The purpose of the nursing theories is to provide an interrelating framework focusing on the nursing practice. The defined nursing theories promote better patient care, improve the status of nursing profession, and improve the communication between the nurses, and provide guidance to the researches and education (Keefe, 2011). Not all nursing theories have the same meanings; however, they play the important role of explaining the key concepts and principles of nursing practice in understanding way.
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Dorothy Orem’s Self-Care Deficit Theory and Sister Callista Roy’s Adaptation Model are considered as grand nursing theories. The grand nursing theories are a conceptual model, which identifies the focal point of nursing inquiry and guide the development of mid-range theories that will become useful to nurses and also to other health professionals. According to Walker and Avant (2011), these theories contributed in “conceptually sorting the nursing from the practice of medicine by demonstrating the presence of distinct nursing perspectives.”
This easy furnishes a comparison and contrast of Orem’s Self Care Deficit Nursing Theory with Sisters Callista Roy’s Adaptation Model in their importance to clinical practice. Roy put forward her theory of nursing in response to motivation of her mentor Dorothy E. Johnson. After doing B.A. in nursing, she did her masters and PhD in sociology which has an impact of her theory of nursing. In her concepts, Persons are viewed as living adaptive systems whose behaviors may be classified as adaptive responses or ineffective responses. These behaviors are due to internal and external stimuli and derived from regulator and cognitive mechanism. Her Model provides the framework for nurses by viewing the adaptability of patients to internal and external stimuli in their environments (Alligood & Tomey, 2006.). Nurses work towards achievement of adaptive response by four adaptive modes; Physical, Group Identity, Role Function, and interdependence. Nurses incorporate four modes by utilizing information about the person, adaptive level and various stimuli. By doing so, nurses manipulate these stimuli to promote adaptive responses and process of health by meeting the goal of survival, growth, reproduction and mastery. Dorothy Orem’s suggests that each person has a need for self care in order to maintain optimal health and wellness. Each person possesses the ability and responsibility for care for themselves. According to Orem, nursing becomes necessary when an individual can no longer care for him or herself. Nursing provides care through acting, guiding, supporting, teaching, and environmental manipulation promoting personal development. Orem developed this theory from her experience and personal connection with the Vincentian-Louisiana nursing tradition of the Daughters of Charity (Libster, 2008.)
Metaparadigm for analysis
The metaparadigm for nursing is the concepts that define the nursing practice. Since 1970s, person, nursing, health, and environment are considered as the core concepts of nursing theories by many nursing theorists.
According to Orem, a person is made of a physical, psychological, and social character with variable degrees of self-care ability (“Dorothea Orem’s Self,” 2011.).Orem described the person as able to appraise situations, reflect upon them, and reason and understand them. Based on this description, the person deliberately chooses to perform specific action, something he or she can do even in the face of internal and external pressure to the contrary. She further explains that actions are goal directed; that is, undertaken to achieve valued outcomes (Orem, 1980). This view of the person as self-determined, action oriented, and goal directed is captured in Orem’s portrayal of the person as agent or as having agency. In view of Whall and Fitzpatrick (2005) Orem challenged, to some extent, the more prevalent view of nursing that the person is an adaptive system and can be understood as adapting to his or her environment.
Roy views a person as “an adaptive system that responds to internal and external stimuli in their environments” (Alligood & Tomey, 2010). Within the adaptive model, person is described as an adaptive system, a whole made of parts that adapts to changes in the environment and also affects the environment. The mechanistic view of person is inconsistent with the holistic view espoused by Roy. However, Roy has stated that the focus on parts is only for descriptive purpose and that the model is based on a holistic view espoused by Roy. However, Roy has mentioned that the focus on parts is only for descriptive purpose.
Orem and Roy have the different attitude toward the concept of nursing. Orem sees nursing as an intervention to meet the daily needs for self-care and medical-care patients need (“Dorothea Orem’s Self,” 2011). Nursing when defined in terms of focus (for knowledge and practice), is a specialized health care service necessitated by an individual’s inability to maintain the amount and quality of self -care that is therapeutic in sustaining life and health, in recognizing disease from injury or in coping with their effects. Nurses create a Nursing-System as helping system in which the method of helping is determined by the degree to which the patient is able to accomplish his or her self-care requirements as explained by Whall and Fitzpatrick (2005, p 113).
Roy believes nursing as a key player to help patients to develop coping mechanism and positive outcome from the constant stimuli exposure. Roy’s goal is for the patient to achieve adaptation leading to optimum health, well-being, quality of life, and death with dignity, and finding in life by participating in their own care (Andrews & Roy, 1999.).Two aspects of nursing are unique to the model: the two-level assessment in the nursing process and intervention as management of stimuli. The two-level assessment provides for the evaluation of the patients behavior (response) and the stimuli to which the person is responding. This notion is appropriate to the model that it focuses on person responding to stimuli. Nursing enhances adaptation through the use of nursing process, thereby promoting health through the management of stimuli or the strengthening of coping process (Andrews & Roy).
