Concept Comparison and Analysis Across Theories

Concept Comparison and Analysis across Theories

The process of choosing a nursing model or theory to guide one's clinical practice, curriculum development or theoretical framework for research can be facilitated by analysis of and comparison of existing theories. The concept of care is a core concept common to many nursing theories. Caring is considered by many as one central feature within the metaparadigm concept of nursing knowledge and practices (Watson & Smith, 2002, p. 456). The topic of this paper is to selects a core concept that is common to several nursing theories and then to compare and analyze the concept among several theories. Specifically, this paper compares four theoretical understandings of the core concept caring, including Madeleine Leininger's Theory of the Culture Care Diversity and Universality, Jean Watson's Theory of Philosophy and Science of Caring, Dorothea Orem's Self-Care Model, and Dorothy Johnson's Behavioral Systems Model. Jean Watson's theory of Philosophy and Science of Caring will be discussed further.

Madeleine Leininger's Theory of the Culture Care Diversity and Universality is based on transcultural nursing, whose goal is to provide care measures that are balanced with cultural values, beliefs, and practices. Leninger suggests that "care is the essence of nursing and culturally based care can be predicted to enable health and well-being for humans of diverse cultures" (Fitzpatrick & Whall, 2005, p. 178). This model consists of 3 levels that provide a base of knowledge for delivering cultural care. The definition of caring for Leininger is linked to the proposed modes of nursing action:

1. Cultural care preservation refers to nursing care activities that help people maintain or preserve health, recover from illness, or face death.

2. Cultural care accommodation refers to those nursing care activities that aid people to adapt to or negotiate for a beneficial health outcome.

3. Cultural care re-patterning refers to those nursing care activities that help a client restructure or change lifestyles while respecting the client's cultural values. (Fitzpatrick & Whall, 2005, p. 179).

In comparison, Jean Watson's Theory of Philosophy and Science of Caring proposes 10 nursing carative factors. Care is about forming humanistic-altruistic value system. It is instilling faith-hope. Care is about cultivating sensitivity to self and others. It is developing helping-trust relationship. It is promoting expression of feelings. It is using problem-solving for decision making and promoting teaching-learning. Care is promoting supportive environment and assisting with gratification of human needs. It allows for existential-phenomenological forces of wellness.

In this theory, Watson's caring model is action driven. Caring can be demonstrated and practiced. Caring consists of carative factors, mentioned above. Watson views the "carative factors" as a guide for the core of nursing. She uses the term carative to contrast with conventional medicine's curative factors. Her carative factors attempt to "honor the human dimensions of nursing's work and the inner life world and subjective experiences of the people we serve" (Cara, 2003). Caring promotes growth. A caring environment accepts a person as he is and looks to what the person may become and offers development of potential. Caring promotes health better than curing. Caring is central to nursing. Caring promotes health, a complete physical, mental, and social well-being and functioning.

On the other hand, Dorothea Orem's Self-Care Model looks at care from the perspective of the patient, who provides self-care with varying degree of assistance from the nurse. Orem's model focuses on each individual's ability to perform self-care. The basic premise of the model is that individuals can take responsibility for their health and the health of others. In a general sense, individuals have the capacity to care for themselves or their dependents. From her Self-Care Model there are three theories that evolved: theory of self-care, theory of self-care deficit and theory of nursing systems. There are three interrelated concepts, which are self-care, self-care deficit and self-care agency. According to this model, self-care encompasses those activities performed independently by an individual to promote and maintain person well-being (Fitzpatrick & Whall, 2005, p. 111). Self-care agency is the individual's ability to perform self-care activities. Self- care deficit occurs when the person cannot carry out self-care. The nursing system meets the self-care needs by acting or doing for guiding, teaching, supporting or providing the environment to promote patient's ability (Wancha,