Nursing theories are widely used in nursing science. In fact, such theories contain the knowledge required by a nurse to inform, direct or care for the patients. The Self-Care Deficit Nursing Theory (SCDNT) of Dorothea Orem is a bright example of nursing theory. If fact, it is closely connected with Virginia Henderson’s Need Theory, since her ideas have been also incorporated in the SCDNT. Like Henderson, Orem emphasizes that the main goal of the nursing staff is to help patients become independent (Green, 2013, p. 5). Self-care is necessary for a person to maintain his/her health and active lifestyle. However, there are many cases when self-care is impossible. In her theory, Dorothea Orem describes nursing as a necessary solution for different problems caused by the self-care deficit (Bhanji, 2012, p. 49). Moreover, the theorist has developed a detailed terminology, which allows incorporating every concept in the field of nursing practice. The essay consists of three sections, such as the importance of nursing theory to the nursing profession, a summary of the theory, as well as application of the theory into clinical practice. Thus, as one of the scientifically proven nursing theories, the SCDNT is based on the principles of self-care, defined as activities and behaviors aimed at maintaining life, health, and well-being, which can be fulfilled by people with and without the help of nurses.
Importance of Dorothea Orem’s Self-Care Deficit Theory
The SCDNT has to be included into Master of Science in Nursing Program as it is an essential knowledge for any nurse practitioner that needs to be widely applied in practice. Owning to the fact that master’s program in nursing presupposes a detailed study of nursing theories, the Orem’s theory teaches nurses to provide qualified care to their patients taking into account his/her individual requirements and problems (Green, 2013, p. 5). Moreover, it allows providing high-quality care to a patient based on the collected and assessed data on his/her state of health, the methodology of nursing process, and the results of efficiency evaluation, which assesses both medical and social assistance to the patient.
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The SCDNT is useful to the nursing profession, as the Orem’s theory also evaluates a patient based on the self-care deficit. The nursing profession is connected with structural and functional activities of a patient, his/her ontogenetic development and well-being (Hiroko et al., 2014, p. 27). Dorothea Orem associates the concept of nursing profession with standard determination of health, disease and treatment in medicine. Queir?s, Vidinha, and Filho (2014) state that Orem’s theory is useful for the nursing practice:
The SCDNT has been very useful to guide clinical practice, education and management, as well as to promote structures from which other more accurate and testable concepts derived. Although this theory has only been used sparingly due to its complexity and lack of validation, it has proven to be useful and valuable to expand nursing science (p. 162).
Nursing process uses scientific knowledge to assess self-care needs and special skills required to plan and perform the actions aimed at care for other people. Dorothea Orem states that nursing profession is an addition to the treatment of the patient, and the nursing actions add to the treatment performed by doctors or the one performed by a patient himself (Queiros, Vidinha, & Filho, 2014, p. 158). Thus, the theorist attempts to separate nursing profession from other healthcare jobs.
The Orem’s theory includes nursing care systems, which are a result of the interaction between a nurse and a patient in definite clinical settings. Nursing care systems classify different clinical situations, thus help define the roles of nurse practitioners and methods used for the treatment of a patient (Wong et al., 2015, p. 219). Therefore, as a part of self-care deficit theory, nursing care systems are widely used in the nursing profession.
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Summary of Dorothea Orem’s Self-Care Deficit Theory
The SCDNT was developed in the 1950th, but Dorothea Orem (1914-2007) published the final version of the theory in 1971. Having received many awards for her professional development and contribution to the nursing practice, Dorothy obtained her doctorate in 1976 (Hiroko et al., 2014, p. 28). The theory, which considers a person as the unitary whole, is based on self-care principles and personal responsibility for health. At the same time, nursing interventions play an essential role in the theory. The latest, sixth, edition of the theory was published in 2001.
The generalized Orem’s theory includes three subseries including the theory of self-care deficit, the theory of self-care and theory of nursing care systems. The SCDNT describes and justifies the need for nursing care. It occurs when self-care is unable to satisfy all the needs (Wong et al., 2015, p. 220). The lack of knowledge, inability to perform certain operations of self-care, and undervaluation of the importance of self-care are the causes of self-care deficiency.
The main goals of nursing interventions include short-term, intermediate and long-term goals or their combinations, concentrated on a patient and his/her ability of self-care. At the same time, nurses should discuss not only the purposes of nursing interventions but also plan these practices with the patients (Queiros, Vidinha, & Filho, 2014, p. 160). Thus, the nursing interventions can be directed at the expansion of the possibilities for self-care and the changes of the needs.
