Integrating Watson's caring theory and Roy's adaptation model in nursing practice

Personal Nursing Philosophy

Conceptual Background of my Nursing Philosophy

The history of nursing includes foundational shifts of perspective that were, at least in the past, largely functions of the limitations of the discipline in the pre-scientific era of medicine. In fact, at the time that Florence Nightingale pioneered the practice of insisting on a hygienic carative environment, she was unaware of the clinical value of that approach in terms of antisepsis (Reid, 2009; Taylor, Lillis, & LeMone, 2005). Her motivational influence was simply to ensure that patients were treated with dignity. Until the age of modern medicine after the acceptance of Joseph Lister's Germ Theory of bacterial infection and disease, and later, antibiotics, nurses provided more in terms comfort, compassion, and dignity for their patients than they contributed to the clinical efficacy of their medical treatment (Reid, 2009; Taylor, Lillis, & LeMone, 2005). As medicine became more scientific and disciplined, nursing also developed into a scientific discipline that culminated in the late 20th century in the widespread appreciation for the value of empirical evidence-based nursing.

However, some nursing theorists came to the conclusion that the shift toward empirically-based scientific nursing was beneficial in many respects, but potentially detrimental to the overall purpose of nursing in others (Fawcett, 2005). Overemphasis of the scientific model had, in the minds of some, reduced nursing too much to a clinical exercise and removed the element of care that had been the hallmark of nursing in previous eras. In that regard, two theorists in particular outlined approaches to modern nursing that are entirely compatible with empirical evidence-based practice in a framework that simultaneously encompassed the underlying concepts of patient care and clinical practice in a manner that integrated the importance of the patient, the environment, and the professional nurse. Specifically, Jean Watson pioneered her Caring Theory of Nursing and Sister Callista Roy introduced her Adaptation Theory of Nursing designed to address the full range of four conceptual domains of nursing: (1) person, (2) environment, (3) health, and (4) the professional nurse (Fawcett, 2005; Taylor, Lillis, & LeMone, 2005). My personal philosophy of nursing is to practice the comprehensive integration of my scientific training in empirical evidence-based clinical nursing within a framework that applies clinical nursing to the four domains addressed by Roy and with an overall focus on the carative elements outlined by Watson.

Incorporation of Sister Callista Roy's Adaptation Model of Nursing

The foundation of Roy's Adaptation Model of Nursing are the four domains of person, environment, health and illness, and nursing (Dobratz, 2008; Fawcett, 2005). According to Roy, human life entails a perpetual process of adaptation to change from internal (i.e. biological) and external (i.e. social and other environmental) influences on the individual. In that regard, Roy believed that human health encompassed the entire course of human life (literally) from the cradle to the grave and all points in between. Regardless of the stage of life, human health is determined largely by four "bio-psychosocial" considerations such as physiological factors, self-perception issues, role function, and the relationship or interdependence between the individual and myriad aspects of life among other individuals in society. To Roy, the view of human health that focuses exclusively on physiological functions and processes in myopic; to understand the state of health and welfare of the individual, it is necessary to understand how the individual is influenced by the full range of bio-psychosocial factors and considerations (Dobratz, 2008; Fawcett, 2005).

In my professional development, Roy's Adaptation Theory is most relevant and applicable in concrete terms by virtue of her six steps of nursing practice: behavior-based assessment, stimuli-based assessment, clinical diagnosis, setting of goals, intervention, and evaluation (Dobratz, 2008; Fawcett, 2005). Those steps are consistent with my training and applicable to my approach to practice, such as in connection with the importance of observation of the patient from the perspectives of physiology, psychology, and social influences of family environment and social culture (Dobratz, 2008; Fawcett, 2005).

Behaviorally, Roy described patients as either manifesting behavior that is fully functional or dysfunctional (or, more precisely, in her terminology, "adaptive" "ineffective"). Roy's psychological inquiry into patient assessment considers the stimuli that are relevant to the patient's behavior from the perspective of a clinical diagnosis based on identifying the causal interrelationships between those stimuli and dysfunctional (or "ineffective") behaviors. Realistic goal-setting is then based on the individual's potential given those influences rather than on any independent or general scale of goals. Likewise, intervention in Roy's model is also dictated by the information identified in the preceding steps. Roy emphasized that culmination of the value represented in the first four steps of her model realize their value to the patient in the intervention step, simply because that is the essential function of nursing. Finally, the process of evaluation allows nurses to consider whether and to what degree the first four steps have produced interventions that prove beneficial to the patient and, most importantly, to re-evaluate and adjust intervention plans based on that evaluation (Dobratz, 2008; Fawcett, 2005).

Conclusion

Having studied nursing only in the era of scientific medicine, my experience with various nursing theorists and their ideas and concepts has been substantially academic rather than practical. Given the technical challenges inherent in studying and applying scientific empirical evidence-based nursing methodology, it is somewhat easy to regard nursing "theories" as extraneous to the clinical practice of the modern nurse. However, Jean Watson's Caring Theory of Nursing has provided a contextual bridge between the so-called "hard science" of modern nursing and the fundamental motivation that I believe virtually all nurses share, even in the age of sophisticated medical technology and interventions. Likewise, Callista Roy's Adaptation Model of Nursing provides a contextual bridge between the internal physiological determinants of patient health and the crucial aspects of external environment that typically influence patient health and (especially) patient perceptions and attitudes about health and medical or nursing interventions. Together, application of the principles promoted by Watson's Caring Model and by Roy's Adaptation Model of nursing complement my clinical training in a manner that I believe enables me to contribute the most to my patients, to my profession, and to myself as a nurse.