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Comparing Nursing Theories:

Interpersonal Theory & Self-Care Deficit Theory


Stefanie Mack
Holly Blann
Jillian Young

Northern Illinois University

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Introduction
Nursing theorists have guided and influenced the profession of
nursing through their development of theories.

In the past century, nursing has developed as its own entity,


separate of medicine. This has developed nursing practice,
research, and education.

4 Metaparadigms are important when discussing nursing


theory
I. Person
II. Enviroment
III. Health
IV. Nursing 2
Hildegard Peplau & Dorothea Orem

Dorthea Orems Self-care Model and Hildegard Peplaus


Interpersonal Theory can be compared and contrasted in
their origins of theory (development), meanings, logical
adequacy, usefulness and testability (Comley, 1994).

The basis of both models is autonomy for the patient. It


is translated into a lot of related terms: privacy, liberty,
self-governance, and moral independence (Moser &
Houtepen, 2007).

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About Dorothea Orem

Orems theory of self-care is used by many


nurses. According to the theory, self-care is
a human function where people must act for
themselves deliberately (Moser & Houtepen,
2007).

Deliberation means that a person chooses


their action based on foreseen results, they
investigate the situation and reflect and
judge the situation based on the choices they
make.

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Dorothea Orem

Orem emphasizes the concept of self-care and she highlights that self-care is
affected by the presence or absence of power based on the patient.

Self-care agency is related to development of self-direction and demonstrating


the (phase 1) investigative and decision making phase and (phase 2) the self-
care action (Moser & Houtepen, 2007).

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Self-Care Deficit Theory

Through Orems 40 years of nursing practice and education,


she published her concept of self-care deficit in a book titled,
Nursing Concepts of Practice.(Comley, 1994)

This theory is divided into three sub theories which state that
self-care and care of dependents is learned and actually
regulates human structural integrity as well as development and
functioning (Comley, 1994).
I. Self-care
II. Self-care deficit
III. Nursing systems

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Self-Care Deficit Theory Framework

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Orems Self-Care Deficit Theory
According to Orem, self-care behavior is continuous in adult life and
performed on ones behalf to maintain life, health and wellbeing. Orem
divides these needs into three groups (Comley, 1994).

1.) Universal self-care requisites- addresses physiological needs and


functioning.

Included are air, water, food, elimination, activity, rest, social


interaction, and promotion of human functioning.

2.) Developmental self-care requisites- This relates to factors that affect


development through the life cycle. Conditions that support growth and
development are promoted.

3.) Health deviation of self-care requisites- addresses the increased


demands on a person who is experiencing illness or disease.

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Orems Self-Care Deficit Theory

Each of Orems sub-categories can be a point of


alteration for an individual. As that alteration in
functioning occurs, nursing interventions become
necessary and beneficial.

When family members of a patient take over self-care


duties of a patient that they can handle themselves, the
patients autonomy and emotions can be pulled in
negative directions. When patients are given the
autonomy to carry out their own self-care actions, they
exercise their own self-care agency.

Nursing care has a pivotal role in fostering a patients


autonomy by supporting this self-care agency by
providing info and resources to enable patients to make
their own choices which result in the resuming of self-
care actions (Moser & Houtepen, 2007).

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Orems Self-Care Deficit Theory

Orems five assumptions that explain her theory in


full (Comley, 1994).
I. Human beings require autonomy to themselves and their environments in order to
function as humans.

II. Human agency (the power to behave deliberately) is shown in the form of self-care
and others in identifying needs and making necessary inputs.

III. Mature human beings experience limitations for action in care of self and others are
involved in the making of life sustaining and functioning humans.

IV. Human agencies portrayed in discovering, developing and transmitting to others by


way to identify needs for and make inputs for others and self.

V. Groups of human beings with structured relationships allocate responsibility and


cluster tasks to provide care to group members who experience privations for
making required deliberate input to self and others.
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About Hildegard Peplau
Peplau puts the nurse patient relationship as the center of
her theory of interpersonal relationships (Moser &
Houtepen, 2007).

She wrote Interpersonal Relations in Nursing in 1952.

According to Peplau, the nurse/patient relationship is a


continuum:-it involves two people with completely different
goals and interests, however the other end involves both
parties working together to solve the same health difficulty
and there is a common understanding (Comley, 1994).

Her theory was derived from theorists: Maslow, Sullivan,


Miller, Symonds and reflected psychoanalytic theory as well
as different facets of personality development (Comley,
1994).

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Peplaus Interpersonal Theory

There are four phases of the Interpersonal Theory


which overlap and occur over a period of time.
I. Orientation-patient expresses a need and patient/nurse
collaborate to define the problem.

II. Identification-patients react to the nurse who can meet their


needs.

III. Exploitation-patient makes use of the nursing services offered


and orient towards new goals simultaneously. Skills are
developed to reach goals.

