Professional Documents
Culture Documents
Most schools of nursing and health care agencies have developed their own structured
assessment tools. Many of these are based on selected nursing theories. BCCC Department
of Nursing has chosen Marjory Gordon's 11 functional health patterns.
Gordon uses the word pattern to signify a sequence of recurring behavior. The nurse
collects data about dysfunctional as well as functional behavior. Thus, by using Gordon's
framework to organize data, nurses are able to discern emerging patterns.
How well a client is functioning in these different areas can be evaluated with questions and
observations. Sample questions are listed here to help you understand the patterns. Ask
yourself the following questions. Then click on the assignment at the bottom of the page.
Describes the client's perceived pattern of health and well-being and how health is
managed.
What does the person know about links between lifestyle choices and health?
Can this person report the names of current medications s/he is taking and their purpose?
What does this person know about medical problems in the family?
Have there been any important illnesses or injuries in this person's life?
Describes the client's pattern of food and fluid consumption relative to metabolic
need and pattern indicators of local nutrient supply.
How do the person's food choices compare with recommended food intake?
Does the person have any disease that effects nutritional- metabolic function?
PATTERN OF ELIMINATION
Does the person have any disease of the digestive system, urinary system or skin?
How does the person describe her/ his weekly pattern of activity and leisure, exercise and
recreation?
Does the person have any disease that effects her/ his cardio-respiratory system or musclo-
skeletal system?
Does the person have any sensory deficits? Are they corrected?
Does the person have any disease that effects mental or sensory functions?
Describes the client's self-concept pattern and perceptions of self (e.g., self-
conception/worth, comfort, body image, feeling state).
How does this person describe her/ his various roles in life?
Has, or does this person now have positive role models for these roles?
Is this person currently going though any big changes in role or relationship?
How have the person's plans and experience matched regarding having children?
Does this person have any disease/ dysfunction of the reproductive system?
PATTERN OF COPING & STRESS TOLERANCE
Describes the client's general coping pattern and the effectiveness of the pattern in
terms of stress tolerance.
Describes the patterns of values, beliefs (including spiritual), and goals that guide the
client's choices or decisions.
What principals did this person learn as a child that are still important to her/ him?
Does this person identify with any cultural, ethnic, religious, regional,or other groups?
MASLOW'S HIERARCHY OF
NEEDS
from Psychology - The Search for Understanding
by Janet A. Simons, Donald B. Irwin and Beverly A. Drinnien
West Publishing Company, New York, 1987
Abraham Maslow developed a theory of personality that has influenced a number of
different fields, including education. This wide influence is due in part to the high
level of practicality of Maslow's theory. This theory accurately describes many
realities of personal experiences. Many people find they can understand what Maslow
says. They can recognize some features of their experience or behavior which is true
and identifiable but which they have never put into words.
Maslow has set up a hierarchic theory of needs. All of his basic needs are instinctoid,
equivalent of instincts in animals. Humans start with a very weak disposition that is
then fashioned fully as the person grows. If the environment is right, people will
grow straight and beautiful, actualizing the potentials they have inherited. If the
environment is not "right" (and mostly it is not) they will not grow tall and straight
and beautiful.
Maslow has set up a hierarchy of five levels of basic needs. Beyond these needs,
higher levels of needs exist. These include needs for understanding, esthetic
appreciation and purely spiritual needs. In the levels of the five basic needs, the
person does not feel the second need until the demands of the first have been
satisfied, nor the third until the second has been satisfied, and so on. Maslow's basic
needs are as follows:
Physiological Needs
These are biological needs. They consist of needs for oxygen, food, water, and
a relatively constant body temperature. They are the strongest needs because
if a person were deprived of all needs, the physiological ones would come
first in the person's search for satisfaction.
Safety Needs
When all physiological needs are satisfied and are no longer controlling
thoughts and behaviors, the needs for security can become active. Adults have
little awareness of their security needs except in times of emergency or
periods of disorganization in the social structure (such as widespread rioting).
