Self Care Deficit Theory

When identifying uses and meanings of ‘self-care’, I first looked in a dictionary. The concept was defined in the Shorter Oxford dicitonary as, “Self-care (noun) taking care of one-self; self-interested behavior.” I searched the internet to get a generalized view of how the concept was being used and it was defined on Wikipedia as, “Self-care refers to actions and attitudes which contribute to the maintenance of well-being, personal health, and promotion of human developent.” I searched data bases for scholary peer reviewed articlew and retrieved limited amount of English articles on self-care. Key word searches consisted of self-care, self-care maintenance, and self-management. The definitions and uses of the concept were fairly broad. I narrowed the search to post-op patients and self-care. The two uses for the concept in the post op patient would be self-care of the post op patient and also supportive care to promote self-care of the post-op patient. The supportive care could be from a nursing system or a family member.

Dorthea E. Orem’s self-care model emphasizes both a patient 's ability and responsibility to care for themselves. Self-care as defined by Orem as “the practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being” (Catalano, 2015, p. 58). Since individuals function at varying levels, Orem has identified three levels of nursing care: wholly compensated care, partially compensated care, and supportive developmental care. This theories goal is to help each individual reach his or her maximum level of function and to take responsibility for his or her health (Catalano, 2015). Self-reliance is also core value in my own personal life. I believe that a person who is capable of performing any part of their own self-care should be encouraged to do so because it will help them become independent, improve their psychosocial status, and promote self worth at a time when they rely so heavily on other people for their care. Orem’s theory matches my own belief of the importance of independence and self-reliance because the main goal is to help patients become as self-reliant as possible in their healthcare. This theory emphasizes the important role of education in nursing in order to enable them to take control of their own health. Because of health deficits, some individuals may require more assistance from care providers. However, even these patients should be encouraged and allowed to do whatever they are able to do for

Dorothea Orem’s theory accepts and describes the premise of self-directed personal care (Alligood et al., 2010). Orem’s theory also explains and predicts when the nurse will be needed once the illness has challenged an individual's functional capacity. The purpose of the theory is to focus on individual’s being able to care for themselves on their own, identify when nurses are needed to help individuals progress to better health. Besides, self-health care is put in place to acknowledge that nurses can aid individuals to get back to their functional baseline abilities on time. (Alligood et al.,

According to Petiprin (2015), Dorothea Orem’s theory is used to encourage a person to become more independent. Petiprin (2015) further states that it is true of rehabilitation settings, (Such as,)for example HealthSouth Sunrise Rehabilitation Hospital in which patients are transitioning out of being cared for by physicians and nurses and to exclusive self-care at home. According to George (2011), Dorothea Orem has developed three connecting theories: the theory of self-care, the theory of self-care deficit and the theory of the nurse system. George defines the term metaparadigm as the core content of a discipline (2011). George further states that the metaparadigm of the discipline of nursing comprises of four major concepts: person, health, environment and nursing (2011). At HealthSouth Sunrise Rehabilitation Hospital, the mission of our operations is the delivery of quality healthcare in the most appropriate, safe, patient-centered environment (HealthSouth, 2015). The purpose of this paper is to discuss Dorothea Orem theory, metaparadigm and how it relates to nursing practice at HealthSouth Sunrise Rehabilitation Hospital.

The nursing process does not merely treat the patient as a physical body, but rather treats the patient holistically. The central philosophy of Dorothea Orem's self-care deficit nursing theory "is that all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they're able" (Dorothea Orem, 2012, Nursing Theory). However, although self-care may be the core of Orem's theory, the decision to engage in self-care must be facilitated by the patient's social and physical environment, of which the family can play a critical role in shaping.

In 1947, shortly after graduating with her Master’s in nursing, Dorothea Orem accepted a position with the Indiana State Board of Health, where she first thought of her theory of nursing. She left that position to work at the U.S. Department of Health, Education, and Welfare (HEW), the predecessor for the U.S. Department of Health and Human Services, from 1957-1959. While at HEW, she took on the role of curriculum consultant and was tasked with the improvement of nurse training through curriculum development (Johnson & Webber, 2010). It was Orem’s role in this project that provided the impetus for her nursing theories as she began to explore the connections between nursing, education, and self-care. Taylor (2011) notes that Orem’s first published article,

The model is concerned with the provision and management of self-care. A requirement for nursing exists when a person is unable to maintain for him/herself self-care action which is therapeutic in sustaining life and health, recovering from disease and injury or coping with their effects. Meet own needs through nutrition, fitness, hygiene, rest and relaxation, interpersonal relationships, meaningful work, spiritual practices, prevention and health promotion practices

Orem identified the requirements of self-care divided into three groups of requisites. The universal requisites are the basic needs of people: air, food, water, elimination/excretion, activity and rest, solitude/social interaction, functioning/well-being, normalcy. The developmental self-care requisites refer to both maturational and situational requirements for growth associated with developmental processes, derived from a condition, or associated with an event. Lastly, the health deviation requisites are associated with genetic, human and functional deviations arising from illness, injury, defects, physical or mental disability, or from the medical treatment. Effectively meeting both the universal and developmental self-care requisites is essential when dealing with the health deviations.

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

Orem’s theory of self care deficit specifies when nursing is needed. “Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self care” (Current Nursing, 2010, para. 16). Orem’s created five methods of helping; which are acting for and doing for others, guiding others, supporting one another, providing an environment that promotes personal development, and teaching one another.

The application of the Chinn and Kramer model to my selected theory, brought into view that even though this theory was developed in 1959, it will continue to remain a theory that will stand the test of time and of importance to the nursing profession. I feel that Orem’s self-care theory will stand the test of time, due to providing a clear understanding of the scope of nursing, and the theory helps define goals for

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 Orem’s self-care deficit theory’s nursing goal is to assist individuals to meet all their self-care needs by teaching them with skillful healthy habits (Hood, 2014, p. 137). In order for nurses to provide the support needed by an individual, they must assess all their patients’ self-care requisites. As explained by Moore (2015), “Orem uses the self-care requisites as a basis for assessment [in] the nursing process.” These self-requisites are universal needs that arise due to illness and/or changes in developmental stages (Hood, 2014). Dennis (1997) described in detail Orem’s basic conditioning factors that must be assessed to gather sufficient information about the individual and about their ongoing and emerging self-care requisites. Orem’s basic conditioning factors include: age, gender, developmental state, health state, health care system, sociocultural/spiritual orientation, family systems, patterns of living, environment, and available resources (Dennis, 1997).

Orem’s Self-Care Theory lays the foundation to measure self-care maintenance, management, and confidence. The framework of Orem’s theory contributes an optimistic patient view to their own personal healthcare and the goal of nurses, and the independent function of their patients. The identification of nursing as a science and an art are identified as well as its boundaries, and serve as unique contributions to nursing. The research that Orem completed was designed to measure self-care deficits and the quality of life to help determine the correlation between both (Seed & Torkelson, 2012).

Nursing Science continued to transform in the 70’s.Dorothea Orem was one of the most prominent nursing personalities that thrived in improving the standards of nursing through self-care deficit theory in 1971. The main objective of care is the self and thus catering every needs that revolve around it to perform self-care. Orem’s work had become so significant today that her Assessment for Care Evaluation method is the standard for evaluating health conditions.