- Introduction
As a profession, nursing existed since the early years of civilization. Although nursing in the early days was not sophisticated or complex as it is in the contemporary, various attempts were made to improve on care given to the patients (Parker, 2010). In fact, nursing as a field has its roots in the early attempts by human kind to provide care to the sick and the weak. It was through progressive modifications, adjustments and improvements that nursing or caring evolved into a large field with its roots deeply grounded in various concepts. Nursing concepts since the inception of care have continued to have significant impacts on care and nursing with different people developing various concepts aimed at bridging gaps within provision of care. It can be confidently said that nursing is a profession that has been shaped by the successive development of concepts and improvements of these concepts (Parker, 2010). Concept development involves a keen observation of nursing procedures and how care is primarily being offered and subsequently identifying where gaps or weaknesses lie within the care processes. Once a niche has been identified, concepts based on evidence and thorough researches of the situations are developed as a way of addressing the niches in provision of care. Concepts are then evaluated for effectiveness and in the event that they prove to be effective, they are incorporated in nursing processes and practice.
During the peak years of human civilization and enlightenment, various scholars began to see the importance of nursing in the society and shifted attention towards developing theories or rather models aimed at improving provision of nursing care in the overall (Snowden et al.,2014). To a large extent, theories can be termed to have developed in a similar manner as nursing concepts. Primarily, nursing theories qualify to be termed as tested concepts. Historically, different theories have continued to remold or shape nursing practice trough out the years and the current levels of expertise and efficiency found in nursing fields can be attributed to the enormous contribution of these theories. Theories impact on nursing by introducing change or shifts within nursing standards, procedures and processes. However, it is important to understand that nursing theories are not static but dynamic or flexible. As much as nursing theories require nurses to operate within a certain prescribed frameworks, it does not imply that such frameworks are fixed or rigid. Nursing profession is constantly evolving and day in day out, human kind is faced by different challenges that require review and revision of existing models (Alligood, 2013). To make theories relevant with time, it is important to ensure that theories are regularly evaluated for their effectiveness and adjusted or improved to meet the healthcare needs (Snowden et al., 2014). Modern day nurses have the role to build upon the theories created by earlier nurses and incorporate their real clinical experiences in providing improvements or perhaps better alternatives. As afore-mentioned, nursing is an ever-evolving body of knowledge and this is demystified by constant modifications that have been done by the subsequent nurses thorough out the years. Although some theorists have developed theories from their self-initiated concepts, many theorists seem to have worked to improve the existing theories, through identifying their weaknesses and subsequently addressing the weaknesses (Parker, 2010). This may elucidate why many theories show sheer resemblances and congruence in terms of the concepts driving them.
- Nursing Theories
Orem’s self-care deficit theory of nursing
Orem’s self-care deficit theory of nursing is widely used in all clinical settings (Alligood, 2013). The theory is anchored on four domain concepts, namely; nursing, health, environment and human being. Under this model, nursing is described as the art of assisting individuals to attain a healthy equilibrium with their environments. This means that nursing aims at supporting individuals in their pursuit of self-care. Simply, the nursing process assists individuals to take charge of their health through promoting self-care. On the other hand, the health is the primary objective of care. Health is defined as wholeness and encompasses structural and functional soundness. This implies that a healthy person is supposed to be in sound structural and functional shape (Taylor et al., 2011). On the hand, the environment under this model is described as a collection of enthronement factors that affect the health. To foster good health, the environment and the individual must strike a sheer balance. This model describes the human being as a unitary system that can function socially, symbolically and biologically.
Orem’s self-care deficit theory of nursing encompasses three basic theories. These include the self-care theory, self-care deficit theory and the nursing systems theory. The self-care theory asserts that individuals are in constant pursuit of adjusting their environments to maximize their self-care abilities as a way of maintaining life and wellbeing (Orem, 2003).
Self-care deficit theory describes a situation whereby an individual has no ability to provide self-care. Absence of self-care is occasioned by the inability of an individual to meet his/her self-care needs and as such the need of external support. Forces such as aging, gender predispositions and trauma may compromise an individual’s ability to provide self-care.
