Journal of Advanced Nursing.

1986,11,409-419

Comparison of two theorists on care: Orem and Leininger

Janet N. Rosenbaum RN MSN Associate Professor and Director. University of Windsor. School of Nursing, 401 Sunset Avenue, Windsor. Ontario. N9B 3P4, Canada, and PhD Student in Nursing. Wayne State University. Detroit. Michigan. USA
Accepted for publication 4 October 1985

ROSENBAUM J. N. (\9?>(y) Journal of Advanced Nur.sing 11,409-419 Comparison of two theorists on care: Orem and Leininger Dorothea Orem and Madeleine Leininger are two nursing scholars who are contributing significantly to the body of nursing knowledge. This paper contrasts their backgrounds, the origins of their theories., their views of the nature of nursing, use of theory development strategies, and contributions to nursing science. The concepts of Leininger's care and Orem's self-care will be compared as these relate to their theories with the examination of similarities and differences. INTRODLCTION The purpose of this paper is to compare and contrast the works of two nurse theorists, Dorothea Orem and Madeleine Leininger, from several perspectives. The origins of their theories, their views of the nature of nursing, their use of theory development strategies and their contribution to the development of nursing science will be explored. Within these areas of examination, this writer will focus on the concept of care as a theme since variations of the term "care' are central to the theories of both Orem and Leininger. A comparison of Orem and Leininger's use of the concepts care and self-care will be included. opment Conference Group, which examined nursing problems and research. The group members presented their work in the first edition of Concept Formation in Nursing: Process and Product in 1973, edited by Orem (Nursing Development Conference Group 1979). Orem's interest in curriculum development helped establish educational programmes which developed nursing scholarship and the art of helping. Leininger developed ideas on care theory in the mid-1950s, and cross-cultural care in the early 196O's while fulfilling doctoral requirements for a PhD in anthropology, and studying care from a nursing perspective. While in New Guinea. Leininger completed an ethnography and ethnoscience study of care in relation to the social structure and world view of the Gadsup people (Leininger 1985b). She discovered that care and health ideas are embedded in the world view, values and practices of the people. Since nurses were not prepared in anthropology or did not have a background in cross-cultural knowledge, it was difficult to communicate and share her evolving ideas ahout transcultural care and health with other nurses. From the mid-1960's through present time, she developed baccalaureate, masters, and doctoral courses or programmes in transcuttural nursing to educate nurses in the new field.
409

ORIGINS Since 1958, Orem (1980) began isolating problems which she viewed as specific to nursing. She identified distinctive nursing knowledge, defined boundaries of nursing, and theorized about when nursing is a legitimate service in her book Nursing: Concepts of Practice (Orem 1980). As a faculty member at the School of Nursing, Catholic University of America, she chaired a faculty committee, the Nursing Devel-

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Almost single-handedly, she founded the field of transeultuiai nursing and has remained active in education, research and publishing in thisarea(Leininger 1981. 1984a. 1984b. 1985a). Her publications, public addresses and field work have influenced many nurses' thoughts about cultural care. In 1973. she initiated the TranscuUural Nursing Care Conferences, and in 1978. the National Researeh Caring Conferences. She has been an active leader in encouraging nurses to use transeultural nursing concepts., principles, and practices in their work. Her theory and other scholarship attributes are being valued world-wide. Comparisons Looking ai Orem's and Leininger's approach to the development of nursing knowledge, there are both similarities and dilTerences. Orem moved primarily in an inductive direction. Rinehart (1978) describes this as a process of movement from the concrete particulars ol" experience to the abstract knowledge level. In her taped remarks from the Nurse Theorists Conference (1978). Orem deseribes how she came about the self-care idea as an 'aha' moment. She draws upon her e.xperience, as empirical generalizations, to eonceplualize that people need nursing only under certain conditions when they have self-care limitations. This inductive approach is illustrated by the Nursing Development Conference Group's description of a conceptual framework as a cognitive structure that results from the observations, inferences, insights, andeonceptualizationsiNursing Development Conference 1979). Orem's concept of self-care is unique and based upon her experience. Orem states that the Self-Care Deficit Theory of nursing 'expresses an accumulation of insights that integrate a variety of types of data from nursing praeliee situations' (Orem 1983). Her middle range theories of Self-Care Defieit and Self-Care and Nursing Systems were deduced from her macro-level conceptual model. There is also some further evidence of deduction in Orem's works as well. Rinehart (1978) describes deduction as the process of inferring conclusions from premises; deduction moves from the general lo the specific. For instance. Orem (1985) applies health requirements at Leavell and Clark's levels of prevention. She

