BDBDBSHXHX

TEORI
KEPERAWATAN
Ns. Maridi M. Dirdjo, M.Kep.

Latar Belakang
n Banyak pakar sepakat bahwa teori dan
perspektif yang unik digunakan oleh suatu
disiplin atau profesi untuk mebedakan
dengan disiplin lain.
n Teori digunkan oleh anggota profesi untuk
menjelaskan asumsi dasar dan nili-nilai
yang dibagikan serta menentukan sifat,
tujuan dan hasil dari praktik profesi tersebut
(Alligood, 2006; Rutty, 1998).
Latar Belakang
n NURSING IS….
• Ilmu keperawatan) definisikan sebagai “the substantive,

discipline-specific knowledge that focuses on the
human-universe-health process articulated in the nursing
SCIENCE • frameworks and theories” Barrett (2002
•
ART • seni
Hubungan Teori, Praktik dan Riset
Teori
Keperawatan
Praktik Riset
Ilmu (Science)
n Science is both a process and a product.
n Parse (1997) defines science as the
“theoretical explanation of the subject of
inquiry and the methodological process of
sustaining knowledge in a discipline”
Pola Pengembangan Pengetahuan
Paradigma Abstrak
Model Konseptual
Teori Konkrit
Paradigma
Cara melihat fenomena dalam disiplin yang

mengarahkan metodologi dan proses
perkembangan
Paradigma Keperawatan
ILMU
n Kumpulan pengetahuan yang padat dan proses
mengetahui melalui penyelidikan sistematis dan
terkendali: metode ilmiah
n Proses perbaikan diri berkesinambungan yang

melibatkan perkembangan teori dan uji empiris.
n Bertujuan mengamati, mengklarifikasi dan

menyelidiki hubungan yang memberikan
pengertian tentang fenomena.
Pentingnya Ilmu Bagi Profesi
Keperawatan
n Identify certain standards for nursing practice
n Identify settings in which nursing practice should occur and the characteristics
of what the model’s author considers recipients of nursing care
n Identify distinctive nursing processes and technologies to be used, including
parameters for client assessment, labels for client problems, a strategy for
planning, a typology of intervention, and criteria for evaluation of intervention
outcomes
n Direct the delivery of nursing services
n Serve as the basis for clinical information systems including the admission
database, nursing orders, care plan, progress notes, and discharge summary
n Guide the development of client classification systems
n Direct quality assurance programs
“Body of Knowledge”:
4 Jenis pengetahuan
n Scientifik/ empirik tentang perilaku manusia
dalam keadaan sehat dan sakit
n Persepsi estetik tentang pengalaman manusia yang

berarti
n Pemahaman personal tentang keunikan sendiri

sebagai individu
n Kapasitas membuat keputusan dalam situasi nyata

dengan melibatkan aspek moral atau pengetahuan
etik.
TEORI
n Serangkaian hubungan antar konsep yang
menguraikan dan meramalkan fenomena
disiplin
n Mencakup: ASUMSI, KONSEP, PRINSIP

& PROPOSISI
ASUMSI
Pernyataan mengenai fenomena sentral suatu

disiplin yang mewakili pakar teori
KONSEP
Ide abstrak tertulis pada tingkatan teoritis yang

merupakan fondasi bangunan suatu teori
Istilah yang secara abstraks menguraikan dan

memberi nama suatu objek atau fenomen
Konstruk Respon Emosional Abstrak
Konsep Kecemasan
Variabel Telapak tangan

berkeringat konkrit
PRINSIP
Pernyataan yang menghubungan 2 atau lebih

konsep tertulis pada tingkat teoritis
Proposisi
Pernyataan yang menghubungkan 2 atau lebih
prinsip sehingga menjadi pedoman untuk
riset dan praktik
Hirarki Pernyataan
Proposisi Umum
Proposisi khusus
Hipotesis
Proses Pengembangan Ilmu Keperawatan
Konsep Pernyataan Teori Uji Teori
Revisi Konsep
Ilmu Uji Teori Revisi Pernyatann

Keperawatan Lanjutan
Revisi Teori
Jenis Teori
n Teori Saintifik
n Teori substantif
n Teori Tentantif
Teori Saintifik
n Metode valid dan reliabel
n Diuji berulangkali mellaui riset
n Generalisasi empiris
Teori substantif
n Menjelasan fenomena penting suatu disiplin
n Dikembangakan pada disiplin lain
n Beberapa pernyataan telah diuji

Teori Tentantif
n Baru diusulkan
n Belum banyak dikritik oleh disiplin
n Sedikit/ belum diuji coba

Konseptual Model Keperawatan
 Model keperawatan dibuat dari beberapa
komponen atau ide-ide keperawatan. Komponen
tersebut adalah:
1. Filosofi dan keyakinan keperawatan
• Sepanjang kehidupan manusia akan mempunyai keterkaitan
atau ikatan dengan masyarakat, mempunyai keyakinan dan
pandangan tentang manusia dan tentang benar salah.
• Nilai dan ide-ide moral individu akan digambarkan oleh
masyarakat dimana individu itu tinggal
• Keyakinan adalah sesuatu yang dijadikan panutan atau
pedoman bagi individu dalam bertindak atau berperilaku
dalam kehidupan sehari-hari.
MODEL KONSEPTUAL Kep.
 Serangkaian konsep dan pernyataan yang
terintegrasi menjadi susunan berarti:
– Umum
– Abstrak
– Tak terbatas
 Pedoman
– Apa yang dilihat
– Bagaimana memandang
– Aspek yang dipertimbangkan
Konseptual Model Keperawatan
2. Konsep
 Konsep merupakan keyakinan yang komplek

terhadap obyek, benda, suatu peristiwa atau
fenomena berdasarkan pengalaman dan persepsi
seseorang berupa ide, pandangan dan keyakinan.
 Sebagai contoh adalah sel merupakan unit terkecil
dari tubuh manusia, maka konsep adalah merupakan
unit atau bagian dari fikiran manusia.
Model Konseptual Keperawatan
3. Teori
 Teori adalah hubungan beberapa konsep atau definisi yang
dapat memberikan penjelasan bagaimana dan mengapa
sesuatu itu terjadi.
 Ditinjau dari cara mempelajarinya maka terhadap dua jenis
teori yaitu deduktif dan induktif.
 Teori deduktif adalah teori yang mempelajari suatu ide
kemudian dikembangkan menjadi suatu kerangka yang luas.
Sedangkan teori induktif adalah mempelajari sesuatu
kerangka konsep yang luas kemudian ditarik menjadi suatu
kesimpulan atau ide.
 Sebagai contoh deduktif adalah tentang kontak dini antara
ibu dan anak yang dapat dijelaskan secara luas dan bidang
keperawatan anak dan keperawatan kebidanan.
Komponen-komponen model
keperawatan
 Sesuatu yang menjadi keyakinan perawat
secara nyata atau aktual akan
mempengaruhi cara mereka dalam
berperilaku. Model dalam praktek
keperawatan didasarkan isi teori dan konsep
dari praktik keperawatan itu sendiri.
 Model konseptual keperawatan mempunyai
tiga komponen yaitu (Kozier, Erb dan
Oliveri, 1991):
keperawatan
Asumsi (assumptions)
 Asumsi adalah pernyataan dari fakta atau pendukung
(supposition) bahwa seseorang menerima dasar-dasar teori
untuk dikonseptualisasikan terhadap keperawatan. Assumsi
ditarik dari teori ilmiah atau dari praktek atau gabungan
keduanya dan dapat diverifikasi lebih lanjut oleh siapapun.
Beberapa model keperawatan menggambarkan asumsi dari teori
adaptasi, yang lainnya dari teori sistim umum dan beberapa
model juga menggambarkan asumsi yang berasal dari praktik
keperawatan.
 Asumsi berbeda jauh dari model yang satu dengan yang lainnya
sehingga ia digambarkan secara berbeda pula.
keperawatan
Sistem nilai (value system)
 Keyakinan yang mendasari profesi adalah system nilai.
Umumnya keyakinan ini hampir sama dari model yang satu
dengan model yang lainnya, yaitu:
 Perawat mempunyai fungsi yang unik dimana mereka harus
bekerjasama dengan profesi kesehatan lainnya.
 Keperawatan adalan suatu pelayanan yang diarahkan untuk
memenuhi kebutuhan dasar pada orang sehat atau sakit baik
individu, kelompok (keluarga atau masyarakat)
 Keperawatan menggunakan proses sistematik yaitu proses
keperawatan untuk mengoperasionalkan model konseptualnya.
 Keperawatan merupakan serangkaian hubungan interpersonal.
Hubungan perawat dan klien adalah hubungan perbantuan.
Unit-unit utama (major units) model
keperawatan
Terdapat tujuh unit-unit utama model keperawatan
yang dibentuk dari asumsi dan nilai. Unit-unit utama
tersebut adalah sebagai berikut:
1. Tujuan keperawatan (goal of nursing).
– Tujuan akhir dari keperawatan adalah sama dengan
tujuan dari semua profesi kesehatan yaitu
meningkatkan kesehatan, mempertahankan atau
memelihara kesehatan, mencegah masalah kesehatan,
pemulihan kesehatan dan sebagainya. Tujuan khusus
keperawatan mempunyai tujuan yang berbeda dari
model yang satu dengan model yang lainnya tergantung
pada asumsi tentang manusia.
keperawatan
2) Klien (client)
– Klien bukan hanya seseorang yang menerima pelayanan
keperawatan tetapi konsepsi tentang seseorang atau
kelompok. Beberapa model mengindikasikan bahwa klien
adalah suatu biopsikososial.
3) Peran perawat (role of nurse)
– Peran perawat semstinya harus dicari, dibutuhkan dan
diterima oleh masyarakat seperti halnya peran kuratif dokter
dan pengacara. Beberapa perawat mengatakan perannya
adalah memberikan asuhan keperawatan (caring). Orem
mengatakan peran perawat adalah memberikan bantuan
untuk mempengaruhi perkembangan klien untuk meraih
tingkat perawatan dirinya (Orem, 2001).
keperawatan
 Sumber kesulitan (source of difficulty)
– Sumber kesulitan terletak pada klien bukan pada
perawat, dengan kata lain asal masalah atau penyebab
pada klien menjadi sasaran tindakan keperawatan.
 Fokus tindakan (focus intervention)
– Menurut Orem fokus tidakan keperawatan adalahsuatu
kekurangan klien dalam mempertahankan perawatan
dirinya dan menurut Roy fokus keperawatannya adalah
merangsang klien yang mengalami kesulitan melakukan
adaptasi.
keperawatan
 Jenis tindakan (modes of intervention)
– Jenis tidakan adalah cara yang digunakan perawat
untuk melakukan intervensi kepada pasien. Dalam
adaptasi modelnya Roy, fokus tindaknnya adalah
merangsang klien yang mengalami kesulitan adaptasi
dengan cara memanipulasi rasangangan tersebut.
Dalam keyakinan Nightingale, jenis tindakan
keperawatan adalah memanipulasi lingkungan.
 Akibat (consequences)
– Akibat yang dimaksud adalah akibat dari tindakan
keperawatan yang diinginkan.
Teori dan Model keperawatan
FALSAFAH KEPERAWATAN
NIGHTINGALE WATSON BENNER
MODEL KEPERAWATAN
JOHNSON KING LEVIN OREM ROGER NEUMAN ROY
TEORI KEPERAWATAN
ORLANDO ERIKSON MERCER LININGER PARSE NEWMAN
FALSAFAH KEPERAWATAN
 RUFAIDAH AL ASLAMIYAH
 FLORENCE NIGHTINGALE: Nursing
Phylosophy (Falsafah Keperawatan)
 JEAN WATSON’S: Phylosophy and
Science of Caring (Falsafah dan Ilmu
Caring )
 BENNER: Philosophy in Nursing Practice
(Falsafah Praktik Keperawatan)
MODEL KEPERAWATAN
 JOHNSON: Bevavioral system model
(Model system perilaku)
 KING: Open system model
 ROY: adaptation model
 OREM: conceptual model of self care
 PENDER: Health Promotion Model
 LEVIN: Conservation model
 NEUMAN: Helath care system model
 WATSON: Theory of caring
 ROGERS: Science of Unitary Human Being
TEORI KEPERAWATAN
 ORLANDO: Nursing process theory

 ERIKSON: Modeling and Role Modeling
 MERCER: Becoming a Mother Theory
 LEININGER: Theory of culture care
Diversity and universality (Transcultural
Nursing).
 PARSE: Human Becoming Theory
 NEWMAN: Theory of Health as Expanding
Consciousness
RUFAIDAH AL
ASLAMIYAH
Dasar Keperawatan Islam
Kontroversi
Literatur barat tahap Sejarah Islam mencatat

awal perkembangan Rufaidah Al- Aslamiyah
keperawatan dimulai sebagai pionir dan
pada zaman “lady of the inspirasi untuk profesi
lamp” Florence keperawatan di dunia
Nightigale (Tymby, 2007). Islam
Rufaidah adalah Mummaridahatul Islam al Ula

RUFAIDAH Binti SAAD
O Rufaidah Al Aslamiyyah binti Saad yang
hidup pada zaman Nabi Muhammad SAW
pada abad 8 M
O Nama lengkap Rufaidah binti Sa’ad Al-Bani
Aslam Al-Khazraj
O Diakui sebagai perawat Islam profesional
pertama dunia Arab dan Islam
O Dia dikenal sebagai Asiya dan disebut “Ibu
Keperawatan”
Latar belakang Pribadi
Rufaidah
O Dia lahir di Yathrib, Madinah pada tahun 570 M
dan wafat pada tahun 632 M.
O Dia lahir dari keturunan Bani Aslam dari Khazraj
di Madinah
O Ayahnya seorang dokter dan Dia belajar
merawat pasien-pasien ayahnya
O Sejarah mengilustrasikan atribut seorang
perawat yang baik
O Empatik, pemimpin yang mumpuni, organizer
yang mampu memobilisasi orang lain untuk
bekerja dengan baik dan memiliki ketrampilan
klinik baik.
Performance Rufaidah sebagai
seorang perawat klinik
O Berperan besar saat perang Badar, Uhud, dan
Khandaq berkobar.
O Mengelola rumah sakit lapangan selama masa
damai
O Merawat masyarakat (laki-laki dan perempuan)
selama masa damai
O Membantu setiap muslim yang membutuhkan:
yang miskin, yatim dan orang cacad
O Memberi perawatan spiritual pada pasien
(sentuhan kemanusiaan yang merupakan aspek
penting dalam keperawatan)
Performance Rufaidah sebagai
seorang perawat komunitas
O Kontribusi unik Rufaidah adalah sebagai
perawat komunitas dengan pergi keluar rumah
sakit dan mencoba mengatasi masalah penyakit
yang ada di masyarakat
O Melatih perawat di sekolah yang Dia dirikan
O Berpartisipasi dalam perang suci dan
mengemban beberapa tugas selama perang
yang bekerjasama dengan: Ummi Ammara,
Aminah, Ummi Ayman, Safiyat, Ummi Sulaim dan
Hindun yang tercatat dalam sejarah
perkembangan keperawatan Islam
Rufaidah sebagai
“IBU KEPERAWATAN”
Dia berhak menyandang Ibu Keperawatan,
karena
Ia adalah perawat pertama di dunia
Dia yang mendirikan sekolah perawat pertama
Pertama kali menetapkan kode etik
Pemimpin pertama dalam keperawatan komunitas
Miller, 2007
Sejarah Keperawatan Islam
O Masa penyebaran islam /The Islamic Periode ( 570 – 632 M).
pada masa ini keperawatan sejalan dengan peperangan yang
terjadi pada kaum muslimin (Jihad). Rufaidah Al-Asalmiya
adalah perawat yang pertama kali muncul pada mas ini.
O Masa setelah Nabi / Post Prophetic Era (632 – 1000 M).
Pada masa ini lebih didominasi oleh kedokteran dan mulai
muncul tokoh-tokoh kedokteran islam seperti Ibnu Sinna, Abu
Bakar Ibnu Zakariya Ar-Razi (dr. Ar-Razi).
O Masa pertengahan/ Late to Middle Age (1000 – 1500 M). Pada
masa ini negara-negara arab membangun rumah sakit dengan
baik, pada masa ini juga telah dikenalkan konsep pemisahan
antara ruang rawat laki-laki dan ruang rawat perenpuan. Juga
telah dikenalkan konsep pasien laki-laki dirawat oleh perawat
laki-laki dan pasien perempuan dirawat oleh perempuan.
Definisi Keparawatan dalam
Islam
O Al Quran surat Thaha ayat 40 di
artikan sebagai dalil keperawatan
oleh beberapa ahli (Saffarzade,
2001; Pickthall, 2001; Ironik, 2009;
Qaraee, 2009).
O Dalam bahasa Arab Al Momarez 
perawat
O Dalam beberapa kasus
diterjemahkan sebagai
“mempertahankan” dan “perubahan”
Interprestasi kata
“Keperawatan”
O Istilah keperawatan telah digunakan dalam
beberapa tafsir Al Quran, meliputi:
1. Tafsir surat Al Fajar ayat 17 (Tayeb,
1999)
2. Tafsir surat Thaha aya 9 -11 (Tayeb,
1999)
3. Surat Yusuf ayat 36-38 (Qureshi
Banaee, 1998; Tehrane, 1978)
4. Surat Al Imran Ayat 35-44 (Ameli, 1981)
Tinjauan Teks dalam Al Quran
Mereview Al Quran kita akan memehami keperawatan:
O Nabi Ayyub AS di rawat oleh isterinya saat ia sakit
dan sedih (Sakit diseluruh tubuhnya dan kematian
anaknya) (QS Shaad (38): 41; Al Anbiya (21): 73-84)
O Merawat anak yatim sebagai orang tua daripada
memberi uang sebagai contoh Zakaria merawat
Maryam
O Merawat terpidana oleh Nabi Yusuf (Nabi Yusuf
bertanggungjawab membantu dan menuntun
narapidana (aspek pendidikan kesehatan)
O Merawat anak oleh ibunya
Arti Keperawatan dalam
kontek Bahasa Arab dan Persia
O Merawat - Caring
O Menjaga – keeping
O Perlindungan – protection
O Melindungi - petronage
Keperawatan menurut Al
Quran dan Islam
O Asuhan untuk memberi perawatan kepada orang
lain meliputi seluruh aspek kebutuhan manusia
dan keurangnya pengetahuan dengan cara caring
O Keperawatan berpusat pada pasien berdasarkan
permintaan yang Nampak maupun tersembunyi
dari pasien (pencari asuhan)
O Karakteristik keperawatan mirip kasih saya ibu
O Proses dalam keperawatan merupakan
pengembangan nilai dan kapasitas perawat dalam
membantu perkembangan diri
Perspektif Islam terhadap
sehat dan sakit
O Persepsi pasien-pasien muslim terhadap
sehat dan sakit sebagai ujian dari Allah.
O Sakit dan kematian harus diterima sabar,
tawakal dan diiringi dengan doa dan shalat.
O Pasien muslim memahami penyakit,
pemderitaan dan kematian adalah bagian
dari kehidupan (sunattullah)
Allah akan menguji dengan rasa takut,
lapar dan sakit…dan kabar gembiralan bagi
orang-orang yang sabar (Al Baqarah)
Teori Henderson
Pandang thd
Tujuan Kep Masalah Kep
Kep
• Membantu • Mengusai dan • Kurang
individu mandiri dalam pengetahuan
menjadi menjalan dan kekuatan
mandiri aktivitas untuk
dengan 14 sehari-hari melaksanakan
aktivitas 14 aktivitas
Teori King
Pandang thd Kep Tujuan Kep Masalah Kep
•Proses tindakan, •Membantu •Jika perawat dan

reaksi dan individu pasien tidak saling
ineraksi antara mempertahankan menerima satu
perawat dengan kesehatan dengan yang
pasien dalam sehingga mereka lainnya dan tujuan
mencapai tujuan dapat tidak akan
di dalam melaksanakan tercapai
lingkungan fungsi dan
perannya
Teori Johnson
•Kerja kekuatan •Keseimbangan •Fungsi structural

pengatur system dan stress dalam
eksternah untuk subsistem sistem
mempertahankan perilaku yang
organisasi dan berfungsi efektif
integrase perilaku dan efisien
pasien pada
tingkat yang
optimal
Teori Watson
•Keperawatan ada;ah •Pertumbuhan •Ketidakseimbangan

imu tentang manusia mental dan spiritual disebabkan oleh
yang berisikan manusia kekurangan
tentang •Menemukan makna transendetal
pengetahuan, dari keberadaan dan manusia
pikiran, nilai, filosofi, pengalaman •Ketodakharmonisan
komitmen tindakan seseorang antara seseorang
penuh cinta kasih dengan duniannya
dalam transaksi
perawatan manusia
Pandangan Islam
•Keperawatan adalah •Pemberian perawatan •Manusia berusaha

ilmi antropologi manusia berdasarkan untuk memenuhi
•Keperawatan di asuhan kebutuhan yang tinggi
konsentrasikan pada •Keperawatan tetapi sering
kesempurnaan melakukan remediasi mengalami masalah
keberradaan manusia ulang pada seluruh atau kendala dan
berdasarkan aspek manusia (jiwa perawat melakukan
kebutuhan (tampak dan raga) asuhan untuk
dan tersembunyi) •Seluruh alam adalah mengatasi nya
•Manusia dapat ciptakan Allah
memiliki kemampuan
yang tinggi dan
perawat
bertanggungjawab
untuk
mempromosikannya
Definisi Keperawatan
Modern
O Keperawatan merupakan suatu bentuk
pelayanan profesional yan merupakan
bagian integral dari pelayanan yang
didasarkan pada ilmu dan kiat keperawatan
berbentuk pelayanan biopsikososial dan
spiritual yang komprehensif ditujukan
kepada individu,keluarga, dan masyarakat
baik sehat maupun sakit yang mencakup
seluruh proses kehidupan manusia
65
KARAKTERISTIK KEPERAWATAN
Ka
ISLAMI
1. Profesional
2. Ramah
3. Amanah
4. Istiqomah – Bekerja sungguh-sungguh
5. Sabar
6. Ikhlas
Rifki Muslim, t tahun

