The development of nursing theories became active within the latest decades. It is partially due to the rise of nursing as a science. These theories are mainly aimed at specifying, forecasting, and interpreting the phenomenon of nursing. There are some kinds of nursing theories like grand, mid-range, and nursing practice theories. The grand nursing theories are more abstract than the mid-range ones (Parker & Smith, 2015). They consist of concepts and relational statements. Self-Care Deficit Nursing Theory by Dorothea E. Orem is among the grand nursing theories which are crucial for contemporary nursing. It presents the problem of self-care deficit, its reasons, and the ways to solve it.
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Self-Care Deficit Nursing Theory Background
The theory under analysis was developed by the American scholar Dorothea E. Orem. This researcher dedicated her life to improving the nursing practices with the generation of theories that could be helpful in nursing education as well as applied to practice. Thus, Orem’s ideas were shaped both, theoretically and practically. Orem was guided by her experience, education, and work in her research. She studied the concept of nursing which resulted in the Self-Care Deficit Nursing Theory. Having basic nursing education, Dorothea E. Orem was able to view the problem from inside. She continued her studies until she completed the MSN Ed at Catholic University in1946. After that, she was assigned a Director of Nursing Service and Education at Provident in Detroit. Being conscious of the fact that nurses are able to “do nursing,” she realized they could not present nursing neither to their colleagues nor other specialists (Parker & Smith, 2015).
This fact did not let nurses improve practice. Orem tried to formulate the definition of nursing in her report to the Indiana Board, “The art of nursing in hospital service: An analysis” (Renpenning & Taylor, 2003). This work depicted the ideas prior to the concept of self-care (Parker & Smith, 2015). One more important reference concerning this theory is the work by Orem and Taylor (1986), the ideas of whom resulted in the definition of the nursing role and conditioned the creation of Self-Care Deficit Nursing Theory. Another printed work by Dorothea E. Orem, “Guides for Developing Curriculum for the Education of Practical Nurses,” presents the unique idea in nursing for that time, its proper object. Orem states (as cited in Parker & Smith, 2015, p.122): “The condition is the inability of persons to provide continuously for themselves the amount and quality of required self-care because of situations of personal health.” In fact, Orem’s theory contributed to the definition of nursing significance in health care popularization as well as in the comfort of a patient.
Among the other researchers who investigated the concept of self-care deficit is Fitzgerald (applied self-care model in the development of diabetics’ educational program), and Anna et al. (concentrated on the practical application of Orem’s theory) (McKenna, Pajnkihar, & Murphy, 2014).
The theory addresses the problem of low self-care culture. With the modern development of medical science, people become careless and unconcerned about their health. They hope that in case of emergency the doctors will be able to help. Still, good self-care may reduce illnesses and diseases. The other aspect of the self-care problem is that people are often not able to take proper care of themselves when they are ill. They are not informed and not taught to act adequately in situations concerning health issues. Thus, the self-care deficit appears, and the Self-Care Deficit Nursing Theory is aimed at educating both nurses and the community about the problem and assisting with its resolution.
Self-Care Deficit Nursing Theory Description
The theory is based on the assumption that self-care needs and activities are the primary focus of nursing practice (Nies & Even, 2014). It applies both inductive and deductive reasoning to reveal the features of the nursing profession. Inductive reasoning is used for the explanation of personal and professional experiences application. Deductive reasoning is evident in collecting the data from various researchers and sciences to help with defining the interrelations of nursing and other spheres of knowledge.
Orem singles out some major nursing concepts, important for the theory’s meta-paradigm. Among them are nursing, person, the environment, and health. Speaking about “person,” Orem (as cited in Greer, 2011) means “men, women, and children cared for either singly or as social units,” who appear to be the “material object” of nurses and other specialists providing care. As for the environment, it has physical, chemical, and biological aspects. Such components as family, culture, and community are also included here. In respect of health, Orem considers it “being structurally and functionally whole or sound.” Besides, the researcher examines the health of individuals as well as that of groups of people.
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The author is rather consistent in his theory. Its components are integral and depending on one from another. Orem talks of self-care as the implementation of activities that people introduce and accomplish by themselves to remain healthy. The concept of self-care agency is also introduced. It means the ability of a person to provide self-care and is influenced by various factors. Among these factors are age, experiences, gender, the state of developmental, health condition, socio-cultural situation, health care system, family factors, the way of life, the state of the environment, and access to health-care resources. The ability to provide self-care is not given at birth but can be taught and trained.
The concepts of the Self-Care Deficit Nursing Theory are defined mainly explicitly. They are clearly stated and comprehensible by any reader, both a focused specialist and an ordinary person. For example, Orem’s definition of the environment is rather transparent. It includes the components that people see in their everyday life, like family or community, biological or physical elements. Correspondently, such explicit character makes Orem’s theory available to the diverse population.
All the concepts of the theory are interrelated. The person (patient) is in the center of nursing activity. Moreover, the health condition of a patient is influenced by the environment. A healthy person can take care of him/herself. In the case of illness and, consequently, bad health conditions, the person cannot provide adequate self-care. In this situation, the nursing help is necessary to facilitate the patient’s self-care. The primary task of a nurse is to evaluate the person’s condition and capability to maintain the necessary health care, and to assess the patient’s surrounding. The aim of these actions is to reduce the disadvantages caused by health conditions. Nursing, in its turn, has an impact on a person’s health. Apart from the medical aspect and, it improves the level of knowledge of the people on health issues. Such education may help to increase prevention and, as a result, reduce the illness rated in general.
