Description: Orem's Grand Nursing Theory
Dorothea Orem formulated her theory of nursing in the 1950s after working in many clinical settings and achieving her Diploma, Bachelor’s
Degree in Nursing, and Master’s degree in Nursing Education. Orem's initial definition of nursing's concern included "man's need for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects" (Orem, 1959, p. 3). In 1971, Dorothea published Nursing: Concepts in Practice, and continued refining her theory as published in a later version in 2001. The defined purpose of Orem’s theory is that individuals strive to meet their care needs to maintain their optimal health and wellness through self-care. Orem makes assumptions about people and the degree of independence in their daily existence. She assumes individuals are willing and able to take care of themselves and their dependents, and that this self-care fulfills a need, allowing them to attain health and well-being. The degree of ability to independently care for the self is manifested in Orem’s concepts within the three “sub-theories” of ; Self-Care, Self-Care Deficit, and Nursing Systems. These concepts address the universal needs of people, the individuals’ ability to care for themselves or to have an agent deliver care while they are unable, the nurse giving just enough care to supplement the person’s deficit and only meet the needs that the person cannot meet themselves. The metaparadigm concepts of nursing have the structure of discrete, overlapping common areas or circles; Health, environment, person, and nursing are all interrelated to each other. For example, part of the person is defined by his/her health, mediated by environmental factors, and influenced by the nurse (Edney, Jaime, & Young, n.d.). Orem’s theories focus on the person, the “you and me”, and the “we “ of the community. The environment affects the person’s health needs – and can be modified to meet the person’s needs by the nurse. Health is the state of well-being reached by the person with or without the nurse intervening as much as the person’s self-care deficit requires.
Degree in Nursing, and Master’s degree in Nursing Education. Orem's initial definition of nursing's concern included "man's need for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects" (Orem, 1959, p. 3). In 1971, Dorothea published Nursing: Concepts in Practice, and continued refining her theory as published in a later version in 2001. The defined purpose of Orem’s theory is that individuals strive to meet their care needs to maintain their optimal health and wellness through self-care. Orem makes assumptions about people and the degree of independence in their daily existence. She assumes individuals are willing and able to take care of themselves and their dependents, and that this self-care fulfills a need, allowing them to attain health and well-being. The degree of ability to independently care for the self is manifested in Orem’s concepts within the three “sub-theories” of ; Self-Care, Self-Care Deficit, and Nursing Systems. These concepts address the universal needs of people, the individuals’ ability to care for themselves or to have an agent deliver care while they are unable, the nurse giving just enough care to supplement the person’s deficit and only meet the needs that the person cannot meet themselves. The metaparadigm concepts of nursing have the structure of discrete, overlapping common areas or circles; Health, environment, person, and nursing are all interrelated to each other. For example, part of the person is defined by his/her health, mediated by environmental factors, and influenced by the nurse (Edney, Jaime, & Young, n.d.). Orem’s theories focus on the person, the “you and me”, and the “we “ of the community. The environment affects the person’s health needs – and can be modified to meet the person’s needs by the nurse. Health is the state of well-being reached by the person with or without the nurse intervening as much as the person’s self-care deficit requires.
Description: Roy's Grand Nursing Theory
Roy’s adaptation model acknowledged three types of stimuli (conditions, circumstances, and influences) that affect a patient’s four modes of functioning. These modes of adaptation are physiologic needs, self-concept, role function and inter-dependence. She further defined how the nurse recognizes maladaptive behaviors and modifies stimuli to improve the patient’s adaptation (Nursing Theories, 2012).
The level of the theory is presented as a grand nursing theory based on and interactive process centering on the premise that health is an
assessment and that a continuum of health varies from top level wellness to sickness. Additionally, it can be classified as a deductive theory based on nursing practice (McEwen& Wills, 2011).
The origins of the theory entail Johnson’s nursing model which was the motivation for the advance of Roy’s adaptation model. Other concepts
incorporated by Roy were Helson’s adaptation theory, von Bertalanffy’s system model, Rapoport’s system definition, the stress and adaptation theories of Dohrenrend and Selye, and the coping model of Lazarus (McEwen, 2011).
