Florence Nightingale’s Environmental Theory

Florence Nightingale is considered the first nursing theorist. She believed the environment had a
strong influence on patient outcomes, and many elements of her Environmental Theory are still
practiced today. There are 10 key aspects of the theory. They are:
1. Patients should have clean air and a temperature-controlled environment
2. Patients should have access to direct sunlight and not be subjected to unnecessary noise,
especially when sleeping
3. Rooms should be kept clean
4. Hospital facilities should be well-constructed
5. Bedding should be changed and aired frequently
6. Patients should be kept clean and nurses should wash hands frequently
7. Patients should be offered a variety of scenery, such as new books or flowers, to prevent
boredom
8. Nurses should be positive but not offer false hope to patients or make light of their illness
9. Offer a variety of small meals instead of large ones, and do not do patient care while patient
is eating as it is distracting
10. Consider not only the individual patient but the context of where he or she lives
Where Did the Theory Come From?
The environmental theory created by Florence Nightingale concentrates on the patient’s
environment and the external conditions that effect disease and death. Known as the ‘Lady with
the Lamp”, Nightingale’s theory continues to guide nursing practice today. Influenced by her
experiences during the Crimean war, Nightingale understood the significance of unsanitary
conditions and the impact of the sanitary reforms on death rates. By carefully examining how the
environmental conditions impacted patient health and outcomes Nightingale’s environmental
theory was formed. In this assignment, Nightingale’s environmental theory is summarized.
Throughout this assignment, this writer will explore how Florence Nightingale established the
environmental theory through a personal perspective after careful literature review. Through
analysis of the concepts, explanations of the relationships, and validation of her theory,
Nightingale was able to create a foundation of nursing knowledge that has improved the quality of
patient care.

Stage 1: Theorizing
Though my parents disproved of my wish to become a nurse I was determined to following my
calling and signed up for nursing school in 1850 at the age of thirty. Expected to marry to maintain
my family’s social prominence becoming a nurse which was viewed as menial labor went against
my prosperous parent’s expectations. Believing that my life would be more useful I entered nursing
to help those in poverty and alleviate suffering and illness. I felt that I was called by God to be a
nurse. By becoming a nurse I was able to serve God by providing assistance to those with illness.
I felt that nursing was a calling. Nursing is not only an art but also a science that requires
specific education. As a nurse, any lack of understanding or nursing skill can interrupt the process
of healing. By using the nursing art of caring and standardized practices nurses can improve the
health of patients. I believe that nursing allows nature to influence health. Appropriate nursing care
can be achieved through alteration of the environment. Changes in internal and external
environmental factors helps to attain a desired health status. Within the nursing role is the
responsibility to manipulate the factors that affect heath and illness to enhance patient recovery
and outcomes. The practice of nursing is also a rather distinct and separate profession from
medicine. Within the nursing practice, one must recognize the body’s essential needs and work
accordingly to ensure that there is suitable fresh air, light, warmth, cleanliness and quiet for the
patient, this is where nursing differs from medicine.