Nursing systems theory encompasses the role of nurses in fostering self-care. One an individual experiences deficit in self-care, it is the role of a nurse to intervene and support the individual in meeting these needs. Self-care can only thrive in the presence of three major self-care deficits. These include universal, developmental and health deviation requisites. In the absence of any of the self-care requisites, an individual’s self-care abilities are significantly compromised.
Nursing interventions may take place in three forms of approaches, and it is up to the discretion of the nurse to use a certain nursing system in addressing self-care deficits. Nursing systems under this model are classified as wholly compensatory, partially compensatory or supportive/educative systems.
Working of Orem’s self-care deficit theory of nursing
As demystified in the above diagram, under Orem’s theory, nursing systems may be classified as wholly compensatory, educative/supportive and partially compensatory. The decision on which system to use by a nurse I guided by a thorough assessment of the patient’s needs. Wholly Compensatory systems are used when the patient is totally deprived the sense of self-care and hence the nurse provides complete assistance (Richard & Shea, 2011). On the other hand, educative/supportive systems are used in the event when the nurse acknowledges the fact that an apparent self-care deficit is occasioned by gaps or niches in information or knowledge. As such, as a way of fostering self-care the nurse undertakes provision of support or education to address the lack of information. Partially compensatory systems are used when there is a partial absence of self-care. Partially compensatory systems may be termed as supplementary or complimentary to the existing self-care abilities of the patient. In utilizing the Orem’s theory, the nurse utilizes the nursing process including diagnosis, treatment and evaluations (Orem, 2003). The diagnosis phase includes an assessment of the patient’s self-care abilities and needs, while the treatment or interventional phase involves the use of the plausible intervention or nursing system to alleviate self-care deficits. Evaluation phase involves collecting data on the efficiency of the nursing system used and subsequently making rectifications or adjustments if need be. As such the role of a nurse is to act as a bridge between the environment and patient’s self-care needs. The nursing systems primarily intend to strike a sheer balance between self-care needs and the environment as a way of fostering self-care.
Roy’s adaptation model
Roy’s adaptation model is an important nursing theory that was developed by Roy Callista in 1976. The model views an individual as a bio-psycho-social being who constantly interacts with a changing environment. According to the model an individual use the acquired as well as the innate mechanisms to effectively cope with the changing environments that surround him/her. Additionally, illness and health are inevitable aspects in an individual’s life that are mainly as a result of the environmental changes within person’s life (Blais and Hayes, 2011). As such, an individual must adapt to the environmental changes in order for him/her to respond positively to these changes. On the other hand, failure of an individual to adapt to these changes leads to negative outcomes that are associated to a person’s illness.
Roy’s adaptation model incorporates various concepts from the “adaptation-level theory of perception. Some of the major concepts that are incorporated into the model include personal, health, environmental, nursing and adaptation concepts.
According to Roy, human beings are holistic creatures who constantly interact with their surrounding environments and use acquired as well as innate mechanisms to respond and adapt to environmental stimuli. On the other hand, environment is described as a set of conditions, influences and circumstances that have effect behavior development of individuals as an adaptive system (Paiva Rodrigues, 2008). Therefore, the environment is a type of stimuli that an individual must adapt to so as to ensure positive response. These environmental stimuli are categorized as residual, focal or contextual stimuli. Health is another concept that is incorporated in the model and is described as a condition whereby human beings adapt themselves to the stimuli that they encounter. Therefore, health occurs as a result of being able to core and adapt to the external and internal stimuli while on the other hand illness is the failure to adapt to these stimuli (Parker, 2005). Nursing is another concept that is incorporated in the model whereby nurses facilitate the adaptation of individuals to various stimuli and promote effective coping mechanisms that lead to desirable outcomes. The adaptation concept involves conscious awareness that leads to environmental integration. The internal adaptation process is described as an individual’s coping mechanisms whereby an individual uses the brain to cope with the existing stimuli through interdependence, self-concept and role functioning of the adaptive modes. Thus, individual adaptive modes include self-concept, physiologic, role function and interdependence. On the other hand, the adaptive modes for groups include group identity, interdependence and role function.