Teori dan Model
Konseptual Florence
Nightingale
Maridi M. Dirdjo
O Lahir: 12 Mei 1820)
Florence, Grand Duchy
of Tuscany Italia
O Meninggal: 13 Agustus
1910 (umur 90) Park
Lane, London, Inggris
Raya
O Profesi: Perawat dan
Statistician
O Lembaga: Selimiye
Barracks, Scutari
O Spesialis: Higiene dan
sanitasi Rumah Sakit
O Dikenal untuk: perintis
keperawatan modern
Florence Nightingale
meningkatkan status
keperawatan untuk
menjadi pekerjaan yang
dihormati,
meningkatkan kualitas
asuhan keperawatan,
dan mendirikan
pendidikan keperawatan
yang modern
Kontribusi Florence
Nightingale
O Nightingale mengubah citra negatif dari
keperawatan untuk yang positif.
O Dia berjasa dalam:
O Pelatihan orang untuk pekerjaan yang
mereka akan lakukan.
O Memilih hanya mereka yang memiliki
karakter terhormat sebagai calon perawat.
O Meningkatkan kondisi sanitasi untuk pasien
O Tingkat kematian secara signifikan berkurang
pada tentara Inggris.
Kontribusi…
O Menyediakan pendidikan kelas dan mengajar
klinis untuk perawat.
O Menganjurkan bahwa pendidikan keperawatan
harus proses seumur hidup
O Pengakuan bahwa gizi yang merupakan bagian
penting dari asuhan keperawatan.
O Membangun kedudukan wanita untuk dihormati.
O Yakin bahwa keperawatan terpisah dan berbeda
dari kedokteran.
O Mengidentifikasi kebutuhan pribadi pasien dan
peran perawat dalam memenuhi kebutuhan
tersebut.
Origins of Nightingale’s Theory for
Nursing Practice:
• Florence Nightingale was a prolific writer. She
lived from 1820 to 1910 in Victorian England.
• Her ideas, values, and beliefs on a wide range of
topics can be identified in her documents.
• They contain philosophical assumptions and
beliefs regarding all elements found in the
metaparadigm of nursing.
• In 1859, she was the first to conceptualize
nursing’s work into a theoretical framework.
• She was credited with founding the practice of
nursing.
Relevansi terhadap keperawatan
saat ini
• Florence Nightingale developed a body of nursing
knowledge clearly expressed in the 79 pages of Notes
on Nursing: What It Is and What It Is Not
(Nightingale, 1969).
• A 221 page second edition (Nightingale, 1992) was
intended for the professional nurse, and is relevant
to nurses today who are searching for wisdom on her
perspectives on illness, the person, their
environment, and holistic nursing.
Quotations:
• On the purpose of nursing.”…the
proper use of fresh air, light,
warmth, cleanliness, quiet, and the
proper selection and
administration of diet- all at the
least expense of vital power to the
patient”
• On the empowering partnership
with clients in the community.” We
must not talk to them or at them
but with them”
Relevant to Nursing
Organization:
• Florence Nightingale • Her plan was that
provided a professional nurse training would
model for nursing not threaten the
organization in Britain status of the doctors,
that spread across much but crucially that they
of the world. should accept the
• She emphasized disciplinary authority
subservience to doctors, of the matron and the
allowing nursing to gain new hierarchy of
a foothold within a nurses within the
hospital. hospital.
Relevance to Nursing Education:
• The idea that nursing • Schools of nursing
required specific were established on
education was her model throughout
th
revolutionary in 19 - the world.
century England.
• Nightingale’s nursing • They emphasized the
education emphasized moral qualities of
the need to blend a nursing and
mixture of theoretical introduced
and clinical humanitarian, patient-
experiences. centered values that
are still relevant today.
Individual Relevance of
Florence Nightingale:
• She was empowered • Besides “getting
through her personal the science right”,
philosophy, which was Florence
deeply spiritual and at the Nightingale made
same time fundamentally it comprehensible
practical and related to to lay people,
everyday life. especially the
• She was a systematic politicians and
thinker and passionate senior civil
statistician, using bar and servants who
pie charts, highlighting key made and
points. administered the
laws.
Relevant to Nursing Knowledge:
• The body of • Regardless of
knowledge left whether the
by Florence environment is
Nightingale high tech, the
includes an “nurse remains
environmental responsible for
adaptation altering the
theory, which is environment to
entirely relevant improve it for
to the modern the benefit of
setting. the client”
Assumptions of Florence Nightingale’s
Theory:
• Natural laws
• Mankind can achieve perfection
• Nursing is a calling
• Nursing is an art and a science
• Nursing is achieved through environmental alteration
• Nursing requires a specific educational base
• Nursing is distinct and separate from medicine
Major Premises of Environmental
Adaptation Theory:
• People are multidimensional, composed of
biological, psychological, social and spiritual
components.
• Disease is more accurately portrayed as dys-ease
or the absence of comfort.
• Symptoms alert nurses to the presence of illness,
which allows for appropriate interventions.
• Breaking the natural laws will cause disease.
• Improvement in the health of individuals and
families lead to the improved health of society.
The Environmental
Adaptation Concepts:
• Florence Nightingale’s original Six D’s of Dys-ease:
theory for nursing practice was
Dirt
holistic.
Drink (need clean
• Her concepts included drinking water)
human/individual, Diet
society/environment, Damp
health/disease and nursing. Draughts (Drafts)
• She focused more on physical Drains (need proper
factors than on psychological needs drainage and sewer
systems)
of patients because of the nature of
nursing practice during her time.
Pandangan Florence Nightingale
A Comparison of Nightingale’s
Canons and Modern-Practice:
Nightingale’s Canons: Modern Concepts:
Ventilation and warming Physical environment
Light, Noise
Cleanliness of rooms/walls
Health of houses
Bed and bedding
Personal cleanliness
Variety Psychological environment
Chattering hopes and advices
Taking food. What food? Nutritional status
Petty management/observation Nursing care planning and
management
Origin of Nightingale’s Environmental
Concepts:
• Nightingale believed that the environment could
be altered to improve conditions so that the
natural laws would allow healing to occur.
• This grew from empirical observation that poor or
difficult environments led to poor health and
disease.
• In her Crimean experience, filth, inadequate
nutrition, dirty water, and inappropriate sewage
disposal led to a situation in which more British
soldiers died in the hospital than of battlefield
wounds.
Concepts of Nursing:
• The goal of nursing is to place the patient in
the best possible condition for nature to act.
• Health is “not only to be well, but to be able to
use well every power we have”
• Health nursing, or general nursing are those
activities that promote health (as outlined in
canons) which occur in any caregiving
situation. They can be done by anyone.
• Nursing proper is reserved for those
individuals who are educated in the art and
the science of nursing.
The Holistic Person Model:
Nightingale’s Model for Nursing
Practice:
Many Other Theories Use Nightingale’s
Holistic Concept:
• Neuman’s Systems Model

• Roy’s Adaptation Model
• Levine’s Conservation Theory
• Modeling and Role Modeling
(MRM) Theory
The listed theories differ in environmental

influences and other aspects of nursing, but
share holistic concepts.
Research Article:
• Shades of Florence Nightingale: Potential impact
of noise stress on wound healing was chosen.
• This article examines the potential effects of noise
stress on wound healing.
• It explains theoretical linkages between the
normal processes of wound healing, endocrine
aspects of the stress response, and the effects of
stress hormones on the biological function of
leukocytes involved in wound healing.
• The effects of noise on patient sleep and cognitive
function are well-documented.
Research Findings:
• Exposure to increased or novel environmental
noise has been shown to elicit neuroendocrine
changes indicative of the stress response.
• They are associated with alterations in the
biological functions of cells involved in wound
healing.
• Clinical research studies have shown that levels
of environmental noise in patient care units
exceed those recommended by the EPA and are
disturbing to patients.
Research Conclusions:
• Recovery rate of patients would be
greatly enhanced by reduction of
noise stress.
• If, as Nightingale stated, the
patients are to be put in the best
condition for nature to act on them,
it is the responsibility of nurses to
reduce noise, to relieve patients’
anxieties, and to help them sleep.
In Nursing Today:
• Nurses old and young have

been influenced by
Florence Nightingale’s
Theories.
• Environmental Adaptation
remains the basis of our
holistic nursing care.
• I am proud to follow in the
important work of of “The
Lady with the Lamp.”
Reference List:
Attewell, A. (1998) Florence Nightingale’s relevance to nurses.

Journal of Holistic Nursing, 16 (2), 281-291
McDonald, L. (2001). Florence Nightingale and the early origins of

evidence-based nursing, EBN Notebook 4(3), 68-9
McCarthy D, Ouimen M, Daun J. (1991) Shades of Florence
Nightingale: Potential impact of noise stress on wound healing.
Holistic Nursing Practice. 5(4) 39-48
Nightingale, F. (19690. Notes on nursing: What it is and what it is
not. New York: Dover. (original work published 1860)
Selanders, L. (1998) The power of environmental adaptation. Journal
of Holistic Nursing, 16,(2) 247-263
Watson J. (1998), Florence Nightingale and the enduring legacy of
Transpersonal Human Caring. Journal of Holistic Nursing, 16(2), 292-294
TEORI DAN MODEL KONSEPTUAL
DARI WATSON
Nama lengkapnya:
Margaret Jean Harman Watson
LATAR BELAKANG
• KEPERAWATAN BIO-PSIKO-SOSIAL-
SPIRITUAL APLIKASI PENGEMBANGAN
TEORI KEPERAWATAN M MUTU
• CARING WATSON
LANDASAN TEORI
• WATSON (1998)
Caring adl esensi dari keperawatan yang
berarti pertanggung jawaban hubungan
antara perawat-klien, dimana perawat
membantu partisipasi klien, membantu klien
memperoleh pengetahuan dan
meningkatakan kesehatan.
EARLY HISTORY
• Born and raised in West Virginia
• Received the following degrees from the University of

Colorado
• Bachelor of Science in Nursing in 1964
• Masters Degree of Science in 1966
• Doctor of Philosophy in 1973
https://www.papermasters.com/jean-watson-nursing-
theory.html
The Philosophy and Science of Caring

was her first book published in 1979
(Black, 2014)
http://libguides.daemen.edu/c.php?g=32927&p=208372
Career Milestones
• Author and co-author of over 20 books
• Past President of the National League of Nursing

Photo by: www.mceyo.com
• Fellow of American Academy of Nursing

• Distinguished Professor of Nursing and Chair in Caring Science at the University
of Colorado Health Sciences Center (watsoncaringscience.org, 2015)
• Founding member of International Association in Human Caring and International
Caritas Consortium (watsoncaringscience.org, 2015)
• Founder and Director of the Watson Caring and Science Institute
(watsoncaringscience.org, 2015)
• In 2010 launched the Million nurse Global Caring Field Project (, 2015)
• October 2013 was inducted as a Living Legend by the American Academy of
Nursing (Kelly, 2013)
AWARDS
• The Fetzer Institute Norman Cousins Award (watsoncaringscience.org,2015)
• International Fellowship in Australia (watsoncaringscience.org,2015)
https://www.governmentjobs.com/jobs?keyword=
• Fulbright Research Award in Sweden (watsoncaringscience.org,2015) Nursing
• Holds 10 honorary Doctoral Degrees including 8 International honorary Doctorates

(watsoncaringscience.org,2015)
• 2010 Holistic Nurse of the Year (ahna.org, 2010)
http://www.teamusa.org/usa-canoe-kayak/resources/awards
http://quotesgram.com/dr-jean-watson-quotes/
HOW WATSON’S THEORY OF
TRANSPERSONAL HUMAN CARING WAS
INFLUENCED:
• Jean Watson said that Nightingale’s blueprint
for transpersonal meanings and models of
caring transcend history.
• It “called forth the full use of self, connecting
the divine within and without as a source of
inspiration as well as the foundation for a
professional code”.
• Watson also said that Nightingale “made
explicit the connections between and among
all aspects of self, other, humanity, the
environment, nature, and the cosmos as a
means of learning, understanding, and
connecting health, caring, and healing”.
THE THEORY
Jean Watson’s Theory can be broken down into four
categories.
•1.) The Caritas Processes

•2.) The Transpersonal Caring Relationship
•3.) The Caring Occasion/Caring Moment
•4.) Caring and Healing Model
When looking at this theory of practice, Black informs us that

the emphasis for nursing practice focuses primarily on “How
can I create an environment of trust, understanding, and
openness so that the patient and I can work together in
meeting his or her needs?” (Black, 2014).
CARATIVE FACTORS
• Goal was to provide a framework for the “core of
nursing”
Watson referred to the “core” as the
philosophy, science and art of caring
• Transitioned from Carative Factors to Caritas

Processes as Watson’s ideas and values evolved
• Caritas-comes from the Latin word meaning “to

cherish and appreciate, giving special attention
to, or loving.”
• Builds upon Carative Factors
• Caritas processes openly displays more love and

caring and a deeper human experience
(Watson, 2014)
http://carebears.wikia.com/wiki/Take_Care_Bear
5 ASPEK CARING
1. MERUPAKAN SIFAT MANUSIA (HUMAN

TRAIT)
2. PERILAKU CARING BERDASAR MORAL
IMPERATIVE
3. DITUNJUKKAN DENGAN PENUH PERASAAN
(AFFECT)
4. HUBUNGAN INTERPERSONAL PERAWAT-
KLIEN
5. INTERVENSI TERAPEUTIK DALAM ASUHAN
KEPERAWATAN
ORIGINAL 10 CARATIVE FACTORS
1 .Formation of a humanistic–altruistic system of values
2. Instillation of faith–hope
3. Cultivation of sensitivity to one’s self and to others
4. Development of a helping–trusting, human caring relationship
5.Promotion and acceptance of the expression of positive and negative feelings
6. Systematic use of a creative problem solving caring process
7. Promotion of transpersonal teaching– learning
8. Provision for a supportive, protective, and/or corrective mental, physical, societal, &
spiritual environment
9. Assistance with gratification of human needs
http://mind42.com/public/bdd85724-5aa0-40ca-b956-cf0d61ce1ab9
10. Allowance for existential–phenomenological–spiritual forces (Watson, 2014)
FAKTOR CARATIVE UTAMA DALAM
CARING
1. MEMBENTUK & MENGHARGAI SISTEM NILAI

HUMANISTIC DAN ALTRUISTIK
2. MENANAMKAN SIKAP PENUH

PENGHARAPAN
3. MENANAMKAN SENSITIFITAS THD DIRI

SENDIRI & ORANG LAIN
4. MENGEMBANGKAN HUBUNGAN SALING
PERCAYA DAN SALING MEMBANTU
5. MENINGKATKAN DAN MENERIMA EKSPRESI

PERASAAN POSITIF DAN NEGATIF
6. MENGGUNAKAN METODE SISTEMATIS

DALAM MENYELESAIKAN MASALAH CARING
UNTUK PENGAMBILAN KEPUTUSAN SECARA
KREATIF DAN INDIVIDUALISTIK
7. MENINGKATKAN PROSES BELAJAR
MENGAJAR INTERPERSONAL
8. MENCIPTAKAN LINGKUNGN FISIK, MENTAL,

SOSIAL DAN SPIRITUAL YANG SUPORTIF,
PROTEKTIF DAN ATAU KOREKTIF
9. MEMENUHI KEBUTUHAN DASAR MANUSIA

DENGAN PENUH PENGHARGAAN DALAM
RANGKA MEMPERTAHANKAN KEUTUHAN &
MARTABAT MANUSIA
10. MENGIJINKAN TERBUKA PADA EKSISTENSI-FENOMENOLOGIKAL DAN
DIMENSI SPIRITUAL CARING SERTA PENYEMBUHAN YG TIDAK DAPAT
DIJELASKAN SECARA UTUH DAN ILMIAH MELALUI PEMIKIRAN
MASYARAKAT MODERN
FROM CARATIVE TO CARITAS
1. Formation of a humanistic–altruistic system of values becomes the practice of loving
2. Instillation of faith–hope becomes being authentically present and enabling and

sustaining the deep belief system and subjective life world of self and one being cared
for
3. Cultivation of sensitivity to one’s self and to others becomes cultivation of one’s own
spiritual practices and transpersonal self, going beyond ego self, opening to others with
sensitivity and compassion
http://zeroturnaround.com/blog/xrebel-share-because-sharing-
4. Development of a helping–trusting, human caring relationship becomes developing is-caring/
and sustaining a helping–trusting, authentic caring relationship
5. Promotion and acceptance of the expression of positive and negative feelings

becomes being present to, and supportive of, the expression of positive and negative
feelings as a connection with deeper spirit of self and the one being cared for
(authentically listening to another’s story)
6. Systematic use of a creative problem solving caring process becomes creative use of
self and all ways of knowing as part of the caring process; to engage in the artistry of
caring-healing practices (Watson, pg. 325).
CARITAS PROCESSES
7. Promotion of transpersonal teaching learning becomes engaging in genuine
teaching-learning experience that attends to unity of being and meaning,
attempting to stay within others’ frames of reference
8. Provision for a supportive, protective, and/or corrective mental, physical,

societal, and spiritual environment becomes creating a healing environment at all
levels(a physical and nonphysical, subtle environment of energy and
consciousness, whereby wholeness, beauty, comfort, dignity, and peace are
potentiated)
9. Assistance with gratification of human needs becomes assisting with basic

needs, with an intentional caring consciousness, administering “human care
essentials,” which potentiate wholeness and unity of being in all aspects of care;
sacred acts of basic care; touching embodied spirit and evolving spiritual
emergence
Allowance for existential–phenomenological–spiritual forces becomes opening
and attending to spiritual-mysterious and existential dimensions of one’s own life- http://www.findmemes.com/sharing-is-caring-memes
death; soul care for self and the one being cared for. “Allowing for miracles.”
(Watson, 2014).
“We are the light in institutional darkness, and in this caritas model we get to return
to the light of our humanity” - Watson, 2008
THE TRANSPERSONAL CARING
RELATIONSHIP
• This portion of the theory focuses on “the one caring and the one cared
for.” (Cara, 2003). The nurse and patient can develop a deep divine
relationship that blends together and promotes overall health and well-
being.
• This process requires the use of “Actions, words, behaviors, cognition, body
language, feelings, intuition, thought, senses, and the energy field”
(Watson & Woodword, 2010).
• The nurse has a professional as well as a personal obligation to not only

see the patient as more than an object but to also protect and assist with
improving the patient’s dignity. (Cara, 2003)
• The nurse should be using her professional experience to promote healing

and bonding with the patient. This may include the use of various
http://www.findmemes.com/sharing-is-caring-memes communication techniques, both verbal and non-verbal to achieve a
healing and gentle relationship. (Watson & Woodward, 2010)
• The nurse and the patient are transformed together in this relationship.
(Black, 2014).
THE CARING OCCASION/
CARING MOMENT
• This portion of the theory focuses on an actual tangible moment in
time in which the nurse recognizes the connection that is
developed between him/herself and the patient. (Cara, 2003).
This moment dictates the ability for the nurse to have an overall
impact on the patient.
• According to Cara, The Caring Moment “Consists of feelings,

bodily sensations, thoughts, spiritual beliefs, goals, expectations,
environmental considerations, and meanings of one’s
perceptions—all of which are based upon one’s past life history,
one’s present moment, and one’s imagined future.” (Cara, 2003).
• This can occur during various nursing interventions and interactions

with each patient.
http://southernhillsbaptist.tv/the-church-caring/
CARING & HEALING MODEL OF
THEORY
• The nurse is able to help the patient with overall well-being
by assisting them with the release of “disharmony and
blocked energy” (Watson & Woodward, 2010).
• The use of this portion of the theory helps the patient with
overall healing and renewal. (Black, 2014).
http://sujanpatel.com/business/7-ways-to-show-your-
customers-you-care/
• Nurses can impact the patient through “health promotion,
health restoration, and illness prevention” (Black, 2014).
CREATING THE THEORY (WHY)
• Plan was to bring new meaning and dignity to nursing
• Used concepts from personal and professional experience
• Inducted, grounded, and combined with philosophy, ethical, intellectual,
and experimental background.
• The goal was to enhance the publics view of humanity and life in correlation
with nursing
• Watson’s commitment: professional role and mission of nursing; ethical
covenant with society as sustaining human caring and preserving human
dignity; attending to and helping to sustain human dignity, humanity, and
wholeness in the midst of threats and crises of life and death
http://www.communityclinicofdoorcounty.org/the-healing-project/
CREATING THE THEORY (HOW)
• “Dr. Watson drew parts of her theory from nursing writers like
Florence Nightingale as well as from works of psychologists and
philosophers.” (Theory Description, n.d.)
• “Her theory is one based on the human interactive process that

recognizes the spiritual and ethical dimensions relevant to the
human care process.” (Theory Description, n.d.)
CREATING THE THEORY (HOW)
Dr. Watson states that though her life’s work had been to live out her theory, she
did not fully understand her purpose until she was involved in a freak accident
where she lost her eye. She describes it as:
My soul life journey, purpose and learning transcended my professional

world.
“It was only after a traumatic eye injury and uncanny golfing accident
with my grandson, (where I lost my eye, literally, metaphorically and
symbolically – losing my eye/(ego)/ I, did I get it. I had to learn to be still, to
surrender to all, to let go, to learn to receive, to be open to unknown
mystery and miracles – it was the mystic and metaphysical/spiritual
practices and inner experiences that carried me through.
It was this journey of losing my eye and losing my world as I had known it,
including my beloved and devoted husband, who shortly thereafter,
committed suicide –that I awakened and grasped my own writing. I was
http://healing.about.com/od/crystaltherapy/ss/top-10-
healing-gemstones.htm
given the painful but loving, growing blessings of spiritual mystical
experiences, that I have experienced and learned my oneness with all. I
learned that all there is is Love. We are all energy of LOVE.” (Watson,
2015).
CARATIVE FACTORS & NURSING
“Watson’s theory offers a

conceptual approach to care
that is focused on the
nonmedical, human-to-human
caring relationships that are
viewed as the core of nursing
practice.” (Marckx, 1995, p. 46)
https://hsl.osu.edu/mhc/local-nursing-legends https://www.pinterest.com/nursinghistory/evolution-of-the-nursing-uniform/
USING THE CARATIVE
FACTORS…..
• Illness as disharmony
• Carative factor #9: provide assistance with basic human
needs while also designing specific interventions to instill
hope. (Marckx, 1995)
• Humanistic and altruistic values

