The Self-Care Deficit Nursing Theory

According to Orem, Renpenning and Taylor (2003), the self-care deficit theory of nursing developed by Dorothea E. Orem focuses on the factors and requirements that an individual needs to meet in order to enhance his/her health and wellbeing. Fundamentally, nursing is required only when an individual cannot meet his/her health care demands. The self-care deficit theory of nursing, therefore, enables nurses to help patients to meet their self-care needs consequently enhancing the health and wellbeing of the patient. The theory comprises of three theories which are interrelated including: theory of self-care, theory of self-care deficit and theory of nursing systems.

Essentially, Orem’s self-care deficit theory of nursing is premised on a model whereby the nurses key role in enhancing the wellbeing and health of the client to achieve and maintain ‘adequate level of self-care’. In this sense, each of the theories developed under Orem’s self-care deficit theory of nursing focus on different dimensions of a person. The theory of self-care is concerned with the self, and I of a person, the theory of self-care deficit is concerned with me and you and, finally the theory of nursing systems is concerned with the we, that is, the individual as part of a community.

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The theorist's background

Born in Baltimore, Maryland in 1914 Dorothea E. Orem had a rich educational background. She first attended the Providence Hospital School of Nursing in Washington, DC where she received a diploma in nursing. Consequently, she enrolled in the Catholic University of America where she graduated in 1939 with a Bachelor of Science in Nursing Education and later in 1945 a Master of Science in Nursing Education.

Orem’s educational background played a key role in the development of the self-care deficit theory of nursing which she began developing in the 1950’s.

In addition, Orem’s vast experience as a nursing practitioner enabled her to conceptualize a nursing model during a period which lacked explicit nursing oriented theories to support the nursing curriculum and practice. As a nursing professional, Orem was involved in different fields including nursing practice, nursing education and nursing service. She worked in different positions including as including a staff nurse, nurse educator, private duty nurse, administrator and nurse consultant. Orem educational background and vast experiences as a nurse impacted the development of the self-care deficit theory of nursing significantly. By combining knowledge acquired through the years both through formal and during practice of nursing she was able to develop a theory which would help to enhance the nursing curriculum as well as be applied in practice. Crucial references

Crucial references in Orem’s theory include the Nursing Development Conference Group (1979) that was involved in the development of the initial foundations and key concepts of the theory. Essentially, Nursing Development Conference Group (1979) recognized the need for an upgrade in practical nursing curriculum and dissatisfaction emanating from the lack of an organizing knowledge for nursing knowledge. Another crucial reference for the self-care deficit theory includes Orem and Taylor (1986) who fundamentally focused on the “interest in and insights about the domain and boundaries of nursing” which consequently helped in defining the role of nurses and thus shaping the development of the self-care deficit nursing theory.

Other authors who have written about the self-care deficit nursing theory include Fitzgerald (1980) who used Orem’s model of self-care to design an education program for diabetics and Anna et al (1978) who focused on the implementation of Orem’s conceptual framework in practice. Phenomenon of concern or problems addressed by the theory

Orem’s theory helped to define the role of nursing in promotion of health care and well-being of a client. Essentially, the theory articulates when nursing is required a factor which was not previously explored. Orem’s theory also provides a conceptual framework which defines diverse contemporary concepts that ensure promotion and maintenance of health by defining the prerequisites for self-care. Orem’s theory argues that in order to successfully implement the self-care model in practice it is imperative to meet the prerequisites of primarily care. In addition, stakeholders in health care must strive to enhance an individual’s knowledge of potential health problems in order to enhance the individual’s self-care behavior. Theory Description

Reasoning Used by the Theorist
The self-care deficit nursing theory uses deductive reasoning. Essentially, Orem developed key assertions which she identified as a requisite for an individual’s health and wellbeing. The assumptions used in the theory are logical in nature. In developing the self-care deficit nursing theory Orem uses key assumptions including; an individual should be responsible for his/ her health and wellbeing, self-care is a key component of primary care, it is critical for individuals to have knowledge of their health problems so that they can exercise self-care behavior and, self-care can only be learned through the social context. The assertions developed by Orem’s theory form the basis for the conclusion drawn. Major concepts of the theory

According to Orem, Renpenning and Taylor (2003), Orem defines four nursing concepts which are basically an imperative for their meta-paradigm including: nursing, person, the environment and health. Essentially, the environment is the sub-component of an individual thus provides the context within which such an individual exists. The environment forms part of an integrated system which has the profound impact on the individual’s health. The environment can also be modified in order to meet an individual’s health care needs. Health as a concept of nursing encompasses the soundness of an individual’s physical, social and mental functions. The health status of an individual is highly influenced by his/her environment and self-care behavior.

