A. Background
The theory of Self-care Deficit was developed by Dorothea Orem. This theory states that a self-care deficit occurs when the patient or the guardians of dependents are unable to meet the requisites for self-care (Edney, Jaime & Young, n.d.). When this happens, nursing help is needed. More specifically, nursing care is used to help people enhance their self-care abilities, which they would need for survival and for maintaining their well-being and their quality of life.
Born in Baltimore, Maryland in 1914, Orem completed her diploma program from the Providence High School of Nursing and later received her bachelor’s and master’s degree from the Catholic University of America in Washington, DC (Instructor Ashley, 2010). She also completed several doctorate degrees. She worked as a consultant to the Office of Education in 1958 (Instructor Ashley, 2010), but she also had work experiences as a nurse educator, private duty nurse, and staff nurse (“Dorothea Orem's Self-Care Theory,” 2012).
The development of the theory began in the 1950s when the bases of nursing education program curriculums were conceptual models from sociology, psychology, and medicine (Fawcett, 2001). With no solid or direct basis for nursing education, Orem pioneered the development of distinctive nursing knowledge. More specifically, the development of the theory came about from her initiatives to upgrade curriculums for practical nursing programs. This task involved the identification of the boundaries and domain of nursing as an art and a science. In this regard, the theory was developed in order to solve the problem of the lack of specification of an agreement about general nursing elements that provide directions for isolating nursing-specific problems and the problem of organizing knowledge that is obtained from research in problem areas (Fawcett, 2001).
Orem obtained the ideas for the theory from her intensive exposure to nurses and their endeavors from 1949 to 1957 (Fawcett, 2001). She served as a nursing consultant in the Division of Hospital and Institutional Services of the Indiana State Board of Health during this time and she developed the idea that nursing involved both a mode of communication and a mode of thinking (Fawcett, 2001). Her ideas then evolved from a global focus on preventive healthcare to a formal search for developing a knowledge of nursing that would deepen and enlarge its meaning and for identifying a proper nursing focus. Orem aimed to identify what nurses do and what they should do as nursing practitioners; why they do what they do; and what the results are from what they do as nursing practitioners.
Her theory was first published in the book Nursing: Concepts of Practice in 1971, as well as in later editions of the book in 1980, 1995, and 2001 (“Dorothea Orem's Self-Care Theory,” 2012). Work on the theory continued due to the concern and dissatisfaction over “the absence of an organizing framework for nursing knowledge and the belief that a concept of nursing would aid in formalizing such a framework” (Fawcett, 2001, p. 34). Changes that were made on the theory included refinements of the expression, the development of substantive structure, and continued validations. However, no changes were made on the theory’s conceptual elements.
B. Analysis
Orem used the induction approach in developing the theory. With this approach, the theorist moved from specific observations to broader theories or generalizations (Trochim, 2006). In particular, the theorist began with specific measures and observations from which she detected regularities and patterns and then formulated tentative hypotheses that could be further explored before general conclusions or theories were developed. More specifically, Orem based her theory on her observations of nursing practice when she herself worked as a nurse in various nursing fields and on her analysis of nursing care materials. However, it can be said that she also used the deduction approach, which began from the general and moved to the specific, in that the development of the theory was also based on her previous knowledge and beliefs with regards to motivation and deliberate human actions. She would have also gained much of her general knowledge from the nursing theory conferences she attended, the women’s movement, and her knowledge about practical nursing curriculum development (El-Kader, n.d.).
The major concepts of the theory are theoretically defined and their definitions have not changed throughout the development of the theory. The theorist has also been consistent in their use. In particular, these concepts are self care, self-care agency, basic conditioning factors, therapeutic self-care demand, self-care deficit, nursing agency, and nursing system (Gonzalo, 2011).
Self-care refers to the practice or performance of functions that people perform or initiate for the maintenance of their well-being, health, and life (Gonzalo, 2011) while self-care agency refers to the power or ability of people to exercise self care (Gonzalo, 2011). This ability in turn is influenced by the basic conditioning factors, which include resource adequacy and availability; environmental factors; patterns of living; family system factors; health care system factors; socio-cultural orientation; health state; developmental state, gender, and age (Gonzalo, 2011).
