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Nursing Theory Comparison

CAPS 401 General Education Capstone

June 14, 2020













An introduction, including an overview of both selected nursing theories

For the delivery of best healthcare practices, nursing is a vital profession. Much of the nursing practices and knowledge were silently implied in the first century of nursing. Nursing professionals learned by practicing at the bedside of the patients as they were trained as apprentices to physicians. For the effective practice of the nursing profession, it became vital gradually that a distinct body of knowledge is essential.

The pioneer of modern nursing, Florence Nightingale, tried to explain the late 19th-century nursing that was implicit in nature. The role of nurses was identified by Nightingale in 1969 through her “Notes on Nursing: What It Is and What It Is Not.”It was stated by her that for allowing the reparative procedures to be enacted it was essential for the nursing functions to ensure that the patients are kept in the best state.The work of Nightingale holds significant importance because it explicitly elaborated on an area of practice that was different from that of physicians, paving the standard and way for the training of nursing professionals and identified the scope of a nurse’s work (Medeiros et al., 2015). One another important difference highlighted was that nurses were concerned with the environment of the patients’ whereas physicians addressed the bodily diseases and its related issues.

Dorothea Orem was one another influential thinker in the field of nursing. She worked all over the United States, as she was born in 1914 and until she died in 2007, she remained an expert nurse.Orem assisted in shaping the holistic approach towards patient care that nursing professionals must take and her self-care deficit theory of 1971 is widely taught in nursing schools all over the world. The self-care deficit theory stresses the significance of the patients’ maintaining autonomy themselves over their self-care processes as well as helping nurses in determining the specific aspects of patient care they must be concentrating in a given condition or situation (Orem, 2001).It is elaborated in Orem’s self-care deficit theory as to how nursing professionals should and can intervene in helping patients to maintain autonomy.

Two theories will be reviewed in this essay namely; Environmental Theory of Florence Nightingale and Self-care Deficit Theory by Dorothea Orem. The core issues, central concepts, its development, and application will be examined. Along with its practical applications, the critiques of the essays will also be discussed.

Background of the theories

With the turn of the 20th century, the nursing profession gradually started to establish rather than as a mere vocational skills course. Petitions for improving the working conditions, training, licensing, and registration of nurses was initiated by nursing organizations like The British Nurses Association. This led to the dissemination of the nursing practices and catalyzing of nursing research in attempts to establish nursing as a full-fledged profession (McDonald, 2008). From the 1950s to the 1970s, early versions of nursing frameworks were published such as the theoretical work of Orem and the work of Neuman to name a few.

In the 1980s, the Theory Era was relying on these frameworks as a precedent that witnessed the proliferation of nursing programs, conferences, journals, and literature. A metaparadigm of nursing knowledge was developed during this era by Fawcett that identified four key aspects in the nursing profession such as nursing, health, environment, and person. For the understanding of various literature and theories of knowledge in nursing used this metaparadigm widely as a common context since its inception (Clarke and Lowry, 2012). There has been a heavy reliance on nursing theories and knowledge in the nursing profession. It is stated that the development of theories in nursing science is the sole reason for the continued evolution of the nursing profession. Moreover, concerns about the relation between theory and practice have always been there.

Nurses were once addressed by Nightingale and stated that theory without practice is ruinous to nursing professionals, thus it was expressed that theory can be useful when adopted through practice. On the other hand, critics have further articulated that researches and theoretical frameworks were never relevant or sufficient for the nursing practitioners. But it is argued by Nightingale that theory needs to be evaluated according to its contribution to practice and it should be supporting the nursing practices (Medeiros et al., 2015).

An Environmental Adaptation Theory by Florence Nightingale

The theory by Nightingale is centered on the environment. In her book ‘Notes on Nursing: What It Is and What It Is Not’ this claim is clearly evident through her writings.Changing the poorly sanitized environment of soldiers under her care as her past experience, Nightingale’s knowledge was based on that, fuelling her mission for bringing improvements in the environmental situations in health care institutions and hospitals (Medeiros et al., 2015). She believed that the patient’s environment should be modified in order to affect the work of nature as Nightingale believed in the restorative power of nature and she was herself a devoutly spiritual person.

