Nursing Theories, Roys Adaptation Model - Essay Example

Nursing Theories Introduction Nursing theory includes different notions, definitions, connections and hypothesizes or the assumption that are imitated from the various models of nursing contributed by the different philosophers with the view of phenomena in order to design specific interrelationships with the different concepts for the purposes of relating, illumination, forecasting and prescribing questions related to the discipline of nursing. Nursing theory plays an importation foundation in the field of nursing practice in order to generate the further knowledge, predict as well as explain phenomenon that are related to nursing (McEwen & Wills, 2014). In this regard, the essay will present a detail, understanding of the Roys Adaptation Model, the Kings theory of goal attainment, Orems self-care deficit, Watsons caring theory, and Leiningers cultural care theory. Precisely, the essay will provide a brief background, analysis and evaluation of the mentioned theories. Roys Adaptation Model Theory Description Sister Callista Roy in the year 1964 proposed the Adaptation Model, while enduring her master’s degree in nursing. Her work was published, in the 1976 as ‘Introduction to Nursing: An Adaptation Model’. The theory is an important nursing theory in the field of nursing practices. Furthermore, Roy is highly influenced by observations, practice and insights driven from the existing theories and other literature works (Connell School of Nursing, 2013; McEwen, 2011). The main purpose and the framework of theory are based on the tenets of ‘interconnected’, ‘holistic individual’ and their interfaces with the prevailing environment. The Roy’s Adaptation Model (RAM) has a broader scope as it is used to construct or evaluate the other nursing theories. Person, environment, nursing and health are the major metaparadigm in the RAM. The major concepts of the theory are that it views person or group as an overall adaptive system in which environment act as an internal and external stimuli with health as the process of being integrated as a whole (McEwen, 2011). The assumptions that are included in the theory are broadly classified into the three categories that include scientific, cultural and philosophic assumptions. With regards to the theoretical proposition of the theory, the Roy’s theory is highly descriptive power of an individual as adaptive system, but on the other hand, in the context of predictive and prescriptive power, the theory has limited scope (Meleis, 2011). Nevertheless, the theory documents all the aspects like in an intellectual manner and covers all areas of practice (Roy & Andrews, 1999). Theory Analysis In the nursing practice the scope of the theory is classified into three categories, grand, middle range and situation specific. The RAM is a grand theory as it explains central phenomena of nursing like meta-paradigm concept of person, environment, health and nursing. Whereas, the middle range models and theories only focus on the limited scope with regards to its concept. Thus, it can be stated that the theoretically and operationally concepts and the statement is well defined in the model (Mateo & Foreman, 2013). The linkages in the concepts and statements are partially explicit in order to provide a proper rational of different variables and make the theory more believable. The concepts of the model logically organized as each of the major concepts of the theory signifies recurring idea in order to maintain integrity with adaptation (Gonzalo, 2011). The graphic representation of the theory reflects physiologic-physical, self-concept, role, function and interdependence approaches for the proper examination and understanding (Roy & Andrews, 1999). Figure showing Graphic Representation of the RAM (Source: Roy & Andrews, 1999) Furthermore, the outcome and the consequences are predicted in the model as individuals or in groups are viewed as adaptive system in order to create integration between people and the environment (Gonzalo, 2011). Theory Evaluation RAM theory is congruent with nursing practice and it has been congruent in the field of current nursing interventions as well as therapeutics. Interventions and therapeutics have been tested empirically. Furthermore, it helps to provide significant supports and one of the most commonly employed models in order to guide and draw proper conclusions in various nursing research researches (Cheng et al., 2008). With respect to the evidence of the use of the model in the real practice, it can be apparently observed that in more than 30 years RAM has been used for better understanding and enhancing nursing practice for improving care for the patients (Senesac, 2013). As the theory is based on the adaptation on four adaptive modes including ‘physiologic-physical’, ‘self-concept-group identity’, ‘role function’, and ‘interdependence’ that are directly related to people or group so the theory has socially applicable adaptation (1Gonzalo, 2011). Additionally, RAM can be relevant to the cross-cultural field in order to guide cross-cultural pin through the researches. It has also been used in the discipline of nursing in order to conceptualize and drew a proper plan of the care for the patients and creates an intervention measure for the separate clinical population. Finally, the implementation of the same in the nursing practice is ascertained to be significantly helpful in providing acute care to the patients (Senesac, 