Introduction
Nursing is a noble profession that involves the provision of services to patients in a holistic manner. Since patients have different illnesses and conditions, they require varied healthcare services for them to recover well. Nursing theorists have formulated a number of theories that elucidate the nursing practice and nature of patients. Elucidation of nursing practice and natural patients as human beings enables nurses to provide effective healthcare services that boost recovery and wellbeing of patients. Recovery of patients is an intricate process that requires application of theories for nurses to deliver healthcare services and predict the expected outcomes using certain theoretical models. Modern nursing practice requires that nurses apply theoretical models in diagnosis and treatment of patients. According to Jarrin (2012), to improve the nursing practice, nurses should apply nursing theories that “consider the phenomena holistically, dynamically, and within the context of nursing discipline and profession” (p.8). Application of varied nursing theories enables nurses to develop their intuition and promote patient outcomes. This paper compares and contrasts two nursing theories: Sister Callista Roy’s Adaptation Model and Martha Roger’s Science of Unitary Human Beings to enhance understanding of nursing theories.
Present Purpose and Rationale
The theory of Adaptation Model by Sister Callista Roy is widely applicable in nursing practice because it is a versatile model. The Roy’s Adaptation Model (RAM) has six steps that guide nurses when providing healthcare services to patients. In the first step, nurses assess behaviors that a patient manifests in different adaptive modes and then analyze stimuli that cause observed behaviors in the second step. In the third step, “nurses can make nursing diagnosis based on observed behaviors before defining a way of promoting adaptive process in the fourth step” (Shosha & Kalaldeh, 2012, p.29). After defining the adaptive process, nurses can then apply effective interventions to manage stimuli in the fifth step and eventually evaluate the adaptive process in the sixth step. Shosha and Kalaldeh (2012) assert, “RAM is consistent nursing process that directs nursing practice towards providing a holistic care for patients” (p.26). Hence, the model enhances standardization of nursing care.
The rationale for applying RAM in nursing is that it is a flexible and a versatile model. RAM postulates that a person is a holistic adaptive system, which interacts continually with both external and internal environments through an adaptive process that enables patients to regain their health. According to Roy, the main objective of nursing is to promote health of patients in four aspects of adaptive modes, viz. “physiological-physical, self-concept, role function, and interdependence” (Rogers & Keller, 2009, p.22). The physiological-physical mode depicts physiological and physical activities that a patient exhibits, while self-concept mode defines psychosocial aspects of a patient. Moreover, role function and interdependence modes depict roles that a patient plays in the society and nature of relationships that exist thereof respectively. Hence, these adaptive modes provide means of assessing the adaptive process that a patient undergoes during recovery.
The theory of Science of Unitary Human Beings by Martha Rogers is applicable in nursing because it postulates that nursing is both science and art of providing healthcare to patients. The theory demands that nurses should apply scientific knowledge in an artistic manner to enhance patient outcomes. Since the theory postulates that human beings and environment have intricate links, understanding of these links is central in nursing as nurses help patients to interact mutually with their environments. According to Jarrin (2012), “in the nursing practice, integrality involves the realization that the observer is integral to what he or she is observing” (p.14). Hence, integrality enables nurses to make objective observation in nursing diagnosis and prognosis.
The rationale for applying Rogers’ theory of Science of Unitary Human beings in nursing is that it perceives nursing as an art and science. Nursing is an art in part because it practice entails application of scientific knowledge in a creative way to improve the wellbeing of patients, and science in part because it utilizes scientific principles. The concept of unitary being is paramount in nursing as it contextualizes and defines the role of patient in nursing care, thus enabling nurses to assist patients to recover well. According to Jarrin (2012), the concept of health in Rogers’ model postulates that health is a dynamic process, which occurs as an expression of processes in life following interaction of a human being and environment. Therefore, the concept of unitary being and health forms the basis of application of the theory in nursing.
