Nursing Models and Theories - Essay Example

Task: Nursing Models and/or Theories Table of Contents Introduction  4 Roys Adaptation Model (RAM) 5 Strengths 6 Weaknesses 7 Jean Watsons Caring Theory of Nursing 7 Strengths 8 Weaknesses 8 Dorothea Orem Theory of Nursing 9 Self-Care/Dependent Care: 9 Self-Care Deficit: 9 Nursing System: 9 Strengths 10 Weaknesses 10 Data collection according to Orem’s Theory of Self Care Deficit 10 Patient profile 10 Basic conditioning factors 11 Self care deficit requisites according to Orem’s Theory of Self Care Deficit 11 Universal requisites 12 Developmental requisites 12 Health deviation requisites 12 Nursing care process according to Orem’s Theory 12 Orem’s nursing care plan 14 Application of the self care deficit theory to the nursing care plan for Mr. Tan 15 1. Therapeutic self care demand: deficient area - food 15 2. Therapeutic self care demand: deficient area - activity  16 3. Therapeutic self care demand: deficient area - disease awareness and management 16 Appendix 20 Bibliography 20 Introduction  Nursing can be termed as the process of offering care to an individual and/ or a patient together with their family (UCLA, 1999; Ritchie and Hall, 2011). Moreover, nursing care has a number of important steps (procedures) that a nurse should seek to fulfil at each instance that they encounter a needy patient. These include: assessment of the patient, diagnosis, outcome identification, planning, implementation and evaluation of the patient. Assessment involves the collection of the patient’s data. The nurse reviews the clinical records of the patient and their history. Moreover, the nurse can also do physical examinations, functional assessments and finally they can consult with the patient with regard to the information collected. Diagnosis involves interpreting the patient’s data and trying to make sense out of it. Outcome identification involves the identification of the expected outcomes with regard to the collected patient’s data. Planning relates to the establishment of priorities, development of outcomes, setting timeframes for the outcomes, identification of the interventions and finally documenting a care plan for the patient. Implementation involves the review of the planned interventions, planning the patient’s care, implementation of the care plan, counselling the individual about the care plan, involving the patient in the health care plan and finally documenting the provided care. Evaluation involves the establishment of outcomes, evaluating the actual and expected outcomes, summarizing the evaluation results, identify reasons that led to the lack of expected outcomes achievements, taking corrective measures so as to ensure that the expected outcomes are attained and finally documenting the evaluation results (Yura et al., 1988). Nursing has had a very long history since the Biblical times. The first nurse (by the name of Phoebe) was named in the Holy Book of Romans during the era of the Roman Christian Church (DeWit, 2009). Nursing care became a necessity which led to the construction of a number of hospitals in each and every Cathedral town; the earliest being one that was built by Saint Sampson who was a professional physician in the township of Constantinople followed by the second in Turkey by Saint Basil the Great (New Advent, 2009). Through time, there developed in-patient nursing care. This was a concept propagated by the Byzantine innovation as well as Christian Mercy (McClellan and Dorn, 2006). Through this idea, modern in–patient hospitals came into existence in most parts of the world. The 19th century gave rise to nursing theories, concepts and the development and utilization of nursing technologies. Nurses like Phoebe are known to have propagated the nursing care concept from Medieval Europe to Modern Europe and the rest of the world. Based on that, this essay shall aim at discussing three (3) nursing theories that have had an impact on nursing care. These include: Roys Adaptation Model, Jean Watsons Theory of Caring and Dorothea Orem Self-Care Deficit Theory. Nursing models and theories  Roys Adaptation Model (RAM) The theory was developed by Sister Callista Roy in 1976 on the basis of five major concepts. These include: adaptation, person, health, environment and nursing. Adaptation is the “process and outcome whereby thinking and feeling persons as individuals or in groups, use conscious awareness and choice to create human and environmental integration” (Roy and Andrews, 1999). Person refers to the human as the entity that receives nursing care. Moreover, a human entity includes families, organisations, the society and the community at large. According to Roy (2009), a human being is an “adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes”. Cognator subsystem includes the four cognitive emotion channels such as: judgment and emotion; learning and perceptual and information processing. On the other hand, regulator subsystem includes the correspondence to neural, chemical and endocrine channels (Roy, 2009). As an “adaptive system”, a person will always find means to ensure that they adapt well to the environment that they live in so as to guarantee their health and well being. Environment refers to the situation that causes a person to respond. In addition, the environment is an agent that is subject to probability – that is, its attributes are very unclear and so as the outcomes. Health refers to the outcome of the adaptation. That is, the results of a person’s interaction to the environment. Lastly, nursing defines the aspect of ensuring that a person’s adaptation to their environment is smooth so as to guarantee that their health is whole (CurrentNursing, 2012). Strengths 1. The model guides the nurse on how to assess a person’s behaviour based on the adaptive modes. 