• Carative factor #1: respecting the patient’s autonomy and
freedom of choice in determination of care. (Marckx,
1995)
http://photobucket.com/images/nursing%20sho
es
http://wallpapershidef.com/nursing-cartoon-pictures.html
THE ATTENDING NURSE CARING MODEL
- WATSON, J. & FOSTER, R (2003)
• There is one nurse who oversees care similar

to that of a hospitalist
• The Attending Caring Nurse is responsible for:
• Establishing and maintaining a continuous
caring relationship with their patients
• Providing a comprehensive assessment of
caring needs and concerns
• Creating a plan for comprehensive caring
and healing with the patient and family
• Creating plans for direct communication with
other members of the healthcare team
ensuring continuity. (Watson & Foster, 2003)
Photo courtesy of:
https://www.pinterest.com/justinebuckle/babynursebabygirl/
WATSON’S MODEL USED IN PRACTICE: AT
ST. PATRICK’S HOSPITAL SYSTEM IN
WESTERN MONTANA
Photo courtesy of:

www.montana.providence.org
HOW NURSES RELATE TO THE
THEORY
 Embrace altruistic values and Practice loving kindness with self and
others.
 Instill faith and thope and honor others.
 Be sensiive to self and others by nurturing individual beliefs and
practices.
 Develop helping – trusting- caring relationships.
 Promote and accept positive and negative feelings as you authentically
listen to another’s story
 Use creative scientific problem-solving methods for caring decision
making.
 Share teaching and learning that addresses the individual needs and
comprehension styles.
 Create a healing environment for the physical and spiritual self which
respects human dignity.
 Assist with basic physical, emotional, and spiritual human needs.
 Open to mystery and Allow miracles to enter.
Nurses seem to just have
compassion in their blood.
Compassion is not a trait that
can be taught. Watson’s Ten
Caritas Processes relate to
nursing in a way that many
other theories may not. Watson
focused on not only the
physical aspect of nursing but
providing spiritual and
emotional needs as well. It is
our duty as nurses to provide
not only physical care to help
heal a patient but also to
provide emotional and spiritual
support and to respect a
patient’s religion.
Provision 8
Provision 9 The nurse collaborates
Provision 7
The profession of nursing, with other health
The nurse, in all roles and
collectively through its professionals and the
settings, advances the
professional organizations, public to protect
profession through
must articulate nursing human rights, promote
research and scholarly
values, maintain the health diplomacy, and
inquiry, professional
integrity of the profession, reduce health
standards development,
and integrate principle of disparities.
and the generation of
social justice into nursing
both nursing and health
Provision 1 and health policy.
policy.
The nurse practices
with compassion and
respect for the
inherent dignity,
worth, and unique
attributes of every
Provision 6
person. The Ten Caritas The nurse, through
Processes is very similar individual and collective
to our nursing code of effort, establishes,
ethics. As we look at
each provision of the maintains, and improves
ANA Nursing Code of the ethical environment
Ethics, each one relates of the work setting and
Provision 2 in some way to the Ten conditions of
The nurse’s primary Caritas Processes. employment that are
commitment is to conducive to safe,
the patient, quality health care.
whether an
individual, family,
group, community,
or population.
Provision 3
The nurse Provision 4
promotes, The nurse has authority, Provision 5
advocates for, and accountability, and The nurse owes the same
protects the rights, responsibility for nursing uties to self as to others,
health, and safety practice; makes including the responsibility
decisions; and takes to promote health dand
of the patient.
action consistent with safety, preserve
the obligation to wholeness of character
promote health and to and integrity, maintain
provide optimal care. competence, and
continue personal and
professional growth.
(American Nurses Associtation, 2015)

REFERENCES
American Nurses Association. (2015). ANA Code of Ethics. (2015). Retrieved from
http://www.nursingworld.org/DocumentVault/Ethics_1/Code-of-Ethics-for-Nurses.html.
Black, B. (2014). Professional Nursing Concepts and Challenges. St Louis: Elsevier Saunders.
Cara, C. (2003). A pragmatic view of Jean Watson’s caring theory. International Journal for Human Caring,
7(3), 51-61.
Caring Science Theory & Research. (n.d.). Retrieved from http://watsoncaringscience.org/about-us/caring-
science-definitions-processes-theory/
Kelly, D. (2013, Aug 27). Retrieved from http://www.ucdenver.edu
Lukose, A. (2011). Developing a practice model for watson’s theory of caring. Nursing Science Quarterly,
24(1), 27-30.
Marckx, B. (1995). Watson’s theory of caring: A model for implementation in practice. Journal of Nursing
Care Quality, 9(4), 43-54.
Personal profile: Jean Watson. (2015) Watson Caring Science Institute. Retrieved from
http://watsoncaringscience.org/about-us/jean-bio/personal-profile/
REFERENCES
Schoner, A. (2010, June 24). Holistic Nurse of the Year. Retrieved from American Holistic Nurse Association:
http://anha.org/Home/News- Room/HNY-Award-2010
Theory Description. (n.d.) Jean Watson: Caringscience.
http://jeanwatsoncaringscience.weebly.com/theorydescription.html
Watson Caring Science. (2015). Retrieved from Watson Caring Science Institute:
http://www.watsoncaringscience.org
Watson, J. (2014). Jean Watson’s Theory of Human Caring. (pgs 321-340)
Watson, J (2008). The Philosophy and Science of Caring. Colorado: University Press.
Watson, J., & Foster, R. (2003). The attending nurse caring model: integrating theory, evidence and advanced
caring-healing therapeutics for transforming professional practice. Journal of Clinical Nursing, 12,
360-365.
Watson, J., & Woodward, T. K. (2010). Jean Watson’s theory of human caring. Nursing theories and nursing
practice, 3, 351-369.
Terima kasih
TEORI DAN MODEL KONSEPTUAL
DARI ROY
Sister Callista Roy
 Born October 14, 1939
 Bachelor’s Degree in
Nursing 1963
 Master’s Degree in Pediatric

Nursing 1966
 Master’s Degree in
Sociology 1973
 Doctorate in Sociology 1977
htnursingtheoriestp://.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html
Origin of Roy’s Adaptation Model
 Roy adapted some of her theory development
from Harry Helson’s Adaptation Theory
(Wikipedia 2011).
 Roy incorporated Helson’s theory with Rapoport's

definition of system (Alligood and Tomey 2010).
 1500 scholars and students contributed
130
Theoretical Concepts (cont.)
 Coping Mechanisms
– Regulator
– Cognator
131
 Four Adaptive Modes
o Physiological
o Self-Concept
o Role Function
o Interdependence
 Stimuli
o Focal
o Contextual
o Residual
http://www.infahealth.com/basic-nursing-science/callista-roy-
adaptation-model-of-nursing/
132
ROY ADAPTATION MODEL
Manusia sebagai sistem adaptasi
Control Processes(coping Mechanisme)
cognator
masukan
keluaran
Stimul tingkat
us fugsi konsep respon
stimulus adaptasi
ekster
ekternal (local, fisiologis diri adaptif
nal conteks persepsi
stimulus tual, respon
interde- inefektif
internal residual fungsi
stimulus pendensi
peran
regulator
feedback
mekanisme sub sistem regulator
spinal cord; autonomic
internal neural reflex
brainstem & efectors
stimulus aotonomic respons
reflex
chemical
responsivne
intact resposiven ss body
ess hormonal
intact pathways of terget response
of endorin output organs
to&from or tissues
cirkulasi glands
CNS
perception short term

chemical perception effector
memory
ekternal
stimuli
long term
neural memory
mekanisme sub sistem cognator
internal
stimuli
intact pathways processor
and apparatus for for
perceptual/ selective attention,

information coding & memory
processing
imitation,
learning reinforcement physichomotor
& insight choice of effectors response
response
problem solvin &
judgment decision-making
defenses to seek
emotion elief & affective
apprasial &
attachment
ekternal
stimuli
Four Adaptive Modes (cont.)
 Physiological-Physical Mode
o Oxygenation
o Nutrition
o Elimination
o Activity and Rest
o Protection
136
Self-Concept Mode
* Physical Self * Personal Self
Body sensation Self-consistency
Body image Self-ideal
Moral-Ethical-Spiritual
137
Role Function
(McEwen & Wills, 2011, pg. 172)
138
Interdependence
~ RELATIONSHIPS ~
139
 Types of Stimuli
– Focal
Residual
– Contextual Stimuli
Contextual
– Residual stimuli
Focal
stimuli
Contextual
Residual stimuli
Stimuli
Residual
Stimuli
140
Application to Health
“a state and a process of being and becoming

integrated and a whole person. It is a reflection
of adaptation, that is, the interaction of the
person and the environment”
(as cited in Alligood & Tomey, 2010, pg. 342)
141
http://1010report.com/?p=27
 Four Adaptive Modes
o Physiological
o Self-Concept
o Role Function
o Interdependence
 Stimuli
o Focal
o Contextual
o Residual
http://www.infahealth.com/basic-nursing-science/callista-roy-
adaptation-model-of-nursing/
142
 Physiological-Physical Mode
o Oxygenation
o Nutrition
o Elimination
o Activity and Rest
o Protection
143
Self-Concept Mode
* Physical Self * Personal Self
Body sensation Self-consistency
Body image Self-ideal
Moral-Ethical-Spiritual
144
Role Function
(McEwen & Wills, 2011, pg. 172)
145
Interdependence
~ RELATIONSHIPS ~
146
 Types of Stimuli
– Focal
Residual
– Contextual Stimuli
Contextual
– Residual stimuli
Focal
stimuli
Contextual
Residual stimuli
Stimuli
Residual
Stimuli
147
Application to Health
“a state and a process of being and becoming

integrated and a whole person. It is a reflection
of adaptation, that is, the interaction of the
person and the environment”
(as cited in Alligood & Tomey, 2010, pg. 342)
148
http://1010report.com/?p=27
MANUSIA
• Kesatuan sbg sistem yg sll berinteraksi & beradaptasi
scr konstan dg lingk.
INPUT PROSES OUTPUT

Stimulus Regulator adaptif /
- fokal tingkat adaptasi maladaptif
- kontekstual Cognator
- residual
LINGKUNGAN
• Kondisi, keadaan & pengaruh sekitar yg
mempengaruhi perkembangan & perilaku
individu dlm kelompok
• Berperan sbg input

SEHAT-SAKIT
• Kemampuan individu beradaptasi terhadap
kebutuhan faal, perkembangan konsep diri
positif, peran sosial & balans mandiri-
ketergantungan
KEPERAWATAN
• Suatu disiplin ilmu dan praktik kep.
Menggunakan ilmu untuk memberi layanan
keperawatan pada klien :
a.Tujuan keperawatan ; meningkatkan
interaksi individu terhadap lingk. Hingga
meningkatkan kemampuan adaptasi
b.Aktifitas keperawatan ; menggunakan
proses keperawatan
Application to Nursing Practice
Nursing Process
1. Assess Behavior
2. Assess Stimuli
3. Nursing Diagnosis
http://www.glogster.com/glog.php?glog
4. Goal Setting
Interventions
_id=1420666&scale=54&isprofile=true
5.
6. Evaluation
http://www.ageia.net/p/home_health_care/
http://www. home_Care_resources/bend-or-97702/at-
tobacco-facts.net home-care-group-2737
153
ANALISA SINGKAT
• Kelebihan
- manusia dipandang sbg sistem yg holistik
- teori dpt diaplikasi u/ homeostasis selama
rentang sehat-sakit
- koping sbg mekanisme terbaik dlm
beradaptasi dg lingk.
- aktifitas kep. Diarahkan u/ peningkatan adaptasi
lebih positif
- perkembangan & perilaku indv. Dipengaruhi lingk.
ANALISA 2
• Keterbatasan
- kemampuan adaptasi tiap indv. Unik
- stimuli residual sulit u/ dinilai
- koping tiap individu tdk sll mengarah pd
kemampuan adaptasi yg adaptif
- perawatan kesehatan diri tdk hanya berdasarkan
faktor kemampuan adaptasi diri
KESIMPULAN
1. Teori Roy dpt diaplikasi pd tatanan praktek
keperawatan krn dpt menjelaskan pelbagai hub.
Stimulus dan respons manusia dg lingk. Scr konstan
2. Tiap perubahan membutuhkan energi u/
beradaptasi dg baik
3. Keperawatan diperlukan u/ mengurangi perilaku
maladaptif & meningkatkan perilaku adaptif pada
klien
By
Maridi M. Dirdjo
Faye G. Abdellah
Background
 Born -March 1919
 Nursing Diploma from Fitkin Memorial Hospital
Columbia University
 Bachelors Degree in Nursing 1945
 Masters Degree in Physiology 1947
 Doctorate in Education 1955
Accomplishments (McEwen, 2007)
Dr. Faye Glenn Abdellah
U.S. Public Health Service RN, Ed.D., Sc.D., FAAN
 Chief Nurse Officer RADM(Ret.), USPHS
 Deputy U.S. Surgeon General

Uniformed Services University of Health Sciences
 Founder and First Dean, Graduate School of Nursing
Yale University School of Nursing
 Nursing Instructor
Research (Lessing, 2004)
 Assisted in international nursing research studies during the Korean War (China, Japan, Australia, Russia)
 Abdellah’s research findings led to the first federally-tested coronary care unit in Connecticut
 Theory and research data led to the establishment of the Office of Long-Term Care
Faye Glenn Abdellah’s
Patient-Centered Approaches to Nursing
Faye Glenn Abdellah, pioneer nursing researcher, helped
transform nursing theory, nursing care and nursing education .
In 1960, She was influenced by the desire to promote client-

centered comprehensive nursing care, Abdellah described
nursing as a service to individuals, to families, and, therefore
to, to society.
Former Chief Nurse Officer for the US Public

Health Service , Department of Health and human services,
Washington, D.C.
Dr Abdellah worked as Deputy Surgeon General .
Grand theory based on Human Needs.

Faye G. Abdellah’s Theory
Abdellah’s model describes concerns of nursing rather
1960
than a theory describing relationships among
phenomena. Her theory provides a foundation for
determining and organizing nursing care (McEwen,
 “Nursing is based on an art and science that mold the attitudes, intellectual
competencies, and technical skills of the individual nurse into the desire and ability to
help people, sick or well, cope with their health needs” (Nursing Theories, 2010)
 Originated from nursing practice & desire to promote patient-centered

comprehensive care
 Shifts focus of the profession from disease centered to patient centered
 Concepts of health, nursing problems, and problem solving are interrelated
 Describes nursing as a service to society
(McEwen & Wills, 2007)

Patient-Centered A Human Needs Theory
Approaches to Nursing Human beings have universal and
is…….. objective needs for health and autonomy
and a right to their optimal satisfaction.
Focus
 Nursing Education
 Nursing Practice
Purpose
To guide patient care in the hospital and
community settings
(McEwen, 2007)
“What is patient-centered care?”

http://www.youtube.com/watch?v=C4Ijr4E2870
Abdellah’s Typology of Nursing Problems
(Nursing Theories, 2010)
 Purpose
To provide a method to evaluate a student’s experiences and means of
evaluating a nurse’s competency based on outcome measures
 Three Areas
1. Physical, sociological, and emotional needs of the patient
2. Types of interpersonal relationships between the nurse and the
patient
3. The common elements of patient care
Patient-Centered Approaches to
Nursing
 Patient-centered approach to nursing was developed by Faye G.
Abdellah. Developed inductively from her practice and is
considered a human needs theory.
 This theory was created to assist with nursing education, and is

most applicable to the education of nurses.
 The intension was to guide care of patients in the hospital, it also

has relevance for nursing care in community settings.
 According to Faye, nursing is based on an art and science that

mould the attitudes, intellectual competencies, and technical
skills of the individual nurse into the desire and ability to help
people , sick or well, cope with their health needs
Abdellah’s Theory and Nursing Influence
Physiologic
Psychological
PATIENT Sociologic
Physiologic
 Hygiene and Comfort2

 Activity, Exercise, and Sleep2
 Safety (Accidents vs. Infections)2
 Body Mechanics2
 Nutrition2
 Fluid and Electrolyte Maintenance2
 Disease Process2
 Maintaining or Improving Sensory Function2
 Oxygenation2
 Elimination2
(Faye Glenn Abdellah- Twenty-One Nursing Problems-Cardinal Stritch university Library)
Psychological
 Effective verbal and nonverbal communication2

 Helping the patient accept self during and after
disease2
 Continued motivation to accomplish goals2
 Acknowledging and identifying the patient’s
emotions2
(Faye Glenn Abdellah- Twenty-One Nursing Problems-Cardinal Stritch university
Library)
Sociological
 Therapeutic Relationships2
 Spirituality/ Religious Beliefs2
 Supportive Environment2
 Community Resources2
 “Being aware of domestic concerns and how they
may potentially affect care or treatment of the
patient”
Nursing skills to be used in developing a
treatment:
 Which includes the:

1. observation of health status,
2. skills of communication,
3. application of knowledge,
4. teaching of patients and families,
5. use of resource materials,
6. use of personnel resources,
7. problem-solving
Nursing Responsibilities
Effective communication between patient and caregiver.

Information is accurate, timely and appropriate.
Do everything possible to alleviate patients’ pain and make
them feel comfortable.
We provide emotional support and alleviate fears and
anxiety.
We involve family and friends in every phase of our patients’
care.
We ensure a smooth transition and continuity from one
focus of care to another.
We guarantee every member of our community has access to
our care.
Nursing
 Abdellah and her colleagues developed a list of 21 nursing
problems.
 The 21 problems are actually a model describing the

"arenas" or concerns of nursing, rather than a theory
describing relationships among phenomena.
 In this way, the theory distinguished the practice of

nursing, with a focus on the 21 nursing problems, from the
practice of medicine, with a focus on disease and cure.
 The theory also help to identify nursing responsibilities.

