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Comparison of Nursing Theories: Orem’s Self-Care Theory and the Neuman’s System Model


Nursing theories have been developed for describing, predicting, and explaining the process of nursing for those in the field. They offer a foundation for the nursing practice as well as help to generate further knowledge to indicate the direction in which the discipline should be developed in the future. Comparing and contrasting existing nursing theories can contribute to the enhanced understanding of approaches associated with caring for patients. The current paper will focus on comparing two nursing theories, Orem’s Self-Care Theory and the Neuman’s system model. Dorothea Orem’s self-care deficit theory is based on the premise that human beings can adapt to their environments and thus become independent during their rehabilitation and the management of chronic conditions. Neuman’s systems model represents a nursing theory that is based on the relationship between patients and stress. The central principle of the model is associated with energy resources, such as average temperature, organ strength, response patterns, which are surrounded by several resistance lines. These lines represent internal factors that help patients cope with stressors.

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Background of the Theories

The self-care deficit nursing theory was developed in the course of forty years by Dorothea Elizabeth Orem. The theorist received a diploma Providence Hospital School of Nursing in Washington as well as receive honorary doctoral degrees from Wesleyan University, Georgetown University, and Incarnate Word College. The Systems Model was created by Betty Newman, who obtained a bachelor’s degree in nursing and a master’s in Mental Health Public health consultation, and a Ph. D. in clinical psychology from UCLA. Both models were created on the basis of nurses’ experiences as well as the holistic approach of care delivery.

Philosophical Underpinnings of Theories

Dorothea Orem’s approach to care is grounded on the philosophy that parents wish to care for themselves, which means that they can recover holistically when being dedicated to their own health interventions (Orem, 2001). Thus, it can be suggested that Orem’s theory portrays the idea that nursing is an extraordinary ability to care for another person and to guide them toward achieving autonomy and effectiveness in caring for themselves. This corresponds to the philosophy of care to achieve the optimal level of health. In regards to Neuman’s philosophy, the model’s underpinnings are directly related to deChardin’s and Cornu’s approach on the wholeness in systems (Lowry, 2012). The concept of “wholism” is used for referencing both philosophical and biological concepts “implying relationships and processes arising from wholeness, dynamic freedom, and creativity in adjusting to stressors in the internal and external environments” (Neuman & Fawcett, 2011, p. 10).

Major Assumptions, Concepts, and Relationships

According to Orem, patients are expected to be self-reliant and responsible for addressing their own care as well as others in their family who need it. A person’s knowledge of potential problems in their health is necessary for promoting effective behaviors of self-care. Another critical assumption of the theory is that self-care and dependent care represent practices learned from a socio-cultural context. Within Orem’s theory, nursing is considered an art, service, and technology. Health is described as a state in which something is structurally and functionally whole or sound. Environment represents a combination of enthronement factors, elements, and conditions. A nursing problem refers to the deficit in universal, developmental, and other health-related conditions. Thus, self-care is needed as a practice and activities initiated for performing on individuals’ own behalf for maintaining, life, and general well-being.

Neuman’s system model assumes that each patient is unique in his or her characteristics and factors within a basic structure of responses. Several known, unknown, and universal stressors can influence the well-being of clients. Each of the stressors had an influence on the degree to which a person is protected by the Line of Defense (LOD). When such a protective mechanism is not available to maintain the well-being of patients, it is expected that a stressor would break through the desired state of system stability. Primary prevention is associated with the applied client assessment and a subsequent intervention targeted at the reduction of possible risk factors.

Clinical Applications and the Value to Nursing Science

When applied in practice, Orem’s self-care theory can be used to assess patient conditions, identify their needs, ensure effective communication, solve the identified problems, and evaluate the extent to which the process was effective (Drevenhorn, 2018). Based on the needs of patients, a nurse can assume compensatory, partially compensatory, or supportive and educative roles. For example, if a patient’s health is not significantly compromised, but preventive methods are necessary, Orem’s theory suggests that a nurse should support and educate instead of assuming a compensatory care model.

The application of Neuman’s System Model in practice implies the discovery of stressors that influence the poor well-being of patients. These include lifestyle choices and patterns, the quality of social connections and relationship, socioeconomic status, and many others. Based on the framework of stressors that influence the well-being of patients, a nurse recommends a course of action that will improve the general well-being. A nurse is responsible for considering patients’ psycho-social, physical, developmental, spiritual, and interpersonal factors when eliminating the adverse impact of stress factors on patients (Admadi & Sadeghi, 2017). This means that the model offers a comprehensive look at the range of stressors that should be addressed during treatment.

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Comparison, Parsimony, and Examples

While Orem’s theory encourages patients to be independent in addressing their health, Neuman underlines the role of various factors in shaping the approach to care. Both theories acknowledge the importance of nurses as integral parts of the care process, which means that the two can be used in conjunction to achieve optimal care quality. For example, when providing care to a patient with an autoimmune condition, a nurse will use the self-care theory to educate patients on the most effective management strategies. The system model will also be used in this case to evaluate barriers (factors) that prevent the patient from reaching desired health outcomes. In regards to parsimony, neither of the models require the use of too much money and resources because they are concerned with greater adherence to interventions.


In summary, it should be mentioned that nursing theories are all targeted at enhancing the quality of care and improving patient outcomes. The exploration of Orem’s theory and Neuman’s model showed that approaches to nursing practice could be different; however, the aim is the same. The two theories can be used in combination with each other to approach the practice of nursing from a multi-dimensional perspective. While Orem encouraged nurses to promote autonomy and self-care among thei patients, Neuman suggested eliminating stress-related factors that prevent patients from reaching positive health outcomes.


Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal – Experimental, Translational and Clinical, 3(3), 205.

Drevenhorn E. (2018). A Proposed middle-range theory of nursing in hypertension care. International Journal of Hypertension, 2018, 2858253.

Lowry, L. (2012). A qualitative descriptive study of spirituality guided by the Neuman systems model. Nursing Science Quarterly, 25(4), 356-361.

Neuman, B., & Fawcett, J. (2011). The Neuman systems model (5th ed.). Upper Saddle River, NJ: Pearson Education.

Orem, D. (2011). Nursing: Concepts of practice. Maryland Heights, MO: Mosby.

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