Compare and Contrast: Orem’s Theory of Selfcare Deficit and Roy’s Model of Adaptation
The nursing profession of the 21st century is a product of various stages of development and changes, in culture and civilization at large as well as in particular domains of society, such as health care, science and technology. It has moved into its maturity and the forces which have influenced its development are organized mechanisms of nursing role and spirit of determination. The nurse performs functions that promote and maintain health as well as assist in adapting to achieve optimal health.
According to Orem, “nursing is a practical endeavor, but it is practical endeavor engaged in by persons who have specialized theoretic nursing knowledge with developed capabilities to put this knowledge to work in concrete situations of nursing practice.”(as cited in Alligood&Tomey, 2010, p. 265).
In this paper I will deliberate on central concepts of two key models i.e. Self – Care Deficit Theory (SCDT) and Adaptation Model (RAM) contributed by highly philosophical and intellectual nursing theorists; Dorothea. E. Orem and Sister Callista Roy.
Central theme of both the models:
While reviewing literature I came up with this fact that the central notion of Orem’s theory is self-care and that of Roy’s model is adaptation. Orem believes that “self-care is a human regulatory function that is a deliberate action to supply or ensure the supply of necessary materials needed for continued life, growth and development and maintenance of human integrity” (McEwen& Wills, 2011, p.134), where as a closer look at adaptation shows that it is, “a constantly changing point made up of focal, contextual and residual stimuli, which represents the person’s own standard of the range of stimuli to which one can respond with ordinary adaptive responses” (Roy, as cited in Alligood&Tomey, 2010, p. 338).
An individual’s adaptation level can be described on three levels as integrated, compensatory and compromised. Though the central thought of both the theories is different but on profound analysis it is my contention that both the theories at some point are integrated with each other. For example care is the fundamental concept which is central to human and without which we cannot achieve our goals likewise nursing care is the ultimate and supreme belief without which nursing profession cannot proceed further.
A very important point to ponder is what are certain circumstances which points that a person needs nursing care? A nurse provides care to a dependent person who is unable to carryout self-care needed to maintain healthful functioning, life and wellbeing and assists in such a way that the environmental stimuli a person is receiving from within and outer sphere can result in achieving acceptance and equilibrium. Both the philosophies have distinctive thinking, I will critique on person, health and environment components of both the models through comparison and contrast approach. This will be followed by analysis on models under clarity, simplicity and generality heads.
Orem’s SCDT focuses on the notion of the individual. To her patient and the family are the social units. “Human individuals is defined as men, women and children cared for either singly or as social units and are material object for nurses and others who provide direct care.” (McEwen& Wills, 2011, p.132). She visualizes individual person as a whole and stresses that knowledge level, cultural values and beliefs, readiness and acceptance to learn, are certain factors that influences self-care practices of person and family.
Human interact among themselves and their environment to remain alive and to function. She also emphasizes that “families are the groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members”(McEwen& Wills, 2011, p.133). This component can be better understood with an example.
A middle aged Afghani woman diagnosed with breast malignancy undergoes mastectomy. The physical and emotional trauma will not only impact her physiological and psychological mechanisms but her integrated functioning will also be affected, and if her powers are impaired either permanently or temporarily then actions are required to meet her dependent care needs. Health deviation self – care requisites exists for a persons who are suffering from some disorders and disabilities.
Alligood and Tomey (2010) states that “The characteristics of health deviation extending over time determine the types of care demands that individual experience as they live with the effects of pathological conditions” ( p. 270). Assessment gives a clue that what are her requirement, knowledge level and self-care values and practices. Self-care values and beliefs fluctuate from culture to culture. Here nursing system comes into actions which are “series and sequence of deliberate practical actions of nurses performed at times in coordination with the actions of their patients to know and meet components of patient’s therapeutic self-care demands.”(Alligood&Tomey, 2010, p. 271).