makes frequent use of role theory to flesh out her conceptual model. Nevertheless, although Orem drew upon other sources, her concepts are her own. Leininger states that her theory eonceptual mode! is empirically grounded with anthropological roots (Leininger 1985b) and is based upon her cross-cultural professional experiences in the United States and overseas. The theory has derived elements from Redfield's (1957) world view, anthropological social structure, and functional theory (including symbolic and language environmental aspects). These components are closely interrelated as presented in the "Sunrise Theoretical/Conceptual Model of Transeultural Care Diversity and Universality' (Leininger 1985a) (Figure 1). Il isalsoa methodologieal process theory (Figure 2) as presented in "Leininger'sConceptual and Theory-Generating Model to Study Transeultural and Ethnocaring Constructs'(Leininger 1981). Leininger's (1985a) 'Sunrise' model has both inductive and deduclive components with multiple levels of abstraction. At the highest level of abstraction. Leininger speaks oi 'hypodeductive level of analysis'. It appears from her work that she is referring to deductive levels of abstraction by her method to arrive at discovering nursing knowledge. The researcher can begin at a macrolevel foeusing upon world view, social structure and other dimensions of cultural values. However, the researcher may chose to begin at an empirical inductive level to discover specific or discrete phenomenon. Thus, the researcher may use the "Sunrise' model to generate care from either an inductive or deduclive conceptual approach. The outcome is to discover cultural care and health patterns, processes, and lifestyle needs of individuals, families, or cultural groups, either from an etic (universal) or emic (folk) viewpoint (Leininger 1985c). She favours emically derived data to provide a substantalive base of nursing knowledge. However, the researcher may develop hypodeductive theories and study phenomena related lo components in the 'Sunrise' model. Central to Orem's work is her concept of self-care, and central to Leininger's work is the concepl(s) of care/caring. How do these concepts differ? In what way are they alike? A brief discussion of the typical uses of the concept(s) of care/caring in ordinary language will follow.

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CARE/CARING-ORDINARY LANGUAGE Care and caring evoke a variety of responses. On one hand afTection comes to mind in such statements as 'I really care for Earl and want to marry him'. In contrast, anxiety and worry come to mind in the following statement: 'I care that Mrs Jones has not received her breakfast yet". Care can also mean caution, i.e. 'Ride that motorcycle with care'. The connotations responsibility and protection are assumed by the statement, 'The children under my care demonstrate an above average level of development progress'. Concern and interest are shown with "I care that Mrs Jones recovers from surgery without complications". Taking precaution is illustrated by i am taking care that Mrs Smith does not burn herself in the bathtub'. Additionally. "I will give Bobby his morning care' implies assistance. The notion of comfort is also understood with care and caring such that contentment and pain relief are implied. Caring can also help someone to become self-actualized (Mayeroflf 1971) through patience, honesty, trust, humility and hope. The two general categories in Table 1 encompass examples of identified care/caring indicators and both categories appear useful. Further, these categories may be separate such that a care/caring attitude may not produce taking responsibility, and taking responsibility may not accompany any care/caring attitude. For instance, having a concern about a neighbour may not result in giving assistance. Protecting Mr Jones by pulling him away from a speeding car does not guarantee a care/caring attitude. Research is needed to clarify whether the concept(s) of care/caring require both

attitude and taking responsibility for true care/ caring to occur. Orem's and Leininger's, conceptual models and theories will be further scrutinized for their interpretation of care/caring in the next section. CONCEPTS CARE/CARING, SELF-CARE: COMPARISON It is of interest that Orem addresses the word care in the latest edition of her book Nursing: Concepts of Practice (1985). Orem places care within an interpersonal framework as one person 'in charge of helping another person to meet needs. She gives nursing care, medical care and child care as examples. She views care as a 'state of mind'. She believes that nurses can be involved in both connotations simultaneously, or only one. Orem believes that care is a general term which includes the commonalities of interpersonal, helping and regulation, and is not unique to nursing. These general characteristics, called care/caring are also part of other disciplines providing care. According to Orem what is unique to nursing is the provision of self-care. The concept of self-care will be examined as the major concept of Orem's theory. Orem (1985) defines self-care as "the production of actions directed to self or to the environment in order to regulate one's functioning in the interests of one's life, integrated functioning, and well-being'. Central to her conccpt is the notion of action by the individual on behalf of him/ herself (Orem 1985). The Nursing Development Conference Group (1979) concludes that selfcare is conduct, ego-processed, learned in an interpersonal context, a right and responsibility, and is described subjectively. Finally. Orem (1985) refers to self-care as an 'action system or a dynamic process' and specifies that it is deliberate. It would seem that Orem's concept of selfcare fits primarily into the category (Table 1) of taking responsibility or actions. It is noteworthy, however, that it is the person/client who is the actor for self-care. It is not evident that Orem intended self-care to focus on the attitude category of Table I. While an individual's self-concept could include several of these factors. Orem (1985) is less

