Orem model of nursing, also known as self-care deficit nursing theory (SCDNT), is a grand nursing theory, which was developed by Dorothea Orem between 1971 and 2001, and it emphasizes the role of self-care for patients after interacting with healthcare providers.
The major concepts of SCDNT include nursing, humans, environment, health, self-care, self-care agency, basic conditioning factors, therapeutic self-care demand, self-care deficit, nursing agency, and nursing system (Petiprin, 2016). The following section discusses these concepts.
In Orem’s theory, nursing is the art through which healthcare practitioners in the nursing profession offer specialized assistance to people suffering from different disabilities to facilitate self-care in the end. Moreover, nurses are involved in the medical care that the patient gets from a physician.
Humans are defined as “men, women, and children cared for either singly or as social units” (Petiprin, 2016, para. 4). Humans are also termed as the material objects of nurses and all other healthcare providers who offer direct care.
The environment is a complex set-up with biological, chemical, and physical features together with community, culture, and family components that surround a patient.
Health is defined as the state of being functionally and structurally whole, and it covers both individuals and groups of people. Other components of human health include the ability to communicate with fellow people, symbolize experience, and reflect on one’s self.
Self-care covers all the activities or practices that persons initiate and carry out independently as a way of ensuring health, well-being, and life.
Self-care agency is an individual’s capability to get involved in self-care. This ability is subject to different conditioning factors.
Basic Conditioning Factors
Basic conditioning factors include gender, age, patterns of living, the availability and adequacy of resources, environmental factors, family and healthcare systems, socio-cultural preferences, developmental state, and health state.
Therapeutic Self-care Demand
Therapeutic self-care demand is “the totality of self-care actions to be performed for some duration to meet known self-care requisites by using valid methods and related sets of actions and operations” (Petiprin, 2016, para. 6).
Self-care deficit describes the scenario where nursing care intervention is required. In such cases, patients are not in a position to get sufficient and continuous self-care from themselves (if adults are involved) or parents/guardians (if dependents are involved).
The nursing agency is the complex of different people trained and educated as nursing professionals that allows them to help patients attain their therapeutic needs by exercising or developing personal self-care agency.
The nursing system is the resulting product that arises when nurses engage and relate with clients or patients. This system becomes active only after a patient’s care demands surpass the available self-care agency, hence the need for nursing intervention.
Relationship between Concepts
The concepts of the Orem model of nursing relate through three constructs, which include theories of self-care, nursing system, and self-care deficit. The theory of self-care covers different concepts, such as self-care, self-care agency, and therapeutic self-care demand. These concepts interact with one another based on the care needs of a patient. For instance, in cases where the concept of self-care deficit emerges, other concepts like the nursing agency and nursing system are initiated to address that problem.
As noted earlier, the self-care deficit is experienced when a patient is unable to provide enough and continuous self-care, thus necessitating the need for nursing intervention (Malekzadeh, Amouzeshi, & Mazlom, 2018). In such a scenario, the nursing intervention is described under the concept of nursing agency. Therefore, these two concepts are related as they are required for proper care provision to a patient.
Ultimately, all the concepts are related as they seek to create an enabling environment where self-care deficits are identified and the roles of patients and nurses are defined to meet the available self-care demands. Similarly, the theory of nursing systems underscores the different actions and steps that nurses and patients take to ensure that self-care needs are met. As such, all the concepts related to each other depending on the level of self-care needs thus allowing patients to take care of themselves autonomously.
Structure and Organization
The structure and organization of the Orem model of nursing are formed around the premise that people are self-reliant, and they can care for themselves as their human rights. Therefore, nursing intervention is needed in cases of self-care deficit (Abotalebidariasari, Memarian, Vanaki, Kazemnejad, & Naderi, 2016). As such, the basic structure and organization of this theory is the concept of self-care. At this level, an adult patient is expected to be able to take care of himself or herself through self-care agency.
In cases where dependents are involved, parents or guardians provide this form of self-care. However, if self-care deficit emerges, the concepts of the nursing agency and nursing system are required to offer help to restore the lost self-care capability.
This form of organization facilitates the nursing process through three steps. The first one is the assessment where data is collected to determine the underlying problem. In the second step, diagnosis is carried out together with the creation of a nursing care plan. Finally, the nursing process is implemented and evaluated. Nurses then initiate the health care plan to meet the patient’s goals. Finally, the care plan is evaluated by interpreting results obtained from the implementation process.
Precision and Testability
According to Cramer (2013), precision and testability “demands that a good theory consists of constructs that are clearly defined, tightly interrelated, and readily open to reliable and valid measurement through falsifiable hypotheses” (p. 10). In light of this understanding, it suffices to state that the Orem model of nursing meets the requirements of precision and testability. The constructs or concepts are clearly defined and each can be understood independently as discussed earlier in this paper. Additionally, the concepts are tightly interrelated as they depend on each other to ensure a patient’s self-care capability.
The nursing profession is shifting from the traditional way of delivering care to patient-centeredness. In this model, patients form an integral part of care provision and they receive services aligned to their experiences, lifestyle, and backgrounds. Patient-centered care converges with the Orem model of nursing where patients are required to be actively involved in the care process. As an interventional radiology nurse, one of my duties is to prepare patients on ways to ensure self-care through ongoing education. For instance, IR nurses are expected to engage patients and family members in discharge planning even during the pre-procedure phases. This aspect ensures that patients and family members are in a position to ensure self-care after discharge, which is in line with Orem model of nursing.
Abotalebidariasari, G., Memarian, R., Vanaki, Z., Kazemnejad, A., & Naderi, N. (2016). Self-care motivation among patients with heart failure: A qualitative study based on Orem’s theory. Research and Theory Nursing Practice, 30(4), 320-332.
Cramer, K. M. (2013). Six criteria of a viable theory: Putting reversal theory to the test. Journal of Motivation, Emotion, and Personality, 1(1), 9-16.
Malekzadeh, J., Amouzeshi, Z., & Mazlom, S. R. (2018). A quasi‐experimental study of the effect of teaching Orem’s self‐care model on nursing students’ clinical performance and patient satisfaction. Nursing Open, 5(3), 370-375.
Petiprin, A. (2016). Self-care deficit theory. Web.