The Evaluation of the Self-Care Deficit Nursing Theory
The Self-Care Deficit Nursing Theory by Dorothea E. Orem has some assumptions on its background. One of these is that “nurses deliberately and purposefully perform nursing as a helping service to others” (Self-Care Theory). It means that nursing activity is aimed for the good of people, it should be conscious and determined. Another assumption presupposes that “people are willing and capable of performing self-care for themselves and for dependent family members (children)” (Self-Care Theory), thus leading to the idea that humans are not likely to neglect self-care deliberately. Self-care is influencing people’s health, well-being, and development in general. Thus the adequate self-care is essential.
The assumptions also include the impact of culture and education on the people. It means that the level of self-care depends on the cultural background and the social class of the people. The interaction between people and communication is also a factor that matters. People participate in long-time communication among themselves and their surroundings to stay alive and preserve health. An important issue about self-care is the deliberateness and systematic character of the actions that people do to stay healthy. It also means that the person realizes the needs and is able to make the necessary decisions connected with self-care. One of the core assumptions is that “Each individual is self-reliant and responsible for his or her care and others in his or her family needing care” (Self-Care Theory). It explains the essence of the self-care, for no one can be responsible for the person’s well-being except that person.
All four concepts of the nursing meta-paradigm are reflected in the Self-Care Deficit Nursing Theory. These concepts are person, health, environment, and nursing. A person is considered as a whole, not only physically, but also concerning the psychosocial, cultural, and spiritual issues. The concept of health is limited to having no illnesses. It is a more complex aspect, including the ability to act reasonably. It is usually affected by cultural components. The environment is an equal part of the nursing paradigm. It is the setting where the people live and includes the experiences of all humans. Here two constituents can be singled out, the internal and the external environment. The first one deals with the physiology and the second covers perceptual, operational, and conceptual parts. Nursing mainly deals with support and therapy when they are needed. Its task is also the promotion of healthy lifestyles and the preservation of an individual’s wholeness.
The theory under analysis is lucid. Its principal concepts are clearly outlined and interconnected. The available definitions and easily-reached references are provided as well.
Like every theory, the Self-care deficit nursing theory has some strengths and weaknesses. The main advantage of the theory developed by Dorothea E. Orem is that it may be applied in nursing activity by both beginners and experienced specialists. The notions of self-care, nursing systems, and self-care deficit can be comprehended by nursing students and be the guide to further research of the theory when the nurse continues education and work. The theory describes the situations when nursing is necessary. These are the cases when a person is not able to provide self-care of the quality needed for preserving life and health because of illness or other reasons. It is also the situation when a person needs recovery after the disease or injury or to manage their influence.
Still, the theory has some weak points. Although it looks simple, it is rather complicated. It operates the term of self-care in various aspects of self-care agency, self-care demand, self-care deficit, self-care requisites, and universal self-care (Greer, 2011), which may embarrass the reader. Besides, Orem’s theory does not give enough attention to a person’s emotional needs. It is also a drawback as the emotional component is an integrated constituent of health.
The aim of a theory developer is to introduce the theory into practice. Concerning the practical use, the Self-care deficit nursing theory by Orem is a good example of an effective initiative. It was used as grounds for the research instruments, as the basis for questionnaire on self-care of teenagers and children. The theory has become a framework for nursing schools (Self-Care Theory). Besides, Orem’s theory is applicable to all levels of prevention.
As a nursing student, I apply this theory to education. It is important to study the views of many scholars in my future profession. The different approaches of various theories help to figure out the role of nursing in society and the ways of providing nursing activity. I consider the Self-care deficit nursing theory one of the most profound grand theories. It is close to the real state of things in the sphere of health care. The theory provides clear definitions of the major concepts concerning nursing, and I find it helpful. The other thing that I consider useful about the theory of self-care deficit is the description of interrelations between the components of nursing. I suppose that the theory is a suitable material for an educational course. It should be studied not only by future nurses but by other people. That way they may realize the importance of self-care. Besides, the theory explains the role of a nurse in self-care, which is to assist an individual who is not able to provide the necessary self-care due to illness.
The primary focus of the theory by Dorothea E. Orem is self-care. It comprises the various ways of nursing systems functioning. Still, its main aim is to present the reader with an idea of nursing care as assistance to people. It gives the definitions of some important concepts. Thus, health is defined as a dynamic and changing state, depending on some factors. On the other hand, not all the definitions were discussed to the full extent. For example, the influence of the environment on the nurse-patient relationship was not developed in theory. Still, the function of nurses in patients’ health preservation is well described. According to the author, it should be fulfilled with the consideration of the individual need of the people. Another aspect that may need further investigation is the participation of parents or guardians in the health-care of the dependent individuals. The definition provided by Orem is not relevant to the people who need total care, like babies and elderly people. On the whole, the theory is clearly constructed and may be applied in modern nursing. Even with some drawbacks, it presents sound ideas to be implemented in the study of self-care.
Black, B.P. (2014). Professional nursing concepts and challenges. 7th ed., St. Louis, MS: Elsevier Health Sciences.
Greer, N.P. (2011). Self-care deficit nursing theory. Patho Publishing.
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McKenna, H., Pajnkihar, M., & Murphy, F. (2014). Fundamentals of nursing models, theories and practice. Chichester, West Sussex, UK: Wiley-Blackwel.
Nies, M.A., & Even M.M. (2014). Community/public health nursing. Promoting the health of population. St. Louis, MS: Elsevier Health Sciences.
Parker, M.E., & Smith, M.C. (2015). Nursing theories. Nursing practice. 4th ed., Philadelphia, PA: F.A. Denis Company
Renpenning, K. & Taylor, S. (2003). Self-care theory in nursing. Selected papers of Dorothea Orem. New York, NY: Springer Publishing Company.