2. The model offers a close link between an individual’s assessment data and their intervention. As such the nurse can be in a position to determine the best strategies that could be implemented to help the individual achieve their goals. 3. The model guides the nurse on how to make critical diagnosis after the individual’s assessment (behaviour and stimuli). Weaknesses 1. The model does not give a clear guide on how to ascertain whether how the person is responding to internal and/ or external stimuli is correct. 2. The four adaptive modes have not been defined. 3. The theory is focussed to the patient only and not to the care giver. Jean Watsons Caring Theory of Nursing The concepts behind the Caring theory by Jean Watson include: human beings, health, environment and nursing. Human beings define the individual whom care should be given to. Health defines a “high level of physical, mental and social functioning” (CurrentNursing, 2012). Moreover, it is also the state of being free from illnesses and attaining well being. The environment (society) defines the entity that holds both the nurse and care. Nursing ensures that good health is achieved and illnesses are avoided through treatment. It also includes caring for the sick in hospitals or at homes and helping them to restore their health. The Watson Caring Theory has ten carative factors (CurrentNursing, 2012). These include: 1. Development of humanistic - altruistic system of values: The exchange of humanistic values between individuals. 2. Faith and hope instillation: The nurse ought to offer faith and hope to other humans since they have no other channels to receive these beliefs from. 3. Sensitivity cultivation: The nurse should develop human emotions as they handle other people. 4. Development of a helping and trust relationship: The nurse should portray empathy, warmth and understanding towards other humans. 5. Satisfaction of human needs. 6. Decision making through problem solving methods: Caring involves the use of scientific methods to problem solving. 7. Promotion of interpersonal teaching and learning: The nurse should aim to understand the individual through the learning process and in turn prepare a cognitive plan of action through the teaching process. 8. Allowance of existential-phenomenological forces: Phenomenology is a way of understanding things from an individual’s point of view while existential psychology seeks to study the existence of humans. The nurse should help the individual to understand and accept that life ends with death. 9. Promotion of a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment. 10. Expression for both positive and negative feelings. Strengths 1. The theory focuses on self growth for both the individual and the nurse through the sensitivity cultivation carative factor. 2. Human needs such as psychosocial, biophysical and psychophysical needs have been identified as essential to humans. 3. Psychosocial needs such as: achievement, affiliation and actualization have been prioritized. Weaknesses 1. Biophysical needs such as: food and fluid, elimination and ventilation are ranked as lower order needs. 2. Psychophysical needs such as: sexuality, activity and inactivity are not prioritized. 3. The theory could be difficult to apply in all health care settings since caring is the key concept. Dorothea Orem Theory of Nursing Orem’s theory has three (3) main sub theories. These include: Self-Care/Dependent Care, Self-Care Deficit and Nursing System (Dennis, 1997). Self-Care/Dependent Care: The self care theory includes the following: Self care – activities and actions that an individual performs so as to ensure optimal health and well being. In addition, self care has two agents (agency) which are: self care agency (this is the ability of an individual to practice self care) and dependent care agency (this involves another person offering care to the individual). Moreover, self care has three (3) requisites (self care needs). These include: universal requisites – these are the common needs that humans need such as food, air, water, rest, social interaction, solitude, physical activity etc; health deviation requisites – these includes the needs for treatment and good health; developmental requisites- these includes the need to develop as an individual being (CurrentNursing, 2012). Self-Care Deficit: This refers to the need of nursing when the person is not capable of attaining self care and therapeutic self care demand (self care activities to be undertaken so as to meet self care needs). Orem’s theory mentions that there are five (5) methods that can be used to help the individual. These include: acting for and doing for others; guiding others; supporting one another; teaching one another and promoting an environment that can foster personal development. Nursing System: It describes the nursing responsibilities; patient and nurse roles; nurse – patient relationship and the activities that the nurse had to perform so as to meet the patient’s requisites. Strengths 1. Self reliance: An individual is taught on how to offer themselves self care and dependent care in the event that nursing is not available. 