Running Head: COMPARATIVE ANALYSIS OF NURSING THEORIES
Comparative Analysis of Peplau and Orem's Nursing Theories
Colette Jarvis
College of New Caledonia – Quesnel Campus
Nursing 102
Judy Crain
16 October 2014
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COMPARATIVE ANALYSIS OF NURSING THEORIES
The method of selecting a nursing model or theory that best supports communication in
nursing today falls upon a critical analysis of and comparison of existing theories. This paper
summarizes the major concepts and frameworks of Dorothea Orem's self-care model and
Hildegard Peplau's interpersonal theory, and then compares the two for similarities and
differences in their origins of theory development, the unique contributions and applications to
the nursing science. In this paper it will be clear that both theories apply to the nursing process;
however one module is best used and supported for communication in today's nursing field.
Dorothea E. Orem was a "nursing theorist who clarified the concept of 'self-care' and, in
doing so, influenced many developments in health service delivery" (Pearson, 2008, pg.1). The
self-care model was given by Dorothea Elizabeth Orem in 1971, a time that was filled with the
growth of consumer awareness and the inactive role of the patient was being questioned. The
focus of the model is self-care, self-care agency, self-care demand, self-care deficit, nursing
agency and nursing system. According to Janet Rosenbaum(1986), "she draws upon her
experience, as empirical generalizations, to conceptualize that people need nursing only under
certain conditions when they have self-care limitations" (pg.410). Orem's theory mainly focuses
on helping the patient until the patient is able to help themselves, and giving them the skills and
knowledge they need to be able to care for themselves.
Orem's theory is made up of 3 related theories; the theory of self-care, the theory of selfcare deficit and the theory of nursing systems. Self-care is activities that an individual practices,
performs, or initiates on his or her behalf in order to maintain life, health, and well being. As
stated by Anita L. Comley (1994), "'therapeutic self-care demand' is the total self-care action
needed to meet self-care requisites. When therapeutic self-care demand exceeds the individual's
self-care capabilities ('self-care agency'), deficits occur and nursing intervention is legitimized"
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COMPARATIVE ANALYSIS OF NURSING THEORIES
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(pg. 756). There are three categories of self-care requisites; universal, developmental and health
deviation. As stated by Shaista Rajani (2013), "according to Orem, there are various basic
conditioning factors (age, gender, developmental state, health state and health care system,
sociocultural orientation, and family system, patterns of living, environment and available
resources) that can influence the categories of self-care requisites" (pg. 238). The self-care deficit
occurs when patient or parents of the dependants are unable to meet self-care requisites.
Therefore help is needed and nursing care is used to help individuals enhance self-care abilities
needed for survival, well being and quality of life. Nursing Agency is a complex property or
attribute of people educated and trained as nurses that enables them to act, to know, and to help
others meet their therapeutic self-care demands by exercising or developing their own self-care
agency. Pursuant to Anita L. Comley (1994), "'nursing systems' act to provide direct or indirect
care to compensate for self-care activities the client cannot perform, and to support those selfcare efforts retained" (pg. 756).
Nursing theories have four concepts that are central to their metapardigm: person,
environment, health, and nursing. However, each nurse theorist defines these concepts
differently, depending on their fit into the theory. Somchit Hanucharurnkul (1989) states a
"person is described as an integrated whole, a unity functioning biologically, symbolically and
socially" (pg. 367). A person is viewed as having the capacity for self-knowledge and for
engagement in deliberate action. Environment seems to refer to the person's external
surroundings and consists of physical and psychosocial elements. Along with the person, the
environment makes an integrated system, given that it affects the patients health needs. Health
depends on the environment, therefore health definition varies. Health is defined as 'a state of
wholeness or integrity of human beings', and provision of self-care at a therapeutic level and on a
COMPARATIVE ANALYSIS OF NURSING THEORIES
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continuous basis is viewed as essential to the health of individuals. The Nursing goal is to
provide the patient or family with the necessities to meet the patients self-care needs. Nurses
must assess the person's ability to provide his/her own self care and the environmental context of
the person in order to overcome health-associated limitations.
Hildegard E. Peplau was one of the world's leading nurses and theorists, known to many
as the "Nurse of the Century". Her theoretical and clinical work led to the development of the
distinct speciality filed of psychiatric nursing. Peplau wrote extensively about anxiety and
introduced the "nurse-patient relationship" idea in 1952, at a time when patients did not actively
participate in their own care. Potter and Perry (2014) specified, "Peplau created a way of
thinking about nursing care that directed nurses toward preventing illness and maintaining
health" (pg. 61). Peplau's theory is very much based on working with the patient therapeutically
as well as interactively in order to develop a solid connection between the nurse and the patient.
Potter and Perry(2014) state, "Peplau, a psychiatric specialist, defined the core of nursing care as
the interpersonal relationship between the nurse and the patient" (pg.61).
The interpersonal focus of Peplau’s theory is placed predominately on the interpersonal
process and relationship. When applied correctly, the interpersonal process enhances the
significant differences between co-acting and interaction, as well as the ability to see a situation
from the patient’s point of view. As established, "to enhance the effectiveness of patient
interactions a nurse must use self-reflection to be aware of how their own behavior affects the
patient to promote positive interactions (Parker & Smith, 2010 pg.76). For that reason, there is a
greater emphasis on the relationship between a nurse and their patient.