The adaptation level of an individual varies depending on the type of stimuli one is subjected to, thus an individual’s adaptation level comprises of a region that indicates the type of stimulation that will eventually lead to a positive response. Therefore, an individual has four modes of adaptation that include self-concept, interdependence, physiological needs and role function. According to Roy nursing is a practical science that focuses on expanding the adaptive abilities of individuals and enhances personal transformation (Clarke et al., 2011). As such, the primary goal of nursing is to promote individual, as well as group adaptation in the aforementioned adaptive models. This is made possible by assessing the factors as well as the behaviors that have influence on the adaptive abilities of individuals and subsequently intervening to expand on those abilities as well improve environmental interactions.
Therefore, nursing process is a problem solving approach that involves gathering of data, identification of the needs and capabilities of human adaptive systems, selection and implementation of approaches used in nursing care and evaluating the outcomes of the type of care provide to individuals. According to the model, nursing process involves six steps i.e.
• Behavior assessment
• Stimuli assessment
• Nursing diagnosis
• Goal setting
• Intervention
• Evaluation
Behavior assessment is the first step involved in the nursing process that mainly involves collection of information about an individual’s behavior as part of the adaptive system in the four adaptive modes. The second step in the nursing process is stimuli assessment. This step involves identifying external as well as internal stimuli that influence an individual’s adaptive behavior. The types of stimuli that influence an individual’s adaptive behavior are categorized into three categories i.e. contextual, focal and residual stimuli. Nursing diagnosis is the third step involved in the nursing process and involves the invention of statement that can interpret the collected information about the individual’s adaptive status. Additionally, this step includes the behavior of individuals and the relevant stimuli to the aforementioned behavior. Goal-setting is the fourth step that involves setting out of clear objectives in regard to the behavioral outcomes of the nursing care offered to individuals. The fifth step involved in the process of nursing is the intervention step that involves the use of appropriate measures and tools to offer assistance to an individual in the best possible way in order to attain the set out goals. Evaluation is the last step involved in the nursing process that involves assessing the effectiveness of the type of nursing intervention used in the intervention stage (Fawcett and Desanto-Madeya, 2012). The outcome of the intervention is compared to the established goals to determine whether the intervention used was appropriate.
(Appendix: Case study)
Orem’s theory provides three major assessment points to evaluate the degree or level of impairment/deficits in self-care. These areas include; universal needs, developmental/adaptation needs and health deviation (Orem, 2003). Universal needs encompass all needs that are universally needed by all human including, food, water, rest, elimination, social needs and activity. On the other hand, developmental or adaptation needs encompass ability to adjust to new situations as dictated by age. Finally, the health deviation needs include all the needs that arise as a result of disease, illness or injury (Orem, 2003).
Air
Cate tells the nurse that she regularly experiences shortness of breath accompanied by fatigue and muscle weakness. The nurse thus concludes that Cate must be having an underlying problem, perhaps high blood pressure or diabetes. On the other hand, she is not involved in any physical activity as she opts to stay indoors most of the time.
Water and food
As Cate reports, she has adequate access to food and water. However, she highlights that sometimes she feels very weak to prepare a meal and on average takes one meal a day. She also mentions that she hates being a bother to other people and does not seek any assistance from neighbors. The nurse concludes that Cate cannot be termed as poor although her apparent health condition robs her energy to cook for herself. Although her neighbor frequently visits her, she is majorly reserved to talk about her problems.
Bowel function
Reportedly, Cate has bowel problems, and she tells the nurse, anytime she eats foods high in fiber, she experiences bowel discomforts and stomachaches. The nurse thus concludes that Cate’s reduced oral consumption must have affected the digestive system. She also complains of heartburn after taking her meals, and this may be associated to increased acidity in the system.
Elimination
Cate mentions that all her elimination processes are working properly. This excludes the fear of any kidney failure or impairment.
Rest and activity
When the nurse asked Cate to describe her daily routines or physical activities she mentions that her life is confined to her compound and except for simple cleaning roles and visiting her ranch every evening, she does not engage in any other activity. She also sleeps a bit early every day and wakes up late. She also mentions that sometimes she visits her neighbor but not often. The nurse concluded that Cate is lacking adequate muscular activity. This might have exacerbated her earlier diagnosed obesity and perhaps contributed to the development of the condition to severe levels, leading to diabetes and high blood pressure.
