Conceptual Model

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Topic Description
Meaning
(30 pts.) 1. Describe the main ideas of the theory (should include the assumptions under which the theory operates).
2. What are the main concepts?
3. What are the main relationships between the concepts?
4. How do different concepts affect each other?
Origins of the Theory
(30 pts.) 1. What was going on in the profession of nursing or in American society that may have influenced the theory?
2. What values, theories, evidence, and/or existing knowledge did the theorist cite as support for the theory?
3. What motivated the theorist to write the theory?
4. What approach to theory development did the theorist use?
Usefulness
(20 pts.) 1. How useful is this theory in practice?
2. Is the theory practical and helpful to nursing?
3. Does it contribute to understanding and predicting outcomes?
4. Cite an example/case study where this theory could be used.
Testability
(10 pts.) 1. How testable is this theory?
2. Has this theory generated research? How many and what types of studies?
3. Give one example of a study done using the theory
4. What types of statements are the propositions?
Overall Evaluation
(10 pts.) 1. Is the theory comprehensive and specific?
2. How general is the theory?
3. Summarize the strengths and weaknesses of the theory.
4. Why would you use or not use this theory in your own advanced practice? (Begin to think about your presentation “Synthesis of Nursing Theory”).

This assignment consists of choosing a theory from 1955 to the present and conducting a theory critique. The theorist chosen for this assignment is Dorothea Orem. Orem’s Self-Care Theory is predominantly used in primary and rehabilitation care areas in which the client is motivated to be as self-sufficient as possible. To effectively critique this theory, the background of the theory, theory description, evaluation, and application of the theory must be examined.Conceptual Model And Theory of Nursing Essay

Background
Self-care can be defined as the care of oneself without medical, professional, or other assistance or oversight. Orem’s Self-Care Model designates a structure in which the nurse supports the client to retain a sufficient level of self-care. The amount of nursing intervention depends on the ability or inability to achieve self-care needs.

Dorothea Orem’s Self-Care Deficit Theory, is one of the most extensively used models in nursing. While working at Indiana University Orem’s goal was to upgrade the quality of nursing in facilities throughout the state of Indiana. Orem recognized that nurses had trouble expressing desires to facility administrators of demands concerning matters outside of the realm of patient care. Consequently, Orem realized the necessity to search for the uniqueness of nursing and the boundaries of nursing as a field of practice and a field of knowledge. Furthermore, Orem wanted to know what meaning should be attached to circumstances, conditions, events, persons, and things encountered. According to Fawcett, 2005 Orem mentioned that this task required identification of the nursing field and limitations of nursing as a science and an art. Retrospectively, Orem says the answer came to her as an intuition that the reason why individuals could benefit from nursing was the existence of self-care limitations” (Fawcett, 2005, p. 230). Concepts that facilitated the modeling of the self-care framework were conveyed as Orem experienced an era of great exposure to nurses and their actions from 1949 to 1957 (Fawcett,2005).Conceptual Model And Theory of Nursing Essay

Theory Description
Orem’s Self Care Deficit Theory of Nursing is a conceptual model made up of 3 related theories; Theory of Self-Care, Theory of Self-Care Deficit, and Theory of Nursing Systems. According to Orem, “the three-part theory centers not on individuals, but on persons in relations. Each of the three theories has as its emphasis a precise measurement of the person: the theory of self-care focuses on the self, the I; the theory of self-care deficit focuses on you and me; and the theory of nursing system focuses on we, persons in community” (1990, p. 49). The three theories are uniquely related. The Theory of Self-Care outlines the demands of self-care fundamentals that a person is required to meet to remain healthy or recover from illness. When an individual is unable to achieve these self-care ultimatums, or when self-care stipulations surpasses self-care capabilities, nursing is required. Nurses can assist patients to attain their self-care needs by making use of the techniques in the Theory of Self Care Deficit. Nonetheless, the nurse must accurately evaluate the level of self-care a patient needs so as to apply the nursing system that fits the patient’s ability to accomplish self-care. Ultimately, the nurse supports the patient in accomplishing self-care needs to facilitate a healthy, illness free situation.Conceptual Model And Theory of Nursing Essay

Orem described self-care as the practice of activities that persons individually initiate and accomplish on their own behalf for the preservation, renewal, or upgrade of health in order to retain well-being. The conceptual framework comprises major concepts and supporting concepts. The major concepts are self-care deficits, self-care needs, and nursing systems. Individuals complete deliberate self-care actions in to achieve self-care requirements for health preservation, well-being, and the conservation of life. These needs are altered by a person’s age, incentive, development, experiences, resources, socioeconomic, and cultural background. A self-care deficit occurs when a person is unable to meet self-care needs. Subsidiary concepts consequent to the self-care deficit are Therapeutic Self-Care Demand, which entails self-care activities that must be implemented in order to accomplish needs for the maintenance of life or advancement of well-being and Self-Care Agency, which focuses on the ability to meet one’s requirements for self-care.

