Nursing Theory Comparison: Grand vs. Middle-Range in Nursing Practice

This report provides a comprehensive comparison of two nursing theories: Dorothea Orem's self-care deficit theory (a grand theory) and interpersonal relations theory (a middle-range theory). The report begins with an introduction to nursing theories, differentiating between grand and middle-range theories. It then delves into the background, philosophical underpinnings, major assumptions, concepts, and relationships of both selected theories. The clinical applications and usefulness of each theory are discussed, along with a comparison of their use in nursing practice. Specific examples illustrate how each theory could be applied in a clinical setting. The report concludes with a discussion of parsimony, a summary of the key findings, and a list of references.

Running Head: NURSING
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Nursing 500
6/20/2019

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Contents
Introduction...........................................................................................................................................2
Grand nursing and middle range nursing theory....................................................................................2
Background of the theories....................................................................................................................3
Self-care deficit theory......................................................................................................................3
Interpersonal relations theory............................................................................................................4
Philosophical underpinnings of the theories..........................................................................................4
Orem’s theory....................................................................................................................................4
Interpersonal relations theory............................................................................................................4
Major assumptions, concepts, and relationships....................................................................................5
Orem’s theory of self-deficit..............................................................................................................5
Interpersonal relations theory............................................................................................................5
Clinical applications/usefulness of the nursing theories........................................................................6
Orem’s theory....................................................................................................................................6
Comparison of the use of both theories in nursing practice...................................................................7
Specific examples of how both theories could be applied in your specific clinical setting....................8
Parsimony..............................................................................................................................................9
Conclusion...........................................................................................................................................10
References...........................................................................................................................................11

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Introduction
The report brings about the discussion on the concept of nursing theories, and their
comparison and other related aspects. Nursing theories are the concepts or theoretical visions
stated by the professionals in the nursing field, forms the base of clinical practices. Through
the creative and systematic procedures, nurses are able to develop and implement knowledge
required for improving the care of patients. Here, two types or kids or nursing theories will be
discussed, i.e. middle range and grand theories of nursing that will be compared for
assessing their use in the nursing practices. In addition, the discussion will mention the
usefulness or application of these nursing theories in context to the nursing and health care
(Smith & Parker, 2015).
In this report, I have selected the theory of self-care deficit nursing theory, as one
grand nursing theory and ‘Interpersonal relations’ as middle range theory. These theories has
been selected from the given textbook chapters, therefore these will be described effectively
to the readers giving an understanding of the nursing theory concepts. Thus, the report on the
analysis of nursing theories will be demonstrated with the help of suitable example and
appropriate literature.
Nursing theories (Grand nursing and middle range nursing)
To describe the grand nursing theory, it can be stated that these refer to the most
complex theories, and are often non-specific derived as the result of thoughtful insights and
research in the field of nursing. Grand theories are often composed by theorists, including
Erikson, Sigmund Freud, and Jean Piaget. On the other hand, middle range theories define
about a particular situation, in context to some limited available variables. In earlier years, the
focus of the grand nursing theory was developing and maintaining the nurse-client

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relationship, now the scope has widened. Now, the theories of nursing has adopted a holistic
view to enhance the care of patients and lead better health outcomes (Greenberg, 2017)
Background of the theories
Self-care deficit theory
Dorothea Orem developed the theory of Self-care deficit is recognised one of the
significant grand theories of nursing. Therefore, it is also known as the ‘Orem’s model of
nursing’ encompassing several components of self-care. As developed by the theorist, it has
been found that other theories of self-care are the part of self-care deficit theory (Younas,
2017).
In accordance to the self-care deficit theory, all the patients wish to undertake theie
own health care by themselves. These individuals can recover from their health condition, if
practitioners enable them to perform their self-care with their best potential. In this theory,
Orem identified number of requirements, to be fulfilled forming a condition for the theory. It
determines self-care, and consists of the developmental and other self-care requisites.

