The theory of self deficit was put forward by Dorothea Orem. This is a general theory in nursing is one of the most widely used models in the practice today. (Fawcett, 2005) “The theory is composed of three constructs.” (Coldwell, 1995) which primarily interprets the basic health concepts of human life, the nursing practice, and their relation to the society at large. The theory outlines three steps that can be applied in the nursing practice. The steps can be summarized as assessment, diagnosis/planning, and implementation. The theory explains a lot on the clinical nursing practice but does not say much about “research, learning, and administration.” (George, 2002)
Dorothea Orem’s self-care deficit theory, a general theory in nursing is one of the most widely used models in nursing today. (Fawcett, 2005) Dorothea Orem was born in 1914 in Baltimore, Maryland. She studied nursing at a diploma level at the providence school of nursing, Washington DC in the 1930s. (Coldwell, 1995) She went on to receive a BSN Ed, MSN Ed, and three honorary doctorates in the course of her life. (George, 2002) Earlier in her life, Orem worked as a hospital nurse and this gave her a lot of experience in clinical hospital settings. Orem was thus aware of the difficulties that nurses went through in articulating the needs of the nursing care regarding aspects such as length of patient stay, scheduling admissions, and discharges. (George, 2002) Orem developed her goal to upgrade the nursing system while working at Indiana University. Specifically, Orem was looking for answers to questions such as “what is nursing?” “What is the domain and what are the boundaries of nursing as a field of practice and a field of knowledge?” and “what conditions exist when judgments are made that people need nursing?” This was the beginning of her nursing theories which have profoundly impacted nursing care. This paper seeks to describe Orem’s “self-care deficit” theory, discuss how the theory can be used to guide the practice of nursing, and commend the theory’s applicability and its use as a Framework for the current practice. (Kramer, 2004)
Definition of terms
In the self-care deficit theory Orem defines the following terms:
- Human beings or humanity – as an integrated whole composed of an internal physical, psychologic, and social nature with varying degrees of self-care ability. (Coldwell, 1995) When referring to humans, Orem utilizes the terms such as self-care agent, individual, multi-person unit, or dependent care agent or patient (Reeser, 2010).
- On the concept of health, She says that “health and health are the terms used to describe living things when they are structurally and functionally whole or sound” This is inclusive of that which makes a person human, operating in conjunction with physiological and psychophysiological mechanisms and a material structure (biologic life) and relation to an interacting with other human beings. (George, 2002) Orem further explains her position by “defining health as a state of physical, mental and social well-being and not merely the absence of disease or infirmity” (Bernier, 2002) When referring to health in her various writings, Orem utilizes terms such as health, health state, and well-being. (Fawcett, 2005)
- Orem regards nursing to be an “art through which the practitioners of nursing gives specialized assistance to persons with disabilities of such a character that greater than ordinary assistance is necessary to meet daily needs for self-care and to intelligently participate in the medical care they are receiving from the physician” (Coldwell, 1995) According to Orem, “nursing consists of actions that are deliberately selected and performed by nurses to help individuals or groups under the care to maintain or change conditions in themselves or the environment.” (Fawcett, 2005)
- Self-care refers to actions of individuals directed to self or environment to regulate factors or conditions in the interest of that individual’s life, health, and well-being. (George, 2002)
- Self-care system refers to a coordinated system of actions that are performed “overtime to regulate factors or conditions in the interest of the individual’s life.” (George, 2002) “Dependent-Care system is the term applied to a coordinated system of action performed overtime to meet self-care requirements of a dependent person.” (Fawcett, 2005)
Orem views the environment as an entity that is occupied by “two dimensions physical, chemical, biologic and socio-economic features.” (Kramer, 2004) “The physical, chemical, and biologic features include things as atmosphere, pollutants, weather conditions, pets, infectious organisms and the like.” (Fawcett, 2005) The socio-economic features of the surrounding area centered on the family and the community and include such things as age and gender and age roles, cultural roles, and cultural prescriptions of authority. (Reeser, 2010) Orem explains that the two dimensions that occupy the environment may be interactive. She points out the potential effects of the environment on an individual’s progression. Stating that “it is the total environment, not as a single part of it that makes it developmental” (Fawcett, 2005)
The “self-care deficit” theory (Coldwell, 1995)
The driving force behind Orem’s development of the self deficit theory was the quest to find the meaning of nursing and to develop a body of nursing knowledge based on research. (Coldwell, 1995) She states that “my work in theory development has focused on the beginning development of scientific knowledge in the field of nursing”. (Bernier, 2002) The self-care theory encompasses two aspects that express patient factors and nine other concepts that are vital for the understanding of the theory.