Upon arrival in Scutari during the Crimean War we were faced with barracks filled to capacity and
unsanitary conditions. Horrified by our surroundings, I noted defects in light, ventilation, sewerage
as well as structural defects in buildings. Being overtly aware of the sanitary conditions and high
death rates the nurses went to work immediately upon arrival to meticulously clean the ward and
any soldiers brought in for treatment. Through eliminating unsanitary surroundings and organizing
nursing services the mortality rate in Scutari was decreased. In the course of my work at Scutari I
completed experimentation and examination of the environment and the care provided by nurses.
In turn, guidelines of nursing care were developed. An example of such experimentation was
discussed by Mackey & Bassendowski (2017), in which I compared the dirtiness of the water in
which you have washed when it is cold without soap, cold with soap and hot with soap. Through
this experimentation, it was found that the first cold water without soap hardly removed any dirt
at all, cold water with soap a little more and hot water with soap removed much more dirt. Through
these observations and having thorough records of death rates and the causes I was able to correlate
how improved sanitation and environmental influences played a role in patient outcomes.
Researching the causes of high death rates and making comprehensive recommendations for
changes ensured that the conditions did not reoccur (McDonald, 2014).
Stage 2: Syntax
The environment includes the external conditions and influences that modify a life. The
environment is capable of preventing or contributing to disease or death. Health is not only to be
well, but to be able to use well every power we have to use (Butts & Rich, 2015). The concept of
health extends further than just the absence of disease. Disease is a process given by nature to
clean the body from impurity which has entered the body because one or more of the body’s natural
needs is not fulfilled (Rahim, 2013). By making changes to environmental influences these wants
can be fulfilled and the episode of disease can be eased. Nursing is an art of nature’s work on
humans to make the ill healthy and the health remain the same (Rahim, 2013). The nurse is
responsible for maintaining an environment that is adequate to sustain the health of the patient. A
person or human being is a member of nature whose natural defenses are influenced by a healthy
or unhealthy environment (Medeiros, 2015). By having environmental control around the patient
and the relationships and influences of the nurse, the health and disease states of a patient can be
enhanced.

Stage 3: Theory Testing

In a quantitative study completed by Taneli (2015), the environmental effects on the elderly
were studied. Many factors within the environment of the elderly, including their home, the public,
and community environments, can impact human responses, especially when individuals are ill,
frail, or cognitively impaired. The environment can affect the elder’s daily activities and their
responses to health and illness. According to Taneli (2015), understanding the factors within
environments that facilitate or hamper health, behavior, affect, and care delivery can provide new
insights of theoretical and practical importance. Through quantitative measure of environmental
variables Nightingale’s theory is substantiated within this study.
The need for patient advocacy in originated with Florence Nightingale. Effective patient advocacy
for basic human needs enhances the quality of patient outcomes. In the qualitative study by
Davoodvand, Abbaszadeh, & Ahmadi (2016), review of how internal and external risks that
jeopardize a patient’s health care environment and how the nurse acts as an advocate to reduce the
risk to the patient. Given that disease diminishes an individuals’ ability to defend themselves,
patients must have someone to protect them against these dangers while they are ill. Nightingale
demonstrated patient advocacy through development of the environmental theory.
Furthermore, Nightingale’s environmental theory is tested in a qualitative study completed by
Roque & Carraro (2015), in which high risk post-partum woman’s recovery is influenced by
psychological aspects, which can be affected by the elements of the external environment, such as
lighting, heating, noise or smell. Throughout the study consideration is taken into how creating an
organizational culture within the hospital environment can accommodate the physical and
emotional needs of these patients through controlling environmental elements of care.

Stage 4: Evaluation
The environmental theory impacts many areas of current nursing practice including
personal hygiene, housekeeping procedures, administration of balanced diets to improve wound
healing, observation of the sick and noise to name a few. All of these approaches to care influence
patient outcomes. The theoretical principles established by Florence Nightingale remain relevant
in nursing practice today.
In a study completed by Weaver (2012), it is discussed that a good standard of hygiene in the home
prevents the growth and spread of bacteria, and therefore helps to prevent the development and
spread of infections. This study is in line with Nightingale’s canon for personal hygiene that
includes keeping patient’s patient clean and dry to prevent infection.
Contamination of environmental surfaces takes part in the transmission of pathogens. Increased
attention toward disinfection and environmental cleaning is an important aspect of preventing
healthcare acquired infection (Han, Sullivan, Leas, Pegues, Kaczmarek & Umscheid, 2015). This
is aligned with Nightingale’s canon for cleanliness of patient rooms that concentrates on keeping
the patient’s environment clean. Current evidence based research indicates that proper hygienic
practices and environmental cleanliness can reduce the risk for infection and are fundamental
aspects of nursing care.
Nightingale’s environmental theory also focused on observation of the sick. This canon included
observations and assessments of the patient and appropriate documentation of the observations.
Still applicable to nursing practice today, Inan &Dinç, (2013) discuss how poor documentation
undermines patient care and threatens the safety of patients. Through appropriate documentation
nurses can promotes improved quality of nursing care; enhance communication; ensure continuity
of nursing services and also meet current day legal and professional standards of nursing care.
Nightingale’s environmental theory also focuses on sufficient nutritional intake through
documentation of the total amount of food and liquids consumed. Malnutrition is a reversible risk
factor for pressure ulcers in adults, therefore it is essential that all healthcare professionals are able
to correctly identify those at risk early on and provide appropriate management (Taylor, 2016).
Through adequate observation and assessment nursing professionals can establish nutritional
intake therefore reducing the patients risk of pressure ulcers through implementing interventions
that will correct any nutritional deficiencies.
To Nightingale, healing is concerned with bringing the body, mind, and spirit together to maintain
balance within the body. Having a healing environment is a crucial element of nursing care. Within
the environment are unintended consequences in the form of harmful stimuli such as unnecessary
noise, bright lights, and numerous interruptions due to the inevitability of providing twenty-four-
hour care. According to a study completed by Halm (2016), unwanted noise has adverse
physiological and psychological effects and can adversely effect patient outcomes.

