Orem's and Watson's Nursing Theories: A Comparative Analysis

Introduction

Theory guides practice. This is true of many things, but is especially true of nursing. While many processes, actions, and rules are involved in becoming a great nurse, understanding and applying theory must be among the most important aspects. Nursing theory allows practitioners to examine concepts and then attempt their practical application when theories are tested. Evidence-based practice, for example, is the productive intersection of theory and application: when theories are constructed, they are tested, and if effective, are incorporated into standard practice. This essay provides a synthesis of nursing theory by examining two important frameworks — Orem's Self-Care Theory and Watson's Theory of Human Caring — and traces how nursing theory has evolved since its beginnings.

Background on Nursing Theory

Many say nursing is as old as humankind. If there was someone sick, there was someone willing to care for that person and nurse them back to health. The word "nurse" comes from the Anglo-French nurice and the Latin nutrica, both meaning "to nourish." Nurses nourish patients emotionally, mentally, and physically and provide them with the means of returning to good health (Parker & Smith, 2015). When examining nursing theory, its purpose is to help practitioners comprehend the process of nursing and improve their own thinking related to it. "The purpose of nursing theory goes beyond its study within courses. Nursing theory becomes alive when the ideas are brought to practice. The usefulness of theory in practice is one way that we judge its value and worth" (Parker & Smith, 2015, p. 27).

Many theories exist across various fields, and nursing is no different. It is up to the individual to decide which theory to apply to their own thinking and practice. It is helpful to examine theories via primary sources or the work of prominent scholars who have studied selected theories. Historically, theory was one of the primary forces driving nursing forward, since healthcare in general demanded constant improvement and innovation.

Improvement and innovation cannot be achieved without theory. Even now, new nursing theories continue to emerge that may one day become responsible for standard practice and care. Emergency nursing, for example, requires quick thinking and a broad knowledge of various ailments. Without theory, practitioners have no direction to explore the different dimensions of what it means to be a nurse.

William K. Cody is a respected contributor to Nursing Science Quarterly. In one of his articles, he discusses how convinced he is that theory guides practice — a significant point, because some argue the opposite. As Cody writes:

"To assert the alternative, that theory arises from practice to an equal or greater extent than theory guides practice, would be a misrepresentation of the contemporary art and science of nursing theory development. In actuality, this assertion has been made widely and, I would venture to say, to the detriment of theory development in nursing" (Cody, 2003, p. 225).

Practice comes from thought, and the process of thought is the foundation of theory. One thinks something and then it becomes real through practice. Theories are tested, and sound theories are then implemented into nursing. But the first step is always the initial idea.

Nursing theory has evolved considerably in recent times and has become a primary means of improving patient care. One outcome of this evolution is evidence-based practice — a mode of thinking grounded in theory. One article noted that nurse educators and nurses must embrace both theory-based practice and evidence-based practice, as each offers benefits for improvement and innovation (McCrae, 2012). Evidence-based practice can be considered a step further than theory-based practice: one cultivates a theory, implements it, and then gathers evidence of its usefulness. Practice does not exist without theory, and practitioners are beginning to recognize this more fully.

This recognition can be seen through Carr's four principal approaches, which explain the nature of theory. "Carr terms these approaches the 'common-sense' approach, the 'applied-science' approach, the 'practical' approach, and the 'critical' approach. Each approach is recoverable from the explicit and implicit content of scholarly literature" (Fealy, 1999, p. 74). The common-sense approach locates or grounds theory within everyday understanding, articulated in the world of practice, where it can be refined, reconstructed, and validated (Ghaye & Lillyman, 2014).

An applied-science approach means conforming to standards of validity, reliability, and rigor as established by scientific convention. The practical approach nourishes practical clinical wisdom and is used to support and inform clinical decisions (Ghaye & Lillyman, 2014). A critical approach allows one to understand, through theory, why a practice exists as it does, taking into consideration how political, social, and historical forces serve to constrain or liberate what is done. Seen through these perspectives, nursing theory is integral to everything — especially evidence-based practice.