Comparing Nursing Theories and Concepts, Essay Example

In 1859, Florence Nightingale published a book entitled “Notes on Nursing: What it is, and what it is not.” The introduction to the book professes to describe Nightingale’s humility, as she explains a bit about her view on nursing. As Nightingale describes it, every woman either is, has been, or will be a “nurse,” in the sense that they will likely be faced at some point with the care of an invalid family member, or a child, or any other manner of the ill whom a woman might be called upon to care for. Nightingale describes her book as merely a set of “hints” (Nightingale, 1859) about how women might approach the practice of nursing. In truth, the book contains much more than “hints;” it is actually an incredibly detailed list of activities, practices, and concepts Nightingale had developed and acquired in her experience as a nurse. The concepts that Nightingale proffers are not always clearly delineated; some of them must be gleaned by reading between the lines of her text, while others are presented quite clearly. What is most interesting about the nursing concepts Nightingale presents is that they have remained timeless: though an innumerable amount of nursing theories have arisen since Nightingale’s time, most have some similarities at their core. It is these similarities that are worth a closer look.

Sandra Schmidt Bunkers, RN; PhD; FAAN, writes about this phenomenon in her article, “The Timelessness of Nursing Theory.” Bunker too references Nightingale, and asserts that those who are charged with instructing students, particularly those at the doctoral level who may be involved with theoretical development, to always go back to the roots and the sources of Nursing Theory as a foundational exercise before moving forward. Bunkers’ advice is sound; there are some core concepts that seem to underpin nearly all nursing theories, particularly when it comes to determining how nurses should seek to best understand their patients. There are differences in the wording, or course, and even some significant differences in viewpoint, but it is the similarities that are most striking.

According to the Nursing information clearinghouse at currentnursing.com, almost all Nursing theories have been developed within the last twenty years (this does not mean, of course, that some theories are not older than that). In some cases, the differences between the different theories have had a “polarizing” effect (Canam, et el; 1998), so it is important for instructors to remind students, and for nurses to remind themselves, of the Metaparadigns that overarch all nursing theories, and to remember that, at their core, nursing theories are only worthwhile as far as they serve the needs of patients.

The Metaparadigms of nursing theories are as follows:

Person:

• Recipient of care, including physical, spiritual, psychological, and sociocultural components.
• Individual, family, or community

Environment:

• All internal and external conditions, circumstances, and influences affecting the person

Health:

• Degree of wellness or illness experienced by the person

Nursing:

• Actions, characteristics and attributes of person giving care

(source: currentnursing.com, 2011)

A Nursing Theory is “a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing.” (currentnursing.com). Nursing Theories are a mix of different ideas: the Metaparadigm of Nursing, and the specific concepts and theoretical suppositions that make up the overall Nursing Theory. With so many different Nursing Theories emerging in the last few decades, and with the overwhelming amount of information available when studying these different theories, it is understandable why there can be a “polarizing” effect, as mentioned earlier. Again, this is why it is not just important, but imperative, to remember that Nursing Theories must address the needs of the patient first. It is in this area that there can be seen some commonalities and similarities between and among different Nursing Theories.

One example of a significant Nursing Theory is the Roy Adaptation Model, as first developed by Sister Callista Roy. Sister Roy spent a lifetime involved in nursing, and made important contributions to the theoretical work of nursing. She served as a professor at Boston College of Nursing, and developed and published her views on the role of nurses; her views remain relevant to this day. The Roy Adaptation Model sees people (and, more specifically, patients) as “bio-spsycho-social” beings (Fawcett, 2006).

This “bio-psyco-social” model means that there are different components that make up a person, and the Roy Adaptation Model addresses these three ideas as being significant parts of what makes up a person. There are the biological functions of an individual, which effective nursing must of course address. In addition to these biological functions, nursing must also take into account the psychological needs of the patient. Finally, Sister Roy believed it was necessary to understand that people are inherently social creatures, and that effective nursing would take into account the interrelationships that patients have with family, friends, and other social networks. In order for nursing to be effective, it is necessary to address the entirety of these needs of a patient, rather than just address the biological component of an illness (Fawcett, 2006).

Sister Roy first published her ideas in the journal “Nursing Outlook” in 1970, and the majority of her ideas still serve as a foundation for the Model. Roy described “four modes of adaptation” (Fawcett, 2006):

• Physiologic needs
• Self-concept
• Role function
• Interdependence

Taking into account Sister Roy’s description of people as bio-psycho-social creatures,it is easy to understand these four modes. The physiologic needs are the “bio” part of the equation; the “self-concept” fits the psychological part; and both role function and interdependence address the social aspect of a person or patient.