Children often display the signs of insecurity and the need to be safe.
Needs of Love, Affection and Belongingness
When the needs for safety and for physiological well-being are satisfied, the
next class of needs for love, affection and belongingness can emerge. Maslow
states that people seek to overcome feelings of loneliness and alienation. This
involves both giving and receiving love, affection and the sense of belonging.
Needs for Esteem
When the first three classes of needs are satisfied, the needs for esteem can
become dominant. These involve needs for both self-esteem and for the
esteem a person gets from others. Humans have a need for a stable, firmly
based, high level of self-respect, and respect from others. When these needs
are satisfied, the person feels self-confident and valuable as a person in the
world. When these needs are frustrated, the person feels inferior, weak,
helpless and worthless.
Needs for Self-Actualization
When all of the foregoing needs are satisfied, then and only then are the needs
for self-actualization activated. Maslow describes self-actualization as a
person's need to be and do that which the person was "born to do." "A
musician must make music, an artist must paint, and a poet must write." These
needs make themselves felt in signs of restlessness. The person feels on edge,
tense, lacking something, in short, restless. If a person is hungry, unsafe, not
loved or accepted, or lacking self-esteem, it is very easy to know what the
person is restless about. It is not always clear what a person wants when there
is a need for self-actualization.
The hierarchic theory is often represented as a pyramid, with the larger, lower levels
representing the lower needs, and the upper point representing the need for self-
actualization. Maslow believes that the only reason that people would not move well
in direction of self-actualization is because of hindrances placed in their way by
society. He states that education is one of these hindrances. He recommends ways
education can switch from its usual person-stunting tactics to person-growing
approaches. Maslow states that educators should respond to the potential an
individual has for growing into a self-actualizing person of his/her own kind. Ten
points that educators should address are listed:
10. We must teach people to be good choosers. They must be given practice in
making good choices.
(written by and reprinted with the kind permission of Jacqueline Fawcett, RN,
PhD, FAAN)
Orem's work can be separated into a conceptual model and three theories. Orem’s conceptual
model is constituted from six central or core concepts and one peripheral concept. The central
concepts are self-care, self-care agency, therapeutic self-care demand, self-care deficit, nursing
agency, and nursing system. The peripheral concept is basic conditioning factors.
SELF-CARE AGENCY is defined as a complex capability of maturing and mature individuals to:
(1) determine the presence and characteristics of specific requirements for regulating their own
functioning and development, (2) make judgments and decisions about what to do, and (3)
perform care measures to meet specific self-care requisites.
NURSING SYSTEMS is defined as a dynamic action system produced by nurses as they engage
in the diagnostic, prescriptive, and regulatory operations of nursing practice. The wholly
compensatory nursing system is selected when the patient cannot or should not perform any self-
care actions. The partly compensatory nursing system is selected when the patient can perform
some, but not all, self-care actions. The supportive-educative nursing system is selected when
the patient can and should perform all self-care actions.
BASIC CONDITIONING FACTORS reflect features of individuals or their living situations, such as
age, gender, health state, developmental age, sociocultural, health care system variables, family
system elements, and patterns of living. Basic conditioning factors influence self-care and self-
care agency.
The three theories derived form Orem's conceptual model are the theory of self-care deficit, the
theory of self-care, and the theory of nursing systems.
The central idea of the THEORY OF SELF-CARE DEFICIT is that individuals can benefit from
nursing because they are subject to health-centered or health-derived limitations that render them
incapable of continuous self-care or that result in ineffective or incomplete care.
The central idea of the THEORY OF SELF-CARE is that self-care is a learned behavior that
purposely regulates human structural integrity, functioning, and development.