Conclusion
The influence of the Florence Nightingale’s environmental theory serves as a foundation for
modern nursing practice. Widely known for instilling her nursing practice with proven evidence
to enhance patient outcomes Florence Nightingale is a pioneer of evidence based practice. The
development of and continued application of the environmental theory continues to be vital to
providing optimal patient outcomes through altering the patient’s environment. The attributes of
Nightingale’s theory continue to have merit in current day practice, even 150 years after it was
originally written.
Roy Adaptation Model
The Adaptation Model of Nursing was developed by Sister Callista Roy in 1976. After working
with Dorothy E. Johnson, Roy became convinced of the importance of describing the nature of
nursing as a service to society. This prompted her to begin developing her model with the goal of
nursing being to promote adaptation. She first began organizing her theory of nursing as she
developed course curriculum for nursing students at Mount St. Mary's College. She introduced her
ideas as a basis for an integrated nursing curriculum.
The factors that influenced the development of the model included: family, education, religious
background, mentors, and clinical experience. Roy's model asks the questions:
 Who is the focus of nursing care?
 What is the target of nursing care?
 When is nursing care indicated?
Roy explained that adaptation occurs when people respond positively to environmental changes,
and it is the process and outcome of individuals and groups who use conscious awareness, self-
reflection, and choice to create human and environmental integration.
The key concepts of Roy's Adaptation Model are made up of four components: person, health,
environment, and nursing.
According to Roy's model, a person is a bio-psycho-social being in constant interaction with a
changing environment. He or she uses innate and acquired mechanisms to adapt. The model
includes people as individuals, as well as in groups such as families, organizations, and
communities. This also includes society as a whole.
The Adaptation Model states that health is an inevitable dimension of a person's life, and is
represented by a health-illness continuum. Health is also described as a state and process of being
and becoming integrated and whole.
The environment has three components: focal, which is internal or external and immediately
confronts the person; contextual, which is all stimuli present in the situation that all contribute to
the effect of the focal stimulus; and residual, whose effects in the current situation are unclear. All
conditions, circumstances, and influences surrounding and affecting the development and behavior
of people and groups with particular consideration of mutuality of person and earth resources,
including focal, contextual, and residual stimuli.

