Theories and models took a significant place in the willpower of nursing during the past fifty years. The purpose behind formulating these ideas was to give a theoretical basis for provision of care and attention and reputation of the medical profession. This newspaper will mainly concentrate on both grand nursing care models, the Dorothy Orem's self care deficit medical theory (SCDNT) and Sister Callista Roy's version model (RAM). Firstly, this newspaper will explain the primary concepts in both models and compare the similarities and differences between the two. Furthermore, these models would be analysed as to which model would better apply to the Medical practice.
Orem's ideas fundamentally developed from the reflections of her experience. Orem's familiarity is not limited to nursing sciences only, but her work shows evidence of underpinnings from metaphysical and epistemological framework as well. The foundations of her theory lay in the philosophical system of realism (Alligood & Tomey, 2010). Orem identifies her theory of personal good care deficit as a general theory, which includes three theories, the idea of self health care, self attention deficit and nursing systems model.
Orem's theory of personal care talks about how people care for themselves, and the idea of self health care deficit talks about how precisely people can be helped by nurses or significant others. The idea of nursing systems describes the relationships that should take place and become preserved for medical to be made (McEwen & Wills, 2011). In her model she talks about about several concepts which would be briefly discussed to understand her theoretical construction. In her theory she identifies self care requisites which further branch into general self health care requisites (air, food, water, etc. and avoidance from risks, etc. ), developmental personal care and attention requisites (Developmental aspects), and health deviation self care and attention requisites ( for the sick, injured, pathological conditions, etc. ).
A person is placed in the centre of SCDNT. The theory of self care and attention views a person as taking deliberate actions in keeping and promoting health. This transforms to reliant care agency and self care deficit based on the demands of your person. Nursing care and attention agency makes action, which helps individuals to meet therapeutic self care demands and plays a professional role towards achievements of nursing goals, thus activating the medical systems. Nursing system performs a series of actions to meet the therapeutic self good care demands or regulates the patients self care and attention agency by guiding, directing, educating, providing physical and emotional support, and provision and maintenance of an environment which fosters development. The SCDNT also explains the basic conditioning factors that affect personal care and healing self health care demand namely era, gender, developmental talk about, health state, design of living, healthcare system, family system, socio-cultural, option of resources and exterior environmental factors (Alligood & Tomey, 2010).
The theory of nursing system is divided into supportive educative (wants patient's activities and rules of self attention organization by nurse and patient), partially compensatory (nurses perform some self care and attention functions, assist patients, and patient also works some self care activities and both are involved in the legislation of self care agency), and wholly compensatory ( nurse functions therapeutic self health care, compensates the power of the patient in self health care and shields and supports the individual) (Alligood & Tomey, 2010).
The adaptation model by Sister Callista Roy was a result of her Master's degree project to develop a conceptual model on Medical. Being a paediatric nurse she got seen the quick resilience and version among children in response to physical and subconscious changes (Alligood & Tomey, 2010), leading to the version model. Roy's model is a derivative of Harry Helson's version theory of psychophysics which has communal and behavioural sciences. Roy's adaptation model places focus on the adaptation of any person. The metaparadigms in this model person, environment, health insurance and nursing are interconnected to the primary notion (Alligood & Tomey, 2010).
Major concepts discussed in her model would be offered here to comprehend her theoretical platform. Roy & Andrews (1999) refer to adaptation levels as included, compensatory and affected. Furthermore, that the version level of an individual changes constantly while encountering focal, contextual and residual stimuli and stand for someone's own adaptive reactions. In addition, there are Adaptation problems which raise concern on the list of nurses related to positive version among individuals and groups. Coping processes are described as innate coping mechanisms which can be genetic and attained coping mechanisms which can be developed through learning and encounters. They are further divided into regulator subsystem (chemical substance, neural, and endocrine systems) and cognator subsystem (cognitive- emotive stations: perceptual, information handling, learning, judgement and feelings) (Alligood & Tomey, 2010). The responses can be adaptive (helps the individual achieve, growth, reproduction, survival, mastery, specific and environmental transformations. ) or ineffective (do not attain the goal of adaptation). Designed life process identifies the adaptation level in which constructions and functions of any life process work at meeting individuals needs. These procedures are grouped as Physiological-physical (oxygenation, diet, removal, activity and recovery, and protection and smooth electrolyte balance, senses, neurological function, acid solution foundation balance, and endocrine function. ), Home concept group identity ( mental health and religious needs), role function and interdependence. Role function includes major (girl, her gender, age, etc. ), secondary (role of partner, mom) and tertiary (educator/ role in world). Interdependence function includes connections with significant others and support systems, this means those contributing to interdependence needs (Alligood & Tomey, 2010).