There are four prime elements of the Nightingale’s Nursing Environment Theory that are aligned with the four facets of nursing metaparadigm. Firstly, in Nightingale’s philosophy, the environment is something that must be aligned in a position that puts the patient in the best possible condition or situation in order to make nature’s restorative process in function. There are two essential components of the environment such as the psychological and physical.

By psychological environment it is meant that chattering advice and hopes must be avoided, as it was believed by the theorist that this mocked the patients’ sickness, exaggerating the probability of the patients’ recovery and making light of the ill person’s condition. On the other hand, the physical environment pertained to activity, room temperature, stimulation, medicine, nutrition, light, warmth, and ventilation (Im and Chang, 2012). It was identified by Nightingale that the surroundings are a source of disease and recovery, and therefore, she emphasized on ventilation particularly. Hence, the theorist explained various methods for the manipulation of body temperature measures and surroundings.

Secondly, the patient receiving care is referred to as the person in Nightingale’s theory. It was claimed by Nightingale that a person is a complex creature that comprises of spiritual, social, mental, emotional, and physical elements. Moreover, she explained that the nurse was responsible for the passive patient. Thirdly, in this perspective of Nightingale’s theoretical frameworkhealth is implied to be the nursing of patients from illness to health, promotion of health, and prevention of diseases. Nonetheless, it was envisioned by Nightingale that health could be maintained with social responsibility and environmental control.

Lastly, it was believed by the theorist that there was a spiritual calling that resulted in nursing. Nightingale claimed that by attending to one another’s health, all women would be nurses at some point in their lives. Furthermore, trained nurses required skills and scientific principles in reporting and observing the health status of patients.

In practice, the Environmental Theory has all the essential components that were elaborated earlier. It will be included that the diagnostic assessment would be the evaluation of the psychological and physical environment of the patient. Therefore, according to theorists, it is the goal of the nurse to assist the reparative process of nature.

It can be started from Nightingale’s theory review that most of its core concepts and principles proposed by her are very much applicable to this day. In order to optimize the patient’s recovery, the Environment Theory by Nightingale is quite practical and useful, as it has detailed aspects of the environment that must be considered. Such a conceptualized environment by Nightingale also concentrated on health care centersby taking into account all the psychological, physical, and social elements that must be understood as interlinked. On the other hand, it can be critically highlighted that Nightingale’s theory lacks some scientific basis in the way she rejected the germ theory of disease, as the theory has been written many decades ago (Im and Chang, 2012).

Additionally, the Environment Theory by Nightingale can be critically analyzed by the use of the proposed eight-point criteria by John and Webber. Observably, the theory features understandable language, and it is clear and succinct. It has clearly defined limits as pertaining to nursing practices and this theory by Nightingale has a high consistency. Some notions of Nightingale’s theory may be outdated because it was written some150 years ago such as her claim that only women are nurses but still Nightingale took good care for defining key concepts (McDonald et al., 2008).

The proposals of maintaining cleanliness to avoid morbidity were clearly led by the concepts of Nightingale’s Environment Theory concepts pertaining to environmental hygiene. The underlying knowledge of the theory leads to phenomena explanation and propositions are interpreted with the help of the hypothesis. Eventually, Nightingale’s Environment Theory has clearly highlighted a strong backing to nursing practice and factually, to this day it serves as a major influence for professional nurses.

Self-care Deficit Theory by Dorothea Orem

          In nursing practice, one of the most widely utilized theories is Dorothea Orem’s Self-Care Deficit Nursing Theory. She aimed to improve the quality of the nursing quality in common health institutions as it led to the development of notions of nursing practice of Orem’s along with her nursing experience.There were three main questions that were concentrated by Orem such as; what are the works of nurses, why are nurses doing that works, and what results are gained by the adopted nursing interventions (Orem, 2001).

