Orem’s self-care deficit theory is grounded in the idea of a person’s propensity towards self-care needs, which can be universal, developmental, or health deviation requisites (Black, 2014). It is a composite theory that brings together three models: self-care, self-care deficit, and nursing systems. Self-care is a purposeful practice to achieve individual well-being and recovery from an illness. A self-care deficit arises when the patient’s family is unable to give adequate care to him or her, hence, a nurse has to step in and meet those needs (Younas, 2017).
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In this case, the nursing goal entails determining the patient’s abilities and supporting him/her to utilize them. The key assumptions underlying this theory include nursing care involve a deliberate and purposeful to help patients, individuals/families have the ability to do self-care, self-care capability is shaped by education and culture, human wellbeing/health depends on self-care, and individuals are self-reliant and have unique interests, abilities, and dispositions (Younas, 2017).
The main nursing concepts fundamental to this theory include patient or dependant, environment, health/wellbeing, and nursing (Black, 2014). The concepts are interrelated and converge on the patient as the self-care agent. Based on this theory, a patient’s environment mediates his/her health or wellbeing. Self-care action is only possible when the individual is in a healthy state. Nursing care is required to help a patient with a self-care deficit perform self-care. The four concepts affect each other in the sense the consideration of a person’s capability and health beliefs and his/her environment or socio-cultural orientation through a nursing assessment is critical in helping him/her deal with health-related constraints or adjust to change.
Origins of the Theory
The origins of the self-care deficit theory could be traced to Orem’s development of a national nursing curriculum in the 1950s. The theory was first published in 1959. The curriculum by Orem and her colleagues was developed for the Department of Health at the time. The theory was a product of their work towards enhancing “the quality of nursing in general hospitals in her state” (Black, 2014, p. 44). Clearly, the key factor that influenced this theory was the quality of nursing care in the American hospitals. At the time, there was a growing demand for sweeping modernization of the health care system to enhance the quality of care provided.
Orem utilizes three existing models – self-care, self-care deficit, and nursing systems – as the basis for her grand theory. The self-care theory specifies the self-care requisites and demands, which, if met, allows a person to lead a healthier life, as a self-care agent (Black, 2014). The self-care deficit theory explicates when nursing is required, i.e., when a person is unable to perform self-care activities effectively (Black, 2014). The nursing systems theory delineates three forms of nursing systems for such a person: wholly compensatory, partly compensatory, and supportive-educative (Black, 2014). Its philosophical foundation is that holistic recovery and wellbeing is achieved if patients are supported to perform self-care.
Orem’s primary motivation for writing this theory relates to her aim of promoting the quality of nursing care in the local general hospitals. She sought to write a theory that can nurses can employ to guide self-care in patients based on established theories. The theory development approach adopted by Orem is the grounded-theory method. She relied on existing theories and principles and her observations to develop a grand nursing model.
As a grand nursing theory, the model can be used in various nursing contexts. It can be applied in nursing practice to enhance the post-discharge patient outcomes through assessments that determine the patient’s physical and cognitive abilities to do self-care. Its concepts are helpful in motivating and empowering a patient to assume a proactive role and greater control of his/her own care (Younas, 2017). The theory is practical in an outpatient setting, whereby patient education about the procedure can improve the clinical outcomes. Teaching a patient with a self-care deficit would encourage self-care.
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The theory contributes to greater understanding of patient outcomes. A patient identified as having a self-care deficit through a nursing assessment requires support to improve his/her outcomes. In contrast, meeting the self-care requisites predicts better patient outcomes. An example of where this theory could be used is in mediport-portacath placement or outpatient hemodialysis, where patient education and support would improve self-care.
The theory can be tested in an outpatient setting by comparing the post-discharge outcomes of patients taught on self-care activities and those that receive no education. The research generated by this theory relates to its development, metaparadigm orientation, and the logical relationships among its components. Over six qualitative studies involving a foundational analysis of the self-care theory and several RCTs have been conducted since the 1970s. For example, Younas (2017) describes the implicit and explicit theoretical premises, principles, and assumptions underlying this theory.
Their foundational analysis found that self-care is “a practical endeavor” because it encompasses guidelines on “human growth, development, and understanding” of a person’s potentials and capacities (Younas, 2017, p. 21). The theoretical propositions include age, developmental level, self-care abilities and demands, available resources, and socio-cultural orientation of the patient, among others.
Being a grand theory, Orem’s nursing model is comprehensive but less specific. Clarke and Bennett (2013) note that the theory has a broad scope of nursing practice, but a limited “extent in research, education, and administration” (p. 217). It is a general nursing model in that it contains broad concepts that are applicable in all nursing contexts. Its key strengths lie in its comprehensive base (three theories), cross-functional nature, and support of the nursing process (Clarke & Bennett, 2013). Its limitations include ambiguity in its practical application, limited coverage of the aspects of care, e.g., family/community involvement, and failure to recognize emotional needs.
Black, B. (2014). Professional nursing: Concepts & challenges. St. Louis, MI: Elsevier Inc.
Clarke, L. H., & Bennett, E. V. (2013). Constructing the moral body: Self-care among older adults with multiple chronic conditions. Health, 17(3), 211-228. doi:10.1177/1363459312451181
Younas, A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23.