Among the grand nursing theories of care, the work of Dorothea Orem stands out as one of the most recognized and applied models in healthcare. Orem was born in Baltimore, MD, in 1914, but she started working as a nurse in Washington, DC, after getting a diploma from Providence Hospital School (Alligood, 2017). After that, Orem also received a bachelor degree and a master’s degree in Nursing Education from Catholic University of America (CUA) in the 1940s (Alligood, 2017). The future theorist worked as a nurse in many different settings, gaining experience in operating rooms, adult and pediatric surgical units, home and hospital nursing, emergency rooms, and biological science lessons.
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As an outcome, Orem gained significant knowledge about nursing education, and her career took a course for managing and political roles. Throughout the 1940s, Orem was a director of the Department of Nursing and the nursing school of the Providence Hospital in Detroit (Alligood, 2017). Later, she moved to Indiana, then back to Washington, DC, to work with at the Office of Education in the US Department of Health, Education, and Welfare (Alligood, 2017).
Starting in 1959, Orem has started to develop her nursing theory, which was interested in finding the central matter of nursing (Alligood, 2017). As a result, she created the Self-Care Deficit Nursing Theory, which she continued to revise and improve for decades. She received many honors and awards in the 1980s and 1990s. These included the CUA’s Alumni Association Award for Nursing Theory (1980), Georgetown University’s honorary degree of Doctor of Science (1976), National League of Nursing’s Linda Richards Award (1991), and others (Alligood, 2017). After her passing, Orem’s works continue to be featured in research studies and nursing education.
One can discuss the major concepts that are presented by most nursing models of care. Oren describes nursing as art that practicing nurses utilize to assist patients to meet their needs for self-care (de Brito et al., 2017). Humans, according to Orem, are material objects for those who provide care (Alligood, 2017). The environment includes many aspects, such as one’s culture, family, and community, and can be defined through its biological, chemical, and physical characteristics.
Furthermore, the notion of health considers it to be a state that grants people the ability to communicate with others, reflect on one’s self, and feel whole or sound (Shah, 2015). Finally, this theory introduces the idea of self-care, a practice or set of activities that persons perform for themselves to maintain their health and wellbeing (Alligood, 2017). These definitions show that Orem was viewing all nurse-patient interactions and patients’ own actions through the lens of self-care.
The model of nursing created by Orem can be further divided into three smaller segments. The first one is the theory of self-care that presents the aspects of self-care and its types. For example, Orem states that self-care requisites can be universal, developmental, and related to health-deviation. Universal self-care requisites cover the main needs of any human, including breathing, hydration, nutrition, social interaction, solitude, and others (de Brito et al., 2017).
If a person enters a particular stage of change or is met with new conditions, they also express needs for developmental self-care. Lastly, health deviation self-care requisites encompass actions that people perform as a response to an illness or injury (Alligood, 2017). The second segment is the theory of self-care deficit that shows when nursing is needed – when a person (or their caretaker) cannot provide self-care that is continuous and effective. The third smaller concept is the theory of nursing system, which describes nurse-patient interactions as wholly or partial compensatory and supportive-educative (Shah, 2015). Overall, the model’s classification is necessary to understand why self-care is the primary concern of nursing.
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The importance of self-care as a center of all nursing activities can be connected to Orem’s nursing experience. As a professional who worked in the field of education, Orem was interested in refining the theoretical basis of nursing as a discipline and its necessity to healthcare. Thus, her process of thinking was guided by the question of what can be considered the primary focus that nurses target when caring for patients (Alligood, 2017).
As a result, the theorist determined that self-care is a general term that can include all activities for wellbeing maintenance, while also showing people’s drive for independence. Indeed, these concepts align with the contemporary view of healthcare that prioritizes health promotion and maintenance. The patient-centered philosophy, regarded as the most useful to nursing today, can be elevated using the idea that nurses help people return or increase their abilities of self-care (Landers, O’Regan, & Hegarty, 2018). Orem’s detailed approach to the nursing system also shows how nurses should interact with patients depending on the latter’s abilities. If a patient has some degree of autonomy, nurses can assist them without completely taking away their independence.
Orem’s model is often implemented in improvement initiatives in recovery and patient education. Andersen (2018) bases the intervention to improve post-splenectomy education on the nursing theory of self-care. The author argues that, by using the supportive-educative system, nurses can increase patients’ awareness about vaccination that reduces the risk of dangerous infections which occur after spleen removal. Andersen (2018) reports an improvement in education from 10% to 100% and an increased vaccination rate, concluding that Orem’s model elevates nurses’ roles of practice change leaders. Future research should consider how to increase patients’ response to education.
Another study integrates Orem’s self-care theory in a project for hypertension care. Drevenhorn (2018) notes that hypertension management is based on lifestyle change for patients, which can be considered a type of self-care. Therefore, by approaching patient education from the grand theory’s point of view, nurses can help patients develop self-care skills for maintaining their health with the chronic condition. As a result, the article offers a framework for clinicians to lead meetings with patients to discuss their lifestyle changes.
The author also develops a middle-range theory based on Orem’s model and urges other researchers to consider the latter as a foundation for approaches in other branches of healthcare (Drevenhorn, 2018). Here, the use of the self-care theory is both theoretical and practical, proving the model’s relevance.
Orem’s contribution to the field of nursing education is substantial, and her model is still used in research and practice. The nursing theory of self-care focuses on patients’ independence and the dynamics of nurse-patient relationships. The broad scope of applicability is one of the primary strengths of the study. Orem’s theory is comprehensive and detailed, demonstrating how nurses should act in different settings.
Its definition of self-care can be easily explained to both novice and experienced practitioners, and it aligns with the current philosophies of healthcare. Nonetheless, the amount of detail in the model also makes it highly complex due to the multitude of various terms and theories which nurses have to examine. Moreover, Orem does not consider the emotional needs and spiritual aspects of people’s lives, failing to devote much attention to the patients’ environment.
Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier.
Andersen, A. (2018). An advanced practice registered nurse (APRN)-led initiative to improve post-splenectomy education and vaccine follow-up in adult trauma patients. Journal of Emergency and Critical Care Medicine, 2, 104. Web.
de Brito, L. S. A., de Sousa, N. D. L., Alencar, A. M. P. G., Rebouças, V. D. C. F., Pinheiro, P. P., & Júnior, J. G. (2017). Concepts, theoretical models and nursing theories: Integrative review. International Archives of Medicine, 10(166), 1-8. Web.
Drevenhorn, E. (2018). A proposed middle-range theory of nursing in hypertension care. International journal of hypertension, 2018(285253), 1-11. Web.
Landers, M., O’Regan, P., & Hegarty, J. (2018). A theoretical framework to guide a study exploring cancer related fatigue. Applied Nursing Research, 37, 19-23. Web.
Shah, M. (2015). Compare and contrast of grand theories: Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. International Journal of Nursing Didactics, 5(1), 39-42. Web.