Theories, Conceptual Models and
Concepts applied to Community
Health Nursing.
By the end of this lecture 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
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 that Define Nursing or
Discuss 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.
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”
(Orem, 1991, p. 66).
The Theory of Nursing Systems attempts to
answer the question “What do nurses do?”
Dorothea Elizabeth Orem

Dorothea Elizabeth Orem (1914 – June 22, 2007),
born in Baltimore, Maryland, was a nursing theorist
and founder of the Orem model of nursing, or Self
Care Deficit Nursing Theory.

In simplest terms, this theory states that nurses have
to supply care when the patients cannot provide care
to themselves.

Her Theory is about self-care. It's all about the
capacity to recover themselves with a little help of
Nurses
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The nurse determines whether or not there is
a legitimate need for nursing care. Is a
person able to meet self-care needs? Does a
deficit exist? If a deficit exists, then the nurse
plans care that identifies what is to be done
by whom: the nurse, the client, or other
(family or significant other).
Collectively, the actions of all these people
are called the nursing system.
Orem’s Theory

Orem identified three types of nursing
systems:
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wholly compensatory,
partly compensatory, and
supportive-educative.
Orem’s Theory: compensatory nursing
system
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In the wholly compensatory nursing system,
the nurse supports and protects the client,
compensates for the client’s inability to care
for self, and attempts to provide care for the
client. The nurse would use the wholly
compensatory nursing system when caring
for a newborn or with a client in a
postanesthesia care unit who is recovering
from surgery. Both of these clients are
completely unable to provide self-care.
Orem’s Theory: the partly
compensatory nursing system

In the partly compensatory nursing system, both the
nurse and client perform care measures. For
example, the nurse can assist the postoperative
client to ambulate. The nurse may bring in a meal
tray for the client who is able to feed self. The nurse
compensates for what the client cannot do. The
client is able to perform selected self-care activities
but also accepts care performed by the nurse for
needs the client is unable to meet independently.
Orem’s Theory: the supportiveeducative nursing system

In the supportive-educative nursing system,
the nurse’s actions are to help clients
develop their own self-care abilities through
knowledge, support, and encouragement.
Clients must learn and perform their own
self-care activities. The supportive-educative
nursing system is being used when a nurse
guides a new mother to breastfeed her baby.
Interpretation of Orem’s theory
through Mandala art
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Amy Devis,
student
Interpretation of Orem’s theory
through Mandala art
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Self care: The flag design represents independence. People are
independent when they do what they can to maintain life, health,
and well-being.
Self-care deficit: The handicap symbol, made into a compass,
symbolizes dependency of the patient coupled with the guidance,
direction, and support of the nurse.
Nursing systems: Represented by the fish and hook because it
reminds me of the saying: "Give a man a fish, feed him for a day.
Teach a man to fish, feed him for a lifetime." The nurse
compensates for what the patient cannot do for himself while
teaching how to care for himself.
Nursing Process: All the symbols are encompassed in a larger
symbol- an apothecary symbol. This symbol represents diagnosis
and prescription, determining why nursing care is needed.

Dorthea
Orem's
Self-Care
Model
Nursing systems
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Nursing systems is conceptualized as the providers,
resources, structures, methods and processes essential
for the efficient and effective delivery of nursing care to
aggregates of individuals.
The concentration is directed toward preparing nurse
scientists with expertise in
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(1) evaluating theoretical and empirical knowledge about interand intra-organizational phenomena relevant to the delivery of
nursing care;
(2) developing and validating new theoretical constructs and
models that explain nursing phenomena from a systems
perspective.
Neuman's 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.
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Betty M. Neuman, R.N., B.S.N.,
M.S., Ph.D., PLC., FAAN
Neuman's systems model…
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The Neuman Systems Model was originally
developed in 1970 at the University of California
The model was developed by Dr. Neuman as a way
to teach an introductory nursing course to nursing
students.
The goal of the model was to provide a wholistic
overview of the physiological, psychological,
sociocultural, and developmental aspects of human
beings.
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.
Betty Neuman’s Theory interpreted
through Mandala Art

(Created by
Amy,
undergraduate
nursing student
Fall 2004)
Betty Neuman’s Theory interpreted
through Mandala Art (cont)
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The large circle in the center is the focal
point and includes the symbol for Maslow's
hierarchy of needs: Physiological,
psyhological, sociocultural, developmental,
spiritual. The concentric circles around the
center signify client (brown triangle with a
circle on top), environment (blue clouds and
yellow circle sunshine), health (red crosses),
and nursing (pink hearts).