Nurses provide universal care, psychological support, guiding, teaching and directing in order to overcome deficits. On the contrary, RAM explains human as an individual on the basis of systems theory. Systems theory brings equilibrium in the individual in order to achieve healthy existence. If some changes strikes human body, then compensatory mechanisms activates to achieve homeostasis. A proper balance between external and internal environment helps in adapting the body towards normality.
Continuing with the same example, patient is surrounded with stressors from self – image, family, society. Nurse facilitates patient by assessing her behavior, their thinking and feeling capacities and intervening according to individual so that they adjust effectively to the changes in the environment.
Health and illness are the unavoidable dimensions of a person life and nurse plays a vital role in health promotion. It is my assertion that perceptions of both the theorist converge on the component of health. Both Orem and Roy considers health as a state of being structurally and functionally whole or sound. I will justify my assertion based on the facts given by Roy and Orem on the element of health.
RAM emphasizes that “health is a state and a process of being and becoming integrated and a whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment” (Alligood&Tomey, 2010 , p. 342) and Orem believes that health is being structurally and functionally whole or sound. McEwen and Wills (2011), mentions that “health is a state that encompasses both the health of the individuals and of group and human health is the ability to reflect on one self, to symbolize experience and to communicate with others”(p.132).
The main crux of adaptation is change and vital for survival. Change requires energy and sudden and rapid change requires more energy than a person has it. When the extent of change exceeds the person capacity to adapt results in maladaptation. However, successful adaptation will strengthen self-integrity and lead to the higher level of functioning.
Health follows when a patient or family copes with the change and when coping mechanisms are ineffective, illness result. Health does not mean freedom from expected disease, death and stressors but it is the capability of a person facing challenges in an effective way.
In Orem’s terminology, nursing agency comes into action. Nursing system comprise of action designed by nurses for patients who are dependent for care ultimately moving a person towards health, growth, survival and high integrity. In the above mentioned example of a woman with mastectomy, to her health could be either soundness of physical and mental functioning or acceptance of loss of body image or might be something else. Nurses not only provide physical and psychological support but also teach remedies and develop ways to lead a life style after a significant loss.
Roy says that adaptation occurs in four modes: physiological – physical adaptive mode, self – concept mode, role function and interdependence mode. In physiological – physical mode various physical and chemical process are involved for the human functioning and coping system. Human interact with environment to meet basic needs of oxygenation, nutrition, elimination, activity and rest and protection. In self-concept mode, it is the composite of beliefs or feelings that an individual holds about him or herself at any given time. (Alligood&Tomey, 2010, p. 344).
A persons self – concept include personal self and physical self. Physical self involves the sensation of body image and personal self involves moral, ethical and spiritual beliefs one holds. In the given example, her self – concept would be disturbed as a feministic part of the body is removed. In role function mode are the primary, secondary and tertiary roles an individual performs in society.
Here this woman living in a matriarchal society has to wear various hats in different scenarios. Sometimes she has to be a wife, a daughter, mother and daughter in law. Each role has a certain set of expectations, such as healthy sexual relations being in a wife role are expected but are disturbed due to pathological reasons. The last mode is the interdependence mode which is to give and receive love, value and respect, nurturing, time, and commitment.
An important component of this mode are significant others and social support system like spouse, child, friends and God.The inter relationship of these four modes assists in physiological, psychological and social integrity and move person towards adjustment.
Florence Nightingale, beliefs that environment was a major determinant of the health of persons. Today we are beginning to realize the role of environmental factors such as stress and pollution on health which the pioneer emphasized some hundred years ago. Nurses should be aware of the physical, social and human made environment and how these interact with persons to produce wellness.
Many of the nursing theorists agree that persons constantly interact and change within an ever changing environment (Lindberg, Hunter &Kruszewski, 1990, p.16). Environment has physical and biological features and includes family culture as well as community. On one hand Roy defines environment as, According to Roy and Andrew (1991), “it is the changing environment that stimulates the person to make adaptive responses”. (as cited in Alligood&Tomey, 2010, p. 343).