2. The theory defines the point when there is need for nursing: “Nursing is needed when the individual cannot maintain continuously that amount and quality of self-care necessary to sustain life and health, recover from disease or injury, or cope with their effects” (George, 1995, p. 120). 3. The theory is applicable by junior to senior clinical practitioners. 4. The theory is highly comprehensive thus it can be used in the different fields in nursing (George, 1995, p. 120). Weaknesses 1. Health is as an entity that keeps on changing to non – health, illness and wellbeing (Fitzpatrick and Whall, 2005). 2. Human care and emotions are not defined (George, 1995, p. 121). 3. The theory has a vast variety of definitions. For example, self care has components as self care agency, self care deficit, self care requisites etc. 4. Physical care such as treatment and medications are prioritized while psychological care is not. Case study: Applying Orem’s Self-Care Deficit Theory The case study to be applied the Orem Theory of Self Deficit had been elaborated in the Appendix section. Below is the application of the theory by Orem. Data collection according to Orem’s Theory of Self Care Deficit Patient profile Areas Patient details Name Age Sex Occupation Marital status Diagnosis Theory applied  Mr. Tan 55 years Male Stay at home father Married Diabetes Mellitus Orem’s theory of self care deficit. Basic conditioning factors These are the factors that can influence the care that an individual gives to themselves. Age 55 years Gender Male Health state Amputee due to health condition, need for therapeutic self care Developmental state Loss of attention, helplessness, self pity Family system factors Married, wife is the provider Patterns of living At home with wife Environment Rural area Resource availability Wife available. Children unavailable Self care deficit requisites according to Orem’s Theory of Self Care Deficit Orem’s theory indicates that there are three main requisites that have to be accomplished while offering self care. These include: 1. Universal requisites 2. Health deviation requisites 3. Developmental requisites Universal requisites include needs such as air, water, food, eliminative functions, activity and/or rest, prevention of hazards, social interaction and promotion of normalcy. Developmental requisites are inclusive of the maintenance of developmental environment and prevention/ management of the conditions threatening the normal development. Health deviation requisites include variables such as adherence to medical regimen, awareness of potential problem associated with the regimen, modification of self image to incorporate changes in health status and adjustment of lifestyle to accommodate changes in the health status and medical regimen (MR). Universal requisites Air Breaths normally. Water No adequate intake Food No adequate intake Eliminative functions Not applicable Activity/ rest Moderate pain – pain score is “4”. Emotional guilt. No physical activity Social interaction Interaction with wife. No physical interaction with children as they are far away. Prevention of hazards Need instructions on self and/ or dependent care after amputation. Needs emotional care and attention. Needs instructions on nutrition. Promotion of normalcy Has good interaction with wife. Developmental requisites Maintenance of  developmental environment Ability to feed self. Difficulty in dressing. Difficulty in mobility. Prevention/ management of the conditions threatening the normal development Feels like he is a problem to the family by mentioning “it will be better if I die”. Only talks to the wife. Health deviation requisites Adherence to medical regimen Attends to clinical schedules. Takes medication as required. Awareness of potential problem associated with the regimen Aware about condition and its challenges. Modification of self image to incorporates changes in health status Immobility has led to self pity and hopelessness. Adjustment of lifestyle to accommodate changes in the health status and medical regimen (MR). Emotional pain not tolerated. Physical pain tolerated. Nursing care process according to Orem’s Theory Orem’s nursing care process is a system that seeks to realize the need of care to the patient, care plan for the patient and the implementation of care to the patient. The nursing process has the following steps: Assessment: This step is used to get information relating to the patients history. In addition, it also includes information such as previous symptoms and treatments. Nursing diagnosis: The nurse uses the assessment information to make a diagnosis of what problem the patient has, if any. Diagnosis involves the designing of the nursing care system to be implemented together with its delivery plan. There are three nursing systems that the nurse can implement depending on the patient and their needs. These include: wholly, partly and supportive-educative nursing systems. A wholly system is characterised by the following: The patient lacks an active role in their care; the nurse is the active entity in the care delivery; optimal nursing should be implemented to fully satisfy self care needs; self agency is minimized making the patient rely on dependent care and therapeutic self care is initiated since the patient is incapable of self care. A partly compensatory system is characterised by the following: the nurse and the patient jointly