this presentation very important for all nurses to learn more about nursing theory

1. Tehran University of Medical Sciences
School of Nursing & Midwifery
Preparation by: Ahmed waheed mezban
MS medical surgical nursing
The supervision of: Dr.SHAHSAVARI
Tuesday, November 10, 2015
Sister Callista Roy - Nursing Theorist
And
Dorothy Johnson - Nursing Theorist

2. Roy's Adaptation Model
•Introduction:
•Sr.Callista Roy- nurse theorist, writer, lecturer, researcher and teacher
•Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill
•Born at Los Angeles on October 14, 1939.
•Bachelor of Arts with a major in nursing - Mount St. Mary's College, Los Angeles
in 1963.
•Master's degree program in pediatric nursing - University of California ,Los
Angeles in 1966.
•Master’s and PhD in Sociology in 1973 and 1977.
•Worked with Dorothy E. Johnson
•Worked as f faculty of Mount St. Mary's College in 1966.
•Organized course content according to a view of person and family as adaptive
systems.
•RAM as a basis of curriculum i at Mount St. Mary’s College
•1970-The model was implemented in Mount St. Mary’s school
•1971- she was made chair of the nursing department at the college

3. Assumptions
Explicit assumptions
•The person is a bio-psycho-social being.
•The person is in constant interaction with a changing environment.
•To cope with a changing world, person uses both innate and acquired
mechanisms which are biological, psychological and social in origin.
•Health and illness are inevitable dimensions of the person’s life.
•To respond positively to environmental changes, the person must
adapt.
•The person’s adaptation is a function of the stimulus he is exposed to
and his adaptation level
•The person’s adaptation level is such that it comprises a zone
indicating the range of stimulation that will lead to a positive response.
•The person has 4 modes of adaptation: physiologic needs, self-
concept, role function and inter-dependence.

4. •
"Nursing accepts the humanistic approach of valuing other persons’
opinions, and view points" Interpersonal relations are an integral part
of nursing
•There is a dynamic objective for existence with ultimate goal of
achieving dignity and integrity.
Implicit assumptions:
•A person can be reduced to parts for study and care.
•Nursing is based on causality.
•Patient’s values and opinions are to be considered and
respected.
•A state of adaptation frees an individual’s energy to
respond to other stimuli.

5. Major Concepts
•Adaptation -- goal of nursing
•Person -- adaptive system
•Environment -- stimuli
•Health -- outcome of adaptation
•Nursing- promoting adaptation and health
•Adaptation:
•Responding positively to environmental changes.
•The process and outcome of individuals and groups who
use conscious awareness, self reflection and choice to
create human and environmental integration

6. Person:
•Bio-psycho-social being in constant interaction with a changing environment
•Uses innate and acquired mechanisms to adapt
•An adaptive system described as a whole comprised of parts
•Functions as a unity for some purpose
•Includes people as individuals or in groups-families, organizations,
communities, and society as a whole.
Environment:
•Focal - internal or external and immediately confronting the person
•Contextual- all stimuli present in the situation that contribute to effect of focal
stimulus
•Residual-a factor whose effects in the current situation are unclear
•All conditions, circumstances, and influences surrounding and affecting the
development and behavior of persons and groups with particular consideration
of mutuality of person and earth resources, including focal, contextual and
residual stimuli

7. Health:
•inevitable dimension of person's life
•Represented by a health-illness continuum
•A state and a process of being and becoming integrated
and whole
Nursing:
•To promote adaptation in the four adaptive modes
•To promote adaptation for individuals and groups in the four
adaptive modes, thus contributing to health, quality of life, and
dying with dignity by assessing behaviors and factors that influence
adaptive abilities and by intervening to enhance environmental
interactions

8. Four Adaptive Modes:
•Physiologic Needs
•Self Concept
•Role Function
•Interdependence
THEORY DEVELOPMENT
Philosophical Assumptions:
•Persons have mutual relationships with the world and God
•Human meaning is rooted in an omega point convergence of the universe
•God is intimately revealed in the diversity of creation and is the common
destiny of creation
•Persons use human creative abilities of awareness, enlightenment, and faith
•Persons are accountable for the processes of deriving, sustaining, and
transforming the universe