Social needs
Cate says that her husband was her closest friend and since her demise, her children do not regularly visit and she only communicates with them via phone. Although she has a house assistant, she mentions that they are not close. She says that she is stressed by the fact that her children have isolated her and do not care anymore. Except for her neighbor whom they discuss, she has no other close person. The thus concludes that Cate is suffering from solitude and social isolation.
Developmental needs
The nurse concludes that Cate was unable to accept the demise of her husband and lives in denial and as such her adaptability to the situation is compromised. To some extent, lack of family support must have contributed to this situation.
Nursing diagnosis
According to Orem’s theory of self-care, the role of the nurse to identify the deficit areas and subsequently address the needs of the patient (Orem, 2003). Assessment or diagnosis shows that she has ventilation problems and feeding deficits. Subsequently, her bowel has a deficit a characterized by the pain that accompanies meals.
Although she does not have severe physical deficits, her apparent muscle and joint pains show a partial physical deficit.
Cate also has a deficit in physical activity, and her social life is pretty lacking. The social deficits can be attributed to her solitude and reserved nature.
Nursing Intervention
Implementation
The implementation of these systems will be carried out through adoption of healthy dietary programs. Therefore, she will be put on a diet custom-prescribed to meet her health needs (Riegel, Jaarsma, & Strömberg, 2012).
On the other hand, she will be put on a regular physical exercise program that will enable her to undertake daily exercise including jogging. Moreover; she will be encouraged to be actively involved in her ranch’s activities.
Additionally, the nurse should seek a way to incorporate family support by contacting her children. It is of great importance to design a program that will see her children visiting her every month when they are free especially on weekends. As earlier mentioned, Cate is reserved and hates being a bother and as such, her children may be not aware of her condition. Therefore, the nurse will inform her children about her condition and encourage them to provide emotional and social support to her.
Evaluation
Evaluation during the first phase of her treatment will take place after two weeks. These will include collecting information pertaining to her adherence to medication and diet program as well as the subsequent health response. In the first phase of the treatment, the primary concern is to restore her health and normal physiological functioning.
The second phase will be primarily aimed at increasing physical activity and enlargement of her social circle. Therefore, evaluation will be aimed at collecting information pertaining to her adherence to physical exercise programs and whether she is actively involved in making new social connections with her neighbors and children (Dossey et al., 2012).
4) Conclusion
As seen from the analysis of the three theories, it is apparent that nursing theories have one thing in common. On an overall basis, it is evident that all the three theories have ‘care’ as their central themes (Meleis, 2010). This underscores the importance of care in nursing processes. As earlier mentioned, majority of nursing theories revolve about improving the care process (Parker, 2010). While Orem’s theory emphasizes on the importance of self-care, Roy’s adaptation model emphasizes on expansion of an individual’s adaptability abilities.
Collaboratively, all these models are intended to promote care and wellbeing and as such significantly affect the nursing process. From a common point of view, the environment stands out as an important aspect of care. The environment encompasses different factors that together make-up the human ecology. Human ecology consists of biological factors, cultural factors and adaptation factors. According to Orem’s theory, it is important to fine-tune the environment as a way of ensuring its interplays with an individual maximize their well-being (Alligood, 2013). Cultural beliefs affect biomedical models and as such nurses should try to be as much to be culturally competent and sensitive. On the other hand, it is not all the times that the environment works in favor of health and adaptation to various environmental changes is important. Increased adaptability to the environment expands the body’s line of defense and that way increasing self-care capabilities.
This essay thus unearths the often forgotten significance of nursing theories in nursing and as such helps the author to appreciate the role of nursing theories in nursing.
References
Alligood, M. R, (Ed.), (2013), Nursing theorists and their work, Elsevier Health Sciences.
Blais, K., & Hayes, J. S, (2011), Professional nursing practice: Concepts and perspectives, Boston: Pearson.
Clarke, P. N., Barone, S. H., Hanna, D., & Senesac, P. M, (2011), Roy’s adaptation model, Nursing Science Quarterly, 0894318411419223.
Dossey, B. M., Certificate, C. D. I. N. C., Keegan, L., & Co-Director International Nurse Coach Association. (2012). Holistic nursing. Jones & Bartlett Publishers.