The concepts are captured in four sets outlined below.
Self-care is a “human regulatory function” that relies on the individual’s ability to care for the self. (Fawcett, 2005) Nurses can reveal from their encounters that there is an association between self-care, self-care agency, and therapeutic demand. (Fawcett, 2005) When a patient is so sick that he/she fails to provide self-care, self-care deficit comes into play and the nurse does the activity the patient was not able to do.
This has various meanings depending on the situation and context in which it is being applied. It can be used to describe: “the power inherent in human capabilities essential for deliberate action; a self-action repertoire, and the relationship between the two.” (George, 2002) Thus “self-care limitations are defined as an absence or restriction of one or more human capabilities for engagement in deliberate action.” (Fawcett, 2005) The theory of self care explains the need of taking care of self, known as the self-care fundamentals, the means of utilized for taking care of self, known as the agency, and the results for this which are referred to as the self care practices. (Bernier, 2002)
Therapeutic self-Care Demand
“Therapeutic self-Care demand represents the totality of action required to meet a set of self-care requirements using a set of technologies”. (Coldwell, 1995) In this case, the self care requirements consist of: “formulated goals; orientation of self-care action system, and expression of input requirements for human functioning, for growth and development, for preventing, curing and controlling disease processes.” (Reeser, 2010) There are two types of self care requirements. The first is the universal type which refers to the general self-care requirements for all people but requires modification in accordance to health state, age, developmental stage, and sex. The second is the health deviation type, which refers to requirements that have their origins in disease processes and their effects on medical technologies. (Coldwell, 1995) The technologies for accomplishing the requirements include “the methodologies involving the use of specific resources that are valid in meeting a requirement.” (Coldwell, 1995)
Orem affirms that “if a person’s capabilities are inadequate to meet the therapeutic demand a self deficit exists” Two concepts relate to the self-care deficit. (George, 2002) First, “actual self-care deficit, which is defined as a descriptive statement of the relationship between the therapeutic self-care demand and self-care system in which the actions specified by the self-care demand and present or absent from the self-care system.” (George, 2002) The second is “the potential self-care deficit, a descriptive statement of the relationship between the therapeutic self-care demand and the predicted self-care limitations.” (Fawcett, 2005)
Nursing agency refers to the human agent and action range established for the nursing practice. The functions of the nursing agency comprise: ascertaining the authenticity of the association; “initial operationalization and maintenance of the interpersonal system with a client with his/her significant others and lastly the diagnosis associated with the two patient variables.” (Fawcett, 2005)
The nursing system theory seems to indicate that the nursing system shapes “when the nurse prescribes, design, and provide nursing that regulates the individual’s self-care capabilities and meets therapeutic self-care requirements. ” (Fawcett, 2005) Nursing systems can be divided into three categories; wholly compensatory systems, designed for persons who cannot control and check their surrounding and generate information. The second is partly compensatory systems, required for people who are cannot perform some of the self-care activities. The last, supportive-educative (developmental) systems which are designed for people who need to learn to perform self-care activities. (George, 2002) This theory is relevant in today’s financial realities, as there are smaller insurance reimbursements, and shorter hospital stays are strongly enforced. (Bernier, 2002)Due to this, clients and their family members are always requested to do as much for themselves according to their abilities and nurses partly compensate for the patients’ areas of self deficit. (Bernier, 2002)
Three prepositions can be found in Orem’s theory of self care. The first set of prepositions is related to the theory of self-care deficit (or dependent-Care Deficit). (Coldwell, 1995) Concepts of self-care agency (capabilities), basic conditioning factors (age, developmental state), and the relationship between the self care agency and demand a definition of the type of relationship, and nursing as a legitimate service are further explained through these statements. (Fawcett, 2005)