9. Adaptation and Groups:
•Includes relating persons, partners, families, organizations, communities,
nations, and society as a whole.
Adaptive Modes
A. Persons
•Physiologic
•Self Concept
•Role Function
•Interdependence
B. Groups
Physical
Group Identity
Role Function
Interdependence

10. Adaptation Level
• A zone within which stimulation will lead to a positive or adaptive
response
• Adaptive mode processes described on three levels
• Integrated
• Compensatory
• Compromised
Integrated Life Processes:
• Adaptation level where the structures and functions of the life
processes work to meet needs
•Examples of Integrated Adaptation
•Stable process of breathing and ventilation
•Effective processes for moral-ethical-spiritual growth

11. Compensatory Processes:
• Adaptation level where the cognator and regulator are activated by a challenge
to the life processes
•Compensatory Adaptation Examples:
•Grieving as a growth process, higher levels of adaptation and transcendence
•Role transition, growth in a new role
Compromised Processes:
•Adaptation level resulting from inadequate integrated and compensatory life
processes
•Adaptation problem
•Compromised Adaptation Examples
•Hypoxia
•Unresolved Loss
•Stigma
•Abusive Relationships

12. THE NURSING PROCESS:
•RAM offers guidelines to nurse in developing the nursing process.
•The elements :
•First level assessment
•Second level assessment
•Diagnosis
•Goal setting
•Intervention
•evaluation

13. Introduction:
Dorothy E. Johnson was born on August 21, 1919 in
Savannah, Georgia. She earned her Bachelor of Science in
Nursing in 1942 from Vanderbilt University in Nashville,
Tennessee. In 1948, she received her Master's degree from
Harvard University. During her career, Johnson was an
assistant professor of pediatric nursing, an associate
professor of nursing, and a professor of nursing at the
University of California in Los Angeles. She retired in 1978

14. Dorothy Johnson-Behavioral Systems Model
• The person is a behavioral system comprised of a set of
organized, interactive, interdependent, and integrated subsystems
• Constancy is maintained through biological, psychological, and
sociological factors.
• A steady state is maintained through adjusting and adapting to
internal and external forces.

15. Johnson’s 7 Subsystems
•Affiliative subsystem - social bonds
•Dependency - helping or nurturing
•Digestive - food intake
•Eliminative - excretion
•Sexual - procreation and gratification
•Aggressive - self-protection and preservation
•Achievement - efforts to gain mastery and
control

16. Johnson’s Concepts
1. Person
•A behavioral system comprised of subsystems constantly
trying to maintain a steady state
2. Environment
•Not specifically defined but does say there is an internal
and external environment
3. Health
•Balance and stability.
4. Nursing
•External regulatory force that is indicated only when there
is instability

17. There are four assumptions about system in the model:
• There is "organization, interaction, interdependency and integration of the
parts and elements of behaviors that go to make up the system."
• A system "tends to achieve a balance among the various forces operating
within and upon it, and that man strive continually to maintain a
behavioral system balance and steady state by more or less automatic
adjustments and adaptations to the natural forces occurring on him."
• A behavioral system, which requires and results in some degree of
regularity and constancy in behavior, is essential to man. It is functionally
significant because it serves a useful purpose in social life as well as for the
individual.
• "System balance reflects adjustments and adaptations that are successful
in some way and to some degree."

18. The four assumptions about structure and function are that
• "from the form the behavior takes and the consequences it
achieves can be inferred what 'drive' has been stimulated or
what 'goal' is being sought."
• Each individual person has a "predisposition to act with
reference to the goal, in certain ways rather than the other
ways." This predisposition is called a "set."
• Each subsystem has a repertoire of choices called a "scope of
action."
• The individual patient's behavior produces an outcome that can
be observed.