Therapeutic self-care demand refers to “the totality of self-care actions to be performed for some duration in order to meet known self-care requisites by using valid methods and related sets of actions and operations” (Gonzalo, 2011). On the other hand, self-care deficit describes a situation or instance that requires nursing care, that is, when a patient or a patient’s guardian becomes incapable of or restricted in providing effective and continuous self-care.
Nursing agency refers to the complex attribute or property of individuals with nursing education and training, which enables them to know, act, and help people who meet their therapeutic self-care demands through the exercise or development of their own self-care agency (Gonzalo, 2011). Finally, nursing system is “the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing” (Gonzalo, 2011).
These concepts are related in that people exercise self-care to maintain their health. This is based on their self-care agency, which is also influenced by their basic conditioning factors. If these factors prevent them from exercising self-care them a self-care deficit occurs, which results in a therapeutic self-care demand. This demand is met by an individual who has the required nursing agency. In turn, all of these concepts or elements make up the nursing system.
The Self-care Deficit Nursing theory is a grand theory because it provides an overall explanation of how health and the quality of life can be promoted from the perspective of self-care. It is not specific to any health condition or patient demographic; rather, it is applicable to all patients and to all nursing practitioners. It provides an explanation that is common to all nursing situations and not just to an individual situation (Fawcett, ,2011). Moreover, its concepts and principles can be applied in all levels of education (Fawcett, 2001).
This theory can also be classified as both a developmental model and an interaction model (El-Kader, n.d.). It is a developmental model in that it is used for the development of nursing education curricula. However, it can also be classified as an interaction model because of its emphasis on the interactions between the nurse and the patient; between the nurse and the patient’s family; and between the patient and their environment.
C. Evaluation
Orem held the ecological worldview, which centers on the belief that people’s values have a direct impact on their perception of life patterns and on their interactions with nature (Heuerman & Olson, 2013). This worldview believes in humans’ cooperation with the environment and with each other. It also believes that what matters is one’s authentic relationship with the whole (i.e. nation, organization, or family) and that people work with the environment in gaining an understanding. It also believes that growth is limited, that sustainability is important, that technology cannot solve all problems, and that economic determinism is not common sense (Heuerman & Olson, 2013).
In this regard, Orem reflected this worldview in that she emphasized that people and the environment interact as a self-care system and that a change in either the system of man or the system of the environment affects the self-care system (El-Kader, n.d.). She also believed that the functioning of man is linked to his environment and that man and the environment together form an integrated system. More specifically, Orem emphasized the relationships and interactions between the nurse and the patient and the nurse and the patient’s family as a way of helping the patient cope with their limitations and with the constant changes in their environment. She believed that the requirement for nursing arose from human limitations for self-care that are associated with health situations (Fawcett, 2001).
This worldview is also reflected in the assumptions that were made in the development of this theory. For example, one assumption is that humans continuously communicate and interact with each other and with their environments in order continue to function and survive (Gonzalo, 2011). In addition, there is the assumption that humans exercise their power to act deliberately in order to identify their needs and make the necessary judgments (Gonzalo, 2011). As well, it is assumed that mature individuals “experience privations in the form of action in care of self and others involving making life-sustaining and function-regulating actions” (Gonzalo, 2011). Moreover, it is assumed that human agency is exercised in the discovery, development, and transmission to other means and ways in order to make inputs into and identify the needs for the self and others (Gonzalo, 2011). Finally, it is assumed that “groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members who experience privations for making required deliberate decisions about self and others” (Gonzalo, 2011).
It is clear how these assumptions reflect the core beliefs of the ecological worldview, particularly the cooperation that is needed among humans as well as the cooperation between humans and the environment. They also reflect the belief in the importance of the whole, particularly with the assumption that we are responsible for each other. Finally, it is clear how the assumptions reflect the belief in sustainability as self-care is a sustainable way of promoting and maintaining health. Finally, it is also clear how the assumptions use a natural or organic approach to the provision of care and does not focus on the use of technology in providing care.