Orem's theory and Roy's model are both regarded as grand nursing theories (McEwen & Wills, 2011). These grand ideas are conceptual models which identify a concentrate on nursing inquiry and guide the development of midrange ideas which turn out to be helpful for nurses and also other health care professionals. Besides this Orem's theory is based on human needs for self attention while Roy's on interactive procedures such as version.
Metaparadigms in both ideas are defined in another way as the central concepts of their models fluctuate. Orem uses personal attention as the central idea whereas Roy uses adaptation. Both the models have an alternative core principle, but engender greater patient engagement.
Person: According to RAM, person persistently encounters environmental stimuli, and then a response occurs, resulting in adaptation. This response may be effective (adaptive) or inadequate. Moreover, an individual can be an adaptive system which carries a person, groupings, organizations, neighborhoods and world (McEwen & Wills, 2011). Roy also considered the real human as a bio-psycho-social being. On the other hand, Orem defines a person as a person battling to get self-care needs found in order to live on and mature (Current Nursing, Orem's Theory of Self-care, INDIVIDUAL, 2012). Both the models have defined a person as an individual and his battle to achieve maximum health, but the means are different.
Environment: Relating to Roy, a person constantly interacts with the changing environment and responds to stimuli which ability can determine the version level. (Current Medical, 2012, Roy's Adaptation Model). Orem believes that the surroundings influences the individual. She emphasizes that basic needs such as air, ventilation etc. and protection of hazards are required for individuals integrity and functioning (George, 2002).
Both the models Orem and Roy are of the view that environment performs an integral role in real human development and survival. Roy presents environment as a stimuli that disrupts the integrity of development and then simultaneously a person achieves version in response to the stimuli. In contrast Orem considers environment as a mean to provide basic individuals needs for success.
Nursing: Roy believes a Nurse's role is to help the individual's adaptation effort by controlling the surroundings which results in achieving the optimal level of functioning and health and fitness in a person. Roy's goal of nursing is to accomplish adaptation leading to maximum health, well-being, and quality of life and death with dignity, (Roy & Andrews, 1999). Alternatively, Orem believes that deliberate actions are performed by nurses to achieve the goal of personal care. Aside from prevention and campaign, Orem also focuses on nursing as a supportive educative system which helps individuals to pay the deficit.
Both the models clarify the role of the nurse helping an individual either to adapt to a situation or even to manage the home- treatment deficit. However contrasting both, Orem concentrates more on the support that is necessary opposed to Roy whose emphasis is behaviour change. Moreover Orem focuses on the physiological needs of the individual whereas Roy views both physiological and internal version important.
Health: Previously Roy looked at health being on a continuum from extreme illness to high level of wellness, but later focussed on health being truly a process where health insurance and disorder can co-exist (McEwen & Wills, 2011 ). On the other hand Orem identifies health as "being structurally and functionally whole or sound" (McEwen & Wills, 2011). Orem emphasizes on the physical, mental health, mental and social aspects of health insurance and targets all levels of health maintenance including major, supplementary and tertiary prevention (George, 2002). In view of the way the two theories define health, Roy expresses that a person is healthy if he has modified to his disease in a optimistic manner, while For Orem being healthy means to be holistically sound and efficient.
Orem's style of attention includes three steps of medical process that happen to be assessment, diagnosis and formation of nursing health care plan and the 3rd is implementation. On the other hand Roy's model has six steps to the nursing process, evaluation of patient's behavior, assessment of patient's stimuli, medical diagnosis, setting goals, intervention and analysis (Masters, 2011). Orem's nursing process seems better to use compared to Roy's. The six step medical process may not be that extended, but at a glance it looks as it might be frustrating.
Roy has the spiritual aspect inserted in her model and incorporates spirituality as an important component of the individual adaptive system, whereas Orem's model has skipped this essential feature to handle in her model. In a report, White, Peters and Schim (2011) suggest that integration of the idea of spiritual self good care and spirituality in Orem's SCDNT is an essential part of theory development. Furthermore, understanding is necessary that how spirituality and spiritually established practices contribute and promote health and well being in disease of a person.