The major concepts include adaptation and the metaparadigm concepts of person, environment, health and nursing (Roy, 2009). Adaptation is
“The process and outcome of individuals and groups who use conscious awareness, self-reflection and choice to create human and environmental integration” (McEwen et al., 2011). This is the goal of nursing. Person is representing an adaptive system defined as a whole included of
parts (McEwen et al., 2011). Environment includes stimuli such as surrounds, situations, and effects adjoining and affecting the progress and conduct of person and groups as adaptive arrangements (McEwen et al., 2011). Health exemplifies the outcome of adaptation pivotal of a state and a way of being and becoming unified and completes (McEwen et al., 2011). Nursing is the goal of which is to promote adaptation in the four adaptive modes (McEwen et al., 2011).
The theoretical propositions identified by Chitty & Black (2011) pertaining to the adaptation model come from the perspective of adaptation. When the demands of environmental stimuli are too high or the person’s adaptive mechanisms are too low, the person’s behavioral responses are ineffective for coping.
According the McEwen et al. (2011), philosophical assumptions are
inclusive of people having shared interactions with the world and God and people use human inspired talents of awareness, enlightenment and faith. In addition, McEwen et al., (2011) identified scientific assumptions encompassing consciousness and meaning creating the combination of the individual with its environment and the personality and consciousness of one’s environment is founded in intelligence and emotion. Lastly, McEwen et al. (2011), recognized cultural assumption which covers the effects of how this theory is articulated and cultural expressions with this theory may promote variations of the nursing assessment.
The usefulness of the adaptation model has been to provide scientific knowledge for practice and to organize nursing education part of which was the implementation as an element of the curricular background for numerous colleges of nursing. In addition, the model has been utilized in clinical assessment and intervention and serving as research variables for further study (Nursing Theories, 2012).
The level of the theory is presented as a grand nursing theory based on and interactive process centering on the premise that health is an
assessment and that a continuum of health varies from top level wellness to sickness. Additionally, it can be classified as a deductive theory based on nursing practice (McEwen& Wills, 2011).
The origins of the theory entail Johnson’s nursing model which was the motivation for the advance of Roy’s adaptation model. Other concepts
incorporated by Roy were Helson’s adaptation theory, von Bertalanffy’s system model, Rapoport’s system definition, the stress and adaptation theories of Dohrenrend and Selye, and the coping model of Lazarus (McEwen, 2011).
The major concepts include adaptation and the metaparadigm concepts of person, environment, health and nursing (Roy, 2009). Adaptation is
“The process and outcome of individuals and groups who use conscious awareness, self-reflection and choice to create human and environmental integration” (McEwen et al., 2011). This is the goal of nursing. Person is representing an adaptive system defined as a whole included of
parts (McEwen et al., 2011). Environment includes stimuli such as surrounds, situations, and effects adjoining and affecting the progress and conduct of person and groups as adaptive arrangements (McEwen et al., 2011). Health exemplifies the outcome of adaptation pivotal of a state and a way of being and becoming unified and completes (McEwen et al., 2011). Nursing is the goal of which is to promote adaptation in the four adaptive modes (McEwen et al., 2011).
The theoretical propositions identified by Chitty & Black (2011) pertaining to the adaptation model come from the perspective of adaptation. When the demands of environmental stimuli are too high or the person’s adaptive mechanisms are too low, the person’s behavioral responses are ineffective for coping.
According the McEwen et al. (2011), philosophical assumptions are
inclusive of people having shared interactions with the world and God and people use human inspired talents of awareness, enlightenment and faith. In addition, McEwen et al., (2011) identified scientific assumptions encompassing consciousness and meaning creating the combination of the individual with its environment and the personality and consciousness of one’s environment is founded in intelligence and emotion. Lastly, McEwen et al. (2011), recognized cultural assumption which covers the effects of how this theory is articulated and cultural expressions with this theory may promote variations of the nursing assessment.
The usefulness of the adaptation model has been to provide scientific knowledge for practice and to organize nursing education part of which was the implementation as an element of the curricular background for numerous colleges of nursing. In addition, the model has been utilized in clinical assessment and intervention and serving as research variables for further study (Nursing Theories, 2012).