Marudhar and Bashir (2019) define theories as interconnected ideas, models, definitions, prepositions, and conceptions drawn from assumptions that provide insights into a phenomenon, often naturally predictive and explanatory. Nursing theories are derived through inductive and deductive reasoning. Both forms of reasoning have proven critical in nursing as the field thrives on effective decision-making and efficiency. Nursing continues to benefit from a school of theories proposed as early as the mid-19th century. Theorists such as Dorothea Orem and Madeleine Leininger are among nursing theorists whose theoretical models continue to provide a blueprint for nursing practice. Orem developed the self-care Deficit Nursing theory between 1959 and 2001. The Theory interconnects nursing concepts creating a unique way of viewing a phenomenon.
Orem’s Theory places significant emphasis on self-care, which, as seen in her explorative work, metamorphoses into at least six care paradigms. These paradigms can be collated as self-care, self-care requisite, universal self-care requisite, health deviation self-care requisite, developmental self-care requisite, and therapeutic self-care demand. Orem’s Theory rests on the foundation that humans must continually communicate and interact with their environment to function properly and be alive. Leininger developed the culture care diversity Universality in the 1950s. The Theory was eventually published in 1995. The Theory provides insights into the importance of understanding, knowing, and appreciating the different cultures embedded in nursing that significantly impact nursing practice and health outcomes. Leininger’s model deconstructs health-illness care practices, values, and beliefs which have provided a viable foundation for basing nursing practices. This paper explores the two heroes to understand their continued significance in nursing practice.
The Self-Care Deficit Nursing Theory
Background of the Theory
Orem began developing the self-care deficit nursing theory in 1959. Orem’s motive to develop the Theory came from her strong foundation in the nursing field. Orem and some colleagues produced a practical nursing curriculum for the Department of Health, Education, and Welfare. Orem worked on the Theory for four decades spanning between 1959 and 2001. Over the four decades, Orem collaborated with other stakeholders to develop the Theory. She worked alongside colleagues, students, scholars, administrators, educators, practitioners, and researchers. The Theory initially focused on identifying the uniqueness and similarities with other fields. In searching for distinctive nursing knowledge, Orem sought an answer to a question on nursing domains and boundaries. Orem reflected upon her nursing experience and established gaps in self-care which she noted that the nursing practice could significantly benefit from by bridging the gaps.
The philosophical underpinning of the Theory
Orem’s Theory pays significant attention to the human-to-human connection that keeps people alive. The Theory is underpinned by the belief that people must continually communicate and interact with their environment for proper function and life (McEwen & Wills, 2022). The Theory focuses on the person as the agent. This distinct focus on the relationship between humans justifies the central theme of self-care around which the Theory revolves. Orem denied drawing influence from other philosophers while developing the Theory. Much of her work on this Theory is rooted in her experience in nursing, having worked in several departments of nursing (Tanaka, 2022). Orem’s experience in the nursing field helped her identify the gap, which she termed self-care limitations, which she believed nurses could benefit from.
Assumptions, Concepts, and Relationships
The self-care deficit nursing theory is an umbrella for at least theories. Orem’s Theory is one of the most complex theories partly because it taps into more theories. The Theory amalgamates self-care deficit, self-care, and nursing systems. The assumptions, concepts, and relationships are drawn from the interconnection established among these three models.
The Theory rests on the assumption that humans are distinct individuals. Therefore, each person has a unique way of thinking or feeling. As distinct individuals, Orem assumed that each person should be self-reliant to care for themselves and the people around them, such as families who need the care (Petiprin, 2023). Another underlying assumption I that nursing is an action-oriented practice that involves two or more people interacting. The most fundamental component of primary care and ill-health prevention is successfully meeting the developmental self-care and universal self-care requisites. Individuals have to know about health problems to acquire and promote self-care behaviors. The Theory assumes that dependent care and self-care are learned sociocultural behaviors.
Self-care: Orem defined the concept as a deliberate action that ensures the material needed to support life continuation, maintenance of human dignity, and growth and development are in place (Abyu, 2020).
Universal self-care requisites: Defined as the life processes that maintain human functioning integrity and structure. These include processes or activities such as taking in air, sufficient food, and water (Abyu, 2020).
Self-care requisites: The set of actions individuals perform to control their environment, development, and functioning (Abyu, 2020).
Health deviation self-care requisites: The processes people need to occur for continued growth and development (Abyu, 2020).
Therapeutic self-care demand: Defined as the therapeutic action nurses take to help dependent clients meet their self-care needs (Abyu, 2020).
