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Nursing theories exemplify various sets of interrelated concepts, assumptions, and definitions that create a multifaceted view of nursing phenomena and shape the basis for the development and improvement of clinical nursing practices. The goal of this paper is to compare the concept of health in several nursing theories: Callista Roy’s adaptation theory, Jean Watson’s theory of human caring, and Margaret Newman’s theory of expanding consciousness. The paper also includes a brief analysis of the way, in which Jean Watson’s theory of human caring can be applied in nursing practice. Besides,, implications for the future nursing research are included.
Keywords: nursing, theory, adaptation, health, caring
Analysis of Conceptual Models and Theories Used in Nursing
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The goal of this paper is to reevaluate the concept of health in the three discussed nursing theories and give advice concerning the way, in which Roy’s adaptation model should be applied in nursing practice. A nursing theory is a set of interrelated concepts, definitions, assumptions, and principles that propose a unique perspective on the most complicated nursing phenomena. In its history, nursing science witnessed the emergence of numerous theories and concepts, and the richness of the existing theoretical propositions enables professional nurses to constantly enhance and transform their clinical practices. All nursing theories are equally valuable and deserve professional attention. Among them, there are Callista Roy’s adaptation theory, Jean Watson’s theory of human caring, and Margaret Newman’s theory of expanding consciousness. All these approaches incorporate the same set of metaparadigms: health, nursing, human being, and environment. The concept of health is probably the most interesting and, at the same time, the most controversial one. It is needless to say that different theorists treat the concept of health in entirely different ways. Therefore, it is essential to reconsider its meaning through the prism of diverse nursing theories and provide recommendations to apply one or several of them in practice.
The Concept of Health in Nursing Theories
Nursing theories provide quality guidance to advance nurses’ knowledge of the most problematic concepts. They serve as a valuable source of knowledge about health. One of such theories was created by Callista Roy, a renowned professional and outstanding scholar specializing in clinical and philosophical research (Sigma Theta Tau International, 2011). The central concept of Roy’s theory is adaptation, and the goal of nursing is to provide the patient with physical and emotional resources necessary to adapt to both the health and illness states (Basavanthappa, 2007). In Roy’s grand theory, health is the central element of the conceptual model, because it fosters individual adaptation to the self and the surrounding reality. The most interesting aspect of Roy’s adaptation theory is that the concept of health cannot be viewed separately from the notion of adaptation. In Roy’s view, health is possible only after adaptation (Basavanthappa, 2007). “Health is defined as both a state and a process in which the person is being and becoming integrated and whole and is apparent when the person is able to meet goals of survival, growth, reproduction, mastery and gaining higher levels of adaptation” (Basavanthappa, 2007, p. 121). In other words, it is through adaptation that health is maintained, and it is through the latter that subsequent adaptation is enabled. Based on Roy’s vision of the nursing reality, health is the state of individual integrity and wholeness and the process of becoming even more integrated, providing a person with everything necessary to survive, grow, and reproduce.
Jean Watson views the concept of health in a somewhat different way. Her theory is called the theory of human caring, implying that caring is at the heart of all nursing processes, but not adaptation as Callista Roy asserts. Watson is confident that caring is central to all nursing decisions (Daniels, 2004). It is a unifying paradigm that helps conceptualize and maximize the value of nurse-patient transactions. In this way, Watson advanced the primarily metaphysical orientation in her work, creating a unique basis for the analysis of theoretical nursing concepts. Like Callista Roy, Jean Watson associates the concept of health with the meaning of wholeness. In her theory, health constitutes the unity of the mind, body, and soul (Daniels, 2004). However, Watson goes even further to suggest that this unity is insufficient; only when its ingredients are in harmony, they can be described by means of the term “health” (Daniels, 2004). Moreover, Watson views the latter as the state of congruence between the perceived self and the experienced one (Daniels, 2004). As a result, unlike Callista Roy, she presents health as factual at any given moment of time, without implying that it is a process. Consequently, in Watson’s theory, this concept has nothing to do with adaptation, but suggests that the goal of nursing is to help an individual achieve the desired state of harmony between the mind, body, and soul.
The most interesting and complicated is a way, in which Margaret Newman describes health in her theory of expanding consciousness. Newman indicates that individuals may give different definitions of this concept, but it is what makes clinical nursing paradoxical and perplexing (Basavanthappa, 2007). At the same time, it is wrong to believe that health is only about feeling well. In Newman’s view, the latter may also be indicative of health, because being healthy is a process, but not a state, and is invariably associated with the constantly expanding consciousness (Basavanthappa, 2007). In comparison to the theories mentioned earlier, Newman’s concept incorporates the elements of psychoanalysis, because she believes that sickness manifests individuals’ desire and failure to achieve a better state of physical being (Basavanthappa, 2007). Simultaneously, like Roy and Watson, Newman cannot avoid using the meaning of unity and wholeness in her discussion relating to the health concept. Moreover, it helps explain why being ill and being healthy constitute the health paradigm. In other words, for human beings that are truly unitary, there is no ideal state of health. Rather, they must always display a balanced synthesis of both conditions in order to be regarded unitary (Basavanthappa, 2007).
Based on the points stated above, health is the fundamental concept in all nursing theories discussed in this paper. The major commonality in the way nursing theorists view this concept is its unity and relation to physical and spiritual wholeness. It is the state of harmony, which enables individuals to successfully adapt to the conditions of health and illness. They are both natural, as long as they constitute essential elements of being, but the chief goal of any nurse is to help an individual reach and sustain the ideal balance of the mind, body, and soul. Unfortunately, there is no agreement concerning the point of view whether health is a process or a factual state at any given moment of time. Still, these conceptual disagreements can hardly prevent professional nurses from putting the most interesting nursing theories into practice.
One of the main questions facing clinical nurses is a way, in which various nursing theories have to be applied. Watson’s theory of human caring has broad applications in clinical settings. Given scholar’s emphasis on caring, the so-called transpersonal caring relationship turns into the principal element of using the theory of human caring in nursing practice (Daniels, 2004). Very often, patients faced with illnesses lose the sense of life and cannot overcome their moral and spiritual distress. As a result, the nurses’ task is to help clients examine the meaning of their illness in ways that will allow them to restore the unity of the mind, body, and soul. To put Watson’s theory into practice, clinical nurses should build relationships with their patients, encourage the latter to express their concerns freely, and create a shared understanding of a health problem (Daniels, 2004).
Caring is not less essential for nurse administrators and leaders. Jean Watson (2006) provides a set of recommendations to let nurse administrators become more caring and foster similar caring attitudes in their subordinates. For instance, nurse leaders can promote the need for caring research or launch pilot projects to test the economic and ethical validity of various caring models (Watson, 2006). At the same time, administrators should openly support a caring model, while building their relations with subordinates. Nurse administrators should be able to communicate the vision of caring in nursing and explain to other nurses what caring is and how it works.
All nursing theories incorporate one set of metaparadigms: patient, health, nursing, and environment. Health is the most interesting and controversial one in nursing. Theorists treat its meaning in entirely different ways. For Callista Roy, health is associated with the patient’s ability to adapt to sickness, while Jean Watson suggests that it is a unity and balance of the mind, body, and soul. Margaret Newman creates a conceptual model, in which healthy and unhealthy symptoms make up the concept of health. Based on these differences, nurses will have to adopt different models of caring to meet the health demands of their patients. In case of Jean Watson, transpersonal caring relationships are to become the central element of nursing care in clinical settings. Leaders will have to promote the vision of caring and be able to explain to other nurses how it works.
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