Nursing is one of the most important, diverse and largest professions in the world today. It is a profession that involves a lot of work in not only caring for the sick but also promoting the health of communities, families, and individuals (Hoeve, Jansen & Roodbol, 2014). The nursing profession encompasses collaborative and autonomous care for all. Some of the forms of general nursing practice include community health nursing, hospital-based nursing, mental health nursing, the care of children, geriatric nursing, care for women and advanced nursing practice (Hoeve et al., 2014). All over the world, there is a high demand for nursing services. This is as a result of demographic dynamics, technological advancements in healthcare, healthcare systems reorganization and the rising anticipations of those seeking healthcare services (Masters, 2017). This means that more nurses need to be trained and introduced into the ever-growing market. It also exposes the diversity, importance, and magnitude of the nursing profession.
Despite nursing services having been offered for as long as mankind has existed, professional nursing is attributed to Florence Nightingale, a wealthy British couples daughter (Hoeve et al., 2014). Although Florence Nightingale was well-educated, she defied all odds by going against the then social norms and deciding to pursue a nursing career. According to the social conventions of the time, well-educated and bred ladies were not expected to engage themselves in such unpopular activities such as taking care of sick strangers. The only people they were expected to provide nursing services to were close friends and family members. Florence Nightingale, however, believed that it was only in nursing that women who were well-educated could use their education to apply scientific principles to promoting healthy lifestyles and improving the care of all members of the human race (Hoeve et al., 2014). The nursing profession also became an ideal platform for promoting the social freedom and intellect of women. Despite the initial resistance, nursing gradually developed into a respectable career and today, it is one of the largest careers in the world; thus, the need for theoretical frameworks to guide practice.
A theory refers to an explanation which is at a proposal stage whose status is conjectural and is still subject to experimentation (Rabey, 2008). In science, theories can be defined as explanations of nature that are well-confirmed that are developed in a method consistent to science. Theories are used in justifying the course of an action or even in accounting for a situation. In practices, theories can be described as the set of principles in which an action is based on.
In nursing, theories are organized into a systematic set of statements that aim to answer questions arising in the practice of the nursing profession. These theories are usually derived from nursing models or other disciplines and they illustrate a purposive view of a phenomenon by developing specific inter-relationship between principles with an aim of describing, predicting or prescribing. For a theory to be beneficial, it has to make predictions on a health behavior, population, environment or a behavior. The theory should also be logical, consistent with day-to-day observations and has to be supported by past research in the specific area.
Theoretical frameworks are very beneficial in nursing as they provide descriptions, predictions, and explanations of nursing phenomena. The information provided by the theories is vital in the development of concepts that act as the foundation of nursing. This information can be used to generate further knowledge in nursing and to determine which direction the nursing practice should take as it develops. Nursing theories are important in distinguishing the basis of nursing practice by providing an explicit description of nursing. A properly described nursing profession as several benefits such as enhanced patient care, better communication between nurses and improved guidance in education and research. Nursing theories also assist nurses in analyzing the main exponent of their profession, patient care, as it is not measurable.
It is important to note that initially, as the nursing career advanced, nursing education advanced too. This led to the rise of the need to classify knowledge in such a way that it would be easier for nurses to evaluate the new situations that they would encounter each day in the nursing practice. This classification of knowledge led to the development of crucial theories and models that can provide ideal arrangements for investigation, management and decision-making in the process of providing nursing care (Hoeve et al., 2014). They also provide frameworks for effective communication in healthcare and help in the formulation of goals, values, and beliefs in the career. In that case, nursing theories and models are very crucial not only in class but also in application. This paper examines two nursing theories: the Neumans system model and Orems self-care deficit theory of nursing, and applies one of the theories to a case study. Orems self-care deficit theory of nursing will be applied to the case study.
The Neumans System Model
The Neumans system model refers to a nursing theory developed by a community health nurse, Betty Neuman. The theory is based on an individuals relationship to stress, their reaction to it and the dynamic reconstitution factors. Basically, the model offers practical guidelines used for caregiving in order to produce positive outcomes for clients (Neuman & Fawcett, 2011). Neumans system model has developed a dynamic script that can be utilized by practitioners worldwide, with emphasis on the individuality of the client and through considerations of the clients' unique circumstances and their background.