Orem defines health as “physical, mental and social well being” (“Dorothea Orem’s Self,” 2011.). It adds to the complexity of Orem’s conceptualization that health is presented as an outcome of self-care and as one of the numerous factors that influence self-car agency and self-care demand. To clarify a person in a poor state of health is likely to have diminished self- care agency that add to person’s self-care demand.
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Roy views health as a method used by patients to obtain their utmost possible health, regardless of the presence or absence of disease. Health is a state and a process of being and becoming an integrated and whole person. It can be viewed as a reflection of the interaction or adaptation of human adaptive systems within a changing environment as elaborated by Whall and Fitzpatrick (2005, p 148).
Orem and Roy both state the individual exists in an environment. Orem sees the environment in two dimensions, the physical, chemical, biologic features and socioeconomic features, which influence the self-care requirements of the individual (“Dorothea Orem’s Self,” 2011.) According to Roy, the environment consists of stimuli including conditions, circumstances, and influences surrounding an individual, whether focal, contextual, or residual.
Analysis for Use in Practice
Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model can be applied to groups or individuals, and used at any nursing settings. However, Orem’s Self-Care Deficit Theory is more recommended for the acute-care setting, where a patient receives active but short-term treatment for a severe injury or episode of illness. Orem focuses on finding the self-care deficit of the patient and providing the necessary care to promote his or her well-being. Whereas, Roy is concerned with the different stimuli that forces adaptation in order to achieve optimal health. A nursing model provides the structure to guide practice by providing direction for the nursing process. The adaptation model provides this direction based on its well developed guidelines for the use of nursing process. Simultaneous assessment of the behavior and stimuli leads to the identification of nursing diagnosis and the establishment of goal. The model provides the framework for intervention, which is focused on the management of the stimuli and management of the adaptive processes. Evaluation assesses the effectiveness of the intervention by examining the behavior. Roy’s Adaptation Model views the person as an adaptive system which includes the four adaptive modes. These adaptive modes are: physiological-physical mode, self-concept-group identity mode, role function mode, and interdependence mode. Although first two modes can be identified immediately, the assessment of role function mode and interdependence mode is time consuming. It depicts that Roy’s adaptation model is more suitable for chronic care settings. However, usefulness of the adaptation model in practice has been demonstrated in a variety of settings with diverse population (Alligood & Martha, 2010). Furthermore, the expansion of the model offers a framework for systematic healthcare delivery to aggregate, making it more amenable to community health nursing (2010). The holistic approach of the model helps prevent putting too much emphasis on aspects of illness and allows for the inclusion of health promotion. It all adds in to the efficiency of the model in effectiveness of working on the nursing process and better patient outcome. Along with its usefulness the holistic assessment based on the model can be a lengthy and time consuming process. This concern has been found to be most problematic in intensive care units where there are rapid changes in patient condition and least problematic in long term care settings of the hospitals or health care organizations (Weiss et al., 1994).
The adaptation model goes with the classification furnished by the American Nursing Association (ANA); that is, North America Nursing Diagnosis Association (NANDA), that focus on the component of nursing process. The adaptation model incorporates the specific interventions and outcomes for the specific diagnoses (Wilkinson, 2000.). This adaptation model is more suitable to clinical practice by provision of the framework for the nurses to rehearse the art of nursing process explained in the model.
It is clear from the above discussion that nursing theories promotes better patient care, bring positive impact on nursing practice and improves the overall nursing standard. Along with the directing the nurses to utilize evidenced based and well thought process of care, nursing theories guide in developing nursing educational programs, nursing administration and research pertaining to nursing profession.
Many organizations now exist to support the advancement of nursing profession. Sigma Theta Tau International, the Honor Society of Nursing, is created to “support the learning, knowledge and professional development of nurses committed to making a difference in health worldwide” (“STTI Organizational,” 2011.). It also worth mentioning that the two described models have professional organizations that have as their purpose to support and develop further in the models. International Orem Society “promote the advancement of nursing science and provide scholarship in the area of Orem’s Theory of Self-Care Deficit Nursing to lead to further advancement of knowledge for the discipline of nursing” (“International Orem,” 2011.) The Roy Adaptation Association (RAA) is a society of nursing scholars who want to “advance nursing practice by developing basic and clinical nursing knowledge based on the Roy Adaptation Model” (“Roy Adaptation,” 2011.) These organizations along with progression of the nursing theories will promote the advancement of nursing science and enhance the nursing profession.
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