REVIEW ARTICLE
Comparison and Contrast of Orem's Self Care
Theory and Roy's Adaptation Model
1
Sahreen Malik Bhanji
Generic BScN, MSN (In Progress)*
ABSTRACT
Nursing theories are designed by nurses to define nursing and its essence. Clark (1986) states that
“Nurses who deliver patient care need to apply and evaluate the numerous theories and models proposed
as guides to nursing practice” (p. 127). The basic idea of these theories is to explain the profession of
nursing, its practices and an in depth understanding of its concepts. These theories then provide further
direction to nursing practice and education (Jones, 1978). The applicability and generalizability of the
theories may not be achieved in certain situations. It is however possible that a part of a theory matches a
situation but the other parts of it may not. Regardless of all, nursing theories are valuable and useful in
terms of guiding and conceptualizing nursing practice. Dorothy Orem’s Self-Care Deficit Theory and
Sister Callista Roy’s Adaptation Model are examples of such valuable theories.
KEY WORDS: Orem's Self Care Theory, Roy's Adaptation Model, Nursing Theory .
1
Sahreen Malik Bhanji
The Aga Khan University, School of Nursing and Midwifery.
Journal of Nursing 2012, Vol. 1 (01): 48-53
48
Sahreen Malik Bhanji
INTRODUCTION
Fawcett (2005) defined Metaparadigm as
“the global concepts that identify the
phenomenon of central interest to a discipline,
the global propositions that describe the
concepts, and the global propositions that state
the relations between or among the concepts”
(p. 4). The four major nursing metaparadigms
are person, nursing, health, and environment
which are considered as the core concepts of
nursing theories by many nursing theorists. This
paper is a comparison and contrast of Roy’s
Adaptation model with Orem’s theory of selfcare with the four meta-paradigms listed above
and concludes with the applicability of these
theories in clinical practice.
DISCUSSION
Essential Concepts Of Roy’s Adaptation
Model
Roy’s Adaptation model came into existence
in 1960 and is now used in educational,
research and practice settings. Roy's Adaptation
Model (RAM) is one of the most useful
conceptual frameworks that guides nursing
practice, directs research and influences
education (Shosha, Kalaldeh, & Mahmoud,
2012). Roy’s model is organized around
adaptive behaviors and a set of processes by
which a person adapts to environmental stimuli.
Bertalanffy’s (1968) general system theory and
Helson’s 1964 adaptation theory forms the
original basis of scientific assumptions
underlying Roy’s model of adaptation. Roy at the
th
25 anniversary of the model restated the
assumptions and redefined adaptation as
“process and outcome whereby thinking and
feeling persons, as individuals or in groups, use
conscious awareness and choice to create
human and environmental integration” (Roy and
Andrews, 1999 as cited in George, 2002, p.296).
In her revised edition, Roy focused on people’s
affinity with others, world and God. Roy and
Andrews (1999) state Roy’s postulates that
humans respond to stimuli, initiating a coping
process which has an effect on behavior,
leading to either adaptive or ineffective
Journal of Nursing 2012, Vol. 1 (01): 48-53
response. Roy describes Stimuli (focal,
contextual, and residual) as the input to the
adaptive system that forces the need for
change. Responses to these stimuli fall among
any of the four adaptive modes; psychological,
self-concept,
role
function,
and
interdependence. The infective response, if
produced imposes a threat to adaptation,
leading to a negative response. As a
consequence of this, Roy views the role of the
nurse as promoting patient adaptation. In
addition, the philosophical assumptions of Roy’s
model are based on humanism and veritivity and
cosmic unity. The five assumptions of Roy
include person’s mutual relationship with God,
inclusion of human as an innate part of the
universe, God’s destiny of creation and diversity,
use of human creative abilities, person’s
accountability for deriving, sustaining and
transforming the universe (Perrett, 2007).
