Theoretical Foundations in Nursing

Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson title:
§ BETTY NEUMAN’S SYSTEMS MODEL
§ SISTER CALLISTA ROY’S ADAPTATION MODEL OF
NURSING Materials: Book, pen and notebook
§ DOROTHY JOHNSON’S BEHAVIORAL SYSTEMS
MODEL
Learning Targets:
At the end of the module, students will be able to:
1. Acknowledge the background and credentials of these
nursing theorists;
2. Identify the major concepts with their definitions as utilized in
their respective theory;
3. List down their specific theoretical assertions or assumptions;
4. Highlight their major contributions in the nursing field;
5. Enumerate the major assumptions enclosed within their
theory;
6. Describe each of these theories in view of the four
metaparadigms;
7. Apply the significance of these theories in the nursing
education, research, and practice; and,
References:
Alligood, M. (2018). Nursing theories and their
8. Recognize the application of these theories in nursing today
work (9th ed.). Singapore: Elsevier.
and in the clinical setting.

A. LESSON REVIEW/PREVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the space
provided. You may use the back page of this sheet, if necessary. Have fun!

Instruction: Identify the following statements as wholly compensatory, partial compensatory, and supportive-educative.
1. The nurse and the patient are both in the intervention act and both perform some self-care measures.
Answer: _______________________
2. The nurse is caring for a stroke patient. Since the patient is paralyzing, the nurse does all the self-care measures
needed by the patient.
Answer: _______________________
3. This is usually applied when a nurse supervises the patient on how to clean post-op wounds.
Answer: _______________________
4. The nurse is caring for a patient who is recovering for an abdominal surgery.
Answer: _______________________
5. The self-care measures are done by the nurse.
Answer: _______________________

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 Theoretical Foundations in Nursing
Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

B. MAIN LESSON
You will study and read their book, if available, about this lesson.

BETTY NEUMAN’S SYSTEMS MODEL

“Nursing is a unique profession that is concerned with all of the variables affecting an
individual’s response to stress.”

✔ A unique, systems-based perspective that provides a unifying focus for approaching a

wide range of nursing concerns.
✔ A comprehensive guide for nursing practice, research, education, and administration
that is open to creative implementation.
✔ It has the potential for unifying various health-related theories, clarifying the
relationships of variables in nursing care and role definitions at various levels of nursing
practice.
✔ Based on the person’s relationship to stress, his reaction to it, and reconstitution factors
that are dynamic in nature.
✔ considers the person as an open system which is composed of a basic structure of
energy resources.
✔ These resources include physiologic, psychologic, sociocultural, developmental, and spiritual.
✔ The basic structure, or central core, is surrounded by two concentric boundaries or rings called the lines of
resistance.
✔ These lines represent the internal factors that aid the person defend against a stressor.
✔ The line of resistance is further surrounded by two lines of defense.
o First line of defense is the person’s state of equilibrium or the state of adaptation developed and maintained
over time and which is considered normal for the person.
o Second line of defense is flexible, dynamic, and can be readily and rapidly changed over a short period of
time.
✔ She classified stressors as intrapersonal, interpersonal, and extrapersonal stressors.
✔ Man’s reaction to stress is dependent on the integrity of the lines of resistance and defense.
✔ When the line of defense fails, man’s reaction will now depend on the lines of resistance.
✔ Because of the reaction, man can adapt to a stressor This is called reconstitution.
✔ Therefore, nursing interventions focus on keeping or maintaining the stability of the open system. These
interventions can be carried out on the three levels of prevention: primary, secondary, and tertiary.

Major Concepts & Definitions:

In holistic approach, the client as a whole, whose parts are in dynamic interaction with itself and the environment. It strongly
advises the consideration of all variables that simultaneously affect the client system.

▪ Open system
→ characterized by elements that are in continuous exchange within a complex organization
→ these exchanges may be in the form of information or energy
→ basic to this is stress and stress reaction

▪ Created environment
→ developed unconsciously by the client in order to express the wholeness of the system by using symbols

▪ Client system
→ composed of the five system variables interacting with the environment.

