Week 4 Class 1 Replies

Instructions: Please read both threads and reply with at least 250 words. Each reply must incorporate at least one scholarly citation(s) in APA format. Any sources cited must have been published within the last five years. Acceptable sources include the textbook, the Bible, and scholarly articles.

Thread 1. Grand Theory

                        Sister Callista Roy’s Adaptation Model (RAM) was influenced by many other theories and the work of those before her. Sister Roy’s model provides three categories of assumptions (McEwen & Wills, 2019, p. 173). Given her Roman Catholic affiliation, it is no surprise that the philosophical assumptions center around God and faith. These assumptions place God at the center of all things and state that humans use their innate abilities to interact with and sustain the universe (Roy, 2009, p. 31). Second, the scientific assumptions center around the person and consciousness and have a hierarchical structure of energy and logic. Lastly, the cultural assumptions state that culture influences the model and, thereby, interactions. Nurses can observe four modes of adaptation and respond accordingly. One strength of this model is its relatively simple presentation. The model is worded using easy-to-understand terminology, and the progression of the model follows a logical path. A second strength of the RAM is its personalization. The model supports nurses performing interviews and obtaining data through assessment and observation. Given this one-to-one approach and the models’ adaptability to many settings, it can be highly personalized. One weakness of the model is that it is very time-consuming. This highly personalized approach takes a lot of time. A second weakness is the complexity of putting the model into action. Even though the model is presented in a simple way, putting all the concepts into action can become quite complicated. Given the complex and time-consuming nature of utilizing the model, it may not be the best choice where patient turnover is high, and time is premium.

            Nola Pender’s Health Promotion Model (HPM) is influenced by expectancy-value theory and social cognitive theory but from a nursing perspective (McEwen & Wills, 2019, p. 229). Pender’s HPM is designed to “assist nurses in understanding the major determinants of health behaviors as a basis for behavioral counseling to promote healthy lifestyles” (Pender, n.d., p. 2). It looks at the person in a holistic sense and acknowledges that people are multifaceted and affected by their environment. One Strength of the HPM is that it is simple to follow. The HPM provides a logical flow of ideas and then, given answers to simple open-ended questions, directs the following steps to obtain health-promoting behavior. A second strength is that the model empowers the nurse to assist the patient to achieve a higher level of health-promoting behavior. Nurses are often limited to the order sets that are prescribed for a patient. Utilizing the HPM, the nurse can work with the patient, and based on the answers provided by the patient, the model provides clear next steps. One weakness of Pender’s HPM is that it is highly variable. HPM takes so many aspects into account for the individual that it would not work well for groups of people, like a family unit or workgroup. A second weakness is that the model has limited use for an individual experiencing a current disease or illness. The same can be said for using the model with children, as they do not have the autonomy to make the process work.

Thread 2.

I have chosen to review the Neuman Systems Model, a grand theory, as well as Benner's Model of Skill Acquisition in Nursing, a middle middle-range theory. Examining the Neuman Systems Model first, one can see why this model is so well-known. The model was written by Betty Neuman, a nurse who obtained her doctorate in clinical psychology. She felt stress affected the health of the patient and that by shielding or removing the stress through nursing interventions, the nurse would meet the needs of the patient. (McEwen & Willis, 2019, p. 150) Her five variables, physiologic, psychological, sociocultural, developmental, and spiritual, conjunctively either helped or hurt the overall stability of the person. Neuman used a three-step nursing process to help nurses understand and process these variables. First, the nurse collects the data, then second, interventions are set for the patient and nurse to complete. Finally, feedback is given in regards to the goals that were set. One of the strengths of this model is the ability to apply it in many different scenarios in different cultures. The general applicability makes it a popular model. Another strength is the model's focus on prevention of stress, which it counts as a nursing intervention. One of the weaknesses of the model is the many levels it walks through can be confusing. This could be an obstacle to nurses who are not well-versed in theory. Another weakness is the model is not completely testable. Parts of the theory can be used for testing while others only provide a direction testing could go. (McEwen & Willis, 2019, p. 154) 

The second theory to be examined is Patricia Benner's Model of Skill Acquisition in Nursing. This middle range theory was developed to provide a tool for measuring nursing skills. It outlines five levels: novice, advanced beginner, competent, proficient, and expert. Benner believed it was important to recognize a nurse's growth in her skills and to promote continuous learning. The core of her model centered on competence, skill acquisition, experience, clinical knowledge, and practical knowledge. She had seven areas of nursing that she applied these to such as the helping role or the effective management of rapidly changing situations. One of the strengths of her model is its recognition of a nurse's growth in the field. It gives nurses goals for their career development and progression and helps employers with an honest comparison of their nurses' skill level as compared to others. Another strength is the model is not overly complicated with abstract concepts. It provides a clear application in clinical settings, which makes it easy to understand. One of the weaknesses of the theory is its limitation of only seven nursing areas. These would need to be updated as the nursing role grows and changes with time. Another small weakness of the theory is the update it would need to apply to new programs such as clinical ladders. (McEwen & Willis, 2019, p. 226)

Both of these theories are widely used and accepted in nursing management and nursing education. To the average nurse on the floor, these theories may mean nothing to them. However, there is profit to learning from these wise women who studied and gave back to their profession. As Solomon wrote in Proverbs 1:5, "Let the wise hear and increase in learning, and the one who understands obtain guidance" (Holy Bible, English Standard Version, 2001/2016). Nursing is always evolving and growing. These theories are the fruit of many past experiences and observations. Wise nurses would do well to take note and learn from them.