Callista Roy's Adaptation Model
Nola Pender's Health-Promotion Model
Hildegard Peplau's Interpersonal Relations in
Nursing
Theories that Defy Classification
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Martha Rogers's Unitary Human Beings
Margaret Newman's Health as Expanding
Consciousness
A conceptual model…

is the synthesis of a set of concepts and the
statements that integrate those concepts into
a whole.
Nightingale's theory of
environment
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Florence Nightingale's environmental theory
has great significance to nursing in general
and to community health nursing specifically
because focus on preventive care for
population.
Theory of Nursing Systems =
Orem’s Theory
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This is the unifying theory that “subsumes the
theory of self-care deficit which subsumes
the theory of self-care”
Concept of Self care learned goal oriented
actions to preserve and promote life.
Orem’s Theory
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Orem identified three types of nursing
systems:
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wholly compensatory,
partly compensatory, and
supportive-educative.
Neuman's health care systems
model…
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is based on the individual's relationship to stress, the
reaction to it, and reconstitution factors that are
dynamic in nature.
is a unique, open systems-based perspective that
provides a unifying focus for approaching a wide
range of international health concerns.
Being universal in nature, it is open to creative
interpretation and is widely used throughout the
world as a multidisciplinary, wholistic, and
comprehensive guide for excellence in nursing
practice, education, research, and administration.
Betty Neuman

Betty Neuman is a
community health nurse
and clinical
psychologist who has
developed this theory.

Betty M. Neuman, R.N., B.S.N.,
M.S., Ph.D., PLC., FAAN
Neuman's systems model…
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The model's basic central core consists of
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energy resources (normal temperature range,
genetic structure, response pattern, organ
strength or weakness, ego structure, and knowns
or commonalities)
that are surrounded by
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several lines of resistance,
the normal line of defense, and
the flexible line of defense.
Neuman's systems model…
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The lines of resistance represent the internal
factors that help the patient defend against a
stressor
The normal line of defense represents the
person's state of equilibrium
The flexible line of defense depicts the
dynamic nature that can rapidly alter over a
short period of time.
The Omaha System
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The Omaha System is a research-based,
comprehensive practice and documentation
standardized classification;
it can be used by multidisciplinary health
care practitioners in any setting from the time
of client admission to discharge.
The Omaha System
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Consists of three relational, reliable, and valid
components designed to be used together:
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Problem Classification Scheme (client assessment)
Intervention Scheme (service delivery)
Problem Rating Scale for Outcomes (client
change/evaluation)
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The Omaha System
Problem Classification Scheme
Four levels:
 Four domains appear at the first level and represent
priority areas of practitioner and client health-related
concerns.
 Forty-two terms (concepts), referred to as client
problems or areas of client needs and strengths,
appear at the second level.
 The third level consists of two sets of problem
modifiers: health promotion, potential, and actual as
well as individual, family, and community.
 Clusters of signs and symptoms describe actual
problems at the fourth level.
Roy's Model Of Nursing
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Sister Callista Roy developed the Adaptation Model
Definition
– Roy's model of nursing sees an individual as a set
of interrelated systems, biological, psychological, and
social. The individual tries to maintain a balance
between each of these systems and the outside
world. However, there is no absolute level of balance.
According to Roy we all strive to live within a band
where we can cope adequately. This band will be
unique to an individual. The adaptation level is the
range of adaptability within which the individual can
deal effectively with new experiences.
Roy's Model Of Nursing
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This model comprises the four domain
concepts of
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person,
health,
environment, and
nursing and involves a six step nursing process.
Roy's Model Of Nursing
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Roy's models sees the person as "a biopsychosocial
being in constant interaction with a changing
environment" (Rambo, 1984). The person is an
open, adaptive system who uses coping skills to
deal with stressors.
Roy sees the environment as "all conditions,
circumstances and influences that surround and
affect the development and behaviour of the person"
(Andrews & Roy, 1991).
Roy describes stressors as stimuli and uses the term
'residual stimuli' to describe those stressors whose
influence on the person is not clear
Roy's Model Of Nursing
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Roy employs a six-step nursing process
which includes:
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assessment of behaviour,
assessment of stimuli,
nursing diagnosis,
goal setting,
intervention and evaluation.
Roy's Model Of Nursing
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In the first step, the person's behaviour in each
of the four modes is observed. This behaviour
is then compared with norms and is deemed
either adaptive or ineffective.
The second step is concerned with factors that
influence behaviour. Stimuli are classified as
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focal,
contextual or
residual
Roy's Model Of Nursing
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The nursing diagnosis is the statement of the ineffective
behaviours along with the identification of the probable
cause.
In the fourth step, goal setting is the focus.
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Goals need to be realistic and attainable and are set in
collaboration with the person (Andrews & Roy, 1991).
Intervention occurs as the fifth step, and this is when the
stimuli are manipulated. It is also called the 'doing
phase' (Rambo).
In the final stage, evaluation takes place. The degree of
change as evidenced by change in behaviour, is
determined. Ineffective behaviours would be
reassessed, and the interventions would be revised
Social influence on community oriented
,population –focused nursing
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Communication technology
Genetics
Global economy
Migration
Climate changes