Nursing profession is guided by the grand theories of education, practice, and administration. One of the most significant theories in this field is Orem’s self-care deficit nursing theory that was first proposed in 1971. The researcher’s education and career became the basis of the theory development. Her scientific views were expressed in her works, such as, for instance, Nursing: Concepts of Practice. The theorist achieves her objectives by dividing the model into a nursing system theory, self-care theory, and deficit theory. She employs deductive and inductive reasoning to advance the four concepts which are person, environment, health, and nursing. The theory is also based on the assumptions that have been explicitly and implicitly described. Orem’s self-care deficit nursing theory is continuously being advanced and applied in the field of nursing practice to promote patient care to the individuals dependent on nursing. This paper analyzes the theory in question by discussing the practices and experiences that led to its introduction, development, and advancement in nursing practice.
Nursing, similarly to many other careers, is based on the approaches that are used as references and guiding principles. Theory-based nursing promotes health services delivery, patients’ care, and ethical conducts in the profession under analysis. One of the theories that guide this area of specialization is Dorothea E. Orem’s self-care deficit nursing theory that has been extensively popularized starting from 1970s to 2000s. It focuses on the individual factors needed to meet personal health requirements and fulfill nurses’ roles in promoting health to patients who are unable to practice self-care. The self-care deficit nursing theory has prompted multiple changes in nursing, particularly in patient care delivery owing to its sub-theories of self-care, self-care deficit, and the nursing systems. Its application guides nurses through the nursing concepts based on the nursing metaparadigm. The primary focus of this research paper is on Orem’s self-care deficit nursing theory. The theorist’s background and circumstances that contributed to the development of the theory as well as its description, analysis, and application in nursing practice are discussed.
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Dorothea E. Orem (1914-2007)
Dorothea Elizabeth Orem remains to be one of the most significant theorists and contributors in the discipline of nursing. She came from a humble background with her father working as a construction laborer, her mother being a homemaker, and her elder sister (Clarke, Allison, Berbiglia, & Taylor, 2009). They lived in a simple home in Baltimore Maryland where she spent her childhood life. The parents played a significant role in her education and development of her career. The future scholar joined the field during the inter-war period when nursing practices lacked shape, and the primary concern was to maintain peace and take care of the disaster victims (Clarke et al., 2009). Apart from this, two of her aunts were nurses, which played a crucial role in convincing her to join nursing and develop the self-care deficit nursing theory afterwards.
Education and Career
Orem’s educational background provided her with crucial knowledge that laid the foundations for the self-care deficit nursing theory; she graduated from Seton High School Baltimore in 1931. Later the theorist studied at the Providence Hospital School of Nursing in Washington, D.C., so in 1934 she graduated and got a diploma in nursing (Clarke et al., 2009). Orem enrolled in the Catholic University of America to pursue a BSc in Nursing Education and graduated in 1939. The woman gained a Master of Science in nursing when World War II ended. In 1976, Orem was awarded Honorary Doctorates of Science from Georgetown University and another one from Incarnate Word College in 1980 as a result of her determination and success in the nursing field (Clarke et al., 2009). She gained significant nursing knowledge through research that enabled her to determine the crucial factors in nursing and to develop the theory.
Moreover, Orem’s distinguished career contributed to the theory as a result of her encounters with patients, multiple experiments, and a wide range of observations. She began her career as a practitioner at the Providence Hospital, Washington, D.C., where she practiced nursing from 1934-1936 and 1942, and later at the John’s Hospital, Lowell, Massachusetts in 1936 and 1937(Clarke et al., 2009). In these hospitals she made clinical observations, identified patients with special needs, and determined the factors that resulted in nursing interventions.
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In 1945 after achieving her master’s degree and doctorate, she concentrated on lecturing, research, and administration duties. For instance, she worked as a nurse and lecturer in biological sciences at the Providence Hospital School of Nursing in Detroit from 1939 to 1945. (Clarke et al., 2009). Orem also worked for five years as an Assistant Professor at the Catholic University of America. After this, from 1964 to 1970 she worked as an Associate Professor and also served as the dean at the School of Nursing in 1966. Her teaching experience was combined with her research, which has enormously contributed to her other researches and helped the scholar identify further gaps in nursing.
As a curriculum education consultant, Orem documented various issues raised by her clients, and they formed the crucial basis for the development of the self-care deficit nursing theory. For instance, being a consultant, the woman worked for the government and private institutions such as the United States Department of Health and the Office of Education, (Clarke et al., 2009). She also provided consulting services to schools and educational institutions such as the University of Southern Mississippi and the Washington Technical Institute among others. Most importantly, her practical experience enabled her to guide hospitals such as the Johns Hopkins Hospital (Clarke et al., 2009). Therefore, Orem’s expert knowledge and experience were recognized by schools, hospitals, government, and private agencies.
