Dorothea E Orem’s Self-Care Deficit Nursing Theory
The discipline of nursing uses theory in a variety of health care settings to determine the quality of patients would receive to achieve a desired outcome. In this research paper, I will seek to present significant information about Orem’s Self-Care Deficit Nursing Theory and its Application to nursing. The overall purpose of Orem’s theory is not just to view the person as a whole, but to utilize nursing knowledge to restore and maintain the patient’s optimal health. This research paper will present a basic background of the theorist and the key concepts that Orem used to establish the conceptual framework of Self-Care Deficit Theory.
Dorothea E. Orem, MSNed, DSc. RM was born in 1914 in Baltimore, Maryland. She began her nursing education at Providence Hospital School of Nursing in Washington, DC. After receiving her diploma in the early 1930s, she earned her nursing education in 1945 from the Catholic University of America. According to Hartweg (1991), the original ideas for the model developed while Orem served as a nurse consultant with the Indiana State Board of Health between 1949 and 1957. As she traveled around the state, she became more aware of the ability of nurses to do nursing, but their inability to talk about nursing. After observation and questioning, she summarized her initial ideas about nursing in and Indiana State Board Health report (p.4).
The concepts of the theory were further developed and in 1959, while Orem was a consultant to the office of Education, Department of Health, Education, and Welfare; she participated in a project to improve the practical (vocational) nursing program. During this time, Orem was searching for a pragmatic framework to organize nursing knowledge. She focused on the questions, “What is nursing?” and “When do people need nursing care? From these two questions, Orem conceptualized that people need nursing care when they are unable to care for themselves. In 1971, she presented the Self-Care Deficit Theory of Nursing (SCDTN) in the book Nursing Concepts of Practice and has continually revised and updated her theory (DeLaune, Ladner 2002, p. 34).
Orem’s Self-Care Deficit Theory of Nursing is a grand theory, which is comprised of three interrelated theories: 1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems. Incorporated within these three theories are six central concepts and one peripheral concept. Having a thorough understanding of these central concepts of self-care, self-care agency, therapeutic self-care demand, self-care deficit, nursing agency, and nursing system, as well as the peripheral concept of basic conditioning factors, is essential to understanding her general theory (George, 1995, p. 100)
Orem’s theory of self-care takes into consideration several other concepts, namely self-care, self-care agency, basic conditioning factors, and therapeutic self-care demand. According to George (1995), Orem defined self-care as the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being. When self-care is effectively performed, it helps to maintain structural integrity and human functioning, and it contributes to human development (p.101).
To provide a more clear understanding to the self-care theory, Orem believed that human’s has the ability or power to engage in self-care, this concept is know as Self-care agency. The individual’s ability to engage in self-care is affected by basic conditioning factors namely age, gender, developmental state, health state, sociocultural orientation, family system factors,… resource adequacy and availability (George, 1995). According to Orem, basic conditioning factors are conditions or events in a time-place matrix that affect the value of person’s ability to care for themselves. It is important to note that the influence of the basic conditioning factors on the self-care agency is not assumed to be operative at all times (Parker, 2005, p.150).
Within the theory of self-care, Orem identified three categories of self-care requisites: universal self-care requisites, developmental self-care requisites, and health-deviation self-care requisites. Universal self-care requisites are common to all human beings and include physiological and social interaction needs. For example, the sufficient intake of water, air, food and the maintenance of balance in all area of one’s life. Developmental self-care requisites are the needs that arise as the individual grows and develops. This is has to do with more specific events in an individual’s life, e.g. adjusting to the loss of a job, or adjusting to the birth of a newborn. Health-deviation self-care requisites result from the needs produced by disease or illness (DeLaune, Ladner 2002, p. 34).
The theory of self-care deficit is the core of Orem’s grand theory of nursing because it delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self-care (George 1995). The term “deficit” refers to a particular relationship between self-care agency and self-care demand that is said to exist when capabilities for engaging in self-care are less than the demand for self-care (Parker, 2005, p. 149).