Essential Concepts Of Orem’s Theory Of
Self-Care
According to Clark (1986), Orem’s theory of
self-care revolves around the principle of innate
ability of the individuals and their rights and
responsibilities to care for themselves. Self-care
is regarded as the behavior learned in childhood
and continued in adulthood. It consists of
activities initiated and performed to maintain life,
health and well-being. Orem’s concept of selfcare was first published in 1959. Her self-care
deficit theory is composed of three interrelated
theories. First is the theory of self-care. Second
is theory of self-care deficit. Third is theory of
nursing systems. These theories comprise of
one peripheral and six central concepts. These
concepts are discussed as follows.
Orem defined self-care as “performance or
practice of activities that individuals initiate and
perform on their own to maintain life, health and
wellbeing” (George, 2002, p. 127). It is to be
noted that effective self-care leads to the
integrity of human functioning and development.
Self-care agency is defined as the power or
ability to perform self-care. The factors known as
basic conditioning factors are those that affect
the ability of an individual to engage in self-care.
These
factors
include,
“age,
gender,
developmental stage, health state, socio-cultural
factors , health care system factors ,family
49
Comparison and Contrast of Orem's Self Care Theory and Roy's Adaptation Model
system factors, activities of living, environmental
factors and resource adequacy and availability”
(George, 2002, p. 127). Therapeutic self care
demand is defined as the wholeness of the care
measures necessary at a specific time or
duration of time for meeting an individual’s selfcare requisites through appropriate methods and
associated sets of operations and actions. Self
care requisites are the reasons or desire for self
care. The categories of which include universal
(basic necessities like air water ventilation etc.),
development (associated with human growth)
and health deviation (in case of illness or
disease) (Orem, 2001, p. 522 as cited in
George, 2002).
Orem’s basic element of general theory of
nursing is self-care deficit as it demarcates the
need for nursing. Self care- deficit occurs when
an individual is incapable or has limited ability to
provide effective self-care. Nursing care is
needed either to incorporate the new or complex
measures of self- care which require special
training or when an individual needs to recover
from a disease or injury (Orem, 2001 as cited in
George, 2002).The nurses may act in either of
these five ways to meet individual’s needs.
These include “acting for or doing for, guiding
and
directing,
providing
physical
or
psychological support, providing or maintaining
the environment and teaching” (Orem, 2001,
p.56 as cited in George, 2002, p. 129). Finally
Nursing agency is defined as a complex
property or attribute of nurses that enables them
to act, to know and to help others meet their
therapeutic self-care demands by implementing
or developing their own self-care agency
(George, 2002). The nursing systems may be
wholly compensatory, partly compensatory or
supportive educative based on the requirement
of patient’s needs.
has considered the human person in a “social
context” as a bio-psycho-social being (Hanna &
Roy, 2001, p. 9). Roy has also differentiated
Individual coping mechanism (regulator and
cognator) and Group coping mechanism
(stabilizer and innovator) (George, 2002). On the
other hand, Orem defines an individual as a
person struggling to have self-care needs met in
order to live and mature. She has
conceptualized a human being as a total being
with universal, developmental and health
deviation needs and capable of continuous selfcare. ('Dorothea Orem’s Self-care Theory',
2012). Orem distinguishes humans from other
living things in three ways. First, humans have
the ability to reflect upon themselves and their
environment. Second, humans can symbolize
their experience. Third, humans use their ideas
in thinking and communicating (George, 2002).
Both the theorists have described human or
person in terms of individuality and their struggle
towards achieving optimum health. While the
individual in Roy’s model fights for survival, the
individual in Orem also struggles for survival but
this individual may or may not be affected by
any stimuli. As a contrast, according to George
(2002) where Roy’s focus is not just the
individual’s adaptation but includes groups that
are interconnected, Orem’s initial focus is the
individual’s needs and survival followed by
family and group.