Any positive or negative factors act as an input to the person for maintaining equilibrium. Environmental change demands increase in energy and sudden change requires more energy to adapt to the situation. When the change exceeds the individual capability to cope, lead to illnesses where as if the person has strong coping systems individual’s integrity will be strengthened leading to functional capacity.
In contrast, Orem have not used adaptation in her model but rather focused on individual capacity for self-care. A person needs nursing care in order to cope with the effects of disease or injury. This piece can be understood with the same example of women with Breast cancer. When the woman is diagnosed of having cancer it’s not only the person but significant others connected with the patient are also psychologically and emotionally affected. It’s the fear of minimal survival and prognosis factor, cultural and body image after mastectomy engulfs entire family and person in stress.
If her coping mechanism and support system are strong enough will lead to adaptation but if the stress overcomes patient’s coping ability will end up in maladaptation. Nurses assist with deficits and keep on modifying their action and as the health state becomes favorable nursing needs are reformed and eventually eliminated.
Both Orem’s theory and RAM are clear and transparent in its own end. The concepts mentioned in SCDT are focused on patient as a whole which are consistent with twenty first century. She has elaborated the substantial structure of the concept of self-care, self-care deficit and nursing system in a way that is unique, intellectually sound and applicable in nursing care setup in today’s world. In addition to it, she has given diagrammatic representation of all three principle concepts of the theory in a clear, simple and concise format which is understandable for the readers.
Similarly, Roy has tried to convince her readers and clearly defined four adaptive modes in relation to the environment. Her model is holistic that any change in the environment leads to adaptive response as a whole. Her focus is on person and environment and both affect each other.
Orem’s theory has limited terms and its explanations, therefore easy to absorb and digest. She has tried to show the relationship between three constituent theories through simple diagram. The depth with in the concept is intelligently described by the theorist to comprehend nursing practice discipline. On the contrary, RAM is complex as its origin is psycho – physics in nature and extended to social and behavioral sciences. It has multiple concepts and sub concepts making the model more dense and complex. Though the model is complex but one good thing about the model is it has the capacity to modify with the complexities of twenty first century of person and environment.
Although SCDT and RAM are generalizable in all the settings of nursing practice but Orem’s address to nurse and nursing care for the dependent makes it superior to Roy’s model. Roy’s focus on person and environment adaptation of patient limits the scope but this can serve as foundation for other theories to build on.
Best model for clinical practice:
After understanding both the models I consider that Orem’s theory of self-care deficit fits best for clinical scenario. I have following reasons to support my stand. First, it is simple and applicable in all settings and main emphasis is on patient and nursing care practices. It also involves families and communities. Second, her work is related to practical science paving a way for the development of nursing science.
Third, her conceptualizations are internationally recognized and widely used in nursing education, practice and research evidenced by magnitude of publications leading to the development of knowledge related to SCDT. Being a cardiac ICU nurse I now realize that while taking care of the patient I was unintentionally following Orem’s conceptual model of self-care deficit.
There is no dispute that Orem and Roy are philosophical and intellectually sound models. When nursing practice is supported by theoretical structure, it serves as an organizing framework for a body of knowledge. Nurses utilize knowledge and skills to provide meaningful individualized care and facilitate them to adjust to changed environment.
Each of us is involved in assisting client to change using various strategies because adaptation is vital to health and growth of person. In order to improve the quality of care I recommend that we should move away from medically based models and start utilizing nursing theoretical models, only in this way excellence can become reality.
Alligood, M.R., &Tomey, A.M. (2010). Nursing Theorist and their work (7th ed.). USA:
Lindberg, J.B., Hunter, M.L., Kruszewski, A.Z. (1990). Introduction to nursing concepts, Issues& opportunities. USA: J.B. Lippincott company.
Mc Even, M., Wills, E.M. (2011). Theoretical basis for Nursing (3rd ed.). China: Wolter Kluwer,
Lippincott Williams &Wilkins.
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