NURSING FRAMEWORKS AND MODELS

Johnasse Sebastian C. Naval, RN

NURSING FRAMEWORKS
AND MODELS
Imogene King
Martha Rogers

ERNESTINE Weidenbach
Ida Jean Orlando

Interacting Systems Framework and Theory

of Goal Attainment

Who
is
Imogene
King?

Developed a conceptual model for

nursing in the mid 1960s with the
idea that human beings are open
systems interacting with the
environment
Her work is considered a conceptual
model because it comprises both a
conceptual framework and a theory

Interacting Systems
Framework
A conceptual framework that represents,
Personal
Interpersonal
Social systems

Human being as the basic element in the

system
The relationships between these three
systems led to Kings Theory of Goal
Attainment.

Theory of Goal
Attainment
King believed that interactions between the
nurse and the client lead to transactions that
result in goal attainment.
Based on overall assumption that the focus
of nursing is human beings interacting with
their environment leading to a state of health
for individuals, which is an ability to function
in social roles

Nursing
an observable behavior found in the health

care systems in society

The goal help individuals maintain their
health so they can function in their roles
A process of action, reaction, interaction and
transaction
Perceptions of a nurse influence the
interpersonal process

Person
Individuals are spiritual beings
Individuals have the capacity to think, know,

make decisions, and select alternative courses

of action.
Individuals have the ability through their
language and other symbols to record their
history and preserve culture
Individuals are open systems in transaction with
the environment
Individuals are unique and holistic
Individuals differ in their needs, wants and goals

Health
A dynamic state in the life cycle
Illness is an interference in the life cycle
Implies continuous adjustment to stress in the

internal and external environment through

optimum use of ones resources to achieve
maximum potential for daily living.

Environment
Adjustments to life and health are influenced

by individuals interactions with the

environment

Martha Rogers
Unitary Human Beings

Martha Rogers
Unitary Human
Beings
Energy fields
Fundamental unity of things that are unique,

dynamic, open, and infinite

Unitary man and environmental field

Universe of open systems

Energy fields are open, infinite, and

interactive

Martha Rogers
Unitary Human Beings
Pattern
Characteristic of energy field
A wave that changes, becomes complex and

diverse

Four dimensionality
A nonlinear domain with out time or space

Rogers Definitions
Integrality
Continuous and mutual interaction between

man and environment

Resonancy
Continuous change longer to shorter wave

patterns in human and environmental fields

Martha Rogers
Unitary
Human
Beings

Helicy

Continuous, probabilistic, increasing diversity of

the human and envrionmental fields.

Characterized by nonrepeating rhymicities
Change

THE HELPING ART

OF CLINICAL
NURSING

CREDENTIALS AND BACKGROUND OF

THE THEORISTS
Her interest in nursing began with her

childhood experiences with nurses.

Enrolled in John Hopkins Hospital School
of Nursing.
Held variety of positions in hospitals and
public health nursing agencies in New
York.

Enrolled in John Hopkins Hospital School

of Nursing.
Held variety of positions in hospitals and
public health nursing agencies in New
York.
she continued her education by

attending evening classes at teachers

College at Columbia University, where
she received a Masters degree and
certificate in Public Health Nursing.

Hazel Corbin-persuaded her

to enroll in School for NurseMidwives.

she teach an evening class in
advance maternity nursing at
teachers College
write several articles for
professional publications.
1952, faculty of Yale
University School of Nursing.

1956, Director of Graduate programs in

maternal-newborn health nursing.

develop her from practical

experience and education, after a

long career at Yale,retired and
move to Florida.
1996, she passed away.

THEORETICAL
SOURCES
IDA JEAN ORLANDO
Stimulated Wiedenbachs understanding of the
use of self and the effect of a nurse thoughts
and feelings on the outcome of her actions.
JAMES AND DICKOFF- They identified elements
of prescriptive theory.