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The aspect of self-care deficit occurs, due to the inability of the patient, meeting their
self-care needs or requisites, and therefore self-care deficit occurs. Therefore, it determines
the role of the role of nurse to identify those deficits and provide care (Shelton, Barta,&
Anderson, 2016).
Interpersonal relations theory
The other concept of interpersonal relations theory determines, an individual or
client’s interaction with others determines security, sense of self, and other elements
directing their behaviour. As per the theory, a personality cannot be segregated from the
complexity of interpersonal relations in which the person lives (Smith & Parker, 2015).
Stack Sullivan has described about the interpersonal relations as a middle range
theory, stating that social experiences, contribute in shaping our personality and most of the
life events. The theory has determined six developmental stages, which starts from the period
of infancy until the age of adolescence. The theory has underpinned the concept of self in
three ways, i.e. the good me, the bad me, and not me. Thus, it can be stated that effective or
healthy development of an individual’s personality depends on their capability to establish
intimacy or closeness with others overcoming the anxiety (Arnold & Boggs, 2019).
Philosophical underpinnings of the theories
Orem’s theory
The theorist had interest in number of theories, but SCDNT i.e. self-care deficit
nursing theory has been understood as the formalized theoretical concept of nursing. Here, as
per research on the nursing, the self-care theories emphasizes on the person as an ‘agent’
(Hargie, 2016).

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Interpersonal relations theory
The father of interpersonal psychiatry relations theory, Henry Stack Sullivan, has
researched on the concept of nursing, role of environment and impact on the individual.
Therefore, he stated the purpose of behaviour for the patient is to identify their needs, and
fulfil them through developing interpersonal reactions, and reduce anxiety (De Chesnay &
Anderson, 2019).
Major assumptions, concepts, and relationships
Orem’s theory of self-deficit
Orem (1995,2001) gave the concept of nursing in the following manner:
Nursing has been considered as the practice in which the health practitioner provides support
to the client to fulfil their self-care needs. Humans are perceived to be the men, women and
family as single or social units, and environment consist of chemical, biological and other
elements, (family, culture, and community) affecting health of the person. Thus, it can be
stated that health means being, ‘structurally and functionally sound or whole” (Richardson,
Percy & Hughes, 2015).
One of the assumptions of the self-deficit theory of Orem’s theory explains that
humans are engaged in communication and interaction with their environment, to survive
and function. The role of human agency concept has been found relevant to develop
capabilities to identify the self-care needs and determine inputs. Thus, it determines the
structural relationships amongst humans to take deliberate actions for their self-care
(Afrasiabifar et al., 2016).
Interpersonal relations theory
The concepts under the interpersonal theory of nursing defined the human or
individual as the system of tension or energy. The aim of the tension system is reduction of

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the anxiety or tensions, and the theorists stated that tension arise due to needs of the person,
and the anxiety related to it.
One of the basic premise of the Sullivan’s interpersonal theory includes, that
unhealthy development of personality is the outcome of interpersonal conflicts and other
challenges. Moreover, it has been assumed that if a person has an imaginary playmate it is
considered as normal or healthy, and does not require clinical treatments. In the aspect of
developing relationships, the element of malevolence is determined as bad, and determines
unhealthy relationships. On the other hand, intimacy and self-systems are the aspects that
determine positive interactions and healthy relationships (Ma et al., 2016).
Clinical applications/usefulness of the nursing theories
Orem’s theory
The Orem’s theory of nursing are used in the situations of the has ambulatory care
settings, being used in the health care in many countries. Self-care deficit nursing concept is
primarily used within primary care settings, and the rehabilitation centres that fosters the
aspect of independency in the patients to take care of their health (Wong et al., 2015).
The theory has wide applications to the critical conditions of arthritis, gastrointestinal
disease, and renal health illness. Moreover, the theory of self-care deficit has been used by
the carers in the areas of practice, maternal care, critical care nursing, perioperative nursing
and others. For an example, the use of the theory of self-care theory is found relevant for the
diabetic patients. They are encouraged to focus on their diet, medication and lifestyle to
enhance the element of self-care and eliminate deficits (Hemmati Maslak et al., 2017).
Interpersonal relations theory