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 Theoretical Foundations in Nursing
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Name: _________________________________________________________________ Class number: _______

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1. Physiologic variables are body structure and function

2. Psychological variables include mental processes in interaction with the environment
3. Sociocultural variables are the effects and influences of social and cultural conditions
4. Developmental variables are age-related processes and activities throughout life
5. Spiritual variables are beliefs and influences related to spirituality

▪ Basic client structure

→ composed of a central core surrounded by concentric rings
→ the core reflects basic survival factors or energy resources of the client

▪ Lines of resistance
→ represents resources that help the client defend against a stressor
→ normal line of defense reflects the client’s stability which serves as the guide to assess deviations from the
client’s usual wellness

▪ Flexible line of defense

→ a protective layer for preventing stressors from breaking through the usual wellness state
1. Intrapersonal factors occur within the individual
2. Interpersonal factors occur between one or more individuals
3. Extrapersonal factors occur outside the individual

▪ Preventive interventions
→ purposeful actions to help the client retain, attain, or maintain the stability of the client system and carried
out when a stressor is either suspected or identified

LEVELS DEFINITION EXAMPLES

This is carried out when a stressor is suspected or Teaching a person about weight reduction to
Primary identified. The degree of risk is already known but decrease the client’s chances of developing
the reaction of the client may not yet be visible. diabetes.
Parents that have a disabled child. Initially they
This is carried out when symptoms from stress may feel they can never accept this situation.
Secondary have already occurred. It involves activities that However, they are able to draw on resources they
“treat” the symptoms. were unaware of and eventually find themselves
coping well.
This occurs after the active treatment. It readjusts
the client system toward optimum levels of
Referring the newly diagnosed diabetic client to
Tertiary stability. The goal is to strengthen resistance to
the Diabetic Resource Nurse.
stressors in order to prevent recurrence or
reaction or regression.

▪ Reconstitution
→ occurs following the treatment of stressor reactions; marks the return of the client system to stability

▪ Level of stability
→ after reconstitution, may be higher or lower than the previous level before the invasion of the stressor

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 Theoretical Foundations in Nursing
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Neuman employed a three-step Nursing Process:

STEP 2: DIAGNOSIS, PLANNING,

STEP 1: ASSESSMENT STEP 3: EVALUATION
IMPLEMENTATION
In the initial assessment, the nurse The next step addresses the nursing The next step involves nursing
looks at the client’s basic make-up diagnosis, which describes the outcomes which refers to evaluation
and the known, unknown and context of the whole client as a of the effectiveness of interventions.
universal stressors. system.
This includes assessing changes in
When examining the client’s basic Goals are then determined in intrapersonal, interpersonal, and
makeup, predispositions are collaboration with the client. extrapersonal factors.
considered. They are important
because they affect how the client will Interventions are determined relative Any changes in the nature of the
deal with stressors. to the goals, and are carried out at stressors are examined, as change in
three levels: primary, secondary, and these areas determine the success of
The nurse also looks at Neuman’s tertiary prevention. the nursing interventions.
five variables: physiological,
psychological, sociocultural, If change has not occurred, more
developmental and spiritual. data collection is required and the
The nurse uses these variables to nursing process is repeated.
examine the person’s predispositions
and stressors.

The client’s perception of these

stressors is discussed and the nurse
provides input.

Stressors are identified as

interpersonal, intrapersonal or
extrapersonal.

Theoretical Assertions:
✔ Each client system is unique, a composite of factors and characteristics within a given range of responses.
✔ Many known, unknown, and universal stressors exist. Each differs in its potential for disturbing a client’s usual
stability level or normal line of defense. The particular interrelationships of client variables at any point in time can
affect the degree to which a client is protected by the flexible line of defense against possible reaction to stressors.
✔ Each client/client system has evolved a normal range of responses to the environment referred to as a normal line
of defense. The normal line of defense can be used as a standard from which to measure health deviation.
✔ When the flexible line of defense is no longer capable of protecting the client/client system against an environmental
stressor, the stressor breaks through the normal line of defense.
✔ Whether in a state of wellness or illness, the client is a dynamic composite of the variables’ interrelationships.
Wellness is on a continuum of available energy to support the system in an optimal system stability state.
✔ Implicit within each client system are internal resistance factors known as lines of resistance, which function to
stabilize and realign the client to the usual wellness state.