Abdellah’s Typology of Nursing Problems
1. To promote good hygiene and physical comfort
2. To promote optimal activity, exercise, rest, and sleep
3. To promote safety through prevention of accidents, injury, or other trauma and through the
prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformities
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition of all body cells Purpose
7. To facilitate the maintenance of elimination To guide care and
8. To facilitate the maintenance of fluid and electrolyte balance
promote use of
9. To recognize the physiologic responses of the body to disease conditions
nursing judgment
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept the interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental
needs
19. To accept the optimum possible goals in light of physical and emotional limitations
20. To use community resources as an aid in resolving problems arising from illness
21. To understand the role of social problems(McEwen
as influencing
& Willis,factors
2007) in the cause of illness
Nursing
 They also identified 10 ways to identify the client’s
problems: Which will help the nurses to learn to
know the patient, Identify a therapeutic plan, discuss
and develop a comprehensive nursing care plan.
10 Ways to Identify a Client’s Problem
 Learn to know the patient  Continue to observe and evaluate
the patient over time to identify
any attitudes and clues affecting
 Sort out relevant and significant data
his behavior
 Analyze and make generalizations

 Explore the patient’s and family’s
about available data
reaction to the therapeutic plan
and involve them in the plan
 Identify the therapeutic plan
 Identify how the nurse feels about
 Test generalizations with the patient the patient’s nursing problems
and make additional generalizations
 Discuss and develop a
 Validate the patient’s conclusion about comprehensive nursing care plan
his nursing problems
(McEwen & Wills, 2007)

“Nursing is the use of problem solving approach with key
nursing problems related to health needs of people”
(Abdellah et al., 1960)
Requirements of Care 21 Nursing Problems
Classified in 4 Levels Sorted into 4 groups

1. Sustenal Care 1. Problems r/t comfort, hygiene
2. Remedial Care
and safety
2. Physiologic Balance
3. Restorative Care
3. Psychological and Social Factors
4. Preventative Care
4. Sociologic and Community
Factors
Nursing Diagnosis
(Nursing Theory, 2010)
Rehabilitation Nursing
 Focused on returning patient’s to their optimal level of
functioning physically, emotionally, and cognitively
 Areas include: Neuro, Spinal Cord Injury, TBI, Orthopedic,
Pain Management, and several progressive disease
processes
 Inpatient environment offers physical therapy ,
occupational therapy, speech therapy, and nursing care
Image retrieved from Lexington Place Nursing at:

http://www.lexingtonplacenursing.net/
Nursing
Application to nursing
 Abdellah’s theory state’s that nursing is the use of the
problem solving approach with key nursing problems
related to health needs of people.
 Health is a dynamic pattern of functioning whereby there is

a continued interaction with internal and external forces
that results in the optimum use of necessary resources that
serve to minimize vulnerabilities.
 Such a statement maintains problem solving as the vehicle

for the nursing problems as the client is moved toward
health – the outcome.
Application of Theory related to
Rehabilitation Nursing
 Physiological- PAIN, HYGIENE, SAFETY,
ELIMINATION, HEALING1
 Psychological-TRAUMA, EMOTIONS, COGNITIVE

FUNCTION1
 Sociological- Environmental Factors, Family

Dynamics1
Applying Abdellah’s Theory to
Current Nursing Practice
Marie:
 I find that parts of the theory fit my  Abdellah’s “Ten Ways of Identifying a Client’s
physician office work well as it states that Problem” is utilized in the clinical setting and
it “aims to help people, sick or well, cope are necessary in initiating and implementing
with their health needs” (Nursing Theories, the nursing care plan.
2010) and that is the goal of primary care
in physician offices.
 The 21 nursing problems are relevant to the  Nursing programs encourage nursing students
office setting just as they are to the to utilize patient- centered approaches in the
hospital. clinical setting
Keesha
 In the critical care setting, my current  Problem solving approach is utilized by
practice has shifted from nursing care practitioners in guiding treatment plans within
exclusive to the disease to addressing the their practice. Especially within practices that
patient’s immediate health care needs. deals with clients who have specific health care
Abdellah’s Theory equips me with specific needs and specific nursing problems
guidelines as to how I can better manage a (Nursing Theories, 2010)
variety of patient conditions in the ICU.
How the 21 Problems Theory Influences Future uses in Practice
and Potential Limitations of these Concepts:
 Future Uses in Practice: Framework relates to all fields and
specialties of nursing, this was a theory based off of
research so further innovations in research could help
clarify or breakdown topics into specialty practice
standards. For ex: how can hygiene and activity better be
applied to a newborn rather than remaining generalized.
 Potential Limitations include: research funding, standards

of care, healthcare laws and regulations, and the later
effects of a nursing shortage can affect the number of
nursing educators and researchers in the future.
2000
Inducted into the
National Women’s
Hall of Fame
(www.greatwomen.org)
“We cannot wait for

the world to change..........
Those of us with intelligence, purpose, and vision must take the lead and change
the world. Let us move forward together!......I promise never to rest until my work
has been completed!” – Faye G. Abdellah
(www.encyclopedia.com)
Conclusion
 The 21 Problems theorized by Faye Abdellah directly
relate to nursing care in all specialties. It focuses on
patient care overall and can be utilized in nursing to
provide an outline that encompasses all aspects of
psychological , physiological, and sociological needs.
The theory also ensures that the nurse taking care of
the patient practices competent care and makes
precise nursing judgements.
References
 Lehigh Valley Health Network: A passion for better Medicine ;The Patient-Centered Approach to Care. (2009).
Retrieved September 21st 2009, from http://www.lvhn.org/nurses%7C631.
 Current Nursing: A portals for Nursing Professionals; Nursing Theories: A companion to nursing theories and
models(2009). Retrieved September 21st 2009, from
http://currentnursing.com/nursing_theory/Abdellah.htm
 HighBeam Research: Palliative Care, Oncology Nursing Forum; A Patient-Centered Approach(2008).

 Retrieved September 21st 2009, from http://www.highbeam.com/doc/1G1-181236355.html
 NCBI: A service of the U.S National Library of Medicine and the National Institutes of Health; (1999). Diabetes care
from diagnosis, effects of training in patient-centered care on beliefs, attitudes and behavior of primary
care professionals. Retrieved September 21st 2009, from
http://www.ncbi.nlm.nih.gov/pubmed/10640121?ordinalpos=9&itool=EntrezSystem2.PEn
.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
 McEwen, M. & Wills, E.M. (2006). Theoretical Basis for Nursing: Patient-Centered Approaches to Nursing (2nd Ed).
Philadelphia: Lippincott Williams &Wilkins.

References
 1Faye Glenn Abdellah- National Womens Hall of Fame . (n.d.). Retrieved October 1st, 2013,
from National Women's Hall of Fame: http://www.greatwomen.org/women-of-the-
hall/search-the-hall/details/2/1- Abdellah
 2Faye Glenn Abdellah- Twenty-One Nursing Problems-Cardinal Stritch university Library.
(n.d.). Retrieved October 1st, 2013, from Cardinal Stritch University Library:
http://www.stritch.edu/Library/Doing-Research/Research-by- Subject/Health-Sciences-
Nursing-Theorists/Faye-Glenn-Abdellah---Twenty-One- Nursing-Problems/
 3Lexington Place Nursing and Rehabilitation Community Giving Care Celebrating Life. (n.d.).
Retrieved October 1st, 2013, from Lexington Place Giving Care Celebrating Life:
http://www.lexingtonplacenursing.net/
 4Nursing Theories: Changing the World… One Step at a Time(Faye G. Abdellah). (2009,
July 18th). Retrieved October 1st, 2013, from Nursing Theories:
http://nursingtheories.blogspot.com/2009/07/changing-world-one-step-at-time-
faye-g.html
 5RADM Faye Glenn Abdellah,(Ret.),USPHS,EdD,ScD, RN, FAAN, 2012 Inductee. (n.d.).
Retrieved October 1st, 2013, from American Nurses Association Nursing World :
http://www.nursingworld.org/fayeglennabdellah
INTERPERSONAL
RELATIONS
THEORY
HILDEGARD PEPLAU
 Born on September 1, 1909 @ Reading,
Pennsylvania
 1931- Graduated from Pottstown,
Pennsylvania Hospital School of Nursing
 Worked as an Operating Room
Supervisor@ Pottstown Hospital
 1943- received Bachelor of Arts in
Interpersonal Psychology- Bennington
College, Vermont
HILDEGARD PEPLAU
 1947- Received a Master of Arts in
Psychiatric Nursing- Teacher’s
College, Columbia, New York
 1953- received a Doctor of
Education in Curriculum Development
@ Columbia
 Became a member of the Army Nurse
Corps & worked in a neuropsychiatric
hospital in London, UK- WORLD WAR
II
HILDEGARD PEPLAU
Worked with psychiatrists
Freida Fromm-Riechman and
Harry Stack Sullivan.
March 7, 1999- she died @
her home in Sherman Oaks,
California @ the age of 89.
MAJOR INFLUENCES
- She had her first exposure on
INTERPERSONAL THEORY @
Bennington
- She attended lectures on

INTERPERSONAL RELATIONS by
Harold Stack Sullivan
- She was influenced by the Sullivanian

theory (psychoanalysis) and she aimed
to bring this to the patients.
Interpersonal Relations in Nursing
Theory
 Stresses the importance of nurses’ ability to
understand their own behaviors to help others identify
perceived difficulties.
 Emphasizes the focus on the interpersonal processes
and therapeutic relationship that develops between
the nurse and client.
 Four phases of the nurse-patient relationship are
identified
 Six primary roles of the nurse
 Six secondary roles of the nurse
Theory focuses on interpersonal
communication:
First model to suggest that…
 Nurse and patient act as PARTNERS to initiate change
rather than patient passively receiving treatment and
nurse simply acting on orders from physician.
Effective communication causes
nurse to take on numerous roles:
Primary Secondary
Stranger Technical expert
Teacher Mediator
Resource person Safety agent
Counselor Researcher
Surrogate Tutor
Leader Manager of environment
Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of
Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic
OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 137
Continuum showing changing nurse-
patient relationships:
Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.
Four phases of nurse-patient
relationship:
 Orientation
 Identification
 Exploitation (or working)
 Termination
4 Phases of nurse-patient
relationship
 Orientation-client seeking
assistance, meeting of nurse-
patient, identifying the
problem and services needed
( interview process), and
guidance.
 Identification- identifying
who is best to support needs,
patient addresses personal
feelings about the experience
and is encouraged to
participate in care to promote
personal acceptance and
satisfaction.
Phases cont.
Exploitation- patient attempts to explore, understand
and deal with the problem, and gains independence
on achieving the goal
 Resolution- termination of the therapeutic
relationship to encourage emotional balance for nurse
and patient ( difficult for both patient and nurse as
psychological dependence persists)
Application of Interpersonal Theory
in Nursing Practice
 An article in Current Nursing evaluated using the
theory in nursing practice
 Assessment= Orientation phase
 Nursing diagnosis
 Planning=Identification phase
 Implementing=Exploitation phase
 Evaluation=Resolution phase
(the theory allowed client’s needs to be assessed.
Application of the theory helped provide
comprehensive care to the client)
Phases and changing roles in nurse-
patient relationship:
Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.
MAJOR CONCEPTS:
1. PERSON: man is an organism that lives
in an unstable balance of a given system
2. HEALTH: movement of the personality

& other ongoing human processes that
directs the person towards creative,
constructive. Productive and community
living.- needs must also be met
(physiologic demands & interpersonal
process)
3. ENV’T: forces outside the
organism & in the context of the
socially- approved way of living-
social processes (norms. Customs,
beliefs)
4. NURSING: significant,
therapeutic interpersonal process
KEY AND SUB-CONCEPTS
A.PSYCHODYNAMIC
NURSING:
- Being able to understand
one’s own behavior to help
others identify felt
difficulties & to apply
principles of human relations
to the problem
B. NURSE- PATIENT
RELATIONSHIP
* PHASES *
1. ORIENTATION- Initial interaction
between the nurse and the patient
wherein the latter has a felt need
and expresses the desire for
professional help.
2. IDENTIFICATION- patient and
nurse explore the experience &
the needs of the patient- leads to
relatedness
3. EXPLOITATION- patient
derives the full value of the
relationship as he moves on from
dependent role- independent one.
4. RESOLUTION- patient earns

independence over his care.
C. NURSING ROLES
Nurse assumes several roles
w/c are used in empowering in
meeting the needs of the
patient.
1. ROLE OF THE STRANGER
Nurse must treat the patient
with outmost courtesy-
accepts the patient and
respects the patient’s
individuality
2. ROLE OF THE RESOURCE
PERSON
 (Patient is in dependent role)- nurse
provides answers to pt’s queries-
providing health information,
advices, and simple explanation of
the course of care.
 either straight forward answers or
providing counseling
3. TEACHING ROLE
Gives importance to self-
care
Helping patient understand
the teaching plan
 develop discussions around
the interest of the patient
4. LEADERSHIP ROLE
Acts in behalf of the patient
but also enables pt to make
decisions (achieved through
cooperation and active
participation)
5. SURROGATE ROLE
 Also known as temporary care giver
role- motherly role
6. COUNSELING ROLE
 It has the greatest importance and
emphasis in nursing
STRENGTHS OF THE THEORY
1. Useful in helping psychiatric pts
become receptive for therapy
2. This theory is based on reality and it

can be tested and observed using pure
observation
3. It is used in every aspect of the

nursing profession especially in dealing
with patients.
LIMITATION OF THE THEORY
1. The use of this model/ theory
is limited or impossible in
working with senile, comatose
or newborn patients.
2. Can only be used wherein a
communication occurs between
the nurse and the patient.
APPLICATION TO NURSING
PRACTICE
 In psychiatric nursing, Peplau’s interpersonal
model is used in counselling women undergoing
depression. Because of the strengthened nurse-pt
relationship, women are able to describe patterns
that resulted to negative thinking & independently
found strategies to manage them.
 Provides clear design for the practice of

psychiatric nursing
 Emphasized the development of interpersonal

relationship between the patient and the nurse
APPLICATION TO NURSING
EDUCATION
 Peplau’s book, INTERPERSONAL
RELATIONS IN NURSING, is
being used as a manual to help
graduate nurses and nursing
students alike in creating a
significant nurse- patient
relationship.
 Formulated effective
psychotherapeutic methods.
APPLICATION TO RESEARCH
 Formulated concepts of
anxiety as a means to
constructively resolve angry
feelings through experiential
learning within the nurse-
patient relationship.
Lydia E. Hall
Care, Core, Cure Model of
Nursing
Presented by Maridi M. Dirdjo
Identification of Lydia E. Hall
• Born in New York City September 21, 1906

• Graduated from York Hospital School of Nursing in Pennsylvania
• Bachelor of Science & Master of Arts from Teacher’s College, Columbia
University
• Died February 27, 1969 of heart disease in Queens Hospital of New York
Hall’s Background
• She spent her early years as a registered nurse working for Metropolitan
Life Insurance Company where the main focus was on preventive health.
• Worked for New York Heart Association as a staff nurse.
• Advocate of community involvement in public health issues.
• Professor at Teacher’s College at Columbia University.
• Research analyst in the field of cardiovascular disease (Alligood & Tomey
2010).
Introduction:
 Lydia Eloise Hall-The Care, Core and Cure Nursing Theory.

 Theory also referred as “The Three Interlocking Circles Theory”
Rationale: Related a portion of Hall’s theory to everyday clinical practice.

Hall’s dedication is to achieve interpersonal relationship with the patient
and then facilitate healing. Involvement of the patient in decisions
regarding health care, utilizing self-efficacy, is still currently utilized
frequently.
217
Interest & Research Focus
• Research in the field of rehabilitation of chronically ill patient’s brought her

to develop the Care, Cure, Core Theory.
• Interested in rehabilitative nursing and the role that the professional nurse
played and the patient’s recovery and welfare (Alligood & Tomey 2010).
• She became the founder and first director of the Loeb Center for Nursing
and Rehabilitation at the Montefiore Medical Center in Bronx, New York
Overview:
Lydia Eloise Hall: Nurse theorist of the Care, Core

and Cure model-developed in 1960’s.
220
Overview:
• The three circles are independent yet

interconnected.
• Nurse is presented as the primary role
in all aspects of the circle-nurse only.
• Purpose is to achieve an interpersonal
relationship with the patient.
221
Overview:
• Complex process of teaching and

learning.
• Focused on maintaining optimal health

and quality of life for the patient/family.
• Focused on personalized nursing care

rather than merely “routine care”.
222
Care: consisting of the role of
the nurse; “motherly/ nurturing”
to the patient.
CARE
223
The Care Circle
• Explains the role of nurses and focused on performing that noble task of the
nurturing patients.
• Component of this model is the “motherly care” provided by the nurses
(George, J.B 2000).
• Which may include:
• Comfort measures
• Patient instructions
• Helping patients meet their needs where help is needed.
Major purpose of care is to achieve an interpersonal relationship with the individual that
will facilitate the development of the core ( Texas Woman’s University).
“Everyone in the healthcare
profession either neglects or takes
into consideration any or all of
these, but each profession, to be a
profession, must have an exclusive
area of expertise with which it
practices, creates new practices,
new theories, and introduces
newcomers to its practice (Hall,
1968).
225
Overview:
Core: involves the patient and application of
therapy and use of self-reflection.
CORE
226
The Core Circle
• The person or patient to whom nursing care is directed and needed.

• Core involves the therapeutic use of self, and empathizes the use of
reflections (Texas Woman’s University).
• The core has goals set by himself and not by any other person.
• Behaves according to his or hers feelings and values (George, J. B 200).
Cure: 1st aspect; shared with medicine
(assisting the physicians), 2nd aspect;
nurse assisting the patient through healing
process.
CURE
228
Overview:
Promoted the involvement of the community

for all healthcare issues; intertwining many
aspects of the healthcare field/process.
229
Overview:
 Community recognizes nurses as experts in

the body and the know how to modify care
depending upon patient involvement,
pathology of illness, treatment of illness,
and the unique needs of the patient/families.
230
Overview:
Many healthcare professionals

rely on each other and share in
the patient outcome; core and
cure of her theory are the shared
components corresponding
disciplines
231
The Cure Circle
• Focus on nursing related to the physician’s orders.

• Attention given to patients by medical professionals.
• Shared by the nurse with other health professionals, such as physicians or
physical therapist.
• Interventions or actions geared toward treating the patient for whatever
illness or disease he or she is suffering from (George, J.B 200).
How do nurses relate?
• Hall proposed many ideas of professional practice, such as the nursing

process.
• Improvement of nurses to meet the needs of the patient with better
professional nursing care.
• Management of nursing care.
• Establishment of nurse patient relationship.
• Collaboration with other health professionals.
• Deliverance of care to ill patients.
Limitations to care
• Individuals must pass an acute stage of illness for you to successfully apply
her theory.
• Therefor theory relates to only those who are ill.
• No nursing contact with healthy individuals, families or communities and it
negates the concept of health maintenance and prevention (Gonzalo 2011).
• Lacks application to pediatric care.
Conclusion
• Hall believed patients should only receive care from professional nurses.
• Hall defined her philosophy on the basis of the patient.
• Hall believed that patients come to the hospital in biological crisis (acute
episode of a disease) and that medicine does a great job at treating this
crisis, but fails to treat the chronic underlying disease. This is where she felt
nursing could make a significant difference.
• Hall felt that taking over this sub-acute phase was the way for nursing to
legitimize itself into a true profession.
References
• Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh
edition (No ed.). Maryland Heights: Mosby-Elsevier.
• George, J.B.; Nursing Theories: The Base for Professional Nursing Practice;
2000.
• Gonzalo, (2011). Theoretical foundations of nursing. Nursing
theories.weebly.com/lydia-e-hall.html
• Texas Woman’s University. Nursing Theorist.
Patricia Benner
R.N., Ph.D., F.A.A.N., F.R.C.N.
NURSING THEORIST
FROM NOVICE TO EXPERT
Patricia Benner
(photo by Robert Foothorap)
Patricia Benner
R.N., Ph.D., F.A.A.N, F.R.C.N.
• Current Professor Emerita at

the University of California, San
Francisco
• Has taught and been involved in
research since 1979.
• Well published in journals and
books.
• Named one of the American
Academy of Nursing’s “Living
Legends” in August, 2011.
• Introduced her “Novice to
Expert” theory in 1982.
• Many publications refer to her
Patricia Benner nursing practice model.
http://www.bing.com/images/search?q=Nursing+Symbols
&FORM=RESTAB#
Purpose
• Basic overview of nursing theory
• Explanation of Patricia Benner’s work “From Novice to

Expert” model
• Relation of Benner’s work to current practices
Photo courtesy http://www.123rf.com/search.php?word=abstract_nursing&start=0&searchopts=&itemsperpage=60

What is nursing theory?
• “A nursing theory is a set of concepts, definitions,

relationships, and assumptions or propositions derived
from nursing models or from other disciplines and
project a purposive, systematic view of phenomena by
designing specific inter-relationships among concepts for
the purposes of describing, explaining, predicting,
and/or prescribing.”
• Many nursing theories incorporate the four paradigms:

nursing, person, health and environment

Why is theory important?
• When nursing practice is built on sound theories, the

profession is strengthened
• Using theory in nursing helps us to:

• Think critically
• Analyze information and make clinical judgments
• Assist in decision making
• Support excellence in practice
• Assist novices in becoming experts therefore improving patient care
(Black, 2011)
Photo courtesy http://blogs.hpedsb.on.ca/hjc/1213nevan/
From Novice to Expert Nursing Model
“Patricia Benner developed a concept known as “From Novice

to Expert”. This concept explains that nurses develop skills
and an understanding of patient care over time from a
combination of a strong educational foundation and personal
experiences.” Benner’s theory identifies five levels of nursing
experience: novice, advanced beginner, competent,
proficient, and expert.