Similarities of the Theories
The RAM theory and Rogers’ theory have some similarities that underscore their application in health. The concept of the environment is common in both theories. In both theories, the environment plays a central role in influencing human behaviors in relation to health. According to the RAM theory, environmental stimuli trigger adaptive process of a person. Thus, nurses can change environmental stimuli as a way of influencing adaptive process to occur in a person. Similarly, the Rogers’ theory postulates that the environment is a field that interacts with the human field. The interaction has significant influence on human health as environment and human beings constantly interact. According to Jarrin (2012), this interaction is a concept that “reflects the oneness and unity or wholeness of humans and their environment” (p.14). Therefore, both theories depict human beings as an integral component of an environment for environment influences human health.
The two theories are also similar in the way they describe a human being. The RAM theory describes a human being as an adaptive system, which constantly interacts with the environment. Human beings undergo an adaptive process as they interact with the environment that leads to wellbeing. Shosha and Kalaldeh (2012) clarify, “an individual is described as an adaptive system that can respond to different internal and external environmental stimuli whether positively or negatively” (p.26). As an adaptive system, a patient can respond to changes in both external and internal environment. Similarly, the Rogers’ theory regards human being as unitary and irreducible energy fields that interact with the environment. As the environment is another energy field, exchange of energies between these fields occurs, which is similar to the adaptive process of the RAM theory.
Dissimilarities of the Theories
While the RAM theory postulates that the relationship between human and environment is subject to thinking and feeling, Rogers’ theory postulates that the relationship is a product of energy movement from one field to another. Stimuli influence the way an individual feel or think in a given environment. Changing environment stimulus influences human thinking and feeling and thus triggers adaptive process in an individual. Rogers and Keller (2009) assert that adaptive process occurs due to stimuli that excite regulator and cognator in the adaptive system. In contrast, the Rogers’ theory postulates that field energies enable an individual to interact with the environment. According to Rogers’ theory, energy fields are dynamic in that they vary in terms of extent, density, and intensity of energies. The variation in energies causes imbalances leading to energy movement from one field to another. The concept of openness indicates that energies between the fields flow constantly without any barriers. Thus, while RAM deals with sensual stimuli, Rogers’ theory entails field energies.
Another difference between RAM and Rogers’ theory is the process through which human beings achieve health status. RAM postulates that human beings undergo an adaptive process as a means of improving their health status. The adaptive process consists of both innate and acquired processes. The innate adaptive process emanates from the genetic makeup of an individual while acquired adaptive process depends on experiences that an individual has acquired. Combination of innate and acquired adaptive process determines the ability of an individual to respond to given stimuli from the environment. In contrast, the Rogers’ theory elucidates that an individual achieves certain status of health through a life process driven by the energy field. Fundamentally, energy field is a basic unit of the nonliving and living with variation in terms of extent, density, and intensity of energies. Kim (2008) argues that illness and health are in the same continuum in the energy field; thus, life process depends on the movement of energies between fields. Therefore, RAM involves how an adaptive process occurs in response to a given energy exchange while Rogers’ theory deals with how life process occur in an individual due to exchange of energy.
Philosophical Similarities
RAM and Rogers’s theories have philosophical similarities that underpin their application in nursing care. Philosophically, both theories view a person as an entity in the environment. RAM describes human being as an adaptive system, which balances in response to environmental stimuli. The environmental stimulus emanates from external and internal aspects of the environment thus influences human behaviors in the adaptive process. Shosha and Kalaldeh (2012) explain that a person is an adaptive system, which responds to various stimuli through subsystems of cognator and regulator. Likewise, Rogers’s theory perceives a human being as an entity in the environment. A human being is a unitary and irreducible object in the energy field with specific energy field (Kim, 2008). The exchange of energy between a human being and the environment triggers life processes to continue. As an irreducible and unitary object, human beings have distinctive characteristics that require holistic perception to understand the processes of life that one undergoes.