Figure 1 best describes the Orem’s Self-Care Model

R=relationship, <= deficit relationship, current or projected

http://1.bp.blogspot.com/_c2VIUh4psKE/TE0R3xBuPNI/AAAAAAAAAY4/JYDtClHsG5s/s400/orem03.jpg

Evaluation
Orem’s theory is grounded on explicit and implicit assumptions. Orem’s theory is based on explicit and implicit assumptions. Meleis (2012) summarizes the explicit assumptions as:

(1) Nursing is a measured, focused helping service accomplished by nurses for the sake of others over a period of time. This behavior involved a self-originated, self-engaged, results generating activity.(2) Individuals (human agency) are adept and prepared to achieve self-care for self or for needy members of the family. (3) Self-care is a part of life that is essential for well-being, human growth, and health (4) Learning and culture impact persons. (5) Self-care is learned through human collaboration and communication. (6) Self-care comprises careful and methodical activities executed to meet recognized needs for care. (7) Human agency is used in discerning, evolving and conveying to others ways and means to ascertain needs of self and others.Conceptual Model And Theory of Nursing Essay

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In brief, Meleis (2012) states the implicit assumptions as: (1) Individuals must be independent and accountable for their care needs in addition to others in the household who are unable to care for themselves. (2) People are divergent from others and from their environment (Meleis, 2012).

A proposition is a declaration or proclamation of the connection between concepts. There are seven propositions in Orem’s theory of self-care. (1) Age, experiences, progressive state, and sociocultural upbringing effects self-care capabilities. (2) Abilities to take care of self and care for others are learned and remembered (3) Self-care proficiencies and self-care demands should be balanced by self-care deficits (4)Life involvements, health, sociocultural alignment, resources, developmental stage, and age intercedes self-care or dependent care (5)Nurses, patients and others are involved in therapeutic self-care by meeting self-care needs and regulating self-care abilities (6)Nurses measure patients’ capabilities and skills in meeting and carrying out their self-care needs. (7)Nurses select dependable and effective processes, actions, and skills in meeting needs for self-care.Conceptual Model And Theory of Nursing Essay

Nursing theories have four concepts relative to their metapardigm: person, environment, health, and nursing. Nonetheless, every nurse theorist describes these concepts inversely, contingent on the concept suitability for the theory. The patient is the chief emphasis of nursing care. According to Orem, the person’s health state is mediated by his/her environment. A person, who is healthy, is capable of self-care. When there is illness in the person’s health state, the person is not able to complete all self-care requisites. When this occurs, nursing care is needed to assist the person in completing his/her self-care. Nurses must assess the person’s ability to provide his/her own self- care and the environmental context of the person in order to overcome health-associated limitations. In 1971, Orem defined a human being (humanity) as “…an integrated whole composed of an internal physical, psychological, and social nature with varying degrees of self-care ability” (Chinn& Kramer, 2004). Ultimately, Orem defined a human being as a considerable or physical unity whose parts are designed and accomplish excellence through the variation of the whole during the course of development. Human beings have the ability to reflect and symbolize. When discussing humans, Orem uses the expressions dependent-care agent, individual, multi-person unit, patient, and self-care agent.(Fawcett, 2005).Conceptual Model And Theory of Nursing Essay

In referring to the perception of health, Orem denoted health and healthy as expressions used to describe living things as fundamentally and functionally complete including those things that which make a person human, functioning in concurrence with physiological and psychophysiological mechanisms, a biologic state, and interaction with other human beings. She additionally defined health as not only the nonexistence of sickness or frailty, but a state of physical, mental, and social well-being. Orem also viewed health as a state of comfort, which refers to an individual’s perceived state of existence, categorized by experiences of gratification, pleasure, cheerfulness, and movement in the direction of self-ideals and ongoing personalization (Chinn & Kramer,2004).