IV. Resolution-the nurse/patient relationship comes to an end and


goals are achieved through collaboration, both, on the patient
and nurses part. 12
Peplaus Interpersonal Theory

Nurses assume roles in the phases as follows


Teacher

Resource

Counselor

Leader

Technical expert

Surrogate

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Interpersonal Theory
Psychobiological experiences, per Peplau, provide energy that is
transformed into action (Comley, 1994). These experiences bring forth
destructive or constructive responses in the nurse/patient relationship.
I. Needs
II. Frustration
III. Conflict
IV. Anxiety

There are two major assumptions in Peplaus theory (Comley,


1994).
1. The type of person the nurse is makes a difference to each patient experience
who is experiencing illness or conflict.
2. Trying to foster a personality development towards maturity in a patient
requires use of principles and methods to use every day in interpersonal
problems.
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Comparing and Contrasting
Orems approach was inductive. She pulled from her
experiences and conceptualized that people need nursing only
under certain conditions (Comley, 1994).
Peplau wanted to build a theory based on already established
knowledge and integrated theory from behavioral sciences and
psychoanalysis in a deductive process.
Both nurses used nursing metaparadigms to structure their
theory model.
Orems theory is very holistic. Peplau's theory does not
approach the concept of holism, as in-depth, as Orems model.
Likely due to the fact that Peplaus work pre-dated the adoption
of the holistic approach.

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Comparing and Contrasting
Both theorists viewed health as a dynamic, progressive,
and developing process.

Peplaus concept of health is reflective of the level of the


maturing personality, however, does not address
specifically the biological and physical components of
health (Comley, 1994).

Both Orem and Peplau have very vague definitions of the


environmental variable in their theories. Orem defines it
in a purely developmental context, whereas, Peplau limits
hers to interpersonal perspective.

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Comparing and Contrasting
Both theorists make efforts to define the concept of nursing (Comley,
1994).

Orem was careful to capture the type of care that is unique to nursing
as opposed to other health care disciplines.

Orem describes the main focus of nursing as the promotion of self-


care of the individual and only supplements that care when necessary.

Peplau emphasizes the nurse-patient relationship is a compensatory


nursing system between the two (nurse/patient)she describes her
concept of nursing as more of a mutual benefit and growth
relationship.

Orem does not require the client to be interactive for the nursing care
to occur. In contrast, Peplau believes that if a patient is too ill to
participate in the mutual nurse/patient relationship then the nurse
takes on the authoritative role. The nurse may develop an
interpersonal relationship with the patients loved ones and family.

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Are the Theories Useful?
Orems theory has been used more widely and in a greater variety of
nursing settings than Peplaus theory (Comley, 1994). It is understood
easily by bedside nurses.
Some consider Orems work to be more useful in nursing practice
rather than in research. Also, the theory has an illness oriented
structure that may not be as applicable in a well-patient setting.
Orems self-care model has been the focus of many nursing programs
and widely integrated into nursing curriculums.
Orems impetus to develop her theory stemmed from her
time working to develop standardized nursing education.
Peplaus theory of psychodynamic nursing helped to develop the basis
and foundation of psychiatric nursing. It is a strong, solid theory still
in use today (Comley, 1994).
I. Her theory has been a building block, in which, many other
interpersonal theorists have built their theories on.
II. However, because her theory is limited to the patients that can be
interacted with, it is not considered highly generalizable.
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Both Theories & An Aging
Population
Is the process of aging supported by the Interpersonal &
Self-Care Deficit Theory?

I. Both Orem and Peplau give descriptions of aging


within their theories. This is interesting because this is
primarily the population nurses are caring for in this
day and age (Wadensten & Carlsson, 2003).

II. While neither theory specifically discusses


gerontological care, some aspects of development are
incorporated into both theorists views.

III. The theories show developmental process throughout


life, however, do not show specific developmental
needs of older adults, nor have there been any insights
on the way either theorist feels about the aging process
in comparison to their theory (Wadenstn & Carlsson,
2003).
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In Conclusion
In nursing, a patients autonomy must be cared for just as much as any
other part of the patient.

Nurses can be used as tools to support autonomy in most patient


situations.

Individual patients and nursing situations are difficult to peg into one
specific theory model. We believe that using a combination of
theories, as well as ethical behavior in practice, can help us to cater to
each individual patients needs. We believe that nurse-led, self-care
equilibrium can be achieved which is the best support we can offer to
any patient.

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References

Alvine Moser, R. H. (2007). Patient autonomy in nurse-led shared care: a review of theoretical and
empirical literature. Journal of Advanced Nursing, 357-365.

Anita L Comley MSN, R. O. (1994). A comparative analysis of Orem's self-care model and Peplau's
interpersonal theory. Journal of Advanced Nursing, 755-760.

Carlsson, B. W. (2003). Nursing theory views on how to support the process of aging. Journal of
Advanced Nursing, 118-124.

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