The scholar contributed to the field of nursing education and practice due to her major works since 1959. Orem’s most significant contribution to nursing is the development of the self-care deficit theory of nursing that was formulated in 1971 and published in the first edition of Nursing: Concepts of Practice. The theory has been used and widely referred to in nursing practice and education, and it led to Oren’s recognition as one of the leading theorists in the field (Clarke et al., 2009). Nursing: Concepts of Practice (2nd edition) was released in 1980, and its author continued to develop the theory until the 6th edition, which was published in 2001(Clarke et al., 2009). Every edition of her works provided new insights into nursing as a result of the dynamic nature of the healthcare sector. Owing to the theorist’s invaluable contribution to the nursing field, she received such awards such as the Linda Richards Award from the National League for Nursing.
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One of the most important references to Orem’s theory is the Nursing Development Reference Group in 1979 that was concerned with the development of the key concepts in the theory. The group advocated for the use of the theory to upgrade nursing education curriculum and practice (Clarke et al., 2009). Apart from this, Armer, Shook, Schneider, Brooks, Peterson, and Stewart (2009) used the theory under analysis to popularize the nursing care among the patients that were recently diagnosed with breast cancer. The authors used the self-care theory as the means to prevent the development of post-surgery lymphedema (Armer et al., 2009). The theory continues to be a significant reference point in modern nursing in hospitals and nursing homes.
Problems Addressed by the Theory or Phenomenon of Concern
Orem’s experience and contribution to the nursing education resulted in the formulation of the self-care deficit theory of nursing after she had identified the major gaps in the field. The scholar developed the theory with an intention to improve the deteriorated health care in general hospitals in the US. She sought to solve the problem of patients’ inability to perform self-care activities by making them the central focus of the nursing care. What is more, Orem attempted to address the abovementioned issue by dividing the theory into three sections, and namely: self-care, self-care deficit, and the nursing systems theories (McEwen & Wills, 2011). She also aimed to identify patients’ needs, communicating them to the physicians and providing adequate care to the clients.
Dorothea E. Orem’s Self-Care Deficit Nursing Theory
Among the types of reasoning identified in Orem’s self-care deficit nursing theory, it is possible to identify deductive and inductive reasoning. Inductive reasoning involves making various observations and recollecting past experiences to arrive at the most probable conclusion. In this theory, Orem used the method of induction by explaining how she employed her professional experience to identify the reasons why people need nursing care. In such a way, she demonstrated the significance of the theory in the nursing profession. On the other hand, deductive reasoning, also known as top-down logic, is a technique that involves forming a deduction, development of hypothesis, and testing the hypothesis through experimentation and other research methods to prove its accuracy (McEwen & Wills, 2011). In this theory, possible deductions are made and later supported by clinical examinations and experience. For instance, the theory utilized the data and findings gathered by Orem herself and other scholars to prove its inferences and to define the reasons behind the uniqueness of nursing actions among other practices. The two methods are effectively employed to establish the three sub-theories (Paraska & Clark, 2012). Therefore, logical reasoning forms the basis for arguments in the nursing theory.
Concepts of the Theory
Orem’s theory defines four important concepts that are in conformity with the nursing metaparadigm; these are: person, health, nursing, and environment. Person is a patient in nursing context and he/she forms the primary concern of the theory. Similarly, environment forms the basis of the existence of a person and is a significant factor in determining an individual’s health state. The environment is designed to meet a patient’s healthcare requirement in a nursing setting (Paraska & Clark, 2012). In nursing, health involves mental, emotional, and physical wellness of a patient. Besides, nursing involves the actions and processes taken by nurses to help a person and tools used to meet healthcare needs of a patient. It also includes nursing problems and interventions.
The scholar uses both theoretical and operational techniques to define the concepts of the theory. For instance, she uses a conceptual approach to develop the nursing system theory, self-care theory, and deficit theory (McEwen & Wills, 2011). Besides, the concepts are also operationally defined in their real-life context. For instance, a person is defined as the patient or person who needs healthcare service. The four concepts have been consistently employed in the development of the three sub-theories that form the self-care deficit nursing theory. The theorist is consistent in the use of the concepts and other terms in the theory. She identified and defined other terminologies such as a nursing client who is a patient, nursing problem, process, and therapeutics which are systematic actions geared towards promoting individual’s health.