Student’s art
Neuman’s health care systems model
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applied to a rural county regarding traffic
safety issues concerning the elderly.
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.
http://www.omahasystem.org/
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
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Is a research-based, comprehensive, standardized
taxonomy. It is designed to enhance practice,
documentation, and information management. It is
intended for use with individuals, families, and
communities who represent all ages, geographic
locations, medical diagnoses, socio-economic ranges,
spiritual beliefs, ethnicity, and cultural values.
Its terms are arranged from general to specific, and are
intended to be easily understood by health care
professionals and the general public. It provides a
structure to document client needs and strengths,
describe multidisciplinary practitioner interventions, and
measure client outcomes in a simple and user-friendly,
yet comprehensive, manner.
The Omaha System
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It enables collection, aggregation, and analysis of
clinical data. It supports quality improvement, critical
thinking, and communication. It fosters research
involving best practices/evidence-based practice. It
links clinical data to demographic, financial,
administrative, and staffing data. It is a middle range
theory that supports other established health care
theories. Examples include Donabedian’s structure,
process, and outcome approach and the Neuman
Systems Model.
It is a framework for integrating and sharing clinical
data that has existed in the public domain since
1975.
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.
The Problem Classification Scheme provides a structure, terms, and
system of cues and clues to help practitioners collect, sort,
document, classify, analyze, retrieve, and communicate client
needs and strengths.
The Omaha System
Problem Classification Scheme
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Environmental Domain: Material resources
and physical surroundings both inside and
outside the living area, neighborhood, and
broader community.
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Income
Sanitation
Residence
Neighborhood/workplace safety
The Omaha System
Problem Classification Scheme
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Psychosocial Domain: Patterns of behavior, emotion,
communication, relationships, and development.
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Communication with community resources
Social contact
Role change
Interpersonal relationship
Spirituality
Grief
Mental health
Sexuality
Caretaking/parenting
Neglect
Abuse
Growth and development
The Omaha System
Problem Classification Scheme
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Physiological Domain: Functions and processes that maintain life.
Hearing
Vision
Speech and language
Oral health
Cognition
Pain
Consciousness
Skin
Neuro-musculo-skeletal function
Respiration
Circulation
Digestion-hydration
Bowel function
Urinary function
Reproductive function
Pregnancy
Postpartum
Communicable/infectious condition
The Omaha System
Problem Classification Scheme
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Health Related Behaviors Domain: Patterns of
activity that maintain or promote wellness, promote
recovery, and decrease the risk of disease.
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Nutrition
Sleep and rest patterns
Physical activity
Personal care
Substance use
Family planning
Health care supervision
Medication regimen
The Omaha System
Intervention Scheme
It consists of three levels of professional actions or
activities.
 Four broad categories of interventions appear at the
first level.
 An alphabetical list of 75 targets or objects of action
and one “other” appear at the second level.
 Client-specific information generated by practitioners
is at the third level.
Because the Intervention Scheme is the basis for
planning and intervening, it enables practitioners to
describe and communicate their practice including
improving or restoring health, decreasing
deterioration, or preventing illness.
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The Omaha System
Intervention Scheme
Categories:
 Teaching, Guidance, and Counseling: Activities designed to provide
information and materials, encourage action and responsibility for self-care
and coping, and assist the individual/family/community to make decisions
and solve problems.
 Treatments and Procedures: Technical activities such as wound care,
specimen collection, resistive exercises, and medication prescriptions that
are designed to prevent, decrease, or alleviate signs and symptoms of the
individual/family/community.
 Case Management: Activities such as coordination, advocacy, and referral
that facilitate service delivery, improve communication among health and
human service providers, promote assertiveness, and guide the
individual/family/community toward use of appropriate resources.
 Surveillance: Activities such as detection, measurement, critical analysis,
and monitoring intended to identify the individual/family/community’s status
in relation to a given condition or phenomenon.
The Omaha System
Intervention Scheme
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Targets:
anatomy/physiology
anger management
behavior modification
bladder care
bonding/attachment
bowel care
cardiac care
caretaking/parenting skills
cast care
communication
community outreach worker
services
continuity of care
coping skills
day care/respite
dietary management
discipline
dressing change/wound
care
durable medical equipment
education
employment
end-of-life care
environment
exercises
family planning care
feeding procedures
finances
gait training
genetics
growth/development care
home
homemaking/housekeeping
infection precautions
The Omaha System
Problem Rating Scale for Outcomes
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The Scale consists of three five-point, Likert-type
scales for measuring the entire range of severity for the
concepts of knowledge, behavior, and status. Each of
the sub scales is a continuum providing an evaluation
framework for examining problem-specific client ratings
at regular or predictable times. Suggested times
include admission, specific interim points, and
discharge. The ratings are a guide for the practitioner
as client care is planned and provided; the ratings offer
a method to monitor client progress throughout the
period of service. Using the Problem Rating Scale for
Outcomes with the other two schemes of the Omaha
System creates a comprehensive problem-solving
model for practice, education, and research.
The Omaha System
Problem Rating Scale for Outcomes
http://www.omahasystem.org/shmrate.htm
Roy's Model Of Nursing
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
Sister Callista Roy developed the Adaptation Model in
1976.
Definition
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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
Sister Callista
Roy's Adaptation
Model

Mandala
Representing Roy’s
Adaptation Model

By Noreen
Frodella BSN,
RN, BC,
Graduate student
http://nursing.jbp
ub.com/sitzman/a
rtGallery.cfm

Sister Callista Roy's Adaptation Model


This Mandala, representing Roy’s Adaptation Model, was created to
show the grouping of related/connected units which form a unified
whole (environment/nature) and the adaptations that human beings
undertake while living within an unpredictable natural environment.
The “client/client system” is the central or focal point and is
represented by the sun, the four modes of adaptation are
represented by the four lightening bolts (representative of
activity/energy and interaction needed to adapt), the four major
concepts are represented by the clouds, the stars represent the
nursing process, and the crescent moons represent the ten
supporting scientific and philosophical concepts.
This Mandala utilizes symbols from nature to conceptualize Roy’s
theory that focuses on human beings as an adaptive system; and
as such must also adapt to the environment and the forces of
nature. It reveals our continual interaction with environmental
stimuli.