Nursing is an interpersonal process because it involves interaction between two or more
individuals with a common goal. The attainment of goal is achieved through the use of a series of
COMPARATIVE ANALYSIS OF NURSING THEORIES
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steps following a series of pattern. The nurse and patient work together so both become mature
and knowledgeable in the process. There are four sequential phases in the interpersonal
relationship that occur throughout the duration of the nurse-client interaction. The orientation
phase is directed by the nurse and involves engaging the client in treatment, providing
explanations and information, and answering questions. The identification phase begins when the
client works interdependently with the nurse, expresses feelings, and begins to feel stronger. As
described by Anita L. Comley (1994), "the phase of exploitation is characterized by the client's
making use of interpersonal relationships with nurses to derive full value from what is offered,
while at the same time identifying and working toward new goals" (pg.757). Last but not least, in
the resolution phase, the client no longer needs professional services and gives up dependent
behavior, thus, ending the relationship.
Peplau conceptualized clear sets of nurse’s roles that can be used by each and every
nurse with their practice. It implies that a nurse’s duty is not just to care but the profession
encompasses every activity that may affect the care of the patient. The six main roles that may
emerge during the nurse-patient relationship are; the stranger, resource person, teacher, leader,
surrogate, and counsellor. The function of these roles is to promote growth and development in
both individuals involved.
While both Peplau and Orem's theories focus on the client learning how to grow and take
care of themselves, the theories have some differences in their origin of theory development.
Peplau was strongly influenced by the interpersonal development model of Harry Stack
Sullivan. Potter and Perry (2014) suggested that "building upon the ideas of psychoanalysis
Harry Stack Sullivan, Peplau depicted the practice of nursing as an interactive and therapeutic
relationship" (pg.61). Orem's theory of self-care developed as a result of working toward her
COMPARATIVE ANALYSIS OF NURSING THEORIES
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goal of improving the quality of nursing in general, in her state. Along with origin of theory
development, each nurse has contributed greatly to the unique science of nursing.
Both Peplau's Interpersonal Relations in Nursing theory, and Orem's Self-Care Deficit
theory have greatly contributed to the growth of nursing practice as it evolved and continues to
provide today. Peplau was one of the first nursing theorists to recognize how important the work
of a nurse was, rather than trying to define and delineate nursing. She firmly believed that
nursing should be based on an interpersonal process and the nurse-patient relationship. Through
her experiences of nearly 40 years of nursing practice and education, Dorothea Orem developed
a nursing model based on the concept of self-care deficit, which she published in 1971 in her
book 'Nursing Concepts of Practice'. Orem's theory doesn't need any type of relationship to be
formed, but to just simply care and teach.
Coleen Kumar (2007) summarised the applications of Orem's model when she stated
"[Orem's] Nursing theory and standardized nursing language enhance communication among
nurses and support a client’s ability to self-manage a chronic illness" (pg.103). Orem's theory is
applicable for nursing by the beginning practitioner as well as the advanced clinicians. The
phases of the therapeutic nurse-client are highly comparable to the nursing process making it
vastly applicable. Assessment coincides with the orientation phase; nursing diagnosis and
planning with the identification phase; implementation as to the exploitation phase; and lastly,
evaluation with the resolution phase.
A major strength of Peplau's theory of interpersonal relationships is that the phases
provide simplicity regarding the natural progression of the nurse-patient relationship. This
simplicity leads to adaptability in any nurse-patient interaction, thus providing generalizability.
A major strength of Orem’s theory is that the term self-care, nursing systems, and self-care
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deficit are easily understood by the beginning student nurse and can be explored in greater depth
as the nurse gains more knowledge and experience. A weakness of Peplau's theory is health
promotion and maintenance were less emphasized, and the theory cannot be used on a patient
who doesn’t have a felt need such as with withdrawn patients. A weakness of Orem's theory is
that her definition of health was confined in three static conditions which she refers to as a
“concrete nursing system,” which implies rigidity, and throughout her work there is limited
acknowledgement of the individual’s emotional needs.
In Conclusion, the Interpersonal Relations in Nursing Theory by Hildegard E. Peplau and
the Self-Care Deficit Theory by Dorothea Orem are both very useful theories within the nursing
practice. After comparing and contrasting these two theories, Peplau's theory best supports
communication in nursing today. Her achievements, including her revolutionary work in patientnurse relations, are valued by nurses around the world and her ideas have been incorporated into
virtually every nursing specialty and into the practices of other health care professionals.
Peplau's theory allows a strong bond to be formed between the nurse and the client, as well as
learning to take place amongst everyone involved in the nurse-client relationship. The
knowledge gained from the connection and the healing experience can better one's personal
nursing practice, and be applied to the next encountered situation. Orem and Peplau are two
nursing scholars who contributed significantly to the body of nursing knowledge. I believe both
theorists will continue to lead nurses in expanding nursing to become a truly scientific and
humanistic discipline.
COMPARATIVE ANALYSIS OF NURSING THEORIES
References
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