DOROTHEA OREMS SELF CARE THEORY

There are instances wherein patients are encouraged to bring out the best in them despite
being ill for a period of time. This is very particular in rehabilitation settings, in which patients
are entitled to be more independent after being cared for by physicians and nurses. Through
these, the Self-Care Nursing Theory or the Orem Model of Nursing was developed
by Dorothea Orem between 1959 and 2001. It is considered a grand nursing theory, which means
the theory covers a broad scope with general concepts that can be applied to all instances of
nursing.
Orems theory defined Nursing as The act of assisting others in the provision and
management of self-care to maintain or improve human functioning at home level of
effectiveness. It focuses on each individuals ability to perform self-care, defined as the
practice of activities that individuals initiate and perform on their own behalf in maintaining
life, health, and well-being.

Metaparadigm Concepts as Defined in Orems Theory

Person

Men, women, and children cared for either singly or as social units, and
are the material object of nurses and others who provide direct care.

Environment

Environment has physical, chemical and biological features. It includes

the family, culture and community.

Health

Health is being structurally and functionally whole or sound. Also,

health is a state that encompasses both the health of individuals and of
groups, and human health is the ability to reflect on ones self, to
symbolize experience, and to communicate with others.

Nursing

Nursing is as art through which the practitioner of nursing gives

specialized assistance to persons with disabilities which makes more than
ordinary assistance necessary to meet needs for self-care. The nurse also
intelligently participates in the medical care the individual receives from
the physician.

MADELEINE LEININGERS TRANSCULTURAL NURSING THEORY

Leininger (1995) defined transcultural nursing as both an are of study and an area of nursing
practice. The main features of the Cultural Diversity and Universality Theory focus on
comparative cultural care (caring) vales, beliefs, and practices for either individuals or groups
of people with similar or different cultures. The goal of transcultural nursing is the provision of
nursing care that is culture specific in order to either promote health or to assist individuals face
sickness or death in culturally meaningful ways. Consistent with the focus of her theory,
Leininger defined the metaparadigm concepts of nursing in a manner that causes the nurse to
specifically consider culture in the delivery of competent, nursing care.

According to Leininger (2001), three modalities guide nursing judgments, decisions, and
actions to provide culturally congruent care that is beneficial, satisfying, and meaningful to the
persons the nurses serves. These three modes include cultural care preservation, cultural care
accommodation, and cultural care restructuring. The nurse using the Leiningers theory plans and
make decisions with clients with respect to these three modes of action All three care modalities
require coparticipation of the nurse and client working together to identify, plan, implement, and
evaluate nursing with respect to the cultural congruence of the care.

Metaparadigm Concepts as Defined in Leiningers Theory

Person

Human being, family, group, community or institution.

Environment

Totality of an event, situation, or experience that gives meaning to

human expressions, interpretations, and social interactions in

physical,

ecological, sociopolitical, and/or cultural settings.

Health

A state of well-being that is culturally defined, valued, and practiced.

Nursing

Activities directed toward assisting, supporting, or enabling with needs

in ways that are congruent with the cultural values, beliefs, and

lifeways

of the recipient of care.

HILDEGARD PEPLAUS INTERPERSONAL RELATIONSHIPS THEORY

According to Gonzalo (2011), Peplaus Theory states that nursing is therapeutic because
it is a healing art, assisting an individual who is sick or in need of health care. Nursing can be
viewed as an interpersonal process because it involves interaction between two or more
individuals with a common goal. In nursing, this common goal provides the incentive for the
therapeutic process in which the nurse and patient respect each other as individuals, both of them
learning and growing as a result of the interaction. An individual learns when she or he selects
stimuli in the environment and then reacts to these stimuli.

According to George (2014), the need for a partnership between the nurse and the client
is very substantial in nursing practice. This definitely helps nurses and healthcare providers
develop more therapeutic interventions in the clinical setting. Through these, Hildegard E.
Peplau developed her Interpersonal Relations Theory in 1952, mainly influence by Henry
Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.

Metaparadigm Concepts as Defined in Peplaus Theory

Person

Organism that strives in its own way to reduce tension generated by

needs.

Environment

Does not directly address society/environment, she does encourage the

nurse to consider the patients culture and moves when the patient adjusts
to hospital routine.

Health

A word symbol that implies forward movement of personality and other

ongoing human processes in the direction of creative, constructive,
productive, personal, and community living.