The nursing system designed by the nurse is based on the self-care needs and abilities of the patient to perform self-care activities. If there is a self-care deficit between what the individual can do and what needs to be done to maintain optimum functioning, then nursing care is needed. In the theory of nursing systems, the client’s self-care needs will be met by the nurse, the client, or together. Orem has identified three classifications of nursing systems to meet the self-care requisites of the patient. These systems are the wholly compensatory, the partly compensatory system, and the supportive-educative system (George, 1995, p. 104). In the whole compensatory system as nurse provides complete universal and health function for the patient. An example in which this type of nursing system would be evident is when a patient is in a coma. In this situation, the patient’s ability to make proper judgments regarding the maintenance optimum health is very much impaired. The nurse needs to use critical thinking to in depth knowledge to anticipate and meet the needs of this kind of patient. Partly compensatory is the nursing system in which the both the nurse and the patient contributes to meeting the self-care needs of the patient. For example, A patient who have suffer from a CVA or a stroke, from which he or she may had become paralyzed on one side of his or her body. For this, patient, he or she may be able to do certain things for his or her self, but not completely.
The supportive-educative system is the nursing system in which the persons is able to perform or can and should learn to perform required measures externally and internally oriented therapeutic self-care about cannot do so without assistance. In this nursing system, the primary role of the nurse is to teach and to provide educational support to the patient. For example, patients that are diabetic are able to meet all their basic self-care needs; however, they would require teaching as to what foods need to be eaten to maintain blood glucose level. Additionally, if insulin needs to be injected, the nurse will have to teach the patient how to give self-injections, the amount to draw in to the syringe, where on his or her body the insulin shot needs to be injected, and how to properly dispose of used needles.
One of Orem’s focuses was to diffuse the theory into nursing in a variety of settings. The comprehensive development of the self-care concepts enhances the usefulness of the Self-care Deficit Nursing theory as a guide to nursing practice situations involving individuals across the life span that are experiencing health or illness, and to nurse-client situations aimed at health promotion, health restoration, or health maintenance (Parker, 2005, p. 149).
When planning and providing nursing care, according to Orem, the ultimate goal care Self-care theory is to enable the patient to achieve optimum health and to maintain that health status once it has been accomplished. The concept of self-care agency In order for the nurse to effectively provide nursing care with Orem’s theory, he or she needs to understand the various concepts of theory, and how to use it in conjunction with the nursing process. According to George (1995), Orem defined the nursing process as follows: “Nursing process is a term used by nurses to refer to the professional-technologic operations of nursing practice and to associated planning and evaluative operations” (p.108)
Orem’s Self-Care Deficit Theory can be utilized for Mr. Smith’s case study. The first step is to obtain a detailed assessment and collect data about the patient’s self-care agency and his self-care demand. The purpose of data collection is to determine a relationship between the self-care demands and Mr. Smith’s ability to meet all of his self-care needs prior to his new diagnosis of Type II Diabetes and Obesity. Smith’s basic conditioning factors were provided as 50yrs African American male, store manager, and married with four children. His universal self-care demands: smokes 1 pack per day, lack exercise, likes to eat fried foods and High cholesterol of 250, do not exercise, high blood sugar levels of 220, takes OTC medications for pain, no annual checkups and only seek medical help when needed. Mr. Smith worked 40-65 hours per week had a strong and supportive family, wife worked part time , with four children from age 8 -18, and a 18 year old going to college, the developmental self-care requisites noted and identified. He is in the developmental stage of generativity, which is displayed through a sense of accomplishment in providing for his family, and rearing children. In the case of Mr. Smith, his health deviation: potential to develop heart disease due to high cholesterol, and obesity and other complications due to high glucose levels
Self-care deficits: The difference between Mr. Smith’s knowledge and life style that increased risks for myocardial infarction or neuropathy and other physiological complications due to diabetes. Nursing diagnosis bases on self-care deficits are: Potential for cardiovascular impaired function related to lack of knowledge and current lifestyle. The goal and plan of care: Mr. Smith will reduce cholesterol and blood sugar levels.