In regards to nursing, Orem’s identifies four terms including the nursing problem, nursing client, nursing process and nursing therapeutics. Nursing therapeutics is essentially any actions that are systematic and geared towards enhancing the health of an individual. Nursing's process encompasses the system used in the diagnoses of a client’s health care needs, to plan and implement care. Nursing problem is basically any deficits in health care conditions. Nursing's client is any individual who lacks the requisites for self-care thus rendering him/her dependent on nursing to enhance his health and overall wellbeing. Finally, Orem’s theory also focuses on the concept of the person. The person from a nursing perspective is basically the patient who seeks nursing care.

In some instances, the person will be capable of self-care but in other instances he/she has health, developmental and universal deviation which render him/her reliant on nursing care in order to meet his/her health care needs. The concepts in Orem’s self-care deficit nursing theory are defined both theoretically and operationally. Orem uses the concepts of nursing, environment, person and the environment in the development of the self-care deficit nursing theory. She uses the concepts to develop three interrelated theories including the theory of self-care, theory of self-care deficit and theory of nursing system. In addition, the concepts are consistently used in the development of the three interrelated theories. How the concepts are defined

The concepts used in Orem’s self-care deficit nursing theory are defined explicitly. The concepts are expressed directly and thus are readily observable to any individual. For instance, Orem’s defines the environment as the sub-components in which an individual exits. In essence, Orem’s definition of the environment is direct and can be easily understood and observed by any individual. Orem’s defines nursing process as the system used in the diagnoses of a client’s health care needs, to plan and implement care. This definition is direct and easily observable to any individual thus is implicit. Orem defines person from a nursing perspective which she recognizes as a patient who seeks nursing care. Rem’s definition of a person is simple and direct thus implicit. Orem defines health as the soundness of an individual’s physical, social and mental functions which can be easily deduced by any individual and thus is explicit. Relationships among the major concepts

The concepts in Orem’s self-care deficit nursing theory are interrelated. The environment that is essentially the subcomponents in which the person exists have impact on his her health. In addition, the environment in which the person exists influences his/ her self-care behavior and consequently his/her health status. The health of an individual which is fundamentally the physical, social and mental soundness influences the persons need for nursing care. Nursing which is essentially the actions’ that are performed by nursing professionals to help persons that have health deficits and restore their ability to care for themselves.

Nursing influences a person’s health by enhancing knowledge about health problems that they are predisposed to and create a social context that shapes the persons self-care behavior. The person which Orem defines as a being with developmental, universal and health needs has the ability to conceptualize which has a profound impact on an individual’s self-care behavior and, consequently his/ her environment and health. Evaluation

Explicit and implicit assumptions which are the (values/beliefs) underlying the theory Orem’s self-care deficit nursing theory is premised on several implicit and explicit assumptions. One such assumption is that human beings are continuously involved in continuous interchange amongst themselves and the environment in which they exit in order to function and survive. Another key assumption that Orem’s self-care deficit nursing theory is premised on is that human being have the power to identify and make sound decisions about their needs. There are diverse assumptions that led to the development of Orem’s self-care deficit nursing theory. One such assumption is that nursing is an action that involves interaction between two or more persons.

Orem’s theory is premised on the belief that a person should be “self-reliant and responsible” for their own health and others around them (Orem, Renpenning & Taylor, 2003). In addition, knowledge about one’s potential health problems is an imperative for developing self-care behavior that enhances health and well-being of the individual. Orem’s theory is also based on the presupposition that each person is a distinct individual. Self-care as well as dependent care behavior are fostered and learnt within the social cultural context. Ensuring that both universal and development self-care requisites are successfully meeting an imperative for primary care and enhancing of individuals health in the society. The four metaparadigm concepts of nursing

Orem’s self-care deficit nursing theory has the description of the four metaparadigm concepts of nursing including person, environment, nursing process and health. Orem’s self-care model is premised on the four metaparadigm concepts.

