NSG/415 Week 2: Comparing Grand Theories, sample paper

Handing Over the Insulin Pen: Orem's Self-Care Deficit Theory and King's Theory of Goal Attainment Compared for a 15-Year-Old With Type 1 Diabetes

[Student Name]

University of Phoenix

NSG/415: Theory-Based Nursing Practice

Week 2 Assignment

[Instructor Name]

[Date]

The patient, family and clinic are a composite written for a model paper. No real patient is described.

A composite 15-year-old boy was diagnosed with type 1 diabetes in fourth grade. Until this year, his mother counted carbohydrates and calculated his insulin doses. Now in high school, he wants to manage his diabetes himself, and his parents have agreed. At a clinic visit, his hemoglobin A1c, 7.4% last spring, is now 9.1%, and his glucose meter shows missed checks at lunch and several skipped doses. He says he is tired of everyone "checking up" on him. The clinical problem is a rising A1c; the nursing problem is how responsibility for a lifelong condition moves from a parent to a teenager without the teenager being harmed in the handover. This paper compares two grand theories that offer different answers to that problem.

Orem's Self-Care Deficit Theory

In Orem's account, self-care is deliberate action people take for themselves to sustain their own life, health and wellness (Orem, 2001). Her theory has three connected parts. The theory of self-care describes the requisites every person must meet, universal, developmental and health deviation requisites. The theory of self-care deficit states that nursing is needed when a person's self-care agency, the capacity to engage in self-care, is not adequate to meet the therapeutic self-care demand. The theory of nursing systems describes three ways nurses respond: wholly compensatory, in which the nurse does for the patient what the patient cannot; partly compensatory, in which the work is divided between them; and supportive-educative, when the patient can perform self-care with teaching and support.

For this boy, the therapeutic self-care demand is large: monitoring glucose several times a day, counting carbohydrates, calculating and giving insulin, adjusting for exercise and recognizing low blood glucose. His self-care agency is developing but incomplete; he knows how to do each task but does not yet do them consistently. Orem's theory frames the situation as a deficit and suggests a partly compensatory system shifting toward a supportive-educative one: the nurse and parents keep some responsibility while teaching and supporting him until his agency matches the demand. Orem also recognized dependent-care agents, people such as parents who meet self-care needs for those who cannot, which gives his mother's role a place in the theory.

King's Theory of Goal Attainment

King (1981) described three interacting systems, personal, interpersonal and social, and developed the theory of goal attainment within the interpersonal system. The theory holds that nurse and patient interact, perceive each other and the situation, communicate and, through transaction, mutually set goals and agree on means to achieve them. When perceptions are accurate and goals are mutually set, goals are attained, and goal attainment leads to satisfaction and growth. Key concepts include perception, communication, interaction, transaction, role, stress and growth and development.

For this boy, King's theory frames the visit as an interaction in which the nurse and the teenager must perceive each other accurately and agree on goals. His statement that he is tired of being checked up on is data about his perception: he experiences his parents' and clinicians' involvement as a threat to his independence. King's theory suggests that the nurse's first task is to understand that perception and then to negotiate goals he accepts, such as checking his glucose before lunch four days out of five, rather than imposing the full regimen.

Comparing the Theories

The theories differ in their view of the patient, the nurse's role and the goal. Orem sees the patient as a self-care agent whose capacity may be deficient; the nurse assesses the deficit and designs a system to fill it; the goal is self-care adequate to meet the demand. King sees the patient as a partner in an interaction; the nurse's role is to perceive, communicate and transact; the goal is mutually agreed and attained.

Each reveals something the other obscures. Orem's theory is strong at breaking the task into requisites and matching support to capacity, which helps the team see that the boy may need a structured, gradual transfer rather than all-at-once independence. It also includes the parent as a dependent-care agent. But its language of deficit can sound to a teenager like another adult judging him, and it says little about the negotiation needed when a patient disagrees with the plan. King's theory is strong on exactly that negotiation: it treats his desire for autonomy as legitimate data and makes mutually set goals the mechanism of change. It is weaker at specifying the technical demands of the regimen, which must still be met for his safety.

Which Theory Fits Better

For this transition, King's theory fits better as the primary frame, supported by Orem's structure. The central problem is not that the boy lacks knowledge or skill; it is that he and the adults around him disagree about control, and his adherence is falling as a result. Adolescence is a period in which autonomy is a developmental task, and the diabetes standards for youth recommend gradually transferring responsibility with continued adult involvement and attention to psychosocial needs (American Diabetes Association Professional Practice Committee, 2025). King's emphasis on perception and mutual goal setting speaks directly to this. Orem's categories can then organize the specific tasks within the goals the boy agrees to.

What the Nurse Did

At the visit, the nurse spoke with the boy alone first, asked what diabetes got in the way of and learned that he skipped lunch checks because he felt embarrassed in the cafeteria. Together they set two goals for the next month: checking with a continuous glucose monitor he had previously refused, which would avoid finger sticks at school, and giving his own lunch dose with a phone reminder. His parents agreed to stop asking about every reading and to review the monitor data with him once a week. The plan transferred responsibility on his terms while keeping a safety net.

Conclusion

Orem's self-care deficit theory and King's theory of goal attainment offer different lenses on a teenager taking over his diabetes care. Orem clarifies the tasks and the gap between demand and capacity; King clarifies the interaction and the need for mutually set goals. Because this boy's rising A1c reflected a struggle over autonomy more than a lack of skill, King's theory fits better as the guiding frame, with Orem's structure organizing the tasks within the goals he chose.

References

American Diabetes Association Professional Practice Committee. (2025). 14. Children and adolescents: Standards of care in diabetes-2025. Diabetes Care, 48(Suppl. 1), S283-S305. https://doi.org/10.2337/dc25-S014

King, I. M. (1981). A theory for nursing: Systems, concepts, process. Wiley.

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