2013). The application of RAM has been revealed in the case of physical and psychosocial adaptation in the patients with chronic obstructive pulmonary disease and the model help in interpersonal support to the patients (Akyil & Ergüney, 2012). Additionally, the study of Tsai et al, (2003), the study validated that the theory helps in explaining the outcome of chronic pain in older people suffering with arthritis (Tsai et al, 2003). Kings Theory of Goal Attainment Theory Description The purpose of the Kings theory of goal attainment is to interrelate the various concepts that include ‘perception’, ‘transaction’, ‘interaction’, ‘role’, ‘communication’, ‘self’, ‘stress’, ‘growth’ ‘time’, and ‘development’, into a theory to help nurses provide improved healthcare with better nurse-patient relationship (2Gonzalo, 2011). The scope of the theory is narrower than the grand nursing theorist and termed to be as a mid-range theorist (Kim, 2010). The theory has been originated from the Imogene King concepts in her ‘Interacting Systems Framework’. The major concept and the theoretical proposition in the theory is to discover and explore four “universal ideas” that includes ‘social systems’, ‘perception’, ‘health’, and ‘interpersonal relationships’. She underlines the theoretical proposition that each system has to interact with the other as well as the environment that significantly influences the behavior. Assumptions that are included in the theory emphasizes that human beings are sentient, social, rational, perceiving, time-oriented, spiritual, reacting, purposeful, controlling and action oriented (Meleis, 2011; Parker & Smith, 2010). Theory Analysis The theory of goal attainment is limited to the concept of interaction system, which revolves round the act of nursing. Thus, the definition of the theory is conceptual in nature (Meleis, 2011; Alligood, 2013). King’s theory of goal is logically and sequentially organized as most of the components were clearly defined in the theory. The diagrammatic representation of the model appears to be complex in the general view, but the overall goal achievement is comparatively very simple (2Gonzalo, 2011). Figure Showing Graphic Representation of the Kings Theory of Goal Attainment (Source: 2Gonzalo, 2011) Furthermore, the concepts, statements, and assumptions are used consistently in the theory to promote perceptual interaction in a more significant manner in the present scenario of nurse-client interactions. The outcome or the consequences of theory focuses on desirable consequences with considering all the aspects of the nursing process that includes ‘assessment’, ‘planning’, ‘implementation’ and ‘evaluation’ (Parker & Smith, 2010). Theory Evaluation Kings theory of goal attainment is duly congruent with current nursing practice and it has been congruent in the field of current nursing interventions as well as therapeutics (Calantas, 2014). Additionally, the theory is tested empirically and found to be empirically adequate in the field of nursing practice. The evidence of the theoretical framework of the king’s theory was used in the Ohio State University to provide the basic nursing education (Raingruber, 2014). Furthermore, the theory is relevant in social context, as it explains that power is social force, which helps to maintain and organize the society but not applicable in the context of cross-culture. The theory has been widely been used in the discipline of nursing as the conceptual model nursing administration and communicate with the other nurses for the proper planning of the care for the patients. Finally, the implementation of the same in the nursing practice is identified to support acute care and gives opportunities to the healthcare executives in the promotion of the patient care (Fawcett, 2001, Sieloff, 1991). The application of theory has been revealed in journals and plays a major role in the foundation of significant directive decision-making in the nursing practices (Goodwin et al., 2002). Additionally, the study of Khowaja (2006) validated that the theory plays an effective role in the clinical pathways with regards to the patients having ‘transurethral resection of prostate’ (TURP) (Khowaja, 2006). Orems Theory of Self-care Deficit Theory Description Dorothea Orem develops the theory of self-care deficit in order to improve the quality of nursing practice in the healthcare. The main purpose behind the development of the model is to meet the self-care stipulations of an individual and implement the nursing requirement in those situations when the individual is not able to meet the self-care demands. On the basis of the conceptual framework of the model, the scope of the theory is deemed to be wider and termed to be a grand theory of nursing. The theory has been originated while Orem was functioning in ‘Department of Health Education and Welfare’ (HEW) as a consultant, she enthused the requirement to address the health disparities questions. The major concepts of the theory are that it has four concepts, which are the central meta-paradigm of the model i.e. person, health, environment and nursing. According to the viewpoint of the Orem, a person plays a central role in nursing care and his/her health condition is highly influenced by the environment. The model also stated that, when an individual is healthy, he/she is capable of self-care and when an individual is ill; they will not induce self-care and will need nursing care (Renpenning & Taylor, 2003). The key theoretical