The model includes two subsystems, as well. The cognator subsystem is a major coping process
involving four cognitive-emotive channels: perceptual and information processing, learning,
judgment, and emotion. The regulator subsystem is a basic type of adaptive process that responds
automatically through neural, chemical, and endocrine coping channels.
The Adaptive Model makes ten explicit assumptions:
 1. The person is a bio-psycho-social being.
2. The person is in constant interaction with a changing environment.
3. To cope with a changing world, a person uses coping mechanisms, both innate and
acquired, which are biological, psychological, and social in origin.
4. Health and illness are inevitable dimensions of a person's life.
5. In order to respond positively to environmental changes, a person must adapt.
6. A person's adaptation is a function of the stimulus he is exposed to and his adaptation level.
7. The person's adaptation level is such that it comprises a zone indicating the range of
stimulation that will lead to a positive response.
8. The person has four modes of adaptation: physiologic needs, self-concept, role function,
and interdependence.
9. Nursing accepts the humanistic approach of valuing others' opinions and perspectives.
Interpersonal relations are an integral part of nursing.
10. There is a dynamic objective for existence with the ultimate goal of achieving dignity and
integrity.
There are also four implicit assumptions which state:
 A person can be reduced to parts for study and care.
 Nursing is based on causality.
 A patient's values and opinions should be considered and respected.
 A state of adaptation frees a person's energy to respond to other stimuli.
The goal of nursing is to promote adaptation in the four adaptive modes. Nurses also promote
adaptation for individuals and groups in the four adaptive modes, thus contributing to health,
quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive
abilities and by intervening to enhance environmental interactions. The Four Adaptive Modes of
Roy's Adaptation Model are physiologic needs, self-concept, role function, and interdependence.
The Adaptation Model includes a six-step nursing process.
 The first level of assessment, which addresses the patient's behavior
 The second level of assessment, which addresses the patient's stimuli
 Diagnosis of the patient
 Setting goals for the patient's health
 Intervention to take actions in order to meet those goals
 Evaluation of the result to determine if goals were met
Throughout the nursing process, the nurse and other health care professionals should make
adaptations to the nursing care plan based on the patient's progress toward health.
Essential concepts of Roy’s Adaptation model
Roy’s Adaptation model came into existence in 1960 and is now used in educational, research and
practice settings. Roy’s Adaptation Model (RAM) is one of the most useful conceptual frameworks
that guides nursing practice, directs research and influences education (Shosha, kalaldeh,G.A.,
Mahmoud Al, 2012). Roy’s model is organized around adaptive behaviors and a set of processes
by which a person adapts to environmental stimuli. Bertalanffy’s (1968) general system theory
and Helson’s 1964 adaptation theory forms the original basis of scientific assumptions underlying
the Roy’s model of adaptation. Roy at the 25th anniversary of the model restated the assumptions
and redefined adaptation as “process and outcome whereby thinking and feeling persons, as
individuals or in groups, use conscious awareness and choice to create human and environmental
integration” (Roy and Andrews, 1999 as cited in George, 2002, p.296). In her revised edition, Roy
focused on people’s affinity with others, world and God. Roy and Andrews (1999) state Roy’s
postulates that humans respond to stimuli, initiating a coping process which has an effect on
behavior, leading to either adaptive or ineffective response. Roy describes Stimuli (focal,
contextual, and residual) as the input to the adaptive system that forces the need for change.
Responses to these stimuli fall among any of the four adaptive modes; psychological, self-concept,
role function, and interdependence. The infective response, if produced imposes a threat to
adaptation, leading to a negative response. As a consequence of this, Roy views the role of the
nurse as promoting patient adaptation. In addition, the philosophical assumptions of Roy’s model
are based on humanism and veritivity and cosmic unity. The five assumptions of Roy include
person’s mutual relationship with God, inclusion of human as an innate part of the universe, God’s
destiny of creation and diversity, use of human creative abilities, person’s accountability for
deriving, sustaining and transforming the universe (Perrett, 2007).
Essential concepts of Orem’s Theory of Self-care
According to Clark (1986), Orem’s theory of self-care revolves around the principal of innate
ability of the individuals and their right and responsibility to care for themselves. Self-care is
regarded as the behavior learned in childhood and continued in adulthood. It consists of activities
initiated and performed to maintain life, health and well-being. Orem’s concept of self- care was
first published in 1959. Her self-care deficit theory is composed of three interrelated theories. First
is the theory of self-care. Second is theory of self-care deficit. Third is theory of nursing systems.
These theories comprise of six central and one peripheral concepts. These concepts are discussed
as follows.
Orem defined self-care as “performance or practice of activities that individuals initiate and
perform on their own behalf to maintain life, health and wellbeing” (George, 2002, p. 127). It is to
be noted that effective self-care leads to the integrity of human functioning and development. Self-
care agency is defined as the power or ability to perform self-care. The factors known as basic
conditioning factors are those that affect the ability of an individual to engage in self-care. These
factors include, “age, gender, developmental stage, health state, socio-cultural factors , health care
system factors ,family system factors, activities of living, environmental factors and resource
adequacy and availability” (George, 2002, p. 127). Therapeutic self care demand is defined as the
wholeness of the care measures necessary at specific times or duration of time for meeting an
individual’s self- care requisites through appropriate methods and related sets of operations and
actions. Self care requisites are the reasons or desire for self care. The categories of which include
universal (basic necessities like air water ventilation etc.), development (associated with human
growth) and health deviation (in case of illness or disease) (Orem, 2001, p. 522 as cited in George,
2002).

