This paper examines four foundational nursing theories—the Roy Adaptation Model, Leininger's Transcultural Care Theory, the Orem Self-Care Model, and Watson's Theory of Transpersonal Caring—through a comparative framework. A structured table highlights each theory's definition of nursing, focus, patient conception, view of health, and treatment of environment. The paper then explores questions about the nature of borrowed versus unique theory, knowledge ownership in nursing, and the value of theoretical flexibility in practice. It argues that no nursing theory exists in isolation; all are extensions of human thought, and effective patient care depends on the nurse's ability to apply theory contextually rather than dogmatically.
Since the age of Florence Nightingale — and even before — 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 physician. One of the most important dynamics in the promotion of nursing as a form of medical consumer care has been the development of favorable theories and educational programs that support the nurse as an integral part of the patient's wellness program. The true power of nursing lies, however, in the recognition of the nurse's contribution to the healthcare system and in the knowledge and complex decision-making skills 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 equally important to develop an understanding of the philosophy that underlies the profession itself. Although there are many nursing theories and models, the remainder of this section reflects upon the Roy Adaptation Model, Leininger's Transcultural Model, the Orem Model, and the Watson Transpersonal Care Model with respect to their place in nursing practice. Prior to a detailed discussion of each model, a comparative chart is offered for theory review purposes, followed by a discussion comparing and contrasting the four selected theories.
The table below summarizes each theorist's nursing model, definition of nursing, theoretical focus and purpose, conception of the medical consumer, view of wellness, and treatment of environment.
Roy | Adaptation Model (Unique Systems Theory)
Nursing definition: A process of analyses and action related to the care of the ill or potentially ill person.
Focus and purpose: Nursing actions are derived from demonstration, requiring a process of assessment and intervention. Intervention is performed within the context of the nursing process and involves manipulation of motivation.
Medical consumer: A bio-psychosocial person in constant interaction with an ever-changing environment; an open and adaptive system.
Wellness: A health–illness continuum represented as an unbroken line indicating the degrees of health or illness a person experiences at any given time — inevitable proportions of a person's life.
Environment: All conditions, circumstances, and influences surrounding and affecting the development of an organism or group of organisms.
Leininger | Transcultural Care Theory (Unique Systems Theory)
Nursing definition: A learned humanistic skill and science that focuses on patient behaviors, functions, and processes to promote and maintain health or recovery from illness.
Focus and purpose: The goal of transcultural nursing is to provide care congruent with cultural values, beliefs, and practices. Uses three modes of action — cultural care preservation, cultural care accommodation, and cultural care re-patterning — and a problem-solving approach depicted in the Sunrise Model.
Medical consumer: Human beings are caring and capable of being concerned about the needs, well-being, and survival of others.
Wellness: Viewed as a state of well-being; culturally defined, valued, and practiced.
Environment: 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)
Nursing definition: Concerned with promoting and restoring health, preventing illness, and caring for the sick. Utilizes ten carative (caritas) factors that characterize the nursing caring transaction occurring within a given caring moment or caring occasion.
Focus and purpose: 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.
Medical consumer: A human being to be valued, cared for, respected, nurtured, understood, and assisted.
Wellness: Encompassing a high level of overall physical, mental, and social functioning; a general adaptive maintenance level of daily functioning; an absence of illness.
Environment: A society with all of its influences.
The Jean Watson Theory of Nursing is a multiple epistemological approach that she labels the Theory of Human Caring or the Theory of Transpersonal Caring — a range-exploratory theory (Fawcett, 2000). The pivotal point of the theory is the human component of caring and the actual interchange between the client and the caregiver. Watson has stated that her work was motivated by her search for new meaning in 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 disharmony within a person's mind, body, and soul that can lead to disease. Health, accordingly, is achieved unity and harmony within the mind, body, and soul, and is associated with the degree of harmony between the experienced and perceived self. What is important when reviewing Watson's theory is to remember that she is concerned that the caring values of nursing have been submerged to the point of obscurity within present-day medical systems dominated by economics, nursing shortages, and modern technological advances. Incorporating Watson's theory into practice ultimately requires an undivided moral and spiritual commitment from the nurse toward both himself or herself and the medical consumer.
While Watson's framework is grounded in a humanistic and altruistic value system, the Orem Self-Care Model stresses patient participation in all phases of wellness. The end result is the development of a healthy lifestyle that is self-motivating. Self-care regimens are also self-initiating, purposeful, and planned. According to Orem (1991), 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, a web of influences can disrupt the positive flow of individual wellness. Such influencing factors include 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 — both physical and psychological — goals, desires, beliefs, practices, and worldviews.
Where both Orem and Watson fall short in recognizing the effects of cultural diversity on patient wellness, the Leininger Transcultural Model aptly focuses on cultural sensitivity and understanding in nursing practice. The Leininger approach is unique in that it represents a blending of anthropology with nursing beliefs and principles. As such, according to Leininger, nursing care must be culturally congruent with respect to the cultural beliefs and values of both the medical consumer and the cultural group from which that 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 Model. This model can be characterized as a system of patient wellness wherein patients and medical care professionals are considered psychosocial individuals who are taught to cope with environmental change through adaptation. Put another way, the Roy theory is better understood as the relationship between the environment and a person's adaptation to both external and internal stimuli. The model is organized around four well-defined adaptation modes and how these modes relate to the environment as well as to the nursing process. The four modes identified by Roy are physiological, self-concept, role function, and interdependence (Weiss, Hastings, Holly, & Craig, 1994).
"Whether original nursing theories truly exist"
"Who owns nursing knowledge and how it circulates"
With respect to the overall aspect of nursing care and nursing theories, one of the most important issues yet to be adequately managed is the extent to which the present nursing shortage will impact those nursing services deemed important by theorists such as Leininger, Orem, Roy, Watson, and others. Regardless of the approach a healthcare practitioner takes to patient wellness, the theories of these scholars will be relegated to the annals of history texts should the global nursing shortage not be critically and proactively addressed.
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