In contemporary times, there are many nursing theories, each with a highlighted core concept and value, and each with a unique philosophy. When looking closely at these theories, it is possible to see commonality among them, and theorists can be divided into groups with similar core beliefs. Nursing in general has an underlying goal of identifying and filling the patient's needs, though each theorist comes from a unique perspective on how to accomplish this task. Several nursing theorists are, in fact, considered "needs theorists" as their ideas are directly related to this broader goal. Others are more relationally focused and focus on the interpersonal relationship as essential for healing to occur. The theories identified in this paper are all considered "needs theories" and their theorists all share the core value of increasing patients' autonomy, self-determination and individual independence needs through accomplishing specific nursing interventions. The core concept of valuing patient's sense of autonomy in meeting their basic needs is based on Maslow's hierarchy of needs and the ultimate human striving towards self-actualization (Kagan, 2007).
Virginia Henderson's Need Theory relates nursing practice to intervening in areas where a person would ideally be able to care for himself, but due to current health circumstances or lack of knowledge, requires help. She states that a nurse's function is to be a helper for an individual who in the moment is unable to meet one of his 14 basic needs, "and to do this in such a way as to help him gain independence as rapidly as possible (Murray, 2003)." She was one of the first nurses who conceptualized nursing as more than just following the doctor's orders, and places much emphasis on the nurse's role as supporter and educator, as well as provider of assistance where a need goes unmet. Based on the level of dysfunction of the patient, the nurse will intervene as minimally as possible, to encourage autonomy and independence. The nurse will also provide important information and education that the patient may not be aware of in order to promote further progress and maintenance of health. The varying physiological, spiritual, social and mental health needs are identified in 14 points that Henderson has identified, and the overall goal remains to encourage the person to meet these needs for himself in order to derive maximum personal autonomy.
Another theorist who shares a similar value of meeting patient's needs and aiming towards increasing independence is Ida Jean Orlando. In her Nursing Process Theory, Orlando defines the nurse's goal as identifying what a patient's imminent need for help is and responding as quickly as possible to allow the individual to return to an autonomous state.
Overall her theory is comprised of three elements including patient behavior, nurse's reaction, and nursing interaction. She maintains that the need may not necessarily be representative by the patient's behavior alone, and that the nurse must use her own perceptions, information, intuition, and assessment skills in order to pinpoint the immediate need. For example, the patient may identify feeling ill, but may also feel distressed at seeing a nurse and may exhibit uncooperative behavior, to which the nurse must empathically respond to as part of the imminent-need picture. Orlando shares sentiments with Henderson and Orem's patient-towards-independence and actualization model by encouraging a speedy response by the nurse once the need is identified. Orlando highlights the input of the patient as essential in identifying the problem and encourages nurses to take into account the patient's report of any sensory unbalance, as well as what individual meaning they attach to the experience in their understanding of the problem. Only then can the nurse then use her own judgment of the situation with her medical knowledge to propose a treatment response. This highlights the value of a person as an individual who experiences distress uniquely, and validates their sense of independence and self-determination. The patient is the "core force" of the interaction and must be treated as such (Noakes, 1990.) The nurse must assist the patient in clearly communicating the distress, and must realize that a sense of helplessness due to the problem arising may interfere with clear communication. The nurse can empathize with the patient's predicament, and help identify the need before being able to intervene appropriately.
Individual independence is a Western value, as opposed to Eastern cultures which place more emphasis on familial and community interdependence. Dorothea E. Orem's Self-Care Deficit theory similarly places much importance on the concept of human independence needs by basing her theory on the idea that self-care maintains individual wholeness and integrity. She focuses the nurse's role on increasing the patient's autonomy by supporting his self-reliance needs and providing assistance in areas where he is currently unable to care for himself (Roberson & Kelley 1996.) Orem maintains that humans are distinct individuals who naturally have the ability to care for themselves and be self-reliant (Simmons, 2009), and that nurses should focus on increasing that ability where there is a deficiency.
For example, in a dialysis setting for patients with end stage renal disease, a nurse will take an active role in promoting the patient's involvement in the care by using education and advocacy. The nurse will make attempts to decrease the patient's sense of dependency upon the medical system and include him in his treatment plan in order to increase his feeling of control over his situation (Simmons, 2009) and minimize personal distress.
In order to explore the application of this theory further, it is important to clarify that Orem's theory concept is identified as a "self-care deficit theory." Nursing interventions become necessary when the patient is unable to fulfill biological, psychological, developmental, or social needs (www.currentnursing.com, 2011,) and a deficit in any of these areas is identified. Orem divides her theory into three parts including the Theory of Self-Care, of Self-Care Deficits, and of Nursing Systems. These three components are helpful in identifying where the patient's specific need is, and hence, where and how intervention will be most helpful.
The Theory of Self-Care presumes that a person is naturally capable of being self-reliant when all environmental, physiological and emotional factors are in place and in balance. Human beings achieve a level of well-being when they perform daily tasks that address their basic needs on their own. The components of self-care include universal ADLs (activities of daily living), balance between activity and rest, solitude and social interaction, prevention of hazards to personal well-being, and promotion of continued positive functioning. The nurse's goal is to identify any factors that detract from this natural ability for self-care, such as illness and disease or negative environmental factors, and will intervene accordingly to increase coping and autonomy.
The Theory of Self-Care Deficits identifies when nursing is needed, such as the moment when an individual is incapable or limited in the provision of continuous effective self-care. Orem has identified five methods of helping including doing for others, guiding others, supporting, providing a positive environment which will help patient meet future demands, and teaching. The use of any of the methods of helping will depend on the appropriate level of intervention determined by the nurse, while taking into account not to diminish from any autonomous tasks the person is still capable of doing.
The Nursing Systems Theory describes how the nurse will go about meeting the patient's needs, while maintaining patient integrity. It may be a supportive approach, in which the nurse and patient work together and where the nurse includes educating the patient about preventative measures, or it may be a more involved approach such as a partially or wholly compensatory system of intervention. Ultimately, these three facets of the theory are intertwined and are all parts of the overall meta paradigm that the nurse must identify in order to respond most effectively, with minimal…