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 Theoretical Foundations in Nursing
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Theory in View of Metaparadigms:

Nursing’s primary concern is to define the appropriate action in situations that are stress-related or
concerning possible reactions of the client or client system to stressors. Nursing interventions aim to
Nursing
help the system adapt or adjust and retain, restore, or maintain some degree of stability between the
client system variables and environmental stressors, focusing on conserving energy.
Humans are defined as “men, women, and children cared for either singly or as social units” and are
Person
the “material object” of nurses and others who provide direct care.
Health is defined as the condition or degree of system stability and is viewed as a continuum from
Health wellness to illness. When system needs are met, optimal wellness exists. When needs are not satisfied,
illness exists. When the energy needed to support life is not available, death occurs.
The environment is a vital arena that is germane to the system and its function. The environment may
Environment be viewed as all factors that affect and are affected by the system. In Neuman Systems Model
identifies three relevant environments: (1) internal, (2) external, and (3) created.

SISTER CALLISTA ROY’S ADAPTATION MODEL OF NURSING

✔ The model assumes that systems of matter and energy progress to higher levels
of complex self-organization.
✔ Consciousness and meaning comprise person and environment integration while
awareness of self and environment is rooted in thinking and feeling.
✔ System relationships include acceptance, protection and fostering of independence
✔ Man and his environment have common patterns and integral relationships and
transformations are created in human consciousness.
✔ Integration of man and environment meanings result in adaptation.
✔ Roy’s model of nursing is best exemplified in the nursing process.

The nursing process is a problem solving approach for gathering data, identifying the
capacities and needs of the human adaptive system, selecting and implementing
approaches for nursing care, and evaluating the outcome of care provided. It includes the
following steps:

ASSESSMENT OF The first step of the nursing process which involves gathering data about the behavior of the
BEHAVIOR person as an adaptive system in each of the adaptive modes
The second step of the nursing process which involves the identification of internal and
external stimuli that are influencing the person’s adaptive behaviors. Stimuli are classified as:
ASSESSMENT OF
✔ Focal – those most immediately confronting the person
STIMULI
✔ Contextual – all other stimuli present that are affecting the situation
✔ Residual – those stimuli whose effect on the situation is unclear
NURSING Step three of the nursing process which involves the formulation of statements that interpret
DIAGNOSIS data about the adaptation status of the person, including the behavior and most relevant stimuli
The fourth step of the nursing process which involves the establishment of clear statements of
GOAL SETTING
the behavioral outcomes for nursing care
The fifth step of the nursing process which involves the determination of how best to assist the
INTERVENTION
person in attaining the established goals
The sixth and final step of the nursing process which involves judging the effectiveness of the
EVALUATION nursing intervention in relation to the behavior after the nursing intervention in comparison with
the goal established

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Four Adaptive Modes: These are how the regulator and cognator mechanisms are manifested; in other words, they are the
external expressions of the above and internal processes.

1. Physiological-Physical Mode
▪ Physical and chemical processes are involved in the function and activities of living organisms. These are
the actual processes put in motion by the regulator subsystem.
▪ This mode’s basic need is composed of the needs associated with oxygenation, nutrition, elimination,
activity and rest, and protection.
▪ This model’s complex processes are associated with the senses, fluid and electrolytes, neurologic function,
and endocrine function.

2. Self-Concept Group Identity Mode

▪ The goal of coping is to have a sense of unity, meaning the purposefulness in the universe, and a sense of
identity integrity. This includes body image and self-ideals.