The concepts and ideas that underpin the Roy Adaptation Model fit the Metaparadigm construct, with various parts of the Model addressing the four primary components of the Metaparadigm.  In terms of the “Nursing” part of the four parts of the Nursing Metaparadigm, there are several components. Sister Roy believed that a person’s health was determined largely by his or her ability to adapt to environmental changes (with the term “environment” referring to all aspects of a person’s life, including changing familial and social relationships). In the Roy Adaptation Model, the “Nursing” section of the theoretical paradigm promotes a patient’s ability to adapt to the four modes previously described both on an individual level and in terms of the patient’s larger social relationships, and served to promote both the health and well-being of a patient and the patient’s ability to die with dignity (Fawcett, 2006).

What is most significant about the Roy Adaptation Model is that the needs of the patient are primary. No effective Nursing Theory could do anything but serve the needs of the patient first. As noted earlier, the differences between and among Nursing Theories can and do often have a polarizing effect, with adherents of different theories disagreeing sharply with those who follow different theoretical models. With that in mind, it may be an interesting exercise to examine a Nursing Theory that, on the surface, appears to be one of these potentially polarizing theories when compared to the Roy Adaptation Model, and to look deeper to determine of the two theories share any common ground.

While the Roy Adaptation Model stresses, in part, the significance of a patient’s interdependence and social functions, Virginia Henderson’s Nursing Theory places and emphasis on nurses helping a patient to regain his or her independence and ability to function as an individual (Halloran, 1996). Henderson determined a set of fourteen basic needs of a patient (these will be omitted here in the interest of efficiency; it is understood that they are related to the overall health and well-being of a patient). As with the Roy Adaptation Model, Henderson’s Theory can be viewed through the lens of the Metaparadigm construct. A brief summation of how Henderson’s Theory fits the “Nursing” section of the Metaparadigm is as follows: a nurse assists a patient who does not have the strength or the ability to satisfy his or her basic needs (as described in the fourteen basic needs of Henderson’s Theory); a nurse promotes a patient’s ability to gain independence; finally, a nurse serves to help a patient become “whole” or “complete” and able to function independently. The nurse works with the patient to regain these abilities, but also seeks to assist the patient in becoming independent of the nurse as quickly as possible (Halloran, 1996).

On the surface, these theories would seem to be as different as two theories could be. One seems to stress the way in which patients are interdependent beings, and emphasizes the role that social and familial relationships play in the health of a patient, while the other stresses the importance of a patient regaining independence as quickly as possible.

What must be recognized when examining these two Nursing Theories is that Henderson’s Theory does not place any emphasis on a patient’s social or familial functions. The “independence” that Henderson stresses is not an independence from all other people; it is simply an independence from needing the help of a nurse for the patient to address or meet his or her own basic needs. Henderson’s Theory, therefore, does not discount the importance of a patient’s social functions or needs; it simply does not address them. This is a significant difference, of course, and it is, perhaps, these sorts of differences that can lead to polarization among adherents of different theories.

If one steps back and looks at these two Nursing Theories (or, really, any Nursing Theories), the similarities can not only be seen, but can be understood as being both more significant and more important than any of the differences. At the heart of any Nursing Theory, the patient comes first. This is the most important aspect of any Nursing Theory, and is the most important thing for any nurse to keep in mind. No matter which Nursing Theory, or set of theories, a nurse may adhere to, the most important thing to remember is that, at their core, seeing the patient as not just a hypothetical construct, but as a living, breathing human being, is the most important concept of all.

Bibliography

Bunkers, S. (2008). The timelessness of nursing theory. Nursing Science Quarterly, 21(3), 211-213.

Canam, T, et al. (1998). Nursing’s metaparadigm concepts: disimpacting the debates. Journal of Advanced Nursing, 27(6), 57-68.

Fawcett, J. (2006). The roy adaptation model and content analysis. Aquichan, 6(1), 34-37.

Halloran, E. (1996). Virginia henderson and her timeless writings. Journal of Advanced Nursing, 23, 17-24.

Nightingale, F. (1859). Notes on nursing: what it is, and what it is not. London, UK: Harrison, Pall Mall. Additional conceptual Material: http://www.joannabriggs.edu.au

www.nursingconcepts.com

Sigma Theta Tau Honor Society of Nursing, http://www.nursingsociety.org/default.aspx