Nursing Theory


Please see attached instructions:

Theories to be used:
Grand Theory: Dorothea Orem’s Self Care Deficit

Middle Range Theory: Patricia Benner’s Novice to Expert Theory

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Must use emergency department for any clinical practice reference

One of the references must be the following text:
McEwen, M., & Wills, E. M. (2017). Theoretical Basis for Nursing (5th Edition). Wolters Kluwer Health.



Instructions for Nursing Theory Comparison Paper

Please use these bold headings to organize your paper. You are simply comparing the two theories back and forth.
In your reading, you will find a thorough description of each component below and fully describes what you need to research about your chosen theories to fill in the section.

Overview of your chosen grand theory
Overview of your chosen middle range theory
•    You will have a separate paragraph in each section, one for your grand range theory and one for your middle range theory.

Background of the theories
(Grand theory chosen)-
(Middle range theory chosen) –

Philosophical Underpinnings
(Grand theory chosen)-
(Middle range theory chosen) –

Major assumptions, concepts, and relationships
(Grand theory -)
(Middle range theory -)

Clinical applications
(Hint: usefulness/value to extending nursing science testability)
(Grand theory-)
(Middle range theory -)

Application to nursing practice
(Hint: Comparison of how to use of your theories in nursing practice)
(Grand theory-)
(Middle range theory -)

Application to my practice
(Hint: Specific examples of how both theories could be applied in your specific clinical setting)
Grand theory-
Middle range theory –

(Hint: how simple or complex are the theories?
Grand theory-
Middle range theory

Every formal paper must have a formulated conclusion!

•    Four References: Course text and a minimum of three additional sources.
•    The paper should be 8–10 pages long- not including your Cover and Reference pages.
•    Times New Roman,12-point font, and double-spaced with 1″ margins.
•    APA format (7th ed.) a properly formatted cover page and reference list.



Some things to remember:

  • Every paper must have HEADINGS for each section, I usually give them to you in the Announcement for the paper.
  • We no longer write Running Headon the Cover page!
  • The entire document is double spaced, even between sections (before and after headings)
  • Alphabetize all the names in your Reference page list
  • Every time you quote someone, you must have a citation that includes the Authors Last name, year, and page number!





Grand and Middle Range Theory

Nursing theories have been grouped into various categories that enhance the nursing practice in health organizations. Most of these theories were developed by theorists many years ago, thus instituting major concepts and other nursing components that have improved quality care and patient outcomes. This study reviews and compares a grand theory; Dorothea Orem’s Self-Care Deficit and middle range theory; Patricia Benner’s Novice to Expert Theory.

Grand theories are broad and essential in organizing knowledge for studies, thus more applicable in nursing practice (Hjørland, 2017). Dorothea Orem’s Self-care deficit theory is comprehensive enough to help understand the concepts of self-care among patients. Dorothea’s nursing theory consists of three elements; self-care theory, self-care deficit, and theory of nursing system. Her self-care deficit theory was mainly developed to help nurses recognize those activities that help patients care for themselves and maintain good health (McEwen & Wills, 2017). It is a grand theory due to its broad information that has been applied in educating patients to be independent in sustaining their lives and wellbeing.

Middle range theories focus on a specific scope thus are narrower and can be easily tested for variables. They specify specific concepts to develop theoretical frameworks. Patricia’s Benner’s Novice to expert theory is considered a middle range theory because of its specification in developing the concepts, terminologies, and other components (McEwen & Wills, 2017). She applied the Dreyfus model and developed five stages of nursing skill acquisition; novice, expert, competent, advanced beginner, and proficient in elaborating her theory to the nursing profession.




Dorothea Orem was born in Baltimore, Maryland, in 1914. She attained her diploma and degree in nursing in two Universities in 1939. Later, in 1945 Dorothea attained her Master’s Degree from Catholic University. Due to her experience, she held different positions in the nursing profession like; hospital staff nurse, private duty, and educator. Her work did not stop at the three positions mentioned above. She later became an acting dean of Catholic University in 1959, after assuming the faculty member’s role in the same University. Her interest in nursing theory emerged when she and her colleagues were assigned a role in choosing a curriculum in practical nursing for the department of health, wellbeing, and education in Washington DC. This motivated her to write her first nursing theory book in 1971. She continued developing her self-care and nursing concepts until her demise in 2007 due to complications with health. Her theory proposes that patients can sustain and function well in recovery when independent of their self-care because they can maintain life health and wellbeing independently. It is therapeutic in supporting life, health, recuperating from an illness, and dealing with the outcomes.