3. Role Function Mode

▪ This focuses on the primary, secondary, and tertiary roles that a person occupies in society and knowing
where they stand as a member of society.

4. Interdependence Mode
▪ This mode focuses on attaining relational integrity through the giving and receiving of love, respect and
value. This is achieved with effective communication and relations.

Major Concepts & Definitions:

▪ Health
→ a state and process of being and becoming integrated and whole that reflects person and environmental
mutuality

▪ Adaptation
→ the process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious
awareness and choice to create human and environmental integration

▪ Adaptive responses
→ responses that promote integrity in terms of the goals of the human system, that is, survival, growth,
reproduction, mastery, and personal and environmental transformation

▪ Ineffective responses
→ responses that do not contribute to integrity in terms of the goals of the human system

▪ Adaptation levels
→ represent the condition of the life processes described on three different levels: integrated, compensatory,
and compromised.
Theory Assertions:
✔ Roy’s model views the person as an adaptive system with coping processes.
✔ She described the person as a whole comprising parts and which functions as a unity for some purpose.
✔ It includes people as individuals or in groups (families, organizations, communities, nations, and society as whole).

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✔ The person is an adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four
adaptive modes.
✔ The environment is viewed as 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.
✔ Nursing is the science and practice that expands adaptive abilities and enhances person and environment
transformation.
✔ The goals of nursing are to promote adaptation for individuals and groups in the four adaptive modes, thus
contributing to health, quality of life, and dying with dignity.
✔ This is done by assessing behavior and factors that influence adaptive abilities and by intervening to expand those
abilities and to enhance environmental interactions.

Theory in View of Metaparadigms:

In the Adaptation Model, nurses are facilitators of adaptation. They assess the patient’s behaviors for
adaptation, promote positive adaptation by enhancing environment interactions and helping patients
Nursing
react positively to stimuli. Nurses eliminate ineffective coping mechanisms and eventually lead to better
outcomes.
Based on Roy, humans are holistic beings that are in constant interaction with their environment.
Humans use a system of adaptation, both innate and acquired, to respond to the environmental stimuli
Person
they experience. Human systems can be individuals or groups, such as families, organizations, and the
whole global community.
Health is defined as the state where humans can continually adapt to stimuli. Because illness is a part
of life, health results from a process where health and illness can coexist. If a human can continue to
Health
adapt holistically, they will maintain health to reach completeness and unity within themselves. If they
cannot adapt accordingly, the integrity of the person can be affected negatively.
The environment is defined as conditions, circumstances, and influences that affect humans’
Environment development and behavior as an adaptive system. The environment is a stimulus or input that
requires a person to adapt. These stimuli can be positive or negative.

Application of the Theory:

✔ Nursing process is cyclical in nature – beginning with assessment, diagnosis, planning, implementation, and
evaluation – the evaluation may also serve as the assessment findings for another set of nursing problems.
✔ It means that the assessment component of the nursing process is the stimuli or the input and the planning and
implementation are the throughput processes.
✔ The output is the evaluation which then provides the necessary feedback to the goal of care.
✔ The nurse then decides what necessary actions should be taken next, in the light of the patient’s response to the
nursing interventions. This action by the nurse is adaptation in its simplest terms.
✔ Patients adapt, too. The nursing interventions we perform ultimately elicits a response from our patients, our patients
may or may not actually adapt according to our expectations.

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DOROTHY JOHNSON’S BEHAVIORAL SYSTEMS MODEL

“Nursing is an external force that acts to preserve the organization of the patient’s
behavior by means of imposing regulatory mechanisms or by providing resources while
the patient is under stress.”