In Mr. Smith’s case, to effectively plan his care, the nurse needs to take into consideration the underlining concepts of the Self-Care Theory which are self-care agency, factor conditions and the self-care requite category of Health Deviation Self-care. Mr. Smith is a self-care agency because he has the power to engage in his own self-care. The nurse needs to take into consideration the conditioning factors namely his age, cholesterol and blood sugar levels, inactive lifestyle, overweight, which are the main contributors to his health condition.
The deficit in Mr. Smith’s health is his inability to properly manage is weight and dietery intake which is one of the main causes of his diabetes and high cholesterol. Lack knowledge of the effects cholesterol on body systems and the relieving benefits of exercises
The power of the nurse to design and produce nursing care for others is the critical power that is operative in nursing. The human power with its constituent capabilities and disposition is named the nursing agency. The centrality of the nursing agency as exercised by nurses in producing nursing care is made clear in the Nursing Development Conference Group’s concept of nursing system (Parker, 2005, p. 143).
The nursing system concept of wholly compensatory would not be applicable. Whole compensatory would only be used in cases where patients are unable to care for themselves, e.g. Newborns or an unconscious patient. Although the concept of partly compensatory involves both the nurse and the patient to meet particular needs, it would not be applicable in Mr. Smith’s case. Partly compensatory would only be useful if Mr. Smith had pancreatic surgery, then the nurse would assist Mr. Smith with ambulation or range of motion. The most applicable nursing system in Mr. Smith’s case is the supportive-educative system. This is where the nurse focus on teaching the patient about various foods that will enhance is health and well-being. Provide outpatient resource for client to get follow treatment. The nurse will now have the opportunity to teach Mr. Smith how to use the glucose monitor to test his blood sugar levels on his own and how often.
In conclusion, all the concepts are related in that, the patients is view holistically and not separate from his environment. Orem’s Theory of Self-Care Deficit, takes into consideration the power or the abilities of both the nurse and the patient to restore, promote and maintain physical and physiological wholeness. The regardless of the health condition of patient, basic nursing knowledge and careful observation can significant health improvement patients. The utilization of theory in nursing increases the recognition of nursing as a discipline and rewarding profession.
Annotated Bibliography
DeLane. Sue. C., and Ladner P. K., (2002) Fundamentals of Nursing: Standards & Practice
Albany, NY Thompson Delmar Learning (p.34)
This book provides a detailed summary of basic concepts that Orem used to establish the Self-Care Deficit Theory. Basic examples were used to further clarify the meaning of certain
concepts used in Orem’s Theory.
Foster, P.C., & Caine, R.M. (1995) Self-Care Deficit Nursing Theory: Dorothea E. Orem. In J.B. George (4th Edition) Nursing theories the base for professional nursing practice (pp. 100-150). Upper Saddle River, New Jersey: Prentice Hall.
In this book, the author used significant information to provide a clear understanding of
Orem’s personal and educational background. The key concepts of the Self-Care Deficit Theory
was broken down step-by-step so that the reader could have a good ideas of what each of
the concepts mean in relation to practicing nursing
Hartweg., Donna (1991) Dorothea Orem: Self-Care Deficit Nursing Theory
Newbury London, Sage Publications Inc. (p.4)
The information presented in this book is practically readable and easily understood. The author
provided a clear understanding of Orem’s theory and how it was conceptualized.
Parker, Marilyn E. (2005) Nursing Theories and Nursing Practice
Philadephia F.A. Davis Company (p.149)
This information presented in this books was quite interesting. The author incorporated detailed information about Dorothea E. Orem and other Nursing theorist. On a scale of 1-10, I would give this book a 8.
