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Draper states that nursing theory is a tool This simile, although quite crude, captures the notion of goal orientation that a nursing theory is said to require. Drapper focuses on two goals that a nursing theory has or should have in view. First, a nursing theory serves as a framework to provisionally understand some part of the nursing world by identifying relevant phenomena that need examining, and second, it identifies a special task of nursing, i.e. to postulate an ideal world of nursing. It is the combination of ideas, explanations, relations, and assumptions derived from nursing models or from other disciplines and project. Actually theory is an idea or mixture of ideas that is suggested to explain phenomena. For understanding of theory, it is important to learn about the concept, conceptual frame work, and other elements of the theory. Nursing theories have greater impact on today's nursing, it helps in education, nursing care, and research. In this paper I am discussing the Orem theory and Roy adaption model, and will compare and contrast to conclude the better applicability of it.
Every human has the capability to perform self-care and maintain his/her health and life met paradigm of the theory is human, health, environment, and nursing. Orem's theory is made up of three related theories
Theory of self-care
Theory of self-care deficit
Theory of nursing process
First is theory of self-care, Orem explains that if individual can attain all the needs are capable for self-care. Self-care comprises those activities performed independently by an individual to promote and maintain personal well-being throughout life. She suggested that human beings are capable and responsible for taking action to adjust their health, and life. The term she provided to this capability to take action on one's own behalf is self-care agency. The second is self-care deficit theory, which tells us that human beings have some need for survival, and are capable to attain it for health, and life. Human beings take some action to attain their needs and sustain life, which is called therapeutic self-care demand. When these actions are insufficient to fulfill all or part of the therapeutic self-care demand (needs), a self-care deficit develops. In this way the person is unable to perform and manage everything she/he needs to maintain health, and life. Third is theory of nursing process, to develop and organize an action plan that connects the identified gap between self-care agency and therapeutic self-care demand." (Whitener, 1998, PG). It build up the capabilities to meet their self-care, for example a person is unable to maintain his health. In this way the nurses will help the person to perform the needed action, or find someone to assist in the performance of the actions.
Nursing goal focuses to overcome human limitation for needs and self-care. Nursing process is further divided in to nursing practice and fundamental nursing science. Nursing practice is based on observation, judgment and decision in nursing practice.it is evidence based practice awareness and critical thinking in nursing practice. Critical thinking further divide into diagnostic, prescriptive, regulatory and control evaluation. Orem explains five ways, on the basis of that nurses can help their patients in enhancing self-care: acting and doing for others, guiding, supporting, promoting personal development and teaching.
Roy Nursing Model
Roy developed adaptation model of nursing, and define the delivery of nursing care. Roy explain the Human beings as a set of interrelated system(psychological, biological, and social).human beings are in struggle to bring equilibrium between their system and environment. Human beings are facing factor (stimuli) from the environment, which alter the balance between the individual and environment. Stimuli may be external or internal which help or hinder in the process of adaptation. To bring balance human beings develop coping mechanism (behavior) to the stressor. It is a framework between environment and human beings, and stimuli, human beings changes his capabilities for adaptation.it also comprises the four domain concepts of person, health, environment, and nursing. In Roy's model goal for nursing is to help in adaptation to improve person health, quality of life, and dying with dignity. These are four modes which she used in her model are physiological, self-concept, role function and interdependence. She used six step nursing process assessment of behavior, assessment of stimuli, nursing diagnosis, goal sitting, intervention, and evaluation. It is a complete process, on the basis of which we can do assessment and plan for intervention to get the desire goal.
Roy's model has three basic concepts: the human being, adaptation, and nursing. The human being is continually interacting with the environment (stimuli), and nursing is the helping to bring balance and adaptation. The person has two major internal processing subsystems, the regulator and the cognator." These subsystems are the mechanisms used by human beings to cope with stimuli from the internal and external environment. The regulator mechanism works through the autonomic nervous system and includes chemical, neural, and perception pathways. This mechanism prepares the individual for coping with environmental stimuli. The cognator mechanism includes emotions, perception, processing, learning, and judgment.
There are three types of stimuli focal, contextual, and residual. Important factors in all human beings adaptation include developmental stage, family and culture. In the same way adaptation level of the life process is explained on three different levels: integrated, compensatory, and compromised. Adaptation is a mechanism in which a person is coping mentally, physically, socially, spiritually and emotionally. Nursing role in adaptation process is to help out in adaptation and improve capabilities. Roy adaptation model has a great implication in nursing care, education, and research.
Compare and contrast between the Orem and Roy nursing theory
Dorothy Orem's Self-Care Deficit Theory and Sister Callista Roy's Adaptation Model are grand nursing theories, but their applicability are the same as the middle range theory. The grand nursing theories consist of conceptual model, which find out the main point of nursing investigation and monitor the development of mid-range theories that will be suitable to nurses and as well as 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."
Orem's Health Care Deficit Theory and Sister Callista Roy's Adaptation Model are compared and analyzed for their importance in nursing. The main aim and purpose of the nursing theories is to provide nursing care to the human beings. Orem and Roy nursing theories based on the interrelating framework, which emphasis on the nursing practice. Therefore these theories promote better patient care, improve the status of nursing profession, and help in communication between the nurses, and provide supervision to the researches and education.in both theories the nursing process are the same, first we do assessment, identify the problems, plan goal, intervention , and evaluation. They used the different word for nursing but the process and approach are the same.
Orem and Roy used the same paradigms system which is related to nursing-person, health, environment, and nursing-are basic and important to nursing practice, but the main focus is health and improvement of life. Today the main focus of health professionals is prevent illness, give medication, and implementation. These paradigm have greater relation with each other, help in every intervention of nursing as well as the other professionals.