The central idea of the THEORY OF NURSING SYSTEMS is that nursing systems are formed
when nurses use their abilities to prescribe, design, and provide nursing for legitimate patients by
performing discrete actions and systems of actions that regulate the value of or the exercise of
individuals' capabilities to engage in self-care and meet the self-care requisites of the individual
therapeutically.
Callista Roy maintains there are four main adaptation systems which she calls modes of
adaptation. She calls these the physiological system, the self concept system, the role
mastery system, and the interdependency system.
In 1966 Virginia Henderson formulated a definition of the unique function of nursing. This
definition was a major stepping-stone in the emergence of nursing as a discipline separate from
medicine. Like Nightingale, Henderson described nursing in relation to the patient and the
patient's environment. Unlike Nightingale, Henderson saw the nurse as concerned with both well
and ill individuals, acknowledged that nurses interact with patients even when recovery may not
be feasible, and mentioned the teaching and advocacy roles of the nurse.
Henderson conceptualized the nurse's role as assisting sick or well individuals to gain
independence in meeting 14 fundamental needs:
A.Breathing normally.
B.Eating and drinking adequately.
C.Eliminating body wastes.
D.Moving and maintaining a desirable position.
E.Sleeping and resting.
F.Selecting suitable clothes.
G.Maintaining body temperature within normal range by adjusting clothing and modifying the
environment.
H.Keeping the body clean and well-groomed to protect the integument.
I.Avoiding dangers in the environment and avoiding injuring others.
J.Communicating with others in expressing emotions, needs, fears or opinions.
K.Worshipping according to one's faith.
L.Working in such a way that one feels a sense of accomplishment.
M.Playing or participating in various forms of recreation.
N.Learning, discovering, or satisfying the curiosity that leads to normal development and
health, and using available health facilities.
Henderson has published many works and continues to be cited in current nursing literature. Her
emphasis on the importance of nursing's independence from, and interdependence with, other
health care disciplines is well recognized.
In fact, human beings have always been growing personally or psychologically, even
those who are almost entirely absorbed in struggling for material survival or aspiring for
higher social achievements. But that growth has been most often subconscious, as a
result of the trials and errors of life experience, rather than as a result of a conscious
process of self-development. A conscious effort at developing our personalities requires a
clear conception of what personality is and how it can be altered.
While we are all fairly clear about what constitutes a normal healthy and comfortable
social existence, when it comes to psychological and spiritual progress there is a great
deal of confusion. What does it mean to grow psychologically? What does it mean to
progress spiritually? By psychological growth, some people mean they want greater
freedom to do what they want, pursue their interests and live as they want. Others want to
understand themselves better, develop personal capacities, and experience new things.
Some want to search within themselves for some deeper, truer self or psyche.
So too, spiritual growth means a great many different things to different people : to be of
service to others, pray, meditate, acquire healing powers, read and understand philosophic
and religious texts. Others want direct spiritual experience : to expand their
consciousness, feel the reality of God, commune with the universe, discover their souls or
realize a higher state of knowledge and bliss. A real science of humanity needs to define
and explain these concepts which are so central to the aspirations of millions of people.
Contents
[hide]
• 1 Dimensions of Personality
• 2 Higher Social Accomplishment
• 3 Psychological Growth
• 4 Spiritual Progress
• 5 Transformation
• 6 Spherical vs. Linear Progress
1. Social Accomplishment
2. Psychological Growth
3. Spiritual Progress
4. Transformation
Some of these dimensions naturally increase during our lifetimes as a result of life
experience and conscious effort. Some of them lend themselves to change by a serious
psychological effort. Some can be altered only by spiritual experience. Therefore, those
interested in personal growth need first of all to be clear about the differences between
these four aspects of personality and the methods appropriate for personal growth at each
of these levels.
The capacity for social accomplishment is determined by the overall development of the
personality. The actual level of social accomplishment depends to a large extent on
personal effort. By greater effort we become capable of doing better or more than before.