The philosophical explanation of health is also similar in the two theories. According to RAM, health exists in a continuum of adaptive process that recognizes that a person’s health is dynamic. The dynamism of health stems from the fact that wellbeing and illness of a person exists in the same continuum. It is through adaptive process that a patient regains health. Therefore, health is a process where an adaptive system balances illness and wellbeing simultaneously. In the same view, Rogers’ theory views wellbeing and illness as part of the same continuum as an individual expresses life through exchange of energies with the environment. The energy field enables an individual to exchange energies as a process of gaining health. Hence, both theories philosophically agree that wellbeing and illness exist in the same continuum.
Additionally, RAM and Rogers’ theory ideally concur that human beings intricately link with their external environment. The environment influences how human beings behave and attain a given health status. According to Shosha and Kalaldeh (2012), there is a mutual interaction between human beings and environment, which results into adaptive process. Hence, the environment provides stimuli that trigger adaptive process in a person. Comparatively, Rogers’ theory perceives the environment as an entity with the energy field and intricately links with human energy field. Kim (2008) argues that a human being and the environment are two energy fields that intricately link with one another and coexist in nature. One cannot separate the two forms of energy fields because the openness that exists between them allows continual exchange of energies. Therefore, both theories concur that human beings and the environment are inseparable.
Two Other Theories
The behavioral system model for nursing by Dorothy Johnson is one of the theories that relate to the RAM and Rogers’ theories. The theory postulates that a person is a behavioral system made of subsystems such as affiliative, ingestive, achievement, aggressive, dependence, eliminative, sexual, and role identity. Hence, a person is struggling to achieve balance of external and internal forces of the social environment in the process of learning. In the case of a patient, the theory postulates that a patient is struggling to achieve a balanced behavior relative to social demands. The theory “conceptualizes nursing client as a behavioral system with behaviors of interest to nursing organized into seven subsystems of behavior” (Meleis, 2011, p.280). As a system of behavior, nurses need to modify forces that affect a patient to influence behavior development. Therefore, the theory relates to the RAM and Rogers’ theory because it perceives an individual as a behavioral system, which is under the influence of many forces in the environment.
The theory of goal attainment by Imogene King is another theory that relates with the two theories discussed. According to the theory, there are three interacting systems, which are dynamic in nature. These systems include the “social system, personal system, and the interpersonal system” (Alligood, 2010, p.101). In this context, the personal system represents an individual, who in turn interacts with two or more individuals in various interpersonal systems within the social system. Personal system involves individuals in a unified manner perceiving, identifying, and deciding achievable goals. Personal system supposes that individuals are social, rational, and reacting beings. The system also presumes that individuals have a domineering effect. Interpersonal system involves individuals or groups reacting against each other. Some of the concepts “associated with interpersonal include communication, transaction, interaction, and stress” (Alligood, 2010, p.103). Social system in King’s theory includes individuals that come together to form a society. Hence, the social elements in the theory make this theory relate with RAM and Rogers’s theories.
Conclusion
Nursing theories provide a framework through which nurses can adopt and apply in the process of providing care. RAM and Rogers’ theories give an insight into how human beings interact with their environment and attain a given health status. Both theories are similar in the manner in which they describe human beings and the environment. However, their differences lie in the interaction of human beings and environment and the process of achieving good health. The philosophical similarities of the two theories occur in aspects of health, environment, and definition of human beings. Since there are many theories in nursing, the theory of behavioral system model by Dorothy Johnson and theory of goal attainment by Imogene King relate to the RAM and Rogers’ theories.
References
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Kim, T. (2008). Science of Unitary Human Beings: an update on research. Nursing Science Quarterly, 21 (4), 294-299.
Meleis, A. (2011). Theoretical nursing: Development and progress. London, UK: Lippincott & Wilkins.
Rogers, C., & Keller, C. (2009). Roy’s Adaptation Model to promote physical activity among sedentary older adults. Geriatric Nursing, 30 (2), 21-26.
Shosha, G., & Kalaldeh, M. (2012). A critical analysis of using Roy’s adaptation model in nursing research. International Journal of Academic Research, 4 (4), 26-31.