Credentials and Background of Johnson:

✔ Born August 21, 1919 in Savannah, Georgia.
✔ Graduated BSN from Vanderbilt University in Nashville, Tennessee and her
M.P.H. from Harvard University in Boston.
✔ She was a staff nurse at the Chatham-Savannah Health Council (1943-1944).
✔ She is proud to receive the 1975 Faculty Award from graduate students.
✔ She was an early proponent of nursing as a science as well as an art; also
believed nursing had a body of knowledge reflecting both the science and the art.
✔ Johnson (1959) proposed that the science of nursing necessary for effective nursing care included a synthesis of
key concepts drawn from basic and applied sciences.
✔ In 1961, she proposed that nursing care facilitated the client’s maintenance of a state of equilibrium.
✔ She also proposed that clients were “stressed” by a stimulus of either an internal or external nature.
o These stressful stimuli created such disturbance, or “tensions”, in the patient that a state of disequilibrium
occurred.
✔ She identified 2 areas that nursing care should be based in order to return the client to a state of equilibrium:
o Reduce stressful stimuli
o Support natural and adaptive processes

Theoretical Sources:
✔ Johnson’s behavioral system theory springs from Nightingale’s belief that nursing’s goal is to help individuals
prevent or recover from disease or injury.
✔ The “science and art” of nursing should focus on the patient as an individual and not on the specific disease entity.
The model is patterned after a systems model; a system is defined as consisting of interrelated parts functioning
together to form a whole.
✔ She stated that a nurse should use the behavioral system as their knowledge base. The reason Johnson chose the
behavioral system model is the idea that “all the patterned, repetitive, purposeful ways of behaving that characterize
each person’s life make up an organized and integrated whole, or a system”.

7 Subsystems of Human Behavior: The ultimate goal for each subsystem is expected to be the same for all individuals.

1. Attachment – probably the most critical, because it forms the basis for all social organization
✔ provides survival & security; its consequences are social inclusion, intimacy, & formation and maintenance
of a strong social bond
2. Achievement – attempts to manipulate the environment with its function is control or mastery of an aspect of self
or environment to some standard of excellence
✔ areas of achievement behavior include intellectual, physical, creative, mechanical, & social skills
3. Aggressive – function is protection & preservation which holds that aggressive behavior is not only learned, but
has a primary intent to harm others
✔ however, society has placed limits when dealing with self-protection and that people & their properly be
respected and protected
4. Dependence – promotes helping behavior that calls for a nurturing response
✔ its consequences are approval, attention, or recognition, and physical assistance

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✔ dependency behavior develops from the complete reliance on others for certain resources essential for
survival
✔ an imbalance produces tension, which results in disequilibrium
5. Sexual – has dual functions of procreation & gratification that begins with the development of gender role identity
& includes the broad range of sex role behaviors
6. Ingestive – have to do with when, how, what, how much, and under what conditions we eat
7. Eliminative – have to do with when, how, what, how much, and under what conditions we eliminate

▪ These responses are a set of behavioral responses or tendencies that share a common goal developed through
experience and learning and are determined by numerous physical, biological, psychological, and social factors.
▪ Each subsystem has three functional requirements:
o Each subsystem must be “protected from noxious influences with which the system cannot cope”.
o Each subsystem must be “nurtured through the input of appropriate supplies from the environment”.
o Each subsystem must be “stimulated for use to enhance growth and prevent stagnation”.
▪ As long as the subsystems are meeting these functional requirements, the system and the subsystems are viewed
as self-maintaining and self-perpetuating.

Major Concepts & Definitions:

▪ Behavior
→ the output of intra-organismic structures and processes as they are coordinated and articulated by &
responsive to changes in sensory stimulation
▪ System
→ a whole that functions as a whole by virtue of the interdependence of its parts characterized by organization,
interaction, interdependency, & integration of the parts & elements

▪ Behavioral system
→ encompasses the patterned, repetitive, & purposeful ways of behaving
→ the system is flexible enough to allow influence that affect it

▪ Subsystems
→ mini-systems with its own particular goal & function that can be maintained as long as its relationship to the
other subsystems or the environment is not changed or disturbed
▪ Equilibrium
→ a stabilized but more or less transitory, resting state where the person is in harmony with himself & with his
environment

▪ Tension
→ the state of being stretched or strained can be viewed as an end-product of a disturbance in equilibrium

▪ Stressor
→ a stimulus, either internal or external, that produce tension and result in a degree of instability

Theory Assumptions:
These are in three categories: assumptions about system, assumptions about structure, and assumptions about functions.
✔ Assumptions about system
1. There is “organization, interaction, interdependency and integration of the parts and elements of behaviors
that go to make up the system.”

