Additional Nursing Models

Nursing models offer different ways to organise questions about people, health, environment and professional care. They are not interchangeable, and borrowing a concept does not establish that an intervention is effective. Their use here is as background for thinking about practice alongside Callista Roy's Adaptation Model.

The practice questions below are suggested applications for this wiki. They are not presented as the theorists' endorsements of IEMT, as validated IEMT assessments, or as permission to undertake nursing activities without the relevant qualifications.

Nola J. Pender developed the Health Promotion Model. It examines health-promoting behaviour through prior experience, personal factors, perceived benefits and barriers, self-efficacy, interpersonal and situational influences, and commitment to action. Her 2011 Health Promotion Model manual is an author-produced guide.

Practice question: What change does the person want to make, what makes it worthwhile, and what could help or obstruct the next step? Agree an achievable action and review what happened.

Margaret A. Newman developed Health as Expanding Consciousness, a different theory from Pender's. It emphasises patterns in a person's life and relationships and the possibility of meaning and development within the whole experience of health and illness. The Margaret A. Newman Center for Nursing Theory at UTHSC describes its focus; an archived presentation by Newman provides her own account.

Practice question: What patterns and relationships does the person recognise in their experience? Let the person's account guide exploration, rather than imposing a theory of what their illness must mean.

Patricia Benner describes the development of professional expertise through five levels: novice, advanced beginner, competent, proficient and expert. The model concerns situated skill and clinical judgement, not merely elapsed time or the accumulation of certificates. See her original 1982 article, From Novice to Expert.

Practice question: Which decisions can this practitioner make competently, and where are supervision, training or referral needed? Confidence alone is not evidence of competence. This model does not supply an IEMT accreditation system.

Betty Neuman developed the Neuman Systems Model. Note the spelling: Neuman and Margaret Newman are different theorists. Neuman considers a client system in relation to stressors, stability and prevention.

The model includes five interacting variables: physiological, psychological, sociocultural, developmental and spiritual. It distinguishes a flexible line of defence, a normal line of defence and lines of resistance. These should not be renamed as three fixed physical, psychological and social “lines”. Stressors may be intrapersonal, interpersonal or extrapersonal; prevention is considered at primary, secondary and tertiary levels. See Jacqueline Fawcett's account of Neuman's model and Neuman Systems Model, Inc.

Existing diagram credit: Neuman, B. (2005), The Neuman Systems Model of Nursing. The wiki's original caption records educational-use permission from Dr Betty Neuman (2005).

Practice question: Which pressures and resources are inside the person's experience, between people, or in the wider environment? Consider practical and social changes as well as any agreed session work.

Myra Estrin Levine developed the Conservation Model. Its four principles concern conservation of energy, structural integrity, personal integrity and social integrity. The author is not “Faye Glenn Levine”; that name confuses different nursing theorists. Fawcett's account of Levine's model includes the original publications and an interview with Levine.

Practice question: How can the plan respect the person's physical capacity, dignity, autonomy and social relationships? For example, agree session demands that fit the person's available energy and responsibilities.

Martha E. Rogers describes people and their environments as irreducible wholes in continuous mutual process. Her conceptual vocabulary includes energy fields, openness, pattern and pandimensionality. This is a particular theoretical account of nursing; its terminology should not be treated as a measurement of physical energy or as proof of an IEMT mechanism. See Fawcett's account and interview with Rogers.

Practice question: What is missed if the practitioner considers only an isolated symptom? Explore the wider pattern of daily life while keeping any causal explanation provisional.

Dorothy E. Johnson views the person as a behavioural system. The model identifies seven subsystems: attachment/affiliative, dependency, ingestive, eliminative, sexual, aggressive/protective and achievement. These are not a three-part physical, psychological and social classification. See Fawcett's account and interview with Johnson.

Practice question: Which recurring behaviours affect the person's goals and everyday functioning? Use selected concepts only where relevant and acceptable to the person; the model is not a requirement to ask about every intimate area in an IEMT session.

Rosemarie Rizzo Parse's Humanbecoming theory centres on meaning, rhythmicity and transcendence, with quality of life understood from the person's perspective. The practitioner's presence and dialogue are central to its approach. See Fawcett's account of Parse's theory and primary publications.

Practice question: What does a worthwhile change mean to this person? Do not assume that a lower symptom rating is their only or most important outcome.

Ida Jean Orlando's Deliberative Nursing Process focuses on the person's immediate need for help and on checking the nurse's interpretation of the person's behaviour. It distinguishes the nurse's perception, thought and feeling from an action deliberately informed by the interaction. See Fawcett's account and interview with Orlando.

Practice question: Have I checked what this response means to the person before acting on my interpretation? For example: “I noticed you became quiet. What is happening for you now?” The question leaves the meaning open.

Roy provides the organising framework developed in this wiki. Additional models can prompt useful questions, but their concepts should retain their original meanings and be labelled when adapted. A model is useful here when it improves a concrete decision, makes an assumption visible, or helps review an agreed outcome.

These are editorial suggestions for reflective practice. They do not demonstrate clinical effectiveness. Record the rationale for a decision and the person's subsequent experience using Adaptive Formulation, Treatment Plans and Governing Principles.