The self-care deficit nursing theory was introduced by Dorothea Orem in 1971. The theory was based on the author’s comprehensive experience in various fields of nursing and influenced by the existing theories at the time of writing. Its main premise is the leading role of the patient’s need for self-care as a driving factor of nursing practice. The following paper summarizes the main points of the theory by analyzing its core concepts, establishing its relevance, and summarizing its strengths and weaknesses.
Basic Components and Concepts
Orem’s self-care deficit theory is comprised of several key concepts that address the core components of nursing practice. Four of the said components frame the real-life concepts for the healthcare setting while others are introduced to further clarify the functions and underlying principles of care and establish relationships between the former.
Individuals. According to Orem, humans are material objects that serve as primary objects of nursing and clinical care. Humans can be disaggregated by several demographic indicators, such as gender and age, and can be treated both individually (as patients) and in groups of varying magnitude (ranging from communities to populations). Human beings possess both universal and individual developmental needs and have an intrinsic capacity for self-care that can be utilized in the process of care delivery.
Environment. The environment is interpreted as a combination of tangible and intangible factors that exert their influence on human beings. The former include physical, biological, and chemical properties of the immediate surroundings. The latter is comprised of the social, cultural, and psychological components (Seed & Torkelson, 2012). The environment has a major effect on the health state of the individuals and groups and thus becomes a key determinant of their need for care.
Health. Health is a state of functional and structural wholeness and soundness (Queiros, Vidihna, & Filho, 2014). The concept applies to individuals as well as groups. Health ensures adequate physical and psychological functioning and allows for successful interaction with peers, interpreting life experiences, and self-reflection.
Nursing. A set of practices that allow for the fulfillment of the humans’ needs and thus facilitates the delivery of care. Orem perceives nursing as both technology and art (Peterson & Bredow, 2013). Nurses are considered participants in the process and are expected to facilitate the self-care capacity in humans through the management of adverse effects and maintenance of the normal condition.
Additional Elements and Relationships
Self-care. The set of skills and abilities available to the individual and allowing for successful maintenance of health and well-being.
Self-care demand. The sum total of the actions and factors necessary for maintaining a positive state of health.
Self-care deficit. The condition in which the available self-care capacity is insufficient for addressing the total negative influence of the environment. The deficit requires the involvement of clinicians and nurses.
Nursing agency. The combination of properties that allow for assistance in the case of a deficit. The agency is attained through education, self-reflection, experience, and training.
Nursing system. The result of the interactions between the clinicians, nurses, and patients. The system is initiated in response to the demand and is possible due to the existence of the agency.
From the theorist’s perspective, the theory was relevant in the sense that it encompassed the ideas of nursing practice available at the time and framed in the manner that introduced the patient-centered perspective. The said perspective relied on self-management as a principal source of normal health and introduced nurses as active participants that were expected to guide the patients in the situation where the issue exceeded their intrinsic capacity for self-care. In other words, personal relevance stemmed primarily from the goal of streamlining the existing nursing knowledge and identifying the most viable direction for the set of disciplines collectively identified as nursing science.
Relevance to Healthcare
Orem’s theory is considered one of those most widely used in the modern healthcare setting. The main reason for this is the high degree of alignment between its core principles and the stance of the contemporary theorists. Specifically, according to the consensus, the favorability of the patients’ outcomes depends largely on their participation in the delivery of care (Alligood, 2014). While participation is a broad concept and can be interpreted in numerous ways, self-care is evidently its major component and describes an overwhelming majority of behaviors and strategies necessary for facilitating their autonomy. In addition, the self-care capacity is equally applicable to groups, such as families and communities. Consequently, family involvement has been proven to play an important role in the overall effectiveness of the clinical intervention, and the community resources are often included as means of long-term improvement of public health as well as aids for individual patients.
Application to Practice
In addition to the overall alignment with the direction of the nursing discipline, Orem’s theory provides unparalleled opportunities for long-term care of the post-operational patients, the elderly, and the mentally impaired patients. While the identified groups require significant involvement of nursing practitioners, especially early in the course of care, their self-care capacity eventually increases. At the same time, their self-care demand remains relatively high due to their physical or mental condition. In addition, the increasing autonomy provides an opportunity for enhancing self-esteem, promoting self-sufficiency, and strengthening the decision-making process, which grows in importance in the long run. In other words, self-care has a direct application in the field of long-term care and can be used as a guiding principle for the selection of practices and strategies by the nursing practitioners, educators, and researchers.
The biggest strength of the theory in question is its longevity and encompassing nature. Since its introduction, it has proven to be relevant and applicable to the majority of policies and goals in the domain of nursing. It also required a few changes and adjustments of its basic components and is usable in its current form in many areas of nursing practice. Next, the theory contains instructions for its implementation both at the organization and the individual level, which contributes to its accessibility. Finally, it is equally relevant for a different level of proficiency and leaves space for nurses’ professional and personal development.
However, several weak points can be identified in the theory. First, at least some of its concepts (e.g. health) are vaguely defined, which compromises the theory’s comprehensibility and transparency. It also demonstrates an evident emphasis on the individual whereas human groups are assigned secondary roles. As a result, some viable aspects of self-care promotion, such as public education, are downplayed or overlooked. Finally, the dynamic (rather than discrete) nature of health states does not allow for a conclusive evaluation of health and requires the introduction of an external tool that is not necessarily compatible with the core concepts.
Despite the relatively old age, Orem’s theory remains relevant in the contemporary nursing setting. Admittedly, the vagueness of some of its concepts limits its direct applications in many fields. Nevertheless, with minor adjustments, it is still highly applicable in many areas of nursing practice, research, and education, and aligns well with the goals of several specific practices, such as long-term care for the post-operational and elderly patients.
Alligood, M. R. (2014). Nursing theory: Utilization & application (5th ed.). St. Louis, MO: Elsevier Health Sciences.
Peterson, S. J., & Bredow, T. S. (Eds.). (2013). Middle range theories: Application to nursing research (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Queiros, P.J.P., Vidihna, T.S.S., & Filho, A.J.A. (2014). Self-care: Orem’s theoretical contribution to the nursing discipline and profession. Revista de Enfermagem Referencia, 4(3), 157-163.
Seed, M.S., & Torkelson, D.J. (2012). Beginning the recovery journey in acute psychiatric care: Using concepts from Orem’s self-care deficit nursing theory. Issues in Mental Health Nursing, 33(6), 394-398.