In both of the models age, past experiences, developmental, and sociocultural environment influences the individuals. These factors are directly and indirectly affect the person for self-care and adaptation with the internal and external environment. Nurses, patients, other family members, and environment are involved to improve capabilities, possibilities to attain necessary needs to sustain life and growth Furthermore, Zarkowska and Clements (1994) share Orem's (1991) concept of the dynamic interplay between social, physical, environmental and psychological issues in relation to the adjustment of personal behaviors. They suggest that it is through the manipulation of the environmental settings, triggers, human actions and responses that an individual can be motivated to adjust personal behavior. In both models the nurses assess patients' potential and capabilities to attain their needs, nurse select the most appropriate and effective process and take actions survival and health.
Orem and Roy model are preventive and rehabilitative nursing models. In the Orem nursing theory, she focus on the needs which are required for sustaining life, growth and development. It is used for rehabilitation and as a primary care, in which the individual is encouraged to be independent. The main purpose of this theory is to assess the individual at different level and provide care accordingly to the needs .Roy model of adaptation is also a rehabilitative and preventive model, according to her nursing is a service to the society. Human beings have the capabilities to change the stimuli or adapt the stimuli to promote health and life. Adaptation is a positive response to the surrounding environment and changes; it is the response from the individual and choice to bring equilibrium between self and environment. Before the stimuli to harm the individual, individual responded to the stimuli to build adaptation. The goal of adaptation is build coping mechanism to achieve survival, development and mastering to the stimuli.
Orem's and Roy's nursing theories, addressed each theory with respect to the four meta-paradigms of nursing, and finally compared the one meta-paradigm of health across both theories. This analysis has shown that Orem's theory is more occupied with activities that promote health, while Roy's theory is more concerned with where the patient stands on the health-illness continuum and how he can be brought to greater wholeness. It is argued that Orem nursing theory is always applicable; it is only a theoretical model.
Orem model only focus the individual, that each individual has the capabilities to perform self-care. Every person will perform activities for his/ her needs to survive, maintain growth, health, and life. (Polit & Henderson p. 103). The fundamental principle of the model is that individual will take responsibility for his/ her health and the health of other; it is the main drawback in her theory.in Roy model the there are four adaptive modes for survival, physiological, role function, self-concept, and interdependence mode.it means that Roy adaptive model focus on different perspective of the patient. "In Roy's Adaptation Model, humans are bios psychosocial adaptive systems who cope with environmental change through the process of adaptation." (Polit & Henderson, p. 104).
Orem theory has one limitation i.e. it doesn't not comprise all aspects of care and needs of a specific client. Therefore some dilemma and miss conception has been found with Orem theory, having unclear definition of family, community, nurse society relationship, and public education area. Although the family, community and environment are considered in self-care action, the focus is primarily on the individual (Balabagno, et.al, 2006). Roy model explain the definition of family, community, environment and nurse society relationship it is the nurse role to enhance capabilities in situation of health and illness and to improve the involvement of human systems with the environment, and promote survival (Roy &Andrew, 1999, p.55)
The most noticeable limitation of Orem theory is that in her theory, she did not explain well the individual emotional needs. She focuses on physical care and provides limited stress to psychological care. Roy nursing model explains it very well in detail, but at the same time it needs time and deep knowledge for understanding..
Orem's theory of self-care is more applicable to acute care settings, whereas Roy's adaptation model is more useful in the chronic care setting as elaborated by Alligood and Tommy (2010). The assessment process in adaptation model takes longer time and often happens to be a repetitive process for various components of assessment. So, in acute care setting like in emergency care and in ICU, a less need to adaptation to stimuli is less pronounced. However, self-care model is more applicable in acute care settings. Moreover, Self-care model incorporate concepts of nursing process as developed by American Nursing Association (ANA) that are espoused by North American Nursing
Application in nursing
Every theory has its own implications and importance in nursing, both the theories have greater impact on today's nursing, it help in education, nursing care, and research. Dorothy Orem's Self-Care Deficit Theory and Sister Callista Roy's Adaptation Model are using as a grand nursing theories, but their applicability are the same as the middle range theory. Orem and Roy nursing theories based on the interrelating framework, which emphasis on the nursing practice. These theories follow the same approaches, both the theories help in curriculum development, and nursing care to prioritize the nursing needs. After discussion I conclude that Orem nursing theory is best suited in the clinical practice. Orem nursing theory is more applicable in hospital set up and community, and based on the evidence base critical decision. The self-care theory associates the patient assessments with nursing diagnosis, expected patient outcome, discharge planning, quality assurance, clinical research, and external agency reports. Many researches has been done on the Orem nursing theory application in different area of health .it is applicable acute care units, ambulatory clinics, community, nursing homes, hospice, and rehabilitation center. Orem theory is applicable to a variety of patients, specific diseases, chronic disease, alcoholic, head and neck surgery, arthritis, and cardiac condition (Conway, McMillan, & Solman, 2006). This theory is also applicable to different ages, children, and mother with newborns.
All the nursing theories have their significances; nursing theories create new approaches, and method to nursing practice. Theories challenge the existing knowledge and practice, and change the structure of laws and principle. The main purpose of theory is to improve nursing practice, and the goal is guide the nursing practice. We are familiar that nursing practices are totally based on theories. We are using these theories directly and indirectly in our practice, but it that variety of definitions and concepts explain in nursing theories does not predict anything. It cannot be applied to the clinical practice and have a little impact on nursing practice. All the concepts, paradigm, and frame work guide and provide rationale for practice, but due to advancement in practices the incorporation become problematic.