Nursing theorists and their work have a significant impact on nurse education and clinical practice. They can be applied both in theoretical research and used practically in diverse interventions aimed at the improvement of patient care quality and patient outcomes. One of the theories most commonly employed in practice is Dorothea Orem’s Self-Care Deficit Theory of Nursing. Orem received her nursing diploma in the 1930s and started her career at Providence Hospital School of Nursing in Washington (Berbiglia & Banfield, 2014). In the following decades, she received her BS and MS degrees in Nursing Education. She worked throughout the country following her goal to improve nursing in general hospitals. She is also known for developing a definition of nursing practice and a significant contribution to the nurse education curriculum (Berbiglia & Banfield, 2014). Orem was conferred with many rewards such as the honorary degree of Doctor of Science (1976), the CUA Alumni Association Award for Nursing Theory (1980), etc. This paper aims to analyze the major concepts of the self-care deficit theory, its application in clinical practice, and theory relevance to contemporary healthcare as a whole and patients in particular.
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Analysis of Basic Concepts and Major Relationships in the Theory
The self-care deficit theory of nursing consists of four related theories. The first one, the theory of self-care, includes a description of reasons and ways people use to care for themselves. The second theory of dependent-care includes the ways family members and/or friends “provide dependent-care for a person who is socially dependent” (Berbiglia & Banfield, 2014, p. 244). Next, the theory of self-care deficit describes and explains methods of help for people who need it that can be provided through nursing. Finally, the theory of nursing systems implies descriptions and explanations of relationships that must be developed and preserved for effective nursing involvement in self-care provision (Berbiglia & Banfield, 2014). The major concepts of these theories are interrelated.
The basic concepts of nursing theories are person, environment, health, and nursing. In Orem’s theory, a person is a patient capable of self-care or having needs that can be satisfied by the family of nursing care. Environment, in turn, creates the context in which the person exists. The environment has an impact on the person and can be modified by nurses to satisfy the needs of a patient. Health is treated as a condition of soundness or wholeness as well as the bodily and mental functioning. Nursing in the context of self-care theory comprises actions performed by nurses to provide therapeutic self-care, lead the patient to responsible self-care, or deliver supervision and consultation related to care. All these concepts are interrelated and interdependent. Thus, the person is central to Orem’s theory. A person’s health is influenced by the environment as well as nursing actions. A healthy person does not need assistance in self-care provision. Nevertheless, when the health condition is under the impact of illness, some patients cannot complete self-care activities and need help from other individuals or nurses.
The self-care deficit theory of nursing is widely applied in different aspects of clinical practice. For example, Mohammadpour, Rahmati Sharghi, Khosravan, Alami, and Akhond (2015) examine the impact that a supportive educational intervention grounded on the theory concepts has on the way patients with myocardial infarction provide self-care. The problem that led to the necessity of such interventions is the lack of knowledge of patients with the cardiovascular disease about their health peculiarities and, consequently, are not able to perform self-care. The major finding of this study is an increase in levels of self-care knowledge in patients of the experimental group compared to those of the control group. Also, self-care motivation and skill levels were higher as well. Thus, the self-care deficit theory of nursing can be applied as a basis for educational interventions in patients with health problems.
Another application of the self-care deficit theory is presented in the study by O’Shaughnessy (2014). The researcher investigated the effect of Orem’s theory on the elderly patients on peritoneal dialysis. The study describes the use of Orem’s self-care deficit theory as a model for leading healthcare providers in addressing the capabilities of self-care of the older generation. The researcher claims that the application and promotion of peritoneal dialysis is one of the possible therapies which positively influence the quality of life with an increased sense of self-worth in elderly patients. The major finding in this study is that due to the use of self-care theory, the elderly patients demonstrate improvement in technique while peritonitis-free survival rates are similar to those of the younger population (O’Shaughnessy, 2014). Therefore, the theory under analysis has the potential to improve patient outcomes.
The self-care deficit theory can be applied in the field of women’s health. Wong, Ip, Choi, and Lam (2015) suggest using Orem’s theory to examine self-care behaviors and their associated factors among adolescent girls with dysmenorrhea. Path analysis resulted in the following findings. First of all, age and received menstrual education influenced self‐care behaviors through self‐care agency both directly and indirectly. Secondly, the educational level of parents, pain intensity, as well as self-medication applied by adolescent girls when experiencing dysmenorrhea had an only direct impact on self-care behaviors (Wong et al., 2015). Thus, it can be concluded that self-care agency and self-care behaviors, which are the components of Orem’s theory, are applicable to clinical practice research.
The self-care deficit theory was developed by Dorothea Orem, an American nursing theorist (Berbiglia & Banfield, 2014). Although created in the twentieth century, the theory is still relevant and broadly used in contemporary health care. Self-care deficit theory focuses on a client or patient, which is typical of a popular model of patient-centered care. Moreover, Orem’s theory is frequently used as a basis for research and healthcare interventions. For example, its effectiveness is proven for education in myocardial infarction patients (Mohammadpour et al., 2013), self-care of elderly patients on peritoneal dialysis (O’Shaughnessy, 2014), and educating adolescent girls with dysmenorrhea (Wong et al., 2015). Therefore, the theory is still relevant and applicable to different aspects of clinical practice.
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To summarizing, it should be mentioned that the self-care deficit theory has both strengths and limitations. The strengths are as follows. First of all, the theory is a comprehensive base for nursing practice due to its applicability in diverse spheres of nursing. Thus, it is effective in clinical practice, educational interventions, administrative work, and research. Secondly, the theory can be used by both experienced practitioners and graduate nurses. Finally, the strength of the theory is that it advocates for the application of nursing processes. The following limitations do not depreciate the theory but should also be considered. First of all, the theory looks illness-oriented. Secondly, Orem treats health as being in one of the three conditions, which implies that nursing systems are fixed and constant while health is traditionally considered to be dynamic. Moreover, there is little attention to the emotional needs of a person due to the focus on physical care. Nevertheless, despite some limitations, the self-care deficit theory is a valuable contribution to both practical and theoretical aspects of nursing and is used in a variety of spheres.
Berbiglia, V. A., & Banfield, B. (2014). Self-care deficit theory of nursing. In M. R. Alligood (Ed.), Nursing theorists and their work (8th ed.) (pp. 240-285). St. Louis, MR: Elsevier.
Mohammadpour, A., Rahmati Sharghi, N., Khosravan, S., Alami, A., & Akhond, M. (2015). The effect of a supportive educational intervention developed based on the Orem’s self-care theory on the self-care ability of patients with myocardial infarction: A randomised controlled trial. Journal of Clinical Nursing, 24(11-12), 1686-1692.
O’Shaughnessy, M. (2014). Application of Dorothea Orem’s theory of self-care to the elderly patient on peritoneal dialysis. Nephrology Nursing Journal, 41(5), 495-498.
Wong, C., Ip, W., Choi, K., & Lam, L. (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.