DNP 835 Role of Nursing in This Delivery Paradigm DQ

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DNP 835 Role of Nursing in This Delivery Paradigm DQ

DNP 835 Role of Nursing in This Delivery Paradigm DQ


DQ1 Discuss value-based healthcare delivery. Include the
role of nursing in this delivery paradigm.

DQ2 Discuss how nursing leadership influences value-based
healthcare delivery in systems management.

Nursing Theories within the Totality Paradigm

Numerous features of the totality paradigm are apparent in the adaptation model. This model reflects the person as a holistic adaptive system in continuous interaction with both external and internal environment. The goal of nursing is to promote adaptation within four adaptive modes including psychological, self-concept, role function and interdependence (Roy, 1997, 2009). This illustrates that human beings strive towards an optimal level of health through manipulation of their environment. The practice methodology in this model is the six step process similar to the nursing process (Mitchell & Pilkington, 1990). The nurses using this model will assess patient’s condition according to the adaptive modes, categorize the stimuli for those behaviors, develop a nursing diagnose, intervene, and then evaluate patient’s condition. This practice methodology is consistent with Parse’s (2000) statement that nursing process is the distinctive problem solving method within the totality paradigm. All these features of the adaptation model indicates that it fits within the totality paradigm. Similarly, Orem’s theory views human beings as a summative entity that needs to adapt to their environment to meet their goals (Orem, 1997, 2001). Human beings are recognized as active agents capable of taking deliberate actions to maintain self-care (Orem, 2001; Fawcett, 2005). Orem (1997) considered environment as a means to provide basic human needs for survival. These features are consistent with the totality paradigm. Furthermore, Orem stated that nursing is the intervention to meet the required need for self-care and the need for medical care of patients (1997). This is consistent with the goal of nursing in the totality paradigm which focuses on health promotion and prevention of illness (Parse, 1987). Finally, both of these theorists viewed health as the proper functioning of body. Health was considered to be a measurable and observable entity. This clearly indicates that these theories follow the totality paradigm.

Nursing Theories within the Simultaneity Paradigm

The two important nursing theories within the simultaneity paradigms are: Rogers’ (1970) science of unitary human beings and Parse’s (1998) human becoming theory. The science of unitary human beings presents a holistic view of human beings and their environment and conceptualize them as irreducible and indivisible wholes (Rogers, 1970). Human beings and environmental are viewed as energy fields which change continuously. Roger (1970) claimed that the nature of human beings can only be understood through examination of all dimensions rather than their individual dimensions. These features are in line with the features of the simultaneity paradigm. She also stated that her theory is concerned with specific patterns of human and environmental energy fields that may lead to their optimum well-being. According to her, the goal of nursing is not the management of health problems but the progression of change in the direction of wherever human beings think they are going. This indicates that Rogers’s theory clearly fits within the simultaneity paradigm. Parse’s (1998) human becoming theory is also consistent with the principles of the simultaneity paradigm because she specified that her theory is derived from Roger’s (1970) theory. Parse (1992) stated that “human becoming reflects the unity of the construct man-living-health and in her theory there are no references to particular aspects of humans, such as biological, psychological, or spiritual” (p. 37). She regarded human beings as unitary beings who mutually interact with the rhythmical patterns of their environment. These characteristics directs that this theory fits within the simultaneity paradigm.

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In conclusion, nursing is a multi-paradigmatic discipline. The nursing paradigms play an essential role for understanding multifaceted human beings and related nursing phenomena. The conceptual models and theories in nursing represent different paradigms and aspects of nursing. However, the definitive purpose of these paradigms and the models and theories which follow these paradigms is to improve professional nursing practice through knowledge development.


Bahramnezhad F, Shiri M, Asgari P, & Afshar, P. F. (2015). A review of the nursing paradigm. Open Journal of Nursing, 5(1), 17. Butts, J.B. (2011). Components and levels of abstraction in nursing knowledge. In J.B. Butts, & K.L. Rich (Eds.). Philosophies and theories for advanced nursing practice (pp. 87-108). Sudbury, MA: Jones & Bartlett DiBartolo, M. C. (1998).

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