Dorothea Orem's Self-Care Deficit Theory

I chose to do a concept analysis on ‘Self-Care.’ The nursing theory that uses this concept is Orem’s theory of nursing. This theory is a grand theory and consists of three minor interrelated theories; self-care,

The preceptor applied Dorothea Orem self-care deficit theory to the pediatric clinic and their families. In the future, I’ll ask to nurse in charge for me to assist in administering the

First Step- According to Petiprin (2015), the Self-Care Deficit Theory was created in 1956 Dorothea E. Orem as a product of attempting to improve nursing care quality in general hospitals directly in her state. This theory shows another way of viewing a specific phenomenon; it is applied to an extensive range of patients and is incorporated into the nursing practice to develop and advance patient care; however, consistency with the laws and ethical practices are the key to this theory.

For the purposes of this paper, I will refer to the entity receiving nursing care as the client. The health and well-being of a client is dependent upon the synchrony of five aspects that co-exist in the client’s life: physical health, psychologic health, social networks, cultural needs, and spiritual needs. A client possesses self-care interventions, such as skills, knowledge and tools to keep these aspects in balance. Dorothea Orem’s self-care deficit theory (SCDT) explains “Self-care, or care for oneself, must be learned and be deliberately performed for life, human functioning, and well-being” (Smith & Parker, 2015, p.107). A disruption to one or more of these facets beyond the client’s self-care abilities results in a self-care deficit. It is this deficit or need that brings the nurse and client together. Orem explained, “Nursing is legitimate or needed when the individual’s self-care capabilities and care demands are equal to, less than or more than at a point in time.” (Smith & Parker, 2015, p.108).

Orem’s Theory has helped lay the ground work for modern nursing. In 1971 her theory was first published and includes three related concepts: self-care, self-care deficit and nursing systems. Orem’s theory has given direction to many nurses, inspiring them to seek better ways to develop and express the knowledge base of nursing. The purpose of her theory is to help patients and their families maintain control of their health during their lifetime. The theory consists of three parts the nursing system, self-care and self-care deficit. Care is the primary focus and the ultimate goal is health restoration. Patients are allowed to have primary control over their health and letting healthcare providers educate, promote and encourage healthy

Dorothea Orem’s Self Care Model states, “Nursing care is required when an adult is unable to perform self-care sufficiently to sustain life, maintain health, recover from disease or injury, or cope with the effects of disease or injury” (Orem, 1991). Orem also takes into account that caregivers also need nursing care.

Nursing theory has become vital aspect of health promotion and health restoration to not only nurses, but people in many areas of healthcare. Nursing theory gives nurses and other healthcare professionals a background on how nursing was preformed when our ancestors, like Florence Nightingale, first began nursing. Nursing theories also help healthcare professionals to see how nursing and other areas in health care will progress further into the future. Although most theories are quite old, they are still relevant and used in everyday nursing to ensure quality care to each individual. Types of theories range from practice based theories, to needs theories, to interactional theories, and others. Each theory has one thing in common: they are important to people for different reasons. How significant each of them are, will depend on your individual view of what is most essential to nursing. One theory which I believe to be crucial to nursing in particular, is Dorothea Orem’s theory of self-care. With this paper, my goal is to thoroughly describe Orem’s theory; to show why it is important in order to progress nursing and all other healthcare practices further. Then I will describe how I as a student nurse plan on using the theory in my future practices as an RN, and what goals I hope to achieve in doing so.

Dorothea Orem –the theorist who conceived the Self-Care Deficit theory was born in Baltimore, Maryland in 1914. Orem had completed her Masters of Science in Nursing in addition to her Bachelor of Science in Nursing and her Diploma in Nursing (Johnson & Weber, 2010). She had worked as an instructor and as a dean in the Catholic University of America located in Washington, DC. She also worked in places such as the Indiana State Board of Health and the U.S. Department of Health, Education, and Welfare. She retired at the age of 70 and had passed away at the age of 92 on June 22, 2007.