We can expand our knowledge or enhance our physical, social and mental skills. We can
train ourselves to run faster, jump higher, play a musical instrument, read faster, explain
ourselves more effectively, etc. These changes help us more fully and effectively utilizes
the developed capacities of our personality for higher social accomplishment. If we want
to raise our accomplishment beyond this level, we need to expand our personality, which
is what we mean by psychological growth.
Most of our progress in life falls within this first level of personal growth, because it is
that which is most easily changed by means of education, training or conscious effort.
The capacity for accomplishment is directly enhanced by
Most of us improve on many or most of these criteria during the course of our lives.
Family upbringing, school, work and life experience all contribute to that growth. In
addition, each of us have the ability to consciously improve ourselves on all of these
aspects at any time. We can raise the level of our social accomplishment by a change in
our external behavior:
• We can study to acquire greater knowledge. We can seek training to enhance our
skills.
• We can increase our commitment to Personal values and Work values. We can
become cleaner, more orderly, regular and punctual.
• We can more effectively organize our lives and work. We can become more
systematic and coordinate our efforts better with other people.
• We can also take a conscious effort to be more interested, enthusiastic and
energetic in pursuit of our goals.
If you seek higher accomplishment and are looking for a place to start, see
Strategies for Higher Accomplishment
If you are seeking a comprehensive approach for higher career accomplishment, see
Higher Career Accomplishment.
The first level of personal growth involves growth in our external behavior. The second
level of personal growth requires a psychological change in our attitudes and values.
Psychological growth refers to a qualitative change in the nature of the personality that
can be brought about by conscious intention and effort. This psychological change also
enhances our capacity for social accomplishment, but it does so by expanding the
personality, not just by greater external effort. Psychological growth may also be
described as a qualitative improvement in those attributes that make an individual what
can be regarded as a 'better' and more enlightened person, expressing higher values and
capable of making a greater contribution to the overall welfare and well-being of society.
Many people mistake psychological growth with greater freedom to do what we want,
greater capacity to assert ourselves and live for ourselves. But these things are really
expressions of the vital’s desire to make itself happy by greater self-indulgence. They do
not result in lasting happiness and do not make us better people. Psychological growth
requires an effort to acquire greater self-knowledge and self-control, to master our natural
impulses and direct our energies into something better and higher. If you compile a list of
those human beings who have been most admired and respected, you can easily identify
the characteristics associated with psychological growth – living for an ideal, courage of
conviction, willingness to take risks, integrity, kindness, generosity, service toward
others, etc.
How do we know when we are growing psychologically? Here are some of the
indications. We are growing psychologically when --
• We are more self-reliant: We rely more on ourselves, rather than expecting other
people to do things for us.
• We are more responsible: We feel more personally responsible for the people
around us or the work in which we are involved, rather than depending on others
and blaming them for what goes wrong.
• We aspire for higher achievements: We are no longer satisfied with being secure
or comfortable or gaining the acceptance and recognition of those around us. We
want to live for something more than mere survival or social acceptance. We want
to contribute.
• We have higher standards: We are not satisfied being as good or doing as well as
other people or getting their approval. We strive for something more than mere
acceptance or social approval.
• We are more positive: We react less against other people and no longer think
ourselves superior to others or feel jealous of those who achieve more than we do.
We do not try to dominate others or impose our will on them. We are more
generous, gracious, and willing to give ourselves to other people, rather than
demanding anything from them.
• We live higher values: We respect others more, our thoughts are more objective,
our words are more truthful, our acts are more honest and our relationships are
more harmonious.
• We act according to our understanding rather than our impulses: We do what we
know to be right rather than what we feel like doing or find convenient. We are no
longer carried away by our passions, impulses or preferences. We reflect more on
our own behavior to understand ourselves better. We reflect more on other’s
behavior to see their point of view and become more tolerant.
Changes of this type are difficult to bring about and make permanent. They involve
significant psychological effort and constitute real growth of personality. Relatively few
people make the effort consciously.
