Nursing and medicine has several aspects in common and also several aspects which are very much different. A nurse would be using several nursing theories during their practice. On the other hand, physicians would be concentrating on practice to ensure a certain outcome is attained. Medicine would not be concentrating much on theories, but only ensuring that the process of diagnosis and treatment would help the patient overcome the disease. Although nursing and medicine function in different ways, experts felt that there is a 25 % overlap in both professions (Spielman, 2005). This has given a hope that both these professions, although developed independently, can still utilize some of the theories and ideas of the other profession and in this way improve the quality of care, reduce the costs, increase the accessibility and ensure that shortages in the field are being met or supplemented by the other professions.
Differences between medical practice and nursing practice
There are several differences between medical and nursing practices. Medicine would concentrate on the treatment or management of the patient, whereas nursing would concentrate on the patient itself. A nurse’s role in management of the patient is more holistic, in the sense that it would consider the patient as a whole. Several aspects of the patient including lifestyle, diet, risk factors, health state, managing and interpretation of the patient information, etc, are controlled by the nurse, whereas the physician would concentrate on treating the patient, preventing a condition or diagnosing a disease. Outside the patient the physician would not act, and the nurse would not consider anything outside health or disease. Hence, the role of the nurse is greater than what a physician’s role would actually be (Lavin, 2002).
Florence Nightingale gave a good interpretation of nursing and compared it to medicine. She described medicine as “surgery of functions, as surgery proper is that of limbs and organs” (Quoted by Florence Nightingale from Reference Lavin, 2002) (the main function of medicine would be to correct or treat defects of disease). When she introduced nursing she claimed it to “put the patient in the best condition possible for nature to act” (Quoted by Florence Nightingale from Reference Lavin, 2002), (during any treatment, nursing would ensure that the patient is put in a position that he/she responds positively to treatment). A nurse would be playing a varying role compared to a physician, who would be playing a specific role.
With each aspect of a disease, the viewpoint of nursing and medicine would be different. For instance, there are various aspects of a disease including epidemiology, etiology, clinical features, diagnosis, treatment and prognosis. Medical diagnosis would consider what the disease or condition is, whereas nursing diagnosis would suggest the relationship of the patient to illness or health. In medicine, treatment would include a surgery or administering a substance, whereas in nursing treatment would include nursing interventions. Etiology as per medicine would refer to the cause of the disease, whereas in nursing the factors responsible for the development of a negative response of the body (Lavin, 2002). Nursing seems to be more holistic as compared to medicine, as it considers the patient as a whole.
Compared to medicine, nursing adopts a more humanistic or personal approach. Medicine may take a more professional path, and has been often criticized. Frequently, nurses go beyond what medicine actually encompasses. Many experts have suggested greater use of the nursing model by the physicians as it can enhance the quality of care provided. The nursing models also seem to have greater alternative approaches. Several theories of nursing are applicable, whereas in medicine just a few are being used (Reed, 1994).
The theory of medicine was first framed by Aristotle Hippocratic who emphasized the importance of diagnosis and prognosis for diseases. Today medicine is being practiced with more practical implications rather than a theoretical model. On the other hand, several theories are applicable in nursing practice. Most of the theories in medicine are utilized to obtain definite ends rather than guiding during the performance of certain actions (Miettinen, 2001).
Dorothea Orem’s Self Care Deficit Model has provided a philosophical model for providing care during deviation of health. When any person is sick, the relatives and friends should ensure that help is provided (as self-care cannot be enabled) (TVU, 2005).
Orem has described self-care as a process of helping oneself. It is a sort of voluntary action meant to ensure better living and meet one’s own requirements. Self-care is a continuous process and is required throughout life. It ensures that the human body structures are preserved, functioning of the human body is improved, development is enabled and well-being is stimulated. The self-care agent is usually the person who provides the caring action, whereas the self-care agency is the ability of the individual to perform these activities. The individual should have the skills and the knowledge for self-care and in the case of any difficulty, other people should assist to varying extents depending on the need. The self-care agency would include the self-care agent and the dependent care agent (such as a nurse, friend or a relative). A person can provide self-care to an infant, child, handicapped person, sick individual, dependent person or elder. For an individual to provide self-care several resources are required including education, experience, competence, intelligence, and other cognitive skills. The Self-care requisites may vary depending on the status of health, specific defects and the stage of life the individual. For example, generally, the universal self-care requisites would apply, whereas in illness, the health deviation self-care requisites would apply. During the developmental stages of life (babies and infants), the developmental self-care requisites would be apply (TVU, 2005).
In the status of helath, the Universal self-care requisites would apply and include eight specific needs namely water, air, diet, excretion, rest & physical/mental activity, social needs, removal of risks to health and ensuring greater normality. During the developmental stages of life, the developmental self-care requisites would apply and include age, sex, socio-economic condition, personality and intellectual being. As development is a continuous process, these requisites would apply throughout life. During disease, the human functioning would be affected and the health deviation self care requisites would apply. The individual’s ability to function normally and to take care of self is seriously affected. Besides, diseases, several injuries, traumatic conditions, diagnostic tests and treatment measures also require these self-care requisites to be followed (TVU, 2005).