Environment
Roy’s Adaptation Model has provided us a
conceptual path to study human behavior
(George, 2002). According to Roy’s adaptation
model, an individual is described as an adaptive
system that is able to respond to different
internal and external environmental stimuli
whether positively or negatively. Moreover, Roy
Orem believes that the environment directly
influences the patient. She has emphasized on
individual’s basic needs of air, ventilation etc.
and prevention of hazards to maintain human
integrity and promote human functioning
(George, 2002). Roy believes that the person
constantly
interacts
with
the
changing
environment. According to Roy (2009) the
environment consists of stimuli including
conditions, circumstances, and influences
surrounding an individual, whether focal,
contextual, or residual. The person’s ability to
interact with the environment and respond to the
stimuli determines the adaptation level. This
sums up that Roy considers environment as all:
“conditions, circumstances, and influences
surrounding and affecting the development and
behavior of persons and groups with particular
Journal of Nursing 2012, Vol. 1 (01): 48-53
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Comparison and Contrast of Major Concepts
Person
Sahreen Malik Bhanji
consideration of mutuality of person and earth
resources, including focal, contextual and
residual stimuli” (' Roy’s Adaptation Model',
2012).
Both Orem and Roy are of the opinion that
environment plays an integral role in human
development and survival. Roy presents
environment as a stimuli that disrupts the
integrity of development but at the same time
she appreciates that adaptation is achieved
when human gets connected to the
environment. In contrast, where Roy considers
environment as a source of stimuli and that the
human system must maintain integrity in the
face of environmental stimuli, Clark (1986)
believes that Orem considers environment as
the medium for provision of basic human needs
for survival.
Nursing
Roy considers nursing as a key player to
help patients develop coping mechanism and
positive outcome from the constant stimuli
exposure. According to the Roy’s adaptation
model, nursing is the “science and practice that
expands adaptive abilities and enhances person
and environment transformation with the goal of
promoting adaptation for individuals and groups”
(Barone, Roy, & Frederickson, 2008, p. 354).
Roy’s goal of nursing for the patient is to achieve
adaptation leading to optimum health, wellbeing, and quality of life and death with dignity,
(Roy & Andrews, 1999). According to George
(2012) Roy’s focus in nursing assessment is
behavior of the individual. It includes scientific as
well as philosophical perspective for nursing
interactions with humans such as wholeness,
veritivity and cosmic openness. On the other
hand, Orem believes nursing as “actions
deliberately selected and performed by nurses
to help individuals or groups under their care to
maintain or change conditions in themselves or
their environments” ('Dorothea Orem’s Self-care
Theory', 2012). Taylor & Godfrey (1999) states
Orem’s idea that the nurses’ actions should be
directed towards protecting, preserving, or
promoting patients’ integrity as human beings,
promoting well-being, and fostering continuing
movement toward maturity. Moreover, Orem
also states that nursing is required when selfcare demands of a patient exceeds the self-care
Journal of Nursing 2012, Vol. 1 (01): 48-53
ability. Both complement each other to achieve
self-care through health promotion and
maintenance and emphasis on prevention of
hazards to maintain human integrity and
promote human functioning.
Apart from
prevention and promotion, Orem also focuses
on nursing as a supportive educative system
(George, 2002) which is directed towards
empowering individuals to compensate for the
deficit. In addition to this, Orem supports nurses
to involve family in patient care who is ultimately
responsible for the individual.
In view of the above statements, both the
theorists explain the role of a nurse as health
care promoter and one who facilitates patient to
either adapt to the situation or balance or cope
up with the self- care deficit. However, in
contrast, according to Orem, nursing care
focuses more on the areas and the degree to
which support is needed as opposed to Roy
whose focus is on behavior change (George
2002). Moreover, Orem’s focus is more towards
the physiological needs of the patient whereas
Roy caters to the physiological as well as
psychological adaptation.
Health
According to Barone, Roy, & Frederickson
(2008), Roy defines health as “a state and
process of being and becoming integrated and
whole that reflects person and environmental
mutuality and depends on adaptation” (p.