Orem has explicitly defined the concepts of the self-care deficit nursing theory. The explicit definition of a concept involves thorough description leaving no doubt or room for confusion. She directly distinguished the concept of a person as a patient requiring nursing intervention and care (McEwen & Wills, 2011). Furthermore, the theory regards environment as the sub-component, where a person exists, and as a factor that influences the individual’s health. Besides, nursing is directly described as a process of identifying a person’s health problem, investigating the causes and arriving at a conclusion, determining the best interventions, and taking necessary actions to achieve better health outcomes (McEwen & Wills, 2011). The explicit definition of the concepts by Orem is crucial in ensuring a clear understanding of the arguments in the theory.
Nonetheless, the aspect of the utmost importance in concepts of the theorist’s nursing theory is the link between its major concepts. They are directly related to each other, which indicates that a distortion of one concept leads to a significant impact on the other one. For instance, the environment affects an individual’s behavior which determines his/her health (McEwen & Wills, 2011). The nursing concept is a process that is influenced by a patient’s health state and initiates actions that restore the healthy status to eliminate the deficit. The theory is significant in terms of any action taken as a consequence on the other ones. The person concept is related to the environment as the surrounding, and health is also directly related to and influenced by the environment. Hence, health determines the concept of nursing and defines a person.
Orem’s theory is divided into four explicit and implicit hypotheses. One of the explicit assumptions is that humans can determine their needs and make sound decisions to satisfy them. What is more, people are in a continuous interaction with their environment which determines their survival. The implicit assumptions include the belief that nursing is a process that involves two or more individuals (Paraska & Clark, 2012). The belief requires further elaboration to derive the intended meaning. The theory is built on the hypotheses that an individual should be independent and is responsible for his/her own and others’ health status (Paraska & Clark, 2012). It implies that the knowledge of the patient’s potential health risks is a ground for the formation of health-promoting behavior. Besides, it is also constructed on the assumption that people are distinct beings, so self-care and dependent care behaviors are manifested culturally and socially (Paraska & Clark, 2012). The assumptions enable people to understand the importance of the promotion of individual health leads to meet universal standards of primary health care.
Additionally, the self-care deficit nursing theory describes health metaparadigm as the ultimate goal of nursing. The author of this theory emphasized that the role of nurses is to ensure physical and psychological wellness of a patient (McEwen & Wills, 2011). Health is influenced by the individual environment and behavior. People are empowered to promote personal health, while nurses intervene where patients fail to achieve it through the self-care. It is important to mention that the person’s wellness can be achieved through a careful combination of such components, as the person, environment, and major aspects of nursing. The theory is thus lucid and consistent throughout in terms of its development and application. It is well articulated to ensure clarity and the ease of understanding through a well-structured framework of related concepts (McEwen & Wills, 2011). Also, it uses logic in reasoning and provides explicit explanations to ensure better understanding.
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The self-care deficit nursing theory has various applications in nursing practice. For instance, the theory guides the process of data collection in providing nursing care. First, it elucidates the process of deduction and hypothesis development. After a patient describes his/her problem, one can make deductions about the possible causes of the symptoms he/she experiences. Second, the theory necessitates conducting a lab test to collect data to determine a patient’s health condition and provide a solid conclusion. Third, the theory also guides through the process of determining the best environment to facilitate the recovery process and to choose the best interventions and care activities (Paraska & Clark, 2012). Fourth, the application of the theory in the field of nursing practice is particularly helpful in patients’ treatment as well as patient care activities such as bathing, feeding and medication, and therapy services. Fifth, the theory can be integrated to enhance healthcare outcomes in patients that are heavily reliant on nurses’ help. Besides, Orem’s theory educates nurses on the practices that require the self-care and prohibits actions such as disclosing confidential information to unauthorized parties. Finally, it also promotes patients’ education and guidance during practice to popularize self-care in hospitals and nursing homes.
It has become increasingly evident that Orem’s self-care deficit nursing theory belongs to the most important foundations of nursing education, practice, and administration. The theory was first published in 1971 in the first edition of Nursing: Concepts of Practice and continues to advance the model in other six editions. The theory employs deductive and inductive reasoning to describe the process of nursing care and the four concepts involved. These ideas, which include nursing, person, health, and environment, are implicitly and explicitly defined through theoretical and operational techniques. In addition to this, the theorist uses significant assumptions to support her arguments. The self-care deficit nursing theory is defined through the prism of nursing, people, health, and environment. Most importantly, this model is crucial in major nursing practices and processes related to both care delivered at hospitals and home-based care.