Nursing is a core concept that is common across contemporary nursing theories. Even though the definitions, applications, and philosophies are different with each theory, the concept of nursing plays a vital role in each one. Contemporary theories came about when the teaching of nursing students was not sufficient to the performances of what the nurses were being taught in schools and ultimately affecting patient care in the long run of nursing practice. The role of nursing theories was to enable schools to better equip nursing students for nursing practice that would provide adequate care and teaching to patients in the long run that would better equip the patient in knowledge of health and well-being.
"Nursing systems are a series of actions taken by a nurse to aid in meeting a person's self-care needs" (Baulita, 2010). Nursing describes the nurse's responsibilities, roles of nurse and patient, and the rationales for nurse-patient relationship that focuses on the person. Support modalities are concerned with the patient's ability of self-care involvement and the person's fluctuation between modalities at any given time.
Jean Watson developed the Science of Caring based on the philosophy that nursing is concerned with promotion of health, preventing illness, caring for the sick, and restoring health. Watson defined nursing as "a human science of persons and human health-illness experiences that are meditated by professional, personal, scientific, esthetic, and ethical human care transactions" (Nursing Theory and Theorists, 2008). The Science of Caring theory contains caring factors, or interventions, of the humanistic nature of nursing as reflected in the caring model (Vance, 2000). The theory is centered on enabling a patient toward a higher degree of harmony within the mind, soul, and body.
Virginia Henderson's Need Theory emphasized the philosophy that patients need as much independence as possible upon discharge to enable progress in recovery (Virginia Henderson, 2011). She defined nursing as "assisting the individual, sick or well, in the performance of those activities contributing to health, or its recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength, will, or knowledge" (Nursing Theory and Theorists, 2008). She described the role of nursing as substituting, doing something for the patient, supplementary, helping the patient do something, or complementary, working with the patient to do something. All these roles would enable the patient toward as much independence as possible to continue recovery after discharge.
Dorothea Orem's Self-Care Theory defined nursing as "the act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness" (Nursing Theory and Theorists, 2008). Her philosophy was to focus on activities the patient could perform on their own to maintain life, health, and well-being. The Self-Care Theory identifies three related concepts of self-care, the independent performance of the individual, self-care deficit, or inadequacy in the individual's ability to perform self-care, and the nursing system, the interventions. The nursing system is interventions of wholly compensatory, total care, partial compensatory, assistance, and supportive education, where a nurse helps a client develop and learn through knowledge, support, and encouragement.
The concept of nursing in the three theories is similar in respects to assisting patients toward a higher independence, knowledge, and promoting better health outcomes. Each theory focuses on the person, health, environment, and nursing. The person has their own profile that determines their abilities and knowledge. Each theory looks at improving the health of the patient and considers environmental factors that affect a patient's health. The nursing system in each theory instructs the nurse in caring and assisting the patient to greater outcomes of health and well-being.
The concept is different in the three theories in respect to the focus of each theory. In Watson's theory, nursing focuses on assisting patients to a higher degree of harmony within the mind, soul, and body. In Henderson's theory, nursing focuses on helping patients gain as much independence as possible for recovery to progress after discharge. In Orem's theory, nursing focuses on activities the patient could perform on their own to maintain life, health, and well-being. Where Watson focuses on caring, Orem focuses on the abilities of the patient and working to improve the patient's abilities, and Henderson focuses on assisting the patient to greater independence.
Orem's Self-Care Theory is a combination of three theories; self-care theory, self-care deficit theory, and the theory of nursing systems (Application of Orem's Self-Care Deficit theory, 2011). It can be applied to a variety of health care settings and patient populations. For example, "self-care deficits have been significantly associated with negative health outcomes in heart failure patients" (Britz, 2010). There have been decreases in medication compliance, following a low sodium diet, fluid restriction, and daily weight taking to detect early warning signs of worsening condition. Properly educated patients about disease, treatment options, and consequences of poorly managed care should demonstrate increased self-care abilities and behaviors. They should show decreased symptoms and improved functional abilities.
"Orem (2001) defined the concept of nursing agency as a complex attribute of those persons educated in the field of nursing who are able to help others recognize and meet their therapeutic self-care demands" (Britz, 2010). Therapeutic self-care demands are the total measures of self-care required at a specific moment of time, lasting certain duration, and in a location that would meet self-care requisites as they relate to a certain condition. Nurse practitioners can help people regulate the development of their own self-care agency, the capability to discern what factors must be managed for functioning and development processes.
"A Havracke, et al. (2001) study found there are significant associations between heart failure patients' perceived health and their self-care confidence" (Britz, 2010). Identification of heart failure deficits related to decreases in quality of life outcomes define the requisites that need to be addressed. Three sets of limitations are knowledge, decision making and judgment, and skill and opportunity. Heart failure requires confidence in self-care abilities for continued quality of life. Nurse practitioners have opportunity to enhance a patient's confidence.
A nurse can evaluate a patient's abilities and deficits by evaluating the patient, the patient's health, the living environment, and the nursing that is needed with the universal, developmental and health deviation requisites outlined in Orem's Self-Care Theory. The universal requisites evaluate for adequacy of air, water, food, elimination, activity level, social interaction with others, prevention of hazards, and promotion of normalcy, or family communications. The developmental requisites evaluate for the maintenance of the developmental environment, or the activities of daily living, and the prevention and management of threatening conditions, such as feels the problems are of their own making. There are two categories of developmental self-care requisites. There are conditions that support life process and promote specific developmental stages, such as intrauterine life (Rosales, 2010). Or, there are conditions affecting human development with concerns of provision of care to prevent deleterious effects of adverse conditions and concerns of provision of care to prevent or overcome existing or potential deleterious effects of particular conditions or life events. The health deviation requisites evaluate for adherence to medical regimen, or compliance of doctor's orders, awareness of potential problems, such as disease process, diet, and medication side effects, modification of self-image to incorporate changes in health status, and adjustment of lifestyle, or adjustment to deformities or pain tolerance.
Once the abilities and deficits are identified, the nurse can determine areas of priority. The nurse can offer guidance, support, and teaching based on the patient's needs and abilities, or advice on how the patient can get help to meet the deficits in their own care. The nurse also provides guidance, support, and teaching to family of the patient to provide additional support and teaching to the patient. Ongoing evaluation helps to determine any changes in abilities and deficits. As conditions change, the nurse can…