As defined in the metaparadigm of nursing, environment refers to the individual’s physical surroundings and significant others, in addition to the venue in which nursing transpires, ranging from the person’s home to society as a whole (Fawcett, 2005). According to Orem, environment is tri-dimensional, including the community, physical, and socioeconomic features. Community features are inclusive of the populace and its structure by family units, public units, and by legislative opinions. The physical features comprise preserving the human structure, functioning, and welfare. Socioeconomic features center on the family, as well as structure by roles and ages, responsibilities, and privileges for the family unit. (Fawcett, 2005).Conceptual Model And Theory of Nursing Essay

The metaparadigm concept of nursing is symbolized in the Self-Care Framework by the concept Nursing Agency. Nursing Agency is the action of nurses in shaping the needs for, scheme of, and production of care for individuals with a range of diverse self-care deficits. Nursing Agency contains three scopes which are the interpersonal system, professional-technologic system, and social system. The interpersonal system comprises touching base, relationship, and communication amongst the nurse and the patient. The professional technological system is the system of action productive of nursing. The presence of the professional-technological system is reliant on the presence of the interpersonal system, which consecutively, is dependent on the presence of the social system. The social system consist of the association between the nurse and the patient establishing a contract for the purpose of procuring nursing care when an existent or probable self-care deficit has evolved. (Fawcett, 2005).

In view of clarity, the dialectal component of the theory is steady with the linguistic style used in philosophy. There are no created words. The vocabulary is consistent throughout. The term self-care has various meanings through disciplines; Orem defined the term and expounded the functional arrangement of the concept that is distinctive but also compatible with other interpretations.Conceptual Model And Theory of Nursing Essay

Application
There is sufficient proof in the literature that the theory is beneficial in developing and managing practice and research. It gives guidelines to specific outcomes interrelated to distinguishing and accomplishing the therapeutic self-care demands, regulating the growth and exercise of self-care agency and instituting self-care and self-management systems. The theory is likewise valuable in the scheme of core curriculum for graduate and continuing nursing education. Furthermore, the theory provides direction to nursing administration. The development of theory-based computer systems, assessment forms, and the whole forming of the delivery of care confirms to the practicality of the theory (Tomey & Alligood,2002). Orem’s theory does have discrepancies, but proves to be coherent in the view represented of the world of nursing and the activities of people in it. There are several terms that can be confusing in the beginning until each concept is understood. This multifaceted theory is viewed as balanced between intricate and inadequate. The components are recognized but there is opportunity for development and addition of other fundamentals.Conceptual Model And Theory of Nursing Essay

King’s Conceptual Framework and Theory of Goal Attainment

Within each discipline of science lie conceptual frameworks, which addresses general and abstract concepts of phenomena and postulations that delineate them (Butts & Rich, 2018, p. 96). Conceptual frameworks have practical value as they guide research and practice. In nursing, they enable unique perspectives of the metaparadigm concept and provide a path for concrete theories (Butts & Rich, 2018, p. 96-97). A conceptual framework that can be used in advanced practice nursing is King’s Conceptual System.Conceptual Model And Theory of Nursing Essay

King’s Conceptual System

Imogene King’s Conceptual System scrutinizes the interrelationship between human beings and their environment, which then defines the physical and social conditions for them to function (Sieloff, Frey, & King, 2007, p. 5). Human beings are seen as interacting open systems (Butts & Rich, 2018, p. 466). The environments in which they constantly interact are both internal and external (Sielfoff et al., 2007, p. 5). Understanding these interactions enable the nurse to organize his/her knowledge, skills, and values in adequately assessing the patient and their needs (Butts & Rich, 2018, p. 466). Every patient-nurse interaction is considered a transaction, facilitating the patient’s goal(s) to be met (Butts & Rich, 2018, p. 466). King’s model reflects the general systems theory of nursing by encompassing the metaparadigm concepts of human beings, environment, health, and nursing.

NOW

Metaparadigms

Human Beings (Persons)

Three interacting systems of personal, interpersonal, and social systems comprise the human beings concept of the metaparadigm. “Personal system is defined as ‘a unified, complex whole self who perceives, thinks, desires, imagines, decides, identifies goals, and selects means to achieve them’” (Fawcett, 2017, p. 63). The personal system embodies the individual that interacts and reacts to stimuli from others and the environment, and influencing said individual’s function (Butts & Rich, 2018, p. 467).Conceptual Model And Theory of Nursing Essay

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The interpersonal system occurs between the individual and groups of people and may include the nurse (Butts & Rich, 2018, p. 467). Paramount to the patient-nurse transaction is communication. The nurse must believe in the patient’s speech, have the willingness to listen, and be self-conscious of both his/her verbal and non-verbal language. Borges, Moreira, da Silva, Loureiro, & de Meneses (2017) exclaimed, “communication is the means by which learning happens and, to be effective, it has to happen in an atmosphere of mutual respect and one has to want to be understood” (p. 1774).

