Comparison and Analysis Across Theories

Theory is an arrangement of thoughts meant to describe something. These thoughts and ideas usually have basic principles that validate the purpose of the proposed theory. Nursing theory is a well thought out scholarly structure of concepts. These concepts are created to help guide nursing practice. They explain the fundamentals of nursing care. Multiple clinical decisions are based upon nursing theories. There are many different types of nursing theories developed primarily by nurses. Nursing theorist’s main goal is to examine nursing practice and explain the working or non-working parts

Nursing theories have been a fundamental tool used to explain, guide and improve the practice of nursing. Theorists have contributed enormously to the growth of nursing as a profession. The four grand theorists I chose are Virginia Henderson, Peplau, Myra Levine and Jean Watson. These theorists have contributed tremendously in the field of nursing through their theories, and research. One thing the theorists have in common is that they are patient centered. They are all concerned on ways we can improve our responsibility to the patients, their families and the environment. They have different ideas but they are all aiming towards achieving the same goal, which is patient satisfaction and safety. Their differences are in their areas of

Theory development stems from personal experiences, intuition, and knowledge of the theorist (Burns et al., 2013). When a scholar develops a theory, it has to be tested through research. The findings of the study are then presented to experts in the area of academics and the field of practice (Burns et al., 2013). The presentation of the findings allows experts to provide constructive criticism, highlight the pros and cons of the theory, and acknowledge whether or not the theory can be accepted as a guide to practice. This theory evaluation paper will give the reader a theory description, theory analysis, and an assessment of Dorothea Orem’s self-care deficit theory of nursing (Alligood et al., 2010).

Nursing theories play an integral role in guiding practice, education, and research. Many different theoretical perspectives are maintained in the field of nursing due to the diversity of the field, no single theory is able to account for all nursing knowledge. The purpose of this paper is to compare and contrast two nursing theories that have produced a profound impact on nursing practice. The theories being compared are Dorothea Orem’s Self Care Deficit Nursing Theory (SCDNT) and Sister Callista Roy’s Adaptation Model (RAM). Both theorists have profoundly influenced nursing science, research, practice, and education. Similarly, both of these theories fall into the category of Grand nursing theories which are the most complex theory level and explain broad areas of the discipline, as well as being the broadest in scope (McEwen & Wills, 2014).

Dorothy Orem’s Self-Care Deficit Theory and Sister Callista Roy’s Adaptation Model are considered as grand nursing theories. The grand nursing theories are a

Dorothea Orem is known as one of the foremost nursing theorists. She is credited with the development of a nursing grand theory, the self-care deficit nursing theory (SCDNT). The beginning of her career can be traced back to Washington, D.C. in the mid 1930’s. Though she was a Baltimore, Maryland native, Orem pursued her nursing education at Catholic University of America (CUA) in Washington, D.C., graduating with baccalaureate and Master’s degrees in 1939 and 1945 respectively. Following her education, Orem held many job positions across multiple nursing disciplines, including working as a private nurse, nurse educator, administrator, director, and private contractor (McEwen & Wills, 2011).

Research in the professional practice of nursing was built upon a wide variety of theories that were presented by many well-known nursing theorists. Nursing theories that may be recognized today include Florence Nightingale’s Environmental Theory, Dorothea Orem’s Self-Care Deficit Theory, Madeleine Leininger’s Cultural Care Theory, and Hildegard Peplau’s Interpersonal Process Theory. These individuals and their respective theories

Orem focuses on nursing as a deliberate human action and notes that all individuals can benefit from nursing when they have health-derived or health-related limitations for engaging in self-care or the care of dependent others (Gunther, 2016). The nurse chooses deliberate actions from nursing systems to bring about desirable conditions in persons. The goal of nursing is to move a patient toward responsible self care or to meet existing healthcare needs of those who have health care deficits (Gunther, 2016). Orem expects people to be responsible for themselves and to seek help when they cannot maintain therapeutic self-care or dependent-care (Fawcett, 2003).

Dorothea Orem's self-care deficit theory was born while Dorothea Orem (1917-2007) was working in the Department of Health Education and Welfare (HEW) as a curriculum consultant. At this time in the history of the profession, nursing was just emerging as a unique academic discipline. Orem's theory was designed to answer the fundamental question: What is nursing? Orem defined nursing as a way of realizing every patient's desire to engage in self-care in a manner to "sustain life and health, recover from disease or injury and cope" with the consequences of major health events and daily life (El-Kader n.d.). Major assumptions of the theory include that "people should be self-reliant and responsible for their own care and others in their family needing care" (Dorothea Orem's self-care deficit theory, 2012, Current Nursing). Fundamentally, nursing and the nursing process is designed to enhance self-care and to address deficits in self-care.

Nursing theory is relatively new and as such, it continues to evolve as new knowledge is gained. There are numerous theories of nursing, each of which took years to develop and most of which continue to evolve and adapt. There are commonalities between and among the existing theories although each may focus more heavily on different aspects of responsibilities. It has to do with the philosophical foundations for each theory.

Given that nursing is a hands-on, professional 'practice,' to speak of nursing 'in theory' may at first seem like a contradiction in terms. However, nursing theory is an important tool, offering the practitioner in the field a way to better make decisions. Theory acts as a guide to practice. Of course, in nursing, theory is never subsumed to the specifics of a case. Unlike philosophy or literary theory, no theory can stand apart from the realities of the need to treat a patient effectively. But nursing theory can be helpful in dealing with unexpected situations. Nursing theories consist of "concepts, definitions, models, propositions and are based on assumptions" of deductive and inductive logic (Nursing theories: An overview, 2012, Nursing Theories).

Dorothea E. Orem devoted her life to defining nursing and the nurse’s role in improving the patient’s overall health, which she coined the Self-Care Deficit Theory. Orem’s theory is quite a complex one, which can be simplified by identifying that it is three theories in one: self-care theory, self-care deficit theory and nursing systems theory. In 1959, as Orem first began the evolution of the Self-Care Deficit Theory, she defined the nurse’s role as another self. This nursing theory is the foundation for nursing as it actually defines the art of nursing, the actions that drive the nurse and the nurse’s provision of care through the nursing systems theory. To place in simplistic terms, Orem assumes that all humans desire to care for self. In the self-care theory, she states that individuals are meant to care for themselves and their basic needs by promoting life, health, development and well-being (Banfield, 2011). When something happens that does not allow the human to care for self, a deficit occurs. This deficit drives the need for specialized nursing care to restore the human’s health so they can resume self-care.

The purpose of this research paper is to tell the reader about Dorothea Orem’s self­care deficit theory of nursing. Orem was born in 1914 in Baltimore. In Washington, D.C., Orem received her diploma from Providence Hospital. She earned her Bachelor of Science in Nursing and Master of Science in Nursing from Catholic University of America. In 1976, Orem also earned an Honorary Doctor of Science degree. In 1971, Orem’s self­care deficit theory was published in N​ursing Concepts of Practice.​Orem worked as a private duty nurse, staff nurse, nurse educator and administrator, and nurse consultant.

The foundation for the nursing profession that provides principles to generate knowledge defines nursing theory. Successful nurses must be rooted in theory and understand the philosophy that drives their actions. Dorothea Orem is a nurse with a vision that studied human behavior, with the core concept of self-care in the patient/nurse relationship. This paper seeks to explain Dorothea Orem’s Theory including the contribution of her research as it relates to nursing development and paradigms of nursing.

Orem’s general theory of nursing (Appendix I,II) consists of three interrelated theories that are - the Theory of Self-care, the Self-care deficit theory and the theory of nursing systems. We would focus on the first two theories.