December 1, 2007 | American Society of Registered Nurses®
Journal of Nursing

The Biomedical Model vs. Social Model in American Nursing Practice

The History

The nursing practice has undergone a positive shift from that of a vocation to a professional status today (Potter, 2005). The vocational role of the nurse care as prescribed by a physician is the basis of the Biomedical Model of nursing care. The roots of the Biomedical Model can be traced to Decartes, who advocated the mind-body dualism (www.unc.edu) .On this basis, disease is defined as a biophysical malfunction and the goal of treatment is to correct the malfunction to cure the disease. This model stresses on the pathophysiology and altered homeostasis focusing solely on the treatment of the disease with little or no scope for the role of psychological or social differences of culture and ethnicity (Potter, 2005). It is important here to mention the influence of Parson's sick role (www.unc.edu) in the Biomedical Model that emphasises that the patient is not to be blamed for his illness and he should seek medical help for cure. But a nurse is always in complex situations with noncompliant cases that will not fit into this concept. In contrast, the Social Models take into account, the psycho-social aspects for care and cure.

Florence Nightingale was the first to define a distinct role for nurses in the medical domain stating that nurses can manipulate the environment to promote the patient's well being. These Nursing Models are conceptual models, based on theories or concepts that effectively guide nurses towards the goal of patient care. However, various branches of nursing have their preferred models of nursing. Roy’s Model and Tidal Model are preferred models in Psychiatric nursing. Casey’s Model is preferred in Child care. Orem’s Model is most preferred in adult nursing.These models of nursing provide nurses a foundation to view client situations, organize data and analyze or interpret information. These models of nursing help the nurse understand how the roles and actions of nurses are interrelated. They connect theory and practice focusing more specifically on the events and the phenomena of the discipline and are specific enough to contribute to a sound basis of nursing practice.

The Research Outcome

Research reveals that the use of the terms, models of nursing or nursing model, are limited or confusing as the terms encompass a range of meanings and suggest a three-model typology that clarifies the present position of nursing models, namely, The Theoretical Model, The Mental Model and The Surrogate Model (Wimpenny,2002). Research findings have also shown that the nurses most often assess patients by medical diagnoses for admission with scant or no attention given to psycho-social needs (Griffiths, 1998).

A chronological Review

A chronological review of the neo models of nursing places Florence Nightingale’s work ‘Notes on Nursing (1860); What it is and what it is not (1860) as the first neo theoretical and conceptual model for nursing which defines nursing as not just administration of medications and treatments but rather as being oriented towards providing fresh air, light, warmth, cleanliness, quiet and adequate nutrition recommending improved hygiene and sanitary conditions for the patient’s wellbeing.  Nightingale’s descriptive model provides nurses with an approach to perceive nursing with a frame of reference that focuses on environment and the patients. Hildegard Peplau’s (1952) model of nursing focuses on the individual, the nurse and the process of interaction which gives rise to the nurse client relationship. The unique feature of Peplau’s model has been the description of a collaborative nurse-client relationship through which a social interpersonal effectiveness meets the needs of the client.

Virginia Henderson (1955) also defines nursing from a social perspective as assisting the individual, sick or well, in the performance of those activities that will contribute to health, recovery or a peaceful death and that the individual would perform unaided if he/she had the necessary strength, will or knowledge.  He has classified fourteen basic needs of a whole person which includes physiological, psychological, sociocultural, spiritual and developmental aspects. Faye Abdellah (1960) emphasizes on delivery of nursing care for the whole person to meet his physical, emotional, intellectual, social and spiritual needs.  According to this model, the nurse requires knowledge and skills in interpersonal relations, psychology, growth and development, communication as well as a basic knowledge of the science of Nursing. Dorothy Johnson’s model (1968) defines the nurse’s assessment of the client’s needs in behavior subsystems.  According to this model, under normal circumstances, the client behaves effectively in the environment until stress disrupts normal adaptations making his behavior erratic or less purposeful and the nurse actually provides nursing care to meet the client’s needs.

Martha Roger’s model (1970) views the individual human being as a unitary human being who has an energy field co existing within the Universe.  The ‘Unitary Human being’ of Roger is a “four dimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from the knowledge of the parts”.  The four dimensions described by Roger are Energy field, Openness, Pattern and organization and Dimensionality.  These dimensions are useful in arriving at principles for human development. Dorothea Orem (1971) defines nursing with emphasis on client’s self-care needs and nursing care is a need when the client is unable to perform biological, psychological, developmental or social needs.

