¶ … age of Florence Nightingale, and even before that, the nursing profession has undergone significant transformation. Nurses today are, in their own right, important caregivers with respect to patient wellness -- not simply an extension of the attending. One of the most important dynamics in the promotion of nursing in terms of medical consumer care has been the development of favorable theories and educational programs supporting the nurse as an integral part of the patient's wellness program. The true power of nursing is, however, in the recognition of the nurse's contribution to the healthcare system and the knowledge and complex decision-making skills that are necessary to care for patients. The future of professional nursing is filled with a great deal of opportunity and excitement (Ash, 1998). Knowing that nursing has become a recognizable profession in its own right it is important as well to garner an understanding as to the philosophy the underlies the profession itself. Although there are many nursing theories and models, the remainder of this section of the assignment will reflect upon the Roy Adaptation Model, the Leininger's Trans-cultural Model, the Orem Model, and the Watson Transpersonal Care Model with respect to their place in nursing practice. However, prior to a discussion of the selected nursing models a chart presentation is offered to the reader for theory comparative purposes. Upon review of the chart a short discussion will ensure in terms of comparing and contracting the four selected theories.

Four Selected Nursing Theories: A Comparative Review

Theorist

Nursing Model and Type of Theory

Nursing Definition

Focus and Purpose of Theory

Medical Consumer

Wellness

Environment

Orem

A general theory of nursing -- Borrowed

A Needs Theory

A wellness service designed to overcome human limitations in self-care action for health-related reasons

Nursing actions as judgments as to why patients require nursing

A person is an integrated whole, functioning biologically, symbolically, and socially

A state of wholeness or integrity of the individual, his/her parts & modes of functioning

A subcomponent of man, which together comprise an integrated

system related to self-care

Roy

Adaptation model -- Unique - Systems

Theory

A process of analyses and action related to the care of the ill or potentially-ill person

Nursing actions are derived from the demonstration, requiring a process of assessment and intervention.

Intervention is performed within the context of the nursing process and involves manipulation of motivation.

A bio-psychosocial person in constant interaction with an ever-changing environment. The individual is an open and adaptive system

The health -illness continuum is a unbroken line

representing the degrees of health or illness a person experiences at any given time and are inevitable proportions of a person's life.

All conditions, circumstances, and influences surrounding and affecting the development of an organism or group of organisms

Leininger

Transcultural care theory - Unique Systems

Theory

A learned humanistic skill and science that focuses on patient behaviors, functions, and processes to promote and maintain health or recovery from illness.

The goal of Trans-cultural nursing is to provide care that is congruent with cultural values, beliefs, and practices. Uses 3 modes of action: cultural care preservation, cultural care accommodation, and cultural care re-patterning.

Uses a problem-solving approach as depicted in the Sunrise Model

Human

beings are caring and capable of being concerned about the needs, well-being and survival of others.

Viewed as a state of well-being. Culturally defined, valued, and practiced.

Not specifically defined, but the concepts of worldview, social structure, and environmental context are discussed.

Closely related to the concept of culture.

Watson

Theory of transpersonal caring - Borrowed Systems

Theory

Is concerned with promoting and restoring health, preventing illness and caring for the sick. Utilizes 10 carative (caritas) factors that characterize the nursing caring transaction occurring within a given caring moment or caring occasion.

Caring is the most valuable attribute nursing has to offer. Caring denotes a nurse's responsiveness to a client's problem; the nurse and the client collaborate to help the client gain control, knowledge and health.

Combines scientific research with problem-solving

A human being is to be valued, cared for, respected, nurtured, understood, and assisted.

Encompassing a high level of overall physical, mental, and social functioning; a general adaptive maintenance level of daily functioning; an absence of illness

A society with all of its influences.

The Jean Watson Theory of Nursing is a multiple epistemological approach that she labels as the Theory of Human Caring or the Theory of Transpersonal Caring -- a range exploratory theory (Fawccett,...

The pivotal point of the theory is on the human component of caring and the actual interchange between the client and the caregiver. Jean Watson has stated that her work was motivated by her search of a new meaning to the world of nursing and patient care. The major conceptual elements of the theory are ten Clinical Caritas Processes (originally Carative factors), a Transpersonal Caring Relationship, a Caring Moment/Occasion and a Caring Consciousness (Watson, 1985). According to Watson's theory, the human care process is performed through a Transpersonal Caring Relationship guided by the Carative factors. To Watson illness is a cacophony within a person's mind, body and soul, which can lead to disease. Accordingly, therefore, health, achieved unity and harmony within the mind, body and soul and health is associated with the degree of harmony between the experienced and perceived self. What is important when reviewing Watson's theory is to always remember that she is concerned that the caring values of nursing and nurses have been submerged to the point of obscurity within present day medical systems that are dominated by economics, nursing shortages, and modern technological advances. In the end, incorporating Jean Watson's theory of nursing into practice requires the delivery of an undivided moral and spiritual pledge from a nurse towards his or herself and the medical consumer.
While Watson's system is based more of a humanistic and altruistic value system the Orem Self-Care Model stresses patient participation in all phases of wellness. The end result is, of course, the development of a healthy lifestyle -- one that is self-motivating. Further self-care regimens are self-initiating, purposeful, and planned. According to Orem (1971) an individual's health and well-being is a function of one's ability to meet one's health and developmental needs; and because everyone is responsible for their own life, all individuals are capable of fulfilling their goals and ambitions. Unfortunately, however, a web of influences can disrupt the positive flow of individual wellness. Such influencing factors are a professional lack of awareness by nurses of a patient's health beliefs, a lack of appreciation for a patient's cultural diversity, and the inability to listen to a patient's problems (physical and psychological), goals, desires, beliefs, practices, and worldviews

Where Orem and Watson both fall short in the area of recognizing the effects of cultural diversity in patient wellness the Leininger Trans-Cultural Model aptly focuses on cultural sensitivity and understanding in nursing practice. The Leininger approach to nursing practice is unique in that it is actually a blinding of anthropology and nursing beliefs and principles. AS such, according to Leininger, nursing care must be culturally congruent with respect to cultural beliefs and values of both medical consumer and the cultural group from which the consumer comes. To Leininger the nurse is, by definition, involved in ethno-nursing and follows a sunrise model (Leininger, 2000).

On the other side of the nursing theory spectrum is the Roy Adaptation Mode. The Roy Adaptive Model can be characterized as a system of patient wellness wherein patients and medical care professionals are considered to be psychosocial individuals who are taught to cope with environmental change through adaptation. Put another way the Roy theory is better identified as the relationship between the environment and a person's adaptation to both external and internal stimuli. The model is broken down into four well-defined adaptation modes and how these modes relate to the environment as well as comparing the modes to the nursing process. The four modes, in health and wellness, identified by Roy are physiological, self-concept, role function, and interdependence (Weiss, Hastings, Holly, & Craig, 1994).

With respect to the overall aspect of nursing care and nursing theories one of the most important issues yet to be managed or reported upon is the extent to which the present nursing shortage will impact those nursing services seen as important my Levine -- or any other nursing theorist. Although this issue was not a required discussion topic for the assignment it should, nonetheless, become an important inclusion that must be addressed. Regardless of the approach a healthcare practitioner takes to patient wellness, whether based on Leininger, Orem, Roy, or Watson, and a host of other theorists their theories, will be relegated to the annals of history texts should the shortage problem not be critically and proactively addressed.