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 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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While the nursing theories approach the principle of care from different perspectives, the critical similarity between the two of them is attributed to the need to consider unique patient needs and build care on the basis of their requirements and environments. To compare and contrast the two nursing approaches, it is imperative to elaborate on their background, their philosophical underpinnings, assumptions and concepts, the value to nursing practice, parsimony, and application in practice with examples.
Background of the Theories
The self-care deficit nursing theory was developed in the course of forty years by Dorothea Elizabeth Orem. She was born in 1914 in Baltimore, Maryland, in the family of a homemaker and a construction worker. The theorist received a diploma from Providence Hospital School of Nursing in Washington as well as receive honorary doctoral degrees from Wesleyan University, Georgetown University, and Incarnate Word College. The self-care theory was first explained in Orem’s book Nursing: Concepts and Practice (first published in 1971). Orem’s contribution to the nursing theory is undisputable as she wanted to educate professionals about the need to ensure that patients can be effective ins self-care and practice activities that would be beneficial to improving their health. According to the theorist, “the condition that validates the existence of a requirement for nursing in an adult is the absence of the ability to maintain continuously that amount and quality of self-care which is therapeutic in sustaining life and death” (Sitzman & Eichelberger, 2015, p. 89). When speaking of care for children, Orem mentioned that parents’ inability to maintain the health of their children to the extent that is both high-quality and therapeutic. Therefore, the theory applies to a variety of healthcare contexts and diverse patients.
The Systems Model was created by Betty Newman, an Ohio native, 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. In 1947, Neuman graduated from Peoples Hospital School of Nursing in Akron. Between the years 1992 and 1998, the theorist was awarded two distinct honorary doctorates for the achievements in the nursing study. The systems model was first presented in the theorist’s work “Conceptual Models for Nursing Practice” in 1974. Betty Newman developed the Systems Model due to the need to enhance the education and professional experiences of nurses who deal with patients on a regular basis. The background of the model is linked to the practical perspective as it can be used as a dynamic roadmap employed by nurses around the world. The script of the model underlines the concept of individuality by considering the unique conditions and backgrounds.
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. The three support modalities of nurses’ roles that include complete or partial compensation and educative (supportive) purposes also contribute to the philosophical approach of the model, suggesting that no individual can independently resolve his or her health problems. Thus, the role of nurses in various support modalities is essential.
In regards to Neuman’s philosophy, the model’s underpinnings are directly related to de Chardin’s and Cornu’s approach to 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). Therefore, patients may deal with barriers and stressors differently, which refers to the particular philosophy of the nursing approach – each individual is unique; thus, ways of improving their well-being should also be distinguished.
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.
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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 relationships, 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.
Orem’s theory encourages patients to be independent in addressing their health. This distinguishes the approach from the Neuman systems model, which focuses on nurses as primary actors in alleviating the burden of disease. The self-care theory approach is recognized as a tool for education and practice in a variety of settings and as applied to a diverse set of patients and conditions. As self-care refers to the set of actions implemented deliberately and freely to maintain life and health, this aspect of the theoretical approach is what sets it apart from others.
In comparison to Dorothea Orem’s theory of self-care, Neuman underlines the role of various factors in shaping the approach to care. This distinction between the two approaches is essential to consider in the healthcare setting because the systems model is applied through evaluating the barriers that prevent patients from getting the desired level of care. Therefore, both theories underline the role of nurses in the process of healthcare. Similar to Orem’s approach, Neuman suggests that practitioners should consider the unique needs of their patients.
As applied to the discussion of nursing theories, the principle of parsimony, also referred to as the Occam’s razor suggests that an approach should offer the easiest and the most viable explanation for a particular phenomenon. Also, some may indicate that a good nursing theory shows both natural beauty and aesthetic quality. When considering parsimony as a principle applied to Dorothea Orem’s argument, it is essential to mention that the approach is logical and straightforward when explaining nursing care as a process. The suggestion that care can be enhanced when patients possess enough education and resources to manage their health with minimum supervision. Patients’ autonomy and independence are both accessible and viable components of care that make Orem’s theory exceedingly valuable within modern practice.
Neuman’s nursing theory also approaches the process of care with simplicity and viability because it is logical to suggest that there are stressors that would be preventing patients from reaching the desired health barriers. Such stressors may be associated with the financial situation of individuals or their emotional well-being since every patient is unique and has distinct sets of issues. It is also easy to understand that nurses should understand that in different patients, the resistance to various stressors and care barriers is on various levels. This means that each patient should be approached individually.
The range of examples applicable to the discussion of Dorothea Orem’s theory is greatly extended. Due to the simplicity and the broad application of the model in various contexts, there is a range of nursing situations in which the model can be applied. 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. A patient who has been diagnosed with an autoimmune condition requires a roadmap that he or she can use to keep health under control. Nurses assume educational and supportive roles in such cases to provide guidance and make sure that their patients have enough autonomy and independence when managing their health.
When applying the systems model in practice, nurses will evaluate barriers (factors) or stressors that prevent the patient from reaching desired health outcomes. For instance, the care for a patient with liver problems that have an alcohol addiction can be approached from the perspective of the systems model. Alcohol addiction is a complex healthcare challenge that exasperates through the influence of numerous stressors, such as psychological, socioeconomic, or personal issues. In such a case, a nurse should be prepared not only to assess the situation but also to address healthcare challenges as related to these stressors. For example, referring the patient to a psychotherapist is expected to resolve the underlying problems that contribute to alcohol addiction.
In summary, it should be mentioned that nursing theories are all targeted at enhancing the quality of care and improving patient outcomes. Both models have been created on the basis of nurses’ experiences as well as the holistic approach of care delivery. 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 their patients, Neuman suggested eliminating stress-related factors that prevent patients from reaching positive health outcomes.
An important takeaway from the comparison of theories is that each patient is unique and should be treated differently by healthcare providers. Instead of viewing patients as ‘combinations of illnesses or conditions,’ healthcare professionals should study the specific barriers that prevent the maintenance of positive health outcomes. When interacting with their patients, nurses should explore the personal history, socioeconomic status, mental health state, as well as the range of other stressors that limit well-being. Within a holistic health model, both Neuman’s and Orem’s nursing theories point to the importance of considering patients’ unique circumstances and needs when developing care strategies and educating them on positive self-care practices.
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.
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Orem, D. (2011). Nursing: Concepts of practice. Maryland Heights, MO: Mosby.
Sitzman, K., & Eichelberger, L. (2015). Understanding the work of nurse theorists: A creative beginning. Burlington, MA: Jones & Bartlett Learning.