If you are looking for some simple but very effective ways to expand your personality, see
Strategies for psychological growth.
Human Science is based on the premise that there is a spiritual dimension to reality which
is the foundation and creative source of all that exists and that a progressive evolution in
consciousness makes it possible for human beings to experience and express this spiritual
dimension in their personal lives.
The varieties of spiritual experience are very great. They vary in form, direction, depth,
height, intensity and permanency. They include such experiences as cosmic
consciousness, a concrete sense of oneness with other beings, awareness of an infinite
emptiness or void beyond the manifest universe, discovery of one’s soul or psychic being,
realization of a transcendent Spirit or Conscious Being, contact with godheads from what
Sri Aurobindo refers to as the Overmental plane, direct knowledge from the Supramental
plane of Truth Consciousness, etc.
The term spiritual experience is often used or confused with any type of experience on
the subtle or occult planes of existence that are not normally accessible to our external
consciousness – experiences of subtle beings and forces that influence our lives, of occult
powers, of subtle sounds, visions, voices, etc. In this article, we reserve the term spiritual
only for those powers and experiences that come from the higher spiritual planes of
consciousness. Experiences from these planes are universally associated with spiritual
qualities such as patience, peace, silence, equality (equanimity, non-reaction), harmony,
self-giving, truth, freedom, light, and compassion.
Spiritual experience makes us more aware of our oneness with other people. It helps us
escape from the confines of our ego and see the world and other people through their eyes
and from their point of view. Broadly speaking, progress that enhances the presence and
expression of any or all of these qualities in the personality and life of a person may be
regarded as forms of spiritual progress.
How do we know when we are growing spiritually? Here are some of the indications. We
are growing spiritually when –
If you are looking for some simple but very effective ways to expand and elevate your
consciousness, see Strategies for spiritual progress
If you want to learn more about spirituality and spiritual experience, see
Dimensions of spiritual progress and Spirituality Portal.
[edit] Transformation
Spiritual experience can greatly enhance our capacity for accomplishment, positive
personal relations and personal fulfillment. It can give us a deep sense of inner strength
and security, a faith in life and trust in the spirit. Except in rare instances spiritual
experience cannot alter the very substance or structure of the personality. Western
psychologists generally agree that human character cannot be changed. It is inherited and
fixed for life. According to Eastern spiritual tradition, that form or structure, known in
Sanskrit as swarupa, is the form which the soul has taken for birth during this lifetime
and it remains unchanged through all experiences of this birth. This is also the source of
what Hindus refer to as karma.
Thus, there is also a fourth level of personality formation and personal change. That is the
level of innate capacities that cannot be changed solely by the conscious effort of the
individual. This level includes
• Strength of personality:
This factor is extremely difficult to describe or measure, but differences in the size and
intensity of personality can be readily perceived in some instances, especially when one
is in the presence of a towering personality such as a Napoleon, a Goethe, a Churchill, or
a Gandhi. Every individual has their own characteristic level of intensity which is distinct
from the vital or mental energy that they express and may best be represented by their
overall capacity to change or influence the people with whom they relate and the
environment within which they live.
• Depth of personality:
We have referred elsewhere to several stages in the formation of personality under the
terms Manners-Behavior-Character-Personality-Individuality. There are people such as
Lydia Bennet and Mrs. Bennet in Pride & Prejudice who have not yet developed the self-
control and maturity needed even for reasonably good manners and are very unlikely to
do so, regardless of their upbringing. Their very nerves are not yet capable of that
discipline. Others acquire perfect external manners, such as the teachers and students in
Mona Lisa Smile, but how they behave outwardly does not really reflect how they think
and feel inside. Still others, such as Jane Bennet in Pride & Prejudice, have achieved a
level in which their inner feelings are fully in accord with their external manners. They
truly mean and feel what they say, but the form of their personalities is largely
determined by the social norms and standards of the society in which they were raised.