USE OF EMPIRICAL EVIDENCE

Wiedenbachs model is developed on the

basis of her years of experience in clinical

practice and teaching.
Gustafson did an exploratory study using a
naturalistic inquiry design that found a need
for help in units of vocal and bodily
communications in stage 1 labor.

MAJOR CONCEPTS AND

DEFINITIONS
PATIENT

Any individual who is receiving help of some

kind, be it care, instruction or advice, from a
member of health professions or from a
worker in the field of health.

NEED-FOR-HELP

Is any measure or action required and

desired by the individual and which has
potential for restoring and extending his
ability to cope with the demands implicit
in his situation.

NURSE- The nurse is a functioning

human being. As such she not only acts,

but she thinks and feels as well. The
thoughts she thinks and the feeling she
feels as she goes about her nursing are
important; they are intimately involved
not only in what she does but also how
she does it. They underlie every action
she takes, be it form of spoken word, a
written communication, a gesture, or a
deed of any kind. For the nurse action is
directed toward achievement of a
specific purpose, thoughts and feelings
have a disciplined role to play.

THEORETICAL ASSERTIONS
IDENTIFICATION OF A NEEDFOR-HELP
FIRST- The nurse uses power of

observation to look and listen for actual

consistencies and inconsistencies in the
patients behavior compared with the
nurse expectations for patient behavior.

SECOND- the nurse explores the

meaning of the patients behavior with

the patient.
THIRD- the nurse determines the cause
of the patients discomfort or incapability.
FINALLY- the nurse determines whether
the patient can resolve his or her
problem or if the patient has a need-forhelp.

MINISTRATION OF HELP
Ministration of the needed help involves the

nurse making a plan to meet patient needs

and presenting it to the patient. If the
patient concurs with the plan and accepts
suggestions for implementing it, the nurse
implements it and ministration of needed
help occurs. If the patient does not concur
with the plan or accept suggestions for
implementation, the nurse need to explore
causes of the patients nonacceptance.

If the patient has interfering problem the

nurse needs to explore causes of the

patients ability to solve the problem. If
the patient has a need-for-help, the
nurse once again forms a plan to meet
the need, presents the plan, and seeks
patient concurrence and acceptance of
suggestions for implementation.

VALIDATION THAT NEED-FOR-HELP

WAS MET
The nurse perceives whether the patients

behavior is consistent with the nurse concept

of comfort and seeks clarification from the
patient to determine whether he/she believes
the need-for-help was met. Then, the nurse
needs to take appropriate action on the basis
of feedback.

ACCEPTANCE BY THE NURSING

COMMUNITY
PRACTICE

The practice of clinical nursing is an overt

action, directed by disciplined thoughts and
feelings toward meeting the patients needfor-help
Childbirth as Mothers Say They Like It

EDUCATION

The application of Wiedenbachs model

to clinical practice requires the nurse
to have a sound knowledge of the
normal and pathological states, a
thorough understanding of human
psychology, competence in clinical
skills, and the ability to initiate and
maintain therapeutic communication
with the patient and family. The nurse
must develop sound clinical
judgement in making decisions about
patient care and be able to interpret
the patients behavior.

RESEARCH

The vocal and bodily behaviors of

women in the first stage of labor were
videotaped to determine when a needfor-help occurred. The women and the
researcher reviewed these tapes the
day after delivery. Findings indicate
that care-eliciting behaviors were
influenced by a cognitively
experienced need-for-help and that
these behaviors were observable
measures of nonverbalized need-forhelp and decreased coping.

Ida Jean Orlando

Deliberative Nursing Process

Ida Jean Orlando

Deliberative Nursing Process
The deliberative nursing process is set in

motion by the patients behavior

All behavior may represent a cry for help.

Patients behavior can be verbal or non-verbal.

The nurse reacts to patients behavior and

forms basis for determining nurses acts.

Perception, thought, feeling

Ida Jean Orlando

Deliberative Nursing
Process
Nurses actions should be deliberative,

rather than automatic

Deliberative actions explore the meaning
and relevance of an action.