The SCDNT addresses every nursing metaparadigm (Bhanji, 2012, p. 50-51):
- Patient. Orem considers that the right to be a patient belongs to people who face the impossibility of self-care;
- Health. The sphere of health problems for a theorist includes nurses offering help to their patients and improving their health in case of self-care deficiency;
- Environment. The universal factors of the external environment which affect the ontogenesis of an individual and relate to his/her health needs for self-care or the possibility of self-care are important for the nursing theory;
- Nursing profession. The general tasks of nursing include support of both structural and emotional sovereignty in addition to well-being during the whole human lifecycle. The more specific purpose is the ability of a patient to perform all actions, which are necessary for self-care and ensure health and well-being. If it becomes problematic to achieve these tasks, a patient requires help mainly from the people who took the responsibility for providing the necessary care. Thus, the purpose of the nursing profession is to relief the sufferings and to support the patient’s state of health at a certain level.
The Orem’s theory describes the characteristic features of patients, nurses and relations between them. The theory focuses on the information, which a nurse should obtain, systematize and implement in specific situations faced by the patients. The self-care theory can be used for the education of nurse practitioners as it portrays nursing as a profession with real problems and shows possible nursing practices (Queiros, Vidinha, & Filho, 2014, p. 160). The theory has profound academic grounds to be applied by a Master’s degree pursuer.
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Application of Dorothea Orem’s Self-Care Deficit Theory into Nurse Practitioner Area
The SCDNT defines and explains the factors, which need to be considered by a nurse when teaching his/her patients to self-care. Orem pays special attention to detailed descriptions of the actions, which have to be undertaken to ensure physical independence and normal functioning of an organism. However, the theory hardly covers the problems of mental and social adaptation of a patient with severe diseases or with special needs (Wong et al., 2015, p. 224). Nevertheless, the description of various systems of the nursing process is connected with the situations when a patient faces problems when engages in physical actions or tries to involve lost intelligence in the process, and is unable to make independent decisions (Queiros, Vidinha, & Filho, 2014, p. 161). The theory does not presuppose any solutions of the problems such as suffering, melancholy, pain, etc. In fact, it only undertakes a rationalistic approach.
Orem’s theory is difficult for practical implementation in its direct form. For its successful implementation, it is necessary to develop a concept consisting of a person and reality, reflected in separate sub-theories, which compose a single theory. For example, the theory about the impossibility of self-care can serve as a manual for a nurse practitioner working with a group of patients, trained to conduct medical manipulations. In particular, it concerns patients with skin diseases and diabetes. In such cases, a nurse practitioner should implement the practical measures depending on the state of health estimated by a patient or his/her relatives (Bhanji, 2012, p. 50). The application of the Orem’s theory in the nursing practice is shown in the following examples.
Example 1. A patient diagnosed with fractured left shin bone was placed in the traumatology. After the primary medical check-up, the nurse practitioner assumes that the patient will not be able to move on crutches without the assistance of other people. There is a misbalance between the needs of the patient and his possibilities to self-care, including active movements, visits of toilet, etc. The planning of his nursing care will be based on the compensating and training systems. Thus, the nursing intervention is directed at the restoration of the balance between the patient’s possibilities and needs for self-care.
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Example 2. Green (2013) described the case of the 8-year-old girl, who, accompanied by her mother, came to the clinic complaining on virus infections. The girl’s mother forgets that her daughter is required to stay in bed and drink plenty of fluids. The woman is either unsure whether she does everything correctly, or does not have enough knowledge to help the girl in self-care. There is the imbalance between the possibility of the mother to help her daughter in self-care and the requirements placed on her. The nurse practitioner should plan an educational and consultative intervention aimed at teaching the mother of how to take care of her daughter. The psychological support of the girl’s mother, the praise of her actions can essentially help her care for the daughter.
In conclusion, the SCDNT is based on the self-care principles, used for the preservation of life and well-being of patients. The deficit of self-care is revealed in the nursing interventions aimed at effective training of patients to self-care. Thus, the Orem’s theory can be characterized as a system of principles, which can explain some situations in the nursing profession. Moreover, it can act as a manual to nurses on how to teach the patients to self-care. The theory is important for the Master’s programs as it includes the directions for nursing practice allowing nurse practitioners to direct, teach and train the patients to care for themselves. Moreover, the nursing care systems, discussed by the theorist, are essential for it. During the process of writing this essay, I understood the essence of the Orem’s theory, the importance of self-care and nursing interventions to the care for the patient as well as the training of the patient to self-care.