The social system is the broader interactions that occur within and between groups, in which boundaries, social roles, behaviors, and practices are set (Shanta & Connolly, 2013, p. 175). These groups share commonalities in terms of interests, goals, and values, and include concepts of organization, power, status, authority, and decision-making (Butts & Rich, 2018, p. 467).Conceptual Model And Theory of Nursing Essay

Environment

Environment consists of both internal and external elements. The internal environment is found within the individual, whereas the external occurs outside of the individual’s control. This is transformative as one is able to continuously adjust to changes based on his/her environment. Silefoff et al. (2007) “is an essential factor in one’s adaptation to life and health” (p. 5).

Health

Health is defined as the process of growth and development, and the way in which individuals cope with their stressors and function in their environment (Butts & Rich, 2018, p. 467). It is dynamic and constantly changing, requiring continuous adjustments to maintain physiological and psychological soundness (Butts & Rich, 2018, p. 468). It can be optimized through obtaining appropriate resources in dealing with such stressors as identified in the patient-nurse interpersonal transactions.Conceptual Model And Theory of Nursing Essay

Nursing

Nursing is the helping of individuals to maintain their health in order for them to function within their roles, regardless of age and socioeconomic backgrounds. They help persons maintain their daily lives and satisfy basic needs. Sielfoff et al. (2007) elaborate, “The domain of nursing includes promotion of health, maintenance and restoration of health, care of the sick and injured, and care of the dying” (p. 7).

Value

The value of King’s Conceptual System is its ability to guide nursing practice. Derived from her conceptual framework, King developed the Theory of Goal Attainment. This middle-range theory focuses on the interactional process that is the nature of nursing, guiding individuals in goal attainment of their health. These goals can then be used as criteria in measuring the effectiveness of nursing (Butts & Rich, 2018, p. 469). Moreover, “King’s theory exemplifies respect for patients and places importance on information exchange, goal setting, and patient-centered care” (de Leon-Demara, MacDonald, Gregory, Katz, & Halas, 2015, p. 632)Conceptual Model And Theory of Nursing Essay

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In conclusion, King’s Conceptual System provides a unique perspective of the nursing discipline as abstracted from the metaparadigm concepts. King’s model focuses on the individual and emphasizes the patient-nurse relationship in identifying and overcoming barriers to health, with an underlying holistic theme. Based on her conceptual system, King was able to derive the Theory of Goal Attainment to further advance nursing research and practice.

A theory is a group of related concepts that propose action that guide practice.
Theory refers to “a coherent group of general propositions used as principles of explanation”
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.Conceptual Model And Theory of Nursing Essay
Kerlinger – theories as a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory and predictive in nature.
Theories are composed of concepts, definitions, models , propositions and are based on assumptions.
They are derived through two principal methods:
Deductive reasoning
Inductive reasoning.
Nursing theorists use both of these methods.
Nursing theories are “attempts to describe or explain the phenomenon (process, occurrence and event) called nursing” – Barnum(1998)
Theories are for professional nursing.
Theory is “a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena”
A theory makes it possible to “organize the relationship among the concepts to describe, explain, predict, and control practice”
DEFINITIONS

Concepts
Concepts are basically vehicles of thought that involve images.
Concepts are words that describe objects , properties, or events and are basic components of theory.
Types of Concepts:
Empirical concepts
Inferential concepts
Abstract concepts.
Models
Models are representations of the interaction among and between the concepts showing patterns.
Models allow the concepts in nursing theory to be successfully applied to nursing practice.Conceptual Model And Theory of Nursing Essay
They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice, for example, through specific methods of assessment.
Propositions
Prepositions are statements that explain the relationship between the concepts.
Process
Processes are series of actions, changes or functions intended to bring about a desired result .
During a process one takes systemic and continuous steps to meet a goal and uses both assessments and feedback to direct actions to the goal.
A particular theory or conceptual frame work directs how these actions are carried out .
The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks and theories define the person (patient), the environment, health and nursing.
IMPORTANCE OF NURSING THEORIES

Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978).
It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964).
Theory is important because it helps us to decide what we know and what we need to know (Parsons1949).
It helps to distinguish what should form the basis of practice by explicitly describing nursing.Conceptual Model And Theory of Nursing Essay
This can be seen as an attempt by the nursing profession to maintain its professional boundaries.
CHARACTERISTICS OF THEORIES

Theories:

interrelate concepts in such a way as to create a different way of looking at a particular phenomenon.
are logical in nature.
are generalizable.
are the bases for hypotheses that can be tested.
increase the general body of knowledge within the discipline through the research implemented to validate them.
are used by the practitioners to guide and improve their practice.
are consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated
BASIC PROCESSES IN THE DEVELOPMENT OF NURSING THEORIES

Nursing theories are often based on and influenced by broadly applicable processes and theories. Following theories are basic to many nursing concepts.