Benner’s Motivation for Novice to Expert
• Nursing practice has been studied primarily from a

sociological perspective as opposed to the study of nursing
practice itself
• Nursing knowledge is accrued over time; it is embedded in

expertise. Thoughts are based on the Dreyfus model.
• Knowledge has gone uncharted and unstudied because

differences between practical and theoretical knowledge have
been misunderstood
• Well charted nursing practice and observation are essential

for theory development
(Benner, 2001, p. 1)
Benner’s Philosophy
• Benner “proposed that a nurse could gain knowledge and

skills without actually learning a theory” Described as
“knowing how” without “knowing that”
• Development of knowledge in nursing is “a combination of

knowledge through research and understanding through
clinical experience”
Photo: http://www.canstockphoto.com/nurse-word-cloud-concept-11506014.html
Benner’s influences
• Virginia Henderson
• Benner has acknowledged that her “thinking has been
influenced greatly by Virginia Henderson.”
• Dreyfus model of Skill acquisition
• Developed in 1980
• Describes five levels of skill acquisition and development
• Model showed advancement through the stages by changes in

performance
• Developed by studying chess players and pilots
• Benner adapted the Dreyfus model for clinical nursing

practice, basis for her work: Novice to Expert.
(Tomey & Alligood, 2006)
Dreyfus Model of Skill Acquisition
Skill Level
Mental Novice Competent Proficient Expert Master

function
Recollection Non- situational Situational Situational Situational
situational
Recognition decomposed decomposed Holistic Holistic Holistic
Decision analytical analytical Intuitive Intuitive Intuitive
awareness monitoring monitoring monitoring Monitoring absorbed
Table 1: The model in 1980 shows how skill acquisition changes for the given
mental functions throughout advancement in the given skill levels. (Dreyfus
& Dreyfus, 1980)
Dreyfus vs. Benner
Dreyfus model including the 5 levels as Benner’s Stages of Nursing

of 1986 (moleseyhill.com) Proficiency (nursinginformatics.ca)
Novice to Expert
Benner’s stages of Nursing Proficiency
• Novice
• Advanced Beginner
• Competent
• Proficient
• Expert
Photo courtesy http://nursetopia.net/2011/06/29/star-wars-flavor-to-dr-patricia-benners-novice-to-expert/
The Novice
• Begins with no prior experience
• Taught rules to perform tasks
• Rule governed behavior is limited and inflexible
• Being a novice is not exclusive to students- any nurse

entering a setting without prior experience with that
particular patient population may be limited to the novice
level
Photo: http://shop.atozteacherstuff.com/downloads/daily-
5-self-evaluation-novice-apprentice-practitioner- (Benner, 2001, pp. 20-21)
expert.html
The Advanced Beginner
• Can demonstrate marginally acceptable performance
• Has gained prior experience in actual nursing situations
• Formulation of guidelines or principles from prior

experiences provide guidance in future experiences
Photo courtesy http://youthvoices.net/discussion/nursing (Benner, 2001, pp. 22-23)

The Competent Nurse
• Has been on the job in similar situations for 2-3 years
• Aware of long term goals-- gain perspective from planning

their own actions
• Become more efficient and organized
Photo courtesy http://libguides.gvltec.edu/nursing (Nursing Theory, 2011)

The Proficient Nurse
• Perceives and understands situations as whole parts
• Views patients holistically
• Has learned what to expect in certain situations and

how to modify plans as needed

The Expert Nurse
• No longer relies on principles, rules or guidelines to

connect situations and determine actions
• Performances are fluid, flexible, and highly proficient
• Expertise comes naturally
(Black 2011, p. 137)

http://www.abstractbrokers.com/Buyers/IndustryLinks/tabid/62/Default.aspx
Benner’s Explanation of the Four Paradigms
• Nursing
• Person
• Health
• Environment
Photo courtesy http://www.emporia.edu/nursing/nursing-mission.html

Nursing
Benner viewed nursing as the care and study of the

lived experience and the relationship of these three
elements:
• Health
• Illness
• Disease
Photo courtesy http://cnx.org/content/m13589/latest/

Person
“…the person does not come into the world predefined

but gets defined in the course of living a life”
Benner believed that there are significant aspects that
make the being. She conceptualized these as the roles
of:
• the situation
• the body
• personal concerns
• temporality
Photo courtesy http://www.bing.com/images/search?q=nurse+images&qs=HS&form=QBIR&pq=&sc=8-
0&sp=2&sk=HS1#view=detail&id=8B0FC4FBC4E9A78296B556430D55638F7399DF6D&selectedIndex=832

Health
Benner focused “on the lived experience of being

healthy and being ill”
• Health can be assessed
• Well-being is the human experience of health or wholeness
• Illness is the human experience of loss or dysfunction
(Tomey & Alligood, 2006, p. 151)

Photo courtesy http://learningfundamentals.com.au/resources/
Environment
Benner uses the term situation rather than environment.

“Personal interpretation of the situation is bounded by the
way the individual is in it.”
A person’s past, present, and future influences their current

situation
Photo courtesy http://www.howtolearn.com/2012/01/what- http://bizchicks.org/2011/02/the-emotion-health-connection/

did-we-learn-about-health-and-happiness-in-2011
(Tomey & Alligood, 2006, p. 151)
Relationship of Paradigms to Benner’s Model
The culmination of the four paradigms of nursing

create experiences that nurses utilize to advance
through the stages of Benner’s model From Novice to
Expert
Photo courtesy Photo courtesy

http://www.pearsoned.co.uk/Book http://www.clker.com/clipart-
shop/detail.asp?item=229360 nurse-icon.html
Using Benner’s Model in Practice
Examples of use in practice:
• Preceptorship
• Orientation processes
• Nursing educational programs
• Professional advancement ladders http://www.galaxyhealth.net/
• Interdepartmental job changes (e.g. medical-surgical nurse

transitioning to an intensive care unit)
Benner in Action
American Association of Critical-Care Nurses (AACN)

Synergy Model
• Developed as a basis for nursing
practice
• Development utilized use of Benner’s
Novice to Expert stages of
development
• Combines nursing competencies with
characteristics of patients to “enhance
optimal patient outcomes” (Kaplow,
2002)
• Patient outcomes will be different at
the different levels of the nurse’s
expertise.
(photo courtesy AACN.org)

Benner in Action
Clinical Ladder Programs
• Most are based on

stages of clinical
competence of Benner’s
(Murphy, 2012)
• Intention of the ladder

is to retain experienced
nurses
• Greater rewards at the

expert levels than the
novice level
Conclusion
This model can be applied to all areas of nursing. It looks at

the education and development of a nurse and how they
become an expert.
Patricia Benner examined how nurses learn to nurse

(Nursingtimes.net, 2010)
Photo courtesy http://depositphotos.com/9744222/stock-illustration-Nursing-home-logo.html Photo courtesy http://nursesaidetraining.blog.com/

References
American Association of Critical-Care Nurses (2013). Retrieved from www.aacn.org
Benner, P., (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative
edition). New Jersey: Prentice Hall Health.
Black, B.P. (2011). Becoming a nurse: Defining nursing and socialization into professional practice. In K.K. Chitty
& B.P. Black (Eds.), Professional nursing: Concepts and challenges (6th ed. pp. 126-145). Maryland Heights,
MO: Saunders Elsevier.
Dreyfus, S. E., & Dreyfus, H. L. (1980). A five-stage model of the mental activities involved in directed skill
acquisition (Operations Research Center Rep. No. ORC-80-2).
Kaplow, R. (2002). The synergy model in practice applying the synergy model to nursing education. Critical Care
Nurse, 22(3), 77-81.

References
Murphy, D. (2012, September/October). Novice to expert: clinical ladder programs as a recruitment and retention
tool. Ohio Nurses Review., 16-17. Retrieved from www.ohnurses.org
Nursingtimes.net [website]. (2010, March). Nursing Times. Retrieved from http://www.nursingtimes.net/whats-
new-in-nursing/hall-of-fame/patricia-benner-us-nurse-theorist-and-author-of-from-novice-to-
expert/5012095.article
Nursing Theory. (2011). Patricia Benner: Biography of Patricia Benner. Retrieved from http://nursing-
theory.org/nursing-theorists/Patricia-Benner.php
Nursing Theories. (2013). Patricia Benner: Metaparadigm in nursing. Retrieved from
http://nursingtheories.info/patricia-benner-metaparadigm-in-nursing/
Nursing Theories: a companion to nursing theories and models website. (2012). Retrieved from
www.currentnursing.com/nursing_theory
Tomey, A., & Alligood, M. (2006). Nursing theorists and their work (6th ed.). St. Louis, MO: Mosby Elsevier.
Terima Kasih
Virginia Henderson, RN, MSN
Nursing Theorist
Maridi M. Dirdjo
INTERACTION NURSE-KLIEN
MODEL
VIRGINIA HENDERSON
1897-1996
HISTORY OF VIRGINIA HENDERSON
Virginia Henderson was born November 30, 1897, in Kansas City, Missouri. In 1901, she
and her family relocated to Virginia. Her first teaching position was at Teachers College,
Columbia University in 1934. In 1939, her revision of Bertha Harmer’s Textbook of the
Principles and Practice of Nursing was published. Virginia Henderson directed the
Nursing Index Studies Project from 1959-1971, which led to her publication of the four
volume Nursing Index Studies. Henderson was named research associate emeritus at
Yale at age 75. Virginia Henderson for 70 years made remarkable contributions to
nursing. She paid as an advocate for humane and holistic care for patients, promoter for
nursing research, and author to widely used nursing texts. Henderson died March 19,
1996.4
WHY DID SHE DEVELOP THIS THEORY?
 Two events influenced the development of her definition of nursing and her
theory. 2
1. Her participation in the revision of “The Textbook of the Principles and
Practice of Nursing” written by Bertha Harmer. Following this,
Henderson realized the need to be very clear about the role and
functions of the nurse.2
2. She grew concerned that many states had no provisions for nursing
licensure. She felt it was important to establish the idea of what truly
makes a nurse in order to ensure safe and competent care for patients.
She examined the earlier statements of nursing functions set forth by the
American Nurses Association and viewed these statements as non
specific, unclear, and unsatisfactory. 2
NEED THEORY
 Virginia Henderson’s goal was not to develop a theory in nursing, but a unique focus on the nursing
concept.2
 Need Theory suggests that nurses should be caring for the patient, but at the same time helping the patient
gain independence so that once they are discharged they are able to take care of themselves.2
 The four major concepts addressed in this theory are:
1. The Individual2
2. The Environment2
3. Health2
4. Nursing2
 This theory presents the patient as a sum of parts with biophysical needs rather than as a type of client or
consumer. 2
THERE ARE FOURTEEN COMPONENTS BASED ON HUMAN NEEDS
THAT MAKE UP NURSING ACTIVITIES. THESE COMPONENTS ARE:
 1.Breathe normally. 2
 2. Eat and drink adequately.2
 9.Avoid dangers in the environment and avoid injuring
 3.Eliminate body wastes.2 others.2
 4.Move and maintain desirable postures.2  10.Communicate with others in expressing emotions,
needs, fears, or opinions.2
 5.Sleep and rest.2
 11.Worship according to one's faith.2
 6.Select suitable clothing. That is, dress and undress
appropriately.2  12.Work in such a way that there is a sense of
accomplishment.2
 7.Maintain body temperature within normal range by
adjusting clothing and modifying the environment.2  13.Play or participate in various forms of recreation.2
 8.Keep the body clean and well groomed and protect  14.Learn, discover, or satisfy the curiosity that leads to
the integument.2 normal development and health and use the available
health facilities.2
HOW IT APPLIES…
 Henderson described the nurse's role as substitutive (doing for the person), supplementary (helping the
person), or complementary (working with the person), with the goal of helping the person become as
independent as possible. Henderson wanted to work to rehabilitate patients in order to make them more
independent for themselves.5
 Nurses need to stress promotion of health and prevention and cure of disease.5
 Each nurse would want the 14 concepts for themselves and should strive for their patients to heal in the
same environment.5
ACCOMPLISHMENTS
 Nursing Studies Index – First annotated index of nursing research.2

 Sigma Theta Tau International Library – Named in honor of Virginia Henderson.2
 The Virginia Henderson Award – Award created in her honor for outstanding contributions to nursing
research.2
 Received the first Christianne Reimann Prize for the transitional scope of her work. 2
 Received honorary doctorate degrees from several universities. 2
Background
• Well known author, theorist and nurse educator

• Born in Kansas City, Missouri on November 30,
1897; Died March 19, 1996
• 1937 – with others, created nursing curriculum
for the National League of Nursing
• “patient centered and organized around nursing
problems rather than medical diagnoses”
(Henderson, 1991, p.19)
Definition of Nursing
• Henderson is famous for a definition of

nursing: "The unique function of the nurse is
to assist the individual, sick or well, in the
performance of those activities contributing to
health or its recovery (or to peaceful death)
that he would perform unaided if he had the
necessary strength, will or knowledge" (Wills,
2007,p.139)
Model Konseptual dari Henderson
Interaksi Perawat-Klien
Tujuan: Makna
Perawat Kemandirian Pengetahuan Klien
Pemulihan Kemauan
mempertahankan atau Kekuatan
mati dalam damai
Lingkungan
Henderson’s 14 Activities for
Client Assistance(Henderson,1991,p.22-23)
• Breathe normally • Keep the body clean
• Eat and drink and well groomed
adequately • Avoid dangers in the
• Eliminate body waste environment
• Move and maintain • Express emotions, fears,
desirable posture needs and opinions
• Sleep and rest • Worship one’s faith
• Suitable clothes – dress • Work for client’s sense
and undress of accomplishment
• Maintain body • Participate in recreation
temperature • Learn, satisfy, discover
Concepts
• Metaparadigm
– Nursing, health, patient and environment
• Educated under a medical model transformed
into a nursing model
• Empirical vs. Esthetic Pattern of Knowing
• Art, Science and Teaching – cannot be divided
and examined separately
• “living and an appreciation for human life are
the sine qua non of the modem nurse”
(Halloran, 1996,p.20)
Nursing Theory
• Inuit means 'human beings' - phrase without
bias associated related to race, nationality or
sex (Halloran, 1996,p.18)
• Goal of nursing is to help people be free of
nursing care as soon as possible returning the
patient to a state of independence or the
baseline of autonomy at the onset of his/her
illness
Research
• Testability of the practice and outcomes of
nursing
• “Each of the 14 activities can be the basis for
research” (Wills, 2007, p.140)
• Interpretation: quantitative and qualitative
research has been beneficial in evaluating this
theory due to the combination of actions (14
activities) and the assumed devotion of the
nurse to his/her patients (affective evaluation)
Application to Practice
• Current practice – cardiac step down unit specializing
in heart failure
• Goal of nursing care is to return the patient to his/her
optimal self care ability via education on diet,
medications, daily weights and follow up appointments
to the physician
• Challenges – due to co morbidities associated with
heart failure, some patients may not have the desire or
capability to return to their pre-admission state,
therefore, the nurse must accept the patient’s
perspective and definition of “wellness”
Conclusion
• The 14 components that Henderson has adopted are ideas that all able bodied people should desire to have
for themselves.
• Basic human needs are self-explanatory and uncomplicated.
• Henderson’s practice and concepts of nursing match how she defines nursing.
• Henderson has proven to be an important part of how nursing care should be provided; a sort of team-like
approach and not just a nurse doing for a patient but assisting them into full rehabilitation.
• Care may be different today if her principles had not been adopted into current practice.
references
 1Clark, J. (1997). The unique function of the nurse. International Nursing Review, 44(5), 144-152.
http://eds.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=033cef4b-209f-4b7d-b308-
abd04c893cf7%40sessionmgr112&vid=7&hid=120
 2Nursing Theory. (2013). Virginia Henderson. Retrieved from: http://www.nursing-theory.org/theories-and-
models/henderson-need-theory.php
 3Virginia Henderson - Nursing Need Theory - Nurseslabs. (n.d.). Retrieved October 5, 2014, from
http://nurseslabs.com/virginia-hendersons-need-theory/
 4Virginia A. Henderson (1897-1996) 1996 Inductee. (n.d.). Retrieved September 29, 2014, from
http://www.nursingworld.org/VirginiaAHenderson.
 5Virginia Henderson's Need Theory. (n.d.). Retrieved October 1, 2014, from
http://currentnursing.com/nursing_theory/Henderson.html.
 6Virginia Henderson’s Nursing Need Theory. (2014, August 6). Retrieved October 3, 2014, from
http://nurseslabs.com/virginia-hendersons-need-theory/
 7Virginia Henderson. (1966, January 1). Retrieved October 5, 2014, from http://izquotes.com/quote/236610
References
Halloran, E.. Journal of Advanced Nursing. Virginia
henderson and her timeless writings.23.(1996,
p.17-24).
Henderson, V. A.The Nature of Nursing Reflections
after Twenty Five Years. New York. National
League for Press.
McEwen, M., Wills, E. Theoretical Basis for Nursing.
Wills, E. Grand nursing theories based on human
needs. Philadelphia. Lippincott Williams &
Wilkins.
Dorothea Orem’s Theory: SELF
CARE
MARIDI M. DIRDJO
DOROTHEA OREM’S THEORY OF
SELF CARE DEFICIT
Born in Baltimore, Maryland
in 1914
Orem’s parents
Father was a construction

worker
Mother was a homemaker

1930- graduated from 1935- BSN from Catholic
Providence Hospital University of America
School of Nursing, 1945-MSN from Catholic
Washington, DC University of America
Orem’s World of Academia
 1959- Dean of the School of Nursing at Catholic University of America

 1976- Doctorate of Science from Georgetown University
 1988- Doctor of Humane Letters from Illinois Wesleyan University
 1998- Doctor of Nursing Honoris Causae from University of Missouri
 Retired in 1984
Orem’s nursing experience
 Operating room nurse

 Staff nurse
 Private duty nurse
 Nurse educator
 Nurse administrator
 Nurse consultant
Died June 22, 2007
The Historical Evolution of
Orem’s Model
Worked for the Guidelines for

Orem Office of Developing
worked on Education, in the Curricula for the
developing U.S. Dept. of 1958- Education of
1949- 1958-
nursing Health, 1960 Practical Nurses
1957 1960
curriculum Education and cont’d was developed
and nursing Welfare as a ( Tomey and
practice curriculum Alligood,
consultant 2006).
Evolution continued
Eventually served
as the acting
dean of the Published
1960- School of
Nursing at the 1971 Nursing:
Concepts of
1970 Catholic
University of
Practice
America
Metaparadigms of Orem’s
Model
Person Environment Health Nursing

Metaparadigm: Person
 An individual or group of individuals who

have the ability to acquire the knowledge
necessary to perform tasks of self care.
 Ability to integrate self-care tasks and family,
community and individual needs.
 Motivation to accomplish self care tasks.
 Intellectual ability to cognitively perform,
delegate and evaluate tasks performed.
Metaparadigm: Health
 “Promotes function
and development
within social groups in
accordance with
human potential,
known human
limitation, and the
human desire to return
to normal” (Tomey &
Alligood, 2006 p. 279).
Metaparadigm: Environment
4 realms of state are
encompassed in
Environment:
 Physical
 Chemical
 Biological
 Socioeconomical
Environment continued
 Environment – Physical
 Shelter
 Security- internal and
external
 Climate
 Amenities eg. Heat,
electricity, indoor
plumbing, sanitation…
Environment-Chemical
 Chemical
 Pollutants:
 Air
 Water
 Physical
 Lead paints
 Mercury
 Asbestos
Environment-Biological
 Biological
 Molds
 Pollens
 Allergens
 Mites
 Animal waste and its by-
products
Environment-Socioeconomic
 Socioeconomic
 Family income
 Education level
 Occupation
 Social status
 Resources
Metaparadigm: Nursing
The skilled professional
who evaluates and
Task
acknowledges a Performance
patient’s health deficit.
Nursing plans and Self-Care

Coordinated
implements care based Promotion
on the actual and

potential self-care
deficits.
Supportive Demographics
Concepts Unique to Orem’s Model
Three Nursing Theories
1. The Theory of Self
Care
2. The Theory of Self-
Care Deficit
3. The Theory of
Nursing Systems
Struktur Selfcare agency Orem
Theory of Self-Care
 “Self –care comprises the practice of

activities that maturing and mature persons
initiate and perform, within time frames, on
their own behalf in the interest of
maintaining life, healthful functioning,
continuing personal development and well-
being through meeting known requisites for
functional and developmental
regulations”(Tomey & Alligood, 2006 p.269).
Theory of Self-Care continued
 The Theory of Self-

Care has three
components: universal
self-care needs,
developmental self-
care needs and health
deviation.
Theory of Self-Care Deficit
 A self-care deficit occurs

when an individual cannot
carry out self-care
requisites.
 Examples of self-care
requisites are:
 Wound care
 Activities of Daily Living
 Bowel program
 Glucose monitoring
Universal Self-Care Requisites
The 8 elements :
 Air
 Food
 Water
 Elimination/Excretion
 Activity & Rest
 Solitude/Social
interaction
 Functioning/Well-being
 Normalcy
Developmental Self-Care
Requisites
 Composed of 3 needs
 Promote development
 Engage in self-
development
 Preventing or
overcoming adverse
human conditions and
life situations
Health Deviation Self-Care
Requisites
 When a condition permanently
or temporarily alters structural,
physiological or psychological
function.
 Comatose states
 Autism
 Mental Retardation
Theory of Nursing Systems
 Total compensatory support- patient is

unable to complete any self-care
independently; nursing compensates for
patient’s inability to perform self-care.
 Partial compensatory support- patient is able
to perform self-care tasks with partial or no
assistance from nursing.
 Educative/supportive compensatory– patient
able to perform tasks independently. Nursing
provides ongoing education and support.
Clinical Practice Models for Patient
Assessment
Theory applies to multiple Theory applied in order to:
clinical settings.
 Home  Help identify the patient’s
 By the patient alone or with ability for self-care deficits
assistance provided that need to be addressed
 Doctor’s office to promote health.
 Education provided and care  Help identify support
supervised by a nurse available to patient such as
 Hospital family and environment.
 Needs identified, assessed  Encourage patient to
and plan of care
implemented
develop self-care abilities
 Extended care facility
Orem’s Theory Applied to Nursing
Education
 Teaches the student to
encourage compensatory
care in the patient
population.
 Conceptualize patients’
current and potential self-
care deficits.
 Supports the nursing
process in all 3 nursing
theories.
Research Status of Orem’s Model
 Model used by multiple
nursing specialties due
to encompassing
nature of Orem’s
theory.
 Current research using
Orem’s theory would
include:
 Chinese Medicine
 Battered woman
counseling
Orem’s Strengths
 The Self Care Deficit Theory is
specific to nursing.
 The Theory can be used in
multiple nursing specialties.
 The concept of self-care and
health maintenance are
congruent with
contemporary literature in
healthcare.
 The theory creates a
coordinated nursing care plan
that adjusts to the patient’s
needs throughout recovery.
Orem’s Limitations
 Time consuming for

nurses
 Direct contact is
necessary throughout
the nursing process.
 Multiple levels of the
theory to consider Self
care, self care deficit and
self care deficit potential.
 Does not address cultural
needs
Analysis and Insights
 Three theories
combined into one.
 Cumbersome
 Completely dependent
on nursing to assess
the patient and family’s
ability to complete
self-care requisites and
deficits
 Culturally diverse
References
Marrier Tomey, A. & Alligood, M. (2006). Nursing theorists and their

work. (6th ed.) St. Louis, MO : Mosby Elsevier.
Bruce, E., Gagnon, C., Gendron, Puteris, L., & Tamblyn, A.(2009,
November 7). Dorothea Orem’s Theory of Self Care. Retrieved from
http://www.nipissingu.ca/faculty/arohap/aphome/NURS3006/Resour
ces/DorotheaOremTheory.ppt
Dorothea Orem, Nursing Theory ( 2009, November 7). Retrieved from
http://faculty.ucc.edu/nursing-gervase/Orem%5B1%5D.pps
Science of Unitary Human Beings
by
Jerrene Bramble, Denise Cooney and
Angelique Kinyon
Martha Roger’s Theory of Unitary
Human Beings
Presented By:
 Jerrene Bramble
 Denise Cooney
 Angelique Kinyon
("Vital Life Force Energy," 2011)

Rogerian Model
 Rogers Theory states that "the purpose of nurses is to
promote health and well-being for all persons
wherever they are.” (Roger’s Theory, 2011).
 A person and their environment are one.
 Roger's conceptual model is based on four building
blocks: energy field, universe of open systems, pattern,
and four dimensionality (Roger’s Theory, 2011).
Science of Unitary Human Beings
Rogerian science comes from knowledge bases of many
different sciences such as anthropology, psychology,
sociology, astronomy, religion, philosophy, history,
biology, physics, mathematics, and literature to create a
model of unitary human beings (Gunther, 2010).
Origins of Rogerian Science
 Can be traced back to Nightingale's proposals and data
placing humans within the framework of the natural world
(Gunther, 2010).
 Consists of 8 major concepts:
 Energy Field
 Openness
 Pattern
 Pan-dimensionality
 Homeodynamic Principles
 Resonance
 Helicy
 Integrality (Roger’s theory of unitary human beings, 2011)
Important Definitions in
Understanding Roger’s Model
 Energy Fields
 “irreducible, indivisible, pandimensional unitary human beings and
environments that are identified by pattern and manifesting
characteristics that are specific to the whole and cannot be predicted
from knowledge of the parts.” (Venes, 2009). Humans and their
environment have separate energy fields, but they are dependent on
one another.
 Openness
 A characteristic of human and environmental energy fields; energy
fields are continuously and completely open (Venes, 2009).
 Pattern
 Unique feature of an energy field that gives the field its identity. It
cannot be seen, what we see are the manifestations of the pattern
(Venes, 2009).
 Pandimensionality
 “a nonlinear domain without spatial or temporal attributes.” (Venes,
2009). It may help to think of it in terms of a spiritual domain.
Martha Rogers
M. Rogers
Roger's Theory
 Theory reflects on the concept that nursing is both a
science (organized body of knowledge) and an art
(creative use of science to better people).
 A nurse's “safe practice depends on the nature and
amount of knowledge the nurses brings to her
practice.” (Roger’s Theory, 2011).
(Open Systems & The Science, n.d.)