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2. A system “tends to achieve a balance among the various forces operating within and upon it, and that man
strives 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.”
3. A behavioral system, which requires and results in regularity and constancy in behavior, is essential to man.
It is functionally significant because it serves a useful purpose in social life and the individual.
4. “System balance reflects adjustments and adaptations that are successful in some way and to some
degree.”
✔ Assumptions about structure
1. “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.”
2. Each person has a “predisposition to act concerning the goal, in certain ways rather than the other ways.”
This predisposition is called a “set.”
3. Each subsystem has a repertoire of choices called a “scope of action.”
4. The individual patient’s behavior produces an outcome that can be observed.
✔ Assumptions about functions
1. The system must be protected from toxic influences with which the system cannot cope.
2. Each system has to be nurtured through the input of appropriate supplies from the environment.
3. The system must be stimulated for use to enhance growth and prevent stagnation.

Theory in View of Metaparadigms:

This is viewed as an external force that acts to preserve the organization of the patient’s behavior by
means of imposing regulatory mechanisms or by providing resources while the patient is under stress.
Nursing
Nursing activities are not dependent on medical authority, rather, nursing is complementary to the
practice of medicine.
This is a behavioral system with patterned, repetitive, and purposeful ways of behaving that link the
person to his environment. The person is a system of interdependent parts that requires some regularity
Person
and adjustment to maintain balance or equilibrium. A person’ attempt to regain balance may require an
unnecessary use of energy.
Health as an elusive, dynamic state influenced by biological, psychological, and social factors. A lack
Health
of balance in the structural or functional requirements of the subsystems leads to poor health.
The environment consists of all the factors that are not part of the individual’s behavioral system, but
Environment that influence the system. The nurse may manipulate some aspects of the environment so the goal of
health or behavioral system balance can be achieved for the patient.

Application of the Theory:

✔ The subsystems are interactive and interdependent, restoration in one subsystem could bring about restoration of
behavior in another or others. This means that healthcare practitioners must direct all efforts, interventions, or
actions to all the subsystems.
✔ As nurses, we should provide the highest level of quality care to our patients by taking into consideration the whole
person and trying to understand the interrelatedness of its individual component parts.

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CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed.

1. Goals are then determined in collaboration with the client:

a. Evaluation
b. Assessment
c. Diagnosis, Planning, Implementing
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2. Reconstitution marks the return of the client system to stability. The level of stability after reconstitution should not be
higher or lower than the previous level before the invasion of the stressor.
a. the first statement is correct, the second statement is correct
b. the first statement is incorrect; the second statement is incorrect
c. the first statement is incorrect, the second statement is correct
d. the first statement is correct; the second statement is incorrect
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

3. Primary prevention is carried out when a stressor is suspected or identified. Secondary prevention is carried out when
symptoms from stress have already occurred:
a. the first statement is correct; the second statement is incorrect
b. the first statement is incorrect; the second statement is incorrect
c. the first statement is incorrect, the second statement is correct
d. the first statement is correct, the second statement is correct
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

4. All other stimuli present that are affecting the situation:

a. Focal
b. Contextual
c. Residual
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Consciousness and meaning comprise person and environment integration. Awareness of self and environment is
rooted in thinking and feeling.
a. the first statement is correct, the second statement is correct

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b. the first statement is correct; the second statement is incorrect

c. the first statement is incorrect; the second statement is incorrect
d. the first statement is incorrect, the second statement is correct
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

6. This involves gathering data about the behavior of the person as an adaptive system in each of the adaptive modes.
a. Assessment of Behavior
b. Assessment of Stimuli
c. Nursing Diagnosis
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