Patricia Benner was born in 1942 in Hampton, Virginia, in the United States. She attained her degree in nursing in 1964, then later received a Master of Science in Medical-Surgical Nursing in 1970 and a Ph.D. in 1982. She has worked in the nursing field in various departments of different hospitals, such as a head nurse and an intensive care staff nurse. She has also been a research associate based at the University of California in the nursing school from 1971-1975. She is currently a professor emerita in the Department of Physiological Nursing at the University of California, teaching and researching her nursing theory. She wrote nine books, the likes of ‘Novice to Experts and Nursing Pathways for Patient Safety, and many articles. She has dedicated her life to educating nurses, specializing in clinical nursing, writing nursing articles to help nurses understand the concepts of gaining nursing knowledge and the importance of clinical experiences in their practice. She advocates for well-structured research on nursing with evidence-based practices to help nurses compare with their current level of knowledge. Her theory has diverted the meaning of being an expert in nursing. It gives an insight into nurses’ position levels and the quality of work achieved (McEwen & Wills, 2017).

Philosophical Underpinnings

Dorothea Orem’s nursing theory is considered one of the most used grand theories in nursing practice. Her model is fundamental considering it has three other theories; theory of self-care, self-care deficit, and nursing system that helps understand the importance of self-care in improving health. Orem’s theory derives its major works on the aspect that a person is an agent and requires total attention in maintaining good health and wellbeing (McEwen & Wills, 2017). Therefore, nurses must ensure that they understand using the basic concepts of the self-care deficit theory to intermediate care in patients. She derives her works from the nursing experience during her studies and practice. The nursing theory has been applied by nurses for years now in ensuring that the patient’s care needs are taken into consideration and advised accordingly on the appropriate ways to maintain good health in general.

Patricia Benner’s nursing theory implicates the benefits of rewarding and retaining clinical nurses in their nursing sites because such actions motivate them to do their best and emerge as excellent nurses (Ozdemir, 2019). This also implicates the aspect of good and quality practices in health organizations. She believes that nurses can gain knowledge through continuous practice and research, hence improving their skills slowly by slowly. According to her, nursing practices consist of constant learning that must be adhered to prosper in health organizations. A nurse must be determined to dedicate their life to learning new techniques in nursing because nursing practices change with time as there is diversity in outbreaks and epidemics. Therefore, constant research work is essential in improving nursing practices (McEwen & Wills, 2017). This theory focuses on how nursing practitioners acquire knowledge and skills to offer care to patients. It is essential to provide knowledge and skills to both new and experienced nurses.

Major Assumptions, Concepts, and Relationships

Dorothy Orem’s self-care deficit theory is the major component of self-care. It is applicable mainly when nursing is highly needed (Khademian et al., 2020). Such nursing is mostly required when a patient cannot provide efficient self-care to themselves. Therefore, a professional caregiver steps in to support the necessary nursing care for the patient. Her model elaborates that a nurse can help a patient recover from self-care deficit through five techniques. These are; assisting the patient directly by doing everything for them, teaching them what needs to be done, guiding and directing them, showing physical and psychological support, and suggesting and promoting a healthy environment that encourages personal growth. Her concept belief is that human beings are entirely dependent on socialization processes among themselves, which are influenced by communication and the environment they live in, to take care of themselves and be dependable. Depending on one’s condition, self-care might deteriorate, urging for self-care agency. Human privatization must be considered in enhancing proper self-care, thus teaching, guiding, and directing patients to allow them to feel confident in managing their health (McEwen & Wills, 2017). Self-care through therapies acknowledges that nurses are aware of their responsibility in ensuring the patient meets their self-care needs to function well. Therefore, Orem’s self-care deficit theory interprets the aspect of a person being dependent or independent on someone to meet their self-care needs and continue living healthy.

Patricia Benner’s Novice to Expert Theory describes how nurses acquire new skills and knowledge from the novice to expert level (McEwen & Wills, 2017). A nurse can increase their knowledge and skills in nursing patients from the novice level, where they have no experience only dependent on a few nursing concepts to the expert stage through complete theoretical training and practical learning. She further examines that the development of a nurse moving from one level to another is influenced by the clinical experience levels and position in the nursing profession. Her nursing outlined five stages: a novice, advanced beginner, competent, practice, and expert (Ozdemir, 2019). She discusses that a nurse has no prior knowledge and skills to transfer information into practice in the novice stage and thus requires constant training to adapt to the practice. They begin to acquire knowledge and skills at the advanced beginner level. They can complete treatment requirements assigned orders under the guidance of other experienced nurses to manage patient care (Ozdemir, 2019).

Successful completion of advanced beginner level prompts them to a competent level, where they can advance their knowledge and skills in patient care and learn ethical behaviors when caring for patients. Nurses can learn how to make changes in some clinical situations at the practice levels. They get to adapt to different clinical changing techniques in improving patient care. From there, they can now be acknowledged as experts in nursing practice. Patricia’s model proves to be essential in ensuring that clinical nurses follow the right procedure in managing patient care. This proves that nursing requires constant practical training to understand patients’ needs and attend to them effectively with no medical errors.



Clinical Applications

Many health organizations worldwide have applied Dorothea Orem’s self-care deficit theory. Various hospitals have used her concepts theory in chronic illnesses, ambulatory situations, emergency rooms, and rehabilitation facilities. Nurses can take care of patients’ needs and prescribe effective treatment to enable them to continue with their self-care even on their own. Self-care deficit theory implicates that nurses are responsible for ensuring a patient’s self-care needs are enhanced appropriately to sustain and help them function normally without feeling pain or discomfort. The model’s concepts, such as self-care and the nursing system, emphasize the relationship between the various concepts within the model. This allows the nurses to focus on patient’s needs based on a broader way considered to just specific needs in the essence of improving their personal development.

