Stefanie Mack Holly Blann Jillian Young Northern Illinois University Comparing Nursing Theories: Interpersonal Theory & Self-Care Deficit Theory Stefanie Mack Holly Blann Jillian Young Northern Illinois University

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… Person Enviroment Health Nursing

Hildegard Peplau & Dorothea Orem Dorthea Orem’s Self-care Model and Hildegard Peplau’s 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).

About Dorothea Orem Orem’s 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.

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).

Self-Care Deficit Theory Through Orem’s 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). Self-care Self-care deficit Nursing systems

Self-Care Deficit Theory Framework

Orem’s 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.

Orem’s Self-Care Deficit Theory Each of Orem’s 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 patient’s 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 patient’s 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).

Orem’s Self-Care Deficit Theory Orem’s five assumptions that explain her theory in full (Comley, 1994). Human beings require autonomy to themselves and their environments in order to function as humans. Human agency (the power to behave deliberately) is shown in the form of self-care and others in identifying needs and making necessary inputs. Mature human beings experience limitations for action in care of self and others are involved in the making of life sustaining and functioning humans. Human agencies portrayed in discovering, developing and transmitting to others by way to identify needs for and make inputs for others and self. 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.

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).

Peplau’s Interpersonal Theory There are four phases of the Interpersonal Theory which overlap and occur over a period of time. Orientation-patient expresses a need and patient/nurse collaborate to define the problem. Identification-patients react to the nurse who can meet their needs. Exploitation-patient makes use of the nursing services offered and orient towards new goals simultaneously. Skills are developed to reach goals. Resolution-the nurse/patient relationship comes to an end and goals are achieved through collaboration, both, on the patient and nurses part.

Peplau’s Interpersonal Theory Nurses assume roles in the phases as follows… Teacher Resource Counselor Leader Technical expert Surrogate

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. Needs Frustration Conflict Anxiety There are two major assumptions in Peplau’s theory (Comley, 1994). The type of person the nurse is makes a difference to each patient experience who is experiencing illness or conflict. Trying to foster a personality development towards maturity in a patient requires use of principles and methods to use every day in interpersonal problems.

Comparing and Contrasting… Orem’s 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. Orem’s theory is very holistic. Peplau's theory does not approach the concept of holism, as in-depth, as Orem’s model. Likely due to the fact that Peplau’s work pre-dated the adoption of the holistic approach.

Comparing and Contrasting… Both theorists viewed health as a dynamic, progressive, and developing process. Peplau’s 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.

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.

Are the Theories Useful? Orem’s theory has been used more widely and in a greater variety of nursing settings than Peplau’s theory (Comley, 1994). It is understood easily by bedside nurses. Some consider Orem’s 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. Orem’s self-care model has been the focus of many nursing programs and widely integrated into nursing curriculums. Orem’s impetus to develop her theory stemmed from her time working to develop standardized nursing education. Peplau’s 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). Her theory has been a building block, in which, many other interpersonal theorists have built their theories on. However, because her theory is limited to the patients that can be interacted with, it is not considered highly generalizable.

Both Theories & An Aging Population… Is the process of aging supported by the Interpersonal & Self-Care Deficit Theory? 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). While neither theory specifically discusses gerontological care, some aspects of development are incorporated into both theorists’ views. 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).

In Conclusion In nursing, a patient’s 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 patient’s needs. We believe that nurse-led, self-care equilibrium can be achieved which is the best support we can offer to any patient.

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.