Nursing

Significant, therapeutic, interpersonal process. She defines it as a

human relationship between an individual who is sick, or in need of
health services, and a nurse specially educated to recognize and to respond
to the need for help.

PATRICIA BENNERS NOVICE TO EXPERT THEORY

Patricia Benner introduced the concept that expert nurses develop skills and
understanding of patient care over time through a sound educational base as well as a multitude
of experiences. She also proposed that one could gain knowledge and skills (knowing how)
without ever learning the theory (knowing that). In Lay mans terms, implementation of a
concept is different from understanding a concept. She categorized nursing experience in five
levels such as the novice, advanced beginner, competent, proficient, and expert.

Novice is one who is unfamiliar with a situation and needs a complete guidance.
Advanced Beginner has relevant knowledge of the situation, but are still guided by the rules.
These individuals still have a hard time grasping the whole picture. Competent has the ability to
plan appropriately and discern which aspects are relevant and irrelevant. Also has the ability to
alter rules as the situation warrants them. Proficient their skills have matured exponentially, and
has the ability to ascertain information from subtle changes. This individual has begun the
implementation of intuition to assist the skill set. Expert has the ability to fully utilize intuition
without the need for reliance on contemplating alternatives for diagnosis and treatment.

Metaparadigm Concepts as Defined in Benners Theory

Person

Self-interpreting being, that is, the person does not come into the world
predefined but gets defined in the course of living a life. A person also has
an effortless and non-reflective understanding of the self in the world. The
person is viewed as a participant in common meanings.

Environment

Instead of using the term environment, Benner used the term situation,
because it suggests a social environment with social definition and
meaning.

Health

Defined health as what can be assessed, while well-being is the human

experience of health or wholeness.

Nursing

Described nursing as an enabling condition of connection and concern

which shows a high level of emotional involvement in the nurse-client
relationship.

MARTHA ROGERS SCIENCE OF UNITARY HUMAN BEINGS

Martha Rogers Theory of Unitary Human Beings views nursing as both a science and an
art. The uniqueness of nursing, like any other science, is in the phenomenon central to its focus.
The purpose of nurses is to promote health and well-being for all persons wherever they are. The
development of Rogers' abstract system was strongly influenced by an early grounding in arts, as
well as a background in science and interest in space. The science of unitary human beings began
as a synthesis of ideas and facts.
According to Rogers, the Science of Unitary Human Beings contains two dimensions: the
science of nursing, which is the knowledge specific to the field of nursing that comes from
scientific research; and the art of nursing, which involves using the science of nursing creatively
to help better the life of the patient.

Metaparadigm Concepts as Defined in Martha Rogers Theory

Person

An irreducible, indivisible, pan dimensional energy field identified by

pattern and manifesting characteristics that are specific to the whole and
cannot be predicted from the parts".

Environment

Rogers defined the environment as being inconstant interaction with the

person, or human field pattern manifestation. Furthermore, it has been
defined very simply as everything that is not of the human field pattern
manifestation, It has been defined as: an irreducible, pan dimensional
energy field identified by pattern and manifesting characteristics different
from those of the parts. Each environment field is specific to its given
human field. Both change continuously and creatively.

Health

"Health is participation in the life process by choosing and executing

behaviors that lead to the optimum fulfillment of persons potential and
that "health is a rhythmic patterning of energy that is mutually enhancing
and expresses full life potential".

Nursing

"As a science, designates the term nursing as a noun and signifies that
nursing is an organized body of abstract knowledge. Traditionally, the
term has been used as a verb. Nursing, the science-noun, indicates that
there is a body of knowledge specific to nursing."
FLORENCE NIGHTINGALES ENVIRONMENTAL THEORY

The Environmental Theory by Florence Nightingale defined Nursing as the act of

utilizing the environment of the patient to assist him in his recovery. It involves the nurses
initiative to configure environmental settings appropriate for the gradual restoration of the
patients health, and that external factors associated with the patients surroundings affect life or
biologic and physiologic processes, and his development.

The Environmental Theory of Nursing is a patient-care theory. It focuses in the alteration

of the patients environment in order to affect change in his or her health. Caring for the patient is
of more importance rather than the nursing process, the relationship between patient and nurse,
or the individual nurse.
In this way, the model must be adapted to fit the needs of individual patients. The
environmental factors affect different patients unique to their situations and illnesses, and the
nurse must address these factors on a case-by-case basis in order to make sure the factors are
altered in a way that best cares for an individual patient and his or her needs.
Metaparadigm Concepts of Florence Nightingales Environmental Theory
Person

Is a multidimensional being, that includes biological, psychosocial, social

and spiritual components.