The model of health in Orem’s self-Care structure refers to all the settings that relate to the patient. The nurse does not only provide treatment to the disease condition but takes into consideration the patient as a whole. (Coldwell, 1995) His/her mental, physical, and biological, and spiritual needs have to be met. (Fawcett, 2005) In the year 1991, Orem included an additional aspect to the theory of self-care in the form of self-care requirements. These requirements can be identified “as actions directed toward the provision of self-care.” (Fawcett, 2005) Three sets of categories of self-care requirements can be established: “Universal; developmental and health deviation.” (Kramer, 2004)Universal Self-care requirements are associated with life processes and preservation of the correctness of human body composition and functioning. They are common to all human beings during all stages of the life cycle and should be viewed as interrelated factors each affecting the others. These requirements are similar in all people and they “include the maintenance of air, water, food, elimination, activity, rest, solitude, social interaction and prevention of hazards and promotion of human functioning.” (George, 2002) Developmental Self-care requirements promote processes for life and maturation and prevent conditions deleterious to maturation or mitigate those effects. (Fawcett, 2005)
Health deviation self-care requirements relate to disease or injury that affects not only specific structures and physiologic or psychological mechanisms but also integrated human functioning. (Coldwell, 1995) When the incorporated process is badly affected, the person’s “developing or developed a power of agency are seriously impaired either permanently or temporarily or frustrations resulting from medical care also create requisite for self-care to bring about relief.” (Bernier, 2002)
The main assumptions of Orem’s universal theory of nursing are listed: first, Human beings need continuous inputs to themselves and their environments to remain alive and function in accord with the natural human endowments. (Coldwell, 1995) Second, Human agency, the power to act deliberately, is exercised in the form of care of self and others in identifying needs for and in making needed inputs. (George, 2002) Thirdly, older human beings go through deprivations which appear as limitations or actions in the care of the self and others that concern the making “of life-sustaining and functioning- regulating inputs.” (George, 2002) Fourth, Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for and make inputs to self and others. (Coldwell, 1995) Fifth, assemblies of individuals with “structural relationships come together to provide care to members who undergo deprivation for creating needed purposeful inputs.
According to scholars, “the theory of nursing systems is the most general and includes all the essential terms.” It establishes the constitution and the requirements of the nursing practice. The theory of Nursing systems subsume the theory of self-Care deficit and with it, the theory of self care. (Coldwell, 1995) The theory of self-Care deficit provides the reasons as to why nursing is beneficial to individuals. The theory of self-care is introductory. In this subset, the reason for nursing is to assist people to attain their self-care needs (Bernier, 2002)
Conclusion and recommendations
The self Care deficit Nursing Theory distinguishes the focus of nursing from other specializations. Whereas other areas may find the theory of self-Care helpful and contribute to its development, the theory of nursing systems provides the distinctive outlook of the nursing practice. From the theory, the specific duties of nurses such as diagnosis and prescription are identified. This is vital for the determination of why the nursing practice is required and its role in arriving at conclusions regarding the type of care to be provided to different patients. There is ample proof in the literature that the theory is valuable in developing and guiding practice and research. (Coldwell, 1995) It provides guidelines to nursing-specific effects linked to establishing and fulfilling the remedial self-care requirements, modifying the conduct of self-care agency, putting in place self-care and self-management systems, and others. (Reeser, 2010) The theory has been “extensively applied in the field of production and management of different nursing systems.” (Coldwell, 1995) The theory is also useful in the design of curriculums for pre-service, graduate, and continuing nursing education. (Reeser, 2010) The theory also provides bearing as to how nursing administration should be conducted. It gives the finer details of the nursing practice. This is achieved through the determination of patient/client condition through the nursing diagnosis that is based on the scientific rationale that is strongly advocated in Orem’s theory. (Coldwell, 1995) The creation of theory-linked computer systems, evaluation forms, and the overall formation of the provision of healthcare confirms the importance of the theory.
Among the strengths of the theory is that it provides a strong foundation from which the nursing practice is based. “It also specifies when the nursing is required and finally the approach is contemporary with the concepts of health promotion and health maintenance.” (Reeser, 2010) The limitations of Orem’s theory are that it presents a closed “nursing system suggesting three static conditions in health.” (Bernier, 2002) Secondly, the theory inclines towards sickness and is not applicable in wellness settings
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Fawcett, J. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing models and theories and their work. Philadelphia: F. A. Davis.
George, J. (2002). Nursing theories: The base for professional nursing practice. Upper saddle River: Prentice hall.
Kramer, M. (2004). Integrated knowledge development in nursing. Louis: Mosby.
Reeser, J. (2010). Dorothea Orem’s Self-Care Requisites. Web.