354).Roy views health as reflection of adaptation
on a health illness continuum. On the other
hand, Fawcett (2005) presents Orem’s idea of
health as a state of soundness or wholeness of
developed human structures, bodily and mental
functions. Health encompasses inseparable
“anatomic,
physiological,
psychological,
interpersonal and social aspects” (Orem 2001 as
cited in Fawcett, 2005, p. 239). Both Roy and
Orem view health as a state of well-being and
absence of disease. Roy encompasses health
as “the process of achieving adaptation with the
environmental stimuli, so, the person is
integrated and a whole” (Shosha, Kalaldeh, &
Mahmoud, 2012, p. 2). Roy also conceptualizes
health as simplistic and unrealistic as it excludes
the individuals with chronic or terminal illness,
who despite of their illness are struggling with
their life challenges (Roy, 2009). On the other
51
Comparison and Contrast of Orem's Self Care Theory and Roy's Adaptation Model
hand, Orem supports the world health
organization’s definition of health as a “state of
physical, mental and social well-being and not
merely the absence of disease or infirmity”
(Orem, 2001, p. 184 as cited in George, 2002).
Orem emphasizes on the integrity of physical,
psychological, mental and social aspects of
health and takes into account all the levels of
health
maintenance
including
primary,
secondary and tertiary prevention (George,
2002). However, Orem also believes that “adults
have the right to decide about the kinds of health
care they will accept and the responsibility to act
for themselves in matters of self-care and
health" (Orem 1995, p. 338 as cited in Taylor &
Godfrey, 1999, p. 203).
Applicability Of Orem’s And Roy’s Models In
Clinical Practice
Orem’s theory is derived from the clinical
base which provides a comprehensive base for
nursing practice. According to George (2002) it
can be utilized by professional nurses in the
areas
of
education,
clinical
practice
administration, research and nursing information
system and contributes significantly to the
development of nursing theories. While on the
other hand, Roy’s model is applicable and
important for nursing practice, nursing education
and development (Shosha, Kalaldeh, &
Mahmoud, 2012). Orem focuses on finding the
self-care deficit of the patient and providing the
necessary care to promote his or her well-being.
Whereas, Roy is concerned with the different
stimuli that forces adaptation in order to achieve
optimum health. Orem’s theory can be applied in
clinical practice by a novice nurse as well as
advanced practitioner which is one of the major
strength of this model (George, 2002).
Moreover, Orem in her theory has clearly
defined where nursing is needed; that is when
one’s ability to provide self-care to maintain
quality of life diminishes. However, George
(2002) states that nurse’s role in Roy’s
adaptation model is to identify the stimuli and
planning interventions to either change or
strengthen the adaptive response.
George, 2002, p. 148).This suggests the
applicability of Orem’s theory in acute care
setting as opposed to applicability of Roy’s
model more into the community setting. This is
because; the assessment of role function mode
and interdependence mode is time consuming
and so cannot be applied in acute care setting.
Orem has explicitly defined all the terms in her
theory which are comprehendible and easy to
understand. In contrast, according to Shosha,
Kalaldeh, and Mahmoud (2012) “Roy's
arrangement of concepts is logical, but the
clarity of some terms and concepts is
inadequate to reflect nursing disciplines” (p. 3).
This lack of clarity decreases the application of
Roy’s model in any specialized area of practice
(Shosha, Kalaldeh, & Mahmoud, 2012). Roy’s
model is broad in scope and can be used to
build or test nursing theories and is
generalizable to all approaches existing in
nursing practice. Moreover, according to
(George, 2002) Roy allows for incorporation of
spiritual aspects of human adaptive system,
which is often omitted from nursing assessment.
Whereas, according to George (2002) Orem has
acknowledged the individual’s capacity for
physical movement but does not acknowledge
the emotional or spiritual needs of the individual.
