Dorothea Elizabeth Orem (1914-2007) was a nursing theorist and the pioneer of the self-care nursing theory. She received a nursing diploma from Providence Hospital School of Nursing in Washington, DC. Also, Orem earned a Bachelor of Science in Nursing Education and a Master of Science in Nursing Education from the Catholic University of America. Also, Orem was among the members of the group that presented the original framework for nursing diagnosis known as Patterns of Unitary Humans.
Analysis of Basic Components of Orem’s Self-Care Theory
Orem’s general theory of nursing is comprised of the theory of self-care, the theory of self-care deficit, and the theory of nursing system. The theory of self-care includes the following components:
- Self-care: a framework of activities and practices initiated and performed by an individual on their own behalf in order to maintain health, well-being, and life (Catalano, 2015).
- Self-care agency: an ability of an individual to engage in self-care, which is preconditioned by age, life experience and developmental state, health status, resources, or sociocultural orientation.
- Demand for therapeutic self-care: a framework of self-care actions performed for meeting the requisites of self-care through the use of valid methods, activities, and related operations (Meleis, 2011).
- Self-care requisites: a set of measures targeted at one’s provision of self-care. Three categories of such requisites include developmental, universal, and health deviation self-care requisites.
Orem’s theory of self-care deficit is aimed at specifying in which cases nursing is needed. To clarify, nursing required when an adult (or parent) is unable or has limited capacity to provide adequate and continuous self-care. Within the theory, Orem identified five distinct methods of helping, which include guiding others, acting or doing for others, supporting others, teaching others, and creating an environment that will promote personal development as to meeting the future health demands.
The third component, the theory of nursing systems is targeted at describing how the patient’s self-care needs should be met by the nurse or the patient (or both). The theory also identifies three types of nursing systems required for meeting the patient’s self-care requisites. These classifications include:
- Wholly compensatory systems: the nurse compensates for the patient’s complete inability to engage in self-care processes,
- Partly compensatory systems: both the patient and the nurse take various care measures and other actions associated with ambulation and manipulative tasks.
- Supportive-educative systems: used in situations when a patient has the capacity to perform the necessary self-care measures, although, they cannot do so without help (Orem, 2001).
To conclude the overview of Orem’s nursing theory, it is important to mention the significant assumptions included in the framework. As noted by Orem, people should be responsible and self-reliant when it comes to their own care as well as their family members in need of care. The second assumption of the self-care theory is that people are distinct individuals who have different expectations when being placed in the center of care (Rajani, 2013). Third, nursing is an action, which is based on interactions between two or more people. Fourth, a successful meeting of the necessary self-care requisites of the patient is a crucial component for making sure that ill health is prevented through primary care. Fifth, a patient’s knowledge of the precise health issues that may occur is essential for establishing and promoting self-care behaviors and practices. Lastly, both self-care and dependent systems are practices that individuals learn within a sociocultural context.
Dorothea Orem’s model explains that when a patient possesses self-care capabilities that do not align with the necessary level, a nurse can compensate for that deficit. However, more often than not, Orem put the responsibility of care on the patient, which points to the idea that one’s health drastically depends on whether an individual is attentive to his or her health, and whether he or she is willing to cooperate with the nurse to create a beneficial environment for health management. If to connect the theorist with the theory, the fact that Dorothea Orem predominantly worked as a curriculum consultant at nursing schools, universities, and colleges explains her development of the self-care that is focused on the education of the patient.
With regard to the relevance of the theory to patients and the sphere of healthcare, the encouragement and the promotion of self-care practices are essential for creating an environment for effective care. It is important to understand that without the involvement of the patient (either emotional or actual), the provision of appropriate healthcare services will be nearly impossible. When patients are educated and provided with the necessary information on how to exercise their personal care, the chances of them having better health outcomes tend to be higher.
Dorothea Orem’s theory of self-care is also relevant for the available and future research and nursing practice. Researchers have already investigated the influence of the applied self-care theory on different health outcomes; for example, Apay, Capik, Nazik, and Ozdemir (2015) studied the effect of care given using Orem’s self-care model on the postpartum self-evaluation. However, the aspects of the theory still require investigation and analysis, especially in the context of creating an environment in which patients can achieve improved health outcomes through self-care.
In conclusion, it is important to mention that Orem’s theory was successful in providing both patients and nurses with a comprehensive basis for nursing practice in different fields and areas. Furthermore, the theory of self-care can be applied to the sphere of nursing for anyone ranging from beginning to advanced practitioners. Another strength of the theory is its support for the implementation of the Nursing Process that involves both practical and intellectual components.
When it comes to the weaknesses of Orem’s self-care theory, there is some ambiguity in the application of the theory due to its somewhat limited nature; it does not support or explain all aspects of nursing care. For instance, the self-care deficit component of the theory does not include all aspects of care a specific individual may require. If to provide an example, some confusion associated with Orem’s theory is linked to the lack of a clear definition of the family’s role, the relationship between nurses and the society, as well as the education of the public about the importance of self-care.
Such issues are important in the development of an effective plan for patient care. Lastly, it is noteworthy that throughout Dorothea Orem’s work and theory development, there was a lack of recognition of the emotional needs of the patient as well as what those emotional needs entailed. This means that Orem focused on physical care without addressing the psychological care of the patient. However, other theorists such as Jean Watson managed to account for this limitation through her Theory of Caring.
Apay, S., Capik, A., Nazik, E., & Ozdemir, F. (2015). The effect of the care given usıng Orem’s self-care model on the postpartum self-evaluation. International Journal of Caring Sciences, 8(2), 393-403.
Catalano, J. (2015). Nursing now! Today’s issues, tomorrow’s trends (7th ed.). Philadelphia, PA: F. A. Davis Company.
Meleis, A. (2011). Theoretical nursing: Development and progress (5th ed.). Alphen aan den Rijn, Netherlands: Wolters Kluwer.
Orem, D. (2001). Nursing concepts of practice. Maryland Heights, MO: Mosby.
Rajani, S. (2013). Compare & contrast of Roy and Orem’s nursing theory. International Journal of Innovative Research & Development, 2(8), 237-240.