The theory also contains a description of the four metaparadigms of nursing, namely the person, health, environment, and nursing (Johnson, 2013). In particular, the person refers to the adult who is incapable of self-care or to the child or dependent whose parents or guardians are incapable of providing them with effective self-care. In this regard, health is described in the context of the person’s ability to provide self-care. On the other hand, the description of the environment is generally implied in the theory, although the environment that is specifically described is the condition or environmental factors that restrict a person’s capability for self-care. Finally, the theory describes the need for nursing care as being determined by the occurrence of a deficit in self-care.
The writer was able to gain a good understanding of the theory due to the simplicity and lucidness of the terms and expressions used as well as the straightforward structure of the theory statements. The internal structure of the theory was also logically congruent, especially since the theorist provided definitions for all the major concepts and subconcepts and also described the modes of helping, which would enable nursing practitioners to successfully employ the principles espoused by the theory. In addition, the theory does not reflect more than one contrasting worldview as the principles and assumptions indicated and implied by the theory all stayed true to the ecological worldview. As well, it can be said that the components of the theory logically translated into diverse perspectives. As previously discussed, the Self-care deficit theory is a grand theory, which principles or propositions apply to common nursing situations, that is, it is all-encompassing and not restricted or limited to specific nursing situations, health conditions, or patient demographic.
D. Application
The Self-care Deficit theory leads to nursing actions in that the nursing process enables the determination of self-care deficits and the definition of the nurse’s or the person’s role in meeting the self-care demands (“Dorothea Orem’s Self-care Theory,” 2012). Moreover, while the nursing process steps comprise the technical component of the nursing process, they must still be coordinated with the social and interpersonal processes within nursing situations.
This theory is also used to describe, explain, and control in nursing. For example, there are patients who perform self-care in their homes but would require the nurse’s assistance when they go for their hospital checkups. As a concrete example, a pregnant woman spends most of the time resting at home and practicing self-care. However, when she goes for her checkup then the nurse might assist her on the wheelchair (i.e. control). The nurse may also describe the procedures being performed on the pregnant woman and the nurse may also explain to the pregnant woman what she should and should not do during her pregnancy.
One research article that employed the self-care deficit theory is the Evidence on self-care support within community nursing by Macduff and Sinclair (2008). The researchers aimed to determine the extent and nature of support for patient self-care based on district and family health nursing casenotes. The authors conducted a qualitative case study and used audit methods to review forty-seven casenotes on six long-term conditions in three Scottish sites. The results showed that there is inconsistent evidence that supported the provision of self-care across different long-term conditions and across different sites (Macduff and Sinclair, 2008).
For future research, it is recommended that a study be conducted to determine how self-care can be more effectively promoted through patient education. It is also recommended that a study be conducted to determine how effective nurses are in determining self-care deficits and what can be done to improve any inefficiencies. Finally, it is recommended that a study be conducted on the attitudes and perceptions of nurses regarding self-care and how these affect the quality of care they provide.
References
Dorothea Orem's Self-Care Theory. (2012). Retrieved from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html.
Edney, K., Jaime, N. & Young, L. (n.d.). Dorothea Orem's self-care theory. Retrieved from https://sites.google.com/site/oremstheory/.
El-Kader, N. A, (n.d.). Self-care deficit theory: Dorothea Orem. Retrieved from http://ocw.up.edu.ps/repositories/pdf-archive/New%20orem%20theory.pdf.
Fawcett, J. (2001, January). The Nurse theorists: 21st-Century updates—Dorothea E. Orem.
Nursing Science Quarterly, 14(1), 34-38.
Gonzalo, A. (2011). Dorothea E. Orem: The self-care deficit nursing theory. Retrieved from http://nursingtheories.weebly.com/dorothea-e-orem.html.
Heuerman, T. & Olson, D. (2013). Worldviews. Retrieved from http://www.thephora.net/forum/showthread.php?t=31678.
http://nursing301.blogspot.com/2010/09/history-of-dorothea-orem.html.
Johnson, W. (2013). Four basic metaparadigm concepts in nursing. Retrieved from http://www.ehow.com/list_6106429_four-basic-metaparadigm-concepts-nursing.html.
Macduff, C. & Sinclair, J. (2008, April 3). Evidence on self-care support within community nursing. Nursing Times, 104(14), 32-33.
Trochim, W. M. K. (2006, October 20). Deduction & induction. Retrieved from http://www.socialresearchmethods.net/kb/dedind.php.
