The main idea behind Orem’s theory is that the vast majority of the patients desire to be able to care for oneself and the individual members of one’s family. Some of the major assumptions behind the theory are as follows (Alligood, 2017):
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- Every patient is a distinct individual with a unique cultural, educational, spiritual, and socio-economic background.
- Nursing is an action-interaction process with the end goal of promoting healthcare and improving quality of life.
- The effectiveness of an intervention is largely dependent on the patient’s understanding of his or her own health situation and their willingness to proactively participate in the healing process.
Orem’s theory of self-care deficit revolves around four major concepts, which are Patient, Health, Environment, and Nursing (Alligood, 2017). A patient is described as a being capable of interaction on a biological, symbolical, and social level, with universal development needs and capable of performing self-care. The concept of nursing is stated to be an array of interventions and actions with the ultimate goal of making the patients and their family members capable of taking care of their own and each other’s’ healthcare needs. The concept of health is defined as a state of homeostasis between physiological integrity, psychological balance, and social standing. Lastly, the environment is described as a broad array of enthronement factors, elements, and conditions that surround the patient and the nurse.
The relationship between these concepts is complicated, as all of the factors mentioned above are connected to one another. The patient is the centerpiece of this theory, as Orem suggests that it is within the capability of every individual to influence his or her health and the surrounding environment (Alligood, 2017). Nursing influences all three other concepts by enabling the patient to cope with their health deficiencies through an action-interaction process. The environment, in turn, affects a patient’s capabilities to do so. The concept of health serves as a binding element between concepts, becoming a common medium for them to interact with one another.
Origins of the Theory
Orem’s theory of self-care deficit was first published in 1971. During that time, American nursing did not have an outlined sense of direction, purpose, or focus. It was considered a part of healthcare as a whole, with no clear boundaries or definitions that differed it from other healthcare practices (Alligood, 2017). Orem’s primary goal in developing her theory was to provide the definition of nursing as a practice.
Orem’s work was based on the totality paradigm, which suggested that humans were capable of learning new skills to adapt to the surrounding environment and make up for their physical and psychological deficiencies (Alligood, 2017). Her prerequisites for facilitating medical care were heavily borrowed from Florence Nightingale. In the development and subsequent improvement of her theory, Orem worked with many fellow scientists and researchers, while maintaining a leadership. She also used a number of non-nursing philosophies, as the theoretical material in regards to nursing was lacking, at the time. This rooted her theory in scientific and academic concepts, but at the same time made it difficult for some nurses to accept and criticize.
Orem’s theory redefined the way most nursing professionals saw the purpose of their craft and introduced a scientific and evidence-based way of thinking into the nursing process. In addition, it offered many tools to enhance the standards and outcomes of healthcare by incorporating the patient as a proactive element. The theory is valuable from a practical standpoint, as it reduced the amount of workload on nurses while simultaneously enabling patients and families to take care of their own needs. Orem’s theory serves as a basis for many preemptive and educational interventions.
In terms of understanding and prediction of outcomes, Orem made an important discovery, stating the correlation between the ability of the patient to understand and implement self-care and overall success rate of the treatment. According to Orem, higher rates of participation and understanding are connected with positive patient outcomes (Alligood, 2017). A study by Dabbs et al. (2016) uses Orem’s theory in practice by examining the application of self-management after lung transplantation. As evidenced in that research, self-care is a very important aspect of post-operational and post-discharge healthcare management.
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Orem’s theory is highly testable due to its intrinsic proposition of including self-care procedures into the daily routine of both patients and healthcare providers. It generated a great number of studies in order to examine the feasibility, efficiency, and economic sustainability of various self-care and healthcare promotion practice (Alligood, 2017). Although the majority of the studies took the form of randomized control trials, meta-analyses, and qualitative studies have also been performed to evaluate the applicability of Orem’s theory in clinical settings (Alligood, 2017). An example of a study done using Orem’s theory of self-care can be found in research performed by Shang, Zheng, and Xiao (2016), which evaluated the applicability of self-care in elderly patients undergoing artificial hip replacement.
Orem’s theory can be used as a comprehensive framework for the understanding of nursing principles, evaluation of practice, and foundation of research. It provides an overarching blanket theory (Theory of nursing systems) as well as specific and more narrow instances of the application (partially-compensatory, wholly compensatory, and supportive-educative systems) (Alligood, 2017). The theory’s strengths include providing a comprehensive base for nursing practice, specifying when nursing is needed, and generating utility for nursing practitioners. Some of its limitations include dynamic views on health and orientation towards illnesses. I would use Orem’s theory in the scope of my practice as a solid framework to base research on as well as a tool in educational and self-care interventions.
Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). New York, NY: Elsevier.
Dabbs, A. D., Song, M. K., Myers, B. A., Li, R., Hawkins, R. P., Pilewski, J. M., … Dew, M. A. (2016). A randomized controlled trial of a mobile health intervention to promote self‐management after lung transplantation. American Journal of Transplantation, 16(7), 2172-2180.
Shang, S., Zheng, Y., & Xiao, Z. (2016). Application of Orem self-care mode on hip function recovery of elderly patients with artificial hip replacement. Modern Clinical Nursing, 15(7), 19-22.