Betty Neuman developed this model based on her educational and professional experiences. With a Ph.D. in clinical psychology and years of experience as a community health nurse and a counselor, she developed a theory that provided a comprehensive, flexible and holistic nursing perspective that is system based. To develop this theory, she was influenced by deChardin and Cornus works on the wholeness in a system, von Lertanfaly and Lazlos general system theory, Selyes stress theory and Lararus works on stress and coping.
The Neumans System Model is based on a number of assumptions. From the theory, each clients system is unique and it differs to other clients and there is a wide range of factors and characteristics that determine the responses contained within a basic structure of the client (Masters, 2017). The client is also assumed to be a dynamic system that is usually engaged in energy exchange with the environment. There is a large number of known and unknown stressors that exist. These stressors differ in their potential for disturbing a clients normal Line of Defense (LOD). The line of defense is defined as internal resistance factors that are present in each client whose function is to stabilize and realign the clients to wellness state (Masters, 2017). A particular inter-relationship between the clients variables can hugely affect the degree to which the client is protected by their flexible LOD against reaction from stressors. Each clients system has developed a normal range of responses to their environment. This range of response is referred to as the normal LOD. The normal LOD can be utilized as a standard for measuring health deviation in a client.
Neuman also assumed that when the flexible line of defense is not able to defend the client then the stressor breaks through the clients normal line of defense. The clients state, whether wellness or illness, is determined by a complex inter-relationship of the clients variables. The Neumans System Model also defines primary prevention, secondary prevention, and tertiary prevention (Masters, 2017). Primary prevention is defined as the interventions that are applied in the clinical assessment of individuals to identify and to reduce the actual risk factors. Secondary treatments refer to interventions taken in reaction to a stressor as a treatment in order to reduce their noxious effects. Tertiary treatments describe the adjustive processes that take place as reconstitution is initiated and maintenance factors move back towards primary prevention.
According to the Neumans system model, the clients system comprises of the individuals variables in interaction with the internal and the external environment (Neuman & Fawcett, 2011). The basic system energy resources represented by the unique individual characteristics form the common client survival factors. The clients central core comprises of an individuals basic survival factors such as their ego structure, organ strength, genetic structure, body response pattern and normal temperature range. Stability in individuals only occurs when the energy available in the body exceeds the energy required for use by the system. This system stability is referred to as homeostasis. A homeostatic system is usually in constant interaction with the environment and this interaction leads to a state of balance through input, output, feedback, and compensation.
According to the theory, the clients can maintain their stability as long as the demands do not exceed the available resources. The client is assumed to be in a perpetual cycle consisting of resource exhaustion as well as rejuvenation. This cycle plays a key role in the stability of a patient. The main role of nurses practicing the Neumans system model is to ensure that the patients maintain this stability.
In the Neumans system model, the clients are assumed to possess several layers. Each of these layers has five dimensions; physiological, psychological, social-cultural, developmental and spiritual (Masters, 2017). The physiological variable consists of the physio-chemical structure and the chemical composition of the body. The psychological dimension represents the mental state of the client. The social-cultural aspect is concerned with the clients relationships in combination with their social and cultural expectations. The spiritual variable considers the clients spiritual beliefs. The developmental dimension is concerned with the processes that relate to the development of the clients throughout their lifespans.
The Neumans system model believes that the clients environment is vital to their wellbeing. The environment is defined as the combination of external and internal forces that surrounds an individual with which the individual can interact with at any duration. This includes intrapersonal, interpersonal and extra-personal aggressors. The internal environment describes the environment within the client's system while the external environment describes the environment outside the client's system. Another key aspect of the environment is the environment that is developed unconsciously by the client which is the symbol of the system's wholeness. This environment is referred to as the created environment.
Health is an important paradigm of the Neumans system model which is equated with the wellbeing of the client. Wellness refers to a condition in which all variables are in harmony with the clients system. As the clients tend to grow older, their systems move towards death where the energy needed is greater than the energy available.
The final paradigm of the Neumans system model in nursing. The theory defines nursing as a profession that is concerned with variables that influence a clients response to a stressor (Neuman & Fawcett, 2011). A person is seen as a whole and its the role of nurses to address the wholeness of an individual. The theory tasks the nurses with the...
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