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Although the primary goal of any health care provider is to achieve practical results in the treatment of their patients, it is still impossible for them to do this without getting acquainted with theories. All nursing theories are created to outline the principles, assumptions, and concepts that underlie the practice. Besides, they are always future-oriented, which means that they contribute to the generation of further knowledge in the field. Unless a theory is thoroughly analyzed and implemented according to its initial intention and purpose, a misperception may arise, which could lead to the wrong conclusion that this theory is irrelevant to practice.
A nursing theory gives nurses a sense of identity, which helps them understand their mission more profoundly and comprehensively. That is why the paper at hand is aimed to provide a detailed analysis of the chosen nursing theory (which is Dorothea Orem’s Self-Care Deficit Theory). It attempts to identify the components of theory, its major concepts, possible applications in the particular clinical are, and some practical outcomes that it may have for potential patients.
Introduction of Theorist and Theory
Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of the most prominent American theorists of nursing. After finishing Seton High School in Baltimore, Maryland, she entered the Providence Hospital School of Nursing in Washington, D.C., from which she graduated in 1934. In 1939, Orem earned a B.S. in Nursing Education at the Catholic University of America. She became an M.S. in Nursing Education in 1945. Orem’s career in nursing was indeed remarkable. In 1976, she received Honorary Doctorates of Science from Georgetown University; in 1980 – from Incarnate Word College. In 1988, Illinois Wesleyan University gave her an Honorary Doctorate of Humane Letters. In 1998, Orem earned a Doctorate Honoris Causa from the University of Missouri in Columbia (Clarke, Allison, Berbiglia, & Taylor, 2009).
Orem’s Self-Care Deficit theory is considered to be a grand nursing theory. It means that this theory manages to cover a large scope of issues and provides a set of principles that apply to a wide range of nursing cases. It is concentrated on the capacity of every individual to render self-care services, which he/she does on his/her own accord to maintain health and well-being. The Self-Care Deficit Theory claims that a patient’s condition is largely predetermined (and in many cases – aggravated) by his/her absence of self-reliance (Alligood, 2013).
Orem’s theory is based upon the philosophy that every patient wants to take care of him/herself. This philosophy claims that if you allow patients to do the best they can, they will recover much faster than if they are completely detached from their treatment (Paley, 2006).
The supporting theory for this is the Theory of Self-Care that has includes (Paley, 2006):
- self-care – a combination of activities of patients, performing which they can successfully maintain their health and life;
- self-care agency – the ability to engage in self-care, which is determined by the state of health, age, culture, and resources;
- therapeutic self-care demand – the totality of activities of a certain length that are aimed at meeting self-care requirements through the proper use of methods, strategies, and operations;
- self-care requisites – all actions that are necessary for successful health care provision; subdivided into universal, developmental, and health deviation requisites; the first group is common to everyone (e.g. making sure you have enough air, water, food, physical activity, rest, social interactions, safety, etc.), the second one refers to processes that are associated with certain events (e.g. the ability to adapt to age body transformations), whereas the third group presupposes the condition of disease (seeking medical aid, taking measures to alleviate the condition, modifying your behavior for healing more effectively, learning to live with consequences of your condition, etc.).
This theory is only one of the three related ones, which constitute the grand theory. It supports the general framework of the Self-Care Deficit theory as it concentrates on the patient’s self, on his/her ability to perform the whole range of necessary actions that can lead to healing, sometimes even without medical intervention. The responsibility of the patient for his/her condition is emphasized.
Components of the Nursing Model
The major concepts of the theory include the ones constituting the nursing metaparadigm and some additional ones (Biggs, 2008):
- Nursing is defined as art, help, and technology, which:
- is the total of all the actions that are taken deliberately by nurses to help patients to manage their conditions and environment they are placed in;
- combines the patient’s and the nurse’s vision of the treatment;
- has the goal of making the patient and his/her family members capable of meeting his/her need without assistance;
- is aimed to help the patient regain and maintain his/her normal state of health;
- controls stabilize and mitigate the effects of some serious chronic conditions that tell negatively on the overall state of the patient.
- Health is a state combining the health of separate individuals and groups of people. Its major feature is integrity, which means that it unites physiological and psychological conditions.
- The environment is the total of physical, chemical, social, and other conditions that constitute the context surrounding the patient.
- A human being is seen as a single person or as a part of a group of people with universal needs and functions.