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To determine the significance of interpersonal relations theory in clinical settings,
involves the diagnosis, and treatment of various anxiety related disorders. Nurses contribute
to a large extent directing the family of the patient to maintain healthy relations, and
encourage the individual towards recovery. Nurses understand various aspects of ego
deficits, which act as a major strength deficit in the family. One of the theorist Giblin has
stated the clinical use of manifestation of the interpersonal relations theory in the cases of
medical-surgical nursing, ageing, and geriatric nursing.
Comparison of the both theories of nursing practice
Nursing theories develops the structure and guidelines to undertake care of the patient
in nursing. Two of the main theories i.e. one from grand nursing theory and one from middle
range, has provided an insight into clinical practices. These both theories have created new
and innovative ways to provide care, and encourage or leading them towards better health
outcomes. The self-care model, and interpersonal relations theory has many similarities and
differences in their framework and concepts along with the metaparadigms and the
generalizability. It has been analysed that the basis of the use of both the models and theories is
encouragement of the autonomy, and development of the individual or patient (Hopwood,
Pincus & Wright, 2017).
One of the aspect that self-care deficit model has emphasized on the particular
individual as agent, and the second theory, analyses the aspect of the environment. The later
stated that a person or individual could not develop healthy personality without maintaining
contact or interactions with their external environment. In this theory, people ensure
development of their personality in context to social environment, and without other people,
people have no personality. On the contrary, self-care deficit focuses on the concept of caring
by oneself. Moreover, the self-care deficit theory envelops the aspect of self-care as a primary

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goal of the nursing practices. Whereas, the theory of interpersonal relations theory views the
development of ‘nurse-client’ relationship as their base of their nursing practice (Younas,
2017).
It involves the dependency or development of health through aspects of lifecycle, i.e.
higher involvement of the patient in their care. Interpersonal relationship is the concept which
increases the activity or contribution of the therapist providing care, to improve health. Nurses
aim to improve patient’s health by the element of self-care demand in context to the self-care
deficit theory. Latter theory involves developing core relationship between the expert and
patient (Lopes & Cutcliffe, 2018). Thus, it can be stated that both the theories of self-care
deficit and interpersonal relations aim to enhance the health condition of the patient in longer
period.

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Specific examples of how both theories could be applied in your specific
clinical setting
One example can be the aspect of self-care demand, wherein, ‘food’ acts to be the
area of deficiency, mentioning the inadequacy of self-care. A patient or person was unable to
maintain proper level of nutrition, in consideration to inadequate intake, along with lack of
knowledge. Here, the phenomenon of self-care deficit determines the deficit area, plan,
diagnose, designing nursing system, and attaining positive health outcomes. The patient in
the later stage was able to identify the requisites of self-care, making changes in her diet
enriched with nutrients (Wong et al., 2015).
Furthermore, the example from the concept of middle range theory of nursing, i.e.
Sullivan’s interpersonal relations theory is applied to the patient’s affected by schizophrenia.
A person was identified with the mild anxiety which was diagnosed by the professional and
suggested to reduce the level of anxiety, as it impacted his health. Besides, this they were
suggested to maintain interpersonal relationships with the healthy and positive people in
their environment or surroundings (Nursing theory, 2018).
Parsimony
The term parsimony can be defined as the criteria, of the depth of theory, i.e. the
more complex the theory, the less comprehension is derived. In context to the concept and
application of the SCDNT, in the nursing field, it has been found Orem’s (2001) is wide,
and complex concept. It includes different presuppositions, propositions in each of three
stated theories. However, with increase in health issues, and societal needs of people,
SCDNT has attained more complexity and requires in-depth study.