Orem’s basic element of general theory of nursing is self-care deficit as it demarcates the need for
nursing. Self care- deficit occurs when and individual is incapable or has limited ability to provide
effective self-care. Nursing care is needed either to incorporate the new or complex measures of
self- care which require special training or when an individual needs to recover from a disease or
injury (Orem, 2001 as cited in George, 2002).The nurses may act in either of these five ways to
meet individual’s needs. These include “acting for or doing for, guiding and directing, providing
physical or psychological support, providing or maintaining the environment and teaching” (Orem,
2001, p.56 as cited in George, 2002, p. 129). Finally Nursing agency is defined as a complex
property or attribute of nurses that enables them to act, to know and to help others meet their
therapeutic self-care demands by implementing or developing their own self-care agency (George,
2002). The nursing systems may be wholly compensatory, partly compensatory or supportive
educative based on the requirement of patient’s needs.
Compare and contrast of the major concepts of Orem’s theory of self-care and Roy’s model of
adaptation with Literature Support

Person
Roy’s Adaptation Model has provided us a conceptual path to study human behavior (George,
2002). According to Roy’s adaptation model, an individual is described as an adaptive system that
is able to respond to different internal and external environmental stimuli whether positively or
negatively. Moreover, Roy has considered the human person in a “social context” as a bio-psycho-
social being (Hanna and Roy, 2001p. 9). Roy has also differentiated Individual coping mechanism
(regulator and cognator) and Group coping mechanism (stabilizer and innovator) (George, 2002).
On the other hand, Orem defines an individual as a person struggling to have self-care needs met
in order to live and mature. She has conceptualized a human being as a total being with universal,
developmental and health deviation needs and capable of continuous self-care. (Current Nursing,
Orem’s Theory of Self-care, Human Being, 2012). Orem distinguishes humans from other living
things in three ways. First, humans have capacity to reflect upon themselves and their environment.
Second, humans can symbolize their experience. Third, humans use their ideas in thinking and
communicating (George, 2002).
Both the theorists have described human or person in terms of individuality and their struggle
towards achieving optimum health. While the individual in Roy’s model fights for survival, the
individual in Orem also struggles for survival but this individual may or may not be affected by
any stimuli. As a contrast, according to George (2002) where Roy’s focus is not just the
individual’s adaptation but includes groups that are interconnected, Orem’s initial focus is the
individual’s needs and survival followed by family and group.
Environment
Orem believes that the environment directly influences the patient. She has emphasized on
individual’s basic needs of air, ventilation etc. and prevention of hazards to maintain human
integrity and promote human functioning (George, 2002). Roy believes that the person constantly
interacts with the changing environment. According to Roy (2009) the environment consists of
stimuli including conditions, circumstances, and influences surrounding an individual, whether
focal, contextual, or residual. The person’s ability to interact with the environment and respond to
the stimuli determines the adaptation level. This sums up that Roy considers environment as all
“conditions, circumstances, and influences surrounding and affecting the development and
behavior of persons and groups with particular consideration of mutuality of person and earth
resources, including focal, contextual and residual stimuli” (Current Nursing, 2012, Roy’s
Adaptation Model, para. 7).
Both Orem and Roy are of the opinion that environment plays an integral role in human
development and survival. Roy presents environment as a stimuli that disrupts the integrity of
development but at the same time she appreciates that adaptation is achieved when human gets
connected to the environment. In contrast, where Roy considers environment as a source of stimuli
and that the human system must maintain integrity in the face of environmental stimuli, Clark
(1986) believes that Orem considers environment as the medium for provision of basic human
needs for survival.