Initially, a definition was developed for the basic aim of nursing by Orem for overcoming the limitations of human, concerns of nursing, which is humans need for recovering from diseases or ailments, coping up with these effects, requirements of self-care and the management of opportunities to prolong health and life.

Gradually, this definition turned into a practical nursing theory. Nursing practice is supported in Orem’s model through 3 main theories;

  • Theory of Self-Care Deficit
  • Theory of Self-Care
  • Theory of Nursing Systems

People trying to maintain physical, social, and psychological wellbeing through deliberate actions pertain to self-care. Therefore, it is posited by the Theory of Self-care that mature persons develop behavior and actions in a conscious manner that affects their quality of life, wellbeing, and survival.Moreover, when an individual is not able to perform self-care because of age or its related factors then at that point there is an occurrence of self-care deficit.

Hence, it is stated in the Theory of Self-Care Deficit that the nursing profession is essential as some persons are not able to administer self-care because of their limitations. Thereby, creating a space or situation for nursing. Consequently, it is elaborated in the Theory of Nursing Systems that how individuals with self-care deficit are to be assisted and supported through the nursing process and nursing professionals (Clarke and Lowry, 2012).

Orem’s Conceptual Nursing Framework

          The Nursing Systems by Orem can further be classified into three more categories such as a supportive-educative system, a partly compensatory system, and a wholly compensatory system. The system where the patient is the one accomplishing self-care and nurse guiding and supporting the patients in exercising and regulating the self-care agency is referred to as the supportive-educative system. In the partly compensatory system, assistance is provided to patients as needed and compensating for the self-care limitations of the patient. Whereas, the patients are provided with complete care and the patient’s self-care deficit is compensated in the wholly compensatory system.

In practice, four different operations proceed in Orem’s theory. These operations are diagnostic, prescriptive, regulatory, and control, whereas in the theory each operation encapsulates specific phases.

It is demonstrated from the review of Orem’s theory that the central focus of the theory is revolving around the patient’s self-care agency through its concept and development. The theory underscores the path to recovery, instead of focusing on the patient’s ailments. Therefore, increased attention is given to the processes of nursing and how it can fasten the patient’s self-care agency functions.


It can be concluded from the discussion and comparison of the two selected theories of Nightingale and Orem that for providing the care these theories are the essential knowledge base. The Environment Theory by Nightingale and The Self-Deficit Theory by Orem extend guidance and structure on delivering health care through differently set approaches.

The theoretical framework by Nightingale focused on the adaptation to the surrounding environment to enable a patient to achieve optimal health and recover quickly. Furthermore, it has been posited by Nightingale that to avail nature’s reparative process, it is the role of nurses is to keep a person in the best possible conditions.  Contrastingly, the improvement in the self-care agency of the patient is the center of focus in Orem’s Self-care Deficit Theory.  Consequently, it is elaborated in the Theory of Nursing Systems that how individuals with self-care deficit are to be assisted and supported through the nursing process and nursing professionals.

It is demonstrated that theoretical frameworks are of significant importance for practice in nursing and it is gained through nursing knowledge. Therefore, it is of extreme importance that nursing professionals are well informed and knowledgeable about the different models and theories of nursing education to utilize them appropriately through practical application in cases.














Clarke, P. N., & Lowry, L. (2012). Dialogue with Lois Lowry: Development of the Neuman systems model. Nursing Science Quarterly, 25(4), 332–335.

Im, E., & Chang, S. (2012). Current trends in nursing theories. Journal of Nursing Scholarship, 44(2), 156–164.

McDonald, S., Hetrick, S.E., & Green, S. (2008). Pre-operative education for hip or knee replacement. Australia: The Cochrane Collaboration, John Wiley & Sons Ltd.

Medeiros, A.B., Enders, B.C. & Lira, A.L. (2015). The Florence Nightingale’s Environmental Theory: A Critical Analysis. Escola Anna Nery, 19(3).

Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). St. Louis, MO: Mosby.




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