Thoughts on the “Art” of Nursing
 “Nursing seeks to promote symphonic interaction
between the environment and man, to strengthen the
coherence and integrity of the human beings, and to
direct and redirect patterns of interaction between
man and his environment for the realization of
maximum health potential.” (Roger,1970)
 “Creative use of the science of nursing for human
betterment.” (Roger, 1970)
3 Steps in Theory Process
1. Assessment
 Includes both the patient and their environment.
2. Voluntary mutual patterning
 Includes sharing knowledge, empowering the patient,
nutrition, and pain.
3. Evaluation
Defining Person
 "Rogers defines person as an open system in
continuous process with the open system that is the
environment.” (Gunther, 2010).
 She defines "unitary human being as an 'irreducible,
indivisible, pandimensional energy field identified by
pattern and manifesting characteristics that are
specific to the whole'“ (Gunther, 2010).
Defining Environment
 In Roger's model, environment and person are
intertwined and vital to each other.
 "The environment is an 'irreducible, pan-dimensional
energy field identified by pattern and integral with the
human field.'“
 “Each environmental field is specific to its given
human field. Both change continuously, creatively, and
integrally.” (Alligood & Tomey, 2010)
Defining Health
 Roger's defined health as an expression of the life
process.
 A person's environment and culture influence their
views on health and health choices( Roger’s Theory,
2011).
(“Vital Life Force”, 2011)

Defining Nursing
 “She challenged us to view nursing as understanding and
caring for human beings in the wholeness and mutuality of
the person-environment process rather than as isolated
actions and responses in a limited cause and effect
manner.” (Alligood & Fawcet, 2004)
 Nursing involves directing and redirecting patterns in
energy fields to assist the patient in grasping the meaning
of and reaching their greatest potential on the health
continuum (Alligood & Tomey, 2011).
 One of Martha's hopes was that "knowledge would
continue to evolve to benefit the care of people in an ever
changing world."(Watson, 2002)
6 Domains of Energy Patterning
and Corresponding Nursing Interventions:
 Connecting
 Guided Imagery, therapeutic touch, Reiki, Music/Color therapy,
Aromatherapy
 Conveying
 Accupressure, Reflexology
 Converting
 Nutrition, Herbal therapy, Exercise, Music/Color therapy, Purpose and
meaning
 Conserving
 Biofeedback, Relaxation/Meditation, Breathing, Herbal therapy, Sleep
and rest
 Clearing
 Music/Color therapy, Accupressure, Aromatherapy, Postural movement
 Coursing
 Yoga, Massage, Polarity therapy, Exercise (Leddy, 2003).
TEORI/ MODEL KEPERAWATAN CULTURE CARE
DIVERSITY AND UNIVERSALITY MENURUT LEININGER
OLEH
MARIDI M. DIRDJO
SUMBER TEORI TRANSKULTURAL
KEPERAWATAN
• Diderivasi dari antroplogi yang dikonseptualisasi-
kan yang relevan bagi keperawatan (George,
1995, Marriner-Tomey, 1994).
• Keperawatan transkultural sebagai suatu area
utama dari keperawatan yang menfokuskan pada
suatu studi komparatif dan analisis dari budaya
dan sub budaya yang berbeda didunia yang respek
terhadap tingkahlaku caring, pelayanan
keperawatan, nilai-nilai, keyakinan sehat sakit
dan pola-pola tingkahlaku yang bertujuan untuk
mengembangkan suatu body of knowledge yang
ilmiah dan humanistic untuk memberikan tempat
praktik keperawatan pada budaya tertentu dan
budaya universal (Marriner-Tomey, 1994)
KONSEP UTAMA TEORI
TRANSKULTURAL
KEPERAWATAN
• Care adalah fenomena yang dihubungkan
dengan tingkahlaku asistif, suportif dan
memampukan (enabling) atau untuk individu
(atau kelompok) yang secara nyata atau
dikemudian hari membutuhkan untuk
menjadikannya lebih baik atau meningkatkan
kondisi seorang manusia atau jalan hidupnya.
• Caring adalah tindakan yang diarahkan untuk
membantu, mendukung atau memampukan
individu lain (atau kelompok) yang secara nyata
atau dikemudian hari membutuhkan untuk
menjadikannya lebih baik atau meningkatkan
kondisi seorang manusia atau jalan hidupnya.
KONSEP UTAMA TEORI
TRANSKULTURAL
KEPERAWATAN…
• Culture adalah pembelajaran, pembagian dan transmisi
nilai-nilai, keyakinan, norma-norma dan cara hidup pada
kelompok tertentu yang memberikan petunjuk pikiran,
keputusan, dan tindakan serta pola-pola
pengungkapkannya.
• Cultural care adalah pengetahuan kognitif tentang nilai,
keyakinan, dan pola-pola pengungkapannya yang
membantu, mendukung dan memampukan individu lain
atau kelompok untuk mempertahankan kesejahteraan,
meningkatkan kondisi manusia atau jalan hidupnya, atau
untuk menghadapi kematian atau ketidakmampuan.
• Cultural value adalah hasrat atau keinginan yang tertinggi
tentang tindakan aatau pengetahuan tertentu yang sering
didukung oleh budaya pada waktu tertentu.
KONSEP UTAMA TEORI
TRANSKULTURAL
KEPERAWATAN…
• Cultural care diversity adalah keberagaman arti,
pola-pola, nilai-nilai atau symbol pelayanan yang
secara budaya berasal dari kesehatan
(kesejahteraan) atau untuk meningkatkan
kondisi manusia, cara hidup atau untuk
menghadapi kematian.
• Cultural care universality adalah kebiasan, arti
yang mirip atau seragam, pola-pola, nilai-nilai
atau symbol pelayanan yang secara budaya
berasal dari kesehatan (kesejahteraan) atau
untuk meningkatkan kondisi manusia, cara hidup
atau untuk menghadapi kematian.
• Etnocentrism adalah kepercayaan yang dimiliki
seseorang bahwa ide, kepercayaan, dan
kebiasaan tindakan lebih tinggi dari budaya lain.
KONSEP UTAMA TEORI
TRANSKULTURAL
KEPERAWATAN…
• Cultural imposition (beban budaya) adalah kecenderungan
tenaga kesehatan untuk membebankan keyakinan, kebiasaan
dan nilai-nilai pada budaya lain dikarenakan mereka meyakini
bahwa budayanya lebih tinggi daripada kelompok lain.
• Cultural care preservation (penjagaan atau mempertahankan
budaya) adalah fenomena memberikan bantuan, dukungan
dan memampukan berdasarkan budayanya yang membantu
menjaga atau mempertahankan kesehatan atau pelayanan
yang diinginkan.
• Cultural care accommodation atau negotiation adalah
fenomena memberikan bantuan, dukungan dan memampukan
berdasarkan budayanya yang merefleksikan cara-cara untuk
beradaptasi, bernegosiasi atau menyesuaikan.
KONSEP UTAMA TEORI
TRANSKULTURAL
KEPERAWATAN…
• Cultural care repatterning atau restructuring
adalah merekonstruksi atau merubah desain
untuk membantu merubah kesehatan atau
pola hidup klien yang berarti bagi mereka.
• Transcultural nursing adalah suatu
pembelajaran bagian atau cabang
keperawatan yang berfokus pada studi atau
analisis komparatif dari budaya dengan
respek pada keperawatan dan praktik
pelayanan sehat-sakit, keyakinan dan nilai-
nilai dengan tujuan untuk memberikan
pelayanan keperawatan yang berarti dan
manjur kepada manusia sesuai dengan nilai-
nilai budayanya dalam konteks sehat-sakit.
KONSEP UTAMA TEORI
TRANSKULTURAL
KEPERAWATAN…
• Etnonursing adalah studi tentang keyakinan, nilai-
nilai dan praktik pelayanan keperawatan
sebagaimana secara kognitif dirasakan dan
dipahami oleh suatu budaya yang didesain melalui
pengalaman, keyakinan dan system nilainya.
• Nursing adalah suatu pembelajaran terhadap kiat
humanistic dan ilmu yang difokuskan pada
tingkahlaku perawatan (care behavior), fungsi dan
proses-proses personal (individu atau kelompok)
yang diarahkan pada promosi dan mempertahnkan
tingkah laku sehat atau memulihkan dari sakit
yang dapat berupa fisik, psikokultural, dan sosial
atau arti hal-hal tesebut yang akan dibantu secara
umum oleh seorang perawat professional atau
seseorang dengan peran kompetensi yang hampir
sama.
TEORI LEININGER DAN
METAPARADIGMA
MANUSIA
 Leininger memandang manusia sebagai budaya dalam suatu lingkungan
yang beragam dan melalui berbagai cara.
 Manusia tidak dapat dipisahkan dan dipandang sebagai bagian dari
budaya yang melatar-belakanginya.
 Manusia meliputi individu, keluarga dan kelompok.
 Pola perilaku manusia berasal dari nila-nilai, keyakinan dan kebiasaan
budaya kelompok dan dari sifat universal manusia sebagai makhluk
homo sapiens.
 pendekatan yang harus dilakukan oleh perawat dalam human caring
adalah humanistic care.
 Humanistic care adalah memahami dan mengetahui manusia sebagai
sesuatu yang alamiah atau sebagai manusia apa adanya, dan untuk
bersama-sama mereka memberikan perbantuan, pertolongan, petunjuk
dan memampukan dalam rangka mencapai tujuan tertentu,
meningkatkan atau kondisi dan cara hidup lebih baik dalam menghadapi
ketidakmampuan atau membantu menghadapi kematian
TEORI LEININGER DAN METAPARADIGMA…
MANUSIA…
Keperawatan yang spesifik harus direncanakan dan
diimplementasikan dengan jalan mengenali dan respek
terhadap budaya yang berbeda dan budaya yang hampir
sama.
 cultural universality menunjukan atribut-atribut yang
sering ditemukan atau secara universal selalu ada
berkaiatan dengan perawatan dan kesehatan
 cultural diversity menunjukan pola-pola dan atribut yang
bervariasi tentang kesehatan dan perawatan pada
budaya yang berbeda dan bersifat tidak universal.
Keperawatan harus culturally sensitive dimana perawat
harus mengembangkan sensitivitasnya terhadap nilai-nilai
fundamental dari klien terutama tentang sehat dan sakit,
harus menerima eksistensi nilai-nilai yang berbeda dan
harus respek, interes dan memahami budaya lain tanpa
memberikan penilaian
KESEHATAN
Kesehatan adalah lebih dari sekadar tidak adanya penyakit
atau suatu titik pada suatu rentang
Kesehatan merupakan keyakinan, nilai-nilai dan pola-pola
tindakan yang secara budaya dikethui dan digunakan pada
masa sekarang dan mempertahankan kesejahteraan
individu atau kelompok dan dilakukan sebagai aktivitas
peran setiap hari
Berhubungan dengan kesehatan, Leininger menyebutkan
tentang system kesehatan, praktik keperawatan kesehatan,
perubahan pola kesehatan, peningkatan kesehatan, dan
menjaga kesehatan
Konsep kesehatan sangat penting dalam keperawatan
transkultural karena merefleksikan kepercayaan-
kepercayaan, nilai-nilai, dan praktik-praktik kebudayaan
tertentu dalam kehidupan individu atau kelompok.
Kesehatan adalah sesuatu yang universal dan berbeda
dalam konteks transkultural
MASYARAKAT/ LINGKUNGAN
Leininger mendefinisikan lingkungan lebih pada arti
masyarakat dengan menfokuskan pada struktur sosial dan
konteks lingkungan.
Sosial dan lingkungan merupakan bagian yang terbesar
dari teori Leininger.
Konteks lingkungan didefinisikan sebagai keseluruhan dari
kejadian, situasi, atau pengalaman.
Leininger mengatakan bahwa fokus kebudayaan dan pola-
pola tindakan, pikiran, keputusan terjadi sebagai akibat
“pembelajaran, kebersamaan, transmisi nilai, keyakinan,
norma-norma, dan jalan hidup”.
Pembelajaran, kebersamaan, transmisi dan pola-pola ini
terjadi dalam kelompok orang yang mempunyai fungsi
dalam tempat atau lingkungan tertentu.
kebudayaan dalam hubungannya dengan masyarakat/
lingkungan dan ini merupakan sentral dari teorinya.
 KEPERAWATAN
Leininger pertama kali mendefinisikan keperawatan sebagai
“suatu seni yang mempelajari tentang manusia (humanistic)
dan ilmu yang yang berfokus pada tingkahlaku perawatan
individual, fungsi dan proses yang diarahkan pada promosi
dan mempertahankan tingkahlaku sehat atau pemulihanan
dari sakit menuju pada keadaan fisik, psikokultural, sosial
yang bermakna
Leininger memperjelas, mempertegas dan memperluasnya
bahwa keperawatan adalah “suatu pelajaran nilai-nilai
kemanusiaan dan profesi, dan disiplin ilmiah yang berfokus
pada perawatan manusia dan aktivitas yang bertujuan untuk
membantu, mendukung, menfasilitasi dan memungkinkan
individu atau kelompok untuk mempertahankan dan
meningkatkan kembali kesejahteraannya (atau
kesehatannya) yang bermakna secara budaya dan cara-
cara yang menguntungkan atau untuk membantu seseorang
menghadapi keterbatasan (handicaps) dan kematiannya
 KEPERAWATAN…
Teori atau model keperawatan transkultural dari Leininger
menekankan pada pelayanan keperawatan profesional
(profesional nursing care) dengan pendekatan caring,
karena menurut pendapatnya esensi dari keperawatan
adalah caring
Tingkahlaku caring meliputi: memberi kenyamanan, cinta
kasih (compassion), perhatian, tingkahlaku koping, empati,
memampukan (enabling), menfasilitasi, konsultasi
kesehatan, instruksi kesehatan, pemeliharaan kesehatan,
tingkahlaku perbantuan, ketertarikan (interest), keterlibatan,
cinta, pengasuhan, kehadiran, tingkahlaku perlindungan,
tingkahlaku pemulihan, kebersamaan, tingkahlaku stimulasi,
penurunan stress, memberi pertolongan (succorance),
dukungan, surveilans, tawaran, sentuhan dan kepercayaan
 KEPERAWATAN…
Tiga prinsip pelayanan keperawatan
– Cultural care preservation (or maintenance), yaitu
perbantuan, pemfasilitasan atau memperhatikan
fenomena budaya untuk membantu individu,
menentukan kesehatan dan gaya hidup yang
diinginkan.
– Cultural care accommodation (or negotiation), yaitu
perbantuan, pemfasilitasan atau memperhatikan
fenomena budaya yang merefleksikan cara-cara untuk
beradaptasi, bernegosiasi atau mempertimbangkan
kesehatan dan gaya hidup individu atau klien.
– Cultural care repatterning (or restructuring), yaitu
merekontruksi atau merubah desain untuk membantu
perubahan kesehatan dan pola hidup klien kearah
yang lebih baik.
CULTURE CARE DIVERSITY AND
UNIVERSALITY dan PROSES KEPERAWATAN
 Model sunrise (Lihat gambar) seiring dengan proses
keperawatan, karena keduanya mempresentasikan
suatu proses pemecahan masalah
 Leininger mengistilahkan konflik budaya ini dalam
dua kategori yaitu shok budaya (cultural shock) dan
beban budaya (cultural imposition).
 cultural shock terjadi jika orang dari luar mencoba
mempelajari atau beradaptasi secara efektif terhadap
suatu kelompok budaya lain dan akan merasakan
perasaan tidak nyaman, gelisah dan disorientasi
karena perbedaan nilai-nilai budaya, keyakinan dan
kebiasaan.
 Cultural imposition adalah usaha orang luar baik
secara diam-diam maupun terang-terangan,
memaksakan nilai-nilai budaya, keyakinan dan
kebiasaan/ perilaku yang dimilikinya kepada individu,
CULTURE CARE DIVERSITY AND UNIVERSALITY dan
PROSES KEPERAWATAN…
 Bagian atas dari model sunrise meliputi
pengembangan pengetahuan tentang budaya,
orang dan system pelayanan dalam hal ini
keperawatan.
 Jika digunakan secara benar akan mencegah
terjadinya cultural shock dan cultural imposition.
 Tingkat ini mirip dengan pengkajian dan
diagnosis pada fase dari proses keperawatan.
 Leininger memang tidak mengembangkan
instrument untuk mengkaji keperawatan
transkultural.
 Perencanaan dan implementasi pada model
sunrise dapat dilihat pada nursing care
decision and action.
 Ada tiga jenis tindakan yang diberikan dapat
diberikan perawat dengan mengingat prinsip
pelayanan keperawatan yang sensitive
terhadap budaya.
cultural preservation/ maintenance,
cultural care accommodation/ negotiation,
cultural care repatterning/ restructuring
 Pada bagian akhir dari model sunrise ini

menunjukan evaluasi hasil dari proses
keperawatan, yaitu culturally congruent care
for health, well-being and dying.
 Leininger berasumsi bahwa evaluasi akhir
dari proses keperawatan yang berdasarkan
transkultural adalah perawatan kesehatan
yang sesuai dengan budaya, kesejahteraan
atau kematian
TERIMA KASIH
MANY CULTURE ONE WORLD

TERIMA KASIH
Betty Neuman's Systems Model
Disampaikan oleh: Maridi M. Dirdjo
Unique focus of Neuman systems model
according to Betty Neuman, (2001)
"The Neuman system model reflects nursing's interest in well and ill
people as holistic systems and in environmental influences on
health. Clients' and nurses' perceptions of stressors and resources are
emphasized, and clients act in partnership with nurses to set goals and
identify relevant prevention interventions. The individual, family or
other group, community or social issues, all are client systems which
are viewed as composites of interacting physiological, psychological,
sociocultural, developmental and spiritual variables" (p. 322).
What shaped Betty Neuman
Born in 1924 on a farm in rural Ohio - this background helped her
develop compassion for those in need.
Education
• 1947- RN from diploma
program in OH
• 1957-BSN, UCLA mental
health & public health
• 1966-MSN, UCLA
• 1967-1973, UCLA faculty.
• Developed first community
mental health program for
graduate students at UCLA.
• 1985- PhD Western Pacific
University-clinical
psychology.
History of the Neuman's Systems Model
• Developed in 1970 as a teaching
tool to integrate four variables of
man.
• 1974 - published and classified as a
systems model called "The Betty
Neuman Health-Care Systems
Model: A Total Approach to Patient
Problems"
• Published first book detailing NSM in 1982. Notable change:

"patient" now referred to as "client"
• The Neuman Systems Model, 2nd ed.,1989. Spiritual variable added
to diagram as fifth variable.
• 3rd, 4th & 5th editions of The Neuman Systems Model published in
1995, 2002 & 2010
Who and what influenced the NSM?
• The writings of philospher de Chardin on the wholeness
of life.
• Marxist Cornu's views on the oneness of man and
nature.
• Gestalts theories on the interaction between man and
the environment.
• Von Bertalannfy's, Emery's and Lazarus' views on
systems.
• Selye's concept of stress and Caplan's levels of
prevention.
Fawcett, J. (2001). The nurse theorists: 21st-century updates-Betty Neuman.
Nursing Science Quarterly, 14(3), 211-214.
More on the origins of NSM
(Neuman, 1995)
"The development of the wholistic systemic perspective of the Neuman

systems model was motivated by my own basic philosphy of helping
each other live, many diverse observations and clinical experiences in
teaching and encouraging positive aspects of human variables in a
wide variety of community settings, and theoretical perspectives and
stress related to the interactive, interrelated, interdependent, and
wholistic nature of systems theory. The significance of perception and
behavioral consequences [also] cannot be overestimated" (p. 675-676)
Neuman, B. (1995). The Neuman systems model (3rd ed.). Norwalk, CT:
Appleton and Lange.
Key Concepts of the Neuman Systems
Model
Each client system is made up of 5 variables
• Physiological variables
o bodily structure & function
• Psychological variables
o mental processes & relationships
• Sociocultural variables
o social & cultural funtions
• Developmental variables
o developmental processes of life
• Spiritual variables
o continuum of spirituality - from complete
unawareness to full spiritual understanding.
Client system as a core
Flexible line of defense:
-The outermost ring of
defense, prevents invasion
Lines of of stressors.
resistance
core Normal line of defense:
- Represents the client
Flexible systems normal or usual
line of wellness state.
defense
Lines of resistance:
Normal - Involuntarily activated
line of when a stressor invades
normal line of defense.
defense
KEY TERMS: Client/client system is
conceptualized as:
 Individual
 Family
 Group/ aggregate
 Community
Copyright 2005 by Dr. Betty Neuman 369

Environments:
Internal environment
External environment
Created environment

Environment and Stressors
Internal environment-all forces or influences internal to or contained
within the boundaries of the defined client system, the source of
intrapersonal stressors.
External environment-all forces or

influences external to or outside the client
system, the source of interpersonal and
extrapersonal stressors.
Created environment-subconsciously
developed by the client as a symbolic
expression of system wholeness. Acts as
a safety mechanism to block the reality
of the environment and health experience.
Supercedes the internal and external
environments.
Stressors:
 Intra-personal stressors
 Inter-personal stressors
 Extra-personal stressors

Variance from wellness & illness according to
Betty Neuman
http://www.neumansystemsmodel.org/NSMdocs/nsm_powerpoint_overvie
w.htm
Variance from wellness Illness
• Illness is a state of
• Varying degrees of system insufficiency with disrupting
instability. needs unsatisfied
• The difference from the usual • Illness is an excessive

or normal wellness condition. expenditure of energy… when
more energy is used by the
system in its state of
disorganization than is built
and stored, the outcome may
be death
Nursing Process of the NSM
Neuman's Systems Model Nursing Process Format

1. Nursing diagnosis: determined on the basis of
assessment of the variables and lines of defense and
resistance that make up the specific client system.
2. Nursing goals: determined with the client for desired

prescriptive changes to correct variances from wellness.
3. Nursing outcomes: Nursing interventions are

implemented using one or more of the prevention as
intervention methods.
Fig. 1
"A total person approach to viewing patient problems"

(Neuman and Young, 1972)
Global Concepts
Human being- The client. Viewed as a whole, dynamic. Individuals

interact with their environment, and everything in the environment
relates to the individual.
Environment- Both external and internal. Environment is dynamic,

and this influences the client.
Health- The result of clients interaction with their environment.

Maintained by lines of defenses within the client.
Nursing- Focuses on all aspects of life and problem solving for clients
using one of three levels of prevention while viewing the client as an
integrated being. (Bott, Duke, Marett & Memmott, 2000)
PSIKOLOGIS : SOSIO BUDAYA :
• GPF – Pengambilan keputusan setiap
• GPF – Pemanfaatan pelayanan
hari, komunikasi menejemen stres
kesehatan, alokasi sumberdaya
(verbal atau non verbal)
keluarga, tempat tinggal
• GPN – Pola komunikasi dan
• GPN – Peran sosial, aturan/norma
pengambilan keputusan, mekanisme
sosial
berubah, keterikatan diantara anggota
• GP – Budaya/etnik/adat
keluarga
kebiasaan/kepercayaan
• GP – Nilai-nilai dan kepercayaan
• SD – Sumber keuangan
keluarga
• SD – Definisi keluarga
Secara terpisah mewakili

lapisan yang menggambarkan
lima variabel Sistem Neuman,
• GPF - Garis Pertahanan Fleksibel Sumber dimana satu dengan lainnya
• GPN - Garis Pertahanan Normal Energi saling berhubungan termasuk
• GP – Garis Perlawanan Struktur dengan garis pertahanan,
• SD – Struktur Dasar Dasar garis perlawanan, dan struktur
dasar
SPIRITUAL :
FISIOLOGIS : *)
• GPF – Kondisi spiritual sehari-hari
• GPF – Lapisan epitelium sebagai barier
• GPN – Praktek ibadah
invasi bibit penyakit
• GP – Kepercayaan dan nilai spiritual
• GPN – Sistem respirasi, hepatik,
PERKEMBANGAN : • SD – Sumber daya dan kekuatan
simpatoadrenal, sirkulasi, dan tractus
• GPF – Ketrampilan parenting
urinarius yang berfungsi secara normal
• GPN – Tugas perkembangan
• GP – Aktifasi mekanisme keseimbangan
• GP – Nilai-nilai pribadi yang
(kompensatori) dan atau perubahan fungsi
berkembang sesuai dengan
sistem
pertambahan usia
• SD – Pola respon, kekuatan organ,
kelemahan atau kerusakan
• SD – Riwayat perkembangan Neuman Model
masa lalu
GARIS PERTAHANAN GARIS PERTAHANAN GARIS PERLAWANAN STRUKTUR
FLEKSIBEL NORMAL DASAR
 Ada atau  Sikap/  Fleksibelitas

tidaknya pandangan keluarga
stressor keluarga  Komposisi
 Support keluarga
keluarga terhadap sistem dalam
yang lain perilaku  tipe peran
keluarga keluarga
seksual  Penghasilan
remaja keluarga
 Komposisi  Tingkat
STRESSOR keluarga
(kehamilan tak diinginkan pendidikan
pada anak)
 Keterikatan keluarga
keluarga
Neuman Model
Central Core:
 The central or core structure consists of
basic survival factors [normal temp range,
genetic structure, response pattern, organ
strength/ weakness, ego structure]
(Neuman, 2002).

Flexible Line of Defense (FLD)
 Forms the outer boundary of the defined
client system [individual/ family/ group/
community] (Neuman, 2002)
 Acts as a protective buffer system for the
client’s normal line of defense or wellness
state
 Prevents stressor invasion of the client
system

Normal Line of Defense (NLD)
 The client/ client system’s normal or usual
wellness level
 This line represents what the client has become/
evolved over time (Neuman, 2002)
 The NLD defines the stability and integrity of the
client system, its ability to maintain stability and
integrity
 This normal defense line is the standard against
determining any variance from wellness

Lines of Resistance
 A protective mechanism that attempts to
stabilize the client system and foster a
return to the usual wellness
 LOR contain certain known and unknown
internal and external resource factors that
support the client’s basic structure and NLD
(mobilize WBC, activate immune system
mechanisms)
Optimal System Stability
 Optimal wellness is the greater possible
degree of system stability at a given point in
time (Neuman, 2002).
 Optimal client system stability means the
highest possible health condition achievable
at a given point in time (Neuman, 2002).

Variance from Wellness
 Varying degrees of system instability
(Neuman, 2002).
 The difference from the normal or usual
wellness condition (Neuman, 2002).

Illness
 Illness is a state of insufficiency with
disrupting needs unsatisfied (Neuman,
2002).
 Illness is an excessive expenditure of
energy… when more energy is used by the
system in its state of disorganization than is
built and stored, the outcome may be death
(Neuman, 2002).
Reconstitution
 Is the determined energy increase related to the
degree of reaction to a stressor, and represents the
return and maintenance of system stability
following treatment for stressor reactions
(Neuman, 2002)
 May be viewed as feedback from the input/ output
of secondary intervention
 Complete reconstitution may occur beyond the
previously determined NLD or usual wellness
state, may stabilize the system to a lower level, or
return to the level of wellness prior to illness.
Prevention as Intervention
 Basis for health promotion
 Nursing is prevention as intervention
encompass three dimensions:
(1) Primary Prevention
(2) Secondary Prevention
(3) Tertiary Prevention

How it's done: Prevention as Intervention
• Primary prevention as intervention- nursing actions
o preventing stressor invasion; providing resources to retain or strengthen existing
client/client system strengths; supporting positive coping and functioning;
motivating the client system toward wellness; educating the client system
• Secondary prevention as intervention-nursing actions

o protecting the client system's basic structure; mobilizing and optimizing the client
system's internal and external resources to attain stability and energy
conservation; facilitating purposeful manipulation of stressors and reactions to
stressors; motivating, educating, and involving the client system in mutual
establishment of health care goals; facilitating appropriate treatment and
intervention measures
• Tertiary prevention as intervention-nursing actions
o attaining and maintaining the highest possible level of client system wellness and
stability during reconstitution; educating, reeducating, and/or reorienting the client
system as needed; supporting the client system toward appropriate goals;
coordinating and integrating health services resources; providing primary and/or
secondary preventive intervention as required. The nurse evaluates the outcome
goals by: confirming attainment of outcome goals with the client system and
reformulating goals as necessary with the client system
Contoh Praktis
Nursing interventions are carried out on three preventive levels:
• Primary Prevention would not be applicable because the accident causing the stressors has already
occurred and the patient has already developed the reactions/symptoms of stress.
• Secondary Prevention is applicable in this case. Because of the persistent elevated blood pressure (
above 200/110) accompanied by severe chest pains, the patient was admitted to the hospital for both
diagnostic and therapeutic management. Nursing intervention centered initially on the round the
clock monitoring of the blood pressure and giving of the ordered anti- hypertensive drugs. Since the
EKG showed ischemia, the patient was closely watched for worsening of the pain because of the
possibility of a myocardial infarction. Immediate referral of the patient to the resident physician is to
be made if chest pain persisted despite giving isosorbide dinitrate for proper evaluation. Aside from
giving anxiolytics to decrease the anxiety of the patient, I have to warn visiting relatives to refrain
from talking about the tragedy. Sedatives were given before bedtime to prevent insomnia.
• Tertiary Prevention: Upon discharge, I gave the patient and the immediate family members the
following advice:
1. If possible to stay in a relative’s house for a few weeks because they were being hounded by media
who were camped outside their home.
2. Regular monitoring of the patient’s blood pressure by a daughter who is a student-nurse who should
also monitor her intake of medications as prescribed by the physician.
3. Avoid watching TV shows that mention about the tragedy.
4. Avoid answering the phone.
5. She should have a close relative with her aside from the children who will manage their affairs in the
meantime.
What's the point? Was she just another
hippie?
Neuman System Model grew out of a movement in the 1970's and
1980's that began to recognize the patients as whole systems. With the
growing complexity of medicine, health care became more fragmented
(Bott, et al).
This is where Betty comes in. Her views were shaped by the emerging
health care practices at the time, which included taking a broader look
at patients and their needs. Also around this time the hospice
movement took place.
Neuman System Model has been criticized for being to complicated,

broad and abstract. With increasing complexity of our health and
managing major illnesses, this model is becoming more relevant in the
21st century (Bott, et al).
So what do we do with it?
Neuman System Theory has a way of mashing all the global concepts
together. You really have to look at the individual situation to define
the concepts for that specific situation. They will change every time;
they are dynamic.
This model can be used for any situation at any given time. It is broad
and abstract, but relevant and applicable.
This system seems to be particularly useful for hospice and case

management nursing. It is well suited to not only serve an individual
client, but also families, groups and communities because of its
adaptability.
Nursing and Beyond
Betty Neuman's theory was designed for nursing, but now other parts
of the interdisciplinary health care team are beginning to use her model
Members of the interdisciplinary health care team may include:

 physicians
 physical therapy
 occupational therapy
 respiratory therapy
 speech therapy
 psychologists
 lab, x-ray
What/Who Influenced Betty Neuman?
The influences of this model are deeply rooted in both philosophy and
psychology as they pertain to client health and well being
The influences of Betty Neuman were:
 Pierre Tielhard deChardin

 Gestalt Theory
 General Adaptation Syndrome
 General Systems Theory
Are the Global Concepts Represented?
The overall contributions of the model to the discipline of nursing are

summarized by Neuman:
 "The Neuman's System Model fits well with the wholistic

concept of optimizing a dynamic yet stable
interrelationship of spirit, mind, and body of the client in a
constantly changing environment and society" (Neuman
& Young, 1972).
References
Bott, R., Duke, L., Marett, K., Memmot, R. (2002). Use of the
Neuman Systems Model for interdisciplinary teams. Online
Journal of Rural Nursing and Health Care. 1(2) 35-43.
Fawcett, J. Appendix N1: Conceptual models and theories

of nursing. (n.d.). In Tabers Cyclopedic Medical Dictionary
Retrieved from STAT!ref.
Kozier, B. et. Al (2004). Fundamentals ofNursing:Concepts,Process,

and Practice (4th ed.) New Jersey: Pearson
Marriner-Tomey, A. (1994). Nursing Theorists and Their Work (2nd

edition). St. Louis: Mosby
Neuman, B., & Fawcett, J. (Eds.). (2011). The Neuman systems

model (5th ed.). Upper Saddle River, NJ: Pearson.
References(cont.)
Neuman, B., & Young, R.J. (1972). A model for teaching total
person approach to patient problems. Nursing Research 21,
264-269.
Fig.1: http://nursing.jbpub.com/sitzman/art/Betty%20Neuman%27s%
20Systems%20Model.jpg
Links
http://nursing-theory.org/nursing-theorists/Betty-
Neuman.php
www.rno.org/journal/index.php/online-
journal/article/viewFile/76/73
nursingtheories.blogspot.com/2008/07/betty-neumans.html
http://www.neumansystemsmodel.org/
http://currentnursing.com/nursing_theory/application_Betty
_Neuman's model.html
 Dr. Newman studied nursing at the University of Tennessee, Memphis
 She received her graduate degree at the University of California in
medical-surgical nursing, and received her master’s degree in 1964.
 She earned her PhD at New York University in 1972, where she studied
with Martha Rogers
 She served as a director of nursing at a clinical research center, and taught
nursing at Penn State University (1977-1984) and at University of
Minnesota (1984-1996)
 In 1978 Dr. Newman began to articulate her ideas on the theory of health
in nursing.
 According to Newman’s theory, no matter how terrible a person’s
situation, the person can tune into their own self-consciousness and
become one with herself or himself and find a greater meaning and
opportunity for connectedness with others.
 Consciousness = informational capacity of the system
 System = the human being
 Interconnectedness of all living organisms
 Health and Illness as a unitary process
 Health and evolving pattern of consciousness are the same
 Persons are identified by their pattern ( the pattern of health and disease)
 Link to Newman’s web page here

http://www.healthasexpandingconsciousness.org/home/
Newman (1994b) stated that few experience the sixth
stage, unbinding,or the seventh stage, real freedom,
 Many of Newman's thoughts came from the work of Martha Rogers
 Defined energy fields as the fundamental unit of living things
 Person, family and environment exist as an interconnected, unitary
whole
 A unitary human being is “pandimensional” and is manifested by
“characteristics that are specific to the whole and which cannot be
predicted from knowledge of the parts” (Rogers, 1990, as quoted in Pharris,
2005, p. 218)
 Margaret Newman wrote many articles describing and refining her
theory of Health as Expanding Consciousness
 In her article “The Pattern that Connects,” she describes the nature
and development of nursing knowledge:
◦ “Development of nursing knowledge has evolved from an emphasis on parts to
focus on the unitary pattern as a whole…….Praxis research with the intent of
pattern recognition reveals the nature of nursing practice… focus on pattern
represents a shift to a higher dimension which includes and transcends
previous nursing knowledge” (Newman, 2002).
 Health encompasses disease  According to Newman, health and
and non-disease states illness are “expressions of the life
process”
 When disease is present, it is
a manifestation of the ◦ Are NOT opposite ends of a
underlying pattern of the spectrum
person ◦ Are NOT opposite sides of a
coin
 This pattern is present before
◦ “A world of opposites is a
the physiological changes of world of conflict” (Newman,
the disease are manifested 2003, p. 240)
 “Health is the expansion of ◦ “At the highest level of
consciousness” consciousness, all opposites
are reconciled” (Newman,
(Newman, 1979, as quoted in 2003, p. 241)
Pharris, 2005, p. 219)
“Our nursing responsibility is to help patients let go of the artificial boundaries they have
imposed on their lives and get in touch with the whole” (Newman, 2003).
-Parts of a person’s underlying pattern, that emerge from interaction:

-Physical signs and appearances
-Mental/cognitive insights
-Emotional expressions
-Spiritual insights
-Nurses must strive for pattern recognition and knowing the patient on a
deep level
-Nurse –client relationship often begins in times of disruption, uncertainty,
and unpredictability
-Newman recognizes that nurses are change by their interactions with
patients, just as patients are changed by their interactions with the nurses.
 Moch (1990)
 Studied women with breast cancer
 Focused on their relationships with significant others
 Discovered a pattern of “health within illness” (Moch, 1998)
Yamashita (1999) Neill (2002)
 Studied caregivers of people with  Studied women with rheumatoid
schizophrenia
arthritis
 Discovered themes of “struggling
alone” and “lack of connectedness,”  During second interview phase,
especially from health care providers after reviewing diagram, gave
 Pattern recognition helped them to patients a camera to record what
discover new coping mechanisms was meaningful to them
 Result: reported feeling deepened  Third interview involved using the
connection with providers and with
person with schizophrenia pictures to focus on points of
(Yamashita, 1999) personal growth (Neill, 2002)
Pharris (2002) Pharris and Endo (2007)
 Worked with youth incarcerated for  Nurses in hospital unit learn
homicide about HEC theory
 Used pattern recognition process for  Encouraged to journal about their
community dialogue
 Brought together youth with juvenile experiences and to identify
detention staff, social workers, ED moments of expanding
nurses and physicians, youth consciousness in their patients
workers, and educators
 Youth reported increased feelings of and themselves
connectedness, improved  Nurses come together for regular
relationships, and changed behaviors meetings to share insights
(Pharris, 2002)
(Pharris & Endo, 2007)
 “I try to maintain awareness of not only how I am affecting my patient, but to also
reflect on how all of my patients affect me. This attitude keeps me open to
connecting in new situations and to many kinds of people. It helps me to try and
focus on the whole person, not just their current condition.” (Julie Kalendek)
 “Each day by encouraging my patients to give it their all, and reach a higher power
to recover from their heart surgery. Giving them positive reinforcement, letting
them know that each day will get better, giving them hope that they can live a full
life, once they make it through the recuperation period. This encouragement helps
my patients connect with their inner strength and inner being and helps them
move on. (Lisa Little)
 "Keeping a positive attitude in the work field, and applying a holistic approach to
my field to help patient's get through tough moments, making sure they know that
I am here for them" (Nattallie Masso)
“It is time to break with a paradigm of health that focuses on power,
manipulation, and control and move to one of reflective, compassionate
consciousness”
(Newman, 1997, as quoted in Pharris, 2005, p. 220).
References
 Jones, D. A. (2006). Newman’s health as expanding consciousness [Electronic version]. Nursing
Science Quarterly, 19(4), 330-332.
 Moch, S. D. (1998). Health within illness: concept development through research and practice
[Electronic version]. Journal of Advanced Nursing, 28(2), 305-310.
 Neill, J. (2002). Transcendence and transformation in the life patterns of women living with
rheumatoid arthritis [Electronic version]. Advances in Nursing Science, 24(4), 27-47.
 Newman, M. A. (2010). Overview. In Health as expanding consciousness. Retrieved March 22,
2010, from
http://healthasexpandingconsciousness.org/home/index.php?option=com_content
&task=view&id=5&Itemid=6
 Newman, M. A. (2003). A world of no boundaries [Electronic version]. Advances in Nursing
Science, 26(4), 240-245.
 Newman. M. A. (2002). The pattern that connects [Electronic version]. Advances in Nursing
Science, 24(3), 1-7.
 Pharris, M. D. (2005). Margaret A. Newman’s theory of health as expanding consciousness and
its applications. In M. E. Parker (Ed.), Nursing theories and nursing practice (2nd ed.). (pp. 217-
233). Philadelphia: F. A. Davis.
 Pharris, M. D. (2002). Coming to know ourselves as a community through a nursing
partnership with adolescents convicted of murder [Electronic version]. Advances in Nursing
Science, 24(3), 21-42.
 Pharris, M. D. and Endo, E. (2007). Flying free: the evolving nature of nursing practice guided
by the theory of health as expanding consciousness [Electronic version].Nursing Science
Quarterly, 20(2), 136-140.
 Yamashita, M. (1999). Newman’s theory of health applied in family caregiving in Canada
[Electronic version]. Nursing Science Quarterly, 12(73), 73-79.
The Helping Art of Clinical Nursing
Ernestine Wiedenbach
INTRODUCTION
Ernestine Wiedenbach was born in August 18, 1900, in Hamburg, Germany.
Wiedenbach's conceptual model of nursing is called ' The Helping Art of
Clinical Nursing".
Education:
– B.A. from Wellesley College in 1922
– R.N. from Johns Hopkins School of Nursing in 1925
– M.A. from Teachers College, Columbia University in 1934
– Certificate in nurse-midwifery from the Maternity Center Association School for
Nurse-Midwives in New York in 1946..
Career:
– Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity nursing.
– Assistant professor of obstetric nursing in 1954 and an associate professor in
1956.
– She wrote Family-Centered Maternity Nursing in 1958.
– She was influenced by Ida Orlando in her works on the framework.
She died on March 8, 1998.
CONCEPTS AND
DEFINITIONS
Wiedenbach defined key terms commonly used in nursing practice.
The patient
"Any individual who is recieving help of some kind, be it care, instruction or advice
from a member of the health profession or from a worker in the field of health."
The patient is any person who has entered the healthcare system and is receiving
help of some kind, such as care, teaching, or advice.
The patient need not be ill since someone receiving health-related education would
qualify as a patient.
A need-for-help
A need-for-help is defined as "any measure desired by the patient that has the
potential to restore or extend the ability to cope with various life situations that affect
health and wellness.
It is crucial to nursing profession that a need-for-help be based on the individual
perception of his own situation.
Nurse
The nurse is functioning human being.
The nurse no only acts, but thinks and feels as well.
CONCEPTS AND
DEFINITIONS
Knowledge
Knowledge encompasses all that has been percieved and grasped by the
human mind.
Knowledge may be :
– factual
– speculative or
– Practical
Judgment
Clinical Judgment represents the nurse’s likeliness to make sound
decisions.
Sound decisions are based on differentiating fact from assumption and
relating them to cause and effect.
Sound Judgment is the result of disciplined functioning of mind and
emotions, and improves with expanded knowledge and increased clarity of
professional purpose.
CONCEPTS AND
DEFINITIONS
Nursing Skills
Nursing Skills are carried out to achieve a specific patient-centered purpose rather
than completion of the skill itself being the end goal.
Skills are made up of a variety of actions, and characterized by harmony of
movement, precision, and effective use of self.
Person
Each Person (whether nurse or patient), is endowed with a unique potential to
develop self-sustaining resources.
People generally tend towards independence and fulfillment of responsibilities.
Self-awareness and self-acceptance are essential to personal integrity and self-worth.
Whatever an individual does at any given moment represents the best available
judgment for that person at the time.
Perspektif Wiedenbach
KEY ELEMENTS
Wiedenbach proposes 4 main elements to
clinical nursing. a philosophy
n a purpose
n a practice and
n the art.
The Philosophy
n The nurses' philosophy is their attitude and belief
about life and how that effected reality for them.
n Wiedenbach believed that there were 3 essential
components associated with a nursing philosophy:
– Reverence for life
– Respect for the dignity, worth, autonomy and
individuality of each human being and
– resolution to act on personally and professionally held
beliefs.
The Purpose
n Nurses purpose is that which the nurse
wants to accomplish through what she
does.
n It is all of the activities directed towards the
overall good of the patient.
The Practice
n Practice are those observable nursing
actions that are affected by beliefs and
feelings about meeting the patient’s need for
help.
The Art
n The Art of nursing includes
– understanding patients needs and concerns
– developing goals and actions intended to
enhance patients ability and
– directing the activities related to the medical
plan to improve the patients condition.
n The nurses also focuses on prevention of
complications related to reoccurrence or
development of new concerns.
PRESCRIPTIVE THEORY
n Wiedenbach's prescriptive theory is based
on three factors:
n The central purpose which the practitioner
recognizes as essential to the particular
discipline.
n The prescription for the fullfillment of
central purpose.
n The realities in the immediate situation that
influence the central purpose.
Diagram
Kesimpulan
n Nursing is the practice of identification of a
patient’s need for help through
– observation of presenting behaviors and symptoms
– exploration of the meaning of those symptoms with the
patient
– determining the cause(s) of discomfort, and
– determining the patient’s ability to resolve the
discomfort or if the patient has a need for help from the
nurse or other healthcare professionals.
n Nursing primarily consists of identifying a
patient’s need for help.
RAMONA MERCER'S
MATERNAL ROLE
ATTAINMENT THEORY
HISTORY AND BACKGROUND
• Mercer’s Theory of Maternal Role Attainment was based on