Nursing
Roy considers nursing as a key player to help patients to develop coping mechanism and positive
outcome from the constant stimuli exposure. According to the Roy’s adaptation model, nursing is
the “science and practice that expands adaptive abilities and enhances person and environment
transformation with the goal of promoting adaptation for individuals and groups” (Barone, Roy,
and Frederickson, 2008, p. 354). Roy’s goal of nursing for the patient is to achieve adaptation
leading to optimum health, well-being, and quality of life and death with dignity, (Roy & Andrews,
1999). According to George (2012) Roy’s focus in nursing assessment is behavior of the
individual. It includes scientific as well as philosophical perspective for nursing interactions with
humans such as wholeness, veritivity and cosmic openness. On the other hand, Orem believes
nursing as “actions deliberately selected and performed by nurses to help individuals or groups
under their care to maintain or change conditions in themselves or their environments” (Current
Nursing, 2012, Dorothea Orem’s Self-care Theory, para. 3). Taylor and Godfrey (1999) states
Orem’s idea that the nurse’s actions should be directed towards protecting, preserving, or
promoting patient’s integrity as human beings, promoting well-being, and fostering continuing
movement toward maturity. Moreover, Orem also states that nursing is required when self-care
demands of a patient exceeds the self-care ability. Both complement each other to achieve self-
care through health promotion and maintenance and emphasis on prevention of hazards to maintain
human integrity and promote human functioning. Apart from prevention and promotion, Orem
also focuses on nursing as a supportive educative system (George, 2002) which is directed towards
empowering individuals to compensate for the deficit. In addition to this, Orem supports nurses to
involve family in patient care who is ultimately responsible for the individual.
In view of the above statements, both the theorists explain the role of a nurse as health care
promoter and facilities patient to either adapt to the situation or balance or cope up with the self-
care deficit. However, in contrast, according to Orem, nursing care focuses more on the areas and
the degree to which support is needed as opposed to Roy whose focus is on behavior change
(George 2002). Moreover, Orem’s focus is more towards the physiological needs of the patient
whereas Roy caters to the physiological as well as psychological adaptation.

Health
According to Barone, Roy, and Frederickson (2008), Roy defines health as “a state and process of
being and becoming integrated and whole that reflects person and environmental mutuality and
depends on adaptation” (p. 354).Roy views health as reflection of adaptation on a health illness
continuum. On the other hand, Fawcett (2005) presents Orem’s idea of health as a state of
soundness or wholeness of developed human structures, bodily and mental functions. Health
encompasses inseparable “anatomic, physiological, psychological, interpersonal and social
aspects” (Orem 2001 as cited in Fawcett, 2005, p. 239). Both Roy and Orem view health as a state
of well-being and absence of disease. Roy encompasses health as “the process of achieving
adaptation with the environmental stimuli, so, the person is integrated and a whole” (Shosha,
kalaldeh, & Mahmoud Al, 2012, p. 2). Roy also conceptualizes health as simplistic and unrealistic
as it excludes the individuals with chronic or terminal illness, who despite of their illness are
struggling with their life challenges (Roy, 2009). On the other hand, Orem supports the world
health organization definition of health as a “state of physical, mental and social well-being and
not merely the absence of disease or infirmity” (Orem, 2001, p. 184 as cited in George, 2002).
Orem emphasizes on the integrity of physical, psychological, mental and social aspects of health
and takes into account all the levels of health maintenance including primary, secondary and
tertiary prevention (George, 2002). However, Orem also believes that “adults have the right to
decide about the kinds of health care they will accept and the responsibility to act for themselves
in matters of self-care and health” (Orem 1995, p. 338 as cited in Taylor & Godfrey1999, p. 203).

