Background of Orem’s Theory
The self-care deficit theory is a grand theory that was elaborated by Dorothea Orem to enhance nursing education and practice. After receiving a nursing diploma from Providence Hospital School of Nursing in Washington, DC, she practiced in various hospitals and operated in the role of a curriculum consultant in colleges and universities. In 1939, she graduated from the Catholic University of America with a B.S. in Nursing Education (Hagran & Fakharany, 2015). The experience and research of this author allowed her to design a new theory of nursing, which was presented in “Nursing: Concepts of Practice” book that was published in 1971. The considerations of patient needs and nurses’ professional capabilities served as the underlying reasons for creating the self-care deficit theory. The explorations of this theory continue since scholars study it from different perspectives. For example, Hagran and Fakharany (2015) critique its assumptions in terms of clarity, generality, and accessibility, while Younas (2017) offers the foundational analysis.
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The identified theory aims to determine the source of a patient’s health problems. If the patient, his or her relatives, and/or other caregivers cannot maintain a balance between their abilities and needs for self-care, there is a need for nursing care. In addition, Orem believes that assistance should be provided with the active participation of the patient and his or her family (Smith & Parker, 2015). The focus of nursing intervention is to be devoted to the problem of the identified deficit of self-care and its causes. The reasons for the deficit may be a lack of knowledge, inability to perform individual self-care actions, and a lack of understanding of the importance of self-care. Thus, the theory offers the solution to the problem of poor self-care by connecting a lack of understanding of the need for self-care with the level of development, as well as the patient’s past behaviors.
The self-care deficit theory includes three central concepts, such as self-care, the need for self-care, and the need for therapeutic self-care. The concept of self-care is defined by Orem as the implementation of actions that a person carries out on his or her initiative to maintain health, life, and well-being (Smith & Parker, 2015). All these actions are voluntary and conscious, representing a certain stereotype, and are performed in a certain sequence. They are also focused as they are based on the desire to satisfy the need for self-care. As can be seen from these assumptions, the theory uses deductive reasoning, starting with the premises and ending with conclusions. Self-care, according to Orem, includes the following stages: assessment of the situation, planning, and the implementation of actions. In other words, the reasoning moves from the universal principles to specified ideas.
The need for self-care is represented by the general concepts about the tasks that a person should solve in connection with self-care. The theoretician divides the need for self-care into three categories: universal, those related to ontogenesis, and the ones associated with health disorders (Smith & Parker, 2015). The universal needs for self-care are consistent with the goals of those actions that are necessary for the implementation of a normal life process. Orem identified eight universal needs for self-care: necessary amount of air, water, food, proper allocation processes, a reasonable balance between vigorous activity and rest, solitude, and contact with other people (Younas, 2017). The prevention of life-threatening situations and ensuring the harmony of human life and functioning within social groups by human capabilities also compose the key patient requirements.
The mentioned concepts are defined theoretically and operationally, while their importance to nursing care quality and patient outcomes are also clarified. The theory not only explains the meaning of these concepts but also enlightens the connection between them and their practical application. Orem is consistent with the use of the concepts since there are no contradictory statements in her work (Younas, 2017). More to the point, the author uses the explicit manner of discussing the concepts, fully and unambiguously expressing them and leaving no room for confusion. The relationship between the concepts is provided by linking them to the daily needs of individuals. The self-care agency phenomenon is introduced by the theoretician to connect human ability, engagement in self-care, and fundamental conditioning issues. The environmental and developmental requisites point to maturation needs or body adjustment requirements, which should be taken into account while considering the theory.
Orem’s model considers a person as a whole. It is based on the principles of self-care, which are identified as activities to preserve well-being, life, and health, which people begin and perform independently. In this theory, great attention is paid to patients’ personal responsibility for their health. However, nursing interventions for the prevention of diseases, injuries, and training are also of great importance. The explicit assumption that serves as the foundation is that adults should rely primarily on themselves and bear some responsibility for their dependents (children, adolescents, or any other persons) while maintaining their health. The implicit assumption of the self-care deficit theory is associated with the expectations regarding nurses’ assessment. Namely, it is expected that a nurse is to collect additional information and find why there was a shortage of self-care (Queirós, Vidinha, & Almeida Filho, 2014). The examination, observation, and conversation will help in understanding the potential reason: a lack of knowledge, skills, motivation, or restriction of behavior by frames dictated by social and cultural norms, and so on.
The nursing care meta paradigm system consists of four elements, including person, health, environment, and nursing, while each of them can be found in the theory by Orem. A person is regarded as “an integrated whole composed of an internal physical, psychological, and social nature with varying degrees of self-care ability” (Hagran & Fakharany, 2015, p. 14). Health definition coincides with the statement of the World Health Organization (WHO) that views it as not only the absence of illnesses but also the mental, social, and physical well-being of a person. As for the environment meta paradigm, it integrates two dimensions: the developmental one focuses on gender, age, culture, as well as social and economic factors, while the environmental aspect prioritizes biological, physical, and chemical features (Hagran & Fakharany, 2015). Ultimately, nursing is perceived as an art that should provide specialized help to meet the daily needs of patients and promote their awareness of self-care role.
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Speaking of Orem’s model clarity, one should state that all the concepts have clear explanations and are relevant to the nursing area and self-care. The interconnected assumptions of the theory are properly organized, and there are no gaps. This theory can be easily understood and implemented into practice, both by a student and qualified nurses. There is a unique way of considering nursing since all the ideas are not borrowed from other theories but developed by the author. Thus, this theory can be evaluated as transparent and fully comprehensible.
While conducting the preliminary examination of the condition of a patient, the nurse clarifies if help is needed. For example, if in connection with a fracture of the bones of the lower leg, the patient faces difficulties, the nurse may suggest that he is not able to immediately move without assistance. In this example, an imbalance between the patient’s ability to self-care and some of the universal needs is evident (Wong, Ip, Choi, & Lam, 2015). Namely, the patient cannot move independently and actively, perform personal hygiene, use the toilet, and so on. After that, a special, individualized plan of care should be designed by the nurse to restore the balance and achieve this patient’s self-care efficiency. The self-care deficit theory guides the actions of nurses from the assessment to the intervention and further analysis of results.
In such a personal area of nursing as practice, the identified theory’s supporting and guiding systems can be used in the case when it is necessary to teach patients some actions to satisfy their self-care needs. For example, care for adolescent girls with dysmenorrhea requires education to their parents and themselves, which can help in self‐care behaviors such as pain intensity evaluation and self-medication (Wong et al., 2015). The techniques of support, leadership, creating the right environment, and ongoing education is the direct interventions that can be applied by nurses in terms of the self-care deficit theory.
Hagran, A., & Fakharany, A. (2015). Critique of Orem’s theory. The Journal of Middle East and North Africa Sciences, 1(5), 12-17.
Queirós, P. J. P., Vidinha, T. S. S., & Almeida Filho, A. J. (2014). Self-care: Orem’s theoretical contribution to the nursing discipline and profession. Revista de Enfermagem, 4(3), 157-63.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: FA Davis.
Wong, C. L., Ip, W. Y., Choi, K. C., & Lam, L. W. (2015). Examining self‐care behaviors and their associated factors among adolescent girls with dysmenorrhea: An application of Orem’s self‐care deficit nursing theory. Journal of Nursing Scholarship, 47(3), 219-227.
Younas, A. (2017). A foundational analysis of Dorothy Orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23.