prospective in the theory involves factors such as age, development stage, social background and the experience having the major influence in the self-care ability, each individual is capable of self-care and the care of the other were significantly learned. Whereas, the nurses help to assess the patient capabilities through selecting reliable process, action or the technology in enduring proper health care need. Furthermore, the major assumptions in the theory are that people’ are distinct individuals and should have to be self-sufficient for their own care, whereas, nursing practice is a form of action in order to create interaction among the people. Additionally, the knowledge of a person about the potential health disparities is needed in providing primary care and the self-care along with dependents care is the key behaviors that are learned within the context of social culture (Timmins & Horan, 2007). Theory Analysis Orem in her theory defines various primitive concepts and statements that are both theoretically as well as operationally defined, but the esoteric nature of the terminology is one of the major obstacles that reduce the theory application. The linkage between conditioning factors and the substantive structure of the theory is explicit. Furthermore, the structure of the theory is logically organized and relative, much simple and generalized. The models clarify the theoretical base, with R indicating the relationship among the various components and < representing potential or the current deficits, where the nursing practice is required (Source: 3Gonzalo, 2011). Additionally, there is semantic and structural consistency in the concepts, statements, and assumptions in the theoretical aspect. Nevertheless, though the use of Orem’s three-step model, the proposed outcomes can be predicted (Anna et al., 1978). Figure Showing Graphic Representation of the Orems Theory of Self-care Deficit (Source: 3Gonzalo, 2011) Theory Evaluation Orem’s Self-Care Deficit Nursing Theory (SCDNT) is congruent with current nursing practices and it has been congruent in the field of current nursing interventions as well as therapeutics (Michelle, 2013). The theory is one of the widely used theories in the nursing practice, but in terms of reliability and validity the model has limited acceptance (Timmins & Horan, 2007). The evidence that the theory is used in the field of nursing educators is that it has been rated as one of the frequently used theoretical frameworks in the field of ‘baccalaureate nursing education’ (Berbiglia, 2011). Furthermore, the SCDNT is relevant in the social context, as it applies to the individuals, families, groups or communities (Michelle, 2013). The application of Orem’s theory significantly is identified in the publication of the theoretical content through the publication that allows students to highly engage in the nursing practice (Sitzman& Eichelberger, 2011). Additionally, the study of Surucu, (2012), validated the role of theory in guiding assessment and identifying the outcomes and interventions related to clinical management (Surucu, 2012). Watson’s Caring Theory Theory Description Jean Watson develops caring theory to provide proper guidelines to nurses in order to satisfy the aspect of practice and provide holistic care to the patients. Watson argues that improve care help to assist people to gain significant control, knowledgeable and promote the health challenges. The Watson theory was one of the newest grand theories of nursing practice and emphasis towards humanistic characteristic of nursing linked with scientific facts and nursing practice. The theory has been originated through the initial attempt of Watson to highlight meaning and bring the nursing practices in focus as a one of the emerging discipline and separate health profession. There are four major concepts in the theory that include human being, health, environment and nursing practice. Additionally, the key proposition of the theory stated that people, health, nursing and the environment component of healthcare are interrelated as a person is highly influenced through the nursing care in the physical as well as non-physical environment. Furthermore, through the implementation of the theory, is claimed to help in developing a proper relationship between nurse and patient. The seven key assumptions in the theory reflect that caring will be demonstrated interpersonal. The theory is centered with the various elements and the entire process is useful to provide proper guidelines in order to improve care in professional and personal life (Meleis, 2011; Tomey & Alligood, 2006). Theory Analysis Watson’s caring theory is theoretically and operationally defined. In this regard the concept of the theory establishes a clear meaning of the subject matter and provides an empirical determination. Whereas, the statement is theoretically and operationally defined, as theory relates the various concepts with other related measures (Tomey & Alligood, 2006). The theoretical and operational aspects of the theory statement have explicit linkage and the concept and the entire component is logically organized in the theory. The theory is often represented in a diagrammatic form, which determines the various elements of the theory in a simplified manner. Additionally, though the use of a theoretical concept, the proposed outcomes of the subject matter can be predicted (McCance et al., 1999). Theory Evaluation Watson’s Caring Theory is congruent with