Fawcett, J., & Desanto-Madeya, S, (2012), Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories, FA Davis.
Meleis, A. I, (2010), Transitions theory: Middle-range and situation-specific theories in nursing research and practice, Springer publishing company.
Orem, D. E. (2003), Self-care theory in nursing: Selected papers of Dorothea Orem, K. M. Renpenning, & S. G. Taylor (Eds.), Springer Publishing Company.
Paiva Rodrigues, D, (2008), Roy’s Model in obstetric nursing: analysis from Meleis’ point of view, Escola de Enfermagem da UFRGS.
Parker, M. E., & Smith, M. C, (2010), Nursing theories & nursing practice, FA Davis.
Parker, M. E, (2005), Nursing theories and nursing practice, Philadelphia: F.A. Davis.
Richard, A. A., & Shea, K, (2011), Delineation of Self‐Care and Associated Concepts, Journal of Nursing Scholarship, 43(3), 255-264.
Riegel, B., Jaarsma, T., & Strömberg, A. (2012). A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 35(3), 194-204.
Snowden, A., Donnell, A., & Duffy, T. (2014), Pioneering theories in nursing, Andrews UK Limited.
Taylor, S. G., Geden, E., Isaramalai, S. A., & Wongvatunyu, S. (2000). Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science. Nursing science quarterly, 13(2), 104-110.
Taylor, S. G., Katherine Renpenning, M., & Renpenning, K. M,(2011),Self-care science, nursing theory and evidence-based practice, Springer Publishing Company.
Appendix
Cate is a 71-year old widow who lives in a leafy suburb of the town. She presents in hospital appearing weak, emaciated and visibly hopeless. She says that her health has continually deteriorated for the last few months since the death of her husband. She reckons that her predicaments can all be attributed to the loss of her husband with whom they had a 45-year marriage, a loss she has been unable to overcome. Upon physical tests, she is diagnosed with diabetes. A history examination of the lady reveals that she has never been diagnosed with any chronic illness before nor has the husband. However, a recent visit to the hospital revealed that she had been diagnosed with a pre-diabetes condition and given a care plan that would help her overcome or prevent the development to diabetes. The nurse, seemingly concerned of the health of a lady who has had no problematic issues in the past, then seeks to discover how Cate’s health has deteriorated in recent times. Upon requesting Cate to help her understand her health problems, Cate’s response signaled a lady who was experiencing emotional problems. “You may not understand my situation and even if you do, I don’t think you have all solutions to my problems. I only want you to give me the medication that will help ne overcome the physical pain and breathing difficulties”. Upon reassurance that the nurse will only help her through the situation in the most optimized way, Cate narrates her story. She says that the death of her husband, former navy officer death blow to her life and she has even contemplated in the past to commit suicide and ‘join my husband wherever he is’. Cate also notes that she henceforth following the husband’s death withdrew gradually from her social circles. This was just, but the start of her withdrawn life as her three sons and the daughter all kept away from her with little communication from them even at the toughest time of her life. She decided to find solace in food, and she would feed excessively to help her overcome the new life she was going through. Initially, she says that she did not know that the feeding would affect her health and in any case, she did not have options to survive her new found way of life. However, four months later she started feeling dizzy, experiencing fatigues and one time while at her ranch she fell down and was unconscious at the time she was presented to a local hospital by one of her workers at the ranch. She was diagnosed with a pre-diabetes condition, obesity and an abnormal blood pressure. She was warned of the impending dangers of her eating habits, but she did not adhere to the care plan but has been under medication henceforth. She lives alone with one worker at her homestead but however says that she does not disclose her personal issues to Nanny, her home attendant since she only wants to sort out her issues without bothering anyone. She however assists Nanny perform the daily house routines and even cooks with her. However, in the last two weeks her health has noticeably affected her functionality and capabilities as she cannot engage in simple activities due to breathing difficulties and weakness in the bones. Cate says that her muscles are aching, and she has lost appetite for the last two weeks which explains her emaciated look. She says she has been vomiting frequently, and she is feels as though she is ‘losing the battle’. She however notes she cannot accept to receive care from a nursing home by living there permanently. She says she is ready to invest all her resources to make sure any care she receives is done from home but not a nursing home.