Applicability of Orem’s and Roy’s Models in Clinical Practice

Orem’s theory is derived from the clinical base which provides a comprehensive base for nursing
practice. According to George (2002) it can be utilized by professional nurses in the areas of
education, clinical practice administration, research and nursing information system and
contributes significantly to the development of nursing theories. While on the other hand, Roy’s
model is applicable and important for nursing practice, nursing education and development
(Shosha, kalaldeh, & Mahmoud Al, 2012). Orem focuses on finding the self-care deficit of the
patient and providing the necessary care to promote his or her well-being. Whereas, Roy is
concerned with the different stimuli that forces adaptation in order to achieve optimum health.
Orem’s theory can be applied in clinical practice by a novice nurse as well as advanced practitioner
which is one of the major strength of this model (George, 2002). Moreover, Orem in her theory
has clearly defined where nursing is needed; that is when one’s ability to provide self-care to
maintain quality of life diminishes. However, George (2002) states that nurse’s role in Roy’s
adaptation model is to identify the stimuli and planning interventions to either change or strengthen
the adaptive response.
According to Knust & Quarn (1983) “some practitioners have found Orem’s theory to be more
clinically applicable when more than one system is used concurrently” (as cited in George, 2002,
p. 148).This suggests the applicability of Orem’s theory in acute care setting as opposed to
applicability of Roy’s model more into the community setting. This is because; the assessment of
role function mode and interdependence mode is time consuming and so cannot be applied in acute
care setting. Orem has explicitly defined all the terms in her theory which are comprehendible and
easy to understand. In contrast, according to Shosha, kalaldeh, and Mahmoud Al (2012) “Roy’s
arrangement of concepts is logical, but the clarity of some terms and concepts is inadequate to
reflect nursing disciplines” (p. 3). This lack of clarity decreases the application of Roy’s model in
any specialized area of practice (Shosha, kalaldeh, and Mahmoud Al, 2012). The Roy’s model is
broad in scope and can be used to build or test nursing theories and is generalizable to all
approaches existed in nursing practice. Moreover, according to (George, 2002) Roy allows for
incorporation of spiritual aspects of human adaptive system, which is often omitted from nursing
assessment. Whereas, according to George (2002) Orem has acknowledged the individual’s
capacity for physical movement but does not acknowledge the emotional or spiritual needs of the
individual.

Conclusion
It is evident that the application and evaluation of nursing theories enhances nurse’s image, assists
in the continuous evaluation of nursing knowledge and promotes the acceptance of nursing
profession as science based (Clark, 1980 as cited in Clark, 1986).According to George(2002)
Orem’s theory is well suited for all those who need nursing care and those who need adjustments
in their development phase, Roy’s model has implications for use across life span ; for families
groups etc. but portion of it may be more useful for the nurse at different times. In my judgment
on the basis of above mentioned arguments, Orem’s theory of self-care is best suited for clinical
practice. Orem’s assessment approach according to Clark (1986) is a multisource perspective in
which Client, family, other health-care professionals, and health-care records are utilized, Self-
care abilities, self-care deficits, and self-care requisites are identified and used to decide which out
of three nursing system is suited for the individual. Moreover, Self-care abilities are determined
through several factors like age, sex, developmental stage, health status, socio-cultural orientation,
and financial and other resources. Furthermore, Orem’s self-care deficit nursing theory “gives
substance to the purpose of action and identifies aspects of the situation that have relevance from
a nursing perspective” (Taylor & Godfrey, 1999, p. 203). This comprehensiveness of Orem’s
model provides nurses an opportunity to apply it in clinical practice without regard to being a
novice or an expert.