current nursing practice in order to ascertain proper caring of nurse relationship with patients and it is also consciously congruent to the existing nursing interventions and therapeutics (Gomeset et al., 2013). Additionally, the theory is tested empirically, but needs for further development. The application of Watsons Caring Model is utilized in the nursing administration and practice, which is evident from the effectiveness of same in improving and exploring the health care disparities related to ‘polycystic kidney disease’ (Martin, 1991). Moreover, the theoretical aspect of model is both socially and cross-culturally applicable because the human being is the key component in the theory. The theory is one of the widely used theories in the nursing practice and the implementation of the theory in the nursing practice assists in providing acute care and creates a proper relationship between all the four components (Watson Caring Science Institute, 2014). The application of Watson’ theory can be identified in the publication that is related to the theory of nursing management and Watson model of self-care (Watson, 2008; 1985). Leininger’s Cultural Caring Theory Theory Description Madeleine Leininger is the founder of the cultural caring theory of nursing and the main purpose of developing the theory is to supplement cultural congruent aspect in the current nursing care practices. Leininger theory is also among the one the extensively utilized nursing grand theories and due its limited goal and concept the scope of the theory is narrower. The theory originates from her extensive nursing experiences, ‘anthropological insights’, values, experiences of life, and inspired thinking. The major concept of the theory involves trans-cultural nursing, which is learned through the comparative study and analysis of cultures and nursing caring practices, values and belief. Additionally, the key proposition in the theory is that there are three modes that help in making proper judgments, decisions and taking respective actions in order to promote enhanced care to the patient. The context is used to describe the proper care relationship between the nursing and patient care. Whereas, the key assumption includes that the people from different cultural background, practice care relatively in dissimilar ways. The education, economy, religious among other are the major components of culture, but the human healthcare is universal across the culture (4Gonzalo, 2011; Maier-Lorentz, 2008; Royal College of Nursing, 2002). Theory Analysis Leininger’s cultural caring theory concept and statement is both theoretically and operationally defined fundamental to cultural safety as well as cultural competency (Seaton, 2010). The linkage among the cross-cultural aspect is either explicit or implicit, as the knowledge and idea are primarily learned and explored through the family, and population as whole. Furthermore, the concept and all the major components of the theory elaborate the relationship of various influencing factors and codes. The outcomes or consequences of study that utilizes Leininger’s cultural caring theory can be evaluated through prediction (4Gonzalo, 2011). Figure Showing Graphic Representation of the Leininger’s Cultural Caring Theory (Source: Fitzpatrick et al., 2012) Theory Evaluation: In the current nursing practice, Leininger’s cultural caring theory is congruent with current nursing standards to ascertain the proper caring relationship between patients and nurses. The theory is also consciously congruent with the present nursing interventions and therapeutics (4Gonzalo, 2011). Additionally, the theory is not tested empirically in the field of nursing practice. The Leininger’s cultural caring theory is utilized in the nursing and clinical practice, education and research, which is evidently helpful in promoting culturally congruent and the compassionate care (Allyn, 2007). Moreover, the aspect of model is both socially and cross-culturally applicable because cultural aspect is the key component in the theory. Moreover, the aspects of the theory are extensively used in the nursing practice and the implementation of the theory in the nursing practice assists in providing significant care and create a proper relationship with the various components of culture and nursing care (Leninger, 2002). The application of Leininger’s cultural theory, the transcultural aspect is one of the important factors in the current scenario health care. Furthermore, the various factors that included in the transcultural nursing encourage improved nursing care (Leininger, 2008). Moreover, the theory is applicable to provide powerful insights in order to discover the unknown knowledge that is related to the nursing and the health fields (Leininger, 2002). Conclusion From the foregoing discussion, it can be comprehended that the various theories of the nursing model significantly help in providing knowledge in order to advance the nursing practice, direct the research, and identify and provide proper healthcare. Additionally, it can be concluded that RAM is highly influential nursing theory. With respect to the Kings theory, the role of the theory in the nursing research is identified to be significant as it considers perception and understanding of proposed data from the reality. Orem’s theory involves the human behavior along with the subsequent outcomes and determines how they interact with each other. 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