- A nursing client is a person who has certain limitations that concern his/her ability to self-care. Nursing is required only when the needs of an individual exceed his/her capabilities.
- The nursing problem is a deficit of certain conditions required for an adequate self-care.
- The nursing process is the system that is aimed to determine why the patient is under care, how this care can be provided, and what consequences it will have.
- Nursing therapeutics is a set of systematic actions.
The assumptions that underlie the theory run as follows (Biggs, 2008):
- patients should be self-reliant, which means that it is their main responsibility to take part in treatment;
- all patients are unique and cannot be approached using the same strategies;
- nursing is not a one-sided process: it involves continuous feedback from the patient and his/her family;
- self-care behaviors must be encouraged to prevent the appearance of other health problems.
The nursing process gives a method to determine deficits and to identify the roles of the parties involved. It consists of (Biggs, 2008):
- assessment (diagnosis and prescription, needs assessment, data collection about the patient’s health status, requirements, and perspectives);
- nursing diagnosis and plans with a rationale;
- evaluation of the results.
Current Applications of the Model
The model can be used for (Berbiglia & Banfield, 2010):
- Nursing practice: for the elaboration of the care system using nursing process; for improving the patients’ ability for self-examination of their state; for identification of self-care attitudes (e.g. it can be used for patients suffering from incurable diseases such as diabetes since they need to be able to estimate their state and provide necessary self-care).
- Nursing research: for making generalizations about the effectiveness of self-care; for bridging gaps in the existing knowledge; for an explanation of health deviations; for developing assessment tools (e.g. it would be useful for research in chronic conditions that require constant attention and assessment);
- Nursing education: for systematization of knowledge; for developing the curriculum (e.g. it is perfect for the process of educating specialists as the analysis of this model would help them assess what obstacle patients may have to self-care and eliminate them).
- Nursing administration: for guiding nursing management; for targeting nursing practice (e.g. the model can be used to measure the quality of self-care before the intervention and after it).
An Area of My Practice Where the Theory can be Applied
My clinical area is adult and gerontology nursing, and this model would be very useful for me to apply in practice. Gerontological nursing is a relatively young field of study that is why it lacks a solid theoretical framework. This theory makes an emphasis on patients as active agents in self-maintenance of their lives. It supports the concerns about the elderly people and their condition and identifies at what stages they require intervention (O’Shaughnessy, 2014).
The point is that elderly individuals are sometimes unable to meet their primary life demands (air, water, food, etc.) because of limitations of age. Thus, my nursing practice can be changed considerably if I have an assessment tool for identifying whether an elderly person should be rendered assistance or can cope on his/her own. Besides, it will be also beneficial for patients as they would rely more on themselves. They must know that their age and diseases do not imply that there is nothing they can do about their health without nursing. My task is to discern the borderline beyond which I should perceive an elderly person as a patient who needs help.
Evaluation/ Critique of theory
The theory (Biggs, 2008):
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- encompasses nursing concepts in such a way that allows looking at everything from another perspective;
- is very logically structured;
- is comprehensible;
- gives rise to various hypotheses;
- can be applied in many different spheres to improve practice;
- is consistent with other approaches and can be combined with them, which contributes to further development.
Strong points of the theory (Biggs, 2008):
- it is multi-faceted and comprehensive;
- it can be applied in education, research, practice, and administration;
- it explains when nursing is required;
Weaknesses and limitations of the theory (Biggs, 2008):
- it is rather complex as it includes a lot of terms that are confusing and unclear;
- the definition of health is limited to static conditions;
- emotional needs are ignored;
- the theory is limited to disease orientation.
Alligood, M. R. (2013). Nursing theory: Utilization & application. Amsterdam, Netherlands: Elsevier Health Sciences.
Berbiglia, V. A., & Banfield, B. (2010). Self-care deficit theory of nursing. Nursing Theorists and Their Work, 265-285.
Biggs, A. (2008). Orem’s self-care deficit nursing theory: Update on the state of the art and science. Nursing Science Quarterly, 21(3), 200-206.
Clarke, P. N., Allison, S. E., Berbiglia, V. A., & Taylor, S. G. (2009). The impact of Dorothea E. Orem’s life and work: An interview with Orem scholars. Nursing science quarterly, 22(1), 41-46.
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.
Paley, J. (2006). Nursing philosophy. Nursing Philosophy, 7(3), 186-187.