Both the ideas have strong philosophical support. Orem's model is solely a theoretical system of nursing focussing on average realism. She has also shown involvement in Parsons style of cultural action and system theory by von Bertalanfy (McEwen & Wills, 2011). The impetus behind Roy's model was Johnson's medical model. She's incorporated Helson's adaptation model, Lazarus's coping model, von Bertalanffy's system model, system explanation by Rapoport's system explanation and Dohrenrend and Selye's theories of stress and adaptation. So, both theories have a base of strong philosophical underpinnings.
Besides that, several institutions of medical and colleges have designed their curriculum on the bottom of SCDNT like the "Georgetown University School of Nursing, The College or university of Missouri, Columbia, and the University or college of Florida and so many more (McEwen & Wills, 2011). Regarding to Phillips in McEwen & Wills (2011), Roy's theory is also used at several universities in america, Canada and even Japan. Furthermore, both these ideas are being used in several clinical adjustments and research. Looking at the books, it is good to learn that both these ideas are being found in the fields of nursing practice, education and research. Assessing the testability of both theories, both have been found in several researches and studies and also have shown to be suitable (McEwen & Wills, 2011)
While analysing a research study using the Roy's model, of a young woman, 37 season old who acquired met with an accident, operated on but experienced scars on her behalf face. The nurse assesses that the individual had adapted well, except for the self strategy. It was obvious as she averted social gathering, used heavy cosmetic, dark spectacles and a large head wear. Here, the concentration of care is always to either change the stimuli or strengthen the adaptive processes. Strengthening the adaptive process would be difficult because here the scars on her face wouldn't vanish, but she'd have to reside with them. She could opt for plastic surgery but it will depend on whether she'd be able to bear the expenditures. Alternatively if Orem's model can be used to investigate the same situation, the nurse would provide complete care and attention in the wholly compensatory system (in a healthcare facility) and make an effort to make the woman independent, gradually she would perform treatment activities partially assisting the patient and then finally, the individual would become self-employed looking after herself. In this example, it justifies that Orem's model is comparatively fits better than Roy's model.
In a report when Roy's model was used on battered women, it was challenging for the study group to assist the women to redefine their close relation with the partners in various societies. So, further research is required to explicate the adaptation strategy and the responses from such conditions (Woods & Isenberg, 2001).
If we evaluate, Orem focuses on finding the self-care deficit of the individual and providing the required care to market his / her well-being. Whereas, Roy can be involved with the various stimuli that makes adaptation in order to achieve perfect health. Relating to Denyes, Orem and SozWiss (2001) personal care is recognized as a practical make an effort as it focuses on human performing and growth by deliberate action in existing or changing environment. Furthermore, it's been valued as a practice model because of the depth of knowledge and skills required by attention providers. Orem's theory is derived from the clinical base which provides a thorough base for nursing practice. Through books review, it's been found that Orem's model has been found in several medical situations, community setting, education and research and it has been applicable to all such scenarios.
Orem's model is good in terms of applicability, but tips suggest that an element of spirituality must be put into the model. Spirituality has an essential role in the process of health problems to wellness therefore it requires incorporation in Orem's model. Individuals make use of it as support systems throughout their durations of illness and challenges, specially regarding our eastern culture. Even, White, Peters and Schim (2011) propose the addition of the facet of spirituality in Orem's theory, which means it has equal importance in the traditional western culture as well.
Orem's model is more functional, relatively simple and generalizable to apply to a number of patients in several conditions. It seems complicated as there are three theories contained, but once learned and understood it could be easily put on different medical situations, community configurations, education and research. Basically, when working in the ER, I took attention of the patients and intervened accordingly. When today I examine those interventions, I unintentionally or subconsciously used Orem's model of self-care and this justifies how simple and sensible her model is. Roy's is more challenging to apply credited to a variety of concepts and sub concepts included and their connections among themselves is too intricate. The amount of complexity might create it wide-ranging in range and generalizability, but the compound relations among its sub ideas make its applicability more difficult.
It is important for nurses to examine the different theories and its applicability in several specialized medical situations. The statements and arguments mentioned above justify that Orem's theory would work to nursing practice and is applicable to all or any situations where condition, disorder or disability is involved. Orem's theory and its own comprehensiveness give an possibility to apply it to almost all clinical scenarios.