7. Select the letter that doesn’t describe the nursing process.

a. problem solving approach for gathering data
b. identifying the capacities and needs of the human adaptive system
c. selecting and implementing approaches for nursing care
d. none of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. Roy’s model of nursing is best exemplified in the nursing process. The nursing process evaluates the outcome of care
provided.
a. the first statement is correct; the second statement is incorrect
b. the first statement is correct, the second statement is correct
c. the first statement is incorrect; the second statement is incorrect
d. the first statement is incorrect, the second statement is correct
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. Select the correct order of nursing process.

a. goal setting, assessment of behavior, nursing diagnosis, assessment of stimuli, intervention and evaluation
b. assessment of behavior, nursing diagnosis, assessment of stimuli, intervention, goal setting and evaluation
c. assessment of behavior, assessment of stimuli, nursing diagnosis, goal setting, intervention and evaluation
d. assessment of stimuli, assessment of behavior, nursing diagnosis, goal setting, intervention and evaluation
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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10. This involves the determination of how best to assist the person in attaining the established goals.
a. Intervention
b. Goal setting
c. Evaluation
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

11. Output of intra organismic structures and processes as they are coordinated and articulated by and responsive to
changes in sensory stimulation.
a. Behavior
b. Tension
c. Stimulus
d. Equilibrium
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

12. What are the consequences of Attachment subsystem?

a. Social inclusion
b. Intimacy
c. A & B
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

13. An imbalance in a behavioral subsystem produces ___________, which results in ___________.

a. tension, equilibrium
b. equilibrium, tension
c. tension, disequilibrium
d. disequilibrium, tension
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

14. Areas of achievement behavior include:

a. attention or recognition
b. social skills
c. approval
d. all of the above
ANSWER: ________

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 Theoretical Foundations in Nursing
Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

15. Behavioral system encompasses what way of behaving:

a. patterned
b. repetitive
c. purposeful
d. all of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

16. Subsystem that promotes helping behavior that calls for a nurturing response:
a. Achievement subsystem
b. Attachment subsystem
c. Dependency subsystem
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

17. Which of the following is not a functional requirement of a subsystem?

a. protected from noxious influences with which the system can cope
b. nurtured through the input of appropriate supplies from the environment.
c. stimulated for use to enhance growth and prevent stagnation
d. none of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

18. Achievement subsystem attempts to manipulate the environment. It has the dual functions of procreation and
gratification.
a. the first statement is correct; the second statement is incorrect
b. the first statement is correct, the second statement is correct
c. the first statement is incorrect, the second statement is correct
d. the first statement is incorrect; the second statement is incorrect
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

19. Five assumptions are made about the structure and function of each subsystem. These assumptions are the “tension
response” common to each of the subsystems.
a. the first statement is correct; the second statement is incorrect
b. the first statement is correct, the second statement is correct

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 Theoretical Foundations in Nursing
Module #7 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

c. the first statement is incorrect; the second statement is incorrect

d. the first statement is incorrect, the second statement is correct
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

20. The subsystems are interactive and interdependent, restoration in one subsystem could bring about restoration of
behavior in another or others. This means that healthcare practitioners must direct all efforts, interventions, or actions
to all the subsystems.
a. the first statement is correct; the second statement is incorrect
b. the first statement is incorrect, the second statement is correct
c. the first statement is incorrect; the second statement is incorrect
d. the first statement is correct, the second statement is correct
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

C. LESSON WRAP-UP

AL Activity: CAT 3-2-1

This strategy provides a structure for you to record your own comprehension and summarize your learning. Let us see your
progress in this chapter!

Three things you learned:

1. __________________________________________________________________________________________
2. __________________________________________________________________________________________
3. __________________________________________________________________________________________
Two things that you’d like to learn more about:
1. __________________________________________________________________________________________
__________________________________________________________________________________________
2. __________________________________________________________________________________________
__________________________________________________________________________________________

One question you still have:

1. __________________________________________________________________________________________
__________________________________________________________________________________________

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