Dorothea Elizabeth Orem was born in Baltimore, Maryland in 1914. She was one of the foremost nursing theorists in America. Orem began her nursing career at Providence Hospital School of Nursing in Washington, where she completed the diploma of nursing in the early 1930. Orem did B.S.N.E in 1939 and later on she received M.S.N.E from Catholic University of America in 1946.
Development of theory:
In 1958, she starts working on self-care theory, while she works as a specialist in education. Her theory published in “Guides for Developing Curricula for the Education of Practical Nurses” in 1959. During this time, she continues work to develop her concept about nursing and self care. Orem’s concept of “Nursing Practice” was first published in 1971 and afterward in 1980, 1985, 1991, 1995, and last edition of her theory was published in 2001.
Orem has recognized her philosophical view on the base of action theory. Orem theory is based upon the philosophy that all patients want to do care for themselves because the purpose of her theory was to describe the nursing concern about the man’s needs for self-care action. She wants to provide health care delivery and management on a continue basis in order to endure life and health. In this way, better results of recovery from disease or injury would be seen. She focused on nursing which goal is overcoming human limitations (Berbelgia, 2002).
Nursing models are classified according to the discipline. It is clear that Orem used developmental model in her theory (Montgomery, 2004). Meleis (1998) viewed that “Orem’s theory could be categorized as an interaction model”. Orem’s self-care deficit nursing theory is widely used and accepted by nurses. This theory is one of the most frequently used theories in general nursing practice (Alligood and Marriner-Tomy 2002). (Fawcett 2000) acknowledged that this type of framework is widely recognized as a conceptual model.
Basically, each theory is presented as a set of assumptions and propositions. Orem described three theories in her model are (1) Self-care model (2) Theory of self-care (3) Theory of nursing system. She also described the main concepts in her model i.e. self-care, self-care agency, self-care demand, self-care deficit, nursing agency and nursing system.
These are the several key elements of metaparadigm: nursing, community, health service in the community, art, health, environment and person. In this metaparadigm, Orem observed that nursing is an art because a nurse uses new technology with skillful hands to provide health services to an individual, family and a group of people in the community. She explained that several physical, chemical, biological, and social environmental features have an impact on the health of the person (Horan, 2004). She described the person as a recipient of nursing care and also has the ability to perform constructive actions to meet self-care needs. Self-care needs also called the self-care requisites such as bathing, washing, brushing, combing etc.
The theory of Orem’s self-care based on the notions of self-care, self-care agency, self-care requisites and therapeutic self-care demand. Orem’s self-care deficit nursing theory is widely used and accepted by nurses and is one of the most frequently used theories in general nursing practice (Alligood and Marriner-Tomy 2002).
Orem described three support modalities of nursing systems for the assessment of patient’s dependency / reliance. (1) Wholly compensatory, in which patients totally depends on others for well-being. (2) Partial Compensatory, in which patient can meet some degree of self-care requisites by herself / himself but somehow needs a nurse to help for others. (3) Educative/Supportive, in this system, a patient can meet self-care requisites by himself/herself but needs help in decision-making, behavior control and getting hold of knowledge. Orem described the various roles of a nurse such as councilor, educator, teacher and advocator etc. She gave the concept of inductive and deductive thinking about nursing. Overall, theory of Orem is logically congruent.
Roy’s Adaptation Model
Background of the theorist:
Sister Callista Roy was born on 1939 in Los Angeles. In 1963, she received a B.A in nursing and M.S.N. from the University of California, in 1966. After earning her nursing degrees, Roy did Ph.D. in sociology in 1977 from the same University of California.
Development of theory:
While working in the direction of her master’s degree, Roy was impressed by adaptation as an appropriate conceptual framework for nursing. The Roy adaptation model (RAM) was first time published in 1970 with the title of, “Adaptation: A conceptual framework for nursing.”
Roy has published many books, chapters and periodical articles. The most recent modification and rewording book of the Roy Adaptation Model is published in 1999. After that Roy offered this book as a framework for nursing practice, research, and education (Marriner & Raile, 2002).
Adaptation: Roy defines the term adaptation is “the process and outcome whereby thinking and feeling persons as individuals or in groups, use conscious awareness and choice to create human and environmental integration” (Marriner & Raile, 2002). reference This model consists of four main concepts such as person, health, environment and nursing.
Person: Roy sees the person as “a biopsycosocial being in constant interaction with a changing environment” (Rambo, 1984).
Health: Roy states that health is the process of being and becoming an integrated and whole person (Andrew & Roy).
Environment: Roy sees the environment as “all conditions, circumstances and influences that surround and affect the development and behavior of the person” (Andrew & Roy, 1991).
Nursing: Roy states that nursing is “the promotion of adaptation in each of the four modes, thereby contributing to the person’s health, quality of life and dying with dignity” (Andrew & Roy).
Roy described the five philosophical assumptions in her model: (1) Persons have a mutual relationship with the world and God. (2) Human meaning is rooted in an omega point convergence with the universe. (3) God is ultimately revealed in the diversity of creation and is the common destiny of creation. (4) Persons use human creative abilities of awareness, enlightenment, and faith. (5) Persons are accountable for the processes of deriving, sustaining and transforming the universe (Roy & Andrews, 1999, p. 35).