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The Sullivan’s interpersonal relations theory of nursing is considered parsimonious, as it
stated an in-depth research on the nature of interpersonal relations. It includes various
aspects or propositions, of the interpersonal relations, in the family, community determining
attainment of healthy personality. Thus, the description has stated the concept of parsimony
of both the theories of nursing determining better health of individuals (Bajjani-Gebara &
Reed, 2016).
Conclusion
To conclude the above discussion it has been analysed that health is determined as
the degree of wellness that client experiences in the field of nursing. Nursing theories has
been considered important determining the significance of role of nurses, and professionals to
provide care. The report has discussed well two theories (grand theory and middle-range
theory) of nursing practice. Self-care deficit theory and interpersonal relations theory has
been described along with their clinical use, underlying assumptions and manifestations.
Moreover, the discussion has involved the meaning and application of theories determining
degree of parsimony in the health practices. Hence, it can be stated that an individual must
focus on their self-care and maintain healthy interactions with the external environment
leading to wellbeing throughout life.

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References
Afrasiabifar, A., Mehri, Z., Sadat, S. J. & Shirazi, H. R. G. (2016). The effect of orem’s self-
care model on fatigue in patients with multiple sclerosis: a single blind randomized
clinical trial study. Iranian Red Crescent Medical Journal, 18(8).
Arnold, E. C. & Boggs, K. U. (2019). Interpersonal Relationships E-Book: Professional
Communication Skills for Nurses. United States: Saunders.
Bajjani-Gebara, J., & Reed, P. G. (2016). Nursing theory as a guide into uncharted waters:
Research with parents of children undergoing cancer treatment. Applied Nursing
Research, 32, 14-17.
De Chesnay, M. & Anderson, B. A. (2019). Caring for the vulnerable: Perspectives in
nursing theory, practice, and research. United States: Jones & Bartlett Publishers.
Greenberg, J. R. (2017). Theoretical models and the analyst’s neutrality (1986). In Further
Developments in Interpersonal Psychoanalysis, 1980s-2010s (pp. 30-31). United
Kingdom: Routledge.
Hargie, O. (2016). Skilled interpersonal communication: Research, theory and practice.
United Kingdom: Routledge.
Hemmati Maslak Pak, M., Parizad, N., Shahbaz, A. & Ghafourifard, M. (2017). Preventing
and managing diabetic foot ulcers: application of Orem’s self-care model. Int J
Diabetes Dev Ctries, 1-8.
Hopwood, C. J., Pincus, A. L. & Wright, A. G. (2017). The interpersonal situation:
Integrating personality assessment, case formulation, and intervention. In Purdue
symposium on psychological science. New York: Oxford.
Lopes, J. & Cutcliffe, J. R. (2018). Psychodynamic and Psychoanalytical Theory, Approaches
and Clinical Relevance: Applying the Psychoanalytic Principles and Practices to

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Mental Health Nursing. In European Psychiatric/Mental Health Nursing in the 21st
Century (pp. 75-88). Berlin: Springer.
Ma, J., Batterham, P. J., Calear, A. L. & Han, J. (2016). A systematic review of the
predictions of the Interpersonal–Psychological Theory of Suicidal Behavior. Clinical
psychology review, 46, 34-45.
Nursing theory. (2018). Stack Sullivan’s Interpersonal theory. Retrieved from:
http://www.nursing-theory.org/theories-and-models/Stack-Sullivan-Interpersonal-
Theory.php
Richardson, C., Percy, M. & Hughes, J. (2015). Nursing therapeutics: Teaching student
nurses care, compassion and empathy. Nurse Education Today, 35(5), e1-e5.
Shelton, D., Barta, B. & Anderson, E. (2016). The rediscovery of self-care: A model for
persons with incarceration experience. Journal for Evidence-based Practice in
Correctional Health, 1(1), 3.
Smith, M. C. & Parker, M. E. (2015). Nursing theories and nursing practice. FA Davis.
Smith, M. J. & Liehr, P. R. (Eds.). (2018). Middle range theory for nursing. Berlin: Springer.
Wong, C. L., Ip, W. Y., Choi, K. C. & Lam, L. W. (2015). Examining self‐care behaviours
and their associated factors among adolescent girls with dysmenorrhea: An
application of Orem's self‐care deficit nursing theory. Journal of Nursing
Scholarship, 47(3), 219-227.
Younas, A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and
evaluation of its significance for nursing practice and research. Creative nursing,
23(1), 13-23.