work to achieve self care goals and a help – trust relationship between the nurse and the patient is established. A supportive-educative system is characterised by the following: the nurse teaches the patient and/ or family on how to undertake self care; the patient and/ or family are the sole provider of self care while the nurse is the overseer of how self care is being initiated; the patient is taught on how to perform therapeutic self care; however, they may get some assistance from the nurse and the nurse assists the patient to undertake decision making and control of behaviour while undertaking self care steps. With optimal nursing diagnosis, it is assured that the patient’s therapeutic care demands as well as their self care deficits are satisfied. Moreover, assessment and diagnosis assist the nurse to determine the best care plan to be implemented as per the patient’s needs. Implementation: The nurse goes ahead to implement the best nursing care system as per the diagnostic information. Evaluation: The nurse evaluates the patient to determine if their needs were satisfied and whether the stated goals were achieved with regard to the nursing system that was implemented. If there are problems with the selected nursing system, the nurse can correct it in due time and re-evaluate the patient again. Orem’s nursing care plan While the nursing care process is being followed, the nurse should also come up with a nursing care plan that is suitable depending with the patient needs. The needs of the patient could vary from physical care to hygienically care and nutrition care (Nursing Theory, 2013). Below is the nursing plan for Mr. Tan. Nursing diagnosis  (diagnostic operations) Plan and Results (Prescriptive operations) Implementation (control operations) Evaluation (regulatory operations) Self care deficits Results: Nursing objective and goals Nursing system design. Optimal helping strategy. Nurse- patient activities to aid in: 1. Self agency propagation. 2. Fulfilment of self care requisites. 3. Elimination of self care deficits. Efficiency of the nurse patient activities in the: 1. Promotion of the patient as the self care agent 2. Patient to meet their own self care needs. 3. Patient to decrease dependency care. Effectiveness of the selected nursing system to achieve the targeted care needs. Conclusion, Mr. Tan needs nurse assistance in the following self care requisites: universal, health deviation and developmental requisites (needs). Application of the self care deficit theory to the nursing care plan for Mr. Tan 1. Therapeutic self care demand: deficient area - food Adequacy of self care agency: inadequate Nursing diagnosis: Patient has poor nutrition habits and at times no food intake. Outcomes and plan a. Outcome: Improve nutrition and focus on a balanced diet. Intake of vitamin supplements. b. Nursing goals and objectives Goal: Achieve good nutrition levels for the patient. Objectives: Mr. Tan should:  recite the importance of taking food. State the importance of a balance diet. State the foods that are rich in vitamins. c. Nursing system: Supportive - educative d. Helping strategy: Teaching; Elaborating; Supporting Implementation: Objectives identified. Patient informed about what he has to change to achieve the objectives identified. Evaluation: The patient understood the need for food intake. He also understood the need for a balance diet since he was not taking food. He mentioned to select and eat foods rich in vitamins. Food self care deficit will be reduced based on the nutrition knowledge and intake by the patient. The supportive-educative system was resourceful. 2. Therapeutic self care demand: deficient area - activity  Adequacy of self care agency: inadequate Nursing diagnosis: Dressing self care deficit due to immobility. Outcomes and plan a. Outcome: Self care improvement. Modify mobility options so as to ease dressing actions. b. Nursing goals and objectives Goal: Achieve optimal self care. Objectives: Mr. Tan should: Be able to dress despite limitations. Perform self activities with minimal dependent care. c. Nursing system: Partly compensatory  d. Helping strategy: Teaching; Elaborating; Supporting; Propagating a developmental environment. Implementation: Objectives identified by the nurse and the patient. Patient informed that self care activities will aid in meeting the objectives identified. Evaluation: The patient engaged in dressing activities on a self basis and with minimal dependency on the wife. Patient agreed to engage in self care while at home. The partly compensatory system was quite resourceful. 3. Therapeutic self care demand: deficient area - disease awareness and management Adequacy of self care agency: inadequate Nursing diagnosis: Knowledge deficit could lead to complications of the condition (Diabetes Mellitus). Outcomes and plan a. Outcome: More information to be provided to the patient about the illness. b. Nursing goals and objectives Goal: Educate the patient about the complications of the condition as well as how to avoid (manage) them. Objectives: Mr. Tan should: State the complications to be encountered as well as the prevention and management strategies. State the changes he is likely to endure due to his condition and how to overcome them. Elaborate on the benefits of the medications that he is using as well as their side effects. c. Nursing system: Supportive - educative d. Helping strategy: Teaching; Elaborating; Supporting Implementation: Objectives identified. Patient informed about his condition, its complications, its prevention and management strategies. Patient informed about his medications and their side effects. Evaluation: The patient became fully knowledgeable about his condition and its management strategies. Patient knows the benefits of his medications as well as their consequences. The supportive-educative system was resourceful. Rationale on the application of Orem’s Self care deficit theory Orem’s nursing theory provides explanations of a number of factors that nurses undergo daily with their patient encounters. The theory seeks to propagate the need for self care in patients despite the fact that at times illnesses and other chronic conditions may make a patient lack self care and rely on dependent care from their family or friends. In addition, the theory introduces the self care requisites that nurses should implement with a patient together with the appropriate nursing care system and nursing plan. The self care deficit theory when optimally applied by the nurse, it seeks to establish the current needs of the patient. While stating the patient’s needs, there are a number of perspectives that should be considered. That is, there are a number of needs that a patient could be in demand of such as: universal requisites, developmental requisites and health deviation requisites. Universal requisites include the basic needs such as: air, water, food, activity and rest just to mention a few. Developmental needs include those that aim at ensuring that the patient progresses on well with good heath and treatment if they are ill. Lastly, health deviation needs address factors such as the need for good health and treatment. Once the nurse gains information about these variables, then, it is without doubt that the nursing care plan that the patient will be designed for and given by the nurse will be very resourceful. A good example of this is the nursing plan outlined above for the patient – Mr. Tan. Not only does the self deficit theory outline the nursing care plan but it also establishes variables such as: the nursing diagnosis; the outcomes of the diagnosis; the nursing goals and objectives; the helping strategy; its implementation and evaluation. With regard to Mr. Tan’s case, it was revealed that the nursing system used was dependent on the need deficit based on the nurse’s diagnosis. For example, in the case where he was having a food deficit need, a poor nutrition diagnosis was given by the nurse. Moreover, an outcome was stated, the goals and objectives were outlined and Mr. Tan was offered a helping strategy which was implemented. From the evaluation results, it was revealed that the patient clearly understood the need to fulfil the objectives stated. Lastly, the nursing systems that were used proved resourceful to the progress of the patient. Conclusion  Roys Adaptation Model brings out five (5) major concepts. These are: adaptation, person, health, environment and nursing. The person is viewed as an integration of systems (social, biological and psychological) which ensure that the person is a whole being. Moreover, the person aims at ensuring that they select an environment in which they can adapt to so as to maintain optimal health and well being. Lastly, nursing seeks to ensure that the four adaptive modes. Watsons Theory brings the aspect of care into nursing. Apparently, care is an attribute that the nurse should develop so as to offer it to their patients. In addition, care propagates self growth to the nurse, the patient and all other people in that environment. The theory also has carative factors which when implemented; they lead to the achievement of the needed human requisites. Orem’s Self-Care Deficit Theory prioritizes on the need of self care for the patient. In addition, the theory teaches the nurse to offer dependent theory to the patient in the event that they cannot offer it to themselves. Moreover, the nurse also has the role of teaching the family of the patient how to offer decedent care while at home. Lastly, the nurse has the responsibility of teaching the patient self care. What I have learnt from doing this assignment is that as a nurse, one should not only implement one theory and/ or model while handling the patient, their family and other colleagues. Rather, a number of theories should be implemented so as to ensure that the environment created is adaptable. Word Count = 3955 (Exclusive of Cover page, Table of Contents page, Appendix and Bibliography) Appendix Mr. Tan, 55 years old Chinese man, admitted in hospital for his fifth time leg amputation. He had a history of Diabetes Mellitus; he came to hospital for his amputation accompanied by the wife. The wife is the main caregiver of the patient as all the children are working. Upon assessment, the patient was found to have loss of attention to everything and he feel like he is help less so he lost his respect in society due to his immobility. Basic parameters were BP: 94/60, Temperature: 36.4*C, SpO2: 98%, Heart Rate: 100bpm, Respiration rate: 24, Pain Score “4”. He verbalized that “it will be better if I die, so that I will not be a trouble for my family”. According to Mrs. Tan, she felt very worried and tired to take care of him. The patient had been refused to eat ever since few days ago. Mrs. Tan was depressed and calm all the time. Bibliography CurrentNursing. (January 2012). 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