Still others have a formed character that is capable of higher accomplishment, such as
Darcy in Pride & Prejudice. Then there are a few at the level of personality and true
individuality who have developed to the point where they can transcend the limitations
imposed by society and their own upbringing. Mikhail Gorbachev exhibited real
personality in undermining the monopoly on power of the political party and government
which he headed.
This factor refers to the relative development of the three different centers of
consciousness in human beings which is discussed at length in Physical, Vital, Mental
and Nine Levels. It is this factor which makes us classify a person as a thinker, a dynamic
man of action, a leader of people, an organizer, a loyal follower, a courageous patriot or
sensitive artist. While we can consciously strive to express more of the higher
consciousness with which we are endowed, except by spiritual change the relative blend
and balance of these three elements in our personality cannot be significantly altered.
William Collins may become a wealthy landlord but he can never become a perceptive
thinker like Mr. Bennet. Mary Bennet may become well-read and well-trained but she can
never develop the mental acuity and emotional depth of her sister Elizabeth.
According to Sri Aurobindo, even character and karma can be altered by the descent of
the supramental force into the human personality. But this is an extraordinary spiritual
accomplishment that lies far beyond the scope of psychological growth in the realm of
spiritual transformation.
Our minds tend to think in linear fashion. For the mind, progress is to move from one
point on a line to another point further along or higher up. But human personality and
consciousness are not simple. We consist of more than one dimension. Progress for us
cannot be reduced to any single dimension or direction.
There are countless ways to move from a point to a sphere. You can make progress by
traveling in any direction. But if you focus on only one line of progress, you will end up
at the end of a line, not on the surface of the universal sphere. To become universal we
have to make progress in multiple directions, simultaneously or successively. Our
progress from a point to a sphere is a progress on the dimensions described briefly in this
article and explored in greater detail in the Psychology Portal and Spirituality Portal.
While these different levels or categories of change can be distinguished from another,
they are not entirely separate or independent. Growing psychologically also enhances the
capacity for social accomplishment. Progressing spiritually also enhances the capacity for
psychological growth. It may also be true that greater social accomplishment increases
the readiness for psychological growth and psychological growth may enhance the
inclination or receptivity for spiritual progress. So while we speak of them as distinct
from one another, we think it is better to recognize their interdependence.
Freud developed an elaborate theory of how children grow up, how their sexual
instincts develop and mature. His stress on the sexuality of very young children
was shocking to many when Freud first propounded it; now, infant sexuality is
seen as just one facet of Personality development, not the whole of it.
Children derive pleasure and have problems with all their bodily apertures. From
Potty-Training to "Don't put it in your mouth, Dear", from warm encouragement to
harsh physical punishment, there are areas of the body which may either be the
centres of painful emotional storms or of feelings of warmth, pleasure, and being
loved.
According to Freud's theory, a child's sexual pleasures come from different areas
at different ages. These areas he called EROGENOUS ZONES. The zones give
their names to the stages of Personality development in which they are most
important to the Libido as sources of pleasure. Freud called these stages
PSYCHOSEXUAL STAGES.
Toddler
Autonomy vs Shame and Doubt
Works to master physical environment while maintaining
self-esteem
Preschooler
Initiative vs Guilt
Begins to initiate, not imitate, activities; develops
conscience and sexual identity
School-Age Child
Industry vs Inferiority
Tries to develop a sense of self-worth by refining skills
Adolescent
Identity vs Role Confusion
Tries integrating many roles (child, sibling, student, athlete,
worker) into a self-image under role model and peer pressure
Young Adult
Intimacy vs Isolation
Learns to make personal commitment to another as
spouse, parent or partner
Middle-Age Adult
Generativity vs Stagnation
Seeks satisfaction through productivity in career, family, and
civic interests
Older Adult
Integrity vs Despair
Reviews life accomplishments, deals with loss
and preparation for death