A. General System Theory:

It describes how to break whole things into parts and then to learn how the parts work together in ” systems”.
These concepts may be applied to different kinds of systems, e.g.. Molecules in chemistry , cultures in sociology, organs in Anatomy and health in Nursing.Conceptual Model And Theory of Nursing Essay
B. Adaptation Theory

It defines adaptation as the adjustment of living matter to other living things and to environmental conditions.
Adaptation is a continuously occurring process that effects change and involves interaction and response.
Human adaptation occurs on three levels:
— the internal ( self )
— the social (others)
— and the physical ( biochemical reactions )
C. Developmental Theory

It outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death.
The progress and behaviors of an individual within each stage are unique.
The growth and development of an individual are influenced by heredity , temperament, emotional, and physical environment, life experiences and health status.
COMMON CONCEPTS IN NURSING THEORIES

Four concepts common in nursing theory that influence and determine nursing practice are
The person( patient)
The environment
Health
Nursing (goals, roles, functions)
Each of these concepts is usually defined and described by a nursing theorist. Of the four concepts, the most important is that of the person. The focus of nursing is the person.
HISTORY

Nightingale (1860): To facilitate “the body’s reparative processes” by manipulating client’s environment
Paplau 1952: Nursing is; therapeutic interpersonal process.
Henderson 1955: The needs often called Henderson’s 14 basic needs
Abdellah 1960: This theory focus on delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family.Conceptual Model And Theory of Nursing Essay
Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being.
Johnson’s Theory 1968: Dorothy Johnson’s theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery.
Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through “humanistic science of nursing”
Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs.
King 1971: To use communication to help client reestablish positive adaptation to environment.
Neuman 1972: Stress reduction is goal of system model of nursing practice.
Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes.
Watson’s Theory 1979: Watson’s philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life.
CLASSIFICATION OF NURSING THEORIES

Depending on the generalisability of their principles

Metatheory: the theory of theory. Identifies specific phenomena through abstract concepts.Conceptual Model And Theory of Nursing Essay
Grand theory: provides a conceptual framework under which the key concepts and principles of the discipline can be identified.
Middle range theory: is more precise and only analyses a particular situation with a limited number of variables.
Practice theory: explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved.
School of thoughts in Nursing Theories-1950-1970

Need theorists Interaction Theorists Outcome theorists
Abdellah
Henderson
Orem
King
Orlando
Peterson and Zderad
Paplau
Travelbee
Wiedenbach
Johnson
Levine
Rogers
Roy
Theories can also be categorised as:

“Needs “theories.
“Interaction” theories.
“Outcome “theories.
“Humanistic theories”
“Needs” theories

These theories are based around helping individuals to fulfill their physical and mental needs.
Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position.
“Interaction” theories

These theories revolve around the relationships nurses form with patients.
Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs.Conceptual Model And Theory of Nursing Essay
“Outcome” theories

These portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health (Roy 1980).
Outcome theories have been criticized as too abstract and difficult to implement in practice (Aggleton and Chalmers 1988).
“Humanistic” Theories:

Humanistic theories developed in response to the psychoanalytic thought that a person’s destiny was determined early in life.
Humanistic theories emphasize a person’s capacity for self actualization .
Humanists believes that the person contains within himself the potential for healthy and creative growth.
Carl Rogers developed a person –centered model of psychotherapy that emphasizes the uniqueness of the individual.
The major contribution that Rogers added to nursing practice is the understanding that each client is a unique individual, so person-centered approach now practice in Nursing.
MODELS OF NURSING

A model, as an abstraction of reality, provides a way to visualize reality to simplify thinking.
A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions.
A conceptual model “gives direction to the search for relevant questions about the phenomena of central interest to a discipline and suggests solutions to practical problems”
Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client); the environment (society); nursing (goals, roles, functions); and health.Conceptual Model And Theory of Nursing Essay

Criticisms of nursing theories

To understand why nursing theory is generally neglected on the wards.
A nrsing theory should have the characteristics of accessibility and clarity.
It is important that the language used in the development of nursing theory be used consistently.
Many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory.
Majority of nurses fail to understand and apply theory to practice (Miller 1985).
CONCLUSION

Theory and practice are related
To develop nursing as a profession the concept of theory must be addressed.
If nursing theory does not drive the development of nursing, it will continue to develop in the footsteps of other disciplines such as medicine. Conceptual Model And Theory of Nursing Essay

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