Self-care deficit nursing theory is a needs-based theory that acknowledges the unique needs of different patients. The Theory is founded on the underlying premise that humans must continually communicate and interact with their surroundings to function and live (McEwen & Wills, 2022). Continuous interaction is needed to help nurses, and people take deliberate action to improve individuals’ health.
The self-care deficit nursing theory has been a basic foundation for the nursing curriculum in most nursing schools. Patient-centered care borrows largely from Orem’s Theory. Patient-centered care is based on the fundamental principle that are fundamental partners and not just clients in the treatment process (Araki, 2019). Patients must be fully involved in healthcare delivery to allow healthcare providers to identify their unique needs, values, and underlying beliefs and integrate these factors into care delivery to optimize outcomes. Orem emphasizes the concept of deliberate action taken by patients to care for themselves. Patients recover faster when they exert some degree of independence over their self-care.
Diabetes type 2 is a disease whose management digs into individuals’ self-care capacity. A decade ago, Sürücü and Kızılcı (2012) examined the application of self-care deficit theory in the management of type 2 diabetes. The authors established that the Theory is widely applied in diabetes self-management education to sensitize patients of the value of self-care. The field of Doctor of Nursing Practice continues to integrate Theory into the curriculum.
Orem’s Theory underwent development for four decades. The Theory has undergone several revisions but remains one of the most complex theories (Gligor & Domnariu, 2020; McEwen & Wills, 2022). Orem’s Theory is an umbrella theory housing three theories. Within the Theory lie the nursing system, self-care deficit, and self-care Theory. Each of these theories comes with its propositions and presuppositions.
Cultural Care Diversity and Universality Theory
Background of the Theory
Madeleine Leininger developed the cultural care diversity and Universality theory in the 1950s. Leininger’s interest in the Theory was inspired by the lack of care diversity in children’s mental health care (McFarland & `Wehbe-Alamah, 2015). While working as a specialist in a child guidance mental health center, she noted a large diversity of children who presented with varying cultural backgrounds and needs. However, there were significant challenges in addressing the needs of these children, and most children experienced non-care. Research in the field was also lacking; hence, the importance of integrating culture in nursing and care was largely ignored. The mental health ideas and psychoanalytic models at the time did not address the needs of children. Leininger started pursuing a Ph.D. in anthropology to equip herself with the knowledge of culture, which she lacked at the time of her discovery. Leininger’s goal was to acquire adequate knowledge to develop a model to integrate culture and care into nursing practice, as these two important aspects were missing in the field. After extensive research, she eventually envisioned and developed the cultural care and diversity universality theory.
Leininger developed the Theory out of an identified gap and need that was not addressed. When discovering the culture and care gaps in nursing, the theorist did not possess significant knowledge of culture that could have been instantly useful in developing the Theory. Leininger first opted to pursue a Ph.D. in anthropology to expand her knowledge of culture and diversity. The Theory had its foundation in Leininger’s extensive experience in nursing, heightened intellectual and religious interests, and anthropological knowledge Leininger acquired from her comprehensive education.
Assumptions, Concepts, and Relationships
Leininger derived the Theory’s assumptions from its predictions and tenets. These assumptions made it easy to replicate and use the Theory’s ideas in western and non-western cultures. The Theory assumes that care is the most fundamental, distinct, dominant, and unifying factor that should be the focus of nursing. Care is important for curing individuals. Scientific and humanistic care is needed to ensure individuals’ well-being, growth, survival, and good health. Universalities exist in cultural care despite variations in cultural care expressions, structural forms, processes, patterns, and meanings. Cultural care involves synthesizing two central constructs that guide researchers into accounting for, explaining, and discovering care expressions, well-being, and existing human conditions. Culturally therapeutic and compatible care is attained when cultural beliefs, values, patterns, and expressions are known and utilized meaningfully, sensitively, and properly to serve diversity.
Care: Leininger conceived care as assistive, supportive, and enabling ideas and experiences directed toward other people. Care denotes the practices, attitudes, and actions expressed toward others to facilitate their healing (McFarland & `Wehbe-Alamah, 2015).
Culture Care Universality: Culture care universality refers to the similar or shared culture care phenomenal human features such as lifestyles, patterns, meanings, and symbols that guide caregivers into providing supportive, sensitive, facilitative, and assistive care that enhances health outcomes for people (McFarland & `Wehbe-Alamah, 2015).
