10 Priya Aranha
10 Priya Aranha
Abstract
Rogers’ system model is commonly known as Science of Unitary Human Beings. It views human beings as integral
with their environment. As per the concepts of the Rogers system model, nursing focuses on human beings and the
manifestations that emerge from the mutual interaction of human and environmental field. It is said that the change in
the pattern and organization of man and his environment is transmitted by waves; this pattern emerges as observable
event in the life of man. Thus, better understanding of human experience is made possible. In this paper, the author
has described the nursing care of a client with cerebrovascular accident based on Rogers’ system model where the
author has described how a client, who was initially diagnosed to have hypertension and diabetes leads a life, and then
develops complications and how her life pattern changes. It shows how the client, in spite of frequent hospitalization,
strives hard to move unidirectional towards maximum health within her limits.
Key words: Cerebrovascular accident, Helicy, nursing care, Rogers’ system model, resonancy, unidirectional
model. She derived her concepts from the idea that the The slinky in Figure 1 represents that life process
universe is an open system within which individuals is continuous and it moves unidirectional from
and their environment interact independently and conception to birth in a non-linear plane. Slinky toy is a
continuously (Tomey & Alligod 2006). spiral which moves in a particular direction only. When
the spirals are moulded they do not come back to its
According to Rogers, ‘energy fields’ are the basic units previous state. Similarly, the nature of human change is
of both living and non-living things. These energy spiral like, continuously progressing towards increased
fields provide guidance to perceive human being diversity. Rogers says that human development is not
and environment as whole. She identified man and static, and humans do not ever return to exactly the
environment as the energy fields. The energy fields same place where they were before (Tomey & Alligod
continuously vary in intensity, density, and extent. The 2006). When the person follows the path along the
second building block is ‘openness’ which says that the Slinky, he may have spiralled to a place that is similar to
energy fields, i.e., human being and the environment where he was before but is just one circuit or turn on
are found to be constantly exchanging their energy. the Slinky from that original place. (http://www.suidoo.
The energy flow between these two fields does not com/Rogerian_Theory)
have any boundary that inhibits the flow of energy. The
The principle of integrality explains that there is a
third building block is the ‘pattern’. Rogers explains it continuous and mutual process between human field
as a distinguishing characteristic of an energy field. and environmental field. This principle is divided into
It is perceived as a single wave. Pattern is a character two i.e., reciprocity (wholeness, openness, continuous,
that gives identity to the field. The fourth building and mutual interaction between human being and his
block is ‘pan dimensionality’ which is a non-linear environment) and synchrony (simultaneous change in
domain, without any spatial or temporal attributes; human and environmental fields) e.g. the child playing
its boundaries are imaginary and fluctuate constantly. in the sun on a bright summer day gets a sun burn. This
(http://currentnursing.com/nursing_theory/unitary_human_ is the process of interaction between sun and a child.
beings.html) However, the mutual process between the child and the
sun occurs simultaneously, where he gets Vitamin D
Rogers stated the principles of homeodynamics are
along with the ongoing effects of radiation (George
based on the above building blocks. These principles 2002). This is the ongoing mutual process and is the
help individuals to understand life and the mechanisms nature of human beings and their environment.
affecting life. They also provide knowledge on how to
intervene and redirect the clients. The principles of Rogers explains the four paradigms in her model. They
homeodynamics are resonancy, helicy, and integrality. are human, environment, health, and nursing. She says
that human is an irreducible, pan dimensional energy
According to Rogers, resonancy is the continuous field that can be identified by pattern and manifesting
change from the lower to higher frequency wave pattern characteristics and that are specific to the whole and
in the energy fields. Human beings are perceived as wave they cannot be predicted from the parts. Rogers defines
patterns and a variety of life rhythms like sleep – wake that the environment is in constant interaction with the
rhythms, hormonal levels, and fluctuating emotional human being. Each environmental field is specific to
states can be linked to the wave patterns. The change its given human field and both changes continuously
occurring in these are from lower to higher frequency and creatively. Rogers says that health is an activity in
pattern. Helicy represents the continuous, innovative, the life process which leads to the optimum fulfilment
unpredictable increasing diversity of human and of a person’s potential. Health is a rhythmic patterning
environmental pattern. It means that humans do not of energy that is mutually enhancing and expresses full
regress but become increasingly diverse and complex life potential. According to Rogers, nursing aims to
e.g. slinky toy (George 2002). promote symphonic interaction between the man and
his environment thereby strengthen the coherence and
integrity of the human beings and to direct and redirect
Figure 1: Slinky toy, representing helicy patterns of interaction between the energy fields for
the realization of maximum health potential. (http:// She was fed through nasogastric tube, Foley’s catheter
www.en.wikipedia.org/wiki/Martha_E_Rogers) was draining urine, and bowel pattern was regular. A
decubitus ulcer was present on the sacral region. She
So here, the author during her clinical practice has
had restricted movements of the right side. After
tried to apply Rogers system model and on the
regaining her consciousness and when her condition
basis of which nursing care was provided to Mrs
was stable, she was shifted to medical ward. In the
Geetha (name changed) with the diagnosis Systemic
hypertension (HTN), Diabetes Mellitus (DM), old CVA ward, she looks more relaxed and able to tolerate fluids
[Cerebrovascular accident (CVA)] and septicaemia. orally.