her extensive research on the topic beginning in the late 1960s
and early 1970s
• The initial stimulus for the development of the theory came

from Reva Rubin, who was Mercer’s professor and mentor at
the University of Pittsburgh, where Mercer earned a PhD (Bee,
Legge, & Oetting, 1994).
MAJORS COMPONEN
• According to Mercer (1986, 1995), “the major components of

the mothering role are: (1) attachment to the infant, (2)
gaining competence in mothering behaviors, and (3)
expressing gratification in maternal-infant interactions” (1986,
p. 6; 1995, p. 13).
• Borrowing from transition theory, Mercer (1995) described the
following concepts as having to do with maternal role
attainment: “(1) pregnancy is a marker event upsetting the
woman’s status quo, (2) pregnancy requires the woman to
move from one reality to another, and (3) pregnancy requires
a new role identity” pp. 13, 14).
• Mercer (1986) stated that a woman who becomes a mother
must do the following: “(1) recognize the permanency of the
required change, (2) seek out information, (3) seek role
models, and (4) test herself for competency” (p. 14).
4 STAGE MOTHER ATTAINMENT
THEORY
• Four stages of maternal role attainment adapted from Thorton and Nardi
(1975)—anticipatory, formal (role-taking), informal (role-making), and personal
(role identity)—are part of Mercer’s (1979, 1981, 1985a, 1986, 1990) theory
REVISI THEORI: MENJADI IBU
SETELAH REVISI
APLIKASI TEORI
KESIMPULAN
• Mercer’s Theory of Becoming a Mother is very useful in

assessing, planning, implementing, and evaluating nursing
care.
• The theory is applicable in a wide variety of settings and with
diverse populations.
• Mercer’s theory provides not only a framework for practice but
also a frame of reference for nursing research. Because of the
influence of numerous factors, the process of maternal role
identity is complex.
• Mercer and those building on her work have studied the effect
of these factors as variables in research projects, laying the
foundation for continued research in this area of nursing to
improve practice and the care of women.
IMOGENE KING
Interacting and Open Systems Model, and Attainment Goal
Theory
Introduction
Imogene King
• Born on January 30, 1923 inWest Point, Iowa

• 1945 Received nursing diploma from St. John's Hospital School of
Nursing in St.Louis Missouri
• 1948 Received her BSN in nursing education from St. Louis
University
• 1957 Acquired Master's of Science in Nursing also from St. Louis
University
• 1961 Earned Doctoral of education degree from Teacher's College,
Columbia University in New York City.
• 1966-1968 Spent in the academic settings of Ohio State, University,
Loyola University, and the University of South Florida.
• Died on December 24, 2007
(http://currentnursing.com/nursing_theory/goal_attainment_theory.html)
A nursing theory is a statement of linked
concepts that explain, predict, control, and
understand the occurring phenomena that
interests nurses........
the conceptual models or frameworks are the

conceptual structures that define those concepts,
and are used as tools to integrate and interpret
the information.
(Chitty and Black, 2011)

King's Attainment Goal Theory
(http://www.palmbeachstate.edu/x3194.xml)
Assumption is that the patient and nurse communicate, participate in

mutual goal setting, and take actions to achieve those goals together.
(http://currentnursing.com/nursing_theory/goal_attainment_theory.html) (Williams, L. A., 2001)
King's Interacting and Open Systems Model
(http://nursingtheories.blogspot.com/2009/07/queen-who-is-king.htmltp:)
Assumption is that the focus is on the person and the three

interacting systems: personal, interpersonal, and social, within
their interpersonal relationships and social contexts.
(http://currentnursing.com/nursing_theory/goal_attainment_theory.html) (Williams, L. A., 2001)
Perspektif Konseptual Keperawatan KING
King Model Proses Transaksi
According to King
A Human Being...
• Refers to social beings that are rational and sentient
• The focus of nursing care
• Are open systems constantly interacting with their environment
• Consists of three systems which include
• Individual~Personal System
• Groups~Interpersonal System
• Society~Social System
• Have the ability to perceive, think, feel, choose, set goals, select ways
to achieve goals, and make decisions
• Requires three basic needs
• The need for health information that can be used when needed
• The need for care to prevent illness
• The need for care when a person is unable to help themselves
(http://nursingbuddy.com/2011/02/25/imogene-king)
According to King
The Environment...
• Is consistently changing
• Is the background for human interaction
• Involves two types of environment
• Internal Environment: Transforms energy to allow the person to
adjust to the continuous external environment changes
• External Environment: Includes formal and informal
organizations with the nurse being part of the patient's
environment
HEALTH
According to Imogene King, health involves dynamic life experiences

of a human being, which implies continuous adjustment to stressors in
the internal and external environment through optimum use of one's
resource to acheive maximum potential for daily living.
(http://nursingtheories.info/nursing-theory-by--imogene-king-goal-attainment-theory/)
NURSING
"Nursing for Imogene King is an act wherein the nurse
interacts and communicates with the patient. The nurse helps
the patient identify the existing health condition, exploring
and agreeing on activities to promote health. The goal of the
nurse in Imogene King's theory is to help the patient maintain
health through health promotion and maintenance,
restoration, and caring for the sick and dying."
http://nursingtheories.info/nursing-theory-by-imogene-king-goal-attainment-theory/)
Nursing continued:
• Definition: "A process of action, reaction, and interaction by which
nurse and patient share information about their preception in the
nursing situation." and "a process of human interaction between
nurse and patient whereby each perceives the other and the
situation, and through communication, they set goals, explore
means, and agree on means to achieve goals."
• Action: is defined as a sequence of behaviors involving mental
and physical action
• Reaction: which is considered as included in the sequence of
behaviors described in action.
In addition, King discussed:
o (a) goal
o (b) domain and
o (c) functions of professional nurse
Imogene King's Theory of goal
attainment was first introduced in
the 1960's.
( http://nursing-theory.org/nursing-theorist/Imogene-King.php)
Concept of Goal Attainment Thoery
• The nurse and patient communicate information, set goals together, and then
take action to achieve those goals.
• An interpersonal relationship that allows a person to grow and develop in
order to attain certain life goals.
o Factors that affect the attainment of goals
 Roles
 Stress
 Space
 Time
Concepts for personal systems
• Personal system
o perception, self growth and development, body image, space,
and time.
• Interpersonal system
o interaction, communication, transaction, role, and stress.
• Social system
o organization, authority, power, status, and decision making.
Concepts cont...
• Personal- If perceptual interaction accuracy is present in nurse-
patient interactions, transaction will occur.
o If the nurse and patient make transaction, the goal or goals will
be achieved.
 If the goal or goals are achieved, satisfaction will occur.
• Personal- If role expectations and role performance as perceived by
the nurse and patient, growth and development will be enhanced.
• Interpersonal- If role conflict is experienced by ether the nurse or
the patient (or both), stress in the nurse-patient interaction will
occur.
o If a nurse with special knowledge
communicates appropriate information to the patient, mutual
goal-setting and goal achievement will occur.
According to King...
• The patient is a social being who has three fundamental needs:
o the need for health information
o the need for care that seeks to prevent illness
o the need for care when the patient is unable to help him or
herself
• Also health is involving life experiences of the patient, which

includes adjusting to stressors in the internal and external
environment by using resources available.
http://nursing-theory.org/nursing-theorists/Imogene-King.php
Can The Theory of Goal Attainment be implemented in
the emergency department?
• A busy emergency department often creates an intimidating
environment for patients and they may feel threatened, or feel that
they have no control over decisions that affect their care.
• The primary complaint of emergency room patients is the length of
waiting time. Waiting two hours may seem like an eternity for the
patient, but for the nurse, time passes swiftly.
• In an environment that requires one to be reactive and responsive,
clients often perceive the nurses as being too busy or too hurried
(Williams, 2001).
What can the nurse in
the emergency department
do for the patient using
King's Theory of
Goal Attainment.
• Remember that: "An individual's perceptions of self, of body image, of time and space
influence the way he or she responds to persons, objects, and events in his or her life span,
experiences with changes in structure and function of their bodies over time influence their
perceptions of self" (King, 1981),(Williams, 2001).
• King used ten major concepts from the personal and interpersonal system to support the
Theory of Goal Attainment:
o Human interactions and perception- clients often perceive nurses as being too busy or
hurries, nurses need to be aware of how they present themselves to their clients.
o Communication- Poor communication skills lead to poor transactions and interactions
between the nurse and client. Poor communication skills also affect goal setting and goal
attainment. Good communication skills are crucial.
o Role- The nurse needs to know their role to help the patient through their encounter, and
help them attain their health goals.
o Stress- An emergency room can be a stressful place for the patient and
family. Providing appropriated care, proper communication skills, and decreasing stress in
every was possible.
Continued....
o Time- In the emergency department, the patient's complain of a long wait time. Interventions
that have proven to be successful in this situation, is placing telephones and televisions in the
patient rooms. This seems to pass the time and relieve frustration.
o Space-
o Growth and Development
• These points fit into the concepts of the theory personal, interpersonal, and social.
o Personal being the time that the patient feels they are waiting, and the interventions that can be
done to help reduce the wait time.
o Interpersonal being the good or poor communication skills between the patient and the nurse. It
can also be the stress that the patient feels when they are in the emergency department, and what
the nurse does to relieve that stress.
o Social is the decision making that the nurse makes to get the patient to their goal. The patient
comes into the emergency department with complaints of difficulty breathing. There can be
several outcomes. Does the nurse listen to the patient, the family, what decisions are made to get
to the goal.
Clarification of Origins...
"King's philosophy is "The theory of goal
unique because it provides attainment was
a view of persons from the derived from King's
perspective of their conceptual system."
interactions (or
communications, both
verbal and nonbverbal)
with other people at three
levels of interacting
systems."
(Messmer, 2006)
(Chitty, K.K. & Black, B.P.)

Goal Attainment theory can Narrow
be used in any
setting. Nurses should
View
always be in communication
with the patient to reach the
"Several individuals have developed
goal of health.
theories from King's conceptual system
along with instruments to measure the
concepts. Nurses have published
multiple examples of the usefulness of
the conceptual systems and theory of goal
attainment in practice."
"The concepts of Goal Attainment
are very specific. The nurse and
patient must communicate, set goals
together, and take action to acheive
(Messmer, 2006)
the goals."
What practice situations can/has this model
been used in? Here are two examples...
• Theory of Goal Attainment has been used in numerous practice
situations. According to Messmer, "the neonatal intensive care unit
(NICU) used this theory to transform their practice. The nurses in
the NICU feel that parents believe the NICU prevents them from
assuming a parental role. When the nurses and parents work
together to set goals it helps the parents function in the parental
role."
• "Knowledge of concepts of health, self, role, perception,
transaction, stress, and power in transforming practice with five
elderly women in a nursing home. The nurse made a diagnosis and
mutually set goals with the women then described her actions in
helping them acheive their goals. The application of knowledge of
the concepts in King's theory attests to its value in caring for the
residents in a nursing home."
So What can we Conclude??
• Nurse-client interactions increase mutual goal setting

• Open communication increases the likelihood of nurse-client goal
setting and satisfaction
• Nurse-client satisfaction increases goal attainment
• Reaching goal attainment decreases stress and anxiety and
increases client learning and the ability to cope in nursing
situations
• Nurse-client role and conflict results in decreased interactions
• Nurse-client agreement in role expectations and performance
increases meaningful nurse-client interactions
APA Format for References
TEXT
Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights,
MO: Saunders.
Current Nursing. (2012). Nursing theories: Imogene King's theory of goal attainment. Retrieved
from http://currentnursing.com/nursing_theory/goal_attainment_theory.html
Nursing Science Quarterly 1997 King's Theory of Goal Attainment in Practice.
King's Theory of Goal Attainment in Practice (1997). Nursing Science Quarterly, 10(180), 180-185, doi:
10.1177/089431849701000411.
Manayan and Manlapaz (2009) Manayan M C Manlapaz K K 20090716 Nursing Theories: the Queen Who is
KingManayan, M. C., & Manlapaz, K. K. (2009, July 16). Nursing Theories: the Queen Who is King. Retrieved
from http://nursingtheories.blogspot.com/2009/07/queen-who-is-king.html
Messmer P R 2006 Professional Model of Care: Using King's Theory of Goal Attainment.
Messmer, P. R. (2006). Professional Model of Care: Using King's Theory of Goal Attainment. Nursing Science
Quarterly, 19(227), 227-229, doi: 10.1177/0894318406289887.
NursingBuddy: Online Nursing Resource (2011, February 25) NursingBuddy: Online Nursing Resource
20110225NursingBuddy: Online Nursing Resource (2011, February 25). Retrieved from
http://nursingbuddy.com/2011/02/25/imogene-king
References cont.
Williams, L. A. (2001). Imogene King’s interacting systems theory: Application in emergency and rural
nursing. Online Journal of Rural Nursing and Health Care, (2)1, 25, 26. Retrieved from
http://www.rno.org/journal/index.php/online-journal/article/viewFile/93/89
Imogene King. (2011) Nursing Theory. Retrieved from http://nursing-theory.org/nursing-

theorist/Imogene-King.php
King's Theory of Goal Attainment. (2011) Nursing Theory. Retrieved from http://nursing-
theory.org/theories-and-models/king-theory-of-goal-attainment.php
IMAGES
Palm Beach State College. Goal attainment. Retrieved, 2012, from

http://www.palmbeachstate.edu/x3194.xml
UPOU N207 Students. (2008). Blog archive: Reflections from the past and a vision for the future: King's theory and its
application. Retrieved from http://imogene-king.blogspot.com/
UPOU N207 Students. (2009). Blog archive: The queen who is king: Imogene King: The queen of goal attainment
theory. Retrieved from http://nursingtheories.blogspot.com/2009/07/queen-who-is-king.html
WE ALL HOLD
THE KEY !!
• Mohon maaf jika ada
kesalahan dan kekurangan
• Semoga bermanfaat
467
Modeling & Role Modeling
Theory (Erikson & Swain)
Rosemarie Rizzo Parse Human
Becoming Model
Ibrahim Afaf Meleis : Teori
Transisi
Kolcaba Comfort Theory
Duffy Quality Caring Model
Pamela Reed Trancedental
Nursing Theory
Parker & Barry
Locsin Knowing Person
Ray & Turkel BureauCartic
Caring Theory
TROUTMAN-JORDAN:
Successful aging Theory
Barret

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TEORI

Ns. Maridi M. Dirdjo, M.Kep.

• Ilmu keperawatan) definisikan sebagai “the substantive,

Cara melihat fenomena dalam disiplin yang

n Proses perbaikan diri berkesinambungan yang

n Bertujuan mengamati, mengklarifikasi dan

n Persepsi estetik tentang pengalaman manusia yang

n Pemahaman personal tentang keunikan sendiri

n Kapasitas membuat keputusan dalam situasi nyata

n Mencakup: ASUMSI, KONSEP, PRINSIP

Pernyataan mengenai fenomena sentral suatu

Ide abstrak tertulis pada tingkatan teoritis yang

Istilah yang secara abstraks menguraikan dan

Variabel Telapak tangan

Pernyataan yang menghubungan 2 atau lebih

Konsep Pernyataan Teori Uji Teori

Ilmu Uji Teori Revisi Pernyatann

n Diuji berulangkali mellaui riset

n Dikembangakan pada disiplin lain

n Beberapa pernyataan telah diuji

n Belum banyak dikritik oleh disiplin

n Sedikit/ belum diuji coba

 Konsep merupakan keyakinan yang komplek

 ORLANDO: Nursing process theory

Literatur barat tahap Sejarah Islam mencatat

Rufaidah adalah Mummaridahatul Islam al Ula

Ia adalah perawat pertama di dunia

Dia yang mendirikan sekolah perawat pertama

Pertama kali menetapkan kode etik

Pemimpin pertama dalam keperawatan komunitas

Pandang thd Kep Tujuan Kep Masalah Kep

•Proses tindakan, •Membantu •Jika perawat dan

•Kerja kekuatan •Keseimbangan •Fungsi structural

Pandang thd Kep Tujuan Kep Masalah Kep

•Keperawatan ada;ah •Pertumbuhan •Ketidakseimbangan

•Keperawatan adalah •Pemberian perawatan •Manusia berusaha

Rifki Muslim, t tahun

• Neuman’s Systems Model

The listed theories differ in environmental

• Nurses old and young have

Attewell, A. (1998) Florence Nightingale’s relevance to nurses.

McDonald, L. (2001). Florence Nightingale and the early origins of

• Received the following degrees from the University of

The Philosophy and Science of Caring

• Past President of the National League of Nursing

• Fellow of American Academy of Nursing

• Fulbright Research Award in Sweden (watsoncaringscience.org,2015) Nursing

• Holds 10 honorary Doctoral Degrees including 8 International honorary Doctorates

• 2010 Holistic Nurse of the Year (ahna.org, 2010)

•1.) The Caritas Processes

When looking at this theory of practice, Black informs us that

• Transitioned from Carative Factors to Caritas

• Caritas-comes from the Latin word meaning “to

• Builds upon Carative Factors

• Caritas processes openly displays more love and

1. MERUPAKAN SIFAT MANUSIA (HUMAN

3. Cultivation of sensitivity to one’s self and to others

4. Development of a helping–trusting, human caring relationship

5.Promotion and acceptance of the expression of positive and negative feelings

6. Systematic use of a creative problem solving caring process

7. Promotion of transpersonal teaching– learning

9. Assistance with gratification of human needs

1. MEMBENTUK & MENGHARGAI SISTEM NILAI