Person
Orem’s self-care theory focuses on the person, human being and individual. It is concerned with the self and I of a person. The person is basically the patient who seeks nursing care. In accordance to Orem’s theory, the human being is capable of conceptualizing and reflecting. In some instances, the person will be capable of self-care but in other instances he/she has health, developmental and universal deviation which render him/her reliant on nursing care in order to meet his/her health care needs. The Environment

The environment as a nursing metaparadigm is the surrounding under which an individual exists. Orem argues that the environment has a direct influence on an individual’s self-care behavior. The environment comprises of subcomponents including the physical such as the weather and social-economic such as family structure. Health

Health is essentially the soundness of an individual’s physical, social and mental functions. The health status of an individual is highly influenced by his/her environment and self-care behavior. Nursing

Nursing is the actions that professionals in this field undertake in order to provide care to individuals with health deviations and are not capable of self-care. According to Orem, Renpenning and Taylor (2003), Orem identifies four terms including the nursing problem, nursing client, nursing process and nursing therapeutics. Orem’s self-care deficit nursing theory explains the four metaparadigm concepts of nursing as interrelated concepts. Orem developed three interrelated theories including the theory of self-care, theory of self-care deficit and theory of nursing systems which focus on the four metaparadigm concepts of nursing and how they relate to each other. Clarity of the theory

Orem’s self-care deficit nursing theory is well articulated which ensures ease of understanding and clarity on the concepts discussed. Orem provides a well-structured framework of interrelated concepts thus providing a different perspective of looking at the role of nursing. The self-care model is divided into three concepts including nursing system, self-care and self-care deficit which are further divided into subsections hence reducing ambiguity and ensuring clarity of the theory (Orem, Renpenning & Taylor, 2003). In addition, Orem’s self-care deficit nursing theory is logical in nature and uses explicit reasoning which makes it easy to understand and clear. The theory is also relatively simple and yet can be generalized to suit different situations in nursing practice. Orem’s self-care deficit nursing theory is also consistent with other similar theories, principles and laws. Application

How the theory would guide nursing actions
According to Orem, Renpenning and Taylor (2003), Orem’s self-care deficit nursing theory provides a guiding framework which can be integrated into nursing practice. Orem’s nursing process articulates three steps that can be integrated into practice, in order enhance the health and wellbeing of patients. In order to understand and make sound judgment on patient care required Orem’s model states that nursing professionals must collect data on different aspects of the patient. The data collected must include the health status of the patient, his/her requirement for self-care and capacity to perform the same. In addition, data on the patient as well and physician's perspective on health must be well articulated.

Finally, data on the health goals of the patient within his/ her environment must be clearly specified. The second step in the nursing process requires nursing professionals to develop a plan and system for care delivery. The last process is concerned with the management of nursing systems in order to enhance the patient’s health outcomes both in the short and long term. Use of theory in my area of nursing (Practice, Education, Informatics or Administration) Orem’s self-care deficit nursing theory has helped me in enhancing my knowledge about different concepts and sub concepts articulated in the theory. According to Orem, Renpenning and Taylor (2003), Orem’s self-care deficit nursing theory emphasizes on continuing education as a key component in nursing education. In essence, the theory can enhance knowledge on how I can deliver the best care on a one on one basis.

The self-care deficit patient depends on me to provide the medications and treatments as order, to provide the basic needs such as bathing, feeding and all active daily living (ADL). In addition, the nursing process in Orem’s self-care model can be integrated in practice in order to enhance the health outcomes of the patients. Fundamentally, Orem’s self-care deficit nursing theory can be used to improve practice by integrating the knowledge and concepts articulated in the model during care delivery. Orem’s self-care deficit nursing theory can also be used as the basis for nursing research by professionals in my area of nursing. Essentially, the theory provides a conceptual framework which can serve as the basis of research in different clinical setting thus ensuring it is well integrated in different areas of nursing practice. In the past, the theory has been used in the development of research instruments to test its validity in different clinical settings.

References
Anna, D. J., Christensen, D. G., Hohon, S. A., Ord, L., & Wells, S. R. (1978). Implementing Orem's conceptual framework. Journal of Nursing Administration, 8(11), pp.8-11. Fitzgerald, S. (1980). Utilizing Orem's self-care model in designing an education program for the diabetic. Topics in Clinical Nursing, 2(2), pp.57-65. Orem, D. E., Renpenning, K. M. & Taylor, S.G (2003). Self-care theory in nursing: selected papers of Dorothea Orem. New York: Springer Publishers.