Case description Mrs Geetha was a widow residing with her son. She
Mrs Geetha, a 70 years old female, was admitted to the said, “For seven years my son is spending a lot on my
Intensive Care Unit (ICU) in an unresponsive state and treatment. My sickness has laid burden on him and his
was diagnosed to have septicaemia. She was a known family.” Her son is very supportive and states, “Our
case of hypertension and diabetes mellitus for seven mother has brought us up with lot of difficulties, so
years. She had right sided hemiplegia due to a stroke a we want to take care of her well.” He added, “My
year ago. She was on regular treatment. On admission, mother is very religious and strong enough to face the
she was treated in the ICU for three days and then problems of life.”
shifted to the general medical ward.
Mrs Geetha was treated in the hospital for three weeks
In the ICU she was drowsy, not able to verbalize her and then discharged. On discharge, she was able to
feelings. She stares blankly. Her face looked anxious. tolerate soft diet. Foleys catheter was retained. Family
members were taught about the care to be taken at moving towards maximum health, but she was not able
home. They were referred to social workers. Mrs to achieve it, her condition deteriorated, and she was
Geetha was able to sit with support in the bed, move hospitalized. Her pattern in the hospital had changed
her left limbs, but was dependent on others for all other again, which was decided by others especially the health
activities of daily living. care professionals and her family members. During her
hospitalization, the main concern of the nursing staff
Application of Rogers’ system model to Mrs was to help her achieve maximum health. At the time
Geetha of discharge, family support and rehabilitation was
The data in Figure 2 explains that the pattern of Mrs provided so that she is hale and hearty in future. She
Geetha changed according to the changes in life. was using the resources from family, society, and the
Initially she was healthy, independent, and active in hospital for a better life in future. Based on the above
her life. Once she was diagnosed with HTN, DM and concepts, nursing care was provided to Mrs Geetha
later with hemiplegia, she had to change her life style
using the nursing process.
and adjust with her illness. For the seven years she was
Table 1:
Nursing assessment based on Rogers’ system model
Assessment Nursing Diagnosis
Pattern 1) Self-care deficit related to immobility.
Mrs Geetha is a right sided hemiplegic. She said, “I cannot do anything of my own. I am
dependent on others for everything.” She tolerates only fluid and soft diet and her intake is reduced. 2) Impaired skin integrity related to
She has a deep bedsore over sacral region. prolonged bed rest.
Her pattern is decided by others in the hospital. She said, “I am not able to mix up with others 3) Impaired social interaction related to
due to my condition, I feel lonely.” Mrs Geetha’s son stated, “She is very religious and bold enough activity intolerance and inability to
to face the problems of life, but now she has lost the confidence. She feels lonely and isolated.” travel to usual social activities.
Mrs Geetha strives hard to achieve the fullest health within her limits. 4) Interrupted family process related to
Resonancy financial crisis.
Mrs Geetha is on treatment. She complies with it. She states, “If I do not take these medicines
my condition may deteriorate further.” She further states, “My illness has laid burden on my son.” 5) Anxiety related to prognosis of the
But her son is very supportive. It is observed that sometimes she is pleasant, sometimes dull and disease.
withdrawn. When she was dull she said, “I feel depressed and guilty of my illness. I do not know
what will happen in the future?” 6) Risk for care giver strain related to the
Helicy chronic illness.
In Mrs Geetha’s present condition she is unidirectional in moving towards achieving health within
her limits. She said, “I accept my illness; I may be recovering by using all the resources available. 7) Knowledge deficit of the caregiver related
I do not fear death.” Her son stated, “We will support and care for our mother throughout her to homecare management.
remaining life.”
Integrality 8) Risk for complications related to the
As Mrs Geetha is hemiplegic and ready for discharge, her family has to do some modifications at chronic illness.
home. She has to get treatment for her HTN and DM also. Her son stated, “I do not know how
to take care of her at home and prevent any forth coming problems.”
In the above-mentioned nursing diagnosis, the nursing care has been rendered to Mrs Geetha and according to the priority, a few nursing
care aspects has been discussed herewith.
Table 2:
Nursing care plan for Mrs Geetha
Nursing Goal/ Planning Implementation Evaluation
diagnosis objective
1). Self-care deficit To meet the -To assist the - Performed ADL which the client is not able to Client is carrying
related to immobility self care needs client in meeting do out the activities
(activities of ADL. - Assisted the client in washing, eating, grooming within her limits.
daily -Provide constant etc. Family members
living encouragement -Provided constant encouragement to Mrs Geetha are assisting and
[ADL]) Provide family -Provided constant reinforcement encouraging her.
support. -Taught the family members about care of the
client and involved them in the care of the client
could illustrate Mrs Geetha as a whole, how she has George, J. B. (2002). Nursing Theories, A base for professional
been interacting with her environment and the need to nursing practice. USA; A Pearson Education.
modify the environment according to her condition.
Tomey, A. M., & Alligod, M. R. (2006). Nursing theorists
It is recommended to use Rogers’ system model by
nurses in their day to day practice so as to provide and their work, Philadelphia; Mosby.
comprehensive nursing care to the clients. Application of Nursing Theories, Science of Unitary