Imogene King (1971) has also formulated a goal attainment theory which focuses on three dynamic interacting systems namely, personal, interpersonal and social systems.  Betty Neuman (1972) defines a total person model for nursing incorporating a holistic concept and an open-systems approach.  Neuman views nursing as a profession concerned with the whole person and the goal of nursing as to assist individuals, families or groups to attain a maximum level of total well being.  Leininger’s (1978) Cultural Care Diversity and Universality model sees care as the essence, the dominant, distinctive and unifying feature of nursing.  He views human care as a one that varies among cultures and stresses that nurse interventions should focus on this culture care preservation, culture care accommodation, negotiation, or both and culture care restructuring and repatterning. Sister Callista Roy (1979) in her adaptation theory states that the client is an adaptive system and the goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function and interdependent relations during illness.  Meeting basic physiological needs, developing a positive self-concept, performing social roles and achieving a balance between dependence and independence are basic features of this model of care. Jean Watson’s (1979) model defines nursing as a profession directed at understanding the relationship (interrelationship) between health, illness and human behavior.Benner and Wrubel’s model (1989) stresses on the supremacy of care, where, caring creates coping the adverse situations of the client.  In this model, care is defined as a connection; caring is that persons, events, projects and things matter to people.

Conclusion

The international applicability of conceptual models of nursing developed by nurse theorists from the United States of America has been well documented (Fawcett,2004).These theoretical models  also serve as frameworks for nursing curriculum and practice by increasing the scientific basis of nursing practice. Applications of these models in practice depend on the awareness, understanding and research on their interrelationships. A test approach to these models helps to determine how accurately a model describes a concept. But it is the expert nurse who transports the art and science of nursing into the world of patient care (Potter, 2005).

Reference

• Anthony MK, Brennan PF, O'Brien R, Suwannaroop N. (2004). Measurement of nursing practice models using multiattribute utility theory: relationship to patient and organizational outcomes. Quality Management in Health Care. 13:40-52.

• Dorothy Pringle (2006). Nursing Practice Models: Time for Change. Nursing Leadership .19(3): 1-2.

• Florence Nightingale (1860). Notes on nursing: what it is and what it is not. books.google.com.

• Jacqueline Fawcett (1984). The Metaparadigm of Nursing: Present Status and Future Refinements. Journal of Nursing Scholarship. 16 (3): 77-87.

• Jacqueline Fawcett (2004). Conceptual Models of Nursing: International in Scope and Substance? The Case of the Neuman Systems Model. Nursing Science Quarterly, 17(1): 50-54.

• Jacqueline Fawcett, Diana M. L. Newman and Margaret McAllister (2004). Advanced Practice Nursing and Conceptual Models of Nursing. Nursing Science Quarterly, 17(2):135-138.

• Kerstin Hedberg Nyqvist (1993). Advice concerning breastfeeding from mothers of infants admitted to a neonatal intensive care unit: the Roy adaptation model as a conceptual structure. Journal of Advanced Nursing.18 (1): 54-63.

• Mariah Snyder, Ellen C. Egan and Yoshiko Nojima (1996). Defining Nursing Interventions. Journal of Nursing Scholarship. 28 (2):137-141.

• Maureen A. Frey (2002). King’s Conceptual System and Theory of Goal Attainment: Past, Present, and Future. Nursing Science Quarterly, 15(2), 107-112.

• Pamela G. Reed (1996). Transforming Practice Knowledge into Nursing Knowledge—A Revisionist Analysis of Peplau. Journal of Nursing Scholarship.28 (1): 29-33.

• Patricia A Potter and Anne Griffin Perry (2005). Fundamentals of Nursing, 6th edition, Mosby.

• Pauline Griffiths (1998). An investigation into the description of patients' problems by nurses using two different needs-based nursing models. Journal of Advanced Nursing.289 (5):969-977.

• Penelope Ann Hilton (1997).Theoretical perspectives of nursing: a review of the literature. Journal of Advanced Nursing.26 (6): 1211-1220.

• Peter Draper (1993). A critique of Fawcett's Conceptual models and nursing practice: the reciprocal relationship. Journal of Advanced Nursing, 18(4):558-564.

• Peter Wimpenny (2002). The meaning of models of nursing to practising nurses. Journal of Advanced Nursing. 40(3): 346-354.

• Sarah E. Abrams (2007). Nursing the Community, a Look Back at the 1984 Dialogue between Virginia A. Henderson and Sherry L. Shamansky. Public Health Nursing.24 (4): 382-386.

•www.unc.edu/courses/2007spring/nurs/595/960/
alternative_paradigms/ap_biomed-model.html.

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>A Redefinition Of Action Research

>The Real Public Perception Of Nurses

>The Biomedical Model Vs. Social Model In American Nursing Practice

>Teaching Nurses To Stand Up To Surgeons In The OR

>Are Immigrant Nurses A Threat To The US Nurse?

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