Patricia Benner’s model is an influential tool used by health organizations to check and measure the nurses’ clinical competencies in patient care. Many nursing schools also use the model to educate nursing student’s novice nurses to move from novice to expert stage based on theoretical training and exponential clinical learning. Patricia’s middle-range theory’s five nursing outlined steps enable health organizations to rate their clinical nurses ‘performance based on their knowledge and skills acquisition in patient care. The model emphasizes the importance of the nurses’ knowledge and skills in patient care in improving patient outcomes. The constant practice is a motive to adapt to the various changes and clinical demands that arise with time. This model also enables nurses to acknowledge their capabilities and strengthen their weaknesses in patient care with time. Patricia’s Model of novice to expert theory is essential in clinical practice to improve nurses’ practice in patient care and increase patient outcomes.


Application to Nursing Practice

In Dorothy’s model of self-care deficit theory, nurses can focus on the five methods of treating self-care deficit among patients. They can focus on retaining the patients to their previous state to manage, sustain and function effectively. The nurses can guide, teach and advocate for a good environment that can improve the personal development of the patients. This model can be applied especially among those patients with distress issues, depression, and older age to help them manage their self-care. For instance, nurses can provide physiological and psychological support to a patient going through depression to enable them to perform their usual duties as before and get their life back. This can be done through therapy and medical treatment to control their mood swings, tantrums, and tempers that interfere with their everyday social and interactions with others.

Patricia’s model is applicable in nursing practice in that it enables health organizations to determine the roles and responsibilities of nurses in the facilities. For instance, a nurse; level of knowledge and skills in patient care in the emergency room will help schedule the appropriate role to undertake. If the nurse is at the advanced beginner level, they are likely to be assigned to arrange the surgical equipment, tools, clothing, and any other required item before the surgical team arrives. This also allows them to learn new skills and acquire knowledge that will help them move to competent levels.

Application in my Nursing Practice

Dorothy Orem’s nursing theory is crucial in developing my nursing practice. I am mostly based in the emergency room, and I could use this model to ensure those patients in critical condition are well taken care of. I could do this by going through their previous self-care assessment before falling ill and moderating a few conditions requiring therapeutic attention. In the case of a self-care agency, I will ensure that the patient is attended to and their needs are considered to help them sustain their self-care and function with privacy as possible.

Patricia’s model on novice to expert theory is also crucial in my nursing practice. The model can help determine my knowledge and skill acquisition level in attending to patients at the emergency room. I can use the model as my checkup list to determine my nursing practice level and work on my clinical practice to ensure that I attend to my patients fully without causing unnecessary medical errors. This is also vital in my practice because, in the emergency room, we deal with complicated cases. The first thing is to understand the patient’s condition before conducting any procedure. This can lead to errors in the whole procedure and impact the patient outcomes leading to health complications.


Dorothy Orem’s theory is complex as it entails three composite theories that help understand her theory’s theoretical concepts (McEwen & Wills, 2017). This makes it a little bit complicated to formulate some concepts and interpret them, but all in all, the model’s major concepts help in managing patient self-care deficit.

Understanding the novice to the expert stage is essential in acknowledging ones’ growth in clinical expertise. The five nursing outline stages in the novice to the expert model are beneficial in enhancing quality patient care in clinical settings. Therefore, understanding the basics is vital in the clinical setting to advance knowledge and skills to help change unexpected health situations (Ozdemir, 2019).



The nursing theorists discussed above are essential in clinical settings and improving patient outcomes. The theories have made me appreciate various nursing theorists because we currently enjoy quality healthcare and advancing knowledge and skills in nursing practice due to their writings and articles. If there were no nursing theories, the health system would deteriorate to an extent whereby no human would be surviving at the moment. The nursing profession would not be an honored career as it is today. With all gratitude and appreciation to theorists like Florence Nightingale, nurses can be respected and given ample time to conduct quality care and deliver efficient healthcare services.




Hjørland, B. (2017). Theories are knowledge organizing systems (KOS). KO KNOWLEDGE ORGANIZATION, 42(2), 113-128.

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self care education based on orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: a quasi-experimental study. International journal of community based nursing and midwifery, 8(2), 140.

McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing (5th ed.). LWW.

Ozdemir, N. G. (2019). The development of nurses’ individualized care perceptions and practices: Benner’s novice to expert model perspective. International Journal of Caring Sciences, 12(2), 1279-1285.’_Individualized_Care_Perceptions_and_Practices_Benner’s_Novice_to_Expert_Model_Perspective/links/5d72b3d44585151ee4a14deb/The-Development-of-Nurses-Individualized-Care-Perceptions-and-Practices-Benners-Novice-to-Expert-Model-Perspective.pdf