The hero of nursing, Florence Nightingale, began the profession of nursing which has progressed forward ever since. In the 1950’s through the 1970’s many theories were developed that explains questions on how nursing provides independent care education and practice, and has been the foundation for the practice (Im & Chang, 2012). Theory requires research and research requires practice in order to obtain the data needed to prove best practice! In this paper, Orem’s theory on Self Care will be discussed. There are three components; theory of self-care deficit, theory of self-care, and theory of nursing systems, and a theory that arose later was the theory of dependent care. This

Dorothea E. Orem devoted her life to defining nursing and the nurse’s role in improving the patient’s overall health, which she coined the Self-Care Deficit Theory. Orem’s theory is quite a complex one, which can be simplified by identifying that it is three theories in one: self-care theory, self-care deficit theory and nursing systems theory. In 1959, as Orem first began the evolution of the Self-Care Deficit Theory, she defined the nurse’s role as another self. This nursing theory is the foundation for nursing as it actually defines the art of nursing, the actions that drive the nurse and the nurse’s provision of care through the nursing systems theory. To place in simplistic terms, Orem assumes that all humans desire to care for self. In the self-care theory, she states that individuals are meant to care for themselves and their basic needs by promoting life, health, development and well-being (Banfield, 2011). When something happens that does not allow the human to care for self, a deficit occurs. This deficit drives the need for specialized nursing care to restore the human’s health so they can resume self-care.

Dorothea E. Orem developed the Self-Care Deficit Nursing Theory between 1959 and 2001. This theory is also known as Orem Model of Nursing. Dorothea Orem’s theory of self-care deficit is a grand nursing theory because of the scope of the theory. The care-deficit theory covers a board scope with concept that can be applied by the nurse and patient to all area of nursing care. Dorothea Orem presented the concept of self-care, self- care deficit, and nursing agency as a framework to understand and interpret experiences. The central philosophy of the Self-Care Deficit Nursing Theory is that all patients want and need to care for themselves.

Myra Levine, Dorothea Orem and Sister Callister Roy are the authors of the three nursing theories the following case studies will be applied to. All of these theorists have very practical applications of nursing actions related to their individual models of nursing.

Numerous nursing hypotheses have been developed in the course of the most recent century with an end goal to guide practice, training and research for nursing students, RNs, and other health care professionals. In spite of the differing qualities of these theories and models, four ideal models or metaparadigm concepts have come to light that are presently widely acknowledged as key to the discipline of nursing, i.e., person, health, environment, and nursing (Hanucharunkul, 1989). One of the theories which truly emerges and has the qualities of a competent nursing theory is Dorthea Orem’s Self-Care Theory. The self-care theory depicts self-care and care of dependents as a learned behavior which serves the purpose of regulating the ability to function, develop, and maintain human anatomical strength, by being responsible for self (Orem, 1985). It also explains why and how nursing care should be used to supplement rather than supplant a person’s self-care ability (Denyes, Orem, & Bekel, 2001). An analysis of Orem’s self-care model, since its origin till the present time, reveals that the model’s key concepts are compatible with the four metaparadigm concepts of nursing, and if adapted appropriately, this model can be rewarding when applied to clinical practice, in client care, and also for nursing students and practicing nurses.

Orem saw nursing as a deliberate human action, and believed that anyone with a health related ailment could benefit from nursing. She realized when someone was unable to care for his or herself the individual was suffering from a self-care deficit. This led to the self-care deficit theory. There are three theories within the one theory: the theory of nursing systems, the theory of self-care deficits, and the theory of self-care (Creasia and Friberg, 2011). This theory was selected, because it is easily transferred into daily nursing practice. Not only is it understandable by the group, but transfers easily over to our practice with little difficulties.

Dorothea Orem was an impactful influence to the nursing field in part due to her Self-Care Deficit Theory. Orem was born in Baltimore, Maryland on July 15, 1914 and died on June 22, 2007 (Dorothea Orem Collection, 1975-1976). Orem practiced nursing in her earliest years at Providence Hospital in Washington, DC and St. John’s Hospital in Lowell, Massachusetts, and after receiving her major degrees from the Providence Hospital School of Nursing and the Catholic University of America, she focused more on teaching, administration, and research (Dorothea Orem Collection, 1975-1976). Orem developed the Self-Care Deficit Theory between 1959 and 2001 in order to improve the nursing quality in hospitals in her state (Self Care Deficit Theory, 2016). Orem spent almost her entire life to trying to implement this theory so it can be used for the present and future nursing generation.