Core Concept in Nursing Theory, Coursework Example
The nursing profession has had a long, and sometimes problematic, evolution over the centuries since the concept of “nursing” was first codified. As recently as the 19th century, nursing was generally considered to be a profession for women of questionable moral character, and there was little in the way of formal training or standards of care in the field. This all changed when Florence Nightingale published Notes on Nursing; What it is and What it is Not in 1859 and established a school for nurses in 1860. Nightingale was, in a sense, the first nursing theorist, and her work continues to influence and underpin the nursing profession to this day. In the last half century, the development of nursing theories has expanded rapidly; there are now a great number of different nursing theories, each offering a unique perspective on the profession. At the most fundamental level, however there are several core concepts that inform the construct of many theories; this paper will examine the concept of “adaptation” and discuss how the fundamental components of this concept are manifested in two key nursing theories.
While individual nursing theories each have their own sets of specific ideas and concepts on which they are built, there are several metaparadigms that overarch all of them. These metaparadigms are “human beings, environment, health, and nursing” (Kim & Kollack, 2006). Generally speaking, all nursing theories address these metaparadigms, though each individual theory does so in its own way. Effective nursing theories take into account these metapardigms by delineating specific mechanisms and guidelines for taking these broad ideas and concepts and making them applicable in the real-world setting. Further, those who have crafted nursing theories are building not just on these metaparadigms, but on the historical record, research, and practical knowledge of those who came before them; in this sense, the development of nursing theories is a vibrant and dynamic process.
One of the most significant nursing theories is the Adaptation Model of Nursing, developed by Sister Callista Roy. The notion of “adaptation” as it pertains to human health did not begin with Roy, however; it has its roots in works as early as Darwin’s On the Origin of Species (Kim & Kollack, 2006). Darwin described the manner in which living beings adapted to their environment, noting that those organisms that were best suited to their environmental conditions were more likely to survive and procreate, thus passing along traits to subsequent generations that would allow those generations to survive in the given environmental conditions. This expression of adaptation was not a directed process, but was simply a function of the interaction between organism and environment over time (Kim & Kollack, 2006).
In 1965, author René Dubos published Man Adapting, wherein he described “the individual as a unit of adaptation” (Kim & Kollack, 2006). Dubos posited that the manifestation of illness in an individual is not solely a function of how severe or powerful an infectious agent is, but is largely affected by the behavior of the individual (Kim & Kollack, 2006). Dubos’ views on adaptation in terms of the individual see the process not in Darwinian terms, but instead as a process that is, at least in part, an expression of individual behavior. When an individual succumbs to disease, asserts Dubos, it is a result of the failure of the individual to adapt to environmental pressures.
Roy’s Adaptation Model (RAM) builds upon these concepts of adaptation, developing a framework for viewing a patient in the context of adaptive processes (Basavanthappa, 2007). According to Roy, human beings are a set of systems that process stimuli, both internal and external, and respond to the inputs of these stimuli with outputs that manifest as behaviors with are either helpful and healthy or which are ineffective and allow the individual to succumb to illness (Basavanthappa, 2007). This viewpoint necessarily takes into account not just the patient, but the environment in which the patient exists. Patients have an adaptation level at which they can reach equilibrium with their environmental stimuli, though this adaptation level is not a fixed point, but is instead an ever-shifting state. In the context of Roy’s model, adaptation is not an end result, but is instead an ongoing process wherein the patient responds to a constantly-changing environment.
In Roy’s model, “the human systems’ goals of adaptation are survival, growth, reproduction, and mastery” (Kim & Kollack, 2006). Roy views the patient holistically, taking into account such factors as the human need to be creative, and to find a purposeful meaning for life itself. Roy makes a point of recognizing that human beings are social creatures, and includes the level at which the patient’s needs for social interaction are met, and the extent to which the patient strives to meet such needs, as a significant component of the adaptive process (Dossey and Keegan, 2009).
Betty Neuman’s Neuman System Model shares some commonalities with Roy’s Adaptation Model, though the two models are also divergent in many ways. At the core of the Neuman Systems Model (NSM) is the role of stress and how the patient reacts to stressors (Basavanthappa, 2007). According to NSM, the human body has a set of needs –needs that can often conflict with each other- and the human system is the aggregate of the mechanisms by which the body attempts to satisfy its needs (Basavanthappa, 2007). In a sense, the human system is striving to reach a state of equilibrium, though the internal pressures of conflicting needs and the stressed exerted by a constantly-changing environment ensure that the effort to reach state of equilibrium is an ongoing process.
In the context of the NSM, the human system is impacted by stressors, and is involved in an ongoing series of efforts to process those stressors and produce outputs that help move the system towards a state of equilibrium. This balance between the patient-as-system and the environment in which the patient exists is that the heart of the NSM. When impacted by stressors, the patient can undergo what Neuman labeled “adjustment,” responding to the stressor by making alterations to the functions of the internal system, it can make changes to the environment itself, or it can do both to varying degrees (Basavanthappa, 2007). Neuman emphasizes understanding the patient as system in the context of the overall environment, and asserts that intervention to fend off stressors is a significant component of providing effective patient care.
Though the RAM and NSM nursing theories are different in many ways, they share some fundamental conceptual components. Roy’s ideas about “adaptation” and Neuman’s ideas about “adjustment” are not interchangeable, but they are fundamentally similar. Each theoretical perspective emphasizes the need to understand the environmental context in which the patient functions, and recognizes that both internal and external factors and the patient’s ability to effectively respond to and process the confluences of these factors are critical components of a patient’s well-being. Although a thorough and detailed examination of each theory is beyond the scope of this brief discussion, it bears noting that while each theoretical model shares some commonalities on a conceptual level, each also has specific, and often divergent, approaches to dealing with those commonalities on a practical level.
With regards to the RAM, the NSM, and the broad range of other nursing theories, it is inappropriate to judge any of them as being “superior” to any other; the point of nursing theories is not to weigh them competitively against each other, but rather to use them as lenses through which to view the function of nursing, with an eye towards providing a greater understanding of the profession. With that consideration in mind, however, it bears noting that the RAM has long been viewed as one of the most significant of all theoretical models, and that it has served as the foundation for other theories as well as providing the basis for a considerable amount of curricula at nursing schools and other educational institutions (Daniels, 2004). That is perhaps the greatest strength of the RAM, in that it serves both as a seminal, fundamental theoretical construct while also providing a jumping-off point for the work of other theorists. While no one theory can be considered to be the “best” theory, the RAM is unquestionably one that all nurses and nursing students would do well to explore.
Basavanthappa, B.T. Nursing theories. Jaypee Brothers Medical Publishing. New Delhi, India. 2007.
Daniels, Rick. Nursing fundamentals: caring and clinical decision making. Delmar Learning. Clifton NJ. 2004.
Dossey, Barbara Montgomery; Keegan, Lynn. Holistic nursing; a handbook for practice. Jones and Bartlett Publishers. Sudbury, MA. 2009.
Kim, Hesook Suzie; Kollak, Ingrid. Nursing theories: conceptual & philosophical foundations. Sheridan Books, New York, NY. 2006.
(Dossey and Keegan, 2009)
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