Culture: Leininger assessed culture as a major construct that does not act as an adjective or a modifier to care. Rather, she conceptualized culture as an interlinked and properly synthesized phenomenon that forms a foundation for interconnected ideas (McFarland & `Wehbe-Alamah, 2015).
Care diversity: Leininger conceptualized care diversity as the variabilities or differences among people attached to their cultural care patterns, meanings, lifestyles, symbols, beliefs, and values that guide nurses through providing good care to people from different cultures.
Culture and care are deeply embedded phenomena crucial to achieving optimal healthcare outcomes. Diversity exists within cultures. Nurses and other healthcare providers must understand the basic foundation of different patients’ cultural backgrounds to understand their diversity. Cultural differences influence care outcomes and must be incorporated to care delivery to meet the specific patient’s needs. Cultural similarities or universalities exist even though these similarities may not always be obvious. For instance, every culture treats people as humans needing some form of humanistic type of care. Care diversity occurs when nurses direct care to individuals based on their specific needs. These needs are unique to each client and may be connected to their values and beliefs.
Clinical Application, Usefulness, and Value to Extending nursing testability
Cultural diversity, universality, and care diversity are the current foundations of patient-centered care in primary care. As patient-centered care continues to evolve, Leininger’s ideas of embracing the differences and similarities among people continue to shape care delivery across settings. These differences and similarities have been crucial in understanding patients’ unique perceptions, understanding of, and attitudes toward diseases and care. Del-Grosso (2019) investigated the application of Leininger’s Theory in the history of family medicine. The author established that the principle tenets of the Theory are used extensively to achieve a patient-centered care model. The Theory also forms a basis for the curriculum for nursing education.
The concepts in the Theory are seamlessly interconnected. For instance, understanding that cultural differences exist among people draws a new understanding of diversity and the importance of diversifying care to meet the client’s needs. Leininger’s Theory is multidimensional in that it can be replicated in several settings. The Theory focuses on the differences and similarities among individuals. These similarities and differences, which Leininger terms universality and diversity, are found in people across all settings in nursing or healthcare setting.
Comparison of the Theories
The theme of care is dominant among the theories. Orem focused on drawing understanding to self-care, which she noted is a deficit in certain instances. Similarly, Leininger developed her Theory out of the care gap she noted in the Children’s hospital setting. The theorists emphasize the value of care in facilitating healing and complete recovery. The two theories’ philosophical foundations are based on the experiences of the theorists. Orem worked in various nursing settings and identified the need to integrate self-care, a missing element in care, into nursing practice. Leininger identified a care and diversity gap in the care for children. The two theorists employed knowledge from their educational backgrounds, experiences, and insights from people around them to develop their theories. The differences in the theories are explicit in their concepts. While Orem’s model revolves around self-care, Leininger’s model diversifies into other aspects of care, such as culture, diversity, and universality of certain cultural factors. The limited focus on self-care with varying propositions and presumptions makes Orem’s model more complex yet specific. On the other hand, Leininger’s theoretical concepts are diverse but closely interconnected, making it easily generalizable.
Examples of where the theories can be used in my Clinical setting
Orem’s self-care Theory emphasizes self-care, both dependently and independently. One of the assumptions Orem made in the Theory was that each person should be self-reliant to care for themselves and the people around them, such as families who need the care (Petiprin, 2023). Therefore, nurses must encourage patients to exercise independence to ease their recovery. Orem’s Theory finds a strong footing in primary care involving patient-centered care, a central care model used in my specialty. Patient engagement and family involvement are crucial to enhancing health outcomes for patients. Similarly, Leininger’s Theory emphasizes the importance of care and diversity. Patient-centered care is rooted in respecting patients’ diverse values, beliefs, preferences, and needs. The two theories can successfully be integrated to enhance patient-centered care in my specialty.
Nursing theories provide a robust foundation for nursing practice. Theorists such as Orem and Leininger made significant theoretical contributions in the nursing fields that continue to shape nursing practice. This comparative analysis focused on Orem’s self-care deficit nursing theory and Leininger’s cultural care diversity and universality theory. Orem’s Theory revolves around the self-care concept, which branches to at least six constructs of self-care. Leininger’s Theory digs into diversity, culture, and universality to create a care model that meets individuals’ diverse care needs. The two theories have been widely applied in nursing and clinical settings to improve care and enhance nursing research.
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Del-Grosso, A. (2019). Application of Leininger’s Culture Care Theory in Family Medical History. Retrieved from https://red.library.usd.edu/honors-thesis/43
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