Roy describes six steps in nursing process: (1) Assessment of behavior. (2) Assessment of stimuli. (3) Nursing diagnosis. (4) Goal setting. (5) Intervention. (6) Evaluation.
Basically Roy’s Model has three concepts which are (1) the human being (2) adaptation and (3) nursing. According to Roy’s model, the person has two major internal processing subsystems. Regulator: Physical health status of the family i.e. nutritional status, physical strength and availability of physical resources. Cognator: Educational level, knowledge base of family, source of decision making and ability to process etc. reference Theses subsystems are the mechanisms used by human beings to cope with stimuli from the internal and external environment. Three types of stimuli influence an individual’s ability to cope with environment.
Focal stimuli: that immediately confronts the individual in a particular situation (needs, level of adaptation and environment etc).
Contextual stimuli: That influences the situation.
Residual stimuli: consists of individual beliefs or attitudes that may influence the situation. reference
Q. Compare the main ideas of both models,
There are some similarities and differences in the two models. The similarities make it easier to understand the models. The differences are useful when one model is more appropriate for a given position than the other. To combine both models, the author used the four levels of the nursing process: assessment, planning, intervention and evaluation.
Similarities Main concepts
Orem and Roy used interpersonal technologies such as communicating, coordinating and establishing health status in their theories. Both theorists used regulatory technologies such as maintaining, promoting life processes, growth and development and psycho-physiologic modes of functioning. They both used the methods of helping with specific nursing actions such as acting, doing and guiding, supporting, teaching and providing developmental environment. Roy and Orem address the four basic concepts of nursing metaparadigm: health, person, nursing and environment (Marriner & Raile, 2002).
Both models are based on the philosophical assumptions, that the individual is the focus of nursing. Their personal experience is central to knowing and appreciating. In both models, there is also focus on a health-illness continuum model, by which a person could gain experience at a specified time signifying changing degrees of health or illness.
Contrast the main ideas of both models
Orem theory is a middle-range theory which can be testable and have appropriate overview to be scientifically remarkable. While, Roy’s model is too complex this generated from multiple middle-ranged theories.
Orem’s self-care deficit nursing theory (Orem 2001) is reported to be one of the most widely used theories in nursing practice (Berbiglia 2002). Moreover, Roy’s model is generalized to all settings in nursing practice, but is limited in scope because it focuses primarly on the patient according to information received by the nurse.
Orem used difficult language in nursing theory. We cannot communicate easily with other discipline but Roy used a common language.
Orem views the nursing performance as an effort to meet the self-care needs of individuals across the continuum of care. It means that whole care for one client or just education, maintenance and support for another client with intellectual disabilities (Raven 1988).
Orem mainly focuses on patients because she discusses about self-care deficit needs as well as nursing system. On the other hand, Roy mainly focuses on general view of a person.
Orem’s main stress on self-care needs. However, Roy main focus on environment.
Orem defines therapeutic relationships, because if there are good relations among client and nurse, in this way they build trust. While Roy main focus on adaptation abilities.
Roy’s adaptation model considers a patient’s conduct and coping mechanism but Orem’s main focus on physiological or survival needs (Aggleton & Chalmers, 1984; Tiedeman, 1983).
Come to a conclusion about which model (if any) is better suited to clinical practice.
Nursing is a profession in which nurse is responsible for care given to clients. Using a specific nursing model or a combination of model can benefit the nurse educator or nurse manager in
This paper has emphasized the overall involvement of the self-care model (Orem 2001) has made the nursing too universally and academically. From the learning disabilities point of view, the self-care model is really complex both in the language and the context’s structure. However, there is no clash that philosophically the model is very much aligned to modern philosophies relating to the care of people with intellectual disabilities. Anecdotally, it is beneficial in the clinical setting and has potential usages for the development of education curriculum (Marriner & Raile, 2002).
Better for clinical
Orem’s model and Roy’s model both are going as a parallel in nursing practice. when a nurse practitioner assess the patient’s needs, actually nurse follows Orem theory.
Reference book : Nursing theorists and Their work
(Marriner & Raile, 2002)
Marriner, A., & Raile, M. (2002). Nursing theorists and their work. (Fifth ed., p. 189). United States of America: Mosby.
Banfield, B. (2011). Environment a perspective of the self-care deficit nursing theory. Nursing Science Quarterly, 24(02), 96. Retrieved from http://nsq.sagepub.com/content/24/2/96.refs
(“Poetic elements,” 1998).
Poetic elements. (1998, 10 11). Retrieved from http://www.eng.fju.edu.tw/English_Literature/terms/denotation.htm
Horan, P. (2004). Learning disability practice. Philosophical parity paper: part 1, 07(04), Retrieved from http://learningdisabilitypractice.rcnpublishing.co.uk/archive/article-exploring-orems-self-care-model-in-learning-disability-nursing-practical-application-paper-part-2
Fawcett, J. (2001). The Nurse Theorists: 21st-Century Updates – Dorothea E. Orem. Nursing Science Quarterly, 14 (1), January, 34 – 38.