Environment

An environment that promotes health allows the patient to retain their

energy, or vital powers for use towards self-healing

Health

This is consistent with our perception of health today, where one does not
have to be disease free to be healthy but to maximize their potential to be
in a healthy state.

Nursing

By helping to control environmental influences, nurses can aid in the

maintenance of health of their patients. Only then is it possible to see the
true ailments of a disease, and not just the effects the absence of essentials

RELATIONSHIP OF THE THEORIES TO NURSING PHILOSOPHY

It is the philosophy underlying our practice that brings to life our desire to be nurses.
Philosophy is important because it is 'a natural extension of our interest in the truth about
nursing. What we think is true about nursing is what brings most of us to our practice each day. It
encompasses our values and ethical principles. It also helps clarify for us who we are and who
our patients are, and what we are doing and why we are doing it. Its purpose is to help us practice
wisely and well.
There is a direct correlation between nursing theories and a nurse's individual philosophy
of nursing. Nurses will likely find themselves using certain nursing theories or models
frequently, which are often influenced by their practice field. The following are examples:
Orems theory is relatively simple, but generalizable to apply to a wide variety of
patients. This theory signifies that all patients want to care for themselves, and they are able to
recover more quickly and holistically by performing their own self-care as much as theyre able.
This theory is particularly used in rehabilitation and primary care or other settings in which
patients are encouraged to be independent.

On the other hand, the practice of Leiningers transcultural nursing addresses the cultural
dynamics that influence the nurseclient relationship. Nurses who understand and value the
practice of culturally competent care are able to effect positive changes in healthcare practices
for clients of designated cultures. Culturally competent nursing care can only occur when client
beliefs and values are thoughtfully and skillfully incorporated into nursing care plans.

Further, in Peplaus Interpersonal theory, it entails that a nurses duty is not just to care
but the profession also incorporates every activity that may affect the clients health. However,
the idea of a nurse-client cooperation is found narrow with those individuals who are unfit and
powerless in conversing, specifically those who are unconscious and paralyzed.
Furthermore, Patricia Benners Theory conceptualizes that expert nurses develop skills
and understanding of patient care over time through a sound educational base as well as a
multitude of experiences. It is believed that in order to deliver the quality care that a nurse can
give, one can develop and learn skills through time.
Moreover, to prepare nurses to practice Rogers' Science of Unitary Human Being model,
the focus of nursing curriculum should be the transmission of the body of knowledge, teaching
and practicing therapeutic touch, and conducting regular in-service education. Emphasis should
be on developing self-awareness as a part of the patient's environmental energy field, as well as
the dynamic role of the nurse pattern manifestation on the patient. There should also be an
emphasis on laboratory study in a variety of settings, and the importance of the use of media in
education.
Additionally, nursing has never been simple, nor is serving as a patient advocate.
However, nursing has embraced advocacy as a professional construct. Advocacy includes a
complex interaction between nurses, patients, professional colleagues, and the public.
Nightingales experiences in nursing demonstrated to her the value of advocating for nurses and
patients. She embraced an egalitarian value system and utilized leadership techniques to create
change in nursing. Nightingale demonstrated that advocacy is what gives power to the caring
nurse. In this way, the model must be adapted to fit the needs of individual patients. The
environmental factors affect different patients unique to their situations and illnesses, and the
nurse must address these factors on a case-by-case basis in order to make sure the factors are
altered in a way that best cares for an individual patient and his or her needs.

Given these points nursing theories and philosophies of nursing are related because they
directly affect each other. A nurse's philosophy of nursing will determine what types of models or
theories he or she uses, just as the nursing theories used will help develop his or her personal
philosophy. In some ways, nursing theories and philosophies are the same in that both provide a
way for nurses to approach their daily practice and their individual patients that provides the best
care for them.

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Taylor, S.G. (2006). Dorothea E. Orem: Self-care deficit theory of

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Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development &

Progress 3rd ed. Philadelphia, Lippincott.

K. Masters, Role Development in Professional Nursing Practice

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K. Sitzman and L.W. Eichelberger, Understanding The Work of Nurse

Theorists 2nd Edition, Copyright 2011, ISBN 978-0-7637-7816-3

Gonzalo (2011) Hildegard E. Peplau Theory of Interpersonal

Relations

http://nursingtheories.weebly.com/hildegard-e-peplau.html

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