CONCLUSION
According to Knust & Quarn (1983) “some
practitioners have found Orem’s theory to be
more clinically applicable when more than one
system is used concurrently” (as cited in
It is evident that the application and evaluation
of nursing theories enhances nurse’s image,
assists in the continuous evaluation of nursing
knowledge and promotes the acceptance of
nursing profession as science based (Clark,
1980 as cited in Clark, 1986).According to
George(2002) Orem’s theory is well suited for all
those who need nursing care and those who
need adjustments in their development phase,
Roy’s model has implications for use across life
span ; for families groups etc. but portion of it
may be more useful for the nurse at different
times. In my judgment on the basis of above
mentioned arguments, Orem’s theory of selfcare is best suited for clinical practice. Orem’s
assessment approach according to Clark (1986)
is a multisource perspective in which Client,
family, other health-care professionals, and
health-care records are utilized, Self-care
abilities, self-care deficits, and self-care
requisites are identified and used to decide
Journal of Nursing 2012, Vol. 1 (01): 48-53
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Sahreen Malik Bhanji
which out of three nursing system is suited for
the individual. Moreover, Self-care abilities are
determined through several factors like age, sex,
developmental stage, health status, sociocultural orientation, and financial and other
resources. Furthermore, Orem's self-care deficit
nursing theory “gives substance to the purpose
of action and identifies aspects of the situation
that have relevance from a nursing perspective”
(Taylor & Godfrey, 1999, p. 203). This
comprehensiveness of Orem’s model provides
nurses an opportunity to apply it in clinical
practice without regard to being a novice or an
expert.
REFERENCES
Barone, S. H., Roy, C. L., Frederickson, K. C.
(2008). Instruments Used in Roy Adaptation
Model-Based Research: Review, Critique, and
Future Directions. Nursing Science Quarterly
21(4), 353-362.
Knust, S. J., Quarn, J. M. (2012). Integration Of
Self‐Care Theory With Rehabilitation Nursing.
Rehabilitation Nursing 8(4), 26-28
Perrett, S. E. (2007). Review of Roy Adaptation
Model-Based Qualitative Research. Nursing
Science Quarterly 20(4), 349-356
Roy, Sr. C. (2009). The Roy Adaptation Model
(3rd ed.). Upper Saddle River, NJ; Pearson.
Roy, C., Andrews, H. (1999). The Roy
Adaptation Model (2nd ed.). Stanford, CT:
Appleton and Lange.
Shosha, Kalaldeh,G.A., & Mahmoud Al. (2012).
A Critical Analysis of Using Roy's Adaptation
Model. Nursing Research. International
Journal of Academic Research 4(4), 26.
Taylor, S. G., & Godfrey, N. S. (1999). The
Ethics Of Orem's Theory. Nursing Science
Quarterly 12(3), 202-207.
Clark, M. D. (1986). Application of Orem's
Theory of Self-Care: A Case Study. Journal of
Community Health Nursing 3(3), 127-135.
Current Nursing. (2012). Dorothea Orem’s Selfcare
Theory.
Retrieved
fromhttp://currentnursing.com/nursing_theory/
self_care_deficit_theory.html
Current Nursing. (2012). Roy’s Adaptation
Model.
Retrieved
from
http://currentnursing.com/nursing_theory/Roy_
adaptation_model.html
Fawcett, J. (2005). Contemporary Nursing
Knowledge: Analysis And Evaluation Of
Nursing Models And Theories. Philadelphia:
FA Davis Company.
George, J. B. (2002). Nursing Theories: The
Base For Professional Nursing Practice (5th
ed.).Upper Saddle River, NJ: Prentice Hall.
Hanna, D. R., & Roy, C. (2001). Roy adaptation
model and perspectives on the family. Nursing
Science Quarterly 14(1), 10-13.
Jones, P. S. (1978). An Adaptation Model for
Nursing Practice. The American Journal of
Nursing 78(11), 1900-1906.
Journal of Nursing 2012, Vol. 1 (01): 48-53
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