When a deficit or a defect exists, there would be certain self-care demands. In such a case, an opportunity for a self-care agency would exist to provide self-care. The ideology of nursing is based on this model. Nursing would help deliver and meet the self-care demands as they would overcome the deficits. Self-care can also be directed towards controlling the self-care agency (TVU, 2005).
Dorothea Orem referred to nursing as “provision of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or coping with their effects” (Quoted by Orem from the Reference UCC, 2008).
For self-care, there are three types of compensatory systems, wholly compensatory nursing systems, partially compensatory nursing systems and educative and supportive nursing services. In the wholly compensatory nursing services, the nurse would help the patient who is completely unable to perform certain self-care activities. In partially compensatory nursing services, the nurse and the patient would work towards ambulation and manipulation by employing certain interventions or measures. The patient is able to perform certain self-care activities, but for others is dependent on the nurse, to varying extents depending on their deficits. In the educative and supportive nursing services, the patient is in a position to perform the activities and can even acquire the skills to do so. However, certain amount of assistance is required toe ensure that the patient can make decisions, provide judgments and demonstrate the behavior, knowledge and the skills for self-caring (UCC, 2008).
Orem considered nursing to be a service or an aid to people rather that a branch of medicine, whose main goal would be to ensure the self-care of the patient. Orem categorized nursing into three processes. In the first process, the patient’s requirements of self-care need to be determined. In the second process, the nursing services should be determined and the exact plan needs to be discussed. In the third step, the nursing plan needs to be implemented, along with by using several effective management processes. Orem has given great importance to the use of management processes in nursing such as controlling, directing, planning, initiating, implementing, problem-solving, etc, as they are logical steps and can be appropriately utilized to manage any issue during self-care. Hence, according to Orem, a nurse needs to have effective management skills and utilize them whilst handling patients (UCC, 2008).
Dorothea Orem also determined five ways of providing nursing care namely acting, guiding, teaching, supporting, and ensuring an accommodative setting. Orem’s theory helps to establish the relationship between the nurses and the patients. The functions played by both parties are mentioned and the actions to be taken are chalked out (UCC, 2008).
For Orem, nursing has several elements including the artistic side of nursing, the scientific side of nursing, nursing prudence (to enable quality thorough advice, judgment and decision-making), nursing agency (specialized abilities possessed by the nurse to provide self-care) and nursing service. The nurse and the patient would make an effort to reach self-care, and hence their roles and responsibilities would be distributed depending on the need (promotion and maintenance of health). Better holistic management of the patient would be ensured. Orem has also tried to exclude any legal details in her theory as it would hamper with the normal management of the patient.
Overall, Orem’s theory explains the differences between the role played by the physician and the role played by the nurse in managing the patient. The physician would use the process of examination, diagnosis, treatment and follow-up to manage the condition of the patient. The nurse on the other hand would manage the patient rather than the condition and understand the reason for any deviation from health. The cause for the self-care deficit is understood through the nursing diagnosis process (could be pre-existing or emerging) and then the nursing intervention would ensure that the patient is provided care.
If the core competencies of the dental professional and the nursing professional are being compared, it is found that there is a 38 % overlap, whereas there is a 25 % overlap when the core competencies of the nurse and the physician are compared. Some of the areas in which there would be an overlap include practice models, education, research, and community services. Although these three professionals have developed separately, there is still an overlap and certain similarities. Hence there is greater chances of collaboration and sharing of theories and principles between various professionals. For example, the Orem self-care theory could be given greater consideration by the physicians. The delivery of healthcare in this manner can be improved. The cost of healthcare would come down and the accessibility would be improved. Any shortage in the health professionals would also be met. The New York University’s Dental School and the New York University’s Steinhardt School, department of Nursing, has collaborated to provide benefits for both these two professions (Spielman, 2005).
Lavin, M. A. (2002 ). Essential differences between evidence-based nursing and evidence-based medicine. International Journal of Nursing Terminologies and Classifications , Jul-Sep . http://findarticles.com/p/articles/mi_qa4065/is_200207/ai_n9110743/pg_4?tag=content;col1
Miettinen, O. S. (2001). The modern scientific physician: 7. Theory of medicine. CMAJ, November 13, 165 (10). http://www.cmaj.ca/cgi/content/full/165/10/1327
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Spielman AI, F. T. ( 2005). Dentistry, nursing, and medicine: a comparison of core competencies. J Dent Educ , Nov;69(11):1257-71. http://www.ncbi.nlm.nih.gov/pubmed/16275689?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
TVU (2005). Dorothea Orem’s Self-Care, Retrieved on February 15, 2009, from TVU Web site: http://www.cardiacnursing.co.uk/pdf/orem.pdf
UCC (2008). Dorothea Orem – Nursing Theory, Retrieved on February 15, 2009, from UCC Web site: http://faculty.ucc.edu/nursing-gervase/Orem%5B1%5D.pps