TABLE I Categorizing care/caring terms

.Alliluck

Taking Res

Artec I ion Anjiieiy Caution Concern Inieresi

Assistance Com for I Precaution ProiectLon SupiJorl self-aclualization

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,/. N. Rosenbaum

explicit on these in terms of seli-care. However, her universal self-care requisite which requires maintenance of general well-being would address a psychological self-concept of well-being. Leiningcr (1985c) defines care/caring as follows. Care, as a noun and in a generic sense, refers to ihc
assistunl. supportive or facililaiivep/it'/Kw/cHw toward or tor another individual or group wiih evidcni or aniicipatcd needs Lo ameliorate or impnivc a human condition or lifeway. Caring, as a verb, refers to ihe acriom made to assist, support or facilitate another iiiJividual or group with evident or anticipated needs to amelioriitc or improve a humLin condition or lifeway.

Leininger has been concerned that nurses have used the term "care" without understanding its meaning and differing expressions with persons of diflerent cultures. Care-specific and care-universal dimensions must be identified and studied as well as folk and professional care practices to advance nursing knowledge of care.

TA HI I- ^ l.cminger's nuijcr ia.\imiimii- caring l

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Taking respunsibiliU

Care caring is centra! to Leininger's (1981, J984a) theory. It is the central, unifying and dominantdomainofnursmg. Care is essential for growth, development, and survival. Leininger .searches for both universal aspects of human care cross-culturally and for specific care that may be particular to a culture, individual, family or institutions. While care may be found to be generic to all human beings, it appears to have some differentiating features for nursing, medical, and other health practices for clients of diverse cultures. Leiningcr places emphasis on the care and caring modes for nurses and nursing. She states care "is essential to human health and is the unique and major feature that distinguishes nursing from other disciplines'. She states that there are differences in care and cure phenomena with this important statement: 'there can be no curing without caring, but there may be caring without curing". This quote gives credence to her belief that all professional groups may use caring modes, however it is primarily nursing which has caring as its unique focus. By uniqueness, she is referring to centrality rather than exclusivity. Leininger (1984) believes that care is a universal human phenomenon, but that caring patterns vary among cultures. Care has biophysical, cultural, psychologic, social and environmental dimensions. To date, 70 care constructs have been identified among different cultures, but the forms and expressions of care vary (Leininger 1984). Leininger has classified a number of these constructs as a taxonomy in the phase 2 portion of the process theory (Figure 2). These constructs are included in her three broad categories of assistive, supportive, and (acilitative phenomena identified in her definition of care.

Compassion tongtrn bmpalhy Invoivenifnl Love Surveilluncc Tenderness Trusl

Com furl Coping behaviours Lnabling Heuhli consullalivi: acts Health instruciiun acis Healih maintenance aclii Helping behaviours Nurturance Presence Protective behaviours Restorative behaviour*; Sharing Stimulating behaviours Stress alkviation Succouranue Support

Using the categories presented in Table 1, Leiningcr's (1981) constructs can be classified as atiitude or taking responsibility (Table 2). Leininger (1981) acknowledges the increasing emphasis in the USA on self-care because Americans value self-reliance, but cautions that this is a western phenomenon and not always appropriate for other cultures not valuing self-care. In summarizing the use of care/caring by Orem and Leininger. it could be said that Leininger's scope is broader to include worldwide care. She includes care/caring beyond the interpersonal level to include families, groups and different cultures. Leininger focu.ses on both attitude and responsibility taking while Orem focuses on responsibility taking. Orem's (1985) intentions are to address western needs, therefore she focuses upon self-care which is closely related to western values of self-reliance, freedom, and independence.

Orem and Leininger

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Leininger and Orem have different purposes which Ihey both successfully achieve with their care/caring, self-care concepts. Orem focuses on clinical self-care; Leininger is searching for world-wide human care meanings.

NATURE OF NURSING Orem sees nursing as a science, technology., art, and a helping service given to persons with a legitimate need for it by nurses who have specialized knowledge and skills. Nurses help clients meet existing or anticipated demands for seifcare (Orem I9K5) in order to "sustain life and health, recover from disease or injury and cope wilh their effects". The nurse's primary focus is on individuals. with actions focused upon three possible nursing systems: the wholly compensatory system. the partially compensatory system, and the supportive-educative system. The nurse gives assistance by the following methods: acting for. guiding, supporting, and providing an environment which promotes personal development, and teaching. The nurse's relationship with her client is a complimentary one whereby the client is helped to assume responsibility for his/her own self-care. Nursing intervention is necessary to combat deficiencies in care. The nurse acts in collaboration with the client, when possible, to reduce the deficit, unless a wholly compensatory system is in operation. Nurses provide self-care and guide individuals to move toward selfcare. The result is to increase client self-care

agency with the ultimate goal of structural and functional wholeness. Leininger (1985b) challenges the usual four identified concepts (Fawcett 1984) ofthe nursing metaparadigm. In contrast to Flaskerud and Halloran (1980) who believe that the nursing metaparadigm must include the concept of nursing, she firmly contends that nursing cannot logically be a part of the metaparadigm as described by Fawcett (1984) for several reasons. Leininger (1985b) states that 'when you are trying to identify a phenomenon you cannot use thaE same phenomena'. It is a redundancy in terms. Since care is so central to nursing, if there is any concept which should be part of the nursing metaparadigm then it is logical to include care which is nursing's focus. According to Leininger, nursing is both scientific and humanistic, and goes beyond individuals to include families and cultural groups (i.e. corporations in Japan). Nursing is futuristic, directed to one world with many cultures. Nursing can bridge the gap between folk systems and professional systems through three types of nursing care actions. These are cultural care preservation which maintains, accommodation which enables adjustment or adaptation, and repatterning which refers to alteration. These "principles' which govern nursing decisions can refer to client or nurse. Either the client may repattern or the nurse may repattern (Leininger 1985d). Leininger (1985c) sees nursing to be a profession and a discipline of importance to wellbeing, growth and development, health lifestyles, recovery from illness and peaceful death. She

TABLE 3 Nanirt' c/ nursing - summary

Orem Individuals Nurse helps clienl meel e;(isting or aniigipaleii demands for self-care in order lo sustain life und heiillh. recover from disease or injury and cope wilh iheirefTecK. Provision of self-tare which is iherapculit. Nurse directs action lo gel individual lo meel own needs.

Lcininger Individuals, families, cullural groups, inslilulions. Nurse promoies well-being, growlh and development, health lifeslyle. recovery from illness and peaceful deuth through care expressions and actions. Care(canng) is the focus of nursing (ccniral to nursing but nol exclusive to nursing). Care conslruels directed by nurse to clienl. Clienl involvement is culturally defined, determined and expressed through values, beliefs iind practices.

Focus Goal of nursing

Uniqueness of nursing Clicnl involvemcni

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has geared her research to generate both basic and applied knowledge vviih specific goals for each category of knowledge. Leininger's (1981) care constructs include both scientific and humanistic ways for nurses lo intervene. USE OF THEORY DEVELOPMENT STRATEGIES Using Fawcett's (1980) distinctions between conceptual models and theory, Orem's and Leininger's frameworks will be examined. Orem has both a grand theory with a global orientation referred to as her conceptual model and also a theory. Her general theory of nursing which includes the theories of Self-Care Deficit. Self-Care and Nursing System(s) meets Kerlinger's definition of a theory which Fawcett quotes as 'a set of interrelated constructs (concepts), definitions, and propositions that present a systematic view of phenomena by specifying relations among variables" (Fawcett 1980). Fawcett omits a critical portion of Kcrlinger's definition which must be added for consideration "with the purpose of explaining and predicting the phenomena" (Kerlinger 1973). In general. Orem's theories do meet these criteria. However, there are some difficulties with propositions meeting the definition of 'a relationship between variables asserted by the theory' (Roy & Roberts 1981) since a number of the propositions are not relationship statements. Leininger's 'Sunrise' theoretical/conceptual model is a combination of grand theory at the macrorange. theory at the middle-range, as well as microrange. She has also generally met Kerlinger's criteria for theory. She, too, has some propositions which do not specify all relationships between all actual and potential variables. Since her theory is in a state of further refinement, it is likely that revisions will continue. In fact, many variables may yet be discovered after theory provides a broad framework to state more definitive relationships which will emerge. Both Orem and Leininger have deduced their theories from their conceptual models and Leininger has also deduced empirically testable hypotheses. Both of these theorists have conceptual frameworks which act as guides for research, practice and curricula (Fawcett 1980), Orem has appropriately used theory synthesis

to develop her theory and she has drawn upon her empirical observations as her primary base. Her purposes for theory synthesis seem to be consistent with Walker & Avant's (1983) list of purposes. Orem has theorized what precedes self-care, what arc the effects of self-care, and she has tied this together with how persons can be helped through nursing. She did this, as Walker and Avant suggest, by organizing relational statements, explaining and predicting. She has met the requirements for the use of at least three concepts for her work to be considered theory synthesis in contrast to statement synthesis (Walker & Avant 1983). Orem has included the basicsteps of specifying focal concepts (i.e. self-care, self-care deficits, self-care agents, etc.). She has cited broad references in the literature and has organized her statements to reflect the theory. It would seem that Orem has been generally effective with theory synthesis. Leininger's work is a blend of theory synthesis and concept derivation. Her synthesis begins empirically with observations of transcultural caring phenomena. While Leininger (1978) states that the purpose of her theory is 'to determine the universal and nonuniversal modes of caring behaviour of cultures as a scientific and humanistic base for transcultural nursing theories and practices', she also describes what precedes and results from care, her focal concept. She has also met Walker & Avant's (1983) requirement fora minimum of three concepts to be considered theory synthesis. Leininger's concept derivation comes from her use of anthropological and clinical nursing concepts to explain and predict nursing. She has needed to modify transcultural phenomena to be meaningful to nursing hence it is derivation rather than borrowing. For instance, she has derived the concept ethnonursing from enthnography. Ethnography refers to the total Ufeways of a people. Ethnonursing focuses on selective components of the lifeways which are of special interest to nursing, like health, care and illness. By redefining concepts from anthropology to fit nursing, she has actually created innovative concepts {Walker & Avant 1983). It was particularly appropriate to use concept derivation becau.se Leininger began her work in the I960's when there was little concept development nursing. She skillfully built upon her own

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expertise in anthropology to add to nursing knowledge. The concept derivation itself did not Help with explanations and predictions because there are no relationship statements expected at a that level. It is these derived concepts which have become the building blocks of her theory. CONTRIBLTION TO THE DEVELOPMENT OP NURSING SCIENCE The usual question raised is "What is nursing science?" Andreoli & Thompson (1977) believe that nursing science, still in its formative stage, will achieve ihc status of a science when it has a verifiable knowledge base. Ellis (1982) states that both theory construction and research together develop scientific knowledge, but the nature ofthe question and phenomena determine the method. She values both discovery and validation and believes that premature emphasis on formal research methods may hamper discovery. Nevertheless, theory must have an actual or potential link to observables to be considered scientific. She agrees with Andreoli & Thompson that scientific knowledge must be verifiable. Munhall (1981) questions the traditional glorification ofthe scientific method for nursing because nursing philosophy includes humanism, holism, individualism, and organicism in opposition to the thrust of nursing research which includes reductionism, mechanism and commonalities. To her, reality cannot always be reduced to the measurable. Hence, she advocates qualitative approaches to the development of nursing science. Newman (1983) concurs with Munhall that certain aspects of human experience cannot be studied out of context and other broader methodologies should be considered. Leininger (1985a) has been a firm advocate of qualitative research since the early 1960*s from her cross-cultural research on care. Silva & Rothbart (1984) believe that it is an anachronism to focus on logical empiricism in nursing when this contradicts the present philosophical thrust of holism. They also suggest a variety of other methodologies for scientific progress. They embrace Laudan's (1977) premise thai the test for a theory is "whether it provides acceptable answers to interesting questions: whether, in other words, it provides satisfactory solutions to important problems'.

Both Orem and Leininger provide answers to interesting questions which are viewed as important in the discipline of nursing. Orem (1985) asks and then answers ihe following questions. Why is nursing required? Why is self-care necessary for life? How can persons be helped through nursing? These are useful, important questions and their solutions add substantially to nursing knowledge. Through much of her work which has an applied clinical focus, Orem sought practical solutions to nursing problems. Her theories may be classified as middle-range according to Rinehart's (1978) discussion of scope. While the breadth or extent of her theories demonstrate a set of phenomena at the middle-range, her conceptual model from which ihe theories were deducted, may be classified at Rinchart's macrolevel. Leininger does not seek lo solve problems, but asks questions about the nature of nursing and its distinctive features. Orem fulfils Hardy's (1974) criteria for high generality such that Orem's theories are applicable in many clinical and educational nursing situations in the western world. Clients coming from cultures which do not value self-care would not be appropriate for an Orem nursing mode, Orem's self-care deficit theory predicts nursing requirements, hence Orem's level of theory has reached the level of development of predictive, situation relating (Dickoff& James 1968). It has not yet reached the situation producing level since manipulation and control must follow more instrumentation development and further operationalizing of her concepts. Orem has generated much interest in nursing circles. General articles explaining her model and describing applications have been plentiful (Michael & Sewall 1980. Facteau 1980, Harris 1980, Kinlein 1977, Bromley 1980, Backscheider 1974). Her conceptual model has been used with diabetic clients, with clients who have had enterostomal therapy, with hospitalized children, with alcohol abusers, and with clients who required caesarian deliveries.
Research instruments

Research instruments to measure Orem's concepts are being developed and critiqued (Clinton

J. N. Rosenhaum

et ai. 1977. Kearney & Kleischer 1979. Isenberg I985).Thisinstrunientiitionisan important contribution to fulfil the requirement of testability. Leininger (19850) has also greatly contributed to nursing science because she too is providing acceptable answers to interesting questions. She indicates that her cultural care diversity and universality theory e.xplains and predicts relationships with individuals, families, groups and institutions of different cultures, regarding their health and care patterns, and postulates general principles for congruent nursing care. Her theory is also at DickofT & James's (1968) situation relating level, but dealing broadly at a cross-eulturai relating level. Leininger (1985a) has both a basic science focus and an applied professional focus. She believes that it is necessary to have an early discovery of substantive knowledge using qualitative methodology, as well as a later application to practice situations. She has classified ethnocaring constructs with the eventual goal of determining nursing interventions based upon research findings (Leininger 1981). As for scope. Leininger's work has multiple levels of scope dealing with human cultures and nursing worldwide. She has a broad macrolevel (etic analysis), middle range (emic analysis) and, a concrete empirical level. Her 'Sunrise" model pictorially depicts these multiple theoretical levels. Leininger's work has wide generality since it is even more applicable than Orem's. Selected care constructs arc suitable world-wide and in any clinical situation. Her viewpoint would also be sound in nurse education settings. The research potential is very promising particularly for cross-cultural comparisons. Leininger's conceptual model gives directions to interesting research. Her own and other transcultural research studies address many current issues. For instance Leininger examined southern rural blacks and white American care phenomena (Leininger 1984). Weiss (1984) studied gender-related perceptions of caring in the nurse-patient relationship. Dugan (1984) studied caring phenomena among Latinos. Wang's (1984) researeh involved Appalachian people. Field (1984) studied client care-seeking behaviours. These researchers who have based their studies on Leininger's conceptual model.

have sought solutions to problems which are important to nursing. Leininger has developed several instruments which organize inquiry for her qualitative methodology. Examples are 'Leininger's Ethnocare and Ethnohealth Lifestyle Interview Tool', and Leininger's Care/Caring Inquiry Form'. Her methodology is primarily ethnographical, ethnonursing. and ethnological to approach caring from inductive and deductive levels. Leininger is planning analysis and testing of her theory in phase 3 of her work (Figure 2) to contribute lo nursing science with both discovery and viilidation. SUMMARY In summary, this paper has contrasted the works of two significant nurse theorists Dorothea Orem and Madeleine Leininger. There has been an exploration of their origins, with special emphasis placed on the concepts care/ caring and self-care, and the comparison of the use of these concepts. Their views regarding the nature of nursing, their use of theory development strategies, and finally, their contribution to the development of nursing science were discussed. Both Orem and Leininger should continue to lead